{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:38:57Z","timestamp":1791905937759,"version":"4.3.4"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T00:00:00Z","timestamp":1705536000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>The present study aimed to estimate the prevalence of anemia, and anemia with micronutrient deficiencies (iron\/ vitamin B12\/ folic acid) and their determinants among children aged 12\u201359 months in India. Comprehensive National Nutritional Survey (2016\u20132018) is Asia\u2019s largest nutrition survey conducted among 0\u201319 years aged children in India. We used generalised linear model (modified Poisson) with adjusted prevalence ratio (aPR) to assess the socio-economic and biochemical factors associated with anemia and anemia with micronutrient deficiencies amongst children aged 12 to 59 months. Out of the total of 11,237 children included in the study, 40.5% (95%CI:38\u00b76\u201342\u00b76) were anemic, 30.0% (95%CI:27\u00b78\u201332\u00b74) had anemia with micronutrient deficiencies and 60.9% (95%CI:58\u00b72\u201363\u00b75) had micronutrient deficiencies with or without anemia. Younger age (aPR(95%CI) for one year old: 1.9(1.5\u20132.4), two year old: 1.8(1.5\u20132.2), three year old: 1.4(1.2\u20131.7) compared to four year old children) and lower educational status of the mother (mothers without formal schooling aPR(95%CI):1.4(1.1\u20131.8); 1\u20139 standards: 1.4(1.2\u20131.7)) vs mother educated with high school and above, consumption of less than 100 iron-folic acid tablets during pregnancy (aPR(95%CI):1.3(1.0\u20131.7) vs consumption of \u2265 180 tablets, any self-reported illness among children within two weeks preceding the interview (aPR(95%CI):1.2(1.1\u20131.4) vs no-illnesses, iron deficiency (aPR(95%CI):2.2(2.0\u20132.6)) and zinc deficiency (aPR(95%CI):1.3(1.1\u20131.4)) were associated with anemia in children. Among anemic, the children from scheduled tribe (aPR(95%CI):1.4(1.1\u20131.8)) vs other caste categories, and those following unsafe child faeces disposal practices (aPR(95%CI):1.2(1.0\u20131.4)) vs those who follow safe faeces disposal practices had higher chance of having micronutrient deficiency. One third of children aged 12\u201359 months had anemia with micronutrient deficiency (iron\/ folic acid\/ vitamin B12). More than half of children had micronutrient deficiencies irrespective of anemia. Micronutrient deficiencies, antenatal IFA intake, safe hygiene practices need to be strengthened to leave no stone unturned in control of anemia among under-five children in India.<\/jats:p>","DOI":"10.1371\/journal.pgph.0002095","type":"journal-article","created":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T18:26:32Z","timestamp":1705602392000},"page":"e0002095","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Prevalence and determinants of anemia due to micronutrient deficiencies among children aged 12\u201359 months in India\u2013Evidence from Comprehensive National Nutrition Survey, 2016\u201318"],"prefix":"10.1371","volume":"4","author":[{"given":"Kapil","family":"Yadav","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7637-0292","authenticated-orcid":true,"given":"Gomathi","family":"Ramaswamy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8434-238X","authenticated-orcid":true,"given":"Surabhi","family":"Puri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6635-9142","authenticated-orcid":true,"given":"Kashish","family":"Vohra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1162-2334","authenticated-orcid":true,"given":"Thejas","family":"Achary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1289-5425","authenticated-orcid":true,"given":"Abhishek","family":"Jaiswal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8226-8614","authenticated-orcid":true,"given":"Ravneet","family":"Kaur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohan","family":"Bairwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3615-4250","authenticated-orcid":true,"given":"Archana","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vani","family":"Sethi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,1,18]]},"reference":[{"key":"pgph.0002095.ref001","first-page":"830","article-title":"Global, Regional, and National Prevalence of Anemia and Its Causes in 204 Countries and Territories, 1990\u20132019.","volume":"4","author":"W Gardner","year":"2020","journal-title":"Curr Dev Nutr"},{"key":"pgph.0002095.ref002","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1186\/s13045-021-01202-2","article-title":"Burden of anemia and its underlying causes in 204 countries and territories, 1990\u20132019: results from the Global Burden of Disease Study 2019.","volume":"14","author":"S Safiri","year":"2021","journal-title":"J Hematol Oncol"},{"key":"pgph.0002095.ref003","unstructured":"UNICEF. Comparison of Nutrition Status of children and Anaemia data\u2014NFHS 4 & NFHS 5. 