Hidden hunger — the silent deprivation of essential micronutrients — continues to threaten the health and potential of millions of children worldwide. Among the most pervasive manifestations of this form of malnutrition is anaemia, a condition that quietly drains energy, impairs cognitive growth, and undermines a child’s ability to learn, play, and thrive. Although widely preventable and treatable, anaemia and related nutritional deficiencies remain stubbornly entrenched across developing nations, including India, where they account for a significant share of childhood morbidity and lost developmental potential.1-4 According to the National Family Health Survey (NFHS-5), nearly one in two Indian children aged 6–59 months is anaemic, with many also suffering from concurrent deficiencies of iron, folate, vitamin B12, and other micronutrients.5,6 These figures, though alarming, only represent the visible tip of a deeper crisis — one intertwined with dietary inadequacies, poverty, limited health awareness, and socio-cultural practices. School-aged children, in particular, occupy a neglected space within this spectrum: while early childhood interventions such as the Integrated Child Development Services (ICDS) and adolescent health programs receive focused attention, the middle years of schooling often witness a policy and awareness vacuum. During this crucial stage of physical and cognitive development, insufficient nutrition can leave lasting scars on academic performance, immunity, and future productivity.7-9 Himachal Pradesh, with its rugged terrain and dispersed rural settlements, presents a unique nutritional landscape. Despite comparatively high literacy rates and better health indices than many other Indian states, the region faces persistent challenges in food diversity, dietary quality, and access to nutrition education. Harsh winters, dependence on limited local produce, and regional dietary preferences contribute to hidden deficiencies, particularly among children in government and rural schools. Additionally, misconceptions surrounding iron supplementation, meal skipping due to academic pressures, and inadequate parental knowledge further perpetuate the problem. While national programs such as the Mid-Day Meal Scheme, Anaemia Mukt Bharat, and Weekly Iron and Folic Acid Supplementation (WIFS) have been implemented, their true impact depends largely on the community’s level of awareness, acceptance, and consistent participation.10-14 Research from various parts of India underscores that awareness — or the lack thereof — plays a decisive role in determining health behavior. Parents and teachers often underestimate the signs of nutritional deficiency, mistaking pallor, fatigue, or inattentiveness for laziness or disinterest. Children themselves seldom receive age-appropriate health education that helps them recognize the importance of iron-rich foods or balanced diets. The consequence is a self-perpetuating cycle of ignorance and ill health, where anaemia silently erodes learning capacity and physical endurance, pushing many children into a state of “functional impairment” long before adulthood. Despite the recognized burden of anaemia, there is a scarcity of region-specific evidence from Himachal Pradesh, especially regarding public and school-level awareness. Understanding how well parents, teachers, and even older students comprehend the causes, symptoms, and prevention of anaemia is critical for designing effective, context-sensitive interventions. Local dietary habits, cultural beliefs, and the accessibility of nutrition resources all shape the awareness–practice gap that determines the success or failure of national health missions at the grassroots level. The present study aims to explore these dimensions comprehensively. By assessing awareness levels among different socio-demographic groups, identifying misconceptions, and mapping factors influencing nutritional knowledge, the research seeks to provide actionable insights for educators, policymakers, and healthcare professionals. Ultimately, improving awareness is not merely about disseminating information — it is about empowering communities to recognize anaemia not as an inevitable part of childhood, but as a preventable barrier to the full realization of human potential.

