The Additional Burden of Anaemia



The most common nutritional deficiency in the world today is that of iron. Deficiency in iron and other micro-nutrients like vitamin A and zinc significantly increase susceptibility to infections and the risk of severe illness and death, also adversely impacting cognitive development in children and work capacity in adults. Even in the context of South Asia, India’s situation with reference to nutritional anaemia is particularly adverse. Whether one considers anaemic children below the age of 5 years, wherein India records 75 % prevalence, ranking just above Bhutan (at 81 %) or women in the reproductive age group, where India at 51 % performs, perhaps, better ranking just below Bangladesh, which at 36 % prevalence is the top performer in South Asia, anaemia levels in the country remain unacceptably high, compounding the ill effects of undernutrition. This chapter reviews numerous studies on anaemic populations in India and other countries to bring out the additional health burden that the country bears due to this micro-nutrient deficiency.


Iron Deficiency Iron Deficiency Anaemia Recommended Daily Allowance Digit Span Test Anaemia Prevalence 
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  1. Agarwal, D. K., Upadhyay, S. K., Tripathi, A. M., & Agarwal, K. N. (1987). Nutrition status, physical work capacity and mental function in school children. Scientific Report 6. New Delhi: Nutrition Foundation of India.Google Scholar
  2. Angeles, I. T., Schultink, W. J., Matulessi, P., Gross, R., & Sastroamidjojo, S. (1993). Decreased rate of stunting among anaemic Indonesian preschool children through iron supplementation. American Journal of Clinical Nutrition, 58, 339–342.PubMedGoogle Scholar
  3. Aukett, M. A., Parks, Y. A., & Scott, P. H. (1986). Treatment with iron increases weight gain and psychomotor development. Archives of Disease in Childhood, 61, 849–854.PubMedCrossRefPubMedCentralGoogle Scholar
  4. Ballin, A, Berar, M, Rubinstein, U., Kleter, Y., Hershkovitz, A., & Meytes, D. (1992). Iron state in female adolescents. American Journal of Diseases of Children, 146(7): 803–805.Google Scholar
  5. Basta, S. S., Soekirman, D. S., Karyadi, D., & Scrimshaw, N. S. (1979). Iron deficiency anemia and the productivity of adult males in Indonesia. American Journal of Clinical Nutrition, 32, 916–925.PubMedGoogle Scholar
  6. Bhatia, D., & Seshadri, S. (1992). Growth performance in anemia and following iron supplementation. Indian Paediatrics, 30, 195–200.Google Scholar
  7. Bothwell, T. H., & Charlton, R. W. (Eds.). (1981). Iron deficiency in women. Washington, DC: Nutrition Foundation.Google Scholar
  8. Briend, A., Hoque, B. A., & Aziz, K. M. A. (1990). Iron in tube well water and linear growth in rural Bangladesh. Archives of Disease in Childhood, 65, 224–225.PubMedCrossRefPubMedCentralGoogle Scholar
  9. Bubonis, G. J., Edward, M., & Puri-Sharma, C. (2006). Anemia and school participation. Journal of Human Resources Fall 2006, 41(4): 692–721. Retrieved January 11, 2012, from
  10. Chellan, R., & Paul, L. (2010). Prevalence of iron-deficiency anaemia in India: Results from a large Nationwide Survey, Journal of Population and Social Studies, 9(1), 59–80. Retrieved January 11, 2012, from
  11. Davies, C. T. M., Chukweumeka, A. C., & Van Haaren, J. P. M. (1973). Iron deficiency anemia: its effect on maximum aerobic power in responses exercise in African males aged 17–40 years. Clinical Science (London), 44, 555–562.Google Scholar
  12. Department of Women and Child Development, GoI. (2009). Chapter 7.11, Micronutrient Deficiencies, pp. 267–278. Retrieved February 5, 2012, from
  13. Dossa, R. A., Ategbo, E. A., de Koning, F. L., van Raaij, J. M., & Haulvast, J. G. (2001). Impact of iron supplementation and deworming on growth performance in preschool Beninese children. European Journal of Clinical Nutrition, 55, 223–228.PubMedCrossRefGoogle Scholar
  14. Edgerton, V. R., Gardner, G. W., Ohira, Y., Gunawardena, K. A., & Senewiratne, B. (1979). Iron-deficiency anemia and its effect on worker productivity and activity patterns. British Medical Journal, 2, 1546–1549.PubMedCrossRefPubMedCentralGoogle Scholar
