“nutritional status and prevalence of ida in anganwadi children and the effect … · 2018. 12....

A STUDY REPORT ON

“NUTRITIONAL STATUS AND PREVALENCE OF IDA

IN ANGANWADI CHILDREN AND THE EFFECT OF

IRON SUPPLEMENTS”

SUBMITTED TO STATE PLANNING COMMISSION

GOVERNMENT OF TAMILNADU

PRINCIPAL INVESTIGATOR

Dr. P. SUBASH CHANDRA BOSE, M.D.(Ped),

CONSULTANT PAEDIATRICIAN & NEONATOLOGIST

DEPARTMENT OF PAEDIATRICS

SRM INSTITUTES FOR MEDICAL SCIENCE (SIMS)

VADAPALANI, CHENNAI – 600 026

ACKNOWLEDGEMENT

We are highly indebted to the State Planning Commission, Government

of Tamil Nadu, for giving us the opportunity to embark on this project. This

study demonstrates that concerns of health status of Anganwadi Children

supported by comparative literature and modern technology will always

transcend academics and provide a quest for our times.

We would like to express our sincere thanks to our Chairman Thiru. Ravi

Pachamoothoo, for his dynamism which helped a great deal in doing this

project. In addition, we thank Dr. K. Sridhar, Sr. Vice President (Medical) and Dr.

Raju Sivasamy, Vice President (Medical & Finance), for their enthusiasm,

guidance and constant encouragement to complete this task. We are very

much thankful to Dr. Sripradha, consultant paediatrician, for her efforts and

supported offered for this project.

We extend our thanks to Mr. P. Pichaimani, Executive Secretary, for

helping us in statistical analysis and preparing the study report.

We would also like to place on record our gratitude to Doctors and Para

Medical Staff in the Lab of SIMS Hospital who have devoted their time and

attention in analysing the samples collected from the children and reporting on

them. We also thank the PERS Pharmacy for their timely supply of drugs and

medicines.

Our special thanks to the Department of Social Welfare, Government of

Tamil Nadu, and Anganwadi officials for their continuous support in conducting

this project. We also thank and appreciate the children and their parents for

their positive and kind co-operation without which this project would not have

been possible.

ABSTRACT

High prevalence of iron deficiency anemia is reported worldwide in many

studies and reports. The aim of the study was to assess the nutritional status

and prevalence of IDA in Anganwadi children and the effect of iron

supplements among eight Anganwadi centres around SIMS Hospital,

Vadapalani from June 2015 to December 2015. The haemoglobin levels and

peripheral smear were analysed to categorize iron deficiency anemia in the

study group and nutritional status was assessed with mid arm circumference.

The study group (n=280) showed 1% children with moderate acute malnutrition

and iron deficiency anemia(

TABLE OF CONTENTS

Sl. No. Title Page No.

1 LIST OF TABLES iv

2 LIST OF FIGURES v

3 INTRODUCTION 1

4 AIMS AND OBJECTIVES 3

5 REVIEW OF LITERATURE 4

6 MATERIALS AND METHODS 26

7 RESULTS AND STATISTICAL ANALYSIS 30

8 DISCUSSION 40

9 SUMMARY 43

10 CONCLUSIONS 45

11 RECOMMENDATIONS 47

12 REFERENCES 49

13 APPENDIX 55

LIST OF TABLES

Table No. Title Page No.

1. Sex Distribution of Infants 30

2. Results of the First Round Study 31

3. Distribution of Healthy Children 32

4. Distribution of Anaemic Children 33

5. Severity of Anaemia 34

6. Health Status After Medication 35

7. Status of Nutrition 36

8. Final Result 37

LIST OF FIGURES

Sl. No. Title Page No.

1. Sex Distribution of Infants 30

2. Results of the First Round Study 31

3. Distribution of Healthy Children 32

4. Distribution of Anaemic Children 33

5. Severity of Anaemia 34

6. Health Status After Medication 35

7. Status of Nutrition 36

8. Final Result 37

INTRODUCTION

INTRODUCTION

Anaemia is defined as reduction in the haemoglobin levels in the

circulating blood volume. As the haemoglobin concentration decreases the

oxygen carrying work of the blood will get hampered which will lead to lots of

health issues. Anaemia can be due to various reasons like iron deficiency,

vitamin B12 deficiency, folic acid deficiency, blood loss, haemolysis, chronic

disease states, decreased bone marrow production. Among all the reasons iron

deficiency anaemia is the most common reason for anaemia in children both in

developed and developing countries.

Iron deficiency Anaemia, a manifestation of under-nutrition and poor

dietary intake of iron is a serious public health problem among infants, young

children and adolescents. Data suggests that 7 out of every 10 children aged 6-

59 months in India are anaemic. Three per cent of children aged 6-59 months

are severely anaemic, 40% are moderately anaemic, and 26% are mildly

anaemic. In fact the percentage of children with any anaemia increased from

69.0% in NFHS-II to 72.7% in NFHS-III. Among all the anaemias micronutrient

deficiency is the major cause, which is completely correctable also.

Among micronutrient deficiencies for anaemia in children, iron, folic

acid, vitamin B12 constitutes 58.1%, 2.3% and 1.2% respectively.

The risk of having iron deficiency anaemia in children can cause various

symptoms including loss of appetite, tiredness, repeated infection,

breathlessness cognitive and behavioural problems and growth retardation. As

these symptoms can cause serious implications on a child’s health and the

future and in turn to the society it is very important to treat the anaemia in a

proper way.

AIMS

AND

OBJECTIVES

AIMS AND OBJECTIVES

To assess the nutritional status of the Anganwadi children by recording

the anthropometric details.

To test the haemoglobin levels and peripheral smear study to look for

microcytic hypochromic anaemia in all the children included in the study.

To treat the anaemic children with iron supplements along with

treatment for worm infestation.

To re-assess them after three months to study their haemoglobin and

peripheral smear.

REVIEW

OF LITERATURE

REVIEW OF LITERATURE

IRON

Iron is a very important element for most living organism, including

bacteria, animals and plants1. It is inevitable for all cells such as a carrier of

oxygen and integral part of heme and enzymes that catalyses fundamental

chemical reaction in different tissues2.

Body Iron

Iron as a micronutrient can be found in a small amount in the human

body, the average of iron is 3.8g in men and 2.3g in women3.

Body distribution of iron

Iron containing compounds are the form of iron in human body. Based

on the biological role of iron it is classified as functional and transport or

storage iron. The majority (70%) of iron are functional iron4.

Functional iron containing compounds (Essential compounds)

The functional iron containing compounds are involved in the transport

and utilization of oxygen to produce cellular energy and include: haemoglobin,

myoglobin, heme enzymes(cytochromes, catalases, peroxidases), and iron-

sulfur proteins5 . About 60-70% of total body iron is present in haemoglobin of

circulating RBCs and bone marrow erythroid precursors cells and about 10% is

present in myoglobin of muscle cells. About 3-4% is present in heme enzymes6 .

Iron storage and transport compounds

The iron storage compounds are the ferritin and hemosiderin, present

primarily in the liver, reticuloendothelial cell and erythroid precursors of bone

marrow. Two other proteins involved in the transport, delivery and regulation

of iron uptake to the different tissues are Transferrin and Transferrin receptor7.

Iron metabolism and recycling

The ability to absorb and excrete iron in the body is limited. The

absorption of iron must be controlled in order to compensate the small

unavoidable losses and the increased physiological requirement in association

with growth, menstruation of adolescent girl and at the same time avoid any

accumulation or iron overload from dietary sources8. Placenta maintains the

regulation of iron absorption in embryonic stage; however, after birth,

regulation of iron absorption is accomplished by the intestinal mucosa9. The

reuse of iron from the senescent RBCs is very important because most of the

body iron is found in the haemoglobin of RBCs. The intestinal epithelial cells of

the gastro-duodenal junction absorb only 1-2 mg of iron9. The efficiency of iron

absorption is regulated in accordance with body iron status10,11. In healthy

children, the daily requirements of iron is about 20mg for forming new RBCs.

Dietary Iron

There are two forms of dietary iron - non-heme and heme iron. The two

dietary irons differ greatly in the manner of the absorption of intestinal cells.

Thus non-heme iron has lower absorption rate and is markedly influenced by

concomitantly consumed dietary components. Whereas the absorption of

heme iron is not affected by consumed dietary components12.

Iron absorptions are diminished by phytates, tannates, polyphenols13,14,

oxalates, phosphates (Dallman et al., 1996), calcium, lecitins15. Iron absorption

are enhanced by ascorbic acid (Vitamin C) (National Institutes of Health Office

of Dietary supplements, 2005).

Iron Absorption

Iron is essential for multiple metabolic processes particularly in the

production of erythrocytes haemoglobin and the production of cellular

energy16. Iron can also be potentially toxic. It’s ability to produce free radical

lead to tissue damage. That’s tissue iron concentration must be strictly

regulated17,18.

The primary mechanism of regulation is the intestinal absorption,

particularly the cells of the intestinal crypt which receive the signals from the

body to alter iron absorption and migrate up the villus and differentiate into

mature absorptive enterocytes19.

