Iron deficiency anemia in Indian children – causes, prevalence and management

Introduction

Iron-deficiency anemia (IDA) is a common type of anemia which causes about half of the anemia cases reported in the world. It is estimated that over 1 billion people are iron-deficient. Women are more likely to be affected by IDA than men. IDA can be caused by low intake of iron, low absorption, or loss of iron from bleeding in the intestine, uterus or urinary tract. (1)

Key Point: Anemia is common in Indian children. There can be several reasons for anemia in Indian children, but nutritional deficiency of iron was reported to be most common. Parental education and iron-rich complementary foods remain as the most important methods to prevent this important childhood problem. Prevention, early detection and treatment of IDA could help control this epidemic in India.

IDA is one of the biggest nutrition-related health problems in children across the globe, especially in developing countries like India. IDA is known to decrease children’s normal physical and cognitive development. Strong measures are needed to prevent, detect and treat iron deficiency anemia in children, so that they can achieve their optimal potential. The present review gives a brief overview of the prevalence and management of iron deficiency anemia in Indian children.

Prevalence of anemia in Indian children

According to the data available from the National Family Health Survey (NFHS) III in 2005-06, 79% of the children in India were found to be anemic. Anemia incidence was found more in rural areas, in comparison to urban areas (84% and 71% respectively) (2). The anemia prevalence in children under three years of age was increased by five percent (74% to 79%) in the NFHS III survey, in comparison with the NFHS II survey, while the prevalence of severe anemia decreased from NFHS II to NFHS III (3). According to a review by Kotecha, about 73 million children below three years of age have some form anemia, and over 50 million have moderate to severe symptoms (4). A comparison of the NFHS III data with data available from 1970 on anemia prevalence in Indian children shows that IDA remains a major problem in Indian children from 1970 through 2005 (5). According to the study carried out by the National Nutrition Monitoring Bureau, IDA prevalence among children under 5 year of age was 66%. The prevalence varied from 33 to 93% across various states all over India (6).

Effect of IDA on children

Normal physical growth and development is impaired in children with IDA. This ultimately leads to decreased work output and work capacity as an adult (7). IDA was also found to be associated with[s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()] poor cognitive development, which leads to a disturbance in perception, diminished concentration, and reduced learning in children (8). Additionally, IDA is associated with the decrease of immunoprotective mechanisms that are required to fight microbes in children.

Causes of iron deficiency anemia

Nutritional deficiency of iron remains the most common reason for iron deficiency in children throughout the world (9). There are numerous ways to improve this iron deficiency in children. Children that exclusively feed on breast milk have higher iron stores and are less prone to IDA, in comparison to children that are non-exclusively breastfeed. Anemia in the mother at the time of pregnancy can lead to low iron stores in newborns, which then develops into IDA (10). Early introduction of inappropriate food can lead to decreased breast milk intake and insufficient iron stores. Conversely, late introduction of iron-rich foods in the diet regimen for children can also lead to IDA (11). Increased parasitic infection in children also can lead to increased iron loss.

Management of iron deficiency in Indian children

Iron-SupplementsDepending on the child’s age, the following measures are used to manage iron deficiency:

  • Iron supplementation: Supplementation with iron is one of the most important measures to decrease iron deficiency in Indian children. In a community-led initiative to control childhood anemia, once-weekly iron supplementation and nutritional education were shown to improve the hemoglobin status of children 6 to 35 months of age (12). Fortification of whole wheat flour with iron was reported to reduce iron deficiency anemia and increase body iron stores in children (13). In a study of 246 Indian schoolchildren, a multi micronutrient-fortified drink was also found to be efficacious in reducing iron deficiency (14).
  • Breastfeeding iron level: It was reported that a low level of iron in breast milk is a major factor responsible for IDA in infants. It can be easily prevented by supplementation with iron-fortified complementary foods in pregnant women (15).
  • Weaning: Healthy infants fed with bioavailable iron via complementary foods are at a lower risk, in comparison to children only receiving breastfeeding (16). The above mentioned studies support the recommendation that supplementation with bioavailable iron via complementary foods should be started at 4-6 months of age to prevent iron deficiency during infancy.
Gaurav Gupta, MD Dr. Gaurav Gupta is currently the pediatrics consultant at Charak Child Care in Mohali, India and is also the CEO of TravelSafe Clinic (www.travelsafeclinic.com). He is a member of the American Academy of Pediatrics (AAP) and the Indian Academy of Pediatrics (IAP), with extensive publications and presentations in national and international journals & conferences.

