{"paper_id":"034bf5cb-e8e4-436d-aa06-c68b6dad69f8","body_text":"Prevalence of Iron Deficiency Anemia And Its Impact on Growth And Development In Pediatric Population of Khyber Pakhtunkhwa (KPK), Pakistan | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of Iron Deficiency Anemia And Its Impact on Growth And Development In Pediatric Population of Khyber Pakhtunkhwa (KPK), Pakistan Mohsin Hayat -, Mohammad irshad, Rashida saddiq - This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8796538/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 15 You are reading this latest preprint version Abstract Background Iron deficiency anemia (IDA) is a significant global health issue, particularly in low- and middle-income countries. It leads to impaired physical growth, cognitive development, and overall well-being in children. Despite being widely studied, region-specific data, particularly from Khyber Pakhtunkhwa (KPK), Pakistan, remains limited, emphasizing the need for focused Study in this area. Objectives: Iron deficiency anemia (IDA) is one of the most severe problems of public health, especially within low and middle-income countries. The present study will examine both the problem of IDA among children of the 2–12 years old age group in Khyber Pakhtunkhwa (KPK), Pakistan, and its consequences to the physical and cognitive development of children. Methods: In the current cross-sectional Prospective study 100 children aged 2 to 12 years old were included in the study, including urban and rural samples. Blood samples that were collected in the veins were tested to determine hemoglobin level and iron status in the blood serum. At the same time, the anthropometric measures (height and weight) and the cognitive functioning were assessed by the use of the validated standardized measures. Statistical work was done in SPSS and included descriptive summaries, Chi-square test and multiple regression models in order to look at the relationship between iron deficiency anemia (IDA) and growth and cognitive outcomes. Results: It was found that iron deficiency anemia was very common with 48% of children having mild anemia 30% having moderate anemia and 6% having severe anemia. The physical growth parameters (height and weight) were also much less in anemic children compared to their non-anemic counterparts (p- less than − 0.05). The average height of anemic children was 110cm 7cm and the average weight of non-anemic children was 22.4cm 4.2kg. The cognitive performance score was also significantly lower in children with IDA; the average IQ score was 85.338.37 on anemic children and 93.887.25 on non-anemic children (P=.01). Conclusion: The present study proves that iron deficiency anemia is still endemic in the province of Khyber Pakhtunkhwa and that it causes a strong adverse impact on somatic developmental patterns and neurocognitive maturity in the childhood population. These statistic, in turn, support the necessity of strictly developed intervention measures, including iron fortification measures and more efficient nutrition education, to reduce this health emergency and to promote high health outcomes among the child population of the region. Iron deficiency anemia children growth development Figures Figure 1 Introduction The most common type of nutritional deficiency in the world is iron deficiency anemia (IDA), and this has a great effect on children in low- and middle-income countries. The disorder is caused by inadequate iron supplementation or reduced absorption that inhibits hemoglobin production and consequently interferes with the haemodynamic distribution of oxygen to the rest of the body. Children, especially, are vulnerable to IDA because of the increased growth rates and developmental milestones, which significantly increase the levels of iron requirement. Besides the clear somatic sequelae, which include growth retardation, maturation delay, and immunological deficiency, there is a correlation between IDA and severe cognitive and behavioral deficits which negatively impact academic achievement and quality of life in the later years [ 1 , 2 ]. IDA is especially common in Pakistan, especially in rural areas of the country where there has been little access to iron-rich foodstuffs and proper healthcare services, especially in Khyber Pakhtunkhwa (KPK). Factors such as poverty, lack of nutritional education, poor healthcare facility, and reliance on cereal diets give rise to the problem [ 3 ]. The uneven socio-economic situation in the area also complicates the process of remedying it as children with different ethnic and economic statuses might be characterized by different levels of nutritional deficiency and, therefore, pose a challenge to the introduction of consistent public health intervention [ 4 ]. Undiagnosed IDA may have serious consequences, which include irreversible cognitive delay, poor academic results, and lifelong developmental impairment [ 5 , 6 ]. The iron is important in the biogenesis of hemoglobin and also in the functionality of many enzymes that are critical in growth, metabolism, and immunological functions. Therefore, early identification and timely therapeutic intervention become unavoidable in preventing these undesirable outcomes particularly in the critical stages of development as a child. Although the occurrence of IDA in Pakistan has been carefully reported, the particular implications of the same to child development in Khyber Pakhtunkhwa have not been adequately investigated. Most of the studies in the past have captured the general relationship existing between IDA and growth retardation, but limited studies have potentially challenged the region-specific impact of IDA on physical and cognitive development. This Study paper attempts to close this gap by evaluating the prevalence of IDA and its effects on anthropometric variables (height and weight) and cognitive variables (memory and attention and IQ scores) in children with KPK. The study will provide the Studyer with the region-specific data needed to inform the decisions on the formulation of specific public health policies and intervention measures to prevent the onset of IDA and alleviate its developmental consequences. Additionally, the results will be available in the overall understanding of how IDA affects the health of children and will be of a great help to local health care providers and the international nutrition specialists [ 7 , 8 ].It is a consistent finding that IDA affects cognitive abilities, namely memory and attention, with long-term effects on cognitive functions in the academic performance and social life of a child [ 9 , 10 , 11 ]. While the effects of IDA are well-documented globally, there is a distinct lack of data specific to Khyber Pakhtunkhwa (KPK), a province marked by significant socio-economic disparities. This study aims to fill this gap by examining the prevalence of IDA in children aged 2–12 years and its impact on both physical and cognitive development in this under-Studyed region. Materials and Methods Study Design and Setting: This is cross-sectional Prospective study which was carried out in June 2024 to June 2025 in the Department of Pediatric Medicine, Lady Reading Hospital (LRH), Peshawar. The target population included children aged between two and twelve years in cities and rural population in Khyber Pakhtunkhwa (KPK), Pakistan. The study was aiming to get the heterogeneity of the population in the region, in that regard, the study made an effort to have a variety of participants whose location was in various districts, hence the results would represent the heterogeneity of the socio-economic settings. The tertiary-care hospital setting allows the Studiers to access both inpatient Prevalence and community outreach programs and thus being able to thoroughly evaluate children with diverse demographic backgrounds. Participants: