|Year : 2007 | Volume
| Issue : 1 | Page : 43-45
Childhood anemia - A study in tribal area of Mohana block in Orissa
T Sahu, NC Sahani, L Patnaik
Deptt. of Community Medicine, M.K.C.G. Medical College, Brahmapur , Orissa, India
|Date of Web Publication||6-Aug-2009|
Deptt. of Community Medicine, M.K.C.G. Medical College, Brahmapur , Orissa
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background : Anemia is widely prevalent in India and affects both sexes and all age group. Although the National Anemia Prophylaxis Programme (NAPP) has been set up in all states of the country since 1970, the benefits have not yet been appreciated in the target population.
Objective : 1. To assess the prevalence of anemia and its severity in tribal children. 2. To find out age & sex wise distribution of Hb level in these children. 3. To explore different underlying factors of development of anemia.
Methods : The present study is a cross sectional study conducted in tribal villages of Mohana block in Gajapati district of Orissa. A total of 599 tribal children in the age group 6 month - 14 years were recruited from August 2004 to February 2005. The study variables included age, sex, Hb level, food consumption and clinicoepidemiological factors which were analysed by simple proportion and Z test.
Results : About 94% of under five children were found to be anemic and 8.8% of them were severely anemic. Almost all children of age group 5-14 years were anemic, amongst them 59.4% were moderately anemic and 5. 4% were severely anemic. There is no significant difference in mean Hb level between male and female in both the age groups. It was significantly more in the age group of 5-14 years. About 94% were taking food of low iron bioavailability. Pallor was found in 33.6% and H/O irregular fever in 28.7% of children. 26.9% children had splenomegaly. Only 2.3% children had taken IFA supplementation in last one year.
Conclusions : Anemia is a major health problem in tribal children. Reorientation of primary health care functionaries to cover the children under NNAPP with the help of ICDS workers and school authorities.
Keywords: Anemia in Children, Hb Level, Bioavailability of Iron
|How to cite this article:|
Sahu T, Sahani N C, Patnaik L. Childhood anemia - A study in tribal area of Mohana block in Orissa. Indian J Community Med 2007;32:43-5
|How to cite this URL:|
Sahu T, Sahani N C, Patnaik L. Childhood anemia - A study in tribal area of Mohana block in Orissa. Indian J Community Med [serial online] 2007 [cited 2019 Jun 26];32:43-5. Available from: http://www.ijcm.org.in/text.asp?2007/32/1/43/53398
Anemia is widely prevalent in India and affects both sexes and all age group.  It is a major public health problem in developing countries especially in preschool children and during pregnancy.  The National Family Health Survey-II conducted in 1998-99, documented that about 74% children between the ages 6-35 months were anemic.  Evidence indicates that iron deficiency anemia is associated with impaired performance on a range of mental and physical factors in children including physical coordination and capacity, mental development, cognitive abilities and social and emotional development. 
Although the National Anemia Prophylaxis Programme (NAPP) has been set up in all states of the country since 1970, the benefits have not yet been appreciated in the target population due to constraints like lack of operational feasibility to estimate the hemoglobin level, orientation of field workers and acceptance of the programme by the beneficiaries. Therefore coverage of children under this programme is still poor and more marked in difficult tribal areas where the nutritional anemia remains as a major health problem due to nutritional deficiency, repeated infection and high prevalence of sickle cell anemia. Most physical examinations include clinical assessment of anemia in patients that form the tip of iceberg. But the "true state" can be assessed by verification of Hemoglobin concentration in blood  and this should be done in a community setting.
An attempt was made to estimate the problem of anemia in tribal children with following objectives: (i) To assess the prevalence of anemia in tribal children. (ii) To assess the severity of anemia. (iii) To find out the age and sex wise distribution of anemia in children. (iv) To explore the different underlying factors for development of anemia.
| Material and Methods|| |
The cross sectional study was carried out in six randomly selected tribal villages of Mohana block in Gajapati district during Aug. 2004 to Feb. 2005. The study subjects included 599 children of age 6 month-14 years in these villages, who attended the health camp voluntarily. After thorough clinical examination, their hemoglobin level was estimated by Sahali's acid haematin method as part of other laboratory examinations & degree of anemia was decided based on Hb level for the age group.  Data on recent morbidities and type of food they consumed and iron and folic acid supplementation (Showing the IFA tablets) during last one year were collected from parents by oral questionnaire & analyzed in the Department of Community Medicine, M.K.C.G. Medical College, Brahmapur, Orissa.
| Results|| |
Out of 599 study subjects, 53.9% male children & 46.1% female children, 243 were on age group of 6 month-5 years (47.7% males & 52.3% females) and 356 were in age group of 5-14 years (58% males & 42% females).