References (click to show/hide)

  1. Iron-deficiency anemia. Wikipedia. Available from: http://en.wikipedia.org/wiki/Iron_deficiency_anemia Accessed: 03/10/2014.
  2. International Institute for Population Sciences. India National Family Health Survey (NFHS-3), 2005-06: International Institute for Population Sciences; 2007.
  3. Marco O. National Family Health Survey (NFHS-2): India, 1998-1999. 2000. Mumbia, India. International Institute for Population Sciences.
  4. Kotecha PV. Nutritional anemia in young children with focus on Asia and India. Indian journal of community medicine: official publication of Indian Association of Preventive & Social Medicine. 2011;36(1):8.
  5. Vijayaraghavan K, Brahmam G, Nair K, Akbar D, Rao NP. Evaluation of national nutritional anemia prophylaxis programme. The Indian Journal of Pediatrics. 1990;57(2):183-90.
  6. Prevalence of micronutrient deficiencies. National nutrition monitorting bureau; [cited 2014 March 1]; Available from: http://nnmbindia.org/NNMB%20MND%20REPORT%202004-Web.pdf.
  7. Swaminathan S, Edward BS, Kurpad AV. Micronutrient deficiency and cognitive and physical performance in Indian children. Eur J Clin Nutr. 2013;67(5):467-74.
  8. Grantham-McGregor S, Ani C. A review of studies on the effect of iron deficiency on cognitive development in children. The Journal of Nutrition. 2001;131(2):649S-68S.
  9. WHO. The world health report 2002: reducing risks, promoting healthy life: World Health Organization; 2002.
  10. Sachdev HP, Gera T. Preventing childhood anemia in India: iron supplementation and beyond. Eur J Clin Nutr. 2013;67(5):475-80.
  11. Kapur D, Sharma S, Agarwal KN. Effectiveness of nutrition education, iron supplementation or both on iron status in children. Indian Pediatr. 2003;40(12):1131-44.
  12. Dongre AR, Deshmukh PR, Garg BS. Community-led initiative for control of anemia among children 6 to 35 months of age and unmarried adolescent girls in rural Wardha, India. Food Nutr Bull. 2011;32(4):315-23.
  13. Muthayya S, Thankachan P, Hirve S, Amalrajan V, Thomas T, Lubree H, et al. Iron fortification of whole wheat flour reduces iron deficiency and iron deficiency anemia and increases body iron stores in Indian school-aged children. J Nutr. 2012;142(11):1997-2003.
  14. Thankachan P, Selvam S, Surendran D, Chellan S, Pauline M, Abrams SA, et al. Efficacy of a multi micronutrient-fortified drink in improving iron and micronutrient status among schoolchildren with low iron stores in India: a randomised, double-masked placebo-controlled trial. Eur J Clin Nutr. 2013;67(1):36-41.
  15. Marin GH, Mestorino N, Errecalde J, Huber B, Uriarte A, Orchuela J. Personalised iron supply for prophylaxis and treatment of pregnant women as a way to ensure normal iron levels in their breast milk. J Med Life. 2012;5(1):29-32.
  16. Dube K, Schwartz J, Mueller MJ, Kalhoff H, Kersting M. Iron intake and iron status in breastfed infants during the first year of life. Clin Nutr. 2010;29(6):773-8.


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One Comment

  1. Dr. Kousick Mati
    Posted Jan 2015 at 2:03 pm | Permalink

    IDA is more common in Indian female, because of there irregular food habits. They consume low fluid. Most of there is happened for there economic condition, which is an he most barrier of our child and mother as well as female health. In our clinic daily we see a percentage of patient who is suffering from ch. Anaemia. If we want to reduce our child from IDA we have had to educated our female about anaemia, and there future. The most common symptoms for IDA like vertigo , nausea, dimness of vision, menstrual abnormalities etc to be aware to indian female. This is the approach can reduced the chances of IDA to indian children. With regular health check up and earlier treatment is necessary. Dr Kousick Mati
    . 9903097262
    . Kolkata

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