Among the nutritional deficiency disorders of the world, anemia (measured in terms of hemoglobin concentration) is the most common public health problem that affects low, middle and high-income countries and has significant adverse health consequences, as well as adverse impact on social and economic development [1]. Here, the number of red blood cells or their oxygen-carrying capacity is insufficient to meet physiologic needs, which vary by age, sex, altitude, smoking and pregnancy status. The hemoglobin content of anemic blood is lower than normal as a result of deficiency of one or more essential nutrients. Iran deficiency is the most significant cause of anemia (contributing to 50% of the cases). Micronutrient deficiencies (e.g. foliate, riboflavin, vitamins A and B12), acute and chronic infections (e.g. malaria, cancer, tuberculosis and HIV), helminthic and parasitic infections and inherited or acquired disorders that affect hemoglobin synthesis, red blood cell production or red blood cell survival (e.g. Hemoglobinopathies) are the other causes of anemia [1]. Anemia leads to fatigue, weakness, dizziness and drowsiness in its severe form and can lead to several issues, ranging from fatigue to bone diseases, or even cancer.

The prevalence of anemia, although, decreased between 1990 and 2010 (from 40.2% to 32.9%), it still remained a significant burden on society, with an increase in global YLDs (Years lived with disability) from 65.5 million to 68.4 million over the 20 years period [2].

South Asia has some of the highest rates of anemia worldwide [3]. Anemia prevalence is higher in India as compared to other developing countries in all groups. Anemia affects an estimated 50% of the total population in India. Anemia disproportionately affects women: Eastern region population affected have a significantly higher prevalence (72%) of anemia than the Western states (45%) of India. 20-40 percent of maternal estimated deaths in India are due to anemia. Aggregated data from the National Nutrition Monitoring Bureau and Indian Council of Medical Research shows that 80-90% of pre-school children, pregnant and lactating women and adolescent girls have anemia. All adolescents, male or female, are more susceptible to anemia during this stage of their lives due to the increase in muscle mass and blood volume as a function of growth and development. Deficiencies in women can start with low birth weight infant females and worsen during adolescence with the onset of menstruation. Pregnancy further worsens and taxes an already anemic body [4,5].

Indian Government although launched a number of programs from time to time, the latest being launched in December 2015 which aimed to cut down on anemia levels among the large Indian adolescent population. Nearly 56% of girls and 30% of boys (in the age group of 15-19 years) in India are anemic, with a large percentage suffering from moderate to severe anemia according to Government data. The latest ‘Weekly Iron and Folic Acid Supplementation’ (WIFS) program of Indian Government was focused on adolescent children (in government or aided school children’s), where a tablet of Iron and folic Acid is administered once a week for 13 months. Proper information campaign and counseling were also conducted to ensure timely implementation of the program [6].

LITERATURE REVIEW

Few scientometric studies are available on anemia research. Ramalingam and Chamy [7] studied Indian anemia research output (5085) during 1993-2013, with a focus on authorship pattern, degree of collaboration, most productive authors, subject pattern, major collaborative partners in India, most productive journals, active institutions and highly cited papers. Bansal et al. [8] examined Indian iron deficiency research output (717) using Scopus database during 2006-2015 on selective aspects: publication growth, citation impact, share of international collaborative papers and identification of major international collaborative partners, global rank and share of India amongst the top countries, leading Indian institutes and authors productivity and citation impact, medium of communication in most productive journals. Mesquita et al. [9] analyzed and assessed national and international scientific publication output of anemia in chronic kidney disease, using Scopus database.

 OBJECTIVE

The present study is aimed at making a scientometric assessment of India’s publications in anemia research, indexed in Scopus database during 2008-2017. The specific objectives are to study:

•      The growth and distribution of world and top 10 countries literature and Indian literature on anemia research, its publication output, its global publication share and citation impact;

•      International collaboration and identification of major collaborators with India;

•      The distribution of India’s publication output by broad subject areas and by type of anemia research;

•      The scientometric profile of 10 most productive countries, 15 most productive Indian organizations and 15 productive Indian authors;

•      The leading medium of communication in India and the bibliographic characteristics of highly cited publications by India on anemia research.

