M. Verma, J. Chhatwal and Gurmeet Kaur

From the Department of Pediatrics, Christian Medical College, Ludhiana 141 008, India.

Reprint requests: Dr. M. Verma, Professor and Head, Department of Pediatrics, Christian
Medical College, Ludhiana 141 008, India.

Manuscript received: March 31, 1997; Initial review completed: May 13, 1997;
Revision accepted: July 30, 1998.

 

Abstract:

Objective: To assess the prevalence of anemia among urban school children of Punjab. Design: Cross sectional study. Setting: Urban schools of Ludhiana, Punjab. Subjects: Two thousand school children of 5-15 years age. Methods: Relevant history was taken and a complete physical examination done in all the children. Hemoglobin was estimated using cymnethemoglobin method and peripheral blood smears were also examined. Anemia was diagnosed when hemoglobin was less than 11 g/dl for children of 5-6 years age and 12 g/dl for more than 6 years age. Results: Overall prevalence of anemia was 51.5%. Girls had a significantly higher prevalence of anemia except at 5 years and 10-12 years age. More menarcheal girls were anemic as compared to non-menardzeal ones. The prevalence of atzemia was high (38%) even in higher socioeconomic groups. Nearly half (47.6%) of well nourished children were anemic. The mean Hb also was lower than expected normal values in both nutritional groups. Compared to non-vegetarians (38%), more vegetarians (65.9%) were anemic. The commonest blood picture seen was microcytic hypochromic (55.4%). Conclusions: The present study revealed a high prevalence of anemia among healthy urban school children of higher socio- economic classes. Vegetarians and girls, especially after menarche were more at risk to develop anemia.

Key words: Anemia, Children, Iron deficiency, Prevalence.

ANEMIA in children, especially iron deficiency, is the commonest health problem in many developing countries with an estimated prevalence of 43%(1). There is convincing evidence that iron deficiency causes impaired growth, developmental delay, behavioral abnormalities and impairs cognitive function and school performance. It has also been associated with functional abnormalities of lymphocytes and neutrophils(1-3). Although school children constitute 25% of the total population in India, few studies have been done to evaluate their hematological profile. These studies have shown a wide range for prevalence of anemia (0.5-94%) as the methodology as well as criteria for diagnosing anemia have been variable(2,4-9). Also most of the studies have focussed on the children belonging to lower socio-economic status.

Punjab is an economically advanced and physically robust state of our country. The industrial city of Ludhiana is a good representative of this state. There have been no recent reports from this part on the health status of children. The present study was carried out to assess the prevalence of anemia among the urban school children of the city of Ludhiana.

Subjects and Methods

The study was conducted on two thou- sand children aged 5-15 years studying in the schools of urban Ludhiana. The schools were selected randomly to include government, private and mission run schools and thus comprised of different socio-economic groups. Data regarding socio-economic status was obtained through a proforma given to the students to be completed by their parents/ guardians. The proforma also included information on the known medical problems of the child if any, age of menarche and dietary practices. Children consuming meat products were considered as non-vegetarian and the rest were taken as vegetarians. Modified Kuppuswamy socio-economic scale (urban) was used for classification into various socio-economic groups(10).

All children were weighed and taken as under nourished if their weight was less than 3rd centile NCHS standards. The children were examined for pallor as seen from palpebral conjunctiva, lips, tongue, skin and nail beds. In addition a complete clinical examination was also done. Blood was drawn by venepuncture in EDT A vials. Hemoglobin (Hb) estimation was done using cynmethemoglobin method(11). Twenty micro litre of anticoagulated blood was added to 5 ml of freshly made stan- dardized Drabkin's solution in a vial. This was inverted several times to mix the solution. It was allowed to stand for 10 minutes. The solution was read in spectro-photometer at 540 nm and values were compared with a standard table. All observations were made by a single person to prevent inter-observer bias. Anemia was diagnosed when hemoglobin was less than 11 g/dl for children below 6 years and less than 12 g/dl for more than 6 years of age (WHO standard)(1). Peripheral blood film was prepared and stained (Leishman's stain) by the standard technique. The RBC morphology was studied to know the type of anemia. Statistical analysis was done using Chi-square test.

Results

Out of two thousand school children studied, 51.5% were found to be anemic. The prevalence of anemia was inversely proportional to age, 77% children below and 34.3% above 11 years had anemia. The mean Hb according to age in both sexes is shown in Table I. A significantly higher number (p <0.01) of girls were anemic at all ages except at 5 years and at 10-12 years of age (Fig. 1). A higher (36.4%) proportion of menarcheal girls had anemia.

Fig. 1 Prevalence of Anemia in Relation to age

At almost all ages significantly (p <0.001) more (65.9%) vegetarian children were anemic. As seen from Table II, the mean Hb showed a rising trend with improved socio-economic status. Most of the children belonging to lower socio-economic groups were anemic. The striking finding was that 38% of children of upper and upper middle class had anemia. The prevalence of anaemia was high (71.5%) in the unden:lOurished children but among well nourished group also nearly half (47.6%) were anemic. Even the mean Hb of both these groups was lower than the WHO standards for the age.

Clinical pallor could be detected in 44% of total children while 51.5% were anemic as per hemoglobin estimation. The commonest blood picture was microcytic hypochromic seen in 55.4% followed by normocytic, normochronic in 37.5% and dimorphic picture in 1.7% only. Microcytic hypochromic anemia was noted to be more in younger age groups.