The study involved 100 children between the ages of 2 and 12 years. These were the participants who were selected in the local schools and community health centers around KPK. The convenience sampling was adopted to select children in the areas with both urban and rural environments in order to get the representation of different socioeconomic backgrounds. Inclusion Criteria: Children aged 2–12 years. Criteria: Children whose parents gave informed consent to participation. Children- both urban and rural KPK. Exclusion Criteria: Children having chronic diseases, severe infections or neurological conditions. Children that have genetic syndromes or other disorders that may interfere with their growth or cognitive abilities. In case of parental consent, the participants were tested regarding iron deficiency anemia (IDA) through blood tests on the hemoglobin content and the iron levels. Physical development was measured using height and weight and the cognitive ability test using standardized IQ, attention and memory tests. Ethical Approval Statement. This study was officially approved by the Institutional Review Board (IRB) of Lady Reading Hospital/Medical Teaching Institution ( LRH/MTI), Peshawar ( Reference No. 488/LRH/MTI/23) . The Study was conducted in line with the existing institutional and professional codes of ethics that govern human Study in adherence to a strongly maintained participant confidentiality and unwavering adherence to ethical treatment of all participants. Data Collection Procedures: Blood Tests- Hemoglobin levels were measured to establish the state of anemia in the body and ferritin levels were measured to estimate iron deficiency. Children with hemoglobin levels less than 11g/dL and ferritin levels less than 12ng/mL were considered to have IDA. Physical Measures: To measure the growth parameters, height and weight were measured using standard procedures. Cognitive Assessments: An Prevalence of cognitive functioning was done using a mixture of IQ tests, memory tests and attention span tasks. The Intelligence Scale of the children was also conducted using the Wechsler Intelligence Scale (WISC) in order to derive IQ scores, with attention and memory tests being modified to fit the conventional developmental psychology tests. Statistical Analysis: The analysis of data was done in SPSS version 26.0. Mean, standard deviation, and percentages were used as descriptive statistics in order to describe the characteristics and the outcomes of the participants. The Chi-square test was applied to test the relations between IDA and physical/cognitive parameters. Results Demographic Characteristics of the Participants One hundred children between 2 and 12 years were involved in the research. The overall age of the sample was 8.23 years with a standard deviation of 3.53. The sex distribution was almost same with 48 percent males (n = 48) and 52 % females (n = 52). In terms of residence, 40 % of the children were urban and the rest 60 percent were rural (Table 1). Prevalence and Severe Iron Deficiency anemia. The study population was found to have iron deficiency anemia (IDA) in 48% (n = 48) of the population. In the anemic children, 30% (n = 30) of the children had mild anemia, 12% (n = 12) of the children had moderate anemia and 6% (n = 6) of the children had severe anemia. The rest 52% (n = 52) of children were not anemic (Table 2). Comparison of Growth Physiological parameter. The comparison of the growth parameters of physical growth indicated that there was a significant difference between anemic and non-anemic children. The mean height of children with IDA was greatly lower than that of non-anemic children (110 7 cm versus 118 6 cm, p under 0.05). Likewise, the body weight of anemic children (19.5 ± 3.5 kg) was greatly lower as compared to non-anemic children (22.4 ± 4.2 kg, p < 0.05) (Table 3). Cognitive Function Scores in Anemic and Non-Anemic Children Test Results. The cognitive performance was found to be significantly worse in case of children with iron deficiency anemia. The mean of the IQ score of anemic children was 85 ± 7 which was very low compared to the mean of IQ score of non-anemic children of 94 ± 6 (p < 0.01). Furthermore, the level of attention was much lower in anemic group (12.5 ± 3.2) than non-anemic group (15.1 ± 2.5, p < 0.05). The results of memory tests were also the same, where the anemic children scored much lower (14.8 ± 4.1) than the non-anemic children (17.3 ± 3.1, p < 0.05) (Table 4). Figure 01: Graphical abstract of iron deficiency anemia in children current study. Table 1. Demographic Characteristics of the Participants (n = 100) Characteristic Value Mean age (years) 8.2 ± 3.5 Male sex, n (%) 48 (48%) Female sex, n (%) 52 (52%) Urban residence, n (%) 40 (40%) Rural residence, n (%) 60 (60%) Table 2: Prevalence of Iron Deficiency Anemia (IDA) Severity of Anemia Number of Children Percentage (%) Mild anemia 30 30 Moderate anemia 12 12 Severe anemia 6 6 No anemia 52 52 Overall, 48% of the children were diagnosed with iron deficiency anemia, including 30% with mild anemia, 12% with moderate anemia, and 6% with severe anemia. The remaining 52% of children were non-anemic Table 3: Comparison of Physical Growth Parameters Between Anemic and Non-Anemic Children Growth Parameter Anemic Children (n = 48) Non-Anemic Children (n = 52) p-value Height (cm) 110 ± 7 118 ± 6 < 0.05 Weight (kg) 19.5 ± 3.5 22.4 ± 4.2 < 0.05 Anemic children had significantly lower mean height and weight compared with non-anemic children (p < 0.05). Table 4: Cognitive Function Scores in Anemic and Non-Anemic Children Cognitive Test Anemic Children (n = 48) Non-Anemic Children (n = 52) p-value IQ score 85 ± 7 94 ± 6 < 0.01 Attention score 12.5 ± 3.2 15.1 ± 2.5 < 0.05 Memory score 14.8 ± 4.1 17.3 ± 3.1 < 0.05 Children with iron deficiency anemia demonstrated significantly lower scores in IQ, attention, and memory tests compared with non-anemic children. Discussion Prevalence and Impact of IDA: The empirical findings of the study have proven that iron deficiency anemia (IDA) is a major problem of social health in Khyber Pakhtunkhwa (KPK), and the level of prevalence is 45 per cent in the pediatric group. This high rate is in agreement with the current studies in low- and middle-income environments, where the ramifications of IDA on the health of children are always outlined. Further, our results confirm the built nexus between IDA and impaired physical development and cognitive development in children. In particular, anemic children in KPK had a much lower stature and body mass compared to their non-anemic counterparts (p 0.05), which supports the fact that IDA plays a role in growth retardation and stunting in the pediatric population [ 11 , 12 ]. Cognitive Impairments Due to IDA: Our Study too established that cognitive ability in children with IDA was highly impaired. The IDA had lower scores on IQ, attention and memory tests with the difference being found to be statistically significant (p < 0.01 in case of IQ, p < 0.05 in case of the rest). This is consistent with the results of a meta-analysis that established that iron deficiency has adverse effects on cognitive outcome, specifically, it affects the cognitive outcome negatively in areas like attention and memory, and that iron supplementation can enhance cognitive performance in anemic children, although not consistently with different areas of cognitive performance [ 13 ].We get our results aligned with the past Studyers, who have highlighted the negative impact of iron deficiency on neurodevelopment. Iron plays an important role in neurotransmitters, myelination, and energy metabolism manufacture in the brain, which are vital in the brain to perform cognitive functions. Hence, when iron deficiency affects these processes, it causes cognitive deficits, particularly, at the critical stages of