Correlates of Anemia in Children Under Five: A Meta-analysis of 1.39 Million Cases in India

Context: To help children grow healthily, early detection and prevention of anemia are necessary.Objective: The present meta-analysis focused on estimating the pooled prevalence and key risk factors of anemia among children (under 5 years) in this population.Evidence acquisition: The present study searched PubMed/Google Scholar for studies published (2000-2025), reporting anemia prevalence.A total of 24 studies had 13,90,567 children were included.Data analyses using common/random-effects models were used to estimate pooled prevalence and associated risk factors.Heterogeneity (I), subgroup analysis, and publication bias (Egger's test) were assessed.The Newcastle-Ottawa Scale (NOS) was used for quality assessment.Results: Among 24 studies, the pooled prevalence of anemia among children under five was 62.2% (95% CI: 53.4-70.2%)under the randomeffects model.Inter-state prevalence varied from 4.7 to 92.9%, with Uttar Pradesh reporting the highest pooled estimate (77.4%).Toddlers (12-35 months) were identified as a high-risk age-group for anemia, stunting, under-nutrition, and severe anemia in mothers, with almost triple the likelihood of an anemic child.Low iron biomarkers are the best diagnostic parameter for anemia.Heterogeneity was present across studies (I > 75%) with no significant publication bias (p = 0.203). Conclusion:Overall, the study showed anemia continues to affect a large proportion of Indian children, with significant interstate and demographic disparities.Policymakers must target vulnerable groups, significant risk factors, and region-specific strategies to reduce the anemia burden in early childhood.