Childhood anaemia highlights stark inequality in access to nutrition

Indonesian paediatric experts link childhood anaemia to wider socioeconomic disparities, emphasising early nutrition as a crucial intervention to combat a condition that predominantly affects children in low-income countries.

Childhood anaemia is not only a medical problem but also a marker of wider inequality, according to Murti Andriastuti of the Indonesian Paediatric Society’s haematology-oncology working group. Speaking at a virtual press conference on Tuesday, October 6, she said the condition is generally less common in wealthier countries and becomes more frequent as national income levels fall, reflecting differences in access to iron-rich foods and other essentials. International data support that pattern: the World Health Organisation says anaemia remains a major public health issue in children, with higher rates in low-income countries, while Our World in Data has found that the burden rises sharply as income falls.

Andriastuti said iron deficiency is the leading cause of anaemia in children and that the problem begins very early in life. She pointed to the period when babies start complementary feeding, known in Indonesia as MPASI, as a critical window for introducing foods such as eggs, liver and red meat, which provide highly absorbable iron. She also stressed that infants and adolescents need more iron than many other age groups because both stages are marked by rapid growth. Research cited by the World Health Organisation and by a recent meta-analysis in Public Health Nutrition reinforces that iron deficiency anaemia is concentrated in low- and lower-middle-income countries, where diets are more likely to lack sufficient animal protein.

The paediatrician said anaemia can appear as early as four months of age, with rates rising steeply during the first year of life. She estimated that by nine to 12 months, roughly four in ten children may already be affected in settings with weaker economic conditions. Studies in Europe and Africa show a similar contrast: iron depletion and iron deficiency anaemia are far less common in richer countries, but can affect a very large share of young children in lower-resource regions. In the United States, too, the Centres for Disease Control and Prevention has reported a clear income gradient, with anaemia more common in lower-income households.

Clinically, anaemia means a fall in haemoglobin below the normal range for a child’s age, reducing the blood’s ability to carry oxygen and nutrients. That can leave children tired, weak and less able to thrive. The broader picture, according to the WHO and other public health researchers, is that anaemia is rarely caused by iron deficiency alone; infection, parasites and inherited blood disorders can also contribute. But for children, especially in poorer settings, improving diet and preventing iron deficiency remain the most direct ways to reduce the burden.