Study Design and Setting A descriptive, cross-sectional study was conducted to assess the level of awareness regarding anaemia and nutritional deficiencies among school-aged children in the state of Himachal Pradesh, India. The study was carried out between January and April 2025, covering both urban and rural schools across selected districts representing diverse geographical terrains — including Shimla, Kangra, and Chamba. These areas were chosen to capture variations in socio-economic conditions, dietary patterns, and accessibility to nutrition and health education programs. Study Population The target population included school-aged children (10–16 years) enrolled in government and private schools, along with their teachers and parents, to obtain a holistic perspective on awareness. Inclusion criteria comprised students who were regular attendees and willing to participate with parental consent. Exclusion criteria included children with diagnosed chronic illnesses, known haemoglobinopathies, or any condition that might bias responses regarding nutritional health. Sample Size Determination Sample size was calculated using the single population proportion formula, assuming a 50% expected awareness rate (due to lack of prior state-specific data), 95% confidence level, and a 5% margin of error. The minimum required sample size was estimated at 384, which was increased to 420 to account for possible non-responses or incomplete submissions. Participants were selected using a stratified random sampling technique, ensuring proportional representation of both genders, urban and rural schools, and socio-economic backgrounds. Data Collection Tool A structured, pre-tested questionnaire was developed after extensive review of previous literature, NFHS-5 data, WHO guidelines on anaemia, and existing national program frameworks such as Anaemia Mukt Bharat. The tool comprised four major sections: 1. Socio-demographic information – including age, gender, residence, type of school, parental education, and family income. 2. Knowledge on Anaemia – assessing understanding of causes, symptoms, consequences, and preventive measures. 3. Knowledge on Nutritional Deficiencies – evaluating awareness about dietary sources of iron, folate, vitamin B12, and other essential micronutrients. 4. Awareness of Health Programs and Practices – exploring familiarity with initiatives such as iron-folic acid supplementation, mid-day meal quality, and deworming schedules. Each correct answer was scored as 1, and incorrect or “don’t know” responses were scored as 0. Total awareness scores were categorized as excellent (≥75%), good (50–74%), fair (25–49%), and poor (<25%). Validation and Pilot Testing The questionnaire underwent content and face validation by a multidisciplinary panel comprising experts in community medicine, paediatrics, nutrition, and education. A pilot study involving 30 participants (students and teachers) was conducted in a school not included in the final sampling frame to assess clarity, cultural appropriateness, and comprehension. Based on feedback, necessary modifications were made. The internal consistency of the tool was found to be satisfactory, with a Cronbach’s alpha of 0.84, indicating strong reliability. Data Collection Procedure Following approval from the institutional ethics committee and consent from school authorities, data collection was conducted in person by trained investigators. For younger students, the questionnaire was administered through guided sessions in local languages (Hindi and regional dialects) to ensure understanding. Teachers and parents completed self-administered forms distributed during school meetings or through digital links shared via school platforms. Privacy and anonymity were maintained throughout the process. Data Analysis Data were entered into Microsoft Excel and analyzed using IBM SPSS Statistics (Version 26.0). Descriptive statistics such as mean, standard deviation, frequency, and percentages were used to summarize data. Ethical Considerations Informed consent was obtained from parents or guardians, and assent was taken from all participating children. Participation was voluntary, and respondents were assured of complete confidentiality. The study also ensured that children found to be at risk of anaemia or poor nutrition were referred to appropriate health facilities for further evaluation.

Table 1: Socio-Demographic Characteristics of Participants (n = 420) Variable Category Frequency (n) Percentage (%) Age (years) 10–12 146 34.8 13–14 172 41.0 15–16 102 24.2 Gender Male 208 49.5 Female 212 50.5 Residence Urban 224 53.3 Rural 196 46.7 Type of School Government 250 59.5 Private 170 40.5 Parental Education No formal schooling 38 9.0 Secondary (up to 10+2) 162 38.6 Graduate 146 34.8 Postgraduate and above 74 17.6 Monthly Household Income (INR) <10,000 88 21.0 10,001–25,000 156 37.1 25,001–50,000 118 28.1 >50,000 58 13.8 The study included a total of 420 participants representing a balanced distribution across age, gender, and residence. The majority of children (41.0%) were aged 13–14 years, followed by 34.8% aged 10–12 years and 24.2% aged 15–16 years, ensuring adequate representation of early and mid-adolescents. Gender distribution was nearly equal, with 