• Users Online: 62
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 13  |  Issue : 1  |  Page : 9-12

Evaluation of pediatric anemia in rural population of Maharashtra, India


Department of Pathology, Maharashtra Institute of Medical Education and Research, Talegaon Dabgade, Maharashtra, India

Date of Submission26-Apr-2021
Date of Decision06-May-2021
Date of Acceptance15-May-2021
Date of Web Publication28-Apr-2022

Correspondence Address:
Dr. Debopriya Chatterjee
1401/Sonnet; Kesar Harmony; Kharghar, Sector 6, Navi Mumbai - 410 210, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joah.joah_50_21

Rights and Permissions
  Abstract 


INTRODUCTION: World Health Organization showed that the prevalence of anemia among children of 6–59 months was 42.6% globally in 2011 and 59% in India. Fourth National Family Health Survey, 2016, shows 58.6% of Indian children are anemic, of which 53.8% are in Maharashtra, especially among rural children.
AIMS: The aim of the study was to study the morphologic and cytometric evaluation of anemia in pediatric population.
MATERIAL AND METHODS: The study was conducted after obtaining approval from the ethics committee. All patients that came to outpatient department and inpatient department between 2016 and 2018, satisfying the inclusion criteria were included. Routine investigations performed were hemoglobin estimation, blood indices, and peripheral blood smear examination.
RESULTS: The total number of pediatric patients that were found to be anemic was 400 (54.9%). Toddlers, aged 6 months to 6 years, were most anemic (48.0%). Moderate severity of anemia was seen most frequently (50.5%). Microcytic hypochromic anemia (67.0%), iron deficiency anemia was the most common cause seen (65.2%).
CONCLUSION: The occurrence of anemia in children is essential to be constantly monitored to identify causes, formation of intervention strategies, and ensure already formed national programs are effective.

Keywords: Anemia, India, Maharashtra, pediatrics, prevalence, rural


How to cite this article:
Chatterjee D, More SA, Joshi SR. Evaluation of pediatric anemia in rural population of Maharashtra, India. J Appl Hematol 2022;13:9-12

How to cite this URL:
Chatterjee D, More SA, Joshi SR. Evaluation of pediatric anemia in rural population of Maharashtra, India. J Appl Hematol [serial online] 2022 [cited 2022 Nov 27];13:9-12. Available from: https://www.jahjournal.org/text.asp?2022/13/1/9/344266




  Introduction Top


The World Health Organization (WHO) showed that the prevalence of anemia among children of 6–59 months was 42.6% globally in 2011, of which, 53.8% seen in South East Asia and 59% in India.[1] According to the Fourth National Family Health Survey (NFHS) (2016), 58.6% of Indian children from 6 to 59 months are anemic, of which 53.8% are seen in Maharashtra.[2] It is especially more prevalent among rural children. The prevalence rate of anemia is an important indicator of the nutritional status within the pediatric population.

In India, Anemia is an important health problem as well as one of the major social health problems, especially among children. Since anemic children have reduced exercise capacity, slower rate of growth, impaired cognitive development, reduced behavioral and language development, and scholastic achievement along with delayed wound healing.[3] These children are also at an increased risk of dying due to complications associated with malnutrition and infections.[4] Because of these factors, the study of the etiopathogenesis of anemia in infancy and childhood has attracted wide attention in the recent years in India.[5]


  Materials and Methods Top


The present study was conducted after obtaining the approval from the ethics committee. All patients that came to the outpatient as well as the inpatient department in a rural tertiary care hospital between 2016 and 2018, satisfying the inclusion criteria were involved in the study.

Newborns up to the age of 2 months with hemoglobin below 13.6 g/dL, infants of more than 2 months to 6 months with hemoglobin below 9.5 g/dL, children of 6 months up to the age of 6 years with hemoglobin concentration of below 11.0 g/dL, and children from 6 years of age to 12 years of age with hemoglobin concentration below 11.5 g/dL were included in this study.[6]

Routine investigations that were performed were hemoglobin estimation, blood indices, and peripheral blood smear examination.

The anemic patients were further divided into mild (9.0–11.0 g/dL), moderate (6.0–8.9 g/dL), and severe (<6.0 g/dL). Anemias were also divided into the morphologic classification based on the blood indices.[6]

Further investigation such as serum ferritin, high performance liquid chromatography, and hemoglobin electrophoresis was done when required.


  Results Top


The study screened all pediatric patients from birth to the age of 12 years. Four hundred (54.9%) patients were anemic out of the total 729 cases.

