title: Determinants of anemia among young children in rural India.
abstract: OBJECTIVE
  More than 75% of Indian toddlers are anemic. Data on factors associated with anemia in India are limited. The objective of this study was to determine biological, nutritional, and socioeconomic risk factors for anemia in this vulnerable age group.
  
  
  METHODS
  We conducted a cross-sectional study of children aged 12 to 23 months in 2 rural districts of Karnataka, India. Children were excluded if they were unwell or had received a blood transfusion. Hemoglobin, ferritin, folate, vitamin B(12), retinol-binding protein, and C-reactive protein (CRP) levels were determined. Children were also tested for hemoglobinopathy, malaria infection, and hookworm infestation. Anthropometric measurements, nutritional intake, family wealth, and food security were recorded. In addition, maternal hemoglobin level was measured.
  
  
  RESULTS
  Anemia (hemoglobin level < 11.0 g/dL) was detected in 75.3% of the 401 children sampled. Anemia was associated with iron deficiency (low ferritin level), maternal anemia, and food insecurity. Children's ferritin levels were directly associated with their iron intake and CRP levels and with maternal hemoglobin level and inversely associated with continued breastfeeding and the child's energy intake. A multivariate model for the child's hemoglobin level revealed associations with log(ferritin level) (coefficient: 1.20; P < .001), folate level (0.05; P < .01), maternal hemoglobin level (0.16; P < .001), family wealth index (0.02; P < .05), child's age (0.05 per month; P < .005), hemoglobinopathy (-1.51; P < .001), CRP level (-0.18; P < .001), and male gender (-0.38; P < .05). Wealth index and food insecurity could be interchanged in this model.
  
  
  CONCLUSIONS
  Hemoglobin level was primarily associated with iron status in these Indian toddlers; however, maternal hemoglobin level, family wealth, and food insecurity were also important factors. Strategies for minimizing childhood anemia must include optimized iron intake but should simultaneously address maternal anemia, poverty, and food insecurity.
authors.affiliation: Nossal Institute for Global Health, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Sant-Rayn
authors.initials: SR
authors.lastname: Pasricha
authors.forename: James
authors.initials: J
authors.lastname: Black
authors.forename: Sumithra
authors.initials: S
authors.lastname: Muthayya
authors.forename: Anita
authors.initials: A
authors.lastname: Shet
authors.forename: Vijay
authors.initials: V
authors.lastname: Bhat
authors.forename: Savitha
authors.initials: S
authors.lastname: Nagaraj
authors.forename: N S
authors.initials: NS
authors.lastname: Prashanth
authors.forename: H
authors.initials: H
authors.lastname: Sudarshan
authors.forename: Beverley-Ann
authors.initials: BA
authors.lastname: Biggs
authors.forename: Arun S
authors.initials: AS
authors.lastname: Shet
mesh_terms: D017677:Age Distribution; D000740:Anemia / Q000175:diagnosis / Q000453:epidemiology; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis* / Q000453:epidemiology*; D001774:Blood Chemical Analysis; D002675:Child, Preschool; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D005523:Food Supply / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D006815:Hunger; D007194:India / Q000453:epidemiology; D007223:Infant; D019266:Iron, Dietary; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D015999:Multivariate Analysis; D009752:Nutritional Status; D011203:Poverty; D011336:Probability; D012424:Rural Population; D012720:Severity of Illness Index; D017678:Sex Distribution; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014944:World Health Organization
chemical_list: D019266:Iron, Dietary