Anaemia is a medical condition marked by a decrease in the total number of red blood cells
or haemoglobin level or a lowered ability of the blood to carry oxygen, which could be due to
blood loss, reduced RBC production or increased RBC breakdown. World Health
Organization accounted anaemia as a global public health burden, affecting one-fourth of the
world’s population, especially affecting the under 5 years (pre school-aged) children, 5-12
years (primary school-aged) children and women. In national context, National Family
Health Survey-IV (2015-2016) reported that about 58.4% pre-school- aged children were
anaemic. Burden of this disease was reported to be even more for Haryana with 71.7% of
children as anaemic, indicating it to be one of the significant public health problems of this
In light of this, HSHRC in collaboration with PGIMS, Rohtak, designed and conducted an
interventional study, focussing primarily on the aetiology of anaemia (based on
morphologic assessment of the red blood cells), haemoglobin concentration levels,
anthropometric and nutritional assessment, followed by deficiency treatment regime
interventions with an aim to develop programmed strategies for reducing the
prevalence of anaemia among the primary government school children in the age range
of 5-12 years. A representative sample of children was randomly selected from
Government primary schools of Rohtak district. An equal sample was selected from
boys and girl students.
Pre-Interventional Key Findings:
32% children in the age group 5-12 years were found to be anaemic with a mean
haemoglobin level of primary school children in Haryana was 11.9g/dl. Morphologic
assessment of red blood cells reflected that 60% of the anaemic were of Microcytic –
Hypochromic type and 40% were of Normocytic – Normochromic type but no case of
Macrocytic anaemia was found. It was also found that with increasing education level of
the mother (from illiterate to post-graduation) anaemia prevalence rate displayed a
Anthropometrical and Nutritional Assessment Findings:
Height and weight of each child was measured and Body Mass Index (BMI) was
calculated which was compared with the WHO’s reference charts recommended for
children of age group 2-20 years. The 24 hour recall method was used to record
nutritional history and the usual pattern of consumption of common food items.
One-third of the children were found to be underweight (their BMI was less than 5 th
percentile of the standard WHO growth charts) while 1% children were fund to be
overweight (BMI more than 85 th percentile of standards).
Dietary assessment displayed 60% of primary school children consumed food items from
4-5 designated food groups daily. Most common food group included carbohydrates
consisting of whole grain seeds/wheat, starchy staples like potato, tuberous vegetables,
oils and fats, milk and related products, pulses etc.
Post-Interventional Findings (Impact of Interventions):
After the interventions were carried out, prevalence of Anaemia reduced from 32% to
14% due to the effect of medicines administered under strict supervision. Morphologic
assessment of red blood cells also showed a reverse picture with respect to baseline
examination, with Normocytic-normochromic anaemia at 66% and microcytic-
hypochromic anaemia at 34%.
Interventions influenced the severity of anaemia as well. Normal or non-anaemic cases
increased from 68% to 86% while cases of mild anaemia reduced to approximately one-
third and cases of moderate severity were reduced to half.
This study indicated a high prevalence of anaemia among the primary school-aged
children (5-12 years), and improved status upon implementation of appropriate
intervention strategies. The findings of this study highlight the need for active
interventions (both clinical and dietary) by the Health Departments to reduce the
burden of anaemia on Indian populations.