All the patients were categorized into four age groups, newborn (birth up to 2 months), infants (more than 2 months to 6 months), toddler (more than 6 months to 6 years), and children (more than 6 years to 12 years). It was suggestive that anemia was most commonly affected in the age group of toddlers with 192 (48.0%) patients, followed by children with 138 (34.5%) patients. Newborns and infants were less commonly found to be anemic with only 34 (8.5%) of newborns and 36 (9.0%) of infants [Table 1].
Table 1: Age wise distribution of anemia

Click here to view


To analyze the severity of anemia, hemoglobin concentration of each patient was categorized into mild, moderate, and severe. It was found that most of the pediatric patients that were studied were moderately anemic 202 (50.5%), followed by 145 (36.2%) mildly anemic and 53 (13. 3%) severely anemic patients. The severity of anemia was further analyzed in each of the categorized age groups. Out of the 34 newborn patients, 8 (5.5%) were mildly anemic, 20 (9.9%) were moderately anemic, and 6 (11.3%) were severely anemic. Of the 36 infants, 16 (11.1%) were mildly and 16 (7.9%) moderately effected with anemia and 4 (7.5%) were severely anemic. There were 192 toddlers, of which 72 (49.6%) were mildly anemic, 88 (43.6%) were moderately anemic, and 32 (60.4%) were severely anemic. Out of the 138 children, 49 (33.8%) were mildly anemic, 78 (38.6%) were moderately, and 11 (20.8%) were severely anemic [Table 2].
Table 2: Age wise distribution of severity of anemia

Click here to view


Blood indices (mean corpuscular volume, mean corpuscular hemoglobin [MCH], and MCH concentration) were taken into consideration to classify four basic morphological groups: microcytic hypochromic, normocytic normochromic, dimorphic, and macrocytic. The most commonly found morphological category was microcytic hypochromic 268 (67.0%), followed by dimorphic with 65 (16.3%), with normocytic normochromic 45 (11.2%) patients and macrocytic anemia 22 (5.5%). Microcytic it reveals hypochromic anemia was the most common type of anemia in each of the age groups [Table 3].
Table 3: Age wise distribution of morphology of anemia

Click here to view



  Discussion Top


This study using routine clinical data from a large number of patients attending the inpatients and outpatient clinics of a rural hospital attempted to assess the prevalence of pediatric anemia in a rural setting in Pune, Maharashtra, India. This study was in the age group between newborn and 12 years. The total number of pediatric patients that were found to be anemic was 400 (54.9%) taken into consideration out of 729 patients. Toddlers from the age of 6 months to 6 years were most frequently found to be anemic (48.0%). Moderate anemia was the most common in children (50.5%).

The importance to monitor the prevalence of anemia in the pediatric population because it identifies the nutritional status of this population group.[17] Over time, anemia has become a serious topic for research and study. According to the WHO, the category of public health significance states the prevalence of anemia in more than 40.0% is under Severe Public Health Problem [Chart 1].[7]



Data from National Family Health Survey, India, show that more than 70% children were anemic since 1998 in rural Maharashtra.[9] With a significant drop in 2015–2016 (54.0%) which correlates with our finding (54.9%).[2] It significantly shows that, even with several national programs, the prevalence has not improved.

Overall pediatric anemia in all over India at the time of our study was 58.6% according to the 4th NFHS (2015–2016),[2] which also correlates with several other studies performed in various areas [Table 4].
Table 4: Comparable studies of occurrence of anemia

Click here to view


In several studies across India, it is found that on an average, the most common age group that is affected by anemia is from 6 months to 6 years (48.0%).[11],[12],[13] Physiologically, up to the age of 6 months, a child's body has enough iron stores after which additional iron is required.[16] This is also the time additional iron is required for growth. Children who have insufficient iron supplement at this time suffer from cognitive impairment that restricts their ability to learn.[14] Furthermore, likely causes them to remain vulnerable to infections and have low immunity. This is perhaps the reason that this age group has the highest incidence of anemia and more frequently, microcytic hypochromic anemia (71.8%) that correlates with iron deficiency anemia (65.2%) [Table 5].
Table 5: Comparable studies of morphology and cause of anemia

Click here to view


According to the 4th NFHS, only 5.0% of children in rural Maharashtra in the age group of 6 months to 1 year receive adequate diet and nutrition required for growth.[2] Furthermore, it was seen that only 14.6% of children aged 6–36 months consumed iron-rich food.[2]

Iron supplementation has been the backbone of the National Nutritional Anemia Prophylaxis Programme (1970).[20] However, 49 years later, anemia continues to be Severe Public Health Problem.[7] This is majorly due to partial coverage of the population and inadequate dose of iron supplementation, defective absorption, and malnutrition.[22]


  Conclusion Top


From our study, we can conclude that majority of the pediatric population in the rural area of Maharashtra, India, is anemic. The high frequency of anemia was due to the poor bioavailability of dietary iron coupled with low intake of haem iron derived from animal products.

Our study recommended that the highest occurrence of anemia was seen in the age group between 6 months to 6 years. The factor that plays a role in more frequent cause of anemia in this age group is that, after 6 months of age, exclusive breastfeeding is weaned off and the child does not get enough nutritional support that aids the increased demand due to fast growth. Morphologically, the most commonly seen anemia in our study was microcytic hypochromic, which further correlates with iron deficiency anemia. The study of occurrence of anemia in children is essential to be constantly monitored as it helps identify causes, formation of intervention strategies as well as ensure that the already formed national programs are effective.