2020."},{"key":"pgph.0002095.ref004","unstructured":"Anaemia. [cited 16 Oct 2023]. Available: https:\/\/www.who.int\/data\/nutrition\/nlis\/info\/anaemia"},{"key":"pgph.0002095.ref005","unstructured":"World Health Organization. Preventing and Controlling Iron Deficiency Anaemia Through Primary Health Care. Geneva, Switzerland; 1989."},{"key":"pgph.0002095.ref006","unstructured":"World Health Organization, Vitamin and Mineral Nutrition Information System, VMNIS. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva, Switzerland; 2011."},{"key":"pgph.0002095.ref007","first-page":"150","article-title":"Chronic Iron Deficiency and Cognitive Function in Early Childhood","author":"A Gingoyon","year":"2022","journal-title":"Pediatrics"},{"key":"pgph.0002095.ref008","volume-title":"Nutritional anaemias: tools for effective prevention and control","author":"World Health Organization","year":"2017"},{"key":"pgph.0002095.ref009","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/nyas.14092","article-title":"Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries","volume":"1450","author":"CM Chaparro","year":"2019","journal-title":"Ann N Y Acad Sci"},{"key":"pgph.0002095.ref010","unstructured":"World Health Organization. Iron Deficiency Anaemia: Assessment, Prevention, and Control\u2014A guide for programme managers. Geneva; 2001. Available: https:\/\/www.who.int\/nutrition\/publications\/en\/ida_assessment_prevention_control.pdf"},{"key":"pgph.0002095.ref011","doi-asserted-by":"crossref","DOI":"10.3390\/nu8110693","article-title":"The Proportion of Anemia Associated with Iron Deficiency in Low, Medium, and High Human Development Index Countries: A Systematic Analysis of National Surveys.","volume":"8","author":"N Petry","year":"2016","journal-title":"Nutrients"},{"key":"pgph.0002095.ref012","author":"Ministry of Health and Family Welfare, Government of India","year":"2018","journal-title":"Anemia Mukt Bharat: Intensified National Iron Plus Initiatvie (I-NIPI)\u2014Operational Guidelines for Programme Managers."},{"key":"pgph.0002095.ref013","unstructured":"Ministry of Health and Family Welfare. Government of India. CNNS Report\u2014Nutrition India. [cited 8 Jan 2021]. Available: http:\/\/nutritionindiainfo.in\/rep_wp\/cnns-report\/"},{"key":"pgph.0002095.ref014","unstructured":"World Health Organization. Nutritional Anaemias. Report of a WHO Scientific Group. Geneva, Switzerland; 1968. Available: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/40707\/WHO_TRS_405.pdf?sequence=1&isAllowed=y"},{"key":"pgph.0002095.ref015","doi-asserted-by":"crossref","first-page":"8","DOI":"10.4103\/0970-0218.80786","article-title":"Nutritional Anemia in Young Children with Focus on Asia and India.","volume":"36","author":"V. Kotecha P","year":"2011","journal-title":"Indian J Community Med."},{"key":"pgph.0002095.ref016","volume-title":"Nutritional Anemia.","author":"K Kraemer","year":"2007"},{"key":"pgph.0002095.ref017","unstructured":"World Health Organization. Nutritional Anaemias\u2014Report of a WHO Group of Experts. Geneva, Switzerland; 1972. Available: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/40977\/WHO_TRS_503.pdf?sequence=1&isAllowed=y"},{"key":"pgph.0002095.ref018","doi-asserted-by":"crossref","first-page":"333S","DOI":"10.3945\/ajcn.116.142273","article-title":"Methodologic approach for the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project.","volume":"106","author":"Group on behalf of the BW, Aaron GJ, Group on behalf of the BW, Varadhan R, Group on behalf of the BW","year":"2017","journal-title":"Am J Clin Nutr"},{"key":"pgph.0002095.ref019","unstructured":"National Iron Plus Initiative (NIPI) | National Health Mission | Government Of India."},{"key":"pgph.0002095.ref020","unstructured":"Food and Agriculture Organization of the United Nations. Guidelines for measuring household and individual dietary diversity. 2013. Available: www.foodsec.org"},{"key":"pgph.0002095.ref021","unstructured":"World Health Organization, UNICEF. Core questions on drinking-water and sanitation for household surveys. Switzerland; 2006."