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S
pecial Articles from the Proceedings of Indo-UK Symposium on "Hot Topics in Pediatrics"
held on February 1 and 2, 2003 at New Delhi

Indian Pediatrics 2003; 40:477-479 

Micronutrient Profile of Indian Children and Women: Summary of Available Data for Iron and Vitamin A


Padam Singh
G.S. Toteja

Correspondence to: Dr. Padam Singh, Indian Council of Medical Research, Ansari Nagar, New Delhi 110 029, India.

Considerable research has been conducted in the country on three micronutrients, namely, iron, vitamin A and iodine. Other micronutrients such as zinc, vitamin C and folic acid have also attracted the attention of researchers. There is a need to compile available information on micronutrients for use and ready reference. It is also important to undertake analysis of trend and regional variation with respect to these micronutrients. Further, it is worthwhile identifying the gaps in knowledge and thrust areas for further research. The compilation on ‘Micronutrient Profile of Indian Population’ is an attempt in this direction(1). The reference period for this compilation was from 1950 till date. The objectives of the compilation were: (i) To prepare a scientific document on the micronutrient profile of Indian population based on a thorough review and analysis of both published and unpublished data. The aspects covered include dietary intake of micronutrients as well as their clinical and sub-clinical profiles in children, adolescent girls and pregnant women; and (ii) To update analysis of levels, trend with implications for public health programs and identify gaps in knowledge for future research.

Methodology

Information about prevalence of clinical and sub-clinical deficiences and dietary intake of micronutrients from 1950 to date was collected from major studies conducted in the last five decades as well as individual research papers published in various national and international journals. Information was also collected through Internet search, cross references, and scrutiny of M.Sc., M.D. and Ph.D. theses, and through visits to important institutes and organizations engaged in research in the field of micronutrients.

To start with, all published research papers as well as scientific reports were summarized under a uniform format, giving information on important findings for each study in addition to type of study, place of study, sample size, assessment indicators, etc. Details of major studies and summary of M.Sc. Ph.D. and M.D. theses are also provided, in the compilation.

Based on the published research papers and reports, data have been presented for each micronutrient at regional level, state level, and district level separately for infants, children of different age groups, adolescent girls, and pregnant and lactating women; and again separately for clinical, sub-clinical/biochemical parameters and intake levels. Current status, regional variations, and trends during the last 50 years are discussed. A mapping of the country regarding prevalence and dietary intake levels of micronutrients has also been attempted.

Key Findings

This effort identified 13 major studies on the subject, providing information at national/regional level, which are mainly multicentric and community based. About 600 published research papers from national and international journals were found having information on prevalence of micronutrient-deficiences and dietary intakes. The number of research studies on Iron, Vitamin A and Iodine were 256, 219 and 87, respectively. The research studies on Vitamin C and Zinc were 40 each. Only 15 studies were detected for folic acid. As many as 567 research studies were on children, 165 on pregnant and lactating women, but only 62 on adolescent girls. During 1991-2002, 334 research studies were published. In the earlier years, there were far fewer studies; 21 during 1950-60 and 80 during 1961-70. Of these, community based studies accounted for 41%, hospital based for 28%, school based 21%, and others fewer than 10%.

The salient findings based on these for two important micronutrients, namely, Iron and Vitamin A are summarized below.

Iron Deficiency Anemia

Infants and Children

All India level data available from National Family Health Survey (NFHS-2) (1998-99) for children in the age group 6 months to 35 months indicated an overall prevalence of anemia of 74.3%. The prevalence of anemia was generally the highest in the northern and eastern regions and the lowest in the southern region. The anemia level was the highest among children in the age group 12-23 months (77.7%) as compared to children in the age group 6-11 months (71.7%) and 24-35 months (72%).

An analysis of community based work published from 1950 to mid 2002 indicated a high prevalence of anemia among infants (80%) and in 1 to 2 year old children (78%). The prevalence was 74% among 2-3 years old children. The mean hemoglobin level was low (9.0 g/dL) in both infants and children aged up to three years of age, increasing to only 10.0 g/dL by the age of 6 years.