brain development of early childhood [ 14 ]. Also, the association between IDA and poor cognitive ability in children, as we found in our Study, is consistent with the results of other geographical areas such as South Asia and Pakistan, where IDA has been associated with poor performance and learning impairment in schools [ 16 , 17 ]. Physical Growth and Development The link between IDA and a poor physical growth has been widely reported in the literature. We also confirm these results and indicate that the height and weight of anaemic children were considerably lower in KPK than their anaemic counterparts (p < 0.05). These findings indicate the part of iron in the act of producing hemoglobin and energy metabolism which are vital in physical development. Iron deficiency interferes with the effects of growth hormones like insulin-like growth factor (IGF-1) hence interfering with the somatic growth and resulting to stunted growth [ 15 ].The association between iron deficiency and stunting has also been highlighted by a systematic review as very strong between children. These results are corroborated by the lower means of height and weight of anemic children in our study, which supports the fact that iron is an important determinant of physical growth in childhood. This underscores the significance of early diagnosis and cure of IDA to inhibit the eventual physical developmental deficiencies [ 16 ]. Subclinical Iron Deficiency Besides the clinical IDA cases, our study also indicates that even subclinical iron deficiency in the case where anemia may not be an outcome, can adversely affect cognitive and behavioral performance. This observation is corroborated by the more recent literature which indicates that low iron status despite the absence of anemia may have an impact on cognitive functioning and the behavioral outcome of children [ 17 , 18 ]. Therefore, prevention of iron deficiency before it reaches anemia can be of paramount importance in terms of avoiding developmental delays and promoting a favorable growth and cognitive functioning. Implications for Public Health Interventions: Our results indicate the urgent necessity of the implementation of public health interventions that could prevent and cure iron deficiency in the child population, especially in such areas as KPK where the incidence of IDA is high[ 19 ]. To solve this widespread problem, the priority should be given to targeted interventions, including iron supplementation, nutritional education, and dietary diversification. The use of iron fortification programs and increasing the consumption of iron-enriched foods in school meals can also be important in enhancing the nutritional status of the children in these high-risk areas [ 20 ]. The high prevalence of IDA in KPK children, along with the significant effects on both physical growth and cognitive development, underscores the urgent need for region-specific interventions. Iron fortification programs and targeted nutritional education, particularly in rural areas, are critical to reducing the long-term developmental consequences observed in this study. Limitations and Future Directions: Although this Study is quite informative, it has a number of shortcomings. The cross-sectional design does not provide the possibility to draw causal correlations between IDA and the developmental outcomes. Moreover, the geographical limitation of the study of KPK implies that the results cannot represent the entire population of children in Pakistan. The effects of iron deficiency on physical and cognitive development and the efficacy of intervention to prevent these deleterious effects need to be investigated in future longitudinal Study. Conclusion The findings of this study underscore the urgent need for region-specific interventions to combat iron deficiency anemia (IDA) in Khyber Pakhtunkhwa (KPK). The high prevalence of IDA among children, as well as the severe lack of physical development and cognitive development, would put the situation in strong demand of urgent action by the population. Although the IDA represents a worldwide issue, the socio-economic conditions that the rural population of KPK is exposed to are specific to the country, and so the situation is even worse. The current Study will be useful to make local health policies and interventions by highlighting that specific nutritional education, iron supplementation programs, and iron fortification programs are required. Since the developmental implications of IDA are far-reaching, it is therefore crucial that the healthcare systems in the region manage this problem to maximize the growth and cognitive development of the children of KPK. Declarations Ethics approval and consent to participate: This study was conducted in accordance with the principles of the Declaration of Helsinki(2013). approved by the Institutional Review Board (IRB) of Lady Reading Hospital/Medical Teaching Institution ( LRH/MTI), Peshawar (Reference No. 488/LRH/MTI/23). The requirement for informed consent was waived owing to the cross-sectional Prospective design of the study. Consent for publication: Not applicable. Availability of data and materials: The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: Nil Authors' contributions: Mohsin Hayat and Rashida saddiq conceived and designed the study. Mohsin Hayat and Mohammad irshad collected and analysed the data and drafted the initial manuscript. Mohsin Hayat contributed to data interpretation and critical revision of the manuscript. Rashida saddiq contributed to data acquisition and manuscript editing. All authors read and approved the final version of the manuscript. Clinical trial number: not applicable. Acknowledgements: Not applicable. References Barks AK, Liu SX, Georgieff MK, Hallstrom TC, Tran PV. Early-Life Iron Deficiency Anemia Programs the Hippocampal Epigenomic Landscape. Nutrients. 2021;13(11):3857. 10.3390/nu13113857 . da Silva Lopes K, Yamaji N, Rahman MO, Suto M, Takemoto Y, Garcia-Casal MN, Ota E. Nutrition-specific interventions for preventing and controlling anaemia throughout the life cycle: an overview of systematic reviews. Cochrane Database Syst Rev. 2021;9(9):CD013092. 10.1002/14651858 . 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Lancet Glob Health. 2022;10(11):e1590–9. 10.1016/S2214-109X(22)00367-9 . Micronutrient deficiencies among preschool-aged children and women of reproductive age worldwide: a pooled analysis of individual-level data from population-representative surveys. Tam E, Keats EC, Rind F, Das JK, Bhutta AZA. Micronutrient Supplementation and Fortification Interventions on Health and Development Outcomes among Children Under-Five in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Nutrients. 2020;12(2):289. 10.3390/nu12020289 . Wood SK, Sperling R. Pediatric Screening: Development, Anemia, and Lead. Prim Care. 2019;46(1):69–84. 10.1016/j.pop.2018.10.008 . Zheng J, Liu J, Yang W. Association of Iron-Deficiency Anemia and Non-Iron-Deficiency Anemia with Neurobehavioral Development in Children Aged 6–24 Months. Nutrients. 2021;13(10):3423. 10.3390/nu13103423 . Bathla S, Arora S. Prevalence and approaches to manage iron deficiency anemia (IDA). Crit Rev Food Sci Nutr. 2022;62(32):8815–28. 10.1080/10408398.2021.1935442 . Cusick SE, Georgieff MK, Rao R. Approaches for Reducing the Risk of Early-Life Iron Deficiency-Induced Brain Dysfunction in Children. Nutrients. 2018;10(2):227. 10.3390/nu10020227 . East P, Delker E, Blanco E, Encina P, Lozoff B, Gahagan S. Effect of Infant Iron Deficiency on Children's Verbal Abilities: The Roles of Child Affect and Parent Unresponsiveness. Matern Child Health J. 2019;23(9):1240–50. 10.1007/s10995-019-02764-x . Jullien S. Screening of iron deficiency anaemia in early childhood. BMC Pediatr. 2021;21(Suppl 1):337. 