Iron requirements

The amount of iron required to meet the daily needs of iron for growth

and to afford the normal losses from the body varies due to age and sex. This

amount is consequently required more and more during infancy, early

childhood, adolescence, pregnancy and menstruating adolescents20.

Iron is necessary for infants, children and adolescent to enlarge red cell

mass and growing body tissue. Because of low dietary intakes of iron, infants

and adolescents suffer from negative iron balance. To support the increased

iron requirement, their diet should be rich in highly bioavailable heme iron and

/or they must receive iron supplements. Iron fortified foods are supplemented

in some countries to help prevent negative iron balance in infants and

children21.

Individual must absorb or supply an equivalent amount of iron, that’s

needed for the developmental age, to obtain iron balance within the body. The

amount of dietary iron should be 10 folds greater than the required amount as

only 10% of dietary iron is absorbed22.

Iron deficiency

Iron deficiency is the commonest form of malnutrition worldwide,

affecting 43% of world’s children and particularly common in Asia and Africa. It

is a state in which there is insufficient iron to maintain normal physiological

function of blood and tissues such as brain and muscles. ID can exist in absence

of anaemia if it has not lasted long enough or if it has not been severe enough

to cause the haemoglobin concentration to fall below the threshold for the

specific age group and sex. Anemia occurs during the severe stages of iron

deficiency. Although there have been increased efforts to develop improved

interventions involving food fortification, supplementation and dietary

education in a combined strategy to prevent and control iron deficiency, little

progress has been made towards global elimination of iron deficiency.

Iron deficiency is the most prevalent nutrient deficiency in the world. It

is responsible for approximately 20,854 deaths and a reduction of 2 million

Disability-Adjusted Life Years (DALYs) among children under five years of age.

Iron deficiency has its greatest impact on the health and physical and

intellectual well being of preschool children. Although often more severe in

poor and rural communities, iron deficiency also occurs in wealthier and urban

populations.

Iron deficiency anaemia

Anaemia is defined as a pathological process in which haemoglobin (Hb)

concentration in red cells is abnormally low, considering variation as to age,

gender, sea-level altitude, as a result of several situations such as chronic

infections, hereditary blood conditions, deficiency of one or more essential

nutrients that are necessary for the formation of haemoglobin e.g: folic acid,

B12, B6 and vitamin C and protein. Therefore there is no doubt that iron

deficiency is the cause of most anemias23.

Clinical signs and lab exams for the detection of iron deficiency and anaemia

Iron deficiency anaemia occurs at three stages. The first stage –iron

depletion-occurs when iron content is not enough to meet body requirements.

At the beginning, there is a reduction in iron deposition, characterized by serum

ferritin below 12mcg/L, without functional changes.

If the negative balance persists, the second stage begins –iron deficient

erythropoiesis-characterized by a reduction in serum iron, transferrin

saturation below 16% and an increase in the free erythrocyte protoporphyrin

level. At this stage, work capacity may be reduced.

At the third stage – iron deficiency anaemia –haemoglobin is below the

standards for age and gender. This stage is characterized by the development

of microcytosis and hypochromia 24.

The operational definition of anaemia, in terms of haemoglobin levels,

was established by the World Health Organization, adopting the level of

11.0g/dl for children under the age of six and pregnant women. For children

aged between 6 and 14 years and non-pregnant adult women, the level was

12g/dl and 13g/dl for adult men23.

The clinical signs of anaemia are not easily recognizable, and many times

go unnoticed. These signs include paleness, anorexia, apathy, irritability,

reduced attention and psychomotor deficiencies25.

Causes of iron deficiency

A major etiological factor in iron deficiency is early introduction of cow’s

milk, which is low in iron content. Children must obtain iron from exogenous

sources after 4 months of age and are at risk if not provided. Pediatrician and

nutritionists recommend a healthy weaning diet consisting of home prepared

iron foods. Parents start weaning earlier than the recommended 4-6 months

also they choose low iron containing food for weaning. The reason for such a

poor diet include poverty, lack of access to cheap food, lack of cooking skills

and equipment and a chaotic home environment where there are no fixed

mealtime26.

Stages of iron deficiency

Iron deficiency occurs in three sequentially developing stages

The First stage is depleted iron stores. This occurs when the body no

longer has any stored iron but the haemoglobin remains normal at this stage.

Low serum ferritin level (

For practical purposes, the first and second stages are often referred as iron

deficiency26.

According to WHO, anaemia is classified as mild (10.9 – 9.0gm%),

moderate (8.9 – 7.0gm%) and severe (

The relation between iron, breastfeeding and weaning practices

Iron stores from birth to 6 months of age when the infant receives

exclusive breast feeding, meet the physiological requirements due to high

bioavailability of iron in human milk. However, this bioavailability decrease by

80% when infants are fed other foods. Therefore early introduction of

complementary food is a risk factor for development of iron deficiency

anaemia. After 6 months to twelve months, iron requirements increases with

body weight. Approximately 30% of the iron that is necessary for erythropoiesis

should come from the food. The situation is totally different in adults who

recycle about 95% of iron required from the lysis of red blood cells and need to

obtain only 5% of iron from food.

The relationship between iron and food consumption patterns

The wide varieties of factors that stimulate iron absorption include meat

and vitamin C which are two powerful stimulators. Other stimulators include

beef, poultry, fish, goat, liver and pork. When ascorbic acid is added to the diet,

there is a remarkable increase in iron absorption.

Phytates, tannins, calcium, phosphorous, eggs and other types of foods

inhibit iron absorption by forming precipitates that bind to iron, thus hindering

its absorption. Studies of nutritive compounds of food have shown that milk

derived calcium strongly inhibits the absorption of heme and non-heme iron.

The relation between iron, morbidity and immunization

Some studies say iron deficiency suppresses the immune system and

increases risk for infection. It is well known that gastrointestinal and respiratory

infections often predispose to the reduction of serum iron levels in the body

due to the reduced production of haemoglobin and decreased iron absorption.

Reeves et al have shown that mild diarrheal disease affect approximately

60% of children aged less than 1 year, between the 9th and 12th months of life

and these diseases are associated with low haemoglobin concentration.

Consequences of iron deficiency in infants and young children

Anaemia is a serious condition that impacts cognitive development. The

effects of iron deficiency that are observed in the first 6 months of life can lead

to permanent damage. An afflicted child is likely to remain vulnerable to

infection and continue to have lower immunity toward infection throughout

childhood. Also the overall appetite is reduced and this vicious cycle

perpetuates a series of events that must be stopped, to ensure child’s health.

Iron deficiency anaemia rarely exits in isolation and to dismantle the proportion

of the role played by anaemia from the total level of malnutrition and other

precipitating factors, although desirable, is difficult to get at the community

level.

Studies have shown that children with iron deficiency present worse

performance in psychomotor tests than do non-anaemic children. The greatest

prevalence of iron deficiency among breastfed infants coincides with the final

period of rapid brain development (six to 24 months), when the motor and

cognitive skill, take a shape. Long term prospective studies have also identified

persistent cognitive deficiencies in 10 year old children who had suffered from

anaemia during the first months of infancy.

Iron deficiency can also negatively affect cellular immunity, even before

the child becomes anaemic and this can lead to an increase in illness such as

diarrhoea, respiratory diseases and other infections. These can be reduced by

iron fortified food supplementation.

Infants born to mothers with IDA are more likely to have low iron stores

and to require more iron than can be supplied by breast milk at a younger age.

There is convincing evidence linking IDA to lower cognitive test scores and

these affects can be long lasting. There is also increased susceptibility to heavy

metal poisoning in iron deficient children27.

Prevention of IDA

IDA prevention should be established through the following four

approaches: Nutritional education and improvement of diet quality including

breast-feeding incentive, medicine supplementation, food fortification and

control of infections.

When recommending a diet for infants, some aspects should be dealt

with carefully guaranteeing better body iron content; this includes maintenance

of exclusive breastfeeding upto 4-6 months of life and initiation of

complementary feeding with iron rich foods. Children’s diet should be

diversified, balanced and rich in high-bioavailability iron28.

Medicine supplementation is very efficient in preventing and controlling

anaemia. The Brazilian society of paediatrics recommends iron

supplementation as follows:

1. Full term new-borns: during breast feeding period after the 4th

month or when weaning is initiated upto 24th month of life should

be given 1mg/kg/day of elemental iron or a weekly doses of 45

mg, except for infants who are receiving iron fortified formulas.

2. Preterm/LBW neonate: after the 30th day of life 2mg/kg/day

during 2 months. After that use the same recommendation for

full-term new-borns with normal birth weight.

In public health centres such as day care centre and schools the weekly

proposal has shown better results than the daily regimen since its

administration is facilitated.

The use of fortified food has been an alternative that is preferred by

industrialized countries for 50 years, presenting excellent results. When

choosing the food to be fortified, it is important to remember that foods should

be easily accessible, have a low cost and belong to the usual eating habits of the

region, without having their taste or aspect changed; compounds with good

bioavailability should be used.