},{"key":"pgph.0002095.ref022","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/S2352-4642(20)30094-8","article-title":"Characterisation of the types of anaemia prevalent among children and adolescents aged 1\u201319 years in India: a population-based study","volume":"4","author":"A Sarna","year":"2020","journal-title":"Lancet Child Adolesc Health"},{"key":"pgph.0002095.ref023","unstructured":"World Health Organization, VMNIS | Vitamin and Mineral Nutrition Information System. C-reactive protein concentrations as a marker of inflammation or infection for interpreting biomarkers of micronutrient status. Geneva, Switzerland; 2014. Available: http:\/\/apps.who.int\/iris\/bitstream\/10665\/133708\/1\/WHO_"},{"key":"pgph.0002095.ref024","unstructured":"Demographic and Health Survey. The DHS Program\u2014India: Standard DHS, 2015\u201316. [cited 30 Jul 2023]. Available: https:\/\/dhsprogram.com\/methodology\/survey\/survey-display-355.cfm"},{"key":"pgph.0002095.ref025","unstructured":"Ministry of Health and Family Welfare, Government of India. POSHAN Abhiyaan. [cited 11 Sep 2019]. Available: http:\/\/poshanabhiyaan.gov.in\/#\/"},{"key":"pgph.0002095.ref026","unstructured":"Ministry of Health and Family Welfare, Government of India, International Institute of Population Sciences. National Family Health Survey\u20145. Fact Sheets Phase I. 2019. Available: https:\/\/www.who.int\/en\/news-room\/fact-sheets\/detail\/malaria"},{"key":"pgph.0002095.ref027","journal-title":"Global Nutrition Report Expert GroupNutrition and COVID-19: Malnutrition is a threat-multiplier\u2014Global Nutrition Report"},{"key":"pgph.0002095.ref028","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/mcn.12478","article-title":"Determinants of anemia among women and children in Nepal and Pakistan: An analysis of recent national survey data.","volume":"14","author":"KL Harding","year":"2018","journal-title":"Matern Child Nutr."},{"key":"pgph.0002095.ref029","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0228258","article-title":"Anemia, micronutrient deficiencies, malaria, hemoglobinopathies and malnutrition in young children and non-pregnant women in Ghana: Findings from a national survey.","volume":"15","author":"R Wegm\u00fcller","year":"2020","journal-title":"PLoS One."},{"key":"pgph.0002095.ref030","first-page":"1","article-title":"Prevalence and correlates of anemia among children aged 6\u201323 months in Wolaita Zone, Southern Ethiopia.","author":"M Alemayehu","year":"2018","journal-title":"bioRxiv."},{"key":"pgph.0002095.ref031","article-title":"Point-of-Care Testing Using Invasive and Non-Invasive Hemoglobinometers: Reliable and Valid Method for Estimation of Hemoglobin among Children 6\u201359 Months.","author":"G Ramaswamy","year":"2020","journal-title":"J Trop Pediatr."},{"key":"pgph.0002095.ref032","first-page":"36","article-title":"Validation of Point of Care Hemoglobin Estimation Among Pregnant Women Using Digital Hemoglobinometers (HemoCue 301 and HemoCue 201+) as Compared with Auto-Analyzer.","author":"K Yadav","year":"2020","journal-title":"Indian Journal of Hematology and Blood Transfusion."},{"key":"pgph.0002095.ref033","author":"Ministry of Health and Family Welfare","journal-title":"Government of India. AMB Reports\u2014Anemia Mukt Bharat Dashboard"},{"key":"pgph.0002095.ref034","article-title":"International Institute of Population Sciences (IIPS). National Family Health Survey 4.","author":"Ministry of Health and Family Welfare, Government of India","journal-title":"Fact sheets"},{"key":"pgph.0002095.ref035","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.4081\/jphia.2020.1131","article-title":"Socioeconomic factors associated with anemia among children aged 6\u201359 months in Namibia.","volume":"11","author":"PP Shimanda","year":"2020","journal-title":"J Public Health Afr"},{"key":"pgph.0002095.ref036","first-page":"14","article-title":"Prevalence of anemia and its associated factors among children under five years of age attending at Guguftu health center, South Wollo, Northeast Ethiopia.","author":"A Gebreweld","year":"2019","journal-title":"PLoS One."},{"key":"pgph.0002095.ref037","first-page":"9","article-title":"Determinants of Childhood Anemia in India","author":"NG Onyeneho","year":"2019"},{"key":"pgph.0002095.ref038","doi-asserted-by":"crossref","first-page":"100135","DOI":"10.1016\/j.dialog.2023.100135","article-title":"Wealth inequalities in nutritional status among the tribal under-5 children in India: A temporal trend analysis using NFHS data of Jharkhand and Odisha states\u20142006\u201321.","volume":"2","author":"S Rekha","year":"2023","journal-title":"Dialogues in Health"},{"key":"pgph.0002095.ref039","first-page":"1","article-title":"Prevalence of anaemia among 6- to 59-month-old children in India: The latest picture through the NFHS-4.","author":"S Bharati","year":"2019","journal-title":"J Biosoc Sci."}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0002095","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T18:26:46Z","timestamp":1705602406000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0002095"}},"subtitle":[],"editor":[{"given":"Aditi","family":"Apte","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,1,18]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0002095","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,18]]}}}