Anaemia in under five children attending a tertiary hospital in central Kerala: a cross sectional study

Jessie Jose, Riya Lukose, Thekkumpat S. Athira


Background: Anaemia is the most common nutritional problem in the world with significant impact on the neurological and cognitive development of young, growing children. India has a high prevalence of anaemia among its under-five children. The objectives of the study were to estimate the prevalence of anaemia and iron deficiency anaemia in children in the age group 6 months to 5 years.

Methods: A hospital based descriptive study was done on 51 children attending the outpatient department of a tertiary hospital. They were evaluated by obtaining a detailed history, physical examination and haemoglobin and serum ferritin estimation.

Results: The prevalence of anaemia in the present study was 41.2%. 13 (25.5%) had mild anaemia, 8 (15.7%) had moderate anaemia and none had severe anaemia. Iron deficiency anaemia was present in 17 out of 21 children (81%) with anaemia (p<0.00001). There were significant associations between haemoglobin levels and age (p=0.049) and nutritional status (moderate acute malnutrition) (p=0.034) of the children in the study.

Conclusions: The prevalence of anaemia in children under 5 years in Kerala, which has performed well in other health quality indicators, remains high. A multimodal strategy to address this public health problem is required.


Child, Anaemia, Iron-deficiency, Prevalence

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World Health Organisation. The global prevalence of anaemia in 2011. Geneva: World Health Organization; 2015. Available at: Accessed 12 Aug 2020.

International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-4), 2015-16: India. Mumbai: IIPS; 2017. Available at: Accessed 12 June 2017.

International Institute for Population Sciences (IIPS). National Family Health Survey (NFHS-5),2019-20: India. Mumbai: IIPS; 2021. Available at: Accessed 12 Feb 2021.

Politt E. Iron deficiency and cognitive function. Annu Rev Nutr. 1993;13:521-37.

Lozoff B, Beard J, Connor J, Felt B, Georgieff M, Schallert T. Long-lasting neural and behavioral effects of iron deficiency in infancy. Nutr Rev. 2006;64:S34-91.

Booth IW, Aukett MA. Iron deficiency anaemia in infancy and early childhood. Arch Dis Child. 1997;76(6):549-54.

World Health Organisation. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization, 2011 (WHO/NMH/NHD/MNM/11.1). Available at: Pdf. Accessed 14 June 2020.

World Health Organisation. Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations. Vitamin and Mineral Nutrition Information System. Geneva, World

Health Organization, 2011 (WHO/NMH/NHD/MNM/11.2). Available at: Pdf. Accessed 14 June 2020.

Behera S, Bulliyya G. Magnitude of Anemia and Hematological Predictors among Children under 12 Years in Odisha, India. Anemia. 2016;2016:1729147.

World Health Organization. WHO multicentre growth reference study. WHO child growth standards based on length/height, weight and age. Acta Pædiatrica. 2006:76-85

Wani RT. Socioeconomic status scales-modified Kuppuswamy and Udai Pareekh's scale updated for 2019. J Family Med Prim Care. 2019;8:1846-9.

Kapil U, Kapil R, Gupta A. National Iron Plus Initiative: Current status and future strategy. Indian J Med Res. 2019;150(3):239-47.

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.

Philip RR, Vijayakumar K, Indu PS, Shrinivasa BM, Sreelal TP, Balaji J. Prevalence of undernutrition among tribal preschool children in Wayanad district of Kerala. Int J Adv Med Health Res. 2015;2:33-8.

Saba F, Poornima S, Balaji PA, Varne SR, Jayashree K. Anemia among hospitalized children at a multispecialty hospital, Bangalore (Karnataka), India. J Fam Med Primary Care. 2014;3:48-53.

John JJ, Mohan G, Ajitha K, David A. Iron deficiency anemia among preschool children belonging to affluent families in Kerala, India. J Curr Res Sci Med. 2019;5:23-7.

Manoj S, Meppadath IM. Anaemia in 6-59 months children in rural Kerala and its association with age, gender, nutritional status and dietary habits. J. Evolution Med Dent Sci. 2017;6(29):2358-61.

Ray S, Chandra J, Bhattacharjee J, Sharma S, Agarwala A. Determinants of nutritional anaemia in children less than five years age. Int J Contemp Pediatr. 2016;3:403-8.

Pasricha SR, Black J, Muthayya S, Shet A, Bhat V, Nagaraj S et al. Determinants of anemia among young children in rural India. Pediatrics. 2010;126(1):e140-9.

Santokh I, Gaur BK, Narayan R, Maini B, Bharadwaj AK. Iron deficiency anemia among hospitalized children in a rural teaching hospital: a cross sectional study. Int J Contemp Pediatr. 2018;5:1631-6.

Gebreweld A, Ali N, Ali R, Fisha T. Prevalence of anemia and its associated factors among children under five years of age attending at Guguftu health center, South Wollo, Northeast Ethiopia. PLoS ONE. 2019:14(7):e0218961.

Gupta PM, Perrine CG, Mei Z, Scanlon KS. Iron, anemia, and iron deficiency anemia among young children in the United States. Nutrients. 2016;8(6).

Singh S, Parihar S. Prevalence of anemia in under five-year-old children: a hospital-based study. Int J Contemp Pediatr. 2019;6:842-7.

WHO, UNICEF, WFP, UNHCR. Consultation on the Dietary Management of Moderate Malnutrition in Under-5 Children. Food Nutr. Bull. 2009;30:(3). Available at: Accessed 21 Jan 2021.

World Health Organization. Guideline: Intermittent Iron Supplementation in

Preschool and School Age Children. World Health Organization: Geneva, 2011. Available at: Accessed 10 Feb 2021.

Sachdev HPS, Gera T. Preventing childhood anaemia in India: iron supplementation and beyond. Eur J Clin Nutr. 2013;67:475-80.