CC BY 4.0 · Journal of Child Science 2023; 13(01): e75-e84
DOI: 10.1055/s-0043-1769483
Original Article

Anemia Prevalence, Characteristics, and Hematological Profile among Stunted Children Under 2 Years Old in Bandung Regency, Indonesia

1   Doctoral Programme, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
2   Bandung Regency Health Office, Soreang, Indonesia
3   Bachelor of Medicine Programme, Faculty of Medicine, Universitas Padjadjaran, Sumedang, Indonesia
3   Bachelor of Medicine Programme, Faculty of Medicine, Universitas Padjadjaran, Sumedang, Indonesia
4   Pediatric Health Department, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
5   Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
4   Pediatric Health Department, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
› Author Affiliations
Funding This research was available from Universitas Padjadjaran (under the Academic Leadership Grant, 2019 awarded to Budi Seatiabudiawan) and Research Cooperation Fund of Bandung Regency Health Office and Universitas Padjadjaran 2019.


Anemia and stunted growth are major health problems with adverse consequences for children. This study aimed to determine the prevalence, characteristics, and hematological profile of anemia among stunted children under 2 years old. A nested cross-sectional study from a child cohort was conducted in Bandung Regency, West Java, Indonesia. Two hundred twenty-two children aged 6 to 24 months were randomly selected. These children were reexamined from November 2019 to March 2020 for anthropometric measurements and hematological assessment and interviewed for relevant risk factors of stunted growth and anemia. Ninety-eight stunted children were identified and distributed into stunted and severely stunted groups (47.96 vs. 52.04%). Around 85.4% of the children came from low-income families and 31.7% were severely underweight for age. Surprisingly most of these stunted children had normal birth weight and length and were born at term (68.3, 53.7, and 85.4%). The prevalence rate of anemia among stunted children was 41.8%, they had decreased mean corpuscular volume (56%), decreased mean corpuscular hemoglobin (73%), and normochromic mean corpuscular hemoglobin concentrations (51.2%). Leucocytosis was higher than leucopenia (10 vs. 3.7%) and thrombocytosis (n = 15, 36%) as compared to thrombocytopenia (n = 5, 12%). The prevalence of anemia was high among stunted children. The characteristics of stunted children with and without anemia were similar. The fact that these stunted children had few risk factors for stunting emphasizes the need to focus on improved postnatal care to prevent faltering. Based on the hematology profile, iron deficiency anemia was suspected to be the most etiology in these cases warranting further follow-up and management.

Author's Contribution

All authors contributed to subject recruitment, data collection, review, and discussion of the manuscript.

