Prevalence of anaemia among under five children of brick-kiln migratory labourers among rural community

INTRODUCTION

Anaemia, characterised by a deficiency in red blood cells or haemoglobin, remains a significant public health concern, particularly among vulnerable populations such as under-five children in low-income settings.^[1-3] Optimum level of haemoglobin level is important for the overall nutritional growth, cognitive development and prevention of infection related to low immunity due to anaemia.^[4]

Anaemia remains one of the most prevalent and serious global health issues affecting children under five, primarily in low- and middle-income countries. According to recent estimates, approximately 40% of all children under five years worldwide are affected by anaemia, leading to adverse outcomes in physical growth, neurodevelopment, cognitive performance, and immunity.^[5] In India, the burden is even greater: the latest National Family Health Survey (NFHS-5, 2019–21) revealed that 67.1% of children aged 6–59 months are anaemic, reflecting a continued public health gap despite ongoing national interventions such as the Anaemia Mukt Bharat program.^[6]

Children from marginalised groups—including those of migratory brick-kiln labourers—face heightened risk of undernutrition and micronutrient deficiency. Study done by Roshania et al. reported 51% under-five children living in migrant family are stunted.^[7] These families commonly reside in rural, resource-poor or hard to reach areas where food insecurity, limited access to healthcare, inadequate sanitation, and lesser coverage of government nutrition schemes. This group of population suffer from variable level of micro and macro level of undernutrition. Amongst these, the children of brick-kiln migratory labourers in rural communities of Northern India are particularly at higher risk due to local level presence of various socioeconomic and environmental factors.

These factors, coupled with the burden of strenuous labour and inadequate maternal and child health care, may exacerbate the prevalence of anaemia among their offspring. Moreover, seasonal migration further disrupts the participation in immunisation and nutrition supplementation programs, aggravating the risk of nutritional deficiencies. Studies specifically focusing on under-five children of brick-kiln workers in North India have shown anaemia prevalence rates exceeding 60%, with iron deficiency being the primary cause.^[8] Young children (especially under two years), higher birth order, and shorter exclusive breastfeeding duration are significant risk factors.

Despite these vulnerabilities, there is a considerable paucity of studies assessing the anaemia burden among under-five children in brick-kiln labourer communities. Understanding the prevalence of anaemia among under-five children of brick-kiln migratory labourers in rural North India is crucial for developing targeted interventions and addressing the issue at its root. By shedding light on the factors contributing to anaemia in this specific population, we can devise evidence-based strategies to improve the overall health and well-being of these vulnerable children. Therefore, documenting the magnitude and factors of anaemia in this uniquely at-risk population is essential to inform health policy and enable targeted interventions. Therefore, the present study aimed to assess the prevalence of anaemia among under-five children of brick-kiln migratory labourers in rural North India.

MATERIAL AND METHODS

RESULTS

During the study period, a total of 304 records were retrieved. The male and female children ratio was almost 1:1. Most of the children were from 1 year to 3 years of age (nearly 40%) and of birth order of up to two (66.8%) [Table 1].

As per the different age category, both male and female children were from all age groups, being almost equal in proportion. Male children had slightly higher birth order than female children. Similarly, male children had higher family size [Table 2].

Overall, the prevalence of anaemia was 75%. Mild anaemia was 20.4%, moderate being the highest (48.4%) and 6.2% had severe anaemia [Table 3].

Moderate category anaemia was the most common form overall, and affecting a higher proportion of females than males. Similarly, severe anaemia was also higher among female children. In contrast, the prevalence of no anaemia and mild anaemia was higher among males compared to females.

Among the male children, 31.6% didn’t have anaemia, while 42.5% had moderate anaemia and 5.1% had severe anaemia. On the other side, among female only 18.1% didn’t have anaemia, making a total 81.9% anaemic. The moderate anaemia prevalence was 54.3% while 7.3% had severe anaemia. This prevalence was statistically significant between male and female children (p value: 0.04).

The mean (SD) haemoglobin level was 9.8 (1.9) g/dL (95% CI: 9.5–10.2) among male children and 9.4 (1.9) g/dL (95% CI: 9.1–9.7) among female, with a statistically significant (p = 0.045) difference [Table 4].