10.1186/s12887-021-02725-w . Koleini N, Shapiro JS, Geier J, Ardehali H. Ironing out mechanisms of iron homeostasis and disorders of iron deficiency. J Clin Invest. 2021;131(11):e148671. 10.1172/JCI148671 . Lim TSH, Aw M, Slosky L, Nyp SS. Beyond Picky Eating. J Dev Behav Pediatr. 2020 Oct-Nov;41(8):656–8. 10.1097/DBP.0000000000000846 . Locks LM, Dahal P, Pokharel R, Joshi N, Paudyal N, Whitehead RD Jr, Chitekwe S, Mei Z, Lamichhane B, Garg A, Jefferds ME. Changes in growth, anaemia, and iron deficiency among children aged 6–23 months in two districts in Nepal that were part of the post-pilot scale-up of an integrated infant and young child feeding and micronutrient powder intervention. Matern Child Nutr. 2019;15(2):e12693. 10.1111/mcn.12693 . Epub 2018 Oct 12. Pan W, Gao H, Ying X, Xu C, Ye X, Shao Y, Hua M, Shao J, Zhang X, Fu S, Yang M. Food-derived bioactive oligopeptide iron complexes ameliorate iron deficiency anemia and offspring development in pregnant rats. Front Nutr. 2022;9:997006. 10.3389/fnut.2022.997006 . Roberts H, Woodman AG, Baines KJ, Jeyarajah MJ, Bourque SL, Renaud SJ. Maternal Iron Deficiency Alters Trophoblast Differentiation and Placental Development in Rat Pregnancy. Endocrinology. 2021;162(12):bqab215. 10.1210/endocr/bqab215 . Crider K, Williams J, Qi YP, Gutman J, Yeung L, Mai C, Finkelstain J, Mehta S, Pons-Duran C, Menéndez C, Moraleda C, Rogers L, Daniels K, Green P. Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas. Cochrane Database Syst Rev. 2022;2(2022):CD014217. 10.1002/14651858.CD014217 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 22 Mar, 2026 Reviews received at journal 17 Mar, 2026 Reviews received at journal 16 Mar, 2026 Reviews received at journal 10 Mar, 2026 Reviewers agreed at journal 05 Mar, 2026 Reviewers agreed at journal 05 Mar, 2026 Reviewers agreed at journal 05 Mar, 2026 Reviewers agreed at journal 05 Mar, 2026 Reviewers agreed at journal 24 Feb, 2026 Reviewers agreed at journal 21 Feb, 2026 Reviewers invited by journal 19 Feb, 2026 Editor invited by journal 09 Feb, 2026 Editor assigned by journal 07 Feb, 2026 Submission checks completed at journal 07 Feb, 2026 First submitted to journal 05 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8796538\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":594856741,\"identity\":\"47da55af-d08c-488c-8d2b-02dfe3c75a98\",\"order_by\":0,\"name\":\"Mohsin Hayat -\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Lady Reading Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Mohsin\",\"middleName\":\"Hayat\",\"lastName\":\"-\",\"suffix\":\"\"},{\"id\":594856742,\"identity\":\"b8675b88-5e02-4704-a62c-4364f818676c\",\"order_by\":1,\"name\":\"Mohammad irshad\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYBACNgiyYDBgb2x8kFABFGJmbiBGiwSDAc/hwwYfzoC0MOLXwgDXIpGWJjmzDSRAQAuf9PFnD36USeSbM+QYSPPOq43mbwdq+VGxDbcVfDnmhj3nJCx3NpwxMObddjx3xmHGBsaeM7dxa+HhYZPgbZMwMDjYY5DMu+1YbgNQCzNjGz4t7M8k/4K0HOYxOMw751jufMJaGMykwbYcY0tsnNlQk7uBsBYeM2mZc0AtZ5gPM3w4diB3I1DLQXx+ke8BOuxNmY2Bwf2H7T8Saupy550/fPDBjwrcWtDBYTB5gGj1QFBHiuJRMApGwSgYIQAAWElXIbgS3GwAAAAASUVORK5CYII=\",\"orcid\":\"\",\"institution\":\"Lady Reading Hospital\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Mohammad\",\"middleName\":\"\",\"lastName\":\"irshad\",\"suffix\":\"\"},{\"id\":594856743,\"identity\":\"6afa98c8-1587-4bbc-91ed-1b53a20ad39e\",\"order_by\":2,\"name\":\"Rashida saddiq -\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Lady Reading Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Rashida\",\"middleName\":\"saddiq\",\"lastName\":\"-\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-02-05 11:53:17\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-8796538/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-8796538/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":103345851,\"identity\":\"c9e71e04-7f47-4668-a33f-d564f4f46633\",\"added_by\":\"auto\",\"created_at\":\"2026-02-24 16:16:05\",\"extension\":\"jpeg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":143130,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eGraphical abstract of iron deficiency anemia in children current study.\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage1.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8796538/v1/8e2929ce0dc7ccbb51f8edc1.jpeg\"},{\"id\":104397561,\"identity\":\"463509da-afd2-446d-8a88-eedb393a847b\",\"added_by\":\"auto\",\"created_at\":\"2026-03-11 11:51:53\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1857736,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8796538/v1/1ecd70ee-60f1-4c77-9577-e7a186e27aa4.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Prevalence of Iron Deficiency Anemia And Its Impact on Growth And Development In Pediatric Population of Khyber Pakhtunkhwa (KPK), Pakistan\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eThe most common type of nutritional deficiency in the world is iron deficiency anemia (IDA), and this has a great effect on children in low- and middle-income countries. The disorder is caused by inadequate iron supplementation or reduced absorption that inhibits hemoglobin production and consequently interferes with the haemodynamic distribution of oxygen to the rest of the body. Children, especially, are vulnerable to IDA because of the increased growth rates and developmental milestones, which significantly increase the levels of iron requirement. Besides the clear somatic sequelae, which include growth retardation, maturation delay, and immunological deficiency, there is a correlation between IDA and severe cognitive and behavioral deficits which negatively impact academic achievement and quality of life in the later years [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eIDA is especially common in Pakistan, especially in rural areas of the country where there has been little access to iron-rich foodstuffs and proper healthcare services, especially in Khyber Pakhtunkhwa (KPK). Factors such as poverty, lack of nutritional education, poor healthcare facility, and reliance on cereal diets give rise to the problem [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. The uneven socio-economic situation in the area also complicates the process of remedying it as children with different ethnic and economic statuses might be characterized by different levels of nutritional deficiency and, therefore, pose a challenge to the introduction of consistent public health intervention [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Undiagnosed IDA may have serious consequences, which include irreversible cognitive delay, poor academic results, and lifelong developmental impairment [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. The iron is important in the biogenesis of hemoglobin and also in the functionality of many enzymes that are critical in growth, metabolism, and immunological functions. Therefore, early identification and timely therapeutic intervention become unavoidable in preventing these undesirable outcomes particularly in the critical stages of development as a child. Although the occurrence of IDA in Pakistan has been carefully reported, the particular implications of the same to child development in Khyber Pakhtunkhwa have not been adequately investigated. Most of the studies in the past have captured the general relationship existing between IDA and growth retardation, but limited studies have potentially challenged the region-specific impact of IDA on physical and cognitive development. This Study paper attempts to close this gap by evaluating the prevalence of IDA and its effects on anthropometric variables (height and weight) and cognitive variables (memory and attention and IQ scores) in children with KPK. The study will provide the Studyer with the region-specific data needed to inform the decisions on the formulation of specific public health policies and intervention measures to prevent the onset of IDA and alleviate its developmental consequences. Additionally, the results will be available in the overall understanding of how IDA affects the health of children and will be of a great help to local health care providers and the international nutrition specialists [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e].It is a consistent finding that IDA affects cognitive abilities, namely memory and attention, with long-term effects on cognitive functions in the academic performance and social life of a child [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. While the effects of IDA are well-documented globally, there is a distinct lack of data specific to Khyber Pakhtunkhwa (KPK), a province marked by significant socio-economic disparities. This study aims to fill this gap by examining the prevalence of IDA in children aged 2\\u0026ndash;12 years and its impact on both physical and cognitive development in this under-Studyed region.