The group of international counselling on Nutrition based anaemias

suggest the following recommendations for the control and prevention of

nutrition based anaemias:

a) Nutritional education that motivates the consumption of iron rich

food, respecting the population’s eating habits, associated with

breast feeding incentive programs.

b) Improvement of basic sanitation systems and medical assistance

to all, with control over intestinal parasitosis.

c) Design of iron supplementation programme in prophylactic doses

for risk groups, with supervision and follow-up.

d) Design and incentive to food fortification programs, currently

regarded as the best preventive measure on long run with lower

costs.

The use of milk based formulas and milk fortified with ferrous sulphate,

chelate iron and elementary iron presents rewarding results for infants younger

than 2 years29,30.

Treatment

The objective of the iron deficiency anaemia treatment is to correct the

rate of circulating haemoglobin and restore iron deposition into the tissues

where it is stored.

It is recommended that iron salts be used, preferably by means of oral

administration. Iron salts(sulphate, fumarate, gluconate, succinate, citrate,

etc.,) are inexpensive and quickly absorbed; however they produce more side

effects-nausea, vomiting, epigastric pain, diarrhoea, constipation, dark faeces

and on long run development of dark spots on teeth. Absorption is higher when

iron salts are ingested 1 hour before meals.

Salts contain different iron content. The suggested posology is 3-5mg of

elementary iron/kg/day divided into 2-3 doses. The medication is ingested

together with fruit juice rich in vitamin C, if possible, since this facilitates iron

absorption.

Treatment response is fast and duration of treatment depends on the

severity of the disease. Absorption of iron is higher during the first weeks of

treatment. Here is an estimated iron absorption of 14% during the first week of

treatment, 75 after 3 weeks and 2% after 4 months.

The first month of therapy is crucial for a successful treatment. A

positive response may be measured by the daily increment of 0.1 g/dl in the

concentration of haemoglobin after the fourth day of treatment. A maximum

increase in reticulocytes is observed between the 5th and 10th day of treatment

and a substantial increase in the concentration of haemoglobin is observed

around the third week.

Medication should be continued for about 6 weeks after haemoglobin

reaches normal concentration so that iron organic reserves can be restored.

Blood transfusion is only recommended for infants whose haemoglobin

concentration is less than 5 gm/dl or who presents with signs of cardiac failure.

In these cases, it is advisable to use 10ml/kg of PRBC28.

Robert D. Baker et.al31, his clinical report covers diagnosis and

prevention of iron deficiency and iron-deficiency anaemia in infants (both

breastfed and formula fed) and toddlers from birth through 3 years of age.

Results of recent basic research support the concerns that iron-deficiency

anaemia and iron deficiency without anaemia during infancy and childhood can

have long-lasting detrimental effects on neurodevelopment. Therefore,

pediatricians and other health care providers should strive to eliminate iron

deficiency and iron-deficiency anaemia. Appropriate iron intakes for infants and

toddlers as well as methods for screening for iron deficiency and iron-deficiency

anaemia are presented.

In the study by Aukett et al32, treatment of IDA with oral iron for 2

months was associated with a significantly greater increase in weight velocity

compared to the placebo group. 8 Other studies from Indonesia have

confirmed these observations, and also suggest that correction of anaemia is

associated with a reduction in the increased morbidity (fever, respiratory tract

infections, diarrhoea) seen in children with IDA.

Magnus Domellof et al33., in his study IDA is a global public health

problem, affecting 51% of children below 4 years of age in developing countries

and 12% in developed countries. Iron requirement during late infancy are

higher than during any other period of life. There is well association between

IDA & delayed neurodevelopment in infants and young children. In this study,

they conclude by recommending Iron fortification of common infant food and

iron supplements for infants who were breast fed for longer than 6 months of

age.

Grantham-McGregor S et.al34., It is the study on the effect of iron

deficiency on children’s cognition and behaviour. Longitudinal studies

consistently indicate that children anaemic in infancy continued to have poorer

cognition, school achievement and more behaviour problems into middle

childhood. In anaemic children below 2 years short term trails of iron treatment

have generally failed to benefit development. However possible confounding

factor is poor socioeconomic status. It therefore remains uncertain whether the

poor development of iron deficient infants is due to poor socioeconomic

backgrounds or irreversible damage or is remediable with iron treatment.

McDonagh MS et al35. in his study Supplementation and screening for

iron-deficiency anaemia (IDA) in young children may improve growth and

development outcomes. Their goal of the study was to review the evidence

regarding the benefits and harms of screening and routine supplementation for

IDA. They conclude that although some evidence on supplementation for IDA

in young children indicates improvements in hematologic values, evidence on

clinical outcomes is lacking. No randomized controlled screening studies are

available.

Cusick SE et.al36., he studied anaemia incidence and persistence in low-

income preschool children. Anaemia incidence declined with age. Persistence

remained approximately 30%. Both Asian and black children had greater odds

of persistent anaemia than white children at each age. They conclude that most

follow-up anaemia in each cohort was incident, underscoring the importance of

anaemia prevention throughout early childhood in this population.

Investigation of the causes of anaemia is warranted.

Kumar A et.al37., he assessed the effect of severe maternal iron-

deficiency anaemia and nutritional status on cord blood and breast milk iron

status.

In his prospective observational study over a 6-month period in a

teaching hospital in central India, they found that concentrations of

haemoglobin, iron, and ferritin were significantly lower in the cord blood of

anaemic mothers and showed linear relationships with maternal haemoglobin

and ferritin levels.

Breast milk iron content was significantly reduced in severely anaemic

mothers but not in those with mild-to-moderate anaemia. Breast milk iron level

correlated with maternal haemoglobin and iron levels but not with ferritin

levels. Maternal anthropometry had significant correlations with indices of iron

nutritive in maternal and cord blood but showed no relationship with breast

milk iron content. Placental weight was comparable between anaemic and non-

anaemic mothers. They conclude that maternal anaemia, particularly the

severe type, adversely affects cord blood and breast milk iron status. Maternal

nutritional status exerts a significant influence on fetal iron status but has little

influence on breast milk iron content.

Rahimy MC et.al38., studied the efficacy of oral ferrous fumarate, an

inexpensive, readily available preparation on iron deficiency in infants in Africa.

Four months old (group 1) and 6-18 months old (group 2) healthy infants

attending four primary health care centres (PHC) for vaccination/well-child

visits in Benin were studied. Pregnant women (PW) over 36 weeks gestational

age attending the same PHC during the study period were also studied. Infants

were offered 2 months supplementation with oral powdered generic ferrous

fumarate (GFF), that is, 5 mg/kg/day of elemental iron, given twice and were

re-evaluated 2 months later for haematological indices. The prevalence of

anaemia and iron deficiency among pregnant women was assessed using

haematological indices and transferrin saturation. The prevalence of anemia

was 42.0%, 61.9%, and 37.5% in groups 1, 2, and PW, respectively. All anemic

PW were iron deficient. Haemoglobin level shifted towards high values after

supplementation. They conclude that programs to prevent iron deficiency

should utilize inexpensive preparations, start during pregnancy, continue in

infants at 3 months of age and address problems of noncompliance.

Maria Andersson et.al39., Iron deficiency is prevalent in infants, children

and adolescents worldwide due to their higher iron requirements during

growth, low dietary iron intake and low-bioavailability diet. Low iron status is

associated with adverse health consequences throughout childhood.

Prevention measures should be initiated early and include iron

supplementation of pregnant women, delayed cord clamping at delivery and

exclusive breast-feeding for 6 months. Iron needs to increase sharply after first

4-6 months of life and high iron content of complementary foods is critical. Iron

fortification of infant formulas and infant cereals, addition of micronutrient

powders to home-prepared complementary foods, or provision of iron drops

are the most effective prevention strategies in weaning infants, but early

introduction of meat and delayed introduction of cow’s milk are also important.

In areas of extensive iron deficiency iron supplementation may be required. All

intervention to control pediatric ID should be integrated into larger national

and global health programs for pregnant women and children, including health

education, malaria prevention and deworming. The impact of ID prevention

strategies on iron status and prevalence of ID should be monitored by

measuring iron status periodically in the population.

Klaus Schumann et al40., Infantile iron deficiency anemia reduces

maximal life time cognitive capacity and can threaten the life of an adolescent

mother in childbirth. Administration of iron is a component of strategies for

preventing or reversing iron deficiency. Oral iron supplementation, usually with

folic acid, is the main treatment of IDA in the clinical setting. Fortification of

staple food (such as flour), or age specific foods (infant formula,

complementary foods) are the usual methods of ID prophylaxis. Special iron-

rich preparations (powders, crushable tablets, edible spreads) are available for

home fortification. Side effects and toxicity after oral iron intake are seen in the

gut lumen. After oral and parenteral iron intake, the rise in circulating iron can

increase the risk of complications from coexisting infections, notably the

malaria, and when individual iron status is adequate. Growth impairment

occurs with exposure of iron –sufficient children to iron interventions, so that

targeting of iron to ID individuals seems advisable. Numerous adverse

consequences from accumulation of excessive total body iron stores show up as

a consequence of iron-mediated oxidative stress. Incomplete maturation of

iron homoeostasis may permit higher iron absorption before 6 months of age.

MATERIALS

AND

METHODS

MATERIALS AND METHODS

This is an interventional study.

