Anemia is defined by the World Health Organization as a condition in which the number of red blood cells or their oxygen-carrying capacity is insufficient to meet the body's physiological requirements, and it continues to be recognized as one of the most significant public health problems worldwide, affecting an estimated one-quarter of the global population¹. Among the various forms of anemia, iron-deficiency anemia remains the most prevalent, accounting for nearly half of all anemia cases across developing and developed nations alike^.2

In India, anemia has long been recognized as a major nutritional deficiency disorder of public health importance, with national surveys conducted over the past two decades consistently documenting a high prevalence among women, children, and adolescents across both rural and urban settings³. Early Indian community-based studies reported that a considerable proportion of the adult population, particularly women in the reproductive age group, suffered from varying grades of anemia, often without adequate awareness of its presence or its long-term consequences on health and productivity^.4

Anemia has far-reaching consequences that extend beyond simple hematological deficiency. It is associated with reduced physical work capacity, impaired cognitive development in children, poor pregnancy outcomes including low birth weight and increased maternal mortality, diminished immunity, and an overall reduction in quality of life. These consequences are particularly relevant in adult populations, where anemia often goes undetected due to its insidious onset and non-specific symptoms such as fatigue, weakness, and breathlessness, which are frequently attributed to routine stress or overwork rather than to an underlying medical condition.

Earlier community-based research from India highlighted those poor dietary practices, low literacy, inadequate awareness of iron-rich foods, and limited utilization of health services were important determinants of both the prevalence of anemia and the low level of community knowledge regarding its prevention⁵. Similarly, studies conducted among college students and young adults in various parts of the country found that despite a reasonably high level of general awareness that anemia existed as a condition, specific knowledge regarding its causes, symptomatology, and preventable nature remained substantially deficient^.6

Knowledge and awareness play a pivotal role in the prevention and control of anemia, as they directly influence health-seeking behavior, dietary choices, compliance with iron and folic acid supplementation programmes, and the timely recognition of symptoms warranting medical attention. Population-level health education has therefore been identified as a cost-effective strategy to complement supplementation and food fortification programmes, particularly in resource-limited settings where access to diagnostic and therapeutic services may be constrained.

Despite the existence of long-standing national nutritional anemia control programmes in India, gaps in community awareness have persisted, as documented in several early evaluative studies that pointed to insufficient information, education, and communication (IEC) activities as a contributing factor to the limited success of these programmes⁷.

Given the persistent burden of anemia and its wide-ranging health consequences, understanding the current level of knowledge and awareness among the general adult population is essential for designing effective, targeted health education interventions. However, much of the existing literature has focused on specific vulnerable groups such as pregnant women, adolescent girls, or children, with comparatively fewer studies examining knowledge and awareness among the general adult population inclusive of both sexes. This study was therefore undertaken with the objective of assessing the level of knowledge and awareness of anemia and its health consequences among adults in a community setting, and to determine the socio-demographic factors associated with such knowledge, in order to inform future public health education strategies.

Study Design and Setting

A community-based, descriptive cross-sectional study was conducted over a period of four months (November 2012 to February 2013) in the urban field practice area attached to the Department of General Medicine of a tertiary care teaching hospital. The study area comprised a mixed population of adults residing in both planned residential colonies and adjoining urban slum clusters.

Study Population and Sample Size

The study population consisted of adult men and women aged 18–60 years who were permanent residents of the study area and gave informed consent to participate. Individuals who were critically ill, unable to communicate, or who did not consent were excluded. The sample size was calculated using the formula n = Z²pq/d², assuming an expected proportion of adequate knowledge of anemia of 50% (to obtain the maximum sample size), a relative precision (d) of 5%, and a 95% confidence level (Z = 1.96), yielding a minimum sample size of 384. After adjusting for a non-response rate of approximately 10%, the final sample size was rounded to 420.

Sampling Technique

A list of households in the study area was obtained from the electoral roll maintained at the local health centre, and households were selected using systematic random sampling with a sampling interval calculated by dividing the total number of households by the required sample size. From each selected household, one eligible adult was chosen using the Kish grid method to avoid selection bias. If a selected household had no eligible member available after two repeat visits, the adjoining household was approached.

Data Collection Tool

Data were collected using a pre-designed, pre-tested, semi-structured questionnaire developed after a review of the relevant literature. The questionnaire was divided into three sections: (a) socio-demographic characteristics including age, sex, education, occupation, and socio-economic status classified using the modified B.G. Prasad classification; (b) a 15-item knowledge assessment covering the definition, causes, risk groups, symptoms, prevention, and health consequences of anemia, with each correct response awarded one mark; and (c) questions on sources of health information and prior exposure to anemia-related health education. The questionnaire was initially prepared in English and translated into the local language, then back-translated to ensure semantic equivalence. It was pre-tested on 30 adults in a nearby area not included in the main study, and necessary modifications were made based on the pre-test findings; these 30 participants were excluded from the final analysis.

Scoring and Classification of Knowledge

Based on the total knowledge score (maximum score 15), participants were classified into three categories: poor knowledge (score 0–5), average knowledge (score 6–10), and good knowledge (score 11–15). Awareness of individual health consequences of anemia (reduced work capacity, adverse pregnancy outcomes, impaired child growth and development, increased susceptibility to infection, and cardiovascular strain) was assessed separately as binary (aware/not aware) responses.