The anaemia prevalence according to different categories showed the moderate anaemia highest at the age of 13-24 months and severe anaemia in 25-36 months of age group. These prevalence was differential among male and female children. The moderate anaemia was highest among male of 13-24 months whereas highest prevalence of severe anaemia was noted among male children of up to 12 months of age. However, the total anaemia was noted among male and female of up to 12 months of age [Table 5].

As per the correlation analysis, haemoglobin levels did not show any significant correlation with birth order (r = 0.066, p = 0.254), total number of family members (r = 0.048, p = 0.406), or age of the children (r = 0.096, p = 0.096), suggesting that haemoglobin was relatively independent of these variables [Table 5].

The haemoglobin level was positively correlated with age of the children (r: 0.175, p:0.002). However, the relation was not purely linear. At lower age, female had higher haemoglobin which started to fall with maximum fall at around 20 months of age followed by a slow rise [Figure 1].Figure 1: Correlation of age and haemoglobin level of the male and female children.

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Figure 1:

Correlation of age and haemoglobin level of the male and female children.

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When different predictor variables were compared across the categories of anaemia, female children showed to be having 2.3 odds of developing moderate anaemia compared to males (OR = 2.284, 95% CI: 1.28–4.07, p = 0.005). In all other categories of anaemia, none of the predictor variables showed significant association, though in severe anaemia, female had a higher odds (OR = 2.623, 95% CI: 0.93–7.37, p = 0.067) [Table 6].

DISCUSSION

Our study revealed a notably high burden of anaemia among the under-five children living in the brick-kiln coming from migratory labourers in rural Northern India. The anaemia burden in mild, moderate and severe category was 20%, 48% and 6%. This prevalence was higher than the national estimated reported by NFHS-5 (2019–21), where the prevalence among under-five children aged 6–59 months was 67.1%.^[6,10]

The most common category was moderate level anaemia and disproportionately higher prevalence among female children (54.3% moderate and 7.3% had severe vs 42.5% moderate and 5.1% severe among males). The mean haemoglobin level also found to be significantly lower among females (9.4 g/dL) vs males (9.8 g/dL). This highlighted the gender disparity on anaemia of moderate and severe category. Though the NFHS data usually indicated almost equal prevalence among male and female children, various other studies reported higher anaemia among females indicating some social or nutritional neglect of females.^[11,12]

In our study, the highest anaemia prevalence noted within first two years of age. Even if we ignore the different cut off of anaemia classification, the absolute haemoglobin level also dropped till 20 months of age followed by slow rise. This scenario was reported in another study by Singh et al. where the peak prevalence of anaemia noted in 12-17 months for male and 18-23 months of female.^[13]

Among the socio-demographic factors, age showed a significant positive correlation with haemoglobin level but not birth order, family size. This differed from large scale national survey trends—where higher birth order and younger age (especially 6–23 months) were seen as risk factors for anaemia.^[14] Due to higher socioeconomically vulnerability and coexisting malnutrition and lower sample size may be the reason.

The multinomial analysis found that female children had significantly higher odds of moderate anaemia versus males (OR = 2.28; 95% CI: 1.28–4.07; p = 0.005). The odds for severe anaemia were also higher (OR = 2.62), though not statistically significant (p = 0.067), possibly due to lower case numbers. This differential burden based on the gender may indicate the socio-cultural norms that disadvantage female children in nutrition and healthcare access. These finding is in line with broader concerns of gendered intra-household food distribution and health-seeking prioritisation, which, while documented in older age groups, likely begin early in childhood.^[15]

Public health implications from these findings were clear: the extremely high anaemia burden in this migratory labourer community revealed glaring gaps in nutrition and health service outreach. National programs like Anaemia Mukt Bharat may not adequately reach highly mobile populations lacking stable access to supplementation, deworming, or health education

Therefore, targeted, community-specific interventions—mobile camps, linkages with employers, health camps near brick kilns—are essential.

CONCLUSION

Anaemia among under-five children in this brick-kiln migrant community was alarmingly high, particularly affecting female children. Given the potential for anaemia to impair growth, cognitive development, and increase morbidity, addressing it in such settings is urgent. Policies must incorporate gender-sensitive, outreach-based strategies to serve migratory populations effectively.