The Indian Journal of Pediatrics

, Volume 86, Issue 6, pp 523–531 | Cite as

Prevention and Control of Anemia Amongst Children and Adolescents: Theory and Practice in India

  • Umesh Kapil
  • Radhika KapilEmail author
  • Aakriti Gupta
Review Article


Anemia is a major public health problem in India with prevalence of more than 50% amongst children and adolescents. The decline in the burden of anemia has been insignificant over the past 5 decades. The present review assesses the National Guidelines for Prevention and Control of Anemia in India, the current status of the program implementation and possible reasons for the continued high prevalence of anemia in the country.


Anemia Iron Folic acid Adolescents Children 


Authors’ Contribution

UK, RK and AG: Concept and design and preparation of the manuscript. UK is the guarantor for this article.

Compliance with Ethical Standards

Conflict of Interest



  1. 1.
    GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1789–858.Google Scholar
  2. 2.
    World Health Organization. The Global Prevalence of Anaemia in 2011. WHO Report; 2015.Google Scholar
  3. 3.
    Lozoff B, Jimenez E, Wolf AW. Long-term developmental outcome of infants with iron deficiency. N Engl J Med. 1991;325:687–94.CrossRefGoogle Scholar
  4. 4.
    Pollitt E. Iron Deficiency and Cognitive Function. Annu Rev Nutr. 1993;13:521–37.Google Scholar
  5. 5.
    National Institute of Nutrition; Indian Council of Medical Research. Community studies using common salt fortified with iron. Annual Report; 1978.Google Scholar
  6. 6.
    Rao KV, Radhaiah G, Raju SV. Association of growth status and the prevalence of anaemia in preschool children. Indian J Med Res. 1980;71:237–46.Google Scholar
  7. 7.
    Singla PN, Gupta HP, Ahuja C, Agarwal KN. Deficiency anaemias in preschool children-estimation of prevalence based on response to haematinic supplementation. J Trop Pediatr. 1982;28:77–80.CrossRefGoogle Scholar
  8. 8.
    National Institute of Nutrition; Indian Council of Medical Research. National Nutrition Monitoring Bureau: Prevalence of Micronutrient Deficiencies: NNMB Technical Report No. 22. 2003.Google Scholar
  9. 9.
    Government of India. Annual Health Survey: Clinical, Anthropometric and Bio-chemical (CAB) Survey; 2014.Google Scholar
  10. 10.
    Toteja GS, Singh P, Dhillon BS, et al. Prevalence of anemia among pregnant women and adolescent girls in 16 districts of India. Food Nutr Bull. 2006;27:311–5.CrossRefGoogle Scholar
  11. 11.
    Petry N, Olofin I, Hurrell RF, et al. The proportion of anemia associated with iron deficiency in low, medium, and high human development index countries: a systematic analysis of national surveys. Nutrients. 2016;8:693.CrossRefGoogle Scholar
  12. 12.
    Nelson M, Bakaliou F, Trivedi A. Iron-deficiency anaemia and physical performance in adolescent girls from different ethnic backgrounds. Br J Nutr. 1994;72:427–33.CrossRefGoogle Scholar
  13. 13.
    Spear BA. Adolescent growth and development. J Am Diet Assoc. 2002;102:S23–9.CrossRefGoogle Scholar
  14. 14.
    Beard JL. Iron requirements in adolescent females. J Nutr. 2000;130:440S–2.CrossRefGoogle Scholar
  15. 15.
    World Health Organization. Adolescent nutrition: a review of the situation in selected south-east Asian countries. New Delhi: Reg Off South-East Asia; 2006. p. 1–96.Google Scholar
  16. 16.
    Li R, Chen X, Yan H, Deurenberg P, Garby L, Hautvast JG. Functional consequences of iron supplementation in iron-deficient female cotton mill workers in Beijing, China. Am J Clin Nutr. 1994;59:908–13.CrossRefGoogle Scholar
  17. 17.
    Yehuda S, Rabinovitz S, Carasso RL, Mostofsky DI. The effects of brain iron deficiency on cognitive and behavioral aspects. In: Yehuda S, Mostofsky DI, editors. Iron Deficiency and Overload. Totowa: Humana Press; 2009. p. 195–206.CrossRefGoogle Scholar
  18. 18.
    Ramakrishnan U. Nutritional Anemias. USA: CRC Press; 2001.Google Scholar
  19. 19.
    Seshadri S, Gopaldas T. Impact of iron supplementation on cognitive functions in preschool and school-aged children: the Indian experience. Am J Clin Nutr. 1989;50:675–84,85–6.Google Scholar
  20. 20.
    Soemantri AG, Pollitt E, Kim I. Iron deficiency anemia and educational achievement. Am J Clin Nutr. 1985;42:1221–8.CrossRefGoogle Scholar
  21. 21.
    Pollitt E, Hathirat P, Kotchabhakdi NJ, Missell L, Valyasevi A. Iron deficiency and educational achievement in Thailand. Am J Clin Nutr. 1989;50:687–96,96–7.Google Scholar
  22. 22.
    Soekarjo DD, de Pee S, Kusin JA, Bloem MW. School-based supplementation: lessons learned in Indonesia. SCN News. UK: United Nations System; 2006. p. 14–8.Google Scholar
  23. 23.
    More S, Shivkumar VB, Gangane N, Shende S. Effects of iron deficiency on cognitive function in school going adolescent females in rural area of central India. Anemia. 2013;2013:819136.CrossRefGoogle Scholar
  24. 24.
