Anemia and Micronutrient Deficiencies in Young Children in Urban Slums of Mumbai, India

Abstract

Objectives: To examine the burden of anemia and micronutrient deficiencies among young children living in urban slums of Mumbai, India. Methods: Participants were children 10-18 months of age (n = 278) residing in urban slums in Mumbai who were screened as part of a randomized feeding trial of biofortified pearl millet. Venous blood was collected by a pediatric phlebotomist and hemoglobin (Hb) concentrations were assessed via Coulter counter. Samples were processed and stored < 11.0 g/dL and Hb < 7.0 g/dL. Iron deficiency (ID) was defined as SF < 12.0 µg/L, iron insufficiency was defined as SF < 20.0 µg/L, and inflammation was defined as CRP > 5.0 mg/L. Iron deficiency anemia was defined as Hb < 11.0 g/dL and SF < 12.0 µg/L. Vitamin A deficiency was defined as serum retinol <20.0 µg/L. Vitamin B 12 deficiency and vitamin B 12 insufficiency were defined as <148.0 pmol/L and <221.0 pmol/L; folate deficiency was defined as RBC folate <340 nmol/L. Linear and binomial regression models were used to examine associations of micronutrient biomarkers with Hb levels and risk of anemia. Results: A total of 75.5% of children were anemic and 2.9% had severe anemia. The prevalence of iron deficiency was 61.4% (69.5% after Thurman adjustment), 57.4% of children had IDA, and 9.7% had CRP > 5.0 mg/L. The prevalence of vitamin B 12 deficiency was 17.0%, 41.8% of children had vitamin B 12 insufficiency, and 19.9% had folate deficiency. Among anemic children, 84.5% had ≥1 micronutrient deficiency and 22.7% had ≥ 2 micronutrient deficiencies. Iron deficiency (RR: 2.15; 95% CI: 1.55, 2.99; P < 0.001), and vitamin B 12 deficiency (RR: 1.32; 95% CI: 1.09, 1.60; P < 0.01) were associated with significantly increased risk of anemia. Conclusions: Findings indicate that the burden of anemia, iron deficiency, and vitamin B 12 insufficiency were high in young children in Mumbai, India.