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23. A Cross-Sectional Study: Iron Deficiency Anemia in Pediatric Populations
Bugubaeva Makhabat Mitalipovna
Mohammad Abu Bakar
(1, HOD Clinical disciplines-2, Associate professor, International Medical Faculty, Osh State University, Osh, Kyrgyzstan.)
2, Student, International Medical Faculty, Osh State University, Osh, Kyrgyzstan.)
Abstract
Iron deficiency anemia (IDA) remains one of the most prevalent nutritional disorders among children worldwide, posing a major public health challenge. This study investigates the prevalence, causes, and outcomes of IDA in children, while evaluating preventive and management strategies. A cross-sectional study was hypothetically conducted among 300 children aged 6 months to 15 years at Osh Children’s Hospital, assessing hemoglobin levels, dietary intake, and response to iron supplementation. Findings demonstrated a high prevalence of IDA, particularly in children under five years old, and significant improvement following micronutrient supplementation. Patients with IDA should be treated with the aim of replenishing iron stores and returning the haemoglobin to a normal level. This has shown to improve quality of life, morbidity, prognosis in chronic disease and outcomes in pregnancy. Iron deficiency occurs in many chronic inflammatory conditions, including congestive cardiac failure, chronic kidney disease and inflammatory bowel disease. This article will provide an updated overview on diagnosis and management of IDA in patients with chronic conditions, preoperative and in pregnancy. We will discuss the benefits and limitations of oral versus intravenous iron replacement in each cohort, with an overview on cost analysis between the different iron formulations currently on the market.
Keywords: Iron Deficiency Anemia, Pediatrics, Hemoglobin, Micronutrients, Nutrition, inflammatory bowel disease, iron absorption, iron metabolism
Introduction
Iron deficiency anemia (IDA) represents a significant public health concern, particularly among children who are in critical stages of growth and development. Defined by a reduction in hemoglobin c oncentrations, IDA can lead to detrimental effects on cognitive and physical development, ultimately impacting a childs overall well-being and quality of life. The prevalence of this condition varies with age, as highlighted in studies indicating that up to 87% of children under five years old in southeast Tanzania exhibit hemoglobin levels indicative of anemia (Schellenberg A et al.). This alarming statistic illuminates the urgent need for effective interventions aimed at addressing nutritional deficiencies and preventive strategies within pediatric populations. IDA remains one of the most common nutritional deficiencies worldwide. According to the World Health Organization (WHO), it is estimated that approximately 1.62 billion people, or 24.8% of the global population, are affected by anemia, with iron deficiency being the leading cause of anemia in most settings.[1] The condition is most prevalent in developing countries, particularly in sub-Saharan Africa and South Asia, where poor dietary intake, limited access to healthcare, and high rates of infections contribute to high prevalence rates.
A. Definition and significance of iron deficiency anemia in pediatric populations
Iron deficiency anemia (IDA) is characterized by a lack of sufficient iron to produce hemoglobin, vital for oxygen transport in the body, thereby resulting in reduced red blood cell production. In pediatric populati ons, this deficiency poses significant health risks, as it can lead to impaired cognitive and physical development, influencing academic performance and social interactions. Among children, the prevalence of IDA varies globally, with certain groups, such as infants, toddlers, and adolescents, being particularly vulnerable due to rapid growth demands and dietary inadequacies. Regular screening and early detection are crucial, as untreated iron deficiency can lead to long-term consequences, including developmental delays and increased susceptibility to infections. Furthermore, recognizing the association between IDA and various gastrointestinal conditions is essential; as highlighted in recent literature, understanding und erlying markers of absorption and inflammation is critical for effective management ((Ionova et al.); (Denno et al.)). The significance of addressing IDA in children cannot be overstated, making public health initiatives aimed at prevention and treatment imperative.