    Halterman JS, Kaczorowski JM, Aligne CA, Auinger P, Szilagyi PG. Iron deficiency and cognitive achievement among school-aged children and adolescents in the United States. Pediatrics. 2001;107:1381–6.CrossRefGoogle Scholar
  25. 25.
    UNICEF/UNU/WHO. Iron deficiency anaemia assessment, prevention, and control: a guide for programme managers. 2001. Available at: Accessed 1 Jan 2019.
  26. 26.
    Ministry of Health and Family Welfare. Guidelines for Control of Iron Deficiency Anaemia. National Iron Plus Initiative; 2013.Google Scholar
  27. 27.
    Ministry of Health and Family Welfare. Anemia Mukt Bharat: Intensified National Iron Plus Initiative; 2018. Available at: Accessed 1 Jan 2019.
  28. 28.
    Gera T, Sachdev HPS, Nestel P, Sachdev SS. Effect of iron supplementation on haemoglobin response in children: systematic review of randomised controlled trials. J Pediatr Gastroenterol Nutr. 2007;44:468–86.CrossRefGoogle Scholar
  29. 29.
    National Institute of Nutrition. Nutrient Requirements and Recommended Dietary Allowances for Indians. Indian Council of Medical Research; 2010.Google Scholar
  30. 30.
    Watanabe K, Petri WA. Environmental enteropathy: elusive but significant subclinical abnormalities in developing countries. EBioMedicine. 2016;10:25–32.CrossRefGoogle Scholar
  31. 31.
    Ngure FM, Reid BM, Humphrey JH, Mbuya MN, Pelto G, Stoltzfus RJ. Water, sanitation, and hygiene (WASH), environmental enteropathy, nutrition, and early child development: making the links. Ann N Y Acad Sci. 2014;1308:118–28.CrossRefGoogle Scholar
  32. 32.
    Coffey D. Working Paper: Sanitation Externalities, Disease, and Children’s Anemia. 2014. Available at: Accessed 1 Jan 2019.
  33. 33.
    Coffey D, Spears D, Vyas S. Switching to sanitation: understanding latrine adoption in a representative panel of rural Indian households. Soc Sci Med. 2017;188:41–50.CrossRefGoogle Scholar
  34. 34.
    Coffey D, Spears D. Implications of WASH benefits trials for water and sanitation. Lancet Glob Health. 2018;6:e615.CrossRefGoogle Scholar
  35. 35.
    Coffey D, Geruso M, Spears D. Sanitation, disease externalities and anaemia: evidence from Nepal. Econ J. 2018;128:1395–432.CrossRefGoogle Scholar
  36. 36.
    National Health Mission. Government of India. Accredited Social Health Activist (ASHA) [Internet]. Available at: Accessed 18 Feb 2019.
  37. 37.
    Varghese JS, Swaminathan S, Kurpad AV, Thomas T. Demand and supply factors of iron-folic acid supplementation and its association with anaemia in north Indian pregnant women. PLoS One. 2019;14:e0210634.CrossRefGoogle Scholar
  38. 38.
    Wendt AS, Stephenson R, Young MF, et al. Identifying bottlenecks in the iron and folic acid supply chain in Bihar, India: a mixed-methods study. BMC Health Serv Res. 2018;18:281 p. 1–12.CrossRefGoogle Scholar
  39. 39.
    Baird IM, Walters RL, Sutton DR. Absorption of slow-release iron and effects of ascorbic acid in normal subjects and after partial gastrectomy. Br Med J. 1974;4:505–8.CrossRefGoogle Scholar
  40. 40.
    Rudinskas L, Paton TW, Walker SE, Dotten DA, Cowan DH. Poor clinical response to enteric-coated iron preparations. CMAJ. 1989;141:565–6.Google Scholar
  41. 41.
    Jacobs A, Rhodes J, Peters DK, Campbell H, Eakins JD. Gastric acidity and iron absorption. Br J Haematol. 1966;12:728–36.CrossRefGoogle Scholar
  42. 42.
    Jacobs A, Miles PM. Role of gastric secretion in iron absorption. Gut. 1969;10:226–9.CrossRefGoogle Scholar
  43. 43.
    Sachdev HPS, Kurpad A, Saxena R, Kapil U. National expert group technical consultation on prevention and treatment of iron deficiency anemia. Indian J Comm Health. 2018;30:1–11.Google Scholar
  44. 44.
    Singh HS, Roychowdhury S, Verma P, Bhandari V. A review on recent advances of enteric coating. IOSR J Pharm. 2012;2:5–11.Google Scholar
  45. 45.
    World Health Organization. Guideline: Daily Iron Supplementation in Adult Women and Adolescent Girls; 2016. Available at: Accessed 1 Jan 2019.
  46. 46.
    Hota P. National rural health mission. Indian J Pediatr. 2006;73:193–5.CrossRefGoogle Scholar
  47. 47.
    Low MS, Speedy J, Styles CE, De-Regil LM, Pasricha SR. Daily iron supplementation for improving anaemia, iron status and health in menstruating women (review). Cochrane Database Syst Rev. 2016;4:CD009747.Google Scholar
  48. 48.
    Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. Cochrane Collab. John Wiley & Sons, Ltd; 2011. Available at: Accessed 1 Jan 2019.
  49. 49.
    Liberato SC, Singh G, Mulholland K. Zinc supplementation in young children: a review of the literature focusing on diarrhoea prevention and treatment. Clin Nutr. 2015;34:181–8.CrossRefGoogle Scholar
  50. 50.
    Lazzerini M, Wanzira H. Oral zinc for treating diarrhoea in children. Cochrane Database Syst Rev. 2016;12:CD005436.Google Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2019

Authors and Affiliations

  1. 1.Human Nutrition UnitAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.Department of PathologyJawaharlal Nehru Medical CollegeBelgaumIndia

Personalised recommendations