hshrc STATE HEALTH SYSTEMS RESOURCE CENTRE, HARYANA hshrc

Operational Research

Anaemia in Primary School Children of Haryana


Anaemia is a medical condition marked by a decrease in the total number of red blood cells or haemoglobin level or a lowered ability of the blood to carry oxygen, which could be due to blood loss, reduced RBC production or increased RBC breakdown. World Health Organization accounted anaemia as a global public health burden, affecting one-fourth of the world’s population, especially affecting the under 5 years (pre school-aged) children, 5-12 years (primary school-aged) children and women. In national context, National Family Health Survey-IV (2015-2016) reported that about 58.4% pre-school- aged children were anaemic. Burden of this disease was reported to be even more for Haryana with 71.7% of children as anaemic, indicating it to be one of the significant public health problems of this age group.

In light of this, HSHRC in collaboration with PGIMS, Rohtak, designed and conducted an interventional study, focussing primarily on the aetiology of anaemia (based on morphologic assessment of the red blood cells), haemoglobin concentration levels, anthropometric and nutritional assessment, followed by deficiency treatment regime interventions with an aim to develop programmed strategies for reducing the prevalence of anaemia among the primary government school children in the age range of 5-12 years. A representative sample of children was randomly selected from Government primary schools of Rohtak district. An equal sample was selected from boys and girl students.

Pre-Interventional Key Findings:

32% children in the age group 5-12 years were found to be anaemic with a mean haemoglobin level of primary school children in Haryana was 11.9g/dl. Morphologic assessment of red blood cells reflected that 60% of the anaemic were of Microcytic – Hypochromic type and 40% were of Normocytic – Normochromic type but no case of Macrocytic anaemia was found. It was also found that with increasing education level of the mother (from illiterate to post-graduation) anaemia prevalence rate displayed a declining trend.



Anthropometrical and Nutritional Assessment Findings:

Height and weight of each child was measured and Body Mass Index (BMI) was calculated which was compared with the WHO’s reference charts recommended for children of age group 2-20 years. The 24 hour recall method was used to record nutritional history and the usual pattern of consumption of common food items. One-third of the children were found to be underweight (their BMI was less than 5 th percentile of the standard WHO growth charts) while 1% children were fund to be overweight (BMI more than 85 th percentile of standards).

Dietary assessment displayed 60% of primary school children consumed food items from 4-5 designated food groups daily. Most common food group included carbohydrates consisting of whole grain seeds/wheat, starchy staples like potato, tuberous vegetables, oils and fats, milk and related products, pulses etc.



Post-Interventional Findings (Impact of Interventions):

After the interventions were carried out, prevalence of Anaemia reduced from 32% to 14% due to the effect of medicines administered under strict supervision. Morphologic assessment of red blood cells also showed a reverse picture with respect to baseline examination, with Normocytic-normochromic anaemia at 66% and microcytic- hypochromic anaemia at 34%.

Interventions influenced the severity of anaemia as well. Normal or non-anaemic cases increased from 68% to 86% while cases of mild anaemia reduced to approximately one- third and cases of moderate severity were reduced to half.



Conclusion:

This study indicated a high prevalence of anaemia among the primary school-aged children (5-12 years), and improved status upon implementation of appropriate intervention strategies. The findings of this study highlight the need for active interventions (both clinical and dietary) by the Health Departments to reduce the burden of anaemia on Indian populations.