Target Population

Children attending Anganwadis around Vadapalani , Chennai.

(List of Anganwadi centres – Appendix ).

Inclusion criteria

Children attending above mentioned Anganwadis.

Age group 1 to 10 years

Exclusion criteria

1. Children already on Iron supplements (Though will be treated, will be

excluded from the study)

2. Girl children who have attained menarche

Duration of study

June 2015 to December 2015

(Screening – June 2015 to August 2015)

(Intervention – October 2015 to December 2015)

Process flow

All Children

History & Anthropometry

A

Screening by Pediatrician

Blood Sample Collection

Anemic Normal

No intervention Iron supplements x 3months

Deworming x 2doses

Repeat Blood Sampling

Assessment of improvement

History & Anthropometry

Nutritional status of all the children was assessed by measuring body

height (cm), weight (kg), mid arm circumference (MAC) which was compared

with the NCHS (National Centre for Health Statistics) Standards and the

standards given by ICMR (Indian Council of Medical Research) (2008). Height of

the children was measured by a vertical measuring rod calibrated in

centimetres placed on plain floor. Weighing balance calibrated in kilogram and

gram was used for taking weight of respondents.

Screening by paediatrician

Every child included in the study is examined by the paediatrician for

signs of Protein Energy Malnutrition, haemolytic anaemias.

Blood sample collection & analysis

Sample was collected from all children and assessed for haemoglobin,

MCV, MCH, MCHC, peripheral smear. Results were analysed by haematologist

and paediatrician.

Formation of treatment group

With the analysis of the results the anemic children are grouped under

treatment group for iron treatment and deworming. According to WHO,

anaemia is classified as mild (10.9 – 9.0gm%), moderate (8.9 – 7.0gm%) and

severe (

RESULTS

AND

STATISTICAL ANALYSIS

RESULTS AND STATISTICAL ANALYSIS

Table – 1 Sex distribution of infants

Gender

Male 147

Female 133

Total 280

Figure – 1 Sex distribution of infants

Out of the total 280 children participated in the study the male and female

population were almost equal (52.5% and 47.5%).

147

133

GENDER

Male

Female

Table – 2 Result of the First Round Study

Result of the First Round Study

Healthy 198

Aneamic 82

Figure -2

In the study 71% (n= 198) of the children had normal haemoglobin and 29%

(n=82) had anemia of various severity

198

82

RESULT OF FIRST ROUND STUDY

Healthy

Aneamic

Table -3 Distribution of healthy children

Healthy

Male 102

Female 96

Total 198

Figure -3

Out of 147 male children 102 (69.38%) were healthy and out of 133 female

children 96 (72.18%) were healthy.

102

96

HEALTHY

Male

Female

Table – 4 Distribution of anemic children

Anaemic

Male 45

Female 37

Total 82

Figure – 4

Out of 147 male children 45 (30.61%) and out of 133 female children 37

(27.81%) were anemic.

45

37

ANAEMIC

Male

Female

Table-5 – Severity of anaemia

Anaemic

Mild 69

Moderate 12

Severe 1

Figure -5

Out of 82 anemic chidren 69 were mild anemic and 12 were moderately anemic

and only child had severe anemia.

69

12 1

ANAEMIC

Mild

Moderate

Severe

Table 6 - Health status after medication

Health status after medication

Improved from their original status 53

Mildly Reduced from their original status 10

Figure - 6

53 anaemic children improved after treatment; 10 children did not improve

after treatment

53

10

HEALTH STATUS AFTER MEDICATION

Improved from their original status

Mildly Reduced from their original status

Table 7 - Status of nutrition

Status of nutrition

Normal 277

Moderate acute malnutrition 3

Total 280

Figure - 7

Out of 280 children, 277 children had moderate acute malnutrition

277

3

STATUS OF NUTRITION

Normal

Moderate acute malnutrition

Table 8: Final result

FINAL RESULT

Improvement 65%

Lost follow up 23%

No improvement 12%

Figure - 8

65% of anaemic children showed improvement, 23% lost to follow up and 125

of children not responded to treatment.

65%

23%

12%

FINAL RESULT

Improvement

Lost follow up

No improvement

List of Anganwadis

Anganwadi Centre-wise details of children examined

Sl. No.

Name of the Anganwadi

Date on which examined

No. of Male Child

No. of Female

Child Total

1. Narayanasamy Thottam

13-05-2015 13 21 34

2. Krishna Nagar 15-05-2015 28 22 50

3. Indhira Nagar 20-05-2015 10 16 26

4. School Street 22-05-2015 12 19 31

5. Annaji Rao Nagar 02-06-2015 35 21 56

6. Rajangam Madhya Veethi

04-06-2015 16 10 26

7. Somasundara Bharathi Nagar

10-06-2015 13 14 27

8. Vijayaraghavapuram 16-06-2015 20 10 30

Total 147 133 280

Details of Anaemic Children

Sl. No.

Name of the Anganwadi No. of Male Child

No. of Female

Child Total

1. Narayanasamy Thottam 5 6 11

2. Krishna Nagar 6 4 10

3. Indhira Nagar 5 5 10

4. School Street 2 3 5

5. Annaji Rao Nagar 10 6 16

6. Rajangam Madhya Veethi 5 4 9

7. Somasundara Bharathi Nagar 2 7 9

8. Vijayaraghavapuram 10 2 12

Total 45 37 82

DISCUSSION

DISCUSSION

Nutritional deficiencies are very important to the well-being of the

humans in all age groups. These deficiencies can be critical in some age groups

like infants and children as they may hinder the growth and development. Iron

deficiency anemia is increasingly becoming a public health problem in the

recent times both in the adults and children. To the best of our knowledge, this

is the first study conducted in Anganwadi children for screening for iron

deficiency anemia and to find out the effect of iron supplements on the

anemia. A prospective interventional study was conducted in Anganwadi

children around Vadapalani, Chennai. Around 280 children from eight

Anganwadis were included in the study. The aim of the study is to know the

nutritional status and prevalence of Iron deficiency anemia in those children

and the effect of iron supplements. The results were analysed and presented.

PREVALENCE OF IDA

S. No.

YEAR STUDY GROUP PREVALENCE OF

IDA

1. 1999 M.Verma et al, CMC, Ludhiana 51.5%

2. 2003 Umesh Kapil et al., NFHS-II(1998-1999) 69%

3. 2005-2006 NFHS-III India-72.7% Delhi-57% Bihar-78% Gujarat-69.7% AP-70.8% Karnataka-70.4% Kerala-44.5% TN-64.2%

4. 2010 Ramesh Chellan et al., New Delhi >95%

5. 2011 Prakash V Kotecha et al, New Delhi 70%

The table shows high prevalence of anemia ranging from 44.5% to 95%.

The present study shows only 29% of the children were anemic. This lower

prevalence could be due to the small study population of Anganwadi children

and also because they receive balanced nutrition and nutritional supplements.

The highest prevalence of anemia (95%) was observed in the study

conducted by Ramesh Chellan et al which was carried out among children (0-71

months), adolescent girls (10-19 years) and pregnant women. The lowest

prevalence apart from our study was observed in Kerala in NFHS-III as 44.5%.

51.5% of the studied children aged 5-15 years were anemic in the study

conducted by M. Verma et al. This study is conducted among schools of urban

Ludhiana. They were selected randomly to include government, private and

mission-run schools thus comprised of different socio-economic groups. In this

present study the prevalence is 29% from Anganwadi children of different socio

economic groups. Interestingly in the study conducted by Verma et al, 38% of

the children from upper and upper middle class are found to be anemic as

generally iron deficiency anemia is correlated inversely to socio economic class.

In the present study, male children accounted for 52.5% (147/280) and

female children accounted for 47.5% (133/280). Out of which, anemic children

were 29.28% (82/280). In the anemic group male children accounted for

54.87% (45) and female children accounted for 45.12% (37). There is no major

difference both in the study group and anemic group between male and female

children.

Our present study is first of its kind where anemic children are treated

with iron therapy and deworming after which the same investigations are

repeated to look for the changes in the blood parameters/improvement.

In our study, eight Anganwadi centres were included from which 280

children were taken in to study group. Out of 280 children 99% (277) were in

normal nutritional status and 1% (3) having moderate acute malnutrition.

There were no children with acute severe malnutrition in our study. This is in

contrast with the study done by Thotakura praneeth et al., in which they

included 133 children of 13-60 months. The prevalence of severe malnutrition

was 7.5% and mild to moderate malnutrition was 24%.

There are not many interventional studies with iron therapy in anemic

children and assessing the treatment response. In our study the overall

prevalence of anemia in children is low which may be due to a small sample and

the children are fed with healthy food in the Anganwadis.

The present study reports 29% prevalence of anemia in Anganwadi

children and they require treatment and supplementation. Hence the study

emphasizes the urgent need for multi centric studies in larger sample sizes in

children from various parts of the state and country to form appropriate

guidelines on iron supplementation in the Indian context.

SUMMARY

SUMMARY

A prospective interventional study was conducted to assess the

nutritional status and prevalence of iron deficiency anemia in Anganwadi

children and the effect of iron supplements. 280 children from eight Anganwadi

centres were included in the study. Data was analysed and is presented.

