Prevalence and factors associated with anemia in 6–18 years urban and rural Indian children and adolescents: A multicenter study

Abstract

Background: Anemia in India is a major public health problem. A better understanding of regional differences in the prevalence of anemia and the association of anemia with growth and quality of life (QOL) among children and adolescents is crucial for providing insights for suitable interventions. Objectives: The main objectives were to estimate the prevalence of anemia in rural and urban Indian children and study association of anemia with growth and QOL. Materials and Methods: A multicentre, cross-sectional, and observational school-based study (n=13885, July 2016–October 2017) in urban and rural regions of six Indian states (Maharashtra, Gujarat, Tamil Nadu, Punjab, Chhattisgarh, and Assam) was conducted. Anthropometry and hemoglobin (HemoCue) were measured by trained staff. Demographic details, parental-education, QOL, anthropometry, and hemoglobin were recorded using pre-validated and pre-tested questionnaires/standard procedures. Regression analysis was performed to identify predictors of anemia. Results: Overall, 26% of the study children were anemic (girls [29%] >than boys [23%]). Gujarat was most affected (37% anemic); rural areas had a higher prevalence of anemia than urban (20%; p<0.0001). The prevalence of stunting was higher in anemic children (stunting: 7%, height Z-score <?1=23–26%) than non-anemic (4%; height Z-score <?1=19%) children. Mean QOL score was lower in anemic versus non-anemic (1706±349 vs. 1795±325, p<0.05). Maternal education and child’s age positively predicted anemia; the odds ratio for children of illiterate mothers to have anemia was higher (?=1.7; confidence interval: 1.4–2.1; p<0.05). Conclusion: Prevalence of anemia remains a public health problem among children (6–18-years) in India; maternal education is a contributing factor. Compromised growth and QOL are major considerations.