What is Iron deficiency Anemia and why is it so important especially in developing countries?

Iron Deficiency anemia (IDA) is a condition characterized by a lack of adequate iron in the body, leading to a reduced number of red blood cells or hemoglobin. Hemoglobin is essential for transporting oxygen from the lungs to the rest of the body. When iron levels are insufficient, the body cannot produce enough healthy red blood cells, resulting in symptoms such as fatigue, weakness, dizziness and shortness of breath as shown through Ben's symptoms. 

 

 

Effects of lack of Iron intake in Children 

Insufficient iron levels can have an effect of various aspects of a child’s health and development: 

  1. Cognitive and Behavioral impacts: Iron is essential for brain development and function. Deficiency during critical growth periods can result in: 
  • Impaired Cognitive Development: Children with IDA often exhibit lower scores in cognitive assessments affecting learning and academic performance. (Grantham-McGregor, Sally et al. 2001).  
  • Behavioral issues: Increased irritability, attention deficits, and reduced social engagement are common among iron deficient children.  
  • A study done by Sabapathy (2014) found that babies have an increased incidence of brain development problems. 

 

Case Study: A landmark longitudinal conducted in Costa Rica examined the long-term effects of chronic iron deficiency in infancy. The study found that children with chronic iron deficiency scored lower on cognitive tests and had poorer educational outcomes up to 19 years of age, even after iron levels were corrected. (Gingoyon et. al. 2022). 

 

2. Physical Growth and Development: Iron deficiency can hinder physical growth leading to:  

  • Stunted Growth: Chronic iron deficiency is associated with stunting, characterized by reduced growth rate and shorter stature.  
  • Delayed Motor Development: Children may experience delays in motor skills, affecting coordination and physical activities.  

 

3. Immune Function and Health 

Adequate iron levels are crucial for a robust immune system. Deficiency can result in: 

  • Increased Susceptibility to infections: Iron-deficient children are more prone to infections due to weakened immune responses.  
  • Prolonged Illness Recovery: Recovery from illness may be slower, impacting overall health and wellbeing.  

 

References

1. A Review of Studies on the Effect of Iron Deficiency on Cognitive Development in Children  Grantham-McGregor, Sally et al. The Journal of Nutrition, Volume 131, Issue 2, 649S – 668S 

2. Gingoyon A, Borkhoff CM, Koroshegyi C, Mamak E, Birken CS, Maguire JL, Fehlings D, Macarthur C, Parkin PC. Chronic Iron Deficiency and Cognitive Function in Early Childhood. Pediatrics. 2022 Dec 1;150(6):e2021055926. doi: 10.1542/peds.2021-055926. PMID: 36412051.

Treatment

To treat iron deficiency anemia, here are some general things you can do for you or children...

Dietary Changes                                                          Iron Supplements                                           Treating underlying causes

Treatment 

  1. Dietary Changes: Increasing the intake of iron-rich foods is crucial. This includes red meat, poultry, fish, lentils, beans, tofu, fark leafy greens, and fortified cereals. Vitamin C can enhance iron absorption, so consuming fruits like oranges or strawberries alongside iron-rich foods is beneficial. 
  2. Iron-supplement: If dietary changes are insufficient, healthcare providers may recommend iron supplements. There are available in various forms, such as ferrous, sulfate, ferrous gluconate, or ferrous fumarate. It is important to follow the dosage prescribed by a healthcare professional, as excessive iron can be harmful. See image on the right side for the recommended iron intake based on age group. 

Benefits of Iron supplementation:  

  • Improved Cognitive Function and Academic Performance: A comprehensive analysis of randomized controlled trials assessed the effects of iron supplementation in school-age children. This finding indicated significant improvements in intelligence, attention and concentration, and memory among children receiving iron supplements. (Gutema BT, et al. (2023).  
  • Enhanced Physical Growth:  Iron plays a crucial role in physical growth. Iron supplementation can help children achieve healthier growth milestones, reducing the risk of stunting and physical developmental delays.  
  • Enhanced Immune Function: Iron plays a crucial role in maintaining a healthy immune system. It is involved in the production of immune cells and helps the body respond effectively to infections. Adequate iron levels can enhance the body’s ability to fight off illnesses, reducing the frequency and severity of infections.
  • 3.  Treating Underlying causes: If iron deficiency is due to an underlying condition (like gastrointestinal bleeding or heavy menstruation), treating that condition is essential for effective management. 