SALIENT FINDINGS OF THIS STUDY

Out of the total 280 children participated in the study the male and

female population were almost equal (52.5% and 47.5%).

Majority of children were found in 1 to 3 years of age group and lesser

percentages in the other groups.

71% of the children had normal haemoglobin and 29% had anemia of

various severity.

Out of 82 children with anemia 54.9% were male and 45.1% were

female.

All the 82 children were treated with 2 doses of Albendazole and three

months of iron therapy.

Anemic children in different Anganwadi centres varied from as low as

16% to as high as 40%.

Out of 280 children in this study there were no children with acute

severe malnutrition.

After the initiation of treatment for the anemic children by the doctor,

the rest of the treatment plan was completed with the help of the

Anganwadi workers.

The dropout rate was 23% in the treatment group.

Out of the children treated 16% of them showed no improvement.

Out of the 82 children with anemia 1 (1.2%) child had severe anemia,

12(14.6%) children had moderate degree anemia and 69(84.2%) had

mild degree anemia.

Out of 198 healthy children 48.48% were female and 51.52% were male.

Out of 53 children showed improvement 27(51%) were females and

26(49%) were males.

10(12%) children didn’t show any improvement in their haemoglobin

status.

CONCLUSION

CONCLUSION

The present study found a lower prevalence of iron deficiency anemia of

29% among 280 children in eight Anganwadi centres around Vadapalani,

Chennai. According to WHO, the cut off value haemoglobin for anemia was

11gm%. In the study population anemia was slightly more in the males

compared to the females.

ANEMIA

The study group showed 71% of children with normal haemoglobin and

out of 29% with anemia, 84.2% of children were having mild anemia, 14.6% of

children were having moderate anemia and 1.2% were having severe anemia.

In the intervention group who received two doses of Albendazole and

three months iron treatment 65% showed improvement, 12% didn’t show any

improvement in terms of haemoglobin levels and 23% lost follow-up due to

various reasons. When the anemic status was evaluated by the peripheral

smear for microcytic hypochromic anemia and haemoglobin levels, efforts are

made to rule out other causes of anemia, like folate and vitamin B12 deficiency,

haemolytic anemia by clinically and investigation wise.

NUTRITIONAL STATUS

Both clinically and also mid arm circumference wise there were no

children with acute severe malnutrition. 1% of the study population had

moderate acute malnutrition.

In the study group iron deficiency anemia was found in a lower prevalence

compared to the general population and same age children in the community.

This could be due to the small number of children we studied and the nutrition

and supplements they receive in the Anganwadi. Hence the study emphasizes

the urgent need for multi-centric studies in larger sample sizes including both

rural and urban children belonging to different socio economic groups to assess

the iron deficiency anemia prevalence in the community and to form

appropriate guidelines on supplementation of iron in the Indian context.

RECOMMENDATIONS

RECOMMENDATIONS

1. Significant prevalence of iron deficiency anemia was found in the

present study. In view of low iron content in the breast milk, inadequate

awareness and as clinical manifestations of iron deficiency anemia will

take more time to manifest, supplementation of iron is necessary for

children. Hence there is a urgent need for multicentric interventional

studies in larger sample sizes including both rural and urban population

belonging to different socio economic groups to assess the prevalence of

iron deficiency anemia and the effect of iron supplements on them and

to form appropriate guidelines on supplementation of iron in the indian

context.

2. Since iron is abundant in many foods that are used in day to day life, it is

important to spread the awareness about the importance of iron for the

body and the growing brain of the child and also about the importance

of balance diet to avoid malnutrition. The awareness can be initiated

from the pregnant mothers and to the school children and then to the

entire community in a larger level. The school teachers, anganwadi

workers, primary health centre workers can be motivated and used for

spreading the awareness about iron deficiency anemia and how to

overcome it in an efficient manner.

3. It is always important to have screening check-ups for the children on

regular basis to find out the problems like malnutrition and iron

deficiency anemia and also many other important issues of childhood. It

will also provide an opportunity for the doctors to educate the parents

and children about the importance of healthy lifestyle and a balance

diet. So regular health screening check-ups should be encouraged in

various levels to identify the problems much earlier.

4. At last exclusive breast feeding has to be continued for 6 months in all

infants though iron content is low in human milk, in view of high

prevalence of malnutrition especially in developing countries like India.

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APPENDIX

APPENDIX

Anganwadi Centre-wise details of children examined

Sl. No. Name of the Anganwadi Total

1. Narayanasamy Thottam 34

2. Krishna Nagar 50

3. Indhira Nagar 26

4. School Street 31

5. Annaji Rao Nagar 56

6. Rajangam Madhya Veethi 26

7. Somasundara Bharathi Nagar 27

8. Vijayaraghavapuram 30

Total 280

CONSENT FORM

I __________________________ parent of ________________________

Aged _________ years going to Anganwadi, __________________________

locality understand that my child is registered for the study on the prevalence

of Iron deficiency anaemia and further treatment with Iron supplements and

deworming medication for a period of 3 months starting

____________________. I wholeheartedly agree to enrol my child into this

study and agree for the blood sample to be taken for investigation and for the

medications that will be administered orally.

It has been explained to me about this study in detail by the doctor in my own

language and I wholeheartedly consent for the same without anyone’s

persuasion.

__________________________________

Name:

Date:

CASE RECORD FORM

S. No:

Name of the child:

Age: Gender:

Address:

Address of the Anganwadi enrolled:

Name of the Anganwadi in-charge:

Date of enrolment into the study:

History

Chief complaints:

Past medical history:

Treatment history:

Relevant Antenatal history /Family history:

Immunisation history:

Developmental history:

Anthropometry

Weight: Height:

MAC : HC:

Vitals

HR: RR: BP:

SpO2: CRT: Temp:

Examination

Pallor/ Icterus/ Cyanosis/ Clubbing/ Pedal edema/ Gen lymphadenopathy

Head to toe

CVS:

RS:

ABD:

CNS:

Impression:

Vital Data

Primary investigation date

Treatment started date

Treatment given with

Treatment ending date

Repeat investigation

Primary investigation report

Repeat investigation report

Compliance on drugs: (by history)

Examination during review

Date of review:

Relevant History & examination:

Doctor’s comment

Name & signature of the doctor

Date:

STUDY ON NUTRITIONAL STATUS OF ANGANWADI CHILDREN

Sl. No.

Name of the child Age Sex Father / Mother Height (Cm)

Weight (Kg)

MAC (Cm)

Results of Investigations done Whether the child is healthy /

aneamic HB MCV MCH MCHC

1 Gauthama Rajan MJ 5 M Jaquline 96 12 15 11.3 71 23 33 Healthy

2 Raghavi S 6 F Chithra 110 16.4 16 11.5 74 25 34 Healthy

3 Varshini 5 F Shiva 108 16.1 17 11.4 73 25 34 Healthy

4 Karthikeyan V 4 M Vetrivel 106 20 18 12.4 77 26 34 Healthy

5 Kishore M 3 M Gunasundari 91 13 16 11.5 75 25 33 Healthy

6 Sanjay K 3 M Krishnan 89 10.2 14 9.1 67 20 30 Aneamic

7 Magheshwari 9 F Sundari 126 21.1 17 11.6 79 26 33 Healthy

8 Haripriya 2 F Sundari 79 9.1 14.5 11.1 78 26 33 Healthy

9 Sabarish D 3 M Yogeshwari 90 11.1 14 10.8 71 22 31 Aneamic

10 Abishek 6 M Shiva 112 17.4 17 12.1 81 27 33 Healthy

11 Jevithesh Sai S 3 M Chithra S 90 11.7 15 11.9 74 24 33 Healthy

12 Akshal M 4 F Manohar 101 14.4 16 12.1 77 26 33 Healthy

13 Pooja 3 F Gomathi L 102 12.1 15 11.8 77 25 33 Healthy

14 Dharanidaran S 4 M Deepa S 93 12.9 16 12.7 76 24 32 Healthy

15 Mahalakshmi S 7 F Deepa S 120 16.9 16 11.3 82 26 32 Healthy

16 Varshini A 2 F Ponni 81 8.9 12 9.9 61 18 30 Aneamic

17 Jeshika 3 F Srinath 96 11.5 15 10.6 73 24 33 Aneamic

18 Mythili S 3 F Malar S 87 10.3 15 11.3 71 23 32 Healthy

19 Evanjalin Rupavathi S 3 F Sam Joushwa 98 15.6 17 11.3 76 25 33 Healthy

20 Sarathy K 5 M Krishnan 109 15.3 17 11 78 26 33 Healthy

21 Thanushiya 3 F Alamelu 88 12.4 16 10.5 73 23 32 Aneamic

22 Tamilselvi 5 F Savitha 111 18.5 17 11.2 73 24 33 Healthy

23 Yashvanth M 2 M Amritha 98 13.7 16 10.3 75 25 33 Aneamic

24 Monisri K 3 F Uma K 94 10.7 14 12 76 26 35 Healthy

25 Jeevan 3 M Ammu 87 11.8 16 8.6 62 20 32 Aneamic

Sl. No.


