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Updated: Jun 12, 2026
A Point-of-Care Method with Integrated Decision Support Tool to Estimate Anemia at Population Level
Published on: January 19, 2024
Determinants of anemia among young children in rural India
Sant-Rayn Pasricha1, James Black, Sumithra Muthayya
1Nossal Institute for Global Health, University of Melbourne, Parkville, Victoria, Australia.
Insights
Childhood anemia in India affects over 75% of toddlers. Key risk factors include iron deficiency, maternal anemia, and food insecurity, necessitating integrated interventions for prevention.
Area of Science:
- Pediatric Nutrition
- Hematology
- Public Health in Developing Nations
Background:
- Childhood anemia is a significant public health issue in India, with over 75% of toddlers affected.
- Limited data exists on the specific factors contributing to anemia in this vulnerable Indian population.
Purpose of the Study:
- To identify biological, nutritional, and socioeconomic risk factors associated with anemia in Indian toddlers aged 12-23 months.
Main Methods:
- Cross-sectional study in rural Karnataka, India, involving 401 children.
- Assessed hemoglobin, ferritin, folate, vitamin B12, retinol-binding protein, and C-reactive protein (CRP) levels.
- Evaluated hemoglobinopathy, malaria, hookworm, nutritional intake, family wealth, food security, and maternal hemoglobin.
Main Results:
- Anemia prevalence was 75.3%, strongly linked to iron deficiency (low ferritin), maternal anemia, and food insecurity.
- Child hemoglobin levels were associated with ferritin, folate, maternal hemoglobin, family wealth, age, hemoglobinopathy, CRP, and gender.
- Iron intake and CRP levels correlated with child ferritin, while breastfeeding and energy intake showed inverse associations.
Conclusions:
- Iron status is the primary determinant of anemia in Indian toddlers, but maternal anemia, family wealth, and food insecurity are also critical.
- Effective strategies require optimizing iron intake alongside addressing maternal anemia, poverty, and food insecurity.
Objective:
More than 75% of Indian toddlers are anemic. Data on factors associated with anemia in India are limited. The objective of this study was to determine biological, nutritional, and socioeconomic risk factors for anemia in this vulnerable age group.
Methods:
We conducted a cross-sectional study of children aged 12 to 23 months in 2 rural districts of Karnataka, India. Children were excluded if they were unwell or had received a blood transfusion. Hemoglobin, ferritin, folate, vitamin B(12), retinol-binding protein, and C-reactive protein (CRP) levels were determined. Children were also tested for hemoglobinopathy, malaria infection, and hookworm infestation. Anthropometric measurements, nutritional intake, family wealth, and food security were recorded. In addition, maternal hemoglobin level was measured.
Results:
Anemia (hemoglobin level < 11.0 g/dL) was detected in 75.3% of the 401 children sampled. Anemia was associated with iron deficiency (low ferritin level), maternal anemia, and food insecurity. Children's ferritin levels were directly associated with their iron intake and CRP levels and with maternal hemoglobin level and inversely associated with continued breastfeeding and the child's energy intake. A multivariate model for the child's hemoglobin level revealed associations with log(ferritin level) (coefficient: 1.20; P < .001), folate level (0.05; P < .01), maternal hemoglobin level (0.16; P < .001), family wealth index (0.02; P < .05), child's age (0.05 per month; P < .005), hemoglobinopathy (-1.51; P < .001), CRP level (-0.18; P < .001), and male gender (-0.38; P < .05). Wealth index and food insecurity could be interchanged in this model.
Conclusions:
Hemoglobin level was primarily associated with iron status in these Indian toddlers; however, maternal hemoglobin level, family wealth, and food insecurity were also important factors. Strategies for minimizing childhood anemia must include optimized iron intake but should simultaneously address maternal anemia, poverty, and food insecurity.
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