METHODOLOGY

The global publications and of top 10 countries in anemia research were sourced from Scopus international database (http://www.scopus.com) using a keyword “anemia” for the years 2008 to 2017. The “Article title” or “Keyword” (as shown in the search string below) tags were searched for the keyword restricting the hit to the period 2008-2017 in “date range tag”. This statement became the main search string. The main search string was further restricted to 10 countries one by one in “country tag” for obtaining publication information of these countries (as shown below for India). On further restricting India’s main search string (as provided in analytical functions of Scopus database) by “subject area tag”, “country tag”, “source title tag”, “journal title name” and “affiliation tag”, statistics on distribution of publications by subject, collaborating countries, author-wise, organization-wise and journal-wise were obtained. Separate search strategies were also developed to get information on different type of anemia research (Table 1). Citations data was obtained from the date from date of publication till 19 April 2018.

ANALYSIS

International collaboration

Most productive countries contribution in global anemia research

Subject-wise distribution of Indian research papers

Anemia research output from India published during 2008-2017 was classified under five broad subjects (as defined by Scopus database) during 2008-2017. Medicine accounted for the largest publication share (80.83%) and agricultural and biological sciences 92.71%) for the least. The activity index showed increase in publication activity in biochemistry, genetics and molecular biology and pharmacology, toxicology and pharmaceutics, as against decline in medicine, immunology and microbiology and agricultural and biological sciences from 2008-2012 to 2013-2017. The average value of activity index is 100. Immunology and microbiology registered the highest citation of 9.31 per paper and pharmacology, toxicology and pharmaceutics registered the least citation impact (6.13 per paper) during 2008-2017 (Table 5).

Distribution of Indian papers by types of anemia research

Iron deficiency anemia, among its various types of anemia, registered the largest publication share (16.69%) in Indian output compared to other types of anemia research: anemia of chronic diseases (7.97%), sickle cell anemia (6.06%), aplastic anemia (5.22%), autoimmune hemolytic anemia (2.64%) and pernicious anemia (0.65%) during 2008-2017. In contrast, anemia of chronic diseases registered the highest citation impact (31.48 per paper); compared to much lower citation impact of sickle cell anemia, iron deficiency anemia, aplastic anemia, autoimmune hemolytic anemia and pernicious anemia (from 2.05 to 13.04 per paper) during 2008-2017 (Table 6).

Top 15 most productive Indian organizations contribution and impact

The 15 most productive organizations together contributed 1965 publications (34.34% share) and 34488 citations (69.46% share) in India’s output during 2008-2017. Individually the top 15 organizations contribution varied from 75 to 365 in 10 years. Only three organizations registered productivity rate above the group average of 131 per organization: AIIMS, New Delhi (365 papers), PGIMER, Chandigarh (356 papers) and SGPIMS, Lucknow (134 papers). Only six organizations registered citation impact and relative citation index above the group average of 17.55 citations per publication and 2.02: CSMMU, Lucknow (37.01 and 4.26), SGPIMS, Lucknow (35.26 and 4.06), AIIMS, New Delhi (28.6 and 3.29), CMC, Vellore (27.53 and 3.17), BHU, Varanasi (23.65 and 2.72)) and PGIMER, Chandigarh (19.9 and 2.29). Six organizations registered international collaborative publications above the group average of 11.50%: CMC, Vellore (29.41%), TMH, Mumbai (21.57%), KEMH, Mumbai (19.48%), BHU, Varanasi (15.29%), SGPIMS, Lucknow (11.94%) and AIIMS, New Delhi (11.51%) during 2008-2017 (Table 7).

