Background
Anemia remains one of the most significant public health problems affecting children under five years of age, particularly in low- and middle-income countries. According to the World Health Organization (WHO), nearly 40% of preschool children worldwide are anemic, with iron deficiency accounting for approximately half of all cases. Childhood anemia contributes to impaired physical growth, delayed cognitive development, reduced immunity, increased susceptibility to infections, poor academic performance in later life, and increased childhood morbidity and mortality. In India, despite sustained governmental initiatives such as the National Iron Plus Initiative (NIPI), Anemia Mukt Bharat Programme, Integrated Child Development Services (ICDS), and Poshan Abhiyaan, anemia continues to pose a substantial public health challenge. The multifactorial etiology of anemia includes nutritional deficiencies, recurrent infections, poor maternal health, inadequate infant feeding practices, low socioeconomic status, food insecurity, and maternal educational status. Identification of locally relevant determinants is essential for designing effective interventions aimed at reducing childhood anemia.
Objectives
The present study aimed to determine the prevalence of anemia among under-five children and identify the socioeconomic, maternal, nutritional, and child-related factors associated with anemia.
Methods
A community-based cross-sectional study was conducted among 276 children aged 12–59 months selected through multistage cluster random sampling from rural communities. Information regarding socioeconomic characteristics, maternal factors, infant feeding practices, and child health variables was collected using a structured and pretested questionnaire administered to mothers or primary caregivers. Anthropometric measurements were performed according to WHO Child Growth Standards. Hemoglobin concentration was estimated using a portable digital hemoglobin analyzer from capillary blood obtained through finger-prick sampling. Children with hemoglobin concentrations below 11 g/dL were classified as anemic according to WHO criteria and further categorized as mild, moderate, or severe anemia. Data were analyzed using IBM SPSS Version 25. Chi-square tests assessed associations between categorical variables and anemia status. Variables demonstrating statistical significance were included in multivariable logistic regression analysis to identify independent predictors of anemia. Statistical significance was considered at p < 0.05.
Results
Among the 276 participating children, 53.3% were boys and 46.7% were girls, while 52.5% belonged to the age group of 2–5 years. The overall prevalence of anemia was 43.11%. Among anemic children, 61.34% had mild anemia, 35.5% had moderate anemia, and 3.4% had severe anemia. Multivariable logistic regression identified several significant predictors of childhood anemia. Children belonging to lower socioeconomic households demonstrated markedly increased odds of anemia (Adjusted Odds Ratio [AOR]=14.01; 95% CI: 5.216–37.683). Underweight children were approximately three times more likely to develop anemia than children with normal nutritional status (AOR=2.83; 95% CI:1.731–4.656). Maternal anemia during pregnancy was strongly associated with childhood anemia (AOR=8.32; 95% CI:4.690–14.770), while absence of maternal iron supplementation during pregnancy increased the likelihood of childhood anemia nearly ninefold (AOR=9.40; 95% CI:5.430–16.243). Lower maternal educational attainment also demonstrated significant associations with anemia among children.
Conclusion
The study demonstrates that anemia remains a major public health concern among under-five children. Socioeconomic deprivation, maternal anemia, inadequate antenatal iron supplementation, poor maternal education, and childhood undernutrition were identified as significant determinants. These findings emphasize the importance of strengthening maternal nutrition, promoting female education, ensuring universal antenatal iron supplementation, improving complementary feeding practices, and implementing community-based nutritional interventions. Integrated efforts involving healthcare providers, nursing professionals, policymakers, and community stakeholders are essential to reduce the burden of childhood anemia and improve child health outcomes.
Anemia; Under-five children; Iron deficiency; Nutritional status; Maternal education; Rural health; Cross-sectional study; Public health.
Background
Anemia remains one of the most significant public health problems affecting children under five years of age, particularly in low- and middle-income countries. According to the World Health Organization (WHO), nearly 40% of preschool children worldwide are anemic, with iron deficiency accounting for approximately half of all cases. Childhood anemia contributes to impaired physical growth, delayed cognitive development, reduced immunity, increased susceptibility to infections, poor academic performance in later life, and increased childhood morbidity and mortality. In India, despite sustained governmental initiatives such as the National Iron Plus Initiative (NIPI), Anemia Mukt Bharat Programme, Integrated Child Development Services (ICDS), and Poshan Abhiyaan, anemia continues to pose a substantial public health challenge. The multifactorial etiology of anemia includes nutritional deficiencies, recurrent infections, poor maternal health, inadequate infant feeding practices, low socioeconomic status, food insecurity, and maternal educational status. Identification of locally relevant determinants is essential for designing effective interventions aimed at reducing childhood anemia.
Objectives
The present study aimed to determine the prevalence of anemia among under-five children and identify the socioeconomic, maternal, nutritional, and child-related factors associated with anemia.
Methods
A community-based cross-sectional study was conducted among 276 children aged 12–59 months selected through multistage cluster random sampling from rural communities. Information regarding socioeconomic characteristics, maternal factors, infant feeding practices, and child health variables was collected using a structured and pretested questionnaire administered to mothers or primary caregivers. Anthropometric measurements were performed according to WHO Child Growth Standards. Hemoglobin concentration was estimated using a portable digital hemoglobin analyzer from capillary blood obtained through finger-prick sampling. Children with hemoglobin concentrations below 11 g/dL were classified as anemic according to WHO criteria and further categorized as mild, moderate, or severe anemia. Data were analyzed using IBM SPSS Version 25. Chi-square tests assessed associations between categorical variables and anemia status. Variables demonstrating statistical significance were included in multivariable logistic regression analysis to identify independent predictors of anemia. Statistical significance was considered at p < 0.05.
Results
Among the 276 participating children, 53.3% were boys and 46.7% were girls, while 52.5% belonged to the age group of 2–5 years. The overall prevalence of anemia was 43.11%. Among anemic children, 61.34% had mild anemia, 35.5% had moderate anemia, and 3.4% had severe anemia. Multivariable logistic regression identified several significant predictors of childhood anemia. Children belonging to lower socioeconomic households demonstrated markedly increased odds of anemia (Adjusted Odds Ratio [AOR]=14.01; 95% CI: 5.216–37.683). Underweight children were approximately three times more likely to develop anemia than children with normal nutritional status (AOR=2.83; 95% CI:1.731–4.656). Maternal anemia during pregnancy was strongly associated with childhood anemia (AOR=8.32; 95% CI:4.690–14.770), while absence of maternal iron supplementation during pregnancy increased the likelihood of childhood anemia nearly ninefold (AOR=9.40; 95% CI:5.430–16.243). Lower maternal educational attainment also demonstrated significant associations with anemia among children.
Conclusion
The study demonstrates that anemia remains a major public health concern among under-five children. Socioeconomic deprivation, maternal anemia, inadequate antenatal iron supplementation, poor maternal education, and childhood undernutrition were identified as significant determinants. These findings emphasize the importance of strengthening maternal nutrition, promoting female education, ensuring universal antenatal iron supplementation, improving complementary feeding practices, and implementing community-based nutritional interventions. Integrated efforts involving healthcare providers, nursing professionals, policymakers, and community stakeholders are essential to reduce the burden of childhood anemia and improve child health outcomes.
Anemia; Under-five children; Iron deficiency; Nutritional status; Maternal education; Rural health; Cross-sectional study; Public health.