Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
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It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2011 | Month : April | Volume : 5 | Issue : 2 | Page : 324 - 327

A study on the Iron status In Iron Deficiency Anaemia one month before and after Iron Therapy in school going children

MAHESHWARI B.K, RAUT P,AGARWAL S.K.,JOSHI U, DHIRHE T.C, GAHINE R

Dept of Pharmacology Dept of Pathology

Correspondence Address :
Dr Presenjit Raut, Asst. Prof. (Pharmacology), Pt. JNM medical
college, Raipur, CG-492001
Phone: 09039267377

Abstract

Objective 1) To determine the iron status (Hb, MCV, MCH, MCHC, RDW, Serum Iron, TIBC and Serum Ferritin) before iron therapy in school going children. 2) To determine the haemoglobin concentration after one month of iron therapy in children whose haemoglobin concentrations were lower for the given age and sex. 3) To evaluate the therapeutic outcomes of the oral iron therapy.

A total of hundred anaemic children from three government schools of Raipur city were subjected to anthropometric, iron status and clinical examinations before they underwent iron therapy and the response to therapeutic iron was assessed by the estimation of the haemoglobin percentage after one month following the administration of ferrous sulphate, 6mg/kg body weight along with folic acid. Not a single patient withdrew from the study because of adverse effects.

A significant increase in the haemoglobin (p<0.009) level was observed in both boys and girls after 30 days of iron supplementation.

A total of hundred anaemic children were subjected for the study. In all the 100 children, clinical pallor was the first finding(in 100%), followed by fatigue (in 54%), weakness (in 38%), anorexia (in 18%) and icterus (in 5%). The commonest blood picture was that of microcytic hypochromic. Age dependent MCV, MCH, MCHC and RDW showed that the maximum number of cases had below normal MCV, MCH and MCHC values. RDW values were increased in 74% cases, 82% cases had serum iron values below normal (<50μg/dl) and 91% cases had TIBC values above the normal range. The serum ferritin levels in 35% children was <15ng/ml (in 18% boys and in 17% girls). The nutritional status according to the IAP classification showed that by weight, 19% children were well nourished and that 81% were undernourished. The mean and SD of Hb before therapy was 8.60 ± 2.05 and after therapy, it was 9.55±1.88 respectively.

An early diagnosis of anaemia can be made by assessing the serum ferritin levels and this has been found to be more reliable. If iron is given in the early stages of anaemia to children, the response is quite significant.

Keywords

Anthropometric, MCV (Mean corpuscular volume), MCHC (Mean corpuscular haemoglobin concentration), MCH(Mean corpuscular haemoglobin), serum ferritin.

How to cite this article :

Dr. MAHESHWARI B.K,Dr. RAUT P,Dr. AGARWAL S.K.,Dr. JOSHI U,Dr. DHIRHE T.C, Dr. GAHINE R. A STUDY ON THE IRON STATUS IN IRON DEFICIENCY ANAEMIA ONE MONTH BEFORE AND AFTER IRON THERAPY IN SCHOOL GOING CHILDREN. Journal of Clinical and Diagnostic Research [serial online] 2011 April [cited: 2019 Aug 21 ]; 5:324-327. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=April&volume=5&issue=2&page=324-327&id=1253

Introduction One of the commonest forms of nutritional anaemia which is recognized throughout the world is iron deficiency anaemia. It is responsible for a higher incidence of morbidity because of the lack of proper investigation and prophylactic and therapeutic measures. The estimated prevalence of anaemia is 12% in developed countries, as compared to 51% in the developing countries.

There is a high prevalence of iron deficiency in our country amongst the preschool children. ICMR has shown that as many as 63% of the children between 1-3 years and 44% between 3-5 years have subnormal Hb levels (1). According to the WHO, anaemia is second only to tuberculosis in terms of prevalence and as the world’s most costly health issue (2). Children, during their phase of rapid growth such as the preschool age and the adolescent age, are at a higher risk of developing iron deficiency anaemia. Iron deficiency anaemia is common in rural areas and in children from a poor socioeconomic status.

The incidence of iron deficiency anaemia is higher in infancy andalso in school going children and preadolescents. Although no socioeconomic group has been spared from the incidence of iron deficiency in a large population group, it has been found to be inversely proportional to the economic status of the affected individual.

