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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 3  |  Page : 137-141

Prevalence and severity of anemia among children and adolescent individuals of the age group of 0–18 years old


1 Department Social and Preventive Medicine, Institution Malla Reddy Institute of Medical Sciences, Hyderabad, Telangana, India
2 Department Social and Preventive Medicine, Institution Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, Telangana, India

Date of Submission04-Apr-2021
Date of Decision10-Apr-2021
Date of Acceptance03-Jun-2021
Date of Web Publication25-Sep-2021

Correspondence Address:
Dr. Bhrugun Anisetti
Department Social and Preventive Medicine, Institution Malla Reddy Institute of Medical Sciences, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjhs.mjhs_25_21

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  Abstract 


Background: Since anemia is the most prevalent disorder in India, it got the significance to be studied and understood about. It is necessary to make people aware of the causes in certain age groups and genders, the preventive measures, and the importance of nutritional supplements, proper diet required to prevent anemia.
Objective: The objective of this study is to study the prevalence and severity of anemia among children and adolescent individuals of the age group of 0–18 year old.
Materials and Methods: A cross-sectional survey was conducted from October 2020 to March 2021 (6 months) using the data of 267 children and adolescent individuals (0–18 years old) visiting the laboratory for complete blood count (CBC) investigation in the Hematology Department of Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, Telangana, India. The type and severity of anemia were assessed based on red cell indices and hemoglobin (HGB) levels, respectively.
Results: Most common red blood cell (RBC) morphology was microcytic hypochromic (109) and least being macrocytic morphology. The average age was the highest for microcytic hypochromic. Average HGB was the highest in normocytic normochromic (9.68 g%). Majority were in the age group of 10–18 years. There were 126 male participants and 141 female participants. Average Hb in males was around 8.49 g%; common RBC morphology was microcytic hypochromic. Out of the 267 participants, 37 were nonanemic, 70 mild, 50 moderate, 55 severe, and 55 life-threatening anemias. Moreover, the average ages being 9.31, 8.78, 9.51, 10.67, and 13.6 years, respectively.
Conclusion: The female predominance of anemia between the ages of 10–18 could be attributed to initiation of menstrual cycles and microcytic hypochromic smears could be related to chronic iron deficient diet.

Keywords: Adolescent, anemia, children, prevalence


How to cite this article:
Anisetti B, Komuravelli M. Prevalence and severity of anemia among children and adolescent individuals of the age group of 0–18 years old. MRIMS J Health Sci 2021;9:137-41

How to cite this URL:
Anisetti B, Komuravelli M. Prevalence and severity of anemia among children and adolescent individuals of the age group of 0–18 years old. MRIMS J Health Sci [serial online] 2021 [cited 2021 Oct 25];9:137-41. Available from: http://www.mrimsjournal.com/text.asp?2021/9/3/137/326732




  Introduction Top


Globally, anemia affects more than 2 billion people accounting for over a quarter of the world population.[1],[2] The highest prevalence of anemia exists in the developing world where its causes are multi-factorial. Anemia is responsible for significant morbidity and mortality, particularly in less developed countries. Anemia causes many complications and has been related to reduce work capacity, reduced ability to execute activities of daily living, reduced cognitive function, and fatigue among others.[3],[4] Adolescence has been defined by the World Health Organization as the period of life spanning the ages between 10 and 19 years.[5] In a family with limited resources, there is early inclusion of mother into work which leads to the lack of proper nourishment of the child. The female child is more likely to be neglected. She is deprived of good food and education and is utilized as an extraworking hand to carry out the household chores. The added burden of menstrual blood loss, normal or abnormal, precipitates the crises too often, whereas for the male child, growth spurt and early inclusion into labor activities can precipitate this condition.

The present study was carried out to study the prevalence and severity of anemia among children and adolescent individuals of the age group of 0–18 years old.


  Materials and Methods Top


A cross-sectional survey was conducted in the Hematology Department of Chalmeda Rao Institute of Medical Sciences, Karimnagar, Telangana, India. A total of 267 anemic children and adolescent individuals (0–18 year old) were selected from patients visiting the laboratory for complete blood count (CBC) investigation. The type and severity of anemia were assessed based on red cell indices and hemoglobin (HGB) levels, respectively. The study took place from October 2020 to March 2021 (6 months). The RBC morphology was assessed by a peripheral smear. All the procedures were performed following standard operating procedures and protocol for hematology analyzer.