Publication History

Received: 18 January 2023

Accepted: 05 April 2023

Article published online:
05 June 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 World Health Organization. Nutritional anaemias: tools for effective prevention and control. 2017
  • 2 Kementrian Kesehatan RI. Riset kesehatan dasar (Riskesdas) tahun 2018. Kementerian Kesehatan RI. 2018 . Accessed April 04, 2023 at:
  • 3 Woldie H, Kebede Y, Tariku A. Factors associated with anemia among children aged 6–23 months attending growth monitoring at Tsitsika Health Center, Wag-Himra Zone, Northeast Ethiopia. J Nutr Metab 2015; 2015: 928632
  • 4 Lokeshwar M. Textbook of Pediatric Hematology and Hemato-Oncology. Delhi, India: Jaypee Brothers Medical Publishers (P) Ltd; 2016: 109-123
  • 5 M Robert BK. Stanton Nelson Textbook of Pediatrics. Twentieth ed.. Elsevier; 2016: 2309-2326
  • 6 Yang W, Li X, Li Y. et al. Anemia, malnutrition and their correlations with socio-demographic characteristics and feeding practices among infants aged 0-18 months in rural areas of Shaanxi province in northwestern China: a cross-sectional study. BMC Public Health 2012; 12 (01) 1127
  • 7 Miller LC, Joshi N, Lohani M. et al. Head growth of undernourished children in rural Nepal: association with demographics, health and diet. Paediatr Int Child Health 2016; 36 (02) 91-101
  • 8 Chaturvedi S, Licht C, Langlois V. Hemolytic uremic syndrome caused by Bordetella pertussis infection. Pediatr Nephrol 2010; 25 (07) 1361-1364
  • 9 Chowdhury SD, Ghosh T. Undernutrition in Santal children: a biochemical and hematological study. Homo 2013; 64 (03) 215-227
  • 10 Soliman AT, De Sanctis V, Yassin M, Adel A. Growth and growth hormone-insulin like growth factor-I (GH-IGF-I) axis in chronic anemias. Acta Biomed 2017; 88 (01) 101-111
  • 11 World Health Organization. Global nutrition targets 2025: Stunting policy brief. World Health Organization; 2014
  • 12 United Nations Children's Fund (UNICEF) WHO. Levels and trends in child malnutrition. 2019
  • 13 Badan Penelitian dan Pengembangan Kesehatan. Laporan Provinsi Jawa Barat RISKESDAS 2018. 2018
  • 14 Kemiskinan TNPP. 100 kabupaten/kota prioritas untuk intervensi anak kerdil (stunting). Jakarta: Tim Nasional Percepatan Penanggulangan Kemiskinan; 2017
  • 15 Bupati Bandung. Peraturan Bupati Bandung Nomor 74 Tahun 2019 tentang Rencana Aksi Daerah Percepatan Pencegahan dan Penanggulangan Stunting di Kabupaten Bandung Tahun 2019-2021 2019.
  • 16 Adriyani FHN, Hikmanti A. Correlations of Anemia, Stunting, and Sociodemographic Characteristics and Energy Among Children Aged 6–23 Months at Karangklesem Village, South Purwokerto. Atlantis Press; 2020: 196-203
  • 17 Mohammed SH, Larijani B, Esmaillzadeh A. Concurrent anemia and stunting in young children: prevalence, dietary and non-dietary associated factors. Nutr J 2019; 18 (01) 10
  • 18 Ahmad A, Zulfah S, Wagustina S. Defisiensi Besi dan Anemia pada Anak Usia Bawah Dua Tahun (6-23 Bulan) di Kabupaten Aceh Besar. Gizi Indonesia 2014; 37 (01) 63-70
  • 19 Pacifici GM. Effects of iron in neonates and young infants: a review. Int J Pediatr 2016; 4 (07) 2256-2271
  • 20 Morsing E, Malova M, Kahn A. et al. Brain volumes and developmental outcome in childhood following fetal growth restriction leading to very preterm birth. Front Physiol 2018; 9: 1583
  • 21 Nicolaou L, Ahmed T, Bhutta ZA. et al; MALED Network Investigators. Factors associated with head circumference and indices of cognitive development in early childhood. BMJ Glob Health 2020; 5 (10) e003427
  • 22 Zimmermann P, Curtis N. The influence of BCG on vaccine responses—a systematic review. Expert Rev Vaccines 2018; 17 (06) 547-554
  • 23 Tüfekçi Ö, Özdemir HH, Malbora B. et al. PB1856 hepatitis associated aplastic anemia: etiology, clinical characteristics and outcome. HemaSphere 2019; 3 (S1): 846-847
  • 24 Gutema B, Adissu W, Asress Y, Gedefaw L. Anemia and associated factors among school-age children in Filtu Town, Somali region, Southeast Ethiopia. BMC Hematol 2014; 14 (01) 13
  • 25 Nadiyah, Dewanti LP, Mulyani EY, Jus'at I. Nutritional anemia: Limitations and consequences of Indonesian intervention policy restricted to iron and folic acid. Asia Pac J Clin Nutr 2020; 29 (Suppl. 01) S55-S73
  • 26 Huang Z, Jiang FX, Li J, Jiang D, Xiao TG, Zeng JH. Prevalence and risk factors of anemia among children aged 6-23 months in Huaihua, Hunan Province. BMC Public Health 2018; 18 (01) 1267
  • 27 Xin Q-Q, Chen B-W, Yin D-L. et al. Prevalence of anemia and its risk factors among children under 36 months old in China. J Trop Pediatr 2017; 63 (01) 36-42
  • 28 Johnson-Wimbley TD, Graham DY. Diagnosis and management of iron deficiency anemia in the 21st century. Therapeutic advances in Gastroenterology 2011; 4 (03) 177-184
  • 29 Auerbach M. Patient education: anemia caused by low iron in adults (beyond the basics). UpToDate. 2021
  • 30 Powers JM, Sandoval C, Lorin MI. Approach to the child with anemia. UpToDate. 2021
  • 31 Dan K. Thrombocytosis in iron deficiency anemia. Intern Med 2005; 44 (10) 1025-1026
  • 32 Kucine N, Chastain KM, Mahler MB, Bussel JB. Primary thrombocytosis in children. Haematologica 2014; 99 (04) 620-628
  • 33 Baker RD, Greer FR. Committee on Nutrition American Academy of Pediatrics. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics 2010; 126 (05) 1040-1050