Prevalence and Associated Risk Factors of Undiagnosed Iron Deficiency Anemia in the Pediatric Population

Abstract

Background:
Iron deficiency anemia (IDA) remains one of the most prevalent nutritional disorders among children worldwide and is frequently underdiagnosed, particularly in low- and middle-income countries. Undiagnosed IDA during childhood is associated with impaired cognitive development, reduced immunity, poor academic performance, and delayed growth. Early identification of associated risk factors is essential for effective prevention and timely intervention.

Objective:
To determine the prevalence of undiagnosed iron deficiency anemia and to identify its associated demographic, nutritional, and socioeconomic risk factors among the pediatric population.

Methods:
A cross-sectional analytical study was conducted among pediatric patients aged 6 months to 12 years attending a tertiary care hospital in Lahore Punjab Children with previously diagnosed hematological disorders, chronic systemic illnesses, or current iron therapy were excluded. Data regarding demographic characteristics, dietary habits, socioeconomic status, maternal education, breastfeeding practices, and history of recurrent infections were collected using a structured questionnaire. Complete blood count and serum ferritin levels were obtained for screening and confirmation of iron deficiency anemia. IDA was defined according to World Health Organization criteria. Statistical analysis was performed using SPSS version 26.0. Multivariable logistic regression analysis was used to identify independent risk factors associated with undiagnosed IDA, with p <0.05 considered statistically significant.

Results:
A total of 420 children were enrolled in the study, with a mean age of 5.8 ± 3.1 years. The overall prevalence of undiagnosed iron deficiency anemia was 34.5%. Higher prevalence was observed among children under five years of age, those from low socioeconomic backgrounds, and children with inadequate dietary iron intake. Significant independent risk factors included prolonged exclusive milk feeding (AOR: 2.41; 95% CI: 1.48–3.91), poor dietary diversity (AOR: 2.76; 95% CI: 1.69–4.52), maternal illiteracy (AOR: 1.94; 95% CI: 1.17–3.20), recurrent gastrointestinal infections (AOR: 1.88; 95% CI: 1.10–3.01), and low household income (AOR: 2.57; 95% CI: 1.51–4.36). Children with undiagnosed IDA also demonstrated significantly lower mean weight-for-age and height-for-age z-scores compared to non-anemic participants.

Conclusion:
Undiagnosed iron deficiency anemia is highly prevalent among the pediatric population and is strongly associated with nutritional inadequacies and adverse socioeconomic determinants. Routine screening strategies, parental education, nutritional interventions, and early preventive measures are crucial to reduce the burden of IDA and its long-term developmental consequences in children.