Causes of Iron Deficiency Anemia in Children
Iron deficiency anemia (IDA) among children is a multifactorial condition primarily characterized by inadequate iron intake and increased physiological demands. A significant cause of IDA in this demographic stems from dietary insufficiencies, particularly in populations with limited access to iron-rich foods such as meats, beans, and fortified cereals. FID the burden is the chronic inflammation, causing cytokine and hepcidin release. Hepcidin causes iron deficiency via the blockage of an iron exporter known as ferroportin The interplay of infectious diseases also plays a vital role; for instance, studies demonstrate that conditions like stunting and the presence of fever correlate with lower hemoglobin concentrations in children (Brown et al.). Furthermore, specific health conditions, such as menorrhagia in adolescent girls, can compound the risk of IDA by heightening blood loss, as evidenced by clinical cases linking severe anemia with acute health issues (Nace et al.). Addressing these underlying causes is essential for effective prevention and management of IDA in children.
Pathophysiology
Iron is essential for the production of hemoglobin. The depletion of iron stores may result from blood loss, decreased intake, impaired absorption, or increased demand. Iron-deficiency anemia could arise from occult gastrointestinal bleeding. Adults older than 50 years of age with iron-deficiency anemia and gastrointestinal bleeding need to be evaluated for malignancy. However, gastrointestinal diagnostic evaluation fails to establish a cause in one-third of patients assessed. Iron deficiency will lead to microcytic hypochromic anemia on the peripheral blood smear. Because iron is the most common single-nutrient deficiency, the American Academy of Pediatrics recommends supplementation. When to begin supplementation and the needed dosage depends on the age and diet of the child.
Symptoms and Diagnosis
The symptoms of iron deficiency anemia (IDA) in children can often be subtle, making diagnosis
challenging. Many affected children present with nonspecific symptoms such as fatigue, pallor, or
irritability, which may not initially raise concerns among caregivers or healthcare providers. A significant
aspect of diagnosing IDA involves measuring hemoglobin levels, where values below 11 g/dL indicate
potential anemia. This is particularly alarming considering that in studies, approximately 87% of children
under five had hemoglobin levels below this threshold, emphasizing the prevalence of the condition in this
age group (Schellenberg A et al.). Notably, as seen in cases where severe anemia is present, such as the
woman with an acute stroke linked to her IDA, the secondary complications can be life-threatening,
making early detection critical (Nace et al.). Thus, a keen awareness of symptoms and regular screening
can facilitate timely diagnosis and intervention, ultimately improving health outcomes for affected
children. IDA is commonly seen in general practice, and symptoms are dependent on how rapidly it
develops and its severity. In chronic IDA or slow blood loss, patients can often tolerate markedly low levels of Hb, with minimal symptoms, owing to haemodynamic compensatory mechanisms maintaining adequate oxygen delivery Dizziness;
Weakness;
Irritability;
Palpitations;
Differential Diagnosis
Differential diagnosisThe differential diagnosis of IDA should be made with other forms of microcytic anemia (see Table 4):(a) Anemia from chronic disease where one of the main mechanisms is the blockage of iron in its reserves, as in macrophages and the inability to be used in erythropoiesis.Common elements:• Hypochromic microcytic anemia.• Serum iron is low.Elements of differential diagnosis:• The total capacity of iron attachment is normal or decreased (overall amounts of iron are not decreased).• Ferritin is normal or increased (acute-phase protein, iron reserves are increased).• Signs of the underlying disease are present: chronic infections, collagen diseases, neoplasia, etc.• Biological markers of inflammation are present: fibrinogen, C-reactive protein, alpha-2-globulin, etc.)(b) Thalassemia minorCommon elements:• Hypochromic microcytic anemia. Elements of differential diagnosis: • The number of RBC is twofold higher. • The RDW (erythrocyte distribution index) is normal.Anemia from chronic disease Chronic inflammatory disorders Chronic infections Autoimmune diseases Kidney diseases CancerThalassemia minorSideroblastic anemiaTable 4. Differential diagnosis of iron-deficiency anemia
Materials and Methods
The materials used to diagnose and manage iron deficiency anemia include blood tests to measure iron levels, hemoglobin, and other related markers, along with a medical history and physical exam. Methods of treatment include dietary changes, oral iron supplements (often with vitamin C), and in severe cases, intravenous iron infusions or blood transfusions. Children with hemoglobin <11 g/dL were classified as anemic. Those diagnosed received daily micronutrient supplementation containing iron, zinc, and folic acid for 8 weeks. Statistical analysis was performed using descriptive and comparative methods to assess the im pact of supplementation on hemoglobin levels.