\\u003c/p\\u003e\"},{\"header\":\"Materials and Methods\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eStudy Design and Setting:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis is cross-sectional Prospective study which was carried out in June 2024 to June 2025 in the Department of Pediatric Medicine, Lady Reading Hospital (LRH), Peshawar. The target population included children aged between two and twelve years in cities and rural population in Khyber Pakhtunkhwa (KPK), Pakistan. The study was aiming to get the heterogeneity of the population in the region, in that regard, the study made an effort to have a variety of participants whose location was in various districts, hence the results would represent the heterogeneity of the socio-economic settings. The tertiary-care hospital setting allows the Studiers to access both inpatient Prevalence and community outreach programs and thus being able to thoroughly evaluate children with diverse demographic backgrounds.\\u003c/p\\u003e\\n\\u003ch4\\u003e\\u003cstrong\\u003eParticipants:\\u003c/strong\\u003e\\u003c/h4\\u003e\\n\\u003cp\\u003eThe study involved 100 children between the ages of 2 and 12 years. These were the participants who were selected in the local schools and community health centers around KPK. The convenience sampling was adopted to select children in the areas with both urban and rural environments in order to get the representation of different socioeconomic backgrounds.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eInclusion Criteria:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cul\\u003e\\n \\u003cli\\u003eChildren aged 2\\u0026ndash;12 years.\\u003c/li\\u003e\\n \\u003cli\\u003eCriteria: Children whose parents gave informed consent to participation.\\u003c/li\\u003e\\n \\u003cli\\u003eChildren- both urban and rural KPK.\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eExclusion Criteria:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cul\\u003e\\n \\u003cli\\u003eChildren having chronic diseases, severe infections or neurological conditions.\\u003c/li\\u003e\\n \\u003cli\\u003eChildren that have genetic syndromes or other disorders that may interfere with their growth or cognitive abilities.\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003eIn case of parental consent, the participants were tested regarding iron deficiency anemia (IDA) through blood tests on the hemoglobin content and the iron levels. Physical development was measured using height and weight and the cognitive ability test using standardized IQ, attention and memory tests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eEthical Approval Statement.\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was officially approved by the Institutional Review Board (IRB) of Lady Reading Hospital/Medical Teaching Institution ( LRH/MTI), Peshawar (\\u003cstrong\\u003eReference No. 488/LRH/MTI/23)\\u003c/strong\\u003e. The Study was conducted in line with the existing institutional and professional codes of ethics that govern human Study in adherence to a strongly maintained participant confidentiality and unwavering adherence to ethical treatment of all participants.\\u003c/p\\u003e\\n\\u003ch4\\u003e\\u003cstrong\\u003eData\\u0026nbsp;\\u003c/strong\\u003e\\u003cstrong\\u003eCollection Procedures:\\u003c/strong\\u003e\\u003c/h4\\u003e\\n\\u003cul\\u003e\\n \\u003cli\\u003e\\n \\u003ch4\\u003e\\u003cstrong\\u003eBlood Tests- Hemoglobin levels were measured to establish the state of anemia in the body and ferritin levels were measured to estimate iron deficiency. Children with hemoglobin levels less than 11g/dL and ferritin levels less than 12ng/mL were considered to have IDA. \\u0026nbsp;\\u003c/strong\\u003e\\u003c/h4\\u003e\\n \\u003c/li\\u003e\\n \\u003cli\\u003e\\n \\u003ch4\\u003e\\u003cstrong\\u003ePhysical Measures: To measure the growth parameters, height and weight were measured using standard procedures. \\u0026nbsp;\\u003c/strong\\u003e\\u003c/h4\\u003e\\n \\u003c/li\\u003e\\n \\u003cli\\u003e\\n \\u003ch4\\u003e\\u003cstrong\\u003eCognitive Assessments: An Prevalence of cognitive functioning was done using a mixture of IQ tests, memory tests and attention span tasks. The Intelligence Scale of the children was also conducted using the Wechsler Intelligence Scale (WISC) in order to derive IQ scores, with attention and memory tests being modified to fit the conventional developmental psychology tests.\\u003c/strong\\u003e\\u003c/h4\\u003e\\n \\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003ch4\\u003e\\u003cstrong\\u003eStatistical Analysis:\\u003c/strong\\u003e\\u003c/h4\\u003e\\n\\u003cp\\u003eThe analysis of data was done in SPSS version 26.0. Mean, standard deviation, and percentages were used as descriptive statistics in order to describe the characteristics and the outcomes of the participants. The Chi-square test was applied to test the relations between IDA and physical/cognitive parameters.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eDemographic Characteristics of the Participants\\u0026nbsp;\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eOne hundred children between 2 and 12 years were involved in the research. The overall age of the sample was 8.23 years with a standard deviation of 3.53. The sex distribution was almost same with 48 percent males (n = 48) and 52 % females (n = 52). In terms of residence, 40 % of the children were urban and the rest 60 percent were rural (Table 1).\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003ePrevalence and Severe Iron Deficiency anemia.\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eThe study population was found to have iron deficiency anemia (IDA) in 48% (n = 48) of the population. In the anemic children, 30% (n = 30) of the children had mild anemia, 12% (n = 12) of the children had moderate anemia and 6% (n = 6) of the children had severe anemia. The rest 52% (n = 52) of children were not anemic (Table 2).\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eComparison of Growth Physiological parameter.\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eThe comparison of the growth parameters of physical growth indicated that there was a significant difference between anemic and non-anemic children. The mean height of children with IDA was greatly lower than that of non-anemic children (110 7 cm versus 118 6 cm, p under 0.05). Likewise, the body weight of anemic children (19.5 \\u0026plusmn; 3.5 kg) was greatly lower as compared to non-anemic children (22.4 \\u0026plusmn; 4.2 kg, p \\u0026lt; 0.05) (Table 3).\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eCognitive Function Scores in Anemic and Non-Anemic Children Test Results.