230 - Prevalence, types, and possible drivers of anemia in infants, children and adolescents in Odisha, India; a SHRINE collaborative surveillance.

Publication Number: 1219.230

Leena Das, PGIMER &CH, Bhubaneshwar, Bhubaneswar, Orissa, India; Arjit Mohapatra, SHRINE (Strengthening Global Health and Research Initiatives through Networking and Engagement), Asian Institute of Public Health, Bhubaneswar, Bhubaneswar, Orissa, India; Gayatri Ray, PGIMER and Capital Hospital, Bhubaneswar, Cuttack, Orissa, India; Deniz Ozisik, Georgetown University, Washington, DC, United States; Kepher Makambi, Georgetown University, Washington, DC, United States; Smriti Shikha. Pradhan, Department of Pediatrics, PGIMER & Capital Hospital, Bhubaneswar, Bhubaneswar, Orissa, India; Susmita N. Sarangi, Medstar Georgetown University Hospital, Washi, DC, United States; Pusparaj Aditinandan Pradhan, PGIMER and Capital Hospital Bhubaneswar, Bhubaneswar, Orissa, India; Asha Prakash. Mohapatra, PGIMER and Capital Hospital, Bhubaneswar, Bhubaneswar, Orissa, India; Lewis P. Rubin, Georgetown University School of Medicine, Washington, DC, United States; Pinaki Panigrahi, Georgetown University School of Medicine, Washington, DC, United States

Background: Anemia in children, adolescents, and pregnant women is a worldwide problem. In India, reported prevalence has increased from 58% to 67%. Despite global efforts aimed to meet the WHO goal to decrease anemia by 50% by 2025, most nations, including the U.S., are “not on track”. One factor is limited information on the causes of anemia, including nutritional risks.

Objective: This study aimed to examine the prevalence and causes of pediatric anemia in an eastern Indian state.

Design/Methods: A cross-sectional study was undertaken at the Post Graduate Institute of Medical Education & Research, Capital Hospital, and collaborating sites in Bhubaneswar, Odisha. Children (1-14 yrs of age) seen at outpatient clinics and who had no known history of sickle disease, thalassemias, or malaria received fingerprick Hb testing. After informed consent, those with blood Hb < 11g/dL were enrolled. Patient demography and anthropometry were recorded and venous blood samples were obtained for complete blood count, serum iron, TIBC, transferrin saturation (Tf sat), electrophoresis (HbA, A2, S, F), B12, folic acid, 25(OH)vitaminD3, G6PD activity, peripheral smear, renal function, and rapid malaria diagnostics.

Results: Of 908 children randomly screened, 727 met WHO anemia criteria. Venous blood sampling confirmed low Hb in 685 of these subjects: 46% were 6-59 months; 43%, 5-11 yrs; and 11%, 12-14 yrs old. In the full cohort, by anthropometric criteria, 130 (19%) were malnourished and 109 (16%) were stunted; 94% had concomitant anemia. Folic acid and B12 deficiency were detected in only 3% and 8%, respectively, of anemic children (0.4% had both). Ferritin was within normal limits in 74% and low in 5%. Elevated ferritin and Tf sat in >1/3 of children along with high ferritin and total WBC >12,000 in 1/5 of patients suggested that anemia was commonly associated with chronic disease/ inflammation or other non-nutritional causes. Hemoglobinopathies (sickle trait, sickle disease, ß-thalassemias and trait) and G6PD deficiency were present in 6%, 2%, 9%, 10%, and 4% of anemic children, respectively. Vit D deficiency was prevalent (26%), although not necessarily related to anemia.

Conclusion(s): Anemia is extremely common in this pediatric population drawn from urban, nearby rural, coastal, and tribal locations. Among children with low Hb, iron deficiency was detected in only 40% and fewer had folic acid or B12 deficiency (3-8%). Results from this pilot survey need extension to a broader population-based sampling. These findings should inform better targeted interventions to mitigate pediatric anemia, a major public health concern.