Weight (Kg)

MAC (Cm)



26 Subashri 10 F Devi 128 19.7 18 11 75 24 32 Healthy

27 Tamil Bharathi 4 F Chithra S 104 15.4 16 10.7 71 24 33 Aneamic

28 Vanthanashri 4 F Devi 98 11.5 15 10.7 74 25 33 Aneamic

29 Dhivakar N 2 M Meena 79 7.9 14 12.3 71 25 35 Healthy

30 Hariharan 6 M Jayarani 120 23.5 22 12 75 26 35 Healthy

31 Pavya D 3 F Jayarani 96 12.2 16 12.5 75 26 35 Healthy

32 Vijayalakshmi 3 F Savitha 89 12.2 15 11.5 74 25 33 Healthy

33 Bavishyashree K 1 F Meena 79 16 9.6 58 18 31 Aneamic

34 Rithickshree M 5 F Amutha 102 14.7 15 10.4 74 25 34 Aneamic

35 Vainshnavi R 5 F Shanmugam 96 11.5 15 12.2 77 25 32 Healthy

36 Swetha V 5 F Venkatesan 111 16.6 16 11.9 79 26 33 Healthy

37 Pavithra V 2 F Venkatesan 88 10.8 16 11.1 70 23 32 Healthy

38 Mahalakshmi V 3 F Rajeswari 95 12 17 13 76 26 34 Healthy

39 Mohanapriya K 5 F Lakshmi 108.5 16.8 18 11.3 74 25 33 Healthy

40 Kabeez P 2 M Sivajothi 83 20 15 12.2 70 24 34 Healthy

41 Sai Saran R 1 M Raju 74 9 15 9.8 76 24 32 Anaemic

42 Padmavathi S 3 F Shanmugasundaram 93 11.9 15 12.8 77 26 34 Healthy

43 Guhan B 5 M Balaji 114 20.3 18 11.5 77 26 33 Healthy

44 Havisha Shree K 4 F Kamalakannan 100 14.2 16 13.5 76 27 36 Healthy

45 Bhavani N 5 F Nagaraj 107.5 15.7 16 10.8 72 23 32 Anaemic

46 Praveen Kumar S 9 M Sumathi Nagarajan 138 26 19 12.5 79 27 34 Healthy

47 Subhasree S 7 F Sumathi Nagarajan 130 39.9 28 12.6 83 27 33 Healthy

48 Thaneesa J 2 F Uma 90 11.6 15 12.2 79 27 34 Healthy

49 Kavin Kumar M 4 M Manickaraj 93 11.2 15 11.6 76 25 34 Healthy

50 Jeevan S 8 M Sathish 121 21.6 19 11.9 80 27 34 Healthy

51 Rokith K 1 M Karthikeyan 77 9.2 15 9.6 63 20 32 Anaemic

52 Yuthaya Bharathi V 5 M Vasanthkumar 112 18 17 12.9 83 28 34 Healthy

Sl. No.


Weight (Kg)

MAC (Cm)



53 Rasica B 7 F Balaji 120 19.4 18 12.1 78 26 33 Healthy

54 Sai Ram R 4 M Raju 103 13.7 15 12.5 80 27 34 Healthy

55 Divya Lakshmi Y 3 F Yuvaraj 91 12.1 16 8.5 57 18 31 Anaemic

56 Monish R 3 M Rajeswari 92 11.5 15 11.4 81 28 34 Healthy

57 Sanjai J 6 M Jayanthi 104 16.4 16 11 79 27 34 Healthy

58 Harish Kumar S 5 M Sumathi 107 16.9 18 11 77 26 34 Healthy

59 Keerthana G 7 F Parimala 136 29 20 11.4 85 28 32 Healthy

60 Arul Prakash S 3 M Selvam 102 16.3 17 11.9 80 26 33 Healthy

61 Raksitha M 3 F Senthil Kumar 89 11.1 16 11.4 76 25 33 Healthy

62 Vamsi Krishna SM 2 M Manimekalai 91 12.2 17 10.3 67 21 31 Anaemic

63 Omshree S 3 M Sathish 95 11.8 14 10.7 74 24 33 Anaemic

64 Niranjan B 10 M 134 22.7 17 13.8 77 27 35 Healthy

65 Kishore Kumar S 5 M Suresh Kumar 101 13.9 16 12 76 27 35 Healthy

66 Parinitha R 4 F Bharathi 92.5 12.3 17 13 74 25 34 Healthy

67 Prabanjan B 5 M Balumahendra 106.5 13.5 14 12.4 78 26 34 Healthy

68 Tharani Sree S 3 F Sumathi Nagarajan 92 11.1 14 12.9 74 24 33 Healthy

69 Yuvaraj S 4 M Karthikeyan 105 16.5 18 13.1 75 27 36 Healthy

70 Prem Kumar K 1 M Karthik 77 9.4 15 10.9 72 24 33 Anaemic

71 Karthikeyan K 1 M Kamalakannan 79 10.3 16 11.3 72 24 34 Healthy

72 Kanesh Kumar K 5 M Shanmugalakshmi 115 17.8 16 12.7 76 26 34 Healthy

73 Ragav VS 2 M Venkatesh 90 11.4 15 9.7 61 18 30 Anaemic

74 Praveen N 3 M Nagaraj 92 11.1 15 11 79 26 33 Healthy

75 Pooja R 10 F Rajendran 143 47 27 12.9 77 25 33 Healthy

76 Sai Ram S 1 M Selvam 75 10.4 15 11.3 70 23 33 Healthy

77 Dinesh N 9 M Nagaraj 104 19.2 15 12.8 82 28 34 Healthy

78 Kavitha R 10 F Sumathi 141 34.6 23 11.1 82 28 34 Healthy

79 Priya K 5 F Karthik 111 14.9 17 11.7 83 28 33 Healthy

Sl. No.


Weight (Kg)

MAC (Cm)



80 Vishnu Prasad R 7 M Sumathi 127 25 20 12.2 82 28 35 Healthy

81 Sumateesan K 3 M Karthikeyan 100 14.7 16 11.1 67 22 33 Healthy

82 Vijaya Manokari S 7 F Sumathi Nagarajan 118 18.9 16 13.2 80 28 35 Healthy

83 Hasini A 3 F Arumuga Nayanar 97 12.6 16 10.6 76 25 33 Anaemic

84 Vaishnavi S 4 F Sujatha 105 15.6 17 10.8 83 27 32 Anaemic

85 Naveen S 4 M Gajalakshmi 103 13.8 15 11.7 70 23 33 Healthy

86 Srilakshmi B 3 F Sathya 85 12.7 16 12.2 71 25 35 Healthy

87 Gurudevi Mani G 4 M Kalaivani 105 16.9 16 12.2 72 25 35 Healthy

88 Thanisha P 2 F Sumitha 76 6.4 15 10.1 69 22 32 Aneamic

89 Priyadharshini M 8 F Sathya 110 16.1 15 11.8 78 25 33 Healthy

90 Praveen K 3 M Karthikeyan 91.5 12.9 16 12.3 82 28 34 Healthy

91 Dhanalakshmi M 5 F Mariammal 103 13.5 16 11.7 78 25 33 Healthy

92 Harihara Sikamani B 4 M Vandhana 12 15 11.5 78 25 33 Healthy

93 Baskaran S 3 M Viji 92 13.2 16 11.7 74 24 32 Healthy

94 Nithra R 2 F Thulasi 80 9.9 14 10.8 79 25 32 Aneamic

95 Sadhana S 2 F Bhuvaneswari 92 12 15 9.6 71 23 32 Aneamic

96 Hemamalini M 3 F Mariammal 89 13.2 17 11.3 69 23 33 Healthy

97 Rasika P 4 F Bhuvaneswari 107 16.7 17 12.6 79 26 33 Healthy

98 Subhashini R 3 F Lakshmi 85 10.3 15 11 81 27 33 Healthy

99 Rohan PJ 3 M Mariammal 87 12.2 17 8.4 59 18 31 Aneamic

100 Rithisha P 4 F Sumitha 103.5 13.9 15 11.7 78 26 34 Healthy

101 Kristhilla Shamini M 3 F Salomi 91 12.2 15 12 76 24 32 Healthy

102 Ruban PJ 3 M Mariammal 88 11.6 16 8.3 58 18 31 Aneamic

103 Riya J 4 F Mariammal 97 14.3 16 9.5 65 20 31 Aneamic

104 Kavithanjali D 8 F Suganthi 118 24 20 12 80 26 33 Healthy

105 Lavanya D 4 F Suganthi 102 15 16 10.7 68 22 32 Aneamic

106 Sanjana V 3 F Jayaraman 88 10.9 15 11.8 74 24 33 Healthy

Sl. No.