49.5% males and 50.5% females, reflecting a well-balanced sample. More than half of the respondents (53.3%) belonged to urban areas, while 46.7% were from rural regions, capturing diverse living environments within Himachal Pradesh. A higher proportion of children (59.5%) attended government schools, consistent with state enrollment patterns, whereas 40.5% were from private institutions. In terms of parental education, 38.6% had completed secondary education, 34.8% were graduates, and 17.6% held postgraduate qualifications or above, while 9.0% had no formal schooling, reflecting the mixed literacy landscape of the state. Household income data indicated that a majority (37.1%) of families earned between ₹10,001–25,000 per month, followed by 28.1% in the ₹25,001–50,000 bracket, 21.0% below ₹10,000, and 13.8% above ₹50,000, suggesting moderate economic diversity among participants. Overall, the socio-demographic composition provides a representative cross-section of school-going children in both urban and rural Himachali settings. Table 2: Knowledge on Anaemia Among School-Aged Children (n = 420) Q. No. Knowledge Question Options (Correct in Bold) Correct (n) Correct (%) 1 Anaemia is mainly caused by: a) Lack of calcium b) Lack of vitamin C c) Lack of iron d) Lack of fat 288 68.6 2 Common symptoms of anaemia include: a) Tiredness, dizziness, and pale skin b) Headache and ear pain c) Backache only d) Fever and cough 306 72.9 3 Worm infestation can lead to anaemia because: a) It increases blood cells b) It improves digestion c) It causes blood and nutrient loss d) It helps in vitamin absorption 254 60.5 4 Anaemia can affect school performance because it: a) Reduces concentration and energy levels b) Causes fever only c) Leads to skin rashes d) Improves eyesight 272 64.8 5 Among children, anaemia is more common in: a) Boys only b) Girls during adolescence c) Both equally d) None 264 62.9 6 A long-standing anaemia may lead to: a) Stronger immunity b) Frequent illness and weakness c) Weight gain d) High blood pressure 248 59.0 7 Which of the following foods helps prevent anaemia? a) Green leafy vegetables and jaggery b) Chips and cold drinks c) Sweets and pastries d) Tea and coffee 318 75.7 8 Iron and folic acid tablets are given to: a) Increase height b) Prevent and treat anaemia c) Improve eyesight d) Build muscles 232 55.2 9 Which practice reduces iron absorption from food? a) Eating fruits after meals b) Drinking tea/coffee immediately after meals c) Eating in sunlight d) Skipping dinner 198 47.1 10 Anaemia can be prevented by: a) Eating balanced meals and taking iron supplements b) Avoiding breakfast c) Eating only rice and bread d) Sleeping more hours 334 79.5 The assessment of knowledge on anaemia among school-aged children in Himachal Pradesh demonstrated encouraging but incomplete awareness across the four key domains—causes, symptoms, consequences, and preventive measures. Approximately 68.6% of participants correctly identified iron deficiency as the primary cause, while 60.5% understood that worm infestation contributes to blood and nutrient loss leading to anaemia. Recognition of major symptoms such as fatigue, dizziness, and pallor was high (72.9%), and nearly two-thirds (64.8%) were aware that anaemia impairs school performance and concentration. Awareness of gender vulnerability was moderate, with 62.9% knowing that adolescent girls are at higher risk. Preventive knowledge was relatively strong: 75.7% correctly identified green leafy vegetables and jaggery as iron-rich foods, and 79.5% understood that balanced diets and iron supplementation can prevent anaemia. However, misconceptions persisted, as only 47.1% recognized that tea or coffee after meals inhibits iron absorption, and just 55.2% were aware of the purpose of iron and folic acid tablets. Overall, the data reflect a moderate-to-good awareness level, with clear gaps in understanding biological mechanisms and preventive behaviors requiring focused health education within school settings. Table 3: Knowledge on Nutritional Deficiencies (Other than Anaemia) Among School-Aged Children (n = 420) Q. No. Knowledge Question Options (Correct in Bold) Correct (n) Correct (%) 1 Deficiency of vitamin A mainly leads to: a) Weak bones b) Poor vision and night blindness c) Hair loss d) Tooth decay 294 70.0 2 Lack of vitamin D causes: a) Weak eyes b) Bleeding gums c) Bone softening and rickets d) Skin rash 288 68.6 3 Protein deficiency in children results in: a) Frequent colds b) Obesity c) Stunted growth and muscle wasting d) Dry eyes 276 65.7 4 Vitamin C deficiency leads to: a) Bleeding gums and delayed wound healing b) Swollen feet c) Night blindness d) Back pain 268 63.8 5 A lack of iodine in the diet may cause: a) Weak muscles b) Goitre (enlarged neck gland) c) Nose bleeding d) Constipation 284 67.6 6 Deficiency of vitamin B₁₂ can result in: a) Toothache b) Tingling sensation and weakness c) Bone fractures d) Skin darkening 252 60.0 7 Calcium and phosphorus are important for: a) Blood formation b) Strong bones and teeth c) Improved memory d) Healthy skin 318 75.7 8 Sources of vitamin A include: a) Carrots, spinach, and mangoes b) Rice and bread c) Sweets d) Tea and coffee 306 72.9 9 To prevent protein deficiency, children should eat: a) Fried