  15. Edgerton, V. R., Ohira, Y., Hettiarachchi, J., Senewiratne, B., Gardner, G. W., & Barnard, R. J. (1981). Elevation of hemoglobin and work tolerance in iron-deficient subjects. Journal of Nutritional Science and Vitaminology (Tokyo), 27, 77–86.CrossRefGoogle Scholar
  16. FAO. (2004). Undernourishment around the world: Counting the hungry: latest estimates. In The state of food insecurity in the world, 2004. Rome: Italy. Retrieved February 14, 2012, from
  17. Gardner, G. W., Edgerton, V. R., Senewiratne, B., Barnard, R. J., & Ohira, Y. (1977). Physical work capacity and metabolic stress in subjects with iron deficiency anemia. American Journal of Clinical Nutrition, 30, 910–917.PubMedGoogle Scholar
  18. Gowri, A. R., & Sargunam, H. J. (2000). Assessment of mental and motor abilities of school going children with anaemia. The Indian Journal of Nutrition and Dietetics, 37, 296–302.Google Scholar
  19. Gragnolati, M., Shekar, M., Das Gupta, M., Bredenkamp, C., Lee, Y.-K. (2005). India’s undernourished children: A call for reform and action, HNP discussion series. The World Bank. Retrieved November 3, 2012, from
  20. Haas, J. D., & Brownlie, T., IV. (2001). Iron deficiency and reduced work capacity: A critical review of the research to determine a causal relationship. Journal of Nutrition, 131, 676S–690S, Retrieved February 15, 2012, from
  21. Horton, S., & Ross, J. (2003). The economics of iron deficiency. Food Policy, 28, 51–75, Retrieved February 17, 2012, from Google Scholar
  22. Husaini, M. A., Djojoseobagio, S., & Karyadi, D. (1984). Socioeconomic and dietary correlates of iron deficiency on an Indonesian tea plantation. In Proceedings of the Eighth Annual INACG Meeting. Bali, Indonesia: INACG.Google Scholar
  23. Husaini, M. A., Karyadi, H. D., & Gunadi, H. (1981). Evaluation of nutritional anaemia intervention among anemic female workers on a tea plantation. In L. Hallberg & N. S. Scrimshaw (Eds.), Iron deficiency and work performance (pp. 72–85). Washington, DC: Nutrition Foundation.Google Scholar
  24. Idjradinata, P., & Pollitt, E. (1993). Reversal of developmental delays in iron-deficient anemic infants treated with iron. Lancet, 341, 1–4.PubMedCrossRefGoogle Scholar
  25. Indian Council of Medical Research. (2000). Iron absorption and its implications on strategies to control iron deficiency anaemia, ICMR Bulletin, 30(2), 15–22.Google Scholar
  26. Indian Council of Medical Research. (1992). Field Supplementation Trial in Pregnant Women with 60 mg, 120 mg and 180 mg of Iron with 500 μg of Folic Acid. Report of a Task Force Study, New Delhi.Google Scholar
  27. Judisch, J. M., Naima, J. L., & Oski, F. (1986). The fallacy of the fat iron deficient child. Pediatrics, 37, 987–990. Retrieved March 5, 2012, from
  28. Kotecha, P. V. (2010). Nutritional anemia in young children with focus on Asia and India. Indian Journal of Community Medicine. Retrieved February 23, 2012, from;year=2011;volume=36;issue=1;spage=8;epage=16;aulast=Kotecha
  29. Kotecha, P. V., & Lahariya, C. (2010). Micronutrient supplementation and child survival in India. The Indian Journal of Pediatrics, 77(4), 419. Retrieved March 4, 2012, from;year=2008;volume=33;issue=1;spage=9;epage=10;aulast=Kotecha
  30. Latham, M. C., et al. (1990). Improvements in growth following iron supplementation in young Kenyan school children. Nutrition, 6, 159–165.PubMedGoogle Scholar
  31. Li, R., Chen, X., Yan, H., Deurenberg, P., Gasby, L., & Hautvast, J. G. A. J. (1994). Functional consequences of iron supplementation in iron deficient female cotton mill workers in Beijing, China. American Journal of Clinical Nutrition, 59, 908–913.PubMedGoogle Scholar
  32. Lozoff, B., Jimenez, E., & Wolf, A. W. (1991). Long term developmental outcome of infants with iron deficiency. New England Journal of Medicine, 325, 687–695.PubMedCrossRefGoogle Scholar
