Anaemia (Khoon Ki Kami) in Pakistan: Why Half of Children and Two in Five Women Have It

"Kamzori" is the most commonly self-diagnosed condition in Pakistan, and for once the folk diagnosis is often literally correct — the blood really is short. Pakistan's National Nutrition Survey 2018, the country's largest nutrition survey, found anaemia in 53.7% of children aged 6–59 months (54.2% of boys, 53.1% of girls) and in 43.0% of non-pregnant women of reproductive age. An analysis of the same survey published in Nutrients found 49.1% of children were iron deficient, and that iron-deficiency anaemia specifically affected 18.0% of non-pregnant women and 21.2% of pregnant women.

Two things follow from those numbers. First, anaemia at this scale is not an individual failing — it is a population-level nutrition problem. Second, and more useful clinically: iron deficiency explains a large share of anaemia here but not all of it, which is why "just take an iron tonic" is not a substitute for finding out why the blood is low.

At a glance

• 53.7% of children aged 6–59 months are anaemic (NNS 2018)
• 43.0% of non-pregnant women of reproductive age are anaemic; 49.1% of children are iron deficient
• Iron-deficiency anaemia: 18.0% of non-pregnant and 21.2% of pregnant women
• Vitamin A deficiency affects 27% of women of reproductive age — deficiencies rarely travel alone
• Anaemia is a finding, not a final diagnosis: the cause matters, particularly in men and older adults

Khoon ki kami kya hai?

Khoon ki kami (anaemia) ka matlab hai ke khoon mein haemoglobin — wo hissa jo jism bhar mein oxygen pohnchata hai — kam ho gaya hai. Isi liye thakawat, chakkar, saans phoolna aur chehre ki zardi hoti hai.

Pakistan mein sab se aam waja iron ki kami hai, lekin sirf waja nahi. Auraton mein zyada mahwari (heavy periods), baar baar hamal, aur khurak mein iron ki kami; bachon mein doodh ke ilawa iron wali ghiza ka kam hona; aur logon mein pait ke keeray ya pait mein khoon behna bhi waja ho sakti hai. Mardon aur bari umar ki auraton mein khoon ki kami ko kabhi "normal" na samjhen — un mein iski waja dhoondna zaroori hota hai, sirf iron ki goli shuru kar dena kafi nahi.

Ek amli baat: iron ki goli chai ke saath na lein. Chai ka tannin iron ko jazb hone se rokta hai. Goli ke saath limbu ya koi khatti cheez (vitamin C) ho to iron behtar jazb hota hai.

Symptoms

• Persistent tiredness and weakness (thakawat, kamzori)
• Dizziness or light-headedness, especially on standing (chakkar aana)
• Breathlessness on mild exertion, such as one flight of stairs (saans phoolna)
• Pale skin, inner eyelids, nail beds and tongue (chehre ki zardi)
• Palpitations — a heart that feels like it is working too hard
• Headaches and poor concentration
• Brittle nails, hair fall, cracks at the corners of the mouth
• Craving ice, clay or chalk (pica) — an unusual but genuinely characteristic sign of iron deficiency

Causes and risk factors

• A diet low in iron-rich foods — the dominant driver in the Pakistani survey data
• Heavy or prolonged menstrual bleeding (zyada mahwari)
• Pregnancy and closely spaced pregnancies, which raise iron demand sharply
• Intestinal worm infestation and repeated infections
• Chronic blood loss from the gut — ulcers, piles, or long-term painkiller use. Related: our guide to acid reflux and GERD, where NSAID use comes up for the same reason
• Poor absorption, as in coeliac disease
• Chronic kidney disease, chronic inflammation, and thalassaemia trait — which is not rare in Pakistan and is not corrected by iron

How it's diagnosed

A complete blood count (CBC) establishes whether anaemia is present and gives the first clue to its type from the red-cell size. Ferritin measures iron stores and is the key test for confirming iron deficiency specifically. Depending on the picture, a doctor may add vitamin B12, folate, thyroid tests, stool testing for worms or occult blood, or haemoglobin electrophoresis where thalassaemia is suspected. A general physician or nutritionist can interpret these together with diet; persistent or unexplained anaemia, especially in men, warrants a gastroenterologist's assessment for a source of bleeding.

Treatment

• Oral iron, typically for three to six months — and critically, continued for a couple of months after haemoglobin normalises, to refill stores. Stopping the day the numbers look better is why anaemia so often returns
• Take it right: on an empty stomach if tolerated, with a source of vitamin C; avoid tea, coffee, milk and calcium supplements within a couple of hours (chai ke saath iron ki goli na lein)
• Expect side effects: constipation, dark stools and nausea are common and manageable — dark stools are harmless and expected
• Treat the cause: heavy periods, worms, ulcers or bleeding need addressing, or the deficiency simply comes back
• Dietary iron: meat, liver, eggs and fish are absorbed far better than plant sources; among plant foods, lentils, beans, spinach and dates help, especially paired with vitamin C
• Intravenous iron or transfusion for severe cases, poor absorption, or when a rapid correction is needed — a hospital decision, not a routine one

B12 or folate deficiency anaemia is treated with those vitamins instead; thalassaemia is managed entirely differently, and giving iron to someone who does not lack iron can do harm.

When to see a doctor

• Weeks of unexplained tiredness, breathlessness or palpitations
• Anaemia in a man or a postmenopausal woman — always needs a cause identified
• Anaemia during pregnancy, which affects both mother and baby and needs active management
• A child who is pale, listless, eating poorly or growing slowly
• Blood in the stool, black tarry stools, or heavy periods
• No improvement after two to three months of iron taken correctly — that points to a different cause, not a stronger tonic

Prevention

• Iron-rich foods in regular rotation, and vitamin C alongside plant-based iron
• Keeping tea away from mealtimes, particularly for children and pregnant women
• Iron and folic acid supplementation in pregnancy as advised in antenatal care
• Deworming where recommended, and clean water and hand hygiene to reduce repeated infection
• Iron-rich complementary foods from six months of age, not milk alone

Frequently asked questions

Kya khoon ki kami sirf khurak se theek ho sakti hai?

Halki kami mein behtar khurak madad karti hai, lekin waqai kami hone par sirf ghiza kafi nahi hoti — iron ki goli chahiye hoti hai, aur wo bhi kai mahine. Ghiza is ke baad kami wapas aane se rokti hai.

Do iron tablets have to be taken forever?

No. A defined course of a few months, followed by treating whatever caused the loss, is the usual pattern. Indefinite supplementation without a reason is not the goal.

Is an "iron tonic" from the pharmacy enough?

Many syrups contain far less elemental iron than a proper tablet, and none of them investigate why the blood is low. A CBC and ferritin cost little and change the plan.

Can anaemia cause hair fall?

Iron deficiency is one of the recognised contributors to diffuse hair shedding — see our guide to hair fall for the fuller list.

Sources

• National Nutrition Survey 2018 — Key Findings Report (UNICEF Pakistan)
• "Prevalence and Risk Factors for Iron Deficiency Anemia among Children under Five and Women of Reproductive Age in Pakistan: Findings from the National Nutrition Survey 2018," Nutrients (PMC)

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