Knowledge-Attitude-Practice Gap Among Mothers of Under-Five Children With Iron-Deficiency Anemia and the Association of Maternal Knowledge With Hemoglobin Levels: A Cross-Sectional Study at a Rural Tertiary Care Center in Haryana

Background: Anemia is the third leading cause of disability globally, with iron deficiency as the most common nutritional cause. India accounts for nearly half of the global anemia burden in children under five years of age. Given that mothers play a critical role in child care, this study aimed to identify gaps in their knowledge, attitudes, and practices (KAP) regarding anemia prevention. Method: A hospital-based cross-sectional study was conducted among 102 mothers of anemic children aged 6-59 months diagnosed with iron-deficiency anemia (IDA) and presented to a rural tertiary care center in Haryana. Participants were selected by systematic random sampling after obtaining written informed consent. Data were collected using a prevalidated, interviewer-administered, semistructured questionnaire comprising sociodemographic characteristics, knowledge, attitude, and preventive practice domains. Open-ended responses were categorized using qualitative content analysis. Knowledge scores were calculated for each participant. Pearson's correlation was used to assess the relationship between maternal knowledge scores and children's hemoglobin levels. One-way analysis of variance (ANOVA) with Tukey's honestly significant difference (HSD) post hoc test compared mean knowledge scores across anemia severity groups. Statistical significance was set at p < 0.05. Results: Most mothers had secondary or higher education (n = 75; 73.5%) and were homemakers (n = 85; 83.3%). Over half of the participants failed to recognize the role of antenatal iron-folic acid supplementation (n = 56; 54.9%) and diet (n = 63; 61.8%) in anemia prevention. In addition, several other important knowledge gaps and misconceptions were identified. Only 41 (40.2%) recognized worm infestation as a cause of anemia, 20 (19.6%) incorrectly considered milk and milk products to be iron-rich, and only three (3%) were aware of government anemia prevention programs. Mothers generally demonstrated positive attitudes toward childhood anemia; however, preventive practices such as deworming (n = 39; 38.2%), iron supplementation (n = 25; 24.5%), and cooking in iron utensils (n = 15; 14.7%) were suboptimal. Maternal knowledge scores showed a significant positive correlation with children's hemoglobin levels (r = 0.30, p = 0.002). Mean knowledge scores differed significantly according to anemia severity (ANOVA: F(2,99) = 5.54, p = 0.005), with mothers of children with mild anemia demonstrating significantly higher knowledge scores than those of children with severe anemia (Tukey's HSD, adjusted p = 0.004). Conclusion: Higher maternal knowledge was associated with better hemoglobin levels in their children. Despite generally favorable attitudes, substantial gaps exist between maternal knowledge and preventive practices regarding childhood IDA. This emphasizes the need for targeted educational interventions, especially in rural areas, to reduce anemia prevalence and its associated health impacts.