snacks b) Milk, eggs, pulses and fish c) Pickles d) Soft drinks 310 73.8 10 The best way to avoid vitamin deficiency is to: a) Eat only rice and potatoes b) Take rest often c) Consume a balanced diet with varied foods d) Avoid fruits and vegetables 334 79.5 Assessment of knowledge regarding nutritional deficiencies other than anaemia revealed encouraging general awareness, though certain conceptual gaps persist. Most respondents demonstrated good understanding of vitamin- and protein-related disorders: about 70% correctly linked vitamin A deficiency with poor vision and night blindness, and 68.6% identified vitamin D deficiency as a cause of rickets. Awareness of protein deficiency leading to growth failure and muscle wasting was reported by 65.7%, while 63.8% recognized vitamin C deficiency as the cause of bleeding gums. Similarly, 67.6% associated iodine deficiency with goitre, and 60.0% were aware of the neurological symptoms of vitamin B₁₂ deficiency. Encouragingly, preventive dietary knowledge was strong—75.7% understood that calcium and phosphorus maintain healthy bones, 72.9% correctly identified vitamin A-rich foods like carrots and spinach, and 73.8% recognized protein sources such as milk, eggs, and pulses. The highest awareness (79.5%) pertained to the importance of maintaining a balanced and diversified diet as a universal preventive measure. Collectively, these findings suggest that while schoolchildren possess satisfactory awareness of common vitamin and mineral deficiencies, sustained health-education efforts emphasizing micronutrient diversity and local food choices could further enhance nutritional literacy across communities in Himachal Pradesh. Table 4: Awareness of Health Programs and Practices Related to Anaemia and Nutrition (n = 420) Q. No. Knowledge Question Options (Correct in Bold) Correct (n) Correct (%) 1 The Iron and Folic Acid (IFA) tablets given in schools are meant to: a) Improve appetite b) Prevent and treat anaemia c) Increase height d) Cure cough 236 56.2 2 How often should school students take IFA tablets under the WIFS programme? a) Daily b) Once a week c) Once a month d) Only when ill 214 51.0 3 The Mid-Day Meal Scheme mainly aims to: a) Increase attendance b) Provide free books c) Improve nutrition among schoolchildren d) Promote sports 326 77.6 4 Deworming tablets help children by: a) Increasing height b) Reducing worm burden and improving iron absorption c) Treating cough d) Improving sleep 272 64.8 5 The National Programme for Prevention of Anaemia in India is called: a) Poshan Abhiyan b) Ayushman Bharat c) Anaemia Mukt Bharat (AMB) d) Swachh Bharat 248 59.0 6 Under the Mid-Day Meal Scheme, schools are encouraged to serve: a) Only rice and dal b) Snacks and tea c) Balanced meals with vegetables and protein sources d) Fried foods only 302 71.9 7 The purpose of the National Deworming Day (NDD) is to: a) Distribute medicines for fever b) Provide iron tablets c) Give Albendazole to eliminate intestinal worms d) Offer vaccinations 266 63.3 8 Children should receive a haemoglobin test for anaemia how often? a) Every 5 years b) At least once a year c) Only after illness d) Never needed 238 56.7 9 Who mainly monitors school nutrition and health programs at village level? a) Parents b) NGOs c) ASHA/Anganwadi and school health workers d) Teachers only 226 53.8 10 To maintain good nutrition, children should: a) Skip lunch b) Eat fast foods c) Consume school meals and IFA regularly d) Avoid vegetables 310 73.8 The evaluation of awareness regarding health programs and preventive practices revealed that students possessed a moderate understanding of key national nutrition initiatives but lacked detailed procedural knowledge. A little over half (56.2%) knew that iron-folic acid tablets prevent and treat anaemia, while only 51.0% correctly identified that supplementation under the Weekly Iron and Folic Acid Supplementation (WIFS) program should occur once per week. Awareness of the Mid-Day Meal Scheme was highest (77.6%), with most recognizing its role in improving child nutrition rather than merely increasing school attendance. Similarly, 64.8% understood the benefit of deworming in enhancing iron absorption, and 59.0% correctly named Anaemia Mukt Bharat as India’s flagship anaemia-control initiative. Knowledge of practical details—such as the balanced composition of school meals (71.9%) and the purpose of National Deworming Day (63.3%)—was satisfactory, but fewer students knew that annual haemoglobin testing (56.7%) and village-level monitoring by ASHA and Anganwadi workers (53.8%) are key components of school health programs. Encouragingly, 73.8% emphasized the combined importance of regular school meals and IFA compliance for maintaining good nutrition. These findings suggest that while general awareness of national programs is promising, targeted reinforcement through interactive school health sessions and teacher-led counseling could strengthen understanding and participation in these essential preventive initiatives. Table 5: Domain-Wise Knowledge Score Distribution on Anaemia, Nutritional Deficiencies, and Health Programs Among School-Aged Children (n = 420) Knowledge Domain Score Range (out of 10) Excellent n (%) Good n (%) Fair n (%) Poor n (%) Mean ± SD Anaemia (Causes, Symptoms, Prevention) 0–10 96 (22.9) 148 (35.2) 122 (29.0) 54 (12.9) 7.4 ± 1.8 Nutritional Deficiencies (Vitamins, Minerals, Protein) 0–10 84 (20.0) 138 (32.9) 134 (31.9) 64 (15.2) 7.1 ± 1.9 Health Programs & Practices (IFA, MDM, Deworming) 0–10 66 (15.7) 126 (30.0) 150 (35.7) 78 (18.6) 6.6 ± 2.0 Domain-wise analysis revealed marked differences in awareness levels across the three thematic areas of the study. Knowledge related to anaemia was comparatively higher, with 22.9% of students demonstrating excellent awareness and 35.2% showing good knowledge, resulting in the highest mean score (7.4 ± 1.8) among all domains. This indicates that students were relatively more familiar with the causes, symptoms, and preventive measures of anaemia, possibly reflecting the impact of school-based IFA distribution and health education activities. Awareness regarding general nutritional deficiencies was slightly lower, with only 20.0% scoring excellent and 32.9% good, suggesting moderate familiarity with the roles of vitamins, minerals, and protein in daily diet. The lowest awareness was observed in the Health Programs and Practices domain, where just 15.7% achieved excellent scores, and nearly one-fifth (18.6%) fell into the poor category, yielding the lowest mean (6.6 ± 2.0). This pattern underscores that while students recognize broad nutritional concepts, they are less informed about specific government initiatives, supplementation schedules, and deworming programs. The results collectively highlight a clear need to strengthen practical awareness through interactive school-based sessions, teacher-led nutrition modules, and integration of government health schemes into classroom learning to ensure that knowledge translates into consistent, preventive health behaviors.

The present study sought to explore the level of awareness regarding anaemia and nutritional deficiencies among school-aged children in Himachal Pradesh and to examine their familiarity with health programs and preventive practices. The findings reveal a pattern of moderate yet uneven awareness, with higher knowledge about anaemia itself but relatively weaker understanding of nutritional diversity and government-led interventions. This variation offers valuable insights into the reach and effectiveness of existing school-based health programs and highlights critical areas requiring intensified educational efforts. Awareness on Anaemia The finding that nearly two-thirds of the participants demonstrated good to excellent knowledge about anaemia’s causes and symptoms aligns with earlier studies conducted in northern India and neighboring states such as Punjab and Haryana, where similar levels of understanding were reported among adolescents. The fact that more than two-thirds correctly identified iron deficiency as the primary cause of anaemia and recognized fatigue, pallor, and dizziness as major symptoms suggests that routine exposure to school health campaigns and IFA supplementation programs has contributed to baseline awareness. However, the persistence of misconceptions—such as lack of clarity regarding the role of folic acid, the effect of tea and coffee on iron absorption, and limited awareness of worm infestation as a risk factor—indicates that factual knowledge has not yet matured into comprehensive understanding.6,9,12,14 The awareness that anaemia can impair learning capacity, concentration, and physical growth underscores a positive cognitive link between health and academic performance among children. Yet, the observation that only about half the students understood the role of iron–folic acid tablets reflects the limited penetration of the Weekly Iron and Folic Acid Supplementation (WIFS) program at the grassroots level. This knowledge gap mirrors findings from other studies where inconsistent program implementation and insufficient counseling were identified as barriers to awareness and adherence.13,15 Knowledge on Nutritional Deficiencies Awareness about nutritional deficiencies beyond anaemia showed an encouraging but incomplete pattern. The majority of students could correctly identify the effects of vitamin A and D deficiencies and understood the importance of protein-rich foods, yet fewer recognized the neurological consequences of vitamin B₁₂ deficiency or the systemic effects of vitamin C and iodine insufficiency. This suggests that while students grasp visible outcomes such as poor vision or stunted growth, less tangible biochemical and metabolic aspects remain poorly understood. Similar observations were reported in previous studies, where children displayed high recognition of symptom-based deficiencies but limited comprehension of nutrient–function relationships.10,13,14 The finding that nearly four-fifths of participants acknowledged the role of a balanced and diversified diet in preventing deficiencies is highly encouraging. However, regional constraints—such as reliance on cereal-dominant diets, limited seasonal produce, and affordability issues—may still hinder dietary diversity. In this context, nutritional education must go beyond textbook instruction to include practical demonstrations, school kitchen gardens, and locally adapted meal-planning activities that connect awareness with everyday