Top 15 most productive Indian authors’ contribution and impact

The top 15 most productive authors contributed 22 to 69 papers each and together they contributed 531 papers (9.28%) and received 2670 citations (5.38%) during 2008-2017. Nine authors registered publication productivity above the group average of 35.4: Ghosh (69 papers), Saxena (45 papers), Malhotra (39 papers), Das (38 papers), Chandra (37 papers), Mahapatra, Varma and Varma (37 papers each) and Prabhash (36 papers). Four authors registered impact and relative citation index above the group average of 5.03 citations per publication and 0.58: Prabhash (17.14 and 1.97), Ghosh (6.09 and 0.70), Das (5.24 and 0.60) and Ahluwalia (5.18 and 0.60). Seven authors registered international collaborative publications (ICP) share more than the average ICP share (4.71%): Prabhash (13.89%), Varma (13.51%), Varma (8.11%), Bansal and Malhotra (7.69% each), Ghosh (5.80%) and Das (5.26%) during 2008-2017 (Table 8).

Distribution of publications by source and channel of communication

Of the 5723 publications by India in anemia research, 99.16% (5675) appeared in journals and the rest as books (0.31%), conference proceedings (0.30%) and book series (0.23%) during 2008-2017. The top 15 most productive journals (with contributions from 49 to 306 papers) together contributed 1550 publications (27.31% share of total journal output) during 2008-2017. The cumulative five year journal publication output reported in 15 journals increased from 23.69% during 2008-2012 to 29.54% during 2013-2017. The leading journals contributing to Indian research in anemia research are listed in Table 9: Journal of Clinical and Diagnostic Research (306 publications), followed by Indian Journal of Pediatrics (186 publications), Indian Journal of Hematology and Blood Transfusion (160 publications), BMJ Case Reports (119 publications), etc. during 2008-2017 (Table 9).

Highly cited papers

Out of 5723 papers from Indian scholars published, there were 54 highly cited papers having received citations from 100 to 2790 citations per paper (20 in 100-200 citations range each, 16 in 200-399 citations range, 8 in 400-699 citations range, 6 in 700-100 citations range, and the remaining 5 papers in 1126-2790 citation range) during 2008-2017. Together these 54 papers accounted for 24764 citations, averaging 458.59 citations per paper. The 54 highly cited papers had participation from 83 countries: USA (36 papers), France (24), UK (23), Germany (22), Italy (21), Australia (18), Canada (14) and Spain (10), etc. The significant Indian organizations participating in these 54 highly cited papers include All India Institute of Medical Sciences, New Delhi (7 papers), Postgraduate Institute of Medical Education and Research, Chandigarh (6 papers), Christian Medical College, Vellore and Banaras Hindu University, Varanasi (4 papers each), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow (3 papers), Tata Memorial Hospital, Mumbai and CSM Medical University, Lucknow (2 papers each). The 54 highly cited papers were published in 37 journals, including 15 papers in The Lancet, followed by New England Journal of Medicine and Journal of Clinical Oncology (5 papers each), The Lancet Oncology (4 papers), Indian Journal of Medical Research (2 papers) and 1 paper each in 23 other journals.

SUMMARY AND CONCLUSION

Summary

Anemia research, worldwide originated in 180 countries during 2008-2017. 82.99% of total global publication share, however, came from 10 most productive countries during 2008-2017, which showed increase from 80.07% during 2008-2012 to 85.63% during 2013-2017. USA, among top 10 countries, accounted for the highest publication share (31.78%), followed by UK (8.25%), Italy and Japan (6.97% and 6.44%), France, Germany, India and China (from 5.02% to 5.65%), Spain and Canada (4.20% and 3.69%) during 2008-2017.

India had published 5723 publications in anemia research during 2008-17, which showed increase from 269 in the year 2008 to 675 in the year 2017, averaging 11.65% annual growth rate. India’s share in the global publication output in anemia research was 5.44% during 2008-2017, which showed increase from 4.36% during 2008-2012 to 6.42% during 2013-2017. India’s citation impact in anemia research averaged to 8.68 citations per publication during 2008-2017, which dropped from 13.20 during 2008-2012 to 5.90 during 2013-2017. The share of India’s international collaborative papers share was 12.60% during 2008-2017, which showed increase from 11.67% during 2008-2012 to 13.17% during 2013-2017. Medicine registered the highest publications share (80.83%), followed by followed by biochemistry, genetics and molecular biology (19.22%) and pharmacology, toxicology and pharmaceutics (10.20%), immunology and microbiology (4.16%) and agricultural and biological sciences (2.71%) during 2008-2017.

