Addressing Iron Deficiency Anaemia
Dr Shamim Ahmed
Anaemia is a condition in which the blood fails to supply the body's tissues with sufficient amounts of oxygen. This is due either to reduced quality or quantity of red blood cells or to each cell containing too little of the oxygen-carrying pigment haemoglobin.
It is one of the most widespread nutritional disorders, which affect a substantial section of our population and has important health and welfare, social and economic consequences. There are more than 2 billion people in the world with anaemia - one third of the world's population. Anaemia prevalence is highest in Southeast. Asia. At the national level, anaemia is considered a severe public health problem when anaemia prevalence is equal to or greater than 40 per cent. According to the National Vitamin A Survey 1999,the prevalence is highest (49.2 %) among children 6-59 months and (45.5%) among pregnant women. The prevalence being 27.8% among adolescents (13-19 years) and 33.3% among non-pregnant women.
According to the Anaemia Prevalence Survey of Urban Bangladesh and Rural CHT 2003, the prevalence of anaemia in urban areas was highest in children aged 6-59 months (56%) followed by pregnant women (41%). The anaemia prevalence was higher in slums than in non-slum areas. The prevalence of anaemia in the CHT was higher than the prevalence in the rural areas and the rest of rural Bangladesh for all population groups.
Children, adolescent girls, pregnant women and nursing mothers are at great risk of being iron deficient Healthy iron nutriture throughout the life cycle depends on an individual having sufficient iron stores that can be mobilised during the periods of high demand. Severity of anaemia increases unless iron--deficiency is adequately addressed. Iron Deficiency Anaemia (IDA) among children is associated with poor physiological growth, cognitive and psychomotor development and increased risk of infection. Severe IDA among women of reproductive age is associated with increased risk of maternal mortality, while more moderate forms of IDA are associated with increased risk of infection and lower work capacity and productivity. Maternal anaemia can shorten the length of pregnancy, which increases the possibility of low birth weight and premature death.
There are different determinants of anaemia. Iron deficiency causes 50 percent of anaemia worldwide, making it the largest cause of anaemia. Iron is an essential component of haemoglobin, which is needed to make red blood cells. While iron deficiency causes anaemia by reducing red blood cell production, iron deficiency may be exacerbated by excessive blood cell loss. Anaemia is the most serious manifestation of iron deficiency.
Anaemia is also caused by poor dietary intake and poor absorption of other key nutrients needed for red blood cell formation. Low bioavailability of dietary iron, particularly in plant foods and high intake of foods that interfere with absorption of iron (tea/coffee) result in anaemia.
In conjunction with iron deficiency, deficiencies of folic acid and B-12 result in nutritional anaemia. Other micronutrients such as Vitamin A, Vitamins B-6 and C also have an impact on iron status. Undernutrition itself can cause poor red blood cell production and addressing undernutrition in vulnerable groups is essential to correcting anaemia in a sustainable way.
Peptic ulcers and gastritis cause anaemia by increasing blood loss, but also by reducing stomach acid, resulting in poor absorption of iron.
Genetically linked blood diseases and haemoglobin abnormalities such as sickle cell anaemia and thalessemia cause abnormal haemoglobin production.
Parasitic infections, such as hookworm and chronic infections such as malaria are also important factors. Women who have excessive blood loss during menstruation and childbirth have increased risks of developing anaemia. Having many closely spaced pregnancies can cause "maternal depletion syndrome", in which a number of nutritional deficiencies lead to anaemia.
Several other elements contribute to the presence of anaemia in our country, including social and educational factors. Poverty, poor knowledge and behaviour, lack of access to health services, including low antenatal care and lack of access to sanitation services all contribute to iron deficiency anaemia.
Anaemia can be diagnosed by analysing the haemoglobin concentration in blood or by measuring the proportion of red blood cells in whole blood (haemotocrit). This cutoff figures ranges from 11g/dl for pregnant women and for children 6 months-5 years, to 12g/dl for nonpregnant women to 13g/dl for men.
It is recommended that adults consume 10 to 15 milligrams of iron a day. Recommendations for women are higher to compensate for menstrual losses and reach a peak of 30 milligrams per day during pregnancy.
Iron deficiency can be addressed in a population in a number of ways. However, combination of these is the best solution. These include iron supplementation, dietary improvement through dietary diversification and nutrition education, fortification of foods and helminth control.
Supplementation is the best way to improve iron deficiency within a reasonable period of time in a population with a high prevalence of iron deficiency anaemia. According to the National Guidelines on Prevention and Treatment of Iron Deficiency Anaemia, the pregnant women should be provided with a daily Iron Folic Acid (IFA) tablet starting as soon as pregnancy is detected and continuing throughout pregnancy. Adolescent girls and non-pregnant women should have two tablets weekly. One tablet should contain 60mg iron and 400-microgram folic acid.
Supplementation with 400 microgram of Folic acid around the time of conception significantly reduces the incidence of neural tube defects, a group of severe birth defects.
Within food, dietary iron is available in two forms, haeme and non-haem iron. Haem iron is found in animal products and has a high absorption rate. Good sources include chicken, fresh and dried fish, red meat, beef, liver, kidney and eggs.
Dietary diversification should include plant foods (non-haeme iron) like green leafy vegetables (amaranths, kangkong, beans, yam), vegetables (yam, carrots,bananas), pulses and fruits (melon, tamarind, black berries, amra and dates/jaggery).
At present, the GOB does not have a comprehensive programme to address IDA throughout the country. However, IDA is being addressed through distribution of IFA tablets to pregnant women and adolescent girls in 105 upazilas under the National Nutrition Programme. Iron Deficiency Anaemia is also being sporadically addressed through IFA distribution to all age groups including pregnant women through government facilities under the Directorate of Health Services and Directorate of Family Planning. Currently, a National Strategy to Prevent and Control Anaemia is being developed to address the issue countrywide.
The writer is a Consultant, The Micronutrient Initiative
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