practice.12,15,16 Awareness of Health Programs and Practices The domain of health programs and practices revealed the lowest mean awareness score among all categories, indicating an urgent need for renewed emphasis on communication and behavioral reinforcement. While a substantial proportion of students were aware of the Mid-Day Meal Scheme and its nutritional intent, detailed knowledge about the WIFS program, National Deworming Day, and Anaemia Mukt Bharat remained modest. These findings are consistent with evaluations of adolescent health initiatives, where limited dissemination of program objectives and irregular follow-up hindered full participation.14,16 Particularly concerning is the low awareness of the frequency of IFA supplementation and the monitoring roles of community health workers such as ASHAs and Anganwadi staff. This highlights a missing link between policy and practice: despite adequate program infrastructure, information does not consistently reach beneficiaries in an understandable and actionable form. Integrating schoolteachers more actively into awareness dissemination, supported by visual aids, peer educators, and interactive sessions, could bridge this gap effectively. Comparative Domain Insights The domain-wise analysis revealed that while conceptual knowledge of anaemia and basic nutrition has been reasonably internalized, the applied dimension—awareness of public health programs—remains weaker. The higher mean score in anaemia awareness (7.4 ± 1.8) suggests that continuous visibility through iron tablet distribution and health days has had a positive effect. In contrast, the relatively lower mean in the health program domain (6.6 ± 2.0) implies that government schemes, though operational, have not fully permeated the awareness of their intended beneficiaries. This imbalance underscores the need to shift from information dissemination to participatory engagement, wherein children not only know about programs but also understand their purpose and benefits. Public Health Implications From a policy standpoint, these findings highlight the importance of school-based health education as an intervention platform. Children serve as both learners and change agents, capable of influencing household practices and community perceptions. Strengthening health clubs, organizing nutrition awareness weeks, and involving parents and teachers in coordinated educational drives can substantially elevate understanding. Furthermore, the curriculum should integrate nutrition literacy modules aligned with regional dietary realities, helping students make informed food choices even in resource-limited settings. At the community level, effective collaboration between health and education departments is vital. ASHAs and Anganwadi workers should be equipped with simple, child-friendly materials to convey nutrition messages in schools. Reinforcement through regular hemoglobin screening camps, school assemblies, and parent–teacher meetings could transform awareness into measurable behavioral outcomes. Strengths and Limitations This study adds to the limited body of region-specific data from Himachal Pradesh and captures a diverse representation of urban and rural populations. The use of a validated, reliable tool and stratified sampling enhanced the robustness of findings. However, as a cross-sectional, questionnaire-based study, it assesses knowledge but not actual behavioral practices or biochemical outcomes. Social desirability bias and self-reported responses may have influenced results. Future studies incorporating dietary assessments and hemoglobin testing could provide a more holistic picture of the awareness–practice–outcome continuum.

In summary, the study reveals that while school-aged children in Himachal Pradesh possess moderate knowledge of anaemia and general nutrition, their awareness of health programs and preventive mechanisms remains suboptimal. The disparity between knowing what anaemia is and understanding how to prevent it through consistent program participation calls for immediate attention. Building sustained, locally contextualized nutrition education—rooted in schools and reinforced by families and frontline health workers—can convert awareness into lifelong healthy habits. Ultimately, combating the “hidden weakness” of anaemia and malnutrition requires not only resources but also the collective awakening of awareness, responsibility, and action within the community. Recommendations Strengthening nutrition awareness among school-aged children in Himachal Pradesh requires a multi-pronged, school-centered approach that integrates comprehensive nutrition education into the curriculum, reinforces key messages through interactive sessions, health clubs, and teacher-led counseling, and ensures consistent implementation of national programs such as Anaemia Mukt Bharat, WIFS, and the Mid-Day Meal Scheme. Collaboration between health, education, and community departments should be enhanced to provide regular deworming, haemoglobin screening, and parent–teacher awareness drives. Empowering children as peer educators and change agents can transform knowledge into sustained healthy practices, helping to break the cycle of anaemia and hidden nutritional deficiencies across future generations.