The 15 most leading organizations and authors together contributed 34.34% and 9.28% as their share of Indian publication output and 69.46% and 5.38% as their share of Indian citation output respectively during 2008-2017. Indian organizations, showing comparatively higher productivity in anemia research were: All India Institute of Medical Sciences, New Delhi (with 365 papers), Postgraduate Institute of Medical Education and Research, Chandigarh (356 papers) and Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow (134 papers) during 2008-2017. Similarly, Indian organizations showing comparatively higher citation impact per paper were: CSM Medical University, Lucknow (37.01), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow (35.26), All India Institute of Medical Sciences, New Delhi (28.6), Christian Medical College, Vellore (27.53), Banaras Hindu University, Varanasi (23.65) and Postgraduate Institute of Medical Education and Research, Chandigarh (19.9) during 2008-2017.

Indian authors showing comparatively higher productivity in anemia research were: Ghosh (with 69 papers), Saxena (45 papers), Malhotra (39 papers), Das (38 papers), Chandra (37 papers), Mahapatra, Varma and Varma (37 papers each), Prabhash (36 papers), etc. during 2008-2017. Similarly, Indian authors showing with comparatively higher citation impact per paper were: Prabhash (17.14), Ghosh (6.09), Das (5.24) and Ahluwalia (5.18) during 2008-2017.

Of the 5723 Indian publications on anemia research, 5675 appeared in journals. The 15 most productive journals contributed 27.31% share to the Indian journal publication output during 2008-2017. The publication share in five years from top 15 journals increased from 23.69% during 2008-2012 to 29.54% during 2013-2017. The leading journals contributing to India’s anemia research were: Journal of Clinical and Diagnostic Research (with 306 papers), followed by Indian Journal of Pediatrics (186 papers), Indian Journal of Hematology and Blood Transfusion (160 papers) and BMJ Case Reports (119 papers) during 2008-2017.

Only 54 highly cited papers, out of output of 5723 publications on anemia research from India, received from 100 to 2790 citations per paper during 2008-2017. These 54 highly cited papers together received 24764 citations, averaging to 458.59 citations per paper. The USA accounted for the highest number of papers (36) in the 54 highly cited papers, followed by France (24 papers), UK (23 papers), Germany (22 papers), Italy (21 papers), Australia (18 papers), Canada (14 papers), Spain (10 papers), etc. The 54 highly cited papers were published in 37 journals, including with 15 papers in The Lancet, followed by New England Journal of Medicine and Journal of Clinical Oncology (5 papers each), The Lancet Oncology (4 papers), etc.

Conclusion

India’s anemic population (women and children in particular) face severe health problem, as against moderate health problem in some countries of South-East Asia region. Inflammation caused by infections and genetic partially cause anemia, as against widely caused by nutritional deficiencies. Till today, only select few countries have managed to significantly reduce the prevalence of anemia.

Many policy gaps and programmatic bottlenecks limit the effectiveness of anemia intervention programmes within countries, in spite of availability of informed global recommendations. The WHO consultation [10] indicates that there is an urgent need to develop national policies with regard to anemia and other micronutrient deficiencies. It advocates donors and other stakeholders to support national efforts in preventing anemia. Develop evidence informed strategies to address anemia using current evidence from a situational analysis. It is also suggested that each country should develop specific plans of action and their strategic implementation at national level and prioritize national goals for anemia: (i) for assessment, prevention and control, based on resources available, from highest to lowest priority; women of reproductive age particularly pregnant women, lactating women, pre-pregnant women, adolescents, children aged 0-2 years, children aged 2-10 years, other groups; (ii) adopt national targets and timelines for anemia reduction based on current prevalence and determinants of anemia in the national setting; (iii) Implement a programme of action using WHO’s evidence-informed guidance on preventing anemia to facilitate best practices on preventing iron deficiency and other causes of anemia using specific entry points in the life cycle and action sequences most appropriate to the country context.

• 
  Table 1
• 
  Table 2
• 
  Table 3
• 
  Table 4
• 
  Table 5
• 
  Table 6
• 
  Table 7
• 
  Table 8
• 
  Table 9