The trace amount of iron in many diets, the limited ability of the human body to absorb iron and the need for growth, as well as high parasitism and gastrointestinal blood loss, make children vulnerable to develop negative iron balance and iron deficiency anaemia.

The purpose of this study was to assess the iron status in school going children before iron therapy. The response of one month of iron therapy on these children was assessed by a change in the haemoglobin concentration after the therapy.

Material and Methods

The study population included 800 (368 males and 432 females) healthy school going children of ages between 6-14 years, from three government schools of Raipur city. Both anthropometrical and clinical examinations were carried on these children.

INCLUSION CRITERIA:
1. Iron deficiency anaemia cases (microcytic, hypochromic) 2. Haemoglobin <11gm% 3. Not received blood transfusion in the last one month.1. Homozygous sickle cell disease 2. Sickle cell trait 3. Haemoglobin >11gm% 4. Menstruating girls 5. Patients with peptic ulceration, epistaxis, parasitic infestation and malabsorption 6. Septicaemia.

Out of which 150 (73 males and 77 females) children were found to by clinically anaemic. These 150 clinically assessed anaemic children served as the subjects for haemoglobin estimation. Out of these 150, 100 (55 males and 45 females) cases were selected for the study which followed the WHO criteria for anaemia.

The WHO criteria for anaemia (WHO,1968):
The WHO experts have defined anaemia as a condition in which the concentration of haemoglobin is below the lower limit of the normal for a given age and sex. Haemoglobin levels which are indicative of anaemia amongst children Age/Sex Hb level (g/dl) MCHC(Percent) 6month-6years <11 34 6-14 years <12 34

Grades of anaemia:
MILD:When the haemoglobin concentration is above 80% of the cut off level
MODERATE:When the haemoglobin concentration is between 60%-80% of the cut off level
SEVERE:When the haemoglobin concentration is less then 60% of the cut off level

Haemoglobin levels were estimated in all the children by the cyanmethaemoglobin method. The serum ferritin concentration was determined by ELISA by using a reagent kit (ACCUBIND) which was obtained from Monobind Inc. from the local market and serum iron and TIBC levels were determined by the calorimeter ferrozine method. (both were obtained from Scientific Traders, Tatyapara, Raipur CG). (Siedel , J. et. al. 1984, Clin. 30:975).

Samples were collected for the estimation of haemoglobin by the cyanmethoglobin (HICN) method and for the estimation of serum ferritin by ELISA (UBI) (the Magiwel enzyme immunoassay method for haemoglobin estimation). 20 μl of capillary blood was collected by finger pricking into 5ml of Drabkins solution (which was obtained from Scientific Traders, Tatyapara, Raipur CG) from all the participating students and the haemoglobin and serum ferritin levels were assessed on the same day. For assessing serum ferritin, 3 ml of venous blood was collected in a test tube, left to stand at room temperature for half an hour and was centrifuged at 3500 r.p.m. for 10 minutes. The separated serum was transfused to fresh vials and was stored at 300C. The kit was calibrated against the WHO standard.

The haemoglobin and ferritin levels were estimated under strict quality control in the laboratory of our medical college. Haemoglobin was estimated by the Cyanmethaemoglobin (HICN) method, serum iron and total iron binding capacity were estimated by the Ferrozin method and serum ferritin was estimated by ELISA and was measured by using a spectrophotometer (Systronic Inc. in the Department of Biochemistry of Pt.JNM Medical College, Raipur and the Department of Pathology, Dr BRAM Hospital, Raipur (CG).

Anaemia was diagnosed as per the WHO guidelines (value less than 12g/dL) and iron deficiency was determined when the value of serum ferritin was less than 15ng/ml.

Statistical analysis was done by using the SPSS software and the Chi square test was used to calculate statistical significance.

Ethical Consideration
An informed and written consent was obtained from the Dean, Pt. JNM Medical College Raipur, Block Educational Officer Dharsiva, Raipur and from the parents of the children.