Data Collection Procedure

Data were collected by trained investigators through face-to-face interviews conducted at the participants' residences after obtaining written informed consent. Each interview lasted approximately 15–20 minutes. Confidentiality of the information provided was assured, and participants were free to withdraw from the study at any point without any consequence.

Ethical Considerations

The study protocol was approved by the Institutional Ethics Committee prior to commencement. Written informed consent was obtained from all participants after explaining the purpose and procedure of the study in the local language. Anonymity and confidentiality of participant information were strictly maintained throughout the study.

Statistical Analysis

Data were entered in Microsoft Excel and analyzed using SPSS version 26.0 (IBM Corp.). Descriptive statistics were expressed as frequencies, percentages, mean, and standard deviation. The Chi-square test was used to determine the association between socio-demographic variables and the level of knowledge, and binary logistic regression was used to identify independent predictors of good knowledge. A p-value of less than 0.05 was considered statistically significant.

A total of 420 adults participated in the study, with a response rate of 93.3%. The socio-demographic profile, overall knowledge distribution, awareness of causes, symptoms, and preventive measures, and awareness of specific health consequences of anemia are presented in Tables 1 to 6.

Table 1: Socio-demographic Characteristics of Study Participants (N = 420)

*Modified B.G. Prasad Socio-economic Classification.

Table 2: Overall Level of Knowledge Regarding Anemia (N = 420)

The mean knowledge score of the participants was 8.4 ± 3.1 (out of a maximum of 15), indicating an overall average level of knowledge in the study population.

Table 3: Knowledge Regarding Causes and Risk Groups for Anemia (N = 420)

Table 4: Knowledge Regarding Symptoms and Preventive Measures of Anemia (N = 420)

Table 5: Awareness of Health Consequences of Anemia (N = 420)

Table 6: Association Between Socio-demographic Factors and Level of Knowledge (N = 420)

*Statistically significant at p<0.05 (Chi-square test).

Table 7: Predictors of Good Knowledge of Anemia — Binary Logistic Regression

*Statistically significant at p<0.05.

Sources of Health Information

Television/radio (48.6%) and healthcare workers (42.1%) were reported as the most common sources of anemia-related information, followed by print media/newspapers (26.0%), social media/internet (23.8%), family/friends (21.0%), and community health programmes/camps (17.9%). Only 12.4% of participants recalled receiving structured health education specifically on anemia from a formal source such as a school or workplace programme.

The present study provides essential osteometric data regarding the position and size of the mental foramen in an adult Indian population. The predominance of the second premolar position (52.9%) aligns with the findings of Sankar et al.14, Kalender et al.18, and Al-Shayyab et al.15, who reported similar trends (45–55%). Such consistency suggests a stable evolutionary and functional position related to the premolar apices.

The average horizontal (2.81 mm right, 2.76 mm left) and vertical diameters (2.38 mm right, 2.41 mm left) agree with earlier osteological studies reporting ranges of 2–3 mm.17,18 Absence of significant side variation supports bilateral symmetry, although population-level sexual dimorphism may account for minimal differences reported in other series.20,21

The absence of MF in canine or molar alignment and low frequency between second premolar and first molar (< 10%) corroborates meta-analyses indicating rare posterior displacement in Indian and Asian mandibles compared to Caucasian groups.15,16 Genetic and masticatory loading patterns may explain ethnic variation in MF position.23

Anatomical localization of the MF is indispensable in dental practice. The results of the current study reinforce the need to expect MF near the second premolar region during endodontic and implant procedures. Awareness of such baseline morphometry prevents inadvertent mental nerve injury and ensures effective anesthesia.4,6

The mental foramen was predominantly located in line with the second premolar, with minor positional variations. The mean horizontal and vertical diameters showed no significant right–left differences. These data provide valuable anatomical reference for clinicians performing dental and surgical interventions in the mandibular premolar region.

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2. Al-Shayyab MH, et al. Position, shape, and size of the mental foramen in diverse populations. Dentomaxillofac Radiol. 2015;44(8):20140235. doi:10.1259/dmfr.20140235
3. Sankar DK, et al. Morphometric and positional variations of the mental foramen: a study in dry mandibles. Anat Res Int. 2011;2011:1–6. doi:10.1155/2011/316985
4. Malamed SF. Handbook of Local Anesthesia. 7th ed. Elsevier; 2019.
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6. Kalender A, et al. Assessment of the mental foramen location in Turkish adults with CBCT. Surg Radiol Anat. 2012;34(5):367–374. doi:10.1007/s00276-011-0909-4
7. Padmavathi G, et al. Sex estimation using morphometry of the mental foramen. Forensic Sci Int. 2017;275:1–7. doi:10.1016/j.forsciint.2017.03.002
8. Zmyslowska I, et al. Accessory mental foramina: prevalence and dimensions on CBCT. Clin Oral Investig. 2017;21(6):1957–1964. doi:10.1007/s00784-016-1979-z
9. Budhiraja V, et al. Morphometry of mental foramen in North Indian mandibles. Int J Morphol. 2013;31(3):1–5.
10. Parnia F, et al. CBCT evaluation of the mental foramen in dentate and edentulous patients. Clin Implant Dent Relat Res. 2012;14(4):1–7. doi:10.1111/j.1708-8208.2010.00292.x