In India, iron deficiency anemia due to nutritional causes is most commonly seen in which age group, and what is the recommended daily iron supplementation dose for this population?

Explanation

## Iron Deficiency Anemia in Indian Population: Epidemiology and Management **Key Point:** Preschool children (1–5 years) have the highest prevalence of nutritional iron deficiency anemia in India due to rapid growth velocity, transition from breast milk to complementary foods with low iron bioavailability, and high physiological iron demands. ### Epidemiology in India (NFHS-5, 2019–21) | Age Group | Prevalence (%) | Primary Cause | |-----------|----------------|---------------| | **Preschool (1–5 yr)** | **~67%** | **Nutritional deficiency — rapid growth + poor complementary feeding** | | School-age (6–14 yr) | 40–60 | Nutritional + parasitic (hookworm) | | Adolescent girls (15–19 yr) | 55–65 | Nutritional + menstrual losses | | Adult women (20–49 yr) | ~57% | Menstrual losses + repeated pregnancies | **High-Yield:** According to NFHS-5 data, children under 5 years show the **highest burden of anemia (~67%)** in India, predominantly nutritional in origin. This makes preschool children the most vulnerable group for nutritional iron deficiency anemia specifically. ### Recommended Supplementation Doses (National Iron Plus Initiative / MoHFW India) **For preschool children (1–5 years):** - **10–20 mg elemental iron daily** (as ferrous sulfate syrup) - Given as part of the National Iron Plus Initiative (NIPI) - Typically 1 mg/kg/day elemental iron for prophylaxis **For other groups (for comparison):** - School-age children (6–14 yr): 30–45 mg elemental iron weekly (not 20–30 mg daily) - Adolescent girls/boys (10–19 yr): 60 mg elemental iron weekly (Weekly Iron Folic Acid Supplementation — WIFS) - Pregnant women: 60 mg elemental iron + 500 µg folic acid daily ### Why Other Options Are Incorrect - **Option A (Adult women; 40–50 mg daily):** Adult women have high anemia prevalence but the cause is mixed (menstrual + nutritional); the dose cited is also non-standard. - **Option B (School-age children; 20–30 mg daily):** School-age children receive weekly (not daily) supplementation under WIFS; nutritional anemia is highest in preschool, not school-age. - **Option C (Adolescent girls; 30–40 mg daily):** Adolescent girls are a high-risk group but not the highest for purely nutritional causes; WIFS provides 60 mg weekly, not 30–40 mg daily. **Clinical Pearl:** The National Iron Plus Initiative (NIPI) targets all age groups but preschool children (6 months–5 years) are the primary focus for nutritional iron deficiency, receiving iron syrup supplementation through ICDS/Anganwadi centers (Park's Textbook of Preventive and Social Medicine, 26th ed.). **Mnemonic:** **PRESCHOOL PRIORITY** — Preschool children (1–5 yr) face the highest nutritional IDA burden in India; dose = **10–20 mg elemental iron daily**.