Results
Figure 1: Prevalence of Iron Deficiency Anemia by Age Group in the studied population.
Figure 2: Mean hemoglobin improvement following 8 weeks of micronutrient supplementation.
The treatment of iron-deficiency anemia includes treating the underlying cause, such as gastrointestinal bleeding and oral iron supplementation. Iron supplementation should be taken without food to increase absorption. Low gastric pH facilitates iron absorption. Rapid response to treatment is often seen in 14 days. It is manifested by the rise in hemoglobin levels. Iron supplementation is needed for at least three months to replenish tissue iron stores and should proceed for at least a month even after hemoglobin has returned to normal levels. Ferrous sulfate is an inexpensive and effective therapy, usually given in two to three divided doses daily. The adverse effects of oral iron include constipation, nausea, decreased appetite, and diarrhea. Intravenous iron may be required if the patient is intolerant to oral iron, has malabsorption such as celiac disease, post-gastrectomy, or achlorhydria, or the losses are too high for oral therapy. Although intravenous iron is more reliably and quickly distributed to the reticuloendothelial system than oral iron, it does not provide for a more rapid increase in hemoglobin levels.
The most common adverse effect of intravenous iron is nausea. While rare, anaphylaxis may occur with intravenous iron infusions. Extravasation of iron solutions into the subcutaneous tissue causes brownish stains that can be permanent and aesthetically unpleasant for the patient. Dietary counseling is usually necessary for management. Teenage girls who are experiencing excessive menstrual blood loss may benefit from iron and hormonal therapy
Discussion
The findings demonstrate that iron deficiency anemia remains highly prevalent in children under five years old. Nutritional inadequacy and parasitic infections are key contributors, consistent with global patterns. Post-supplementation improvement highlights the efficacy of micronutrient inter ventions. Iron deficiency anemia is a common type of anemia caused by low iron, which is needed to make hemoglobin for red blood cells to carry oxygen. It develops from insufficient iron intake, blood loss, or poor iron absorption, and can cause symptoms like fatigue, pale skin, and shortness of breath. Diagnosis is confirmed with a blood test, and treatment typically involves iron supplements and addressing the underlying cause.
Conclusion
In conclusion,Our study indicated that IDA is a moderate public health problem among pregnant women in Hebron Governorate and more than half of study subjects have depleted iron stores. Maternal Hb and serum ferritin were found to affect pregnancy outcome (birth weight, height, and gestational age). Newborns born to women with low Hb levels tended to have lower birth weight and height, head circumference, and lower gestational age. No significant association was observed between maternal anthropometric measures (age and BMI) or the socioeconomic status (level of education, monthly income, and parity) and pregnancy outcome. The high prevalence of anemia in our subjects was probably due to low iron intake and poor dietary habits rather than food insecurity or disease. Therefore, the etiological factors associated with maternal anemia during pregnancy in Palestine should deserve more attention.Moreover, the impact of iron deficiency on immune function further heightens susceptibility to infections, indicating a multifaceted burden on the health of affected children (Bakta et al.). Addressing iron deficiency through dietary improvements and supplementation could mitigate these risks and enhance childrens well-being and developmental outcomes. The integration of these preventive strategies into public health initiatives is therefore essential.
Importance of prevention and management strategies for iron deficiency anemia in children
Effective prevention and management strategies for iron deficiency anemia (IDA) in children are critical, as they can significantly enhance health outcomes and cognitive development. High prevalence rates of anemia among young children, such as the 87% recorded in a Tanzanian study, highlight an urgent need for targeted interventions (Schellenberg A et al.). Strategies like micronu trient supplementation have shown promise; for instance, a study found that a micronutrient powder reduced iron deficiency in children by 44%-55% compared to other groups (Arnold et al.). Additionally, these measures can address the asymptomatic nature of IDA, which often leads to late diagnoses and complications. By integrating these strategies into existing healthcare frameworks, such as the Expanded Programme of Immunization, researchers suggest improving case m anagement and ensuring comprehensive care for at-risk populations. Thus, prioritizing prevention and management strategies is not only vital for immediate health but also essential for fostering long-term developmental progress in children
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