Only a few studies are available previous to 1970 (mainly in the southern and northern regions). For this early period, anemia among children under 6 years was 77%. The level showed a decline to 72% during 1971-90 and remained at around 70% for the period 1991 onwards.

Adolescent Girls

There are a limited number of studies on adolescent girls. The data collected for NFHS-2 for married women in the age up to 20 years and without any child has been used as a proxy for adolescent girls. Anemia among this group was about 52%. The other major and individual community based studies (1991 onwards) indicated an overall prevalence of 88.6%. The highest prevalence was generally in the eastern and northern regions.

Because of the dearth of studies previous to 1991 in particular, analysis of a trend over time is not possible for adolescent girls or any proxy for this group.

Pregnant and Lactating Women: The Indian Council of Medical Research (ICMR) multicentre study (District Nutrition Project, 2001) shows overall prevalence of anemia among pregnant women at about 85% and over 60% throughout the regions. Major and individual community based studies (besides NFHS-2) indicated the highest prevalence of anemia is in the eastern region (88%) and the lowest (57%) in the southern region. According to the NFHS-2 the overall prevalence of anemia among pregnant women was 49.7%, with the highest prevalence (52.7%) in the eastern region and the lowest in the southern region (46.0%).

Regarding changeover time, considering community based studies (excluding NFHS-2 data), anemia prevalence among this group was 80.7% during 1950-90 and 83.6% during the period 1991 onwards.

Dietary Intake in Various Populations: Two major studies about dietary intake of iron were analyzed, particularaly with regard to rural population. Information from the National Nutrition Monitoring Bureau (NNMB) of ICMR indicates that the average intake of iron is only about 50% of RDA. The India Nutrition Profile (1995-97) provides dietary intakes of iron for 182 districts in 14 states. None of the districts had iron intake equal to RDA (28 mg/cu/day) as per revised values. Only 6% were meeting 75% of RDA, 47% were meeting 50% of RDA, and the rest (85 districts) did not meet 50% of RDA.

Iron intake is much lower for children, adolescent girls, and pregnant women. According to NNMB data, intake of iron was 44.2% and 45.0% of RDA for 1-3 and 4-6 years old children, respectively. For pregnant and lactating women the intake was 36.8% and 48.7% of RDA respectively.

Vitamin A Deficiency

Children: No data are available at all-India level for mapping the country on the basis of clinical vitamin A deficiency. However, for 11 states information is available through NNMB and India Nutrition Profile reports.

There are studies at district level (69 districts from 28 states) covering one or more districts per state during last six years and out of these 69 districts, 44 districts showed prevalence of Bitot’s spot greater than 0.5%.

The prevalence of Bitot’s spots (based on NNMB pooled data of seven states) was 1.8, 0.7 and 0.7 respectively, during the surveys carried out in 1975-79, 1988-90 and 1996-87. Individual studies carried out between 1950 to date revealed that the prevalence of vitamin A deficiency was 4% during the period up to 1980.

Adolescent Girls: There are a couple of studies on adolescents done in south India, which indicate vitamin A deficiency as 0.8% to 1%.

Pregnant Women: On the basis of NFHS-2, DNP of ICMR and micronutrient study conducted by Ministry of Health and Family Welfare, the prevalence of migh blindness of the magnitude of two-digit level is seen in some parts of the country.

Sub-clinical Vitamin A Deficiency: Screening of individual research papers with information on serum retinol levels among children indicated lack of information on the subject.

Intake of Dietary Vitamin A: The average intake of vitamin A is less than 50% of RDA in most parts of the country.

Key Messages

Prevalence of anemia is high in children, adolescent girls and pregnant women in India.

Magnitude of clinical vitamin A deficiency has declined significantly in India.

 

 References


1. Toteja GS, Singh P. Micronutrient Profile of Indian Population 2003 (in press).

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