Iron Deficiency Anemia (IDA) is a global public health problem with majorconsequences for human health , social and economic development.It is more prevalent in pregnant women and young children.Indicator of both poor nutrition and poor health. Severe health effects lead toincrease risk of maternal and child mortality.Major concern: negative consequences of anemia on cognitive and physicaldevelopment of children and physical performance in work productivity inadults.In 2002, IDA was considered to be among the most contributing factors to theglobal burden of disease.
In 2005, a study showed the prevalence of anemia among antenatal mothers from 56 MOH health clinics was 35% (Hb<11.0 g/dl), higher in the teenage group, Indians, grandmultiparas, the third trimester and from urban residence ( Jamaiyah et al.,2007) The prevalence of IDA in pregnant women who attending their first antenatal clinic at a Maternal and Child Health Clinic in Kubang Kerian was 21.2%, which is similar to other developing countries( Roseline et al., 2007) A study done in 2008 among pregnant women, attended health clinics in Johor Baharu, prevalence of anemia : (Hb<11.0 g/dl) was 36.6% and majority in mild category (Hb 9-<11 g/dl). The associated factors were birth spacing, dietary intake with low iron content and poor iron pill consumption (Siti Khatijah et al.,2010)
Preschool children in Kota Bharu, Kelantan showed that 38.9% had IDA (Siti-Nor et al. 2006). Prevalence of IDA in the male and female adolescents were 5.4% vs. 26.4%, respectively (Foo et al. 2006)
Age Most common in the preschool years and during puberty. Another peak - in old age, when diets frequently deteriorate in quality and quantity.Gender Adolescent females following menarche, often do not consume sufficient iron to offset menstrual losses.Physiological state Substantial amounts of iron are deposited in the placenta &fetus during pregnancy, results in increased need about 700-850 mg in body iron over the whole pregnancy.Pathological state Common infections may impair haematopoiesis eg; Malaria by haemolysis and parasitic infections, e.g.hookworm & schistosomiasis cause blood loss directly.Socioeconomic conditions.
Decreased Iron Intake andIncreased Iron Needs Absorption • Rapid growth • Lack of heme iron sources in (childn,adoles) the diet (e.g., vegetarian diets) • Pregnancy • Low absorption • Blood loss o Taking antacids beyond the o Heavy menstrual recommended dose or periods medicine used to treat o Frequent blood peptic ulcer disease and donation acid reflux can reduce the amount of iron absorbed in o Some stomach and the stomach. intestinal conditions (food sensitivity, hookworms)
2 categories:- screening . reduced supply of plasma iron or poor haemoglobinization of circulating red blood cells Hb, MCH, sr Transferrin, Zinc protoporphyrin definitive measurement. identify IDA by measuring iron-related proteins derived from either the iron storage compartment in macrophages or the iron utilization compartment in red-cell precursors. Sr. Ferritin, bone marrow iron, TIBC
Serum iron: poor indicator, highly variable day to day and during the day Ferritin - most sensitive—chief storage form of iron; directly proportional to iron stored in cells
Zinc protoporphyrin/heme ratio (ZPPH): protoporphyrin binds iron to form heme or zinc to form zinc protoporphyrin In the presence of iron deficiency, ratio will rise (iron deficiency defined as ratio>1:12,000) Not affected by hematocrit or other causes of anemia; highly specific to iron deficiency
Total iron binding capacity (TIBC)—capacity of transferrin to bind iron Transferrin—globulin that binds/transports Fe from gut wall to tissues Percent saturation of transferrin (calculate by dividing serum iron by the TIBC) TIBC increases in iron deficiency
3 main strategies for correcting iron deficiency, alone or in combination: Education combined with dietary modification or diversification, or both, to improve iron intake and bioavailability. Iron supplementation or pharmacological treatment. Iron fortification of foods.
I. Assessing the iron status of populationsi. Screening of IDA in vulnerable group (eg infants, toddlers, school age children )ii. The school health program is a potential strategy to increase the iron status as well as improving the general health and nutritional status of school children.iii. Measurements of serum ferritin and transferrin receptor provide the best approach to measuring the iron status of populations.
II. Evaluating the impact of interventionsto control iron deficiency in populations i. Serum ferritin is the best indicator of a response to an intervention to control iron deficiency and should be measured with the haemoglobin concentration in all programme evaluations.
REAP( Rural Education Action Plan) Harvest Plus
High prevalence of iron deficiency anemia school going children in China. 39% of fourth grade students in Shaanxi Province are anemic.(REAP 2008) 40% of 5 to 9 year old students rural junior high school in Shaanxi Province (Wang, 2008). 36% in Qinghai and Ningxia Provinces (REAP 2009). 50 to 60% Guizhou (Chen et al., 2005).
InterventionSupplementing lunches with animal based (heme) protein through existing school feeding programs;Giving iron and multivitamin supplements directly to children in schools;Delivering school-level and household-level nutritional education campaigns;Providing deworming medication;
The mission of the program is to use plant breeding (bio- fortification) to reduce and prevent global deficiencies of micronutrients (iron, zinc, and vitamin A) in humans, in particular in developing countries. has been found by the World Bank, Gates Foundation, and other donors with more than $50 million dollars during 2003-2007. ◦ Development of rice breeding lines with low phytic acid and enhanced iron content ◦ Breeding of Iron-dense Rice Variety and Its Evaluation of Biological Effect on Human Body ◦ Iron Dense and Bioavailability in Rice Grains and the Regulation in Soil-Crop System
Fortified food commodities consumed: NutriRice (B1, B2, FA, niacin, Zn, Fe, BC), NaFeEDTA-fortified soy sauce, VA-fortified cooking oil Malnutrition rate -50% Vitamin B deficiencies VAD -51%, iron deficiency anemia -82%, zinc deficiency -58% Improved school attention, cognitive & academic performance and physical strengths including aerobic capacity 23
Iron deficiency anemia is a worldwide problem impairing the health and economy of the population. Affected more in young women and children, esp in developing countries. Need to treat underlying cause of IDA such as blood loss, worm infestation. Management include dietary modification, iron supplementation ,iron fortification of foods, as combination or alone. Highest benefit-to-cost ratio is attained with iron food