  33. Lozoff, B. (1989). Methodologic issues in studying behavioral effects of infant iron-deficiency anemia. American Journal of Clinical Nutrition, 50, 641–654.PubMedGoogle Scholar
  34. Lozoff, B., et al. (1982). Behavioural abnormalities with iron deficiency. In E. Pollitt & R. L. Leibel (Eds.), Iron deficiency: Brain biochemistry and behaviour (pp. 183–194). New York: Raven Press Ltd.Google Scholar
  35. Miller, W. (1999). Can vegetarians get enough iron? (Yes!). Retrieved March 7, 2012, from
  36. Nayanatara, S. N., Chidambarathanu, S. J., Krithiga, S., & Manya, V. (2010). India’s Anaemia WoesA Study. Retrieved April 4, 2012, from
  37. O’Donnell, A. M., Carmuega, E. S., & Duran, P. (1997). Preventing iron deficiency in infants and preschool children in Argentina. Nutrition Review, 55, 189–194.CrossRefGoogle Scholar
  38. Pollitt, E. (1991). Effects of a diet deficient in iron on the growth and development of preschool and school-age children. Food and Nutrition Bulletin, 13, 110–118.Google Scholar
  39. Pollitt, E., Hathirat, P., Kotchabhakdi, N. J., et al. (1989). Iron deficiency and educational achievement in Thailand. American Journal of Clinical Nutrition, 50, 687–697.PubMedGoogle Scholar
  40. Pollitt, E., Soemantri, A. G., Yunis, F., & Scrimshaw, N. S. (1985). Cognitive effects of iron deficiency anaemia (letter to the editor). Lancet, 1, 158.PubMedCrossRefGoogle Scholar
  41. Rao, S., Yajnik, C. S., Kanade, A., et al. (2001). Intake of micronutrient-rich foods in rural Indian mothers is associated with the size of their babies at birth: Pune maternal nutrition study. Journal of Nutrition, 131, 1217–1224.PubMedGoogle Scholar
  42. Rowland, T. W., Deisroth, M. B., Green, G. M., & Kelleher, J. F. (1988). The effect of iron therapy on the exercise capacity of nonanemic iron-deficient adolescent runners. American Journal of Diseases of Children, 142, 165–169.PubMedGoogle Scholar
  43. Sanghvi, T. G. (1996). Economic rationale for investing in micronutrient programs: a policy brief based on new analyses. Washington, DC: Office of Nutrition, Bureau for Research and Development, United States Agency for International Development.Google Scholar
  44. Scholz, B. D., Gross, R., Schultink, W., & Sastroamidjojo, S. (1997). Anaemia is associated with reduced productivity of women workers in even less-physically-strenuous tasks. British Journal of Nutrition, 77, 47–57.PubMedCrossRefGoogle Scholar
  45. Seshadri, S., & Gopaldas, T. (1989). Impact of iron supplementation on cognitive functions in preschool and school-aged children: the Indian experience. American Journal of Clinical Nutrition, 50, 675–686.PubMedGoogle Scholar
  46. Seshadri, S., Hirode, K., Naik, P., & Malhotra, S. (1982). Behavioral responses of young anemic indian children to iron-folic acid supplements. British Journal of Nutrition, 48(2), 233–240.PubMedCrossRefGoogle Scholar
  47. Sen, A., & Kanani, S. J. (2006). Deleterius functional impact of anaemia on young adolescent school girls. Indian Paediatrics, 43, 219–226.Google Scholar
  48. Sharma, K. K. (2003). Improving bioavailability of iron in Indian diets through food-based approaches for the control of iron deficiency anaemia, FNA/ANA, 32, 51-57. Retrieved March 15, 2012, from
  49. Shaw, J. G. & Friedman, J. F. (2011). Iron deficiency anemia: Focus on infectious diseases in lesser developed countries. Review Article, Anemia, 2011, Article ID 260380, 10. Retrieved March 15, 2012, from
  50. Siddiqui, M. S., & Siddiqui, M. K. (2008). Public health significance of iron deficiency anaemia. Pakistan Armed Forces Medical Journal, 58(3). Retrieved March 20, 2012, from
  51. Singla, P. N., Gupta, H. P., Ahuja, C., & Agarwal, K. N. (1982). Deficiency anaemia in preschool children-estimation or prevalence based on response to haematinic supplementation. Journal of Tropical Paediatrics, 28, 77–80.CrossRefGoogle Scholar
  52. Soemantri, A. G. (1989). Preliminary findings on iron supplementation and learning achievement of rural Indonesian Children. American Journal of Clinical Nutrition, 50, 698–702.PubMedGoogle Scholar