Procedure

Experienced laboratory personnel collected 5 ml of blood sample for CBC. Anemic patients based on HGB result were selected for the further analysis of the CBC values. The CBC reports were registered (HGB, hematocrit, mean cell volume [MCV], mean cell HGB (MCH), MCH concentration, red cell distribution width (RDW), red blood cell count (RBC count), white blood cell count, platelet, and differential leukocyte count) for each patient. The first step in approaching anemia is to classify the process as microcytic (MCV, <80 fl), normocytic (MCV, 80–100 fl), or macrocytic (MCV, >100 fl), which this exercise markedly narrows the differential diagnosis that needs to be considered in each patient.[6],[7],[8] For typing of anemia, a thin blood smear was prepared on a prenumbered clean glass slide and allowed to dry. Smears were stained with Leishman's stain and examined under the high power of the microscope. An expert opinion of a pathologist was sought while examining the slides. The next day, the results of the hematological investigations were conveyed to the subjects and those found to have anemia were given appropriate treatment and advice regarding proper diet.

Criteria for anemia

Anemia was defined in accordance with the World Health Organization (WHO) criteria as a HGB concentration less than 12.0 g/dl in women and <13.0 g/dl in men.[9] Women who had HGB value between 11 and 12 g/dl, 8–11 g/dl, and <8 g/dl were categorized as having mild, moderate, and severe anemia, respectively. For men anemia <13.0 g/dl, mild 11–12 g/dl, moderate 8–11 g/dl, and severe <8 g/dl was considered to classify the severity of anemia in this study.[10],[11],[12]

Definition and grading of anemia

The following WHO definition of anemia was used to estimate the prevalence of anemia in male and female subgroups:[13],[14]

However, for correlation and stratification of the degree of severity of anemia with immunological progression of the disease (CD4 cell counts), the following system of grading of severity of anemia given by WHO has been used.

Grade Hb values:

  • 0 or “non-anemic” (≥11 g/dl)
  • 1 or “mild anemia” (9.5–10.9 g/dl)
  • 2 or “moderate anemia” (8–9.4 g/dl).
  • 3 or “severe anemia” (6.5–7.9 g/dl)
  • 4 or “life-threatening anemia” (<6.5 g/dl).



  Results Top


The 267 subject's CBC reports were studied, and their age, sex, RBC morphologies, and HGB level (gm %) were noted.

Red blood cell morphology

It was found that the most common RBC morphology in our study was microcytic hypochromic and least being macrocytic morphology. Out of 267 participants, 62 had dimorphic, 10 had macrocytic, 109 had microcytic hypochromic, and 86 had normocytic normochromic.

In [Table 2], we can notice the average age is highest for microcytic hypochromic being 10.69 years and least for normocytic normochromic being 9.97 years. The average HGB being highest in normocytic normochromic with 9.68 g% and the least being in microcytic hypochromic being 7.36 g%.
Table 1: Criteria for Anemia

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Table 2: Distribution of study participants as per red blood cell morphology

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Age groups

The participants were divided into three age groups, i.e. 0–1 (neonates), 2–9 (children), and 10–18 (Adolescents). Most of the cases were in the age group of 10–18 being 151 out of these 61 were male and 90 were female, the average Hb. Levels were 7.88 g% and most common RBC morphology being microcytic hypochromic.

Between the age group of 2–9 years, there were 78 participants out these 46 were male and 32 were female. The average Hb level was 8.82 g% and most common RBC morphology being microcytic hypochromic. Moreover, between the age group of 0–1, there were 38 participants, of which 19 were male and 19 were female. The average Hb levels were 9.42 g% and most common RBC morphology being normocytic normochromic [Figure 1].
Figure 1: Age group versus red blood cell morphologies and average hemoglobin

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Gender

The participants were divided into two groups: male and female. There were 126 male participants and 141 female participants. Based on these, a correlation was established bet sex and Average Hb. level and RBC morphologies.

