Background: Anemia is one of the most common nutritional deficiencies affecting under-five children and continues to be a major public health concern in developing countries, including India. It adversely affects physical growth, cognitive development, immunity, and overall child health. Despite the implementation of national nutrition and anemia control programs, the burden of anemia among under-five children remains unacceptably high. Socio-demographic factors play a crucial role in determining the prevalence and severity of anemia in this vulnerable age group. Objectives: To assess the prevalence of anemia among under-five children and to study its association with selected socio-demographic determinants. Materials and Methods: A hospital-based observational study was conducted among 75 under-five children attending a tertiary care center in India. Socio-demographic details were collected using a pre-designed structured proforma. Hemoglobin estimation was performed using an automated hematologyanalyzer, and anemia was classified according to World Health Organization criteria. Data were analyzed using appropriate statistical tests to determine the association between anemia and socio-demographic variables. Multivariate analysis was performed to identify independent predictors of anemia. Results: Anemia was prevalent in a significant proportion of under-five children, with higher occurrence among children below 15 months of age. Children belonging to lower socioeconomic status, those with inadequately educated mothers, and those receiving nutritionally inadequate diets showed a higher prevalence of anemia. Correlation analysis demonstrated significant associations between hemoglobin levels and age, socioeconomic status, maternal education, and dietary intake. On multiple logistic regression analysis, younger age, lower socioeconomic status, low maternal education, and inadequate dietary intake emerged as independent predictors of anemia. Conclusion: Anemia remains a major public health problem among under-five children and is strongly influenced by socio-demographic and nutritional factors. Early identification of at-risk children, improvement in complementary feeding practices, maternal education, and strengthening of existing nutrition programs are essential to reduce the burden of anemia and its long-term consequences.