Clinical Profile and Associated Risk Factors of Iron Deficiency Anemia in Children Under 5 Years: A Tertiary Care Center Based Study

Anemia is defined as haemoglobin level is more than two standard deviations below the mean for the child’s age and sex. Iron Deficiency Anemia (IDA) is the most common nutritional anemia worldwide, contributing significantly to high rates of morbidity and mortality in developing nations [1]. The World Health Organization (WHO) reported that globally there are 2.1 billion cases of iron deficiency anaemia, which affects approximately 30\% of the world population.

In India, the prevalence of anemia in children under five remains alarmingly high, despite national interventions like the Anemia Mukt Bharat (AMB) strategy and the Integrated Child Development Services (ICDS) program [4]. Iron is essential for multiple functions at the cellular level, including oxygen transport, mitochondrial energy generation, DNA synthesis, and cellular enzymatic processes. In severe iron deficiency, the low level of iron-containing enzymes can compromise immune and tissue functions. Early childhood IDA, particularly in its severe form, has irreversible consequences, including impaired neurocognitive development, compromised immune function, and diminished growth trajectory [2, 5].

While inadequate dietary intake and low iron bioavailability are recognized primary causes, the synergistic effect of other factors like maternal anemia, repeated infections, and low socio-economic status needs to be locally contextualized for effective intervention design. This study aims to provide a comprehensive analysis of the clinical presentation, severity profile, and specific, identifiable risk factors associated with IDA in children under 5 years presenting at a tertiary care hospital in a developing region.

2. MATERIALS AND METHODS

2.1. Study Design and Setting

This was a hospital-based, prospective, cross-sectional study conducted over one year (April 2024 -- March 2025) at the Department of Pediatrics, civil hospital, AHMEDABAD GUJARAT, a major tertiary referral center.

2.2. Study Population and Sample Size

The study included 250 children aged 6 months to 5 years (60 months) who were diagnosed with iron deficiency anemia(IDA) according to WHO diagnostic criteria of anemia and other 250 normal children  aged 6 months to 5 years without IDA as a control group. Inclusion Criteria included children diagnosed with iron deficiency anemia age range of 6 month to 5 years with availability of informed parental consent. Exclusion Criteria involved children with anemia secondary to chronic systemic diseases (e.g., chronic kidney disease, malignancy), known hemoglobinopathies (e.g., Thalassemia, Sickle Cell Disease), or acute blood loss.

2.3. Data Collection

A structured questionnaire was used to collect data covering socio-demographic factors (age,socio-economic status, maternal education), clinical findings, nutritional practices (breastfeeding, complementary feeding initiation and quality), and maternal history (IFA compliance, antenatal care visits).

2.4. Laboratory and Diagnostic Criteria

Anemia was defined as Haemoglobin (Hb) levels below 11 g/dL} for children under 5 years. Iron Deficiency Anemia (IDA) was biochemically confirmed by Serum Ferritin (SF) concentration of < 12 g/L or Transferrin Saturation (TSAT) < 10\%. Hb levels were used to classify IDA severity: Mild (Hb  10–10.9 g/dL), Moderate (Hb  7–9.9 g/dL), and Severe (Hb < 7 g/dL) according to WHO diagnostic criteria of anemia.

2.5. Statistical Analysis

Data were analyzed using SPSS software (Version 25.0). Descriptive statistics were used for demographic and clinical variables. Chi-square tests were used for categorical variables to assess crude associations. Binary logistic regression was performed, including all variables with a p-value < 0.1 in the univariate analysis, to identify independent predictors of moderate-to-severe IDA. A p-value of <0.05 was considered statistically significant.

3. RESULTS

3.1. Demographic and Severity Profile

The distribution by severity showed that most children presented with significant disease burden.

Figure: Distribution of Iron Deficiency Anemia Severity Among Enrolled Children (N=250)

(This pie chart visually represents the following distribution: Mild IDA (14.8%), Moderate IDA (60.0%), and Severe IDA (25.2%))

The highest prevalence of IDA was concentrated in the crucial growth phase of 6-24 months (92.5%), which was statistically significant compared to the older age group (< 0.01).

3.2. Clinical Features

Pallor was nearly universal (98\%) and used as the primary clinical screening tool. Other highly prevalent symptoms, critical for parental recognition, included fatigue or irritability (65%), and loss of appetite (58%). Pica, a classic sign of severe deficiency, was reported in 35% of cases. Figure provides the detailed breakdown of the clinical presentations.

Figure: Vertical Bar Chart - Comparison of the Frequency of Common Clinical Symptoms in Children with Iron Deficiency Anemia (Simulated Data)

3.3. Socio-demographic and Nutritional Factors

Table 1 details the unadjusted associations of key socio-demographic and nutritional factors with the presence of IDA. Notably, low maternal education and poor compliance with antenatal IFA were highly associated with IDA.

Multivariate analysis was conducted to control for confounding variables. The strongest independent risk factors for Moderate-to-Severe IDA (Hb < 10 g/dL) were identified as follows:

4. DISCUSSION

The high prevalence of IDA (85%) and the advanced severity profile (over a quarter of children having Hb < 7g/dL) emphasizes that the disease is often missed or neglected at the primary care level, leading to presentations only when symptoms are pronounced enough to warrant tertiary referral.

The vulnerability of the 6–24-month age group is a crucial finding. This phase represents the point where fetal iron stores are exhausted and the child relies entirely on dietary intake. Our strong finding that delayed complementary feeding (OR 2.5) is a major independent risk factor confirms that inadequate quality and timing of solid foods fail to meet the high iron demands of rapid growth. This critical gap must be addressed through aggressive nutritional counseling.

The most striking predictor, Suboptimal Maternal IFA Compliance (OR 3.1), illuminates the intergenerational cycle of anemia. Maternal iron status during pregnancy directly determines the iron reserves of the neonate. Failure to adhere to antenatal IFA supplementation means the child starts life with low iron endowment, accelerating the depletion of stores. This factor requires programmatic focus, perhaps through adherence monitoring and supply chain improvements in antenatal care (ANC) [6].

Furthermore, Low Maternal Education (OR 1.9) functions as a major socio-demographic determinant, impacting health literacy, access to care, and the timely adoption of correct nutritional practices. This underscores the need for public health interventions that integrate health education and women's empowerment components alongside pure supplementation strategies. The pathway linking these socio-economic and nutritional determinants to IDA is visualized in the conceptual model.

Figure: Conceptual Model for the Intergenerational Cycle of Iron Deficiency Anemia based on Study Findings