\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe cognitive performance was found to be significantly worse in case of children with iron deficiency anemia. The mean of the IQ score of anemic children was 85 \\u0026plusmn; 7 which was very low compared to the mean of IQ score of non-anemic children of 94 \\u0026plusmn; 6 (p \\u0026lt; 0.01). Furthermore, the level of attention was much lower in anemic group (12.5 \\u0026plusmn; 3.2) than non-anemic group (15.1 \\u0026plusmn; 2.5, p \\u0026lt; 0.05). The results of memory tests were also the same, where the anemic children scored much lower (14.8 \\u0026plusmn; 4.1) than the non-anemic children (17.3 \\u0026plusmn; 3.1, p \\u0026lt; 0.05) (Table 4).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFigure 01: Graphical abstract of iron deficiency anemia in children current study.\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 1. Demographic Characteristics of the Participants (n = 100)\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"599\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCharacteristic\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eValue\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eMean age (years)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e8.2 \\u0026plusmn; 3.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eMale sex, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e48 (48%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eFemale sex, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e52 (52%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eUrban residence, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e40 (40%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eRural residence, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e60 (60%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 2: Prevalence of Iron Deficiency Anemia (IDA)\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"611\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSeverity of Anemia\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNumber of Children\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePercentage (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eMild anemia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e30\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e30\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eModerate anemia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eSevere anemia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eNo anemia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e52\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e52\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eOverall, 48% of the children were diagnosed with iron deficiency anemia, including 30% with mild anemia, 12% with moderate anemia, and 6% with severe anemia. The remaining 52% of children were non-anemic\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 3: Comparison of Physical Growth Parameters Between Anemic and Non-Anemic Children\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"636\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eGrowth Parameter\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAnemic Children (n = 48)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNon-Anemic Children (n = 52)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eHeight (cm)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e110 \\u0026plusmn; 7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e118 \\u0026plusmn; 6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt; 0.05\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eWeight (kg)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e19.5 \\u0026plusmn; 3.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e22.4 \\u0026plusmn; 4.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt; 0.05\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eAnemic children had significantly lower mean height and weight compared with non-anemic children (p \\u0026lt; 0.05).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 4: Cognitive Function Scores in Anemic and Non-Anemic Children\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"649\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCognitive Test\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAnemic Children (n = 48)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNon-Anemic Children (n = 52)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eIQ score\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e85 \\u0026plusmn; 7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e94 \\u0026plusmn; 6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt; 0.01\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eAttention score\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e12.5 \\u0026plusmn; 3.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e15.1 \\u0026plusmn; 2.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt; 0.05\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eMemory score\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e14.8 \\u0026plusmn; 4.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e17.3 \\u0026plusmn; 3.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt; 0.05\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eChildren with iron deficiency anemia demonstrated significantly lower scores in IQ, attention, and memory tests compared with non-anemic children.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePrevalence and Impact of IDA:\\u003c/h2\\u003e \\u003cp\\u003eThe empirical findings of the study have proven that iron deficiency anemia (IDA) is a major problem of social health in Khyber Pakhtunkhwa (KPK), and the level of prevalence is 45 per cent in the pediatric group. This high rate is in agreement with the current studies in low- and middle-income environments, where the ramifications of IDA on the health of children are always outlined. Further, our results confirm the built nexus between IDA and impaired physical development and cognitive development in children. In particular, anemic children in KPK had a much lower stature and body mass compared to their non-anemic counterparts (p 0.05), which supports the fact that IDA plays a role in growth retardation and stunting in the pediatric population [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e].\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eCognitive Impairments Due to IDA:\\u003c/h2\\u003e \\u003cp\\u003eOur Study too established that cognitive ability in children with IDA was highly impaired. The IDA had lower scores on IQ, attention and memory tests with the difference being found to be statistically significant (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01 in case of IQ, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 in case of the rest). This is consistent with the results of a meta-analysis that established that iron deficiency has adverse effects on cognitive outcome, specifically, it affects the cognitive outcome negatively in areas like attention and memory, and that iron supplementation can enhance cognitive performance in anemic children, although not consistently with different areas of cognitive performance [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e].We get our results aligned with the past Studyers, who have highlighted the negative impact of iron deficiency on neurodevelopment. Iron plays an important role in neurotransmitters, myelination, and energy metabolism manufacture in the brain, which are vital in the brain to perform cognitive functions. Hence, when iron deficiency affects these processes, it causes cognitive deficits, particularly, at the critical stages of brain development of early childhood [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. Also, the association between IDA and poor cognitive ability in children, as we found in our Study, is consistent with the results of other geographical areas such as South Asia and Pakistan, where IDA has been associated with poor performance and learning impairment in schools [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e].