Weight (Kg)

MAC (Cm)



107 Dhavanesh J 3 M Radha 92 11.9 15 9.1 56 16 29 Aneamic

108 Harisaran S 3 M Sundaravalli 89 11.3 14 10.3 71 25 36 Aneamic

109 Sadhana M 4 F Sathya 94 12.9 15 12.2 78 25 33 Healthy

110 Nakulan S 2 M Gajalakshmi 83 9.3 14 9.5 62 19 31 Aneamic

111 Preethi G 4 F Venda G 98 12 15 12.8 76 25 33 Healthy

112 Deena G 2 M Venda G 79 9.1 15 8.9 58 17 29 Aneamic

113 Dinesh T 4 M Chithra T 105 16.5 17 11.9 74 25 34 Healthy

114 Divya T 3 F Chithra T 90 12.7 16 11.9 72 23 32 Healthy

115 Swetha S 3 F Chithra 94 12.8 16 7.8 62 17 27 Aneamic

116 Sudesh S 4 M Chithra 108 16 16 11.1 73 24 33 Healthy

117 Toshika N 3 F 89 13.1 15 14.5 82 27 33 Healthy

118 Nithanya N 2 F 78 9 14 11.9 77 26 33 Healthy

119 Srija Y 4 F Bhuvaneswari 100 15.5 19 12.4 84 28 33 Healthy

120 Yuvadharshini S 2 F Hemamalini 82 9.4 14 10.6 67 21 32 Aneamic

121 Nithyasri M 5 F Sankari 100 15.7 19 14.6 82 27 33 Healthy

122 Kishore S 7 M Rajeswari 119 19.2 16 12.9 81 28 34 Healthy

123 Pooja S 3 F Rajeswari 89 11.7 15 12.3 76 25 33 Healthy

124 Iyyappan V 5 M Sathya 106 15.7 16 14.6 82 27 33 Healthy

125 Ajai Subramani V 3 M Sathya 91 13.2 16 13.4 78 27 34 Healthy

126 Aakash V 6 M Saraswathi 112 14.5 15 12.4 76 25 33 Healthy

127 Sharmila M 8 F Manikandan 125 21.2 17 12 82 27 33 Healthy

128 Tamilarasi S 2 F Muniammal 93 12.8 17 14.5 82 27 33 Healthy

129 Tharun K 3 M Kalaiselvi 94 16.2 17 12.4 66 22 33 Healthy

130 Prathicksha T 3 F Thiyagarajan 90 11 16 11.9 78 26 34 Healthy

131 Srimathi S 2 F Sankari 80 9.1 13 10.6 69 21 31 Aneamic

132 Nisha M 7 F Manikandan 110 15.6 16 12.3 79 27 34 Healthy

133 Iniya Sree S 2 F Shoban Babu 81 10.4 16 14.6 82 27 33 Healthy

Sl. No.


Weight (Kg)

MAC (Cm)



134 Kavya S 6 F Siva 103 13.7 15 12.4 77 27 35 Healthy

135 Sanjai R 10 M Raju 123 24.8 18 12.2 77 26 33 Healthy

136 Harish R 3 M Raja 97 14.1 15 11.6 80 25 32 Healthy

137 Jayasooriya R 7 M Rajan 117 20.7 18 14.7 82 27 33 Healthy

138 Sneha V 4 F Venkatesh 92.5 13.4 16 12 77 25 32 Healthy

139 Rathnavel 2 M Divya Bharathi 80 9.4 16 7.2 50 14 28 Aneamic

140 Varshini S 4 F Saroja 97 13.9 16 12.4 81 27 33 Healthy

141 Mounikasree S 5 F Saroja 108 17.7 17 12.4 84 28 33 Healthy

142 Harish K 2 M Kandhan 88 11.1 15 11.8 81 29 35 Healthy

143 Yogapriya K 10 F Kandhan 136 32 21 11.7 79 25 32 Healthy

144 Sairam G 3 M Gunasekar 96 13.6 16 10.2 72 23 33 Aneamic

145 Ramsaran G 5 M Gunasekar 114 18.5 15 11.6 75 25 34 Healthy

146 Damodaran A 3 M Anbu 87 10.7 15 11.5 79 27 34 Healthy

147 Tamish K 3 M Karthik 92.5 11.8 15 12 81 27 33 Healthy

148 Siddarth M 1 M Manikandan 76 10.3 15 10.7 65 21 32 Aneamic

149 Dhanushree M 2 F Manikandan 88 10.3 15 12.4 83 28 33 Healthy

150 Nithyashree M 3 F Murugan 94 10.8 15 11.9 80 26 34 Healthy

151 Vishnu V 2 M Vinesh Kumar 96 12.6 15 11.6 70 22 32 Healthy

152 Jagatheeshwari M 8 F Murugan 118 18.9 17 13 82 28 34 Healthy

153 Pradeepa M 10 F Murugan 125 20.4 17 12.8 77 25 33 Healthy

154 Swetha V 12 F Venkatesh 146 33.1 18 13.5 88 29 33 Healthy

155 Pavithra K 16 F Kumaresan 162 43.9 22 12.8 81 26 32 Healthy

156 Kirthika P 3 F Prakash 96 14.1 16 11.9 76 25 33 Healthy

157 Kama;esh V 2 M Venkatesh 88 11.2 15 10.6 66 21 32 Aneamic

158 Priyadharshini D 1 F Damodaran 82 10.9 15 10.6 72 24 33 Aneamic

159 Hema R 2 F Raju 89 12.5 15 11.9 77 25 33 Healthy

160 Karthikeyan R 6 M Raju 108 15.5 16 12.2 82 28 34 Healthy

Sl. No.


Weight (Kg)

MAC (Cm)



161 Mahathi R 2 F Ramesh 92 10.9 15 10.1 78 25 32 Aneamic

162 Tamil A 5 F Arumugam 106 15.5 15 11.5 86 28 33 Healthy

163 Hariharan A 2 M Arumugam 83 11.5 15 11.4 77 25 33 Healthy

164 Avinesh N 4 M Nagaraj 100 14 15 11.4 77 27 35 Healthy

165 Thenmozhi N 8 F Nagaraj 117 20.1 17 11.4 80 28 36 Healthy

166 Shaminishreee A 2 F Annadurai 84 9 15 11.5 78 26 33 Healthy

167 Yogesh Kumar A 7 M Annadurai 125 25.4 19 12.1 75 25 33 Healthy

168 Deiveegan P 5 M Prabhu 107 18.4 18 10.7 73 24 33 Aneamic

169 Deepak P 3 M Prabhu 91 11.4 15 9.3 73 23 31 Aneamic

170 Danish K 4 M Karuppaiah 107 14.2 14 12.7 75 25 33 Healthy

171 Santhosh S 3 M Suresh 91 11.7 16 11.1 71 23 33 Healthy

172 Ananya S 2 F Suresh 83.5 10.4 15 10.7 75 24 32 Aneamic

173 Vigneshwaran K 3 M Karthik 91 11.9 15 9.1 58 17 30 Aneamic

174 Kesavakumar K 2 M Kubendran 90 13.2 17 10.4 71 22 31 Aneamic

175 Varun K 4 M Karthikeyan 104.5 16.1 16 11.2 73 25 33 Healthy

176 Karthika S 2 F Santhanam 84 10.5 15 10.5 68 22 32 Aneamic

177 Vignesh M 5 M Muthu 103 16 16 12.8 77 27 35 Healthy

178 Rajkumar A 10 M Arumugam 142.5 28.1 18 11.2 84 29 34 Healthy

179 Ruthramoorthy A 9 M Arumugam 123.5 20.6 17 11.8 78 27 34 Healthy

180 Vishnuvardhan U 2 M Ulaganathan 89 12.4 17 11.7 74 25 34 Healthy

181 Dharshan U 4 M Ulaganathan 106.5 15.3 16 12.2 79 27 34 Healthy

182 Hariharan K 3 M Karthikeyan 95 12.5 15 12.6 79 27 34 Healthy

183 Anbarasan I 4 M Iyyanar 105 19.2 19 11.7 79 26 33 Healthy

184 Harihara Sudhan I 2 M Iyyappan 80 9.8 15 10.5 72 23 32 Aneamic

185 Pradeepa S 2 F Sofia 80 8.7 14 10.5 67 21 31 Aneamic

186 Sudish S 9 M Santhanam 124 18.5 16 12.2 84 27 33 Healthy

187 Ilayaraja M 4 M Manikandan 107 16.7 16 12.7 77 26 34 Healthy

Sl. No.


