Prevalence of Iron Deficiency and its Sociodemographic Patterning in Indian Children and Adolescents: Findings from the Comprehensive National Nutrition Survey 2016–18

Abstract

Background Anemia control programs in India focus mainly on the measurement of hemoglobin in response to iron–folic acid supplementation. However, representative national estimates of iron deficiency (ID) are not available. Objectives The objective of the present study was to evaluate ID prevalence among children and adolescents (1–19 y) using nationally representative data and to examine the sociodemographic patterning of ID. Methods Cross-sectional data from the Comprehensive National Nutrition Survey in children (1–4 y: n = 9635; 5–9 y: n = 11,938) and adolescents (10–19 y; n = 11,507) on serum ferritin (SF) and other biomarkers were analyzed to determine inflammation-adjusted ID prevalence [SF (μg/L): <12 in 1–4 y and <15 in 5–19 y] and its relation to sociodemographic indicators. Multiple-regression analyses were conducted to identify the exposure associations of iron status. In addition, the relation between SF and hemoglobin was assessed as an indicator of iron utilization in different wealth quintiles. Results ID prevalence was higher in 1- to 4-y-old children (31.9%; 95% CI: 31.0%, 32.8%) and adolescent girls (30.4%; 95% CI: 29.3%, 31.5%) but lower in adolescent boys and 5- to 9-y-old children (11%–15%). In all age groups, ID prevalence was higher in urban than in rural participants (1–4 y: 41% compared with 29%) and in those from richer quintiles (1–4 y: 44% in richest compared with 22% in poorest), despite adjustment for relevant confounders. SF significantly interacted with the wealth index, with declining trends in the strength of association between hemoglobin and SF from the richest to the poorest groups suggesting impaired iron utilization for hemoglobin synthesis in poorer wealth quintiles. Conclusions ID prevalence was indicative of moderate (in preschool children and adolescent girls) or mild (in 5- to 9-y-old children and adolescent boys) public health problem with significant variation by state and age. Focusing on increasing iron intake alone, without addressing the multiple environmental constraints related to poverty, may not result in intended benefits.

Haemoglobin diagnostic cut-offs for anaemia in Indian women of reproductive age

“…1,2 Potentially important causes for this are poor programmatic coverage and compliance to the iron folate (IFA) supplementation program, or persistent in ammation, or other causes. 3,4,5 It is worth considering whether the high anaemia prevalence is an in ated value, or whether iron or folate de ciency is not the primary aetiology.…”

There should always be a free lunch: the impact of COVID-19 lockdown suspension of the mid-day meal on nutriture of primary school children in Karnataka, India

“…A recent national survey of iron status and anaemia reported that ID prevalence was higher, but anaemia was lower, in urban compared with rural children, pointing to a better iron utilisation for erythropoiesis in the former. 6 The findings here emphasise the greater importance of ensuring the supply of diverse food like the MDM single-nutrient supplementary approaches.…”

Nutritional status of school‐age children (5–19 years) in South Asia: A scoping review

“…The prevalence of anaemia was reported by 58 studies across Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan and Sri Lanka (Supporting Information: Table S5 ). Nationally representative data from Bangladesh, Sri Lanka and India indicated iron deficiency prevalence estimates of 7.1%, 19.2% and 30.0%, respectively (Kulkarni et al, 2021 ; Rahman et al, 2016 ; Wray et al, 2017 ). The prevalence of micronutrient deficiency reported by all studies (whether nationally representative or not) ranged from 1.8% (Pakistan, year undisclosed) (Zareen, 2021 ) to 87% (India in 2014–2015) (Ahankari et al, 2020 ).…”