[Table 3] shows sex wise distribution of different parameters. The average Hb. levels in the male participants were around 8.49 g% and the most common RBC morphology being microcytic hypochromic and the least common being macrocytic. The average Hb. levels in the female participants were around 8.24 g% and the most common RBC morphology being microcytic hypochromic and the least common being macrocytic. There was a male predominance noticed in normocytic normochromic morphology and equal distribution in dimorphic variety. In microcytic hypochromic and macrocytic, there was female predominance noticed.
Table 3: Sex wise distribution of different parameters

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[Table 4] shows the distribution of parameters based on severity of anemia. Based on the WHO classification Anemia Grading by Hb., the participants were divided into four classes depending on the Hb levels, i.e. non anemic, mild, moderate, severe, and life-threatening anemia. Out of the 267 participants, 37 were nonanemic, 70 mild, 50 moderate, 55 severe, and 55 life-threatening anemias. Moreover, the average ages being 9.31, 8.78, 9.51, 10.67, and 13.6 years, respectively.
Table 4: Distribution of parameters based on severity of anemia

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  Discussion Top


The present study revealed that the most common RBC morphology is microcytic hypochromic type accounting 109 cases out of 267 (i.e. 40.82%) of the study. The most common cause of this morphology is due to chronic iron deficiency[15] which leads low HGB synthesis this can be due to low iron-diet, malabsorption parasitic infections, etc., Coming to the age groups, most of the cases were between the age group of 10–18 out these the male: female ratio was 61:90 (approx. 2:3) this indicates the advent of puberty among female participants by the age of 8–10 years of age[16] usually, wherein the menstrual cycle begin. Furthermore, it has been shown[17] that blood loss of 40 ml during menstruation yields an average loss of 1.6 mg of iron. Further, consecutive blood loss of more than 60 ml/menstrual period will deplete the body's iron stores. Anemia of the age group 0–1 could be due various factors[18] ill-nourished pregnant women, low birth weight, early inclusion of feeding mothers to work, excess phlebotomy, infection, sepsis, etc.

A rare cause of anemia in an adolescent male was seen in a case of familial adenomatous polyposis.[19] Adolescence is the period of most rapid growth second to childhood. The physical and physiological changes that occur in adolescents place a great demand on their nutritional requirements and make them more vulnerable to anemia.[20] Thus, life-threatening Hb. levels were seen in an average age of 13.6 years old. The worldwide prevalence of anemia among adolescents is 15% (27% in developing countries and 6% in developed countries).[21]

Iron requirement increases two-to-threefold from a preadolescent level of ~0.7–0.9 mg iron/day to as much as 1.37–1.88 mg iron/day in adolescent boys and 1.40–3.27 mg iron/day in adolescent girls.[22],[23] Anemia in adolescence has serious implications for a wide range of outcomes, and nearly all of the functional consequences of iron deficiency are strongly related to the severity of anemia. It causes reduced resistance to infection, impaired physical growth and mental development, and reduced physical fitness, work capacity, and school performance.[20],[23],[24],[25],[26]

Similarly, a study conducted by Gupta et al., the mean HGB level among adolescent girls was 10.91 ± 1.32 g/dl. The prevalence was found as 76.29% in a rural community of Chhattisgarh.[27] In a study conducted in top-level basketball players of adolescent and adult age groups, anemia was found among 25% of athletes (18% in males vs. 38% in females, P = .028). Iron deficiency anemia, defined by the presence of anemia, ferritin levels below 12 μg/L, and transferrin saturation below 16%, was found among 7% of players (3% in males vs. 14% in females, P = .043).[28]


  Conclusion and Recommendation Top


The female predominance of anemia between the age group of 10–18 could be attributed to initiation of menstrual cycles and microcytic hypochromic smears could be related to chronic iron deficient diet. The increased severity of anemia at older ages might be due to increased metabolic demand in advent of puberty. Anemia in the adolescence causes reduced physical and mental capacity and diminished concentration in work and educational performance and also poses a major threat to future safe motherhood in girls. It is stressed that to develop Intensive Adult Education about nutrition education, diet supplementation, and anemia prophylaxis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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