\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePhysical Growth and Development\\u003c/h2\\u003e \\u003cp\\u003eThe link between IDA and a poor physical growth has been widely reported in the literature. We also confirm these results and indicate that the height and weight of anaemic children were considerably lower in KPK than their anaemic counterparts (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). These findings indicate the part of iron in the act of producing hemoglobin and energy metabolism which are vital in physical development. Iron deficiency interferes with the effects of growth hormones like insulin-like growth factor (IGF-1) hence interfering with the somatic growth and resulting to stunted growth [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e].The association between iron deficiency and stunting has also been highlighted by a systematic review as very strong between children. These results are corroborated by the lower means of height and weight of anemic children in our study, which supports the fact that iron is an important determinant of physical growth in childhood. This underscores the significance of early diagnosis and cure of IDA to inhibit the eventual physical developmental deficiencies [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e].\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSubclinical Iron Deficiency\\u003c/h2\\u003e \\u003cp\\u003eBesides the clinical IDA cases, our study also indicates that even subclinical iron deficiency in the case where anemia may not be an outcome, can adversely affect cognitive and behavioral performance. This observation is corroborated by the more recent literature which indicates that low iron status despite the absence of anemia may have an impact on cognitive functioning and the behavioral outcome of children [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. Therefore, prevention of iron deficiency before it reaches anemia can be of paramount importance in terms of avoiding developmental delays and promoting a favorable growth and cognitive functioning.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec16\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eImplications for Public Health Interventions:\\u003c/h2\\u003e \\u003cp\\u003eOur results indicate the urgent necessity of the implementation of public health interventions that could prevent and cure iron deficiency in the child population, especially in such areas as KPK where the incidence of IDA is high[\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]. To solve this widespread problem, the priority should be given to targeted interventions, including iron supplementation, nutritional education, and dietary diversification. The use of iron fortification programs and increasing the consumption of iron-enriched foods in school meals can also be important in enhancing the nutritional status of the children in these high-risk areas [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]. The high prevalence of IDA in KPK children, along with the significant effects on both physical growth and cognitive development, underscores the urgent need for region-specific interventions. Iron fortification programs and targeted nutritional education, particularly in rural areas, are critical to reducing the long-term developmental consequences observed in this study.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec17\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eLimitations and Future Directions:\\u003c/h2\\u003e \\u003cp\\u003eAlthough this Study is quite informative, it has a number of shortcomings. The cross-sectional design does not provide the possibility to draw causal correlations between IDA and the developmental outcomes. Moreover, the geographical limitation of the study of KPK implies that the results cannot represent the entire population of children in Pakistan. The effects of iron deficiency on physical and cognitive development and the efficacy of intervention to prevent these deleterious effects need to be investigated in future longitudinal Study.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eThe findings of this study underscore the urgent need for region-specific interventions to combat iron deficiency anemia (IDA) in Khyber Pakhtunkhwa (KPK). The high prevalence of IDA among children, as well as the severe lack of physical development and cognitive development, would put the situation in strong demand of urgent action by the population. Although the IDA represents a worldwide issue, the socio-economic conditions that the rural population of KPK is exposed to are specific to the country, and so the situation is even worse. The current Study will be useful to make local health policies and interventions by highlighting that specific nutritional education, iron supplementation programs, and iron fortification programs are required. Since the developmental implications of IDA are far-reaching, it is therefore crucial that the healthcare systems in the region manage this problem to maximize the growth and cognitive development of the children of KPK.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003eEthics approval and consent to participate: This study was conducted in accordance with the principles of the Declaration of Helsinki(2013). approved by the Institutional Review Board (IRB) of Lady Reading Hospital/Medical Teaching Institution ( LRH/MTI), Peshawar (Reference No. 488/LRH/MTI/23). The requirement for informed consent was waived owing to the \\u0026nbsp;cross-sectional Prospective design of the study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication:\\u0026nbsp;\\u003c/strong\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials:\\u003c/strong\\u003e The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests:\\u003c/strong\\u003e The authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding:\\u003c/strong\\u003e \\u003cstrong\\u003eNil\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026apos; contributions:\\u003c/strong\\u003e \\u003cstrong\\u003eMohsin Hayat\\u0026nbsp;\\u003c/strong\\u003eand\\u003cstrong\\u003e\\u0026nbsp;Rashida saddiq\\u003c/strong\\u003e conceived and designed the study. \\u003cstrong\\u003eMohsin Hayat\\u0026nbsp;\\u003c/strong\\u003eand\\u003cstrong\\u003e\\u0026nbsp;Mohammad irshad\\u003c/strong\\u003e collected and analysed the data and drafted the initial manuscript. \\u003cstrong\\u003eMohsin Hayat\\u003c/strong\\u003e contributed to data interpretation and critical revision of the manuscript. \\u003cstrong\\u003eRashida saddiq\\u003c/strong\\u003e contributed to data acquisition and manuscript editing. All authors read and approved the final version of the manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003cstrong\\u003eClinical trial number:\\u003c/strong\\u003e not applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements:\\u003c/strong\\u003e Not applicable.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eBarks AK, Liu SX, Georgieff MK, Hallstrom TC, Tran PV. Early-Life Iron Deficiency Anemia Programs the Hippocampal Epigenomic Landscape. Nutrients. 2021;13(11):3857. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3390/nu13113857\\u003c/span\\u003e\\u003cspan address=\\\"10.3390/nu13113857\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eda Silva Lopes K, Yamaji N, Rahman MO, Suto M, Takemoto Y, Garcia-Casal MN, Ota E. Nutrition-specific interventions for preventing and controlling anaemia throughout the life cycle: an overview of systematic reviews. Cochrane Database Syst Rev. 2021;9(9):CD013092. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1002/14651858\\u003c/span\\u003e\\u003cspan address=\\\"10.1002/14651858\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eFarkhondeh T, Mansouri B, Binkowski LJ, Błaszczyk M, Pirsaheb M, Azadi NA, Słoboda M, Amirabadizadeh A, Javadmoosavi SY. Blood lead concentrations in children with iron deficiency anemia: a systematic review and meta-analysis. 