Weight (Kg)

MAC (Cm)



188 Thulasirajan M 5 M Manikandan 118 18.9 16 12.4 77 26 34 Healthy

189 Aishwarya K 7 F Krishnamurthy 107 13.9 14 12.4 80 28 35 Healthy

190 Dhakshayan 3 M Mohanbabu 97 13.4 16 8.7 59 18 30 Aneamic

191 Niranjan T 2 M Thiyagarajan 80 9.4 15 12.1 79 26 33 Healthy

192 Janani T 2 F Thiyagarajan 80 8.4 14 12.9 74 25 34 Healthy

193 Jayanthi Ansal M 2 F Murugan 84 8.6 13 11.3 69 22 32 Healthy

194 Ilavarasan R 4 M Rajendran 99 12 14 12.5 81 27 33 Healthy

195 Kishorekumar S 9 M Snthilkumar 134 23.1 18 10.8 93 30 32 Aneamic

196 Krishnakumar S 6 M Senthilkumar 121 20 17 12.1 78 26 34 Healthy

197 Evangilin Sherin I 3 F Isreal 93 13 16 10.3 73 24 32 Aneamic

198 Rohith S 2 M Amudha 87 13.5 17 10.7 75 26 34 Aneamic

199 Ajai P 2 M Geetha 75 7.6 13 7.9 63 18 29 Aneamic

200 Chandra Kiran Reddy CH 3 M Venkat Reddy 90 12.8 15 11.5 79 27 34 Healthy

201 Johnpal 2 M Selvi 86 12.6 16 12.1 70 23 33 Healthy

202 Yogeshwaran N 2 M Lavanya 89 14.5 15 10.3 76 25 32 Aneamic

203 Vishmupriya S 3 F Kamatchi 88 12.1 15 11.3 70 24 35 Healthy

204 Keerthishree P 4 F Prasanna 101 13.2 15 12 75 24 33 Healthy

205 Keerthana V 2 F Vignesh 80 9.5 13 10.3 74 24 32 Aneamic

206 Pooja B 3 F Annapoorani 90 13.2 16 12.5 76 25 33 Healthy

207 Chithart S 2 M Bhuvaneswari 85 12.1 15 11.2 74 25 33 Healthy

208 Saran V 2 M Sasirekha 83 10 15 9.8 68 21 31 Aneamic

209 Aleena S 2 F Fathima 82 8.7 13 8.5 74 23 32 Aneamic

210 Mitha N 2 F Fasila 84 12 15 11.2 78 26 33 Healthy

211 Sabreen Banu P 3 F Tahira Banu 102 13.6 15 12.1 78 27 34 Healthy

212 Dhanush J 3 M Logeswari 105.5 14.3 16 11.9 77 26 34 Healthy

213 Vimalraj V 3 M Sumalatha 94 10.7 15 11.1 73 25 34 Healthy

214 Nithishkumar N 2 M Rajathi 97 11.7 15 12 75 24 32 Healthy

Sl. No.


Weight (Kg)

MAC (Cm)



215 Dhushan Babu A 2 M Sheela Darthi 80 12 15 8.8 67 21 31 Aneamic

216 Mugunthan S 4 M Karthika 103 15.5 16 11.9 79 26 34 Healthy

217 Rakshana D 4 F Sangeetha 96 13.2 15 11.4 69 23 33 Healthy

218 Dhanush R 5 M Usha 103 14.8 15 11.2 78 26 33 Healthy

219 Kavisri S 2 F Nandhini 70 8.9 12 10.5 73 24 33 Aneamic

220 Jesteen M 2 M Govindammal 85 10.2 14 11.3 65 22 33 Healthy

221 Mathumitha P 2 F Kamali 91 13.9 17 10.2 67 21 32 Aneamic

222 Sri Kugan D 2 M Alagu Pechiammal 79 9.8 15 12 76 25 34 Healthy

223 Mohamed Riyas 3 M Nilofer Nisha 94 14.6 15 12.1 77 26 34 Healthy

224 Arush Krithik. S 2 M Janaki S 88 12.8 16 11.5 72 24 33 Healthy

225 Dharanidharan. S 3 M Suresh 86 12.8 17 11.6 73 25 34 Healthy

226 Varsha. R 3 F Sowbakiya 84 12 17 10.6 65 20 31 Anaemic

227 Dharun. V 3 M Shenbagam V 83 11.6 16 12.1 70 24 34 Healthy

228 Syed Shakir 3 M Syna Banu 89 12.8 17 11.5 76 25 33 Healthy

229 Siva Dharshan M 3 M Dhanalakshmi 93 12.3 14 12 75 25 33 Healthy

230 Krithika B 3 F Babu V 93 13.3 16 12.7 76 26 34 Healthy

231 Sanjay P 3 M Revathy M 89 11.2 13 12.3 78 27 34 Healthy

232 Harini Shree L 4 F Leela L 93 13.6 16 10.5 75 25 33 Anaemic

233 Charu Praba S 3 F Sundaram 84 10.8 14 11.3 80 26 33 Healthy

234 Nithesh Kumaran R 2 M Raghavan 81 11.5 15 12.1 75 26 34 Healthy

235 Shruthi C 3 F Muthulakshmi 88 12.8 16 11.9 74 25 33 Healthy

236 Varshini G 3 F Deepa G 88 12.1 16 11.1 65 22 33 Healthy

237 Ashwin A 2 M Anbalagan 77 10.3 15 11.6 77 25 33 Healthy

238 Sanjeev S 2 M Senthilkumar 81 10.8 15 11.1 78 26 34 Healthy

239 Lakshna S 3 F Selvam 80 11.6 16 10.2 69 22 31 Anaemic

240 Mathivadni K 4 F Kathiravan 99 13.2 15 13.2 78 26 33 Healthy

241 Rackesh A 3 M Anandan 89 12.6 16 11.1 71 23 32 Healthy

Sl. No.


Weight (Kg)

MAC (Cm)



242 Rohith Boss T 2 M Thangapandi 81 11 16 8.5 62 18 28 Anaemic

243 Poojashri A 3 F Karpagam 87 13.3 16 10.3 75 25 33 Anaemic

244 Pavanthika S 3 F Selvakumar 83 11.7 15 10.3 65 21 31 Anaemic

245 Daniel A 3 M Arockiaraj 85 13.7 16 11.1 73 24 33 Healthy

246 Shrinidhi K 4 F Kannan 96 12.5 14 9.7 66 20 30 Anaemic

247 Divya Dharshini S 4 F Subramani 91 13.6 15 11.6 77 25 33 Healthy

248 Nandhini S 4 F Sekar 92 11.2 15 9.4 60 19 31 Anaemic

249 Anikha R 4 F Rajkumar 100 13.1 14 11.2 79 26 33 Healthy

250 Sai Aadhavan P 3 M Saraswathi P 92 11 14 10.7 71 24 34 Anaemic

251 Arivazhagan J 2 M Jayakumar 87 10.7 15 11.2 73 23 32 Healthy

252 Hemavarshini P 2 F Prakash 88 9.6 13 11.1 70 23 33 Healthy

253 Gunaveerasekar 4 M Raghavendran 95 12.8 14 10.8 73 23 32 Aneamic

254 Amirtha A 2 F Ashok 76 9.4 13 11.3 73 23 32 Healthy

255 Kumaran M 2 M Murugan 90 11.1 14 11.9 77 26 34 Healthy

256 Santhosh M 4 M Muthu 91 11.4 14 9.5 70 22 31 Aneamic

257 Abinesh R 3 M Rajkumar 86 11.5 14 10.8 68 23 33 Aneamic

258 Venkatesh K 5 M Karthick 96 12 14 12.2 72 25 35 Healthy

259 Mithun R 3 M Rajini 91 13.5 15 9.3 58 18 31 Aneamic

260 Sivakishore R 3 M Ramakrishnan 86 11.5 15 6.7 64 18 28 Aneamic

261 Sivasankaran V 5 M Vasu 94 10.9 14 11.7 78 27 34 Healthy

262 Jayashree M 3 F Mohan 86 10.2 15 11.6 74 26 35 Healthy

263 Priyadharshan A 4 M Ayyappan 87 10 15 9.9 71 23 32 Aneamic

264 Vishal V 3 M Vijayakumar 90 11.2 15 11.4 71 24 33 Healthy

265 Srinisha S 3 F Sathyamoorthy 81 9.9 15 12.1 75 26 35 Healthy

266 Jagathratchagan 4 M Anantharaman 95 14.3 16 9.2 62 19 30 Aneamic

267 Kaviya M 2 F Muthukumar 88 11.1 15 10 71 23 32 Aneamic

268 Monish M 2 M Murugan 76 7.5 12 12.1 77 25 32 Healthy

Sl. No.


Weight (Kg)

MAC (Cm)



269 Sasikumar K 2 M Karnan 86 10.3 15 11 71 24 33 Healthy

270 Dinesh K 4 M Karnan 100 15.8 18 12.6 76 26 34 Healthy

271 Nithesh A 2 M Anbu 90 11.6 15 10.2 67 21 32 Aneamic

272 Mariammal B 2 F Balasubramanian 87 10.6 15 11.9 76 25 33 Healthy

273 Disha B 4 F Balasubramanian 92 11.6 15 12.2 77 26 33 Healthy

274 Venkat Ajay A 3 M Ashok 85 11.1 15 10.9 67 21 32 Aneamic

275 Aashish S 4 M Umapathy 99 13.9 15 13.2 75 26 35 Healthy

276 Md. Siddik 4 M Iqbal 104 16.4 17 11.8 70 24 34 Healthy

277 Aanbarasi T 5 F Thiruvenkadam 102 13.7 16 12.4 80 27 34 Healthy

278 Cheththanna S 3 F Sudhakar 93 12.3 15 10 71 22 31 Aneamic

279 Vishvasith M 2 M Murugesh 85 12.2 16 9.7 67 21 31 Aneamic

280 Prabhashree M 2 F Murugesan 90 12.3 16 11.4 79 24 30 Healthy

Male 147

Female 133

“nutritional status and prevalence of ida in anganwadi children and the effect … · 2018. 12....

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