1. Khalsa MS, Bansal N. Exploring public awareness on pediatric nutritional deficiencies in Himachal Pradesh. Himalayan Journal of Applied Medical Sciences and Research. 2024;5(2):1–7. 2. Kumar R. Iron deficiency anemia (IDA), their prevalence, and awareness among girls of reproductive age of Distt Mandi, Himachal Pradesh, India. International Letters of Natural Sciences. 2014 Nov;29:24–32. 3. Singh H, Gill HS, Gurmanpreet. To find prevalence of anaemia among school going adolescent girls of Shimla Hills. Scholars Journal of Applied Medical Sciences (SJAMS). 2015;3(6D):2402–7. 4. Gupta A, Parashar A, Thakur A, Sharma D, Bhardwaj P, Jaswal S. Combating Iron Deficiency Anemia among School Going Adolescent Girls in a Hilly State of North India: Effectiveness of Intermittent Versus Daily Administration of Iron Folic Acid Tablets. Int J Prev Med. 2014 Nov;5(11):1475-9. 5. Sharma M, Kumar V, Bhartiya J. Prevalence of iron deficiency anemia in school going children. Int J Res Health Allied Sci 2021; 7(2):80-83. 6. Singh SK, Lhungdim H, Shekhar C, Dwivedi LK, Pedgaonkar S, James KS. Key drivers of reversal of trend in childhood anaemia in India: evidence from Indian demographic and health surveys, 2016-21. BMC Public Health. 2023 Aug 18;23(1):1574. 7. Kumar R. Iron deficiency anemia (IDA), their prevalence, and awareness among girls of reproductive age of Distt Mandi Himachal Pradesh, India. Int Lett Nat Sci. 2014 Nov 2;29:24–32. 8. Khandelwal R, Singh G, Gupta A, Kapil U, Pandey RM, Upadhyay AD. Nutrient intake of adolescents in rural area of Himachal Pradesh. Indian J Comm Health. 2017; 29, 2: 194 - 197. 9. Singh SK, Lhungdim H, Shekhar C, Dwivedi LK, Pedgaonkar S, James KS. Key drivers of reversal of trend in childhood anaemia in India: evidence from Indian demographic and health surveys, 2016-21. BMC Public Health. 2023 Aug 18;23(1):1574. 10. Ashok GM, Hiremath K, Kusuma N. An observational study on the prevalence of iron deficiency anemia in school-aged children. Eur J Cardiovasc Med. 2025 Mar;15(3):262–6. 11. Ray S, Chandra J, Bhattacharjee J, Sharma S, Agarwala A. Determinants of nutritional anaemia in children less than five years of age. Int J Contemp Pediatr. 2016;3(2):403–8. 12. Rathi N, Kansal S, Raj A, Pedapanga N, Joshua I, Worsley A. Indian adolescents' perceptions of anaemia and its preventive measures: Aqualitative study. J Nutr Sci. 2024 Feb 16;13:e9. 13. Haldar D, Chatterjee T, Sarkar AP, Bisoi S, Biswas AK, Sardar JC. A study on impact of school-based health and nutrition education in control of nutritional anemia among primary school children in rural West Bengal. Indian J Community Med. 2012 Oct;37(4):259-62. 14. Rajak BK, Sheoraj S, Vidyarthi AR, Ranjan SK. A cross-sectional study on anaemia related knowledge and dietary practices in school-going adolescents in Gaya District of Bihar, India. Eur J Cardiovasc Med. 2025 Apr;15(4):246–54. 15. Garg N, Bhalla M. To study the prevalence of anaemia among school-going children in rural area of Faridkot district, India. Int J Contemp Pediatr. 2016;3(1):218–23. 16. Salam SS, Ramadurg U, Charantimath U, Katageri G, Gillespie B, Mhetri J, et al. Impact of a school-based nutrition educational intervention on knowledge related to iron deficiency anaemia in rural Karnataka, India: A mixed methods pre–post interventional study. BJOG. 2023; 130(Suppl. 3): 113–123.