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Micronutrient deficiencies among preschool-aged children and women of reproductive age worldwide: a pooled analysis of individual-level data from population-representative surveys.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTam E, Keats EC, Rind F, Das JK, Bhutta AZA. Micronutrient Supplementation and Fortification Interventions on Health and Development Outcomes among Children Under-Five in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Nutrients. 2020;12(2):289. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3390/nu12020289\\u003c/span\\u003e\\u003cspan address=\\\"10.3390/nu12020289\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWood SK, Sperling R. Pediatric Screening: Development, Anemia, and Lead. 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Front Nutr. 2022;9:997006. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3389/fnut.2022.997006\\u003c/span\\u003e\\u003cspan address=\\\"10.3389/fnut.2022.997006\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRoberts H, Woodman AG, Baines KJ, Jeyarajah MJ, Bourque SL, Renaud SJ. Maternal Iron Deficiency Alters Trophoblast Differentiation and Placental Development in Rat Pregnancy. Endocrinology. 2021;162(12):bqab215. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1210/endocr/bqab215\\u003c/span\\u003e\\u003cspan address=\\\"10.1210/endocr/bqab215\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCrider K, Williams J, Qi YP, Gutman J, Yeung L, Mai C, Finkelstain J, Mehta S, Pons-Duran C, Men\\u0026eacute;ndez C, Moraleda C, Rogers L, Daniels K, Green P. Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas. Cochrane Database Syst Rev. 2022;2(2022):CD014217. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1002/14651858.CD014217\\u003c/span\\u003e\\u003cspan address=\\\"10.1002/14651858.CD014217\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-pediatrics\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bped\",\"sideBox\":\"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bped/default.aspx\",\"title\":\"BMC Pediatrics\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Iron deficiency anemia, children, growth, development\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8796538/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8796538/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eIron deficiency anemia (IDA) is a significant global health issue, particularly in low- and middle-income countries. It leads to impaired physical growth, cognitive development, and overall well-being in children. Despite being widely studied, region-specific data, particularly from Khyber Pakhtunkhwa (KPK), Pakistan, remains limited, emphasizing the need for focused Study in this area.\\u003c/p\\u003e\\u003ch2\\u003eObjectives:\\u003c/h2\\u003e \\u003cp\\u003eIron deficiency anemia (IDA) is one of the most severe problems of public health, especially within low and middle-income countries. The present study will examine both the problem of IDA among children of the 2\\u0026ndash;12 years old age group in Khyber Pakhtunkhwa (KPK), Pakistan, and its consequences to the physical and cognitive development of children.\\u003c/p\\u003e\\u003ch2\\u003eMethods:\\u003c/h2\\u003e \\u003cp\\u003eIn the current cross-sectional Prospective study 100 children aged 2 to 12 years old were included in the study, including urban and rural samples. Blood samples that were collected in the veins were tested to determine hemoglobin level and iron status in the blood serum. At the same time, the anthropometric measures (height and weight) and the cognitive functioning were assessed by the use of the validated standardized measures. Statistical work was done in SPSS and included descriptive summaries, Chi-square test and multiple regression models in order to look at the relationship between iron deficiency anemia (IDA) and growth and cognitive outcomes.\\u003c/p\\u003e\\u003ch2\\u003eResults:\\u003c/h2\\u003e \\u003cp\\u003eIt was found that iron deficiency anemia was very common with 48% of children having mild anemia 30% having moderate anemia and 6% having severe anemia. The physical growth parameters (height and weight) were also much less in anemic children compared to their non-anemic counterparts (p- less than \\u0026minus;\\u0026thinsp;0.05). The average height of anemic children was 110cm 7cm and the average weight of non-anemic children was 22.4cm 4.2kg. The cognitive performance score was also significantly lower in children with IDA; the average IQ score was 85.338.37 on anemic children and 93.887.25 on non-anemic children (P=.01).\\u003c/p\\u003e\\u003ch2\\u003eConclusion:\\u003c/h2\\u003e \\u003cp\\u003eThe present study proves that iron deficiency anemia is still endemic in the province of Khyber Pakhtunkhwa and that it causes a strong adverse impact on somatic developmental patterns and neurocognitive maturity in the childhood population. These statistic, in turn, support the necessity of strictly developed intervention measures, including iron fortification measures and more efficient nutrition education, to reduce this health emergency and to promote high health outcomes among the child population of the region.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Prevalence of Iron Deficiency Anemia And Its Impact on Growth And Development In Pediatric Population of Khyber Pakhtunkhwa (KPK), Pakistan\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-02-24 16:15:58\",\"doi\":\"10.21203/rs.3.rs-8796538/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2026-03-23T01:48:56+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-03-17T19:04:22+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-03-16T17:35:37+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-03-10T22:47:49+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"255357710367268562308733086709532357178\",\"date\":\"2026-03-06T03:30:22+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"269075437395882945683952991763728543619\",\"date\":\"2026-03-06T00:52:21+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"268727203342432620166705714918753146825\",\"date\":\"2026-03-05T17:54:37+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"151790503913134914850317868332454931355\",\"date\":\"2026-03-05T13:03:52+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"7502879756486912724817893404464473455\",\"date\":\"2026-02-24T07:06:05+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"235185526020339144483022911466013981521\",\"date\":\"2026-02-21T11:47:19+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2026-02-19T06:51:10+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2026-02-09T08:23:57+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2026-02-07T14:38:42+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2026-02-07T14:38:26+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Pediatrics\",\"date\":\"2026-02-05T11:04:52+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-pediatrics\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bped\",\"sideBox\":\"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bped/default.aspx\",\"title\":\"BMC Pediatrics\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"b8b618fc-4241-4c5d-9ac9-7f7361c744d3\",\"owner\":[],\"postedDate\":\"February 24th, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-05-05T03:53:15+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-02-24 16:15:58\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8796538\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8796538\",\"identity\":\"rs-8796538\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}