The finding of higher prevalence of anemia in rural pediatric patients' further investigation and corroboration in other studies. The intervention for anemia should be directed on the community as a whole.[23]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. The Global Prevalence of Anaemia in 2011. Geneva: World Health Organization; 2015.  Back to cited text no. 1
    
2.
International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-4), 2015-16: India. Mumbai: IIPS.  Back to cited text no. 2
    
3.
George KA, Kumar NS, Lal JJ, Sreedevi R. Anemia and nutritional status of pre school children in Kerala. Indian J Pediatr 2000;67:575-8.  Back to cited text no. 3
    
4.
Rakhee K. Red cell: Basic aspects of anemia. In: Renu S, editor. De Gruchy's Clinical Haematology in Medical Practice. 6th ed., Ch. 2. India: Wiley; 2013. p. 15-32.  Back to cited text no. 4
    
5.
Jain S, Chopra H, Garg SK, Bhatnagar M, Singh JV. Anemia in children: Early iron supplementation. Indian J Pediatr 2000;67:19-21.  Back to cited text no. 5
    
6.
Kliegman RM, Behrman RE, Jenson HB, Stanton BF, editors. Normal ranges. In: Nelson's Textbook of Pediatrics. 18th ed. Philadelphia:, Elsevier; 2007. p. 2018-21.  Back to cited text no. 6
    
7.
World Health Organization. Worldwide Prevalence of Anaemia 1993–2005: WHO Global Database on Anaemia. Geneva: World Health Organization; 2008.  Back to cited text no. 7
    
8.
Nanjuda M. Prevalence of under nutrition and anaemia among under five rural children of south Karnataka, India. Nitte Univ J Health Sci 2014;4:24-7.  Back to cited text no. 8
    
9.
International Institute for Population Sciences (IIPS) and ORC Macro. National Family Health Survey (NFHS-2), India, 1998-99: Maharashtra. Mumbai: IIPS  Back to cited text no. 9
    
10.
Behera S, Bulliyya G. Magnitude of anemia and hematological predictors among children under 12 years in Odisha, India. Anemia 2016;2016:1729147.  Back to cited text no. 10
    
11.
Muthuraman M, Sintha M. A cross sectional analysis of anemia in paediatric population in a tertiary care hospital, Madurai. Int J Pathol 2017;1:42-7.  Back to cited text no. 11
    
12.
Muthusamy BG, Venugopal V, Sumithra S. Prevalence of anaemia among the hospitalized children in a rural tertiary care teaching hospital. Int J Contemp Pediatr 2017;4:431-7.  Back to cited text no. 12
    
13.
Kanchana, Madhusudan Sr, Ahuja S, Nagaraj N. Prevalence and risk factors of anemia in under five-year-old children in children's hospital. Int J Contemp Pediatr 2018;5:499-502.  Back to cited text no. 13
    
14.
NNMB. National Nutrition Monitoring Bureau: Prevalence of Micronutrient Deficiencies: NNMB Technical Report No. 22, National Institute of Nutrition. Hyderabad, India: Indian Council of Medical Research; 2003.  Back to cited text no. 14
    
15.
Qureshi NA, Abid M, Chauha Z, Qureshi NA. Study of anemia and its correlation with hematological parameters in patient of various age group. IOSR J Dent Med Sci 2015;14:29-35.  Back to cited text no. 15
    
16.
Verma M, Chhatwal J, Kaur G. Prevalence of Anemia among Urban School Children of Punjab. Indian Pediatric, 35, 1998,1181-1186  Back to cited text no. 16
    
17.
Sudhagandhi B, Sivapatham S. Prevalence of anemia in the school children of Kattankulathur, Tamil Nadu, India. Int J Nutr Pharmacol Neurol Dis 2011;1:184-8  Back to cited text no. 17
    
18.
International Institute for Population Sciences (IIPS) and Macro International. National Family Health Survey (NFHS-3), 2005–06: India: Volume I. Mumbai: IIPS.  Back to cited text no. 18
    
19.
International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-5), 2019–20: India: Mumbai: IIPS.  Back to cited text no. 19
    
20.
Division A. Ministry of Health and Family Welfare, Government of India. Guidelines for Control of Iron Deficiency Anaemia – National Iron + Initiative: Towards Infinite Potential in an Anaemia Free India. New Delhi: Ministry of Health and Family Welfare, Government of India; 2013.  Back to cited text no. 20
    
21.
Janjale A, Pande S, Sonawane R, Ahire N, Sonawane S. A study of severe anemia in children in a tertiary care institute. MVP J Med Sci 2018;5:33-8  Back to cited text no. 21
    
22.
Neena G, Urja J. Evaluation of efficacy and compliance of ferrous sulfate of National Nutritional Anemia Prophylaxis and Control Programme in comparison with other iron preparations in antenatal females. Indian J Appl Res 2019;9:9-11.  Back to cited text no. 22
    
23.
Malhotra P, Kumari S, Kumar R, Varma S. Prevalence of anemia in adult rural population of north India. J Assoc Physicians India 2004;52:18-20.  Back to cited text no. 23
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed2469    
    Printed48    
    Emailed0    
    PDF Downloaded523    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]