Low Anemia Prevalence in School-Aged Children in Banglore
Low Anemia Prevalence in School-Aged Children in Banglore
Low Anemia Prevalence in School-Aged Children in Banglore
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ORIGINAL ARTICLE
Low anemia prevalence in school-aged children in
Bangalore, South India: possible effect of school
health initiatives
S Muthayya1, P Thankachan1, MB Zimmermann2, M Andersson2, A Eilander3, D Misquith4,
RF Hurrell2 and AV Kurpad1
1
Division of Nutrition, St John’s Research Institute, St John’s National Academy of Health Sciences, Bangalore, India; 2Human
Nutrition Laboratory, Institute of Food Science and Nutrition, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland;
3
Unilever Food and Health Research Institute, Vlaardingen, The Netherlands and 4Department of Community Health, St John’s
Medical College, St John’s National Academy of Health Sciences, Bangalore, India
Objective: Anemia is a serious public health problem in Indian school children. Since 2003, simple health intervention programs
such as antihelminthic treatment and vitamin A supplementation have been implemented in primary schools in the Bangalore
region, Karnataka, India. This study examines the prevalence of anemia in school children who are beneficiaries of this program.
Design: Cross-sectional survey.
Setting: Bangalore district, South India.
Subjects: A total of 2030 boys and girls, aged 5–15 years, attending schools in the Bangalore district.
Interventions: School-based, twice yearly intervention: deworming (albendazole 400 mg, single oral dose) and vitamin A
supplementation (200 000 IU, single oral dose).
Main outcome measures: Anemia prevalence based on measure of blood hemoglobin (Hb).
Results: Mean age and blood Hb concentration of all children were 9.572.6 years and 12.671.1 g/dl (range 5.6–16.7),
respectively. The overall anemia prevalence in this group was 13.6%. Anemia prevalence was lower in boys than girls (12.0%;
n ¼ 1037 vs 15.3%; n ¼ 993 respectively, Po0.05). There was no significant difference in anemia prevalence between children in
urban and rural locations (14.6 and 12.3%, respectively).
Conclusions: The current low anemia prevalence in Bangalore could be due to the impact of school-based intervention
programs that have been in place since 2003. The beneficial interactions of deworming and vitamin A supplementation could
have widespread implications for current preventive public health initiatives. There is now need for the development of clear
policy guidelines based on these simple and integrated interventions.
Sponsorship: This research was supported by the Micronutrient Initiative, Ottawa, Canada, and Unilever Food and Health
Research Institute, Vlaardingen, The Netherlands.
European Journal of Clinical Nutrition (2007) 61, 865–869; doi:10.1038/sj.ejcn.1602613; published online 24 January 2007
All children 2030 276 13.6 1037 124 12.0a 993 152 15.3
Urban children 1144 167 14.6 581 79 13.6b 563 88 15.6
Rural children 886 109 12.3 456 45 9.9 430 64 14.9
a
Significantly different from girls using a w2test (Po0.05).
b
Significantly different from rural boys using a w2test (Po0.05).
2.1% and 0.3% had mild, moderate and severe anemia, a Urban and Rural
respectively. Boys (n ¼ 1037) had a significantly lower 70
60
% Prevalence
anemia prevalence, 12.0% compared to girls, 15.3%
50
(n ¼ 993, Po0.05). The distribution of anemia prevalence 40
in all children across ages is presented in Figure 1. There is a 30
sharp decline in anemia prevalence from nearly 50% at 5 20
10
years of age to close to 10% between 7 and 11 years. This
0
trend was seen in both genders. Thereafter, anemia pre- 5 6 7 8 9 10 11 12 13 14 15
valence increased in both boys and girls. Age (yrs)
The agewise distribution of anemia prevalence separately All children All children urban All children rural
in urban and rural children, categorized by gender, is
presented in Figure 1. There was no significant difference b Urban
50
40
Discussion 30
20
Our findings indicate that the mean prevalence of anemia is 10
0
only 13.9% in school-age children in the Bangalore region, 5 6 7 8 9 10 11 12 13 14 15
Karnataka, South India. It is also worth noting that the Age (yrs)
prevalence was consistently low between the ages of 7 and All children Boys - rural Girls - rural
11 years in all sites studied. These data contrast sharply with
Figure 1 Percentage anemia prevalence stratified by location, age
reports of 3–4 times higher anemia prevalence in school age and gender in school age children. Panels a, b, c represent all
children from other parts of India (Gomber et al., 2003; children (urban and rural, n ¼ 2030), urban children (n ¼ 1144) and
Kumar et al., 2003; Sethi et al., 2003). For example, a survey rural children (n ¼ 886) respectively. No data were available for the
in the city of Gulbarga in northern Karnataka reported an following age/gender/location groups: (a), ages 12–15 (urban
children); (b), ages 12–15 (both genders); and (c), age 5 (boys)
anemia prevalence of 61% in this age group among girls and age 11 (girls).
(Kumar et al., 2003). This study was conducted before state
government health interventions such as antihelminthic
treatment and vitamin A supplementation, targeting school these integrated child health programs that have been in
children (personal communication from authors of Kumar place since 2003 (Akshara Dasoha, 2003). Specifically, these
et al. (2003). include the regular oral administration of albendazole
Therefore, a possible explanation for the current low (400 mg) and vitamin A of 200 000 IU twice yearly, as well
anemia prevalence in Bangalore could be the impact of as a free daily lunch. Indeed, the Akshara Dasoha scheme as