Results

The study population comprised of 800 students from three government schools of Raipur city. Out of 100 anaemic children, 55% were males and 45% were females. A majority of the subjects belonged to 6 years (19%) and group I (45%) cases. A maximum number of patients (45%) had haemoglobin levels between 9.5-10 .9gm / dl in group I.

Clinical pallor was the most common finding in all the children (in 100%), followed by fatigue (in 54%), weakness (in 38%), anorexia (in 18%) and icterus (in 5%). The commonest blood picture was microcytic, hypochromic, which was seen in 66.6% children in group I, 95.6% children in group II and 87.5% children in group III. Age dependent MCV, MCH, MCHC and RDW values showed that the maximum number of cases had below normal MCV, MCH and MCHC values. The RDW (Red cell distribution width) value was increased in 74% of the cases. (Table/Fig 1)

82% cases had serum iron levels below the normal range (<50μg /dl). 91% cases had serum TIBC levels above the normal range. There was an increase in the serum iron levels in a maximum number of cases. Serum ferritin levels were estimated in all the hundred anaemic children, of which 35% showed below < 15ng / ml values (18% in boys and 17% in girls). The serum ferritin concentration in the three groups is represented in the diagram below. (Table/Fig 2)

Correlation of serum ferritin and iron indices –The estimation of serum iron and TIBC levels in the subjects did not have any correlation with the serum ferritin concentration, as shown in the diagram. (Table/Fig 3)

Assessment of the nutritional status of the children in the 6-14 years age group according to the IAP classification by weight showed that 19% of the children were well nourished and that 81% of the children were undernourished.Out of this, 29% were in the grade I undernutrition, 29% children were in the grade II undernutrition, 21% children were in the grade III undernutrition and 2% were in the grade IV undernutrition category.

The haemoglobin values at the beginning of the study and after 4 weeks (30 days) of haematinic supplementation are shown in the Fig below. (Table/Fig 4)

The mean and SD of Hb before therapy was 8.60±2.05 and after therapy, it was 9.55±1.88 respectively. The present study in the allage groups showed that the tablet, ferrous sulphate 6mg/kg body weight, significantly increased the Hb (P<0.009) concentration after 30 days of supplementation.

Discussion

Nutritional anaemia is global in occurrence and is more of a concern in the developing countries because of the high prevalence in these regions (3).

In the present study, the diagnosis of iron deficiency was based on the finding of a microcytic, hypochromic blood picture, low serum iron levels, a high total iron binding capacity and finally, the response to the iron therapy (4).

A majority of the subjects belonging to the 6 year age comprising 19% of subjects were more in group I. The overall male to female ratio in the study was 1.2:0.8. Dhar et al (1969) (5), Duggal et al (1977) (6), Singla et al (1981) (7) and Gopal Das et al (1985) (8) had studied the same age group.

The clinical features which were observed in this study were very much similar to those reported by other studies.

In a majority of patients, the peripheral smear was microcytic and hypochromic (in 80%), normocytic, normochromic (in 13%) and normocytic, hypochromic (in 7%) and this could be well compared with those reported by Thaman et al (1969), (57%, 31% and 3%), Dhar et al (1969)5 (64.02% and 15.8%), Gupta et al (1971) (9) (64.68%, 21.5%, and 1.8%), Duggal et al (1977)6 (47%, 44% and 1%)(10), (11) and Verma et al (1979) (55.4% and 37.5%) (12), (13). The most common symptoms which were observed in the present study were fatigue (in 54%), followed by weakness (in 38%) and anorexia (in 18%). These were similar to those observed by Patel et al (1959) (14) and Dhar et al (1969) (5).

The ranges of the haemoglobin percentage in the present study was 9.5-10.9 in group I, 8-9.4 in group II and <7.8 in group III, which can be well compared with those reported by Thaman et al (1968)(15), Dhar et al (1969)(\(16), Gupta et al (1971) (17), (18), (19), Verma et al (1979), Singla et al (1981) (7) Raman et al (1992) (15), Sood et al (2002) (19) and Basu et al (2004) (14) by using the same technique.

The present study showed that a maximum number of cases had below normal MCV, MCH and MCHC values and that the RDW value was increased in 74% of the cases. These values are in accordance with the observations made by Smith et al (1959) (18), Dhar et al (1969) (5), Gupta et al (1971) (9) and Raman et al (1992) (15).