[Table 1] shows about 94% of under five children were found to be anemic. 8.8% of them were severely anemic. Severity was found proportionately more in male children than females, but the difference was not significant (p>0.05)
[Table 2] shows that almost all children (99%) were found to be anemic. More than 60% of them had moderate to severe anemia.
Mean Hb level in under five children was found to be 8.62 gm/dl (±1.29) which was 9.07 gm/dl (±1.24) in children of 5-14 year age group.
This difference in mean Hb level between two age groups was found significant (P < 0.01). The difference in mean Hb level between male & female children in each age group was not significant. [Table 3] With a low bioavailability diet, children will not be able to meet their iron requirement. The bioavailability of iron in the diet was decided according to the predominant type of food consumed (WHO)  .
According to [Table 4], 93.7% children were taking food of low iron bioavailability (5-10%) and 6.3% children taking food of intermediate bioavailability (11-18%) for iron and nobody was taking food of high iron bioavailability (>19%).
[Table 5] reveals that about 34% of children were having positive pallor sign (29.6% of 6m.-5 yrs. and 36.2% of 5-14 years). The 28.7% of children gave the H/O irregular fever during last 15 days (17.7% of children of 6m. - 5yrs. age and 36.2% of 5-14 yrs). Splenomegaly was found in 26.9% of children.
Only 3.9% of 5-14 yr. children had taken IFA supplementation during last year and none of under fives had taken IFA during last one year.
| Discussion|| |
It was observed that among the study population, 53.9% were male children and 46.1% were female children.
About 93.8% of under five children were found to be anemic; of them 42.1% had mild anemia, 49.1% had moderate anemia and 8.8% had severe anemia. Schellenberg D. et al found anemia in 87% Tanzanian under five children, 37% of them had moderate and 3% had severe anemia. 
Almost all children (99%) of age group 5- 14 years were anemic. 64.8% of 5-14 years children were having moderate to severe anemia and rest of them were also anemic according to their Hb level. Verma M. et al in their study on urban school children of age group 5-15 years in Punjab found prevalence of anemia was 51.5%.  In contrast to higher mean Hb concentration in anemia, severe form of anemia were prevalent in this age group as compared to under fives. Verma A. et al, in their study on adolescent girls found mild, moderate, severe anemia to be 36.6%, 22.4%, 4.8% respectively.  The causes may be associated with hookworm infestation, malaria and menstrual blood loss in girls.
On analysis of food consumed by tribal children, it was found that about 93.7% children were taking food in which bioavailability of iron was low i.e. 5-10% This may be due to poverty, ignorance etc.
It was observed that about 34% of children were having positive pallor sign of which 29.6% were 6m.-5 yrs. and 36.2% were of 5-14 years. Positive pallor sign could be less sensitive to detect anemia in children as the clinical methods like palmar pallor & pallor in lower palpebral conjunctiva are not standardized and subject to observer variation. In the study by Verma M. et al found clinical pallor in 44% of total children while 51.5% were anemic.  High proportion (28.7%) of irregular fever and splenomegaly (26.9%) was suggestive of malaria in these children contributing towards anemia in tribal area. Only 3.9% of 5-14 yr. children had taken IFA tablets during last year. None of the under fives received IFA within one year which shows poor coverage of children in NNAPP through primary health care.
Anemia is a major health problem in tribal children. Proportion of children with moderate to severe anemia was quite high. Malaria and splenomegaly add to the problem and increase the severity. Poor coverage of IFA prophylaxis in children is a matter of concern. Reorientation of primary health care functionaries to cover the children under NNAPP with the help of ICDS workers and school authorities and early presumptive antimalarial prophylaxis in all fever cases can prevent anemia in tribal children.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]