  53. Soemantri, A. G., Pollitt, E., & Kim, I. (1985). Iron deficiency anemia and educational achievement among school age children in a rural community in Indonesia. American Journal of Clinical Nutrition, 42(6), 1221–1228.PubMedGoogle Scholar
  54. Soewondo, S., Husaini, M., & Pollitt, E. (1989). Effects of iron deficiency on attention and learning processes in preschool children: Bandung, Indonesia. American Journal of Clinical Nutrition, 50, 667–674.PubMedGoogle Scholar
  55. Spurr, G. B., Barac, M., & Maskud, M. G. (1978). Childhood undernutrition: Implications for adult work capacity and productivity. In L. J. Folinsbee, J. A. Wagner, J. F. Borgia, B. L. Drinkwater, J. A. Gliner, & J. F. Bedi (Eds.), Environmental stress: Individual human adaptations (pp. 165–181). New York: Academic Press.CrossRefGoogle Scholar
  56. Stoltzfus, R. J., Kvalsvig, J. D., Chwaya, H. M., Montresor, A., Albonico, M., Tielsch, J. M., et al. (2001). Effects of iron supplementation and anthelmintic treatment on motor and language development of preschool children in Zanzibar: Double blind, placebo controlled study. British Medical Journal, 323(7326), 1389–1393.PubMedCrossRefPubMedCentralGoogle Scholar
  57. Tolentino, K., & Friedman, J. F. (2007). An update on anaemia in developing countries. The American Journal of Tropical Medicine and Hygiene, 77(1), 44–51.Google Scholar
  58. UNESCO. (2004). Iron deficiency anaemia, fresh tools for effective school health (1st ed.). Geneva: World Health Organization.Google Scholar
  59. UNICEF/UNU/WHO. (2001). Iron deficiency anaemia: assessment, prevention, and control, a guide for programme managers. Geneva: World Health Organization.Google Scholar
  60. Unturo, J., Gross, R., Schultink, W., & Sediaoetama, D. (1998). The association between BMI and haemoglobin and work productivity among Indonesian female factory workers. European Journal of Clinical Nutrition, 52, 131–135.CrossRefGoogle Scholar
  61. Vijayalakshmi, P., & Selvasundari, S. (1983). Relationship between iron deficiency anemia and energy expenditure of young adult women. Indian Journal of Nutrition and Dietetics, 20, 113–117.Google Scholar
  62. Vijayalakshmi, P., Kupputhai, U., & Maheswani, V. (1987). Anaemia and work output of farm women. Indian Journal of Nutrition and Dietetics, 24, 253–259.Google Scholar
  63. Vijayaraghavan, K. (2002). Control of micronutrient deficiencies in India: Obstacles and strategies. Nutrition Reviews, 60(2), S73–S76.Google Scholar
  64. Viteri, F. E., & Torun, B. (1974). Anaemia and physical work capacity. Clinics in Haematology, 3, 609–626.Google Scholar
  65. Walter, T., Kovalsys, J., & Stekel, A. (1983). Effect of mild iron deficiency on infant mental development scores. Journal of Paediatrics, 102(4), 519–522.CrossRefGoogle Scholar
  66. Walter, T. (1996). Effects of iron deficiency anaemia on cognitive skills in infancy. In L. Hallberg & N. G. Asp (Eds.), Iron nutrition in health and disease (pp. 219–229). London: John Libby and Co., Ltd.Google Scholar
  67. Webb, T., & Oski, F. (1973). Iron deficiency anaemia and scholastic achievement in young adolescents. Journal of Pediatrics, 82, 827–830.PubMedCrossRefGoogle Scholar
  68. World Health Organization. (2008). Global burden of diseases 2004 update. Geneva: World Health Organization.Google Scholar
  69. WHO, Worldwide Prevalence of Anaemia. (1993–2005). Global database on iron deficiency and anaemia. Geneva: World Health Organization. Retrieved October 12, 2012, from
  70. Wolgemuth, J. C., Latham, M. C., Hall, A., Chesher, A., & Crompton, D. W. (1982). Worker productivity and the nutritional status of Kenyan road construction laborers. American Journal of Clinical Nutrition, 36, 68–78.PubMedGoogle Scholar
  71. Yip, R., & Ramakrishnan, U. (2002). Forging effective strategies to combat iron deficiency. Journal of Nutrition, 132(4), 827S–830S. Retrieved February 02, 2012, from Google Scholar

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© Springer India 2014

Authors and Affiliations

  1. 1.Independent Development ConsultantGurgaonIndia

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