82% of the patients had low serum iron levels and 91% cases had serum TIBC levels above the normal level, irrespective of their peripheral smear morphology. These results are in accordance with those reported by Thaman et al (1968) (20) Dhar et al (1969) (5) and Smith et al (1988) (18).

Various studies have confirmed that the assessment of the serum ferritin levels is one of the most sensitive methods for the assessment of iron stores and for the detection of mild iron depletion. The serum levels of ferritin are directly related to the bone marrow iron content in all the disease groups, except in those involving a chronic inflammatory stage, malignancy and an increased red cell turnover.

However, the students who were enrolled for this study were healthy and did not have any apparent clinical disorder. In our study, 70% cases were in the pre latent phase of iron deficiency anaemia (serum ferritin <10ng/ml and Haemoglobin <12g/dl). These values are in accordance with the observations made by Martti et al (1974)13, Thomas et al (1977)22 and Thavaraj et al (1985)21 et al.

In the present study, there was no correlation between the serum ferritin and the serum iron levels. Krause et al (1980) (19) and Frank et al (1981) (20) also did not find any correlation between the two.

Nutritional status out of 100 children had a different grade of malnutrition. The maximum number of cases belonged to grade I and grade II malnutrition (29%) and there was 21% in grade III and 2% in grade IV.

An effort was made to find the incidence of the iron deficiency with respect to various grades of malnutrition. It was found that the maximum number of anaemic cases were seen in grade II malnutrition i.e. 29% and 26%. In the same way, in the malnutrition grade I category, anaemia was present in 22% (16) and 12% % had grade III malnutrition and a minimum number of cases of IDA (2% and 1%) were observed in the grade IV malnutrition category. Manchanda et.al. (1969) (21), Sharma et. al. (1985) (22) and Sood et. al. (2002) found that 100%, a moderate degree and 97% of the children who were studied were malnourished.

Response to therapy
The response to therapeutic iron was taken as the most reliable evidence of iron deficiency anaemia in a study of this kind and the group that was given iron in the treatment trial showed a significant increase in the mean haemoglobin values at all ages.

The iron supplementation with ferrous sulphate 6mg/kg containing folic acid 0.5mg was given twice a day after breakfast and after dinner to reduce gastric irritation.

Folic acid was added because the children who were suffering from various grades of malnutrition demonstrated folate deficiency. Hence, until a clear evidence of folate deficiency is available, folate may not be required to be given. It may be more prudent to include it in the prophylactic iron supplement.

All the children in our study were free from worm infestation. Only one (2.2%) case in group I showed worm infestation, which was treated with antihelminthic tablets along with haematinic supplementation.

A significant increase in the Hb levels was observed in both boys and girls in all the three groups after 30 days of iron supplementation. The effect of the supplementation on the mean Hb levels showed an increase in the Hb levels in group I who were mildly anaemic (0.78 gm/ dl), in group II who were moderately anaemic (0.97 gm/ dl) and in group III who were severely anaemic (1.17gm/ dl). In the severe anaemic cases, the response was better. It was also noted that the effect on the Hb levels was more in the lower age groups. These results are in accordance with those reported by Single et al (1981) (7), Dallman et al (1981) (22), Chwang et al (2001) (23), Zlotkin et al (2001) (24) and Sood et al (2002) (25).

Conclusion

It has been concluded from this study, that an early diagnosis of anaemia can be made by the assessment of the serum ferritin levels and that this method is more reliable. If iron is given at an early stage of anaemia to the children, the response is quite significant.

The children studying in government schools are found to be malnourished as per the guidelines of IAP. Their poor health and nutritional status warrants an improvement in the socioeconomic status by the inclusion of green leafy vegetables in the diet, increasing the level of education and by a well planned school health service programme according to the local needs.

Acknowledgement

An acknowledgement has been made to Dr. N. Gandhi (Superintendent, Dr. BRAM Hospital), Dr. P.K. Patra (Professor and HOD, Deptt. of Biochemistry.) for their advice and support in the project. Mr. Anant Shreevastava (MSc in Statistics) helped in carrying out the statistical analysis of this study.

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