title: Characterisation of anaemia and associated factors among infants and pre-schoolers from rural India.
abstract: OBJECTIVE
  In India, national databases indicate anaemia prevalence of 80 % among 6-35-month-old children and 58 % among 36-59-month-old children. The present study aimed to characterise anaemia and the associated factors among infants and pre-schoolers living in rural India.
  
  
  METHODS
  Multivariate logistic regression analysis of data collected prior to an intervention trial. Fe-deficiency with anaemia (IDA), Fe deficiency with no anaemia (IDNA) and anaemia without Fe deficiency were defined. Serum ferritin, soluble transferrin receptor (sTfR) and sTfR/log ferritin index were used to indicate Fe status.
  
  
  METHODS
  Twenty-six villages of Nalgonda district, Telangana, India. Data were collected in community sites. Participants Four hundred and seventy-six infants (aged 6-12 months), 316 pre-schoolers (aged 29-56 months) and their mothers.
  
  
  RESULTS
  Prevalence of anaemia among infants and pre-schoolers was 66·4 and 47·8 %, prevalence of IDA was 52·2 and 42·1 %, prevalence of IDNA was 22·2 and 29·8 %, prevalence of anaemia without Fe deficiency was 14·2 and 5·7 %. Among infants, anaemia was positively associated with maternal anaemia (OR=3·31; 95 % CI 2·10, 5·23; P<0·001), and sTfR/log ferritin index (OR=2·21; 95 % CI 1·39, 3·54; P=0·001). Among pre-schoolers, anaemia was positively associated with maternal anaemia (OR=3·77; 95 % CI 1·94, 7·30; P<0·001), sTfR/log ferritin index (OR=5·29; 95 % CI 2·67, 10·50; P<0·001), high C-reactive protein (OR=4·39; 95 % CI 1·91, 10·06, P<0·001) and young age (29-35 months: OR=1·92; 05 % CI 1·18, 3·13, P=0·009).
  
  
  CONCLUSIONS
  Anaemia prevalence continues to be high among infants and pre-schoolers in rural India. Based on sTfR/ferritin index, Fe deficiency is a major factor associated with anaemia. Anaemia is also associated with inflammation among pre-schoolers and with maternal anaemia among infants and pre-schoolers, illustrating the importance of understanding the aetiology of anaemia in designing effective control strategies.
authors.affiliation: 1Division of Micronutrient Research,National Institute of Nutrition,Indian Council of Medical Research,Jamai-Osmania PO, Tarnaka,Hyderabad - 500 007,Telangana,India.
authors.forename: Krishnapillai Madhavan
authors.initials: KM
authors.lastname: Nair
authors.affiliation: 2Behavioural Sciences,National Institute of Nutrition,Indian Council of Medical Research,Hyderabad,Telangana,India.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Fernandez-Rao
authors.affiliation: 3Biostatistics,National Institute of Nutrition,Indian Council of Medical Research,Hyderabad,Telangana,India.
authors.forename: Balakrishna
authors.initials: B
authors.lastname: Nagalla
authors.affiliation: 4Clinical Studies,National Institute of Nutrition,Indian Council of Medical Research,Hyderabad,Telangana,India.
authors.forename: Radhakrishna Vijaya
authors.initials: RV
authors.lastname: Kankipati
authors.affiliation: 1Division of Micronutrient Research,National Institute of Nutrition,Indian Council of Medical Research,Jamai-Osmania PO, Tarnaka,Hyderabad - 500 007,Telangana,India.
authors.forename: Ravinder
authors.initials: R
authors.lastname: Punjal
authors.affiliation: 1Division of Micronutrient Research,National Institute of Nutrition,Indian Council of Medical Research,Jamai-Osmania PO, Tarnaka,Hyderabad - 500 007,Telangana,India.
authors.forename: Little Flower
authors.initials: LF
authors.lastname: Augustine
authors.affiliation: 5Department of International Health,Johns Hopkins Bloomberg School of Public Health,Baltimore,MD,USA.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Hurley
authors.affiliation: 6Department of Pediatrics,University of Maryland School of Medicine,Baltimore,MD,USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Tilton
authors.affiliation: 7Micronutrient Initiative,Ottawa,Ontario,Canada.
authors.forename: Kimberly B
authors.initials: KB
authors.lastname: Harding
authors.affiliation: 8The Mathile Institute for the Advancement of Human Nutrition,Dayton,OH,USA.
authors.forename: Greg
authors.initials: G
authors.lastname: Reinhart
authors.affiliation: 6Department of Pediatrics,University of Maryland School of Medicine,Baltimore,MD,USA.
authors.forename: Maureen M
authors.initials: MM
authors.lastname: Black
mesh_terms: D000740:Anemia / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D015992:Body Mass Index; D001835:Body Weight; D002097:C-Reactive Protein / Q000378:metabolism; D002675:Child, Preschool; D005191:Family Characteristics; D005260:Female; D005293:Ferritins / Q000097:blood; D005492:Folic Acid / Q000097:blood; D005523:Food Supply; D006801:Humans; D007194:India; D007223:Infant; D007501:Iron / Q000097:blood; D000090463:Iron Deficiencies; D016015:Logistic Models; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage / Q000097:blood; D009017:Morbidity; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D015995:Prevalence; D011990:Receptors, Transferrin / Q000097:blood; D012307:Risk Factors; D012424:Rural Population; D012959:Socioeconomic Factors; D014805:Vitamin B 12 / Q000097:blood
chemical_list: D018977:Micronutrients; D011990:Receptors, Transferrin; D002097:C-Reactive Protein; D005293:Ferritins; D005492:Folic Acid; D007501:Iron; D014805:Vitamin B 12
keywords: Anaemia; India; Infants; Pre-schoolers; Risk factors; sTfR/log ferritin index