Gutema BT, Sorrie MB, Megersa ND, Yesera GE, Yeshitila YG, Pauwels NS, De Henauw S, Abbeddou S. Effects of iron supplementation on cognitive development in school-age children: Systematic review and meta-analysis. PLoS One. 2023 Jun 27;18(6):e0287703. doi: 10.1371/journal.pone.0287703. PMID: 37368919; PMCID: PMC10298800.

Having access to resources to meet this recommended intake can be hard; especially living in a country that grapples day by day. Treating iron deficiency anemia (IDA) in children, particularly in resource-limited settings, requires accessible, affordable, and scalable solutions. Various interventions, ranging from dietary adjustments to innovative public health programs, have shown effectiveness even in developing countries where healthcare resources are limited.  

  1. Iron Supplementation Programs: Iron supplementation remains one of the most straightforward and effective interventions for children with IDA. In many developing countries, iron supplements are provided in the form of tablets or syrups that are easy to administer.  

 

Case study: India’s Weekly Iron and Folic Acid Supplementation (WIFS) Program  

In India, the WIFS program provides weekly iron and folic tablets to school-aged children. Over the course of four years, the impact of supplementation on the prevalence of anemia and the compliance rate was evaluated. The overall prevalence of anemia decreased from 73.3% to 25.4% in just four years (Vir et.al, 2008). This program shows the impact of simple, low-cost supplementation in large populations with limited healthcare access.  

Vir, Sheila & Singh, Neelam & Nigam, Arun & Jain, Ritu. (2008). Weekly Iron and Folic Acid Supplementation with Counseling Reduces Anemia in Adolescent Girls: A Large-Scale Effectiveness Study in Uttar Pradesh, India. Food and nutrition bulletin. 29. 186-94. 10.1177/156482650802900304.

 

Ministry of Health & Family Welfare. (2016, May 10). A short video on Weekly Iron Folic Acid (WIFS) supplementation to children [Video]. YouTube. https://www.youtube.com/watch?v=agkN52Zmx6M

 

Food Fortification

2. Food Fortification: Fortifying staple foods, such as rice, flour, or salt, with iron has proven to be an effective way to increase iron intake among children in developing countries. This intervention is especially useful where dietary sources are limited.  

 

Case study: Fortified Flour in Pakistan 

Pakistan introduced an iron-fortification initiative for wheat flour, a staple food. A review of this intervention showed that anemia rates in children decreased by 30% over five years in regions with fortified flour. This approach where many other developing countries can adopt, can effectively increase iron intake without requiring individuals to make major dietary changes.  

 

2022: Pakistan: Engaging small producers to fortify wheat for the hardest to reach | World Food Programme. (2022, September 21). UN World Food Programme (WFP). https://www.wfp.org/publications/2022-pakistan-engaging-small-producers-fortify-wheat-hardest-reach#:~:text=In%20Pakistan%20there%20are%2070%2C000,business%20case%20for%20social%20good.

 

3. Micronutrient Powder (MNP) Programs: Micronutrient powders, often called “sprinkles” are a cost-effective nutrient to children. These powders can be easily mixed with food, making them a practical solution for children who may not like tablets or liquid supplements.  

 

Case Study: MNPs in Bangladesh 

Bangladesh implemented a micronutrient powder program targeting children under five. Studies found significant reduction in anemia among children receiving MNPs compared to those who didn’t. This program, supported by UNICEF, has been expanded due to its success and simplicity in addressing iron deficiency in low-resource settings.  

 

 

 

Rahman S, Lee P, Raqib R, Roy AK, Khan MR, Ahmed F. Effect of Micronutrient Powder (MNP) with a Low-Dose of Iron on Hemoglobin and Iron Biomarkers, and Its Effect on Morbidities in Rural Bangladeshi Children Drinking Groundwater with a High-Level of Iron: A Randomized Controlled Trial. Nutrients. 2019 Nov 13;11(11):2756. doi: 10.3390/nu11112756. PMID: 31766250; PMCID: PMC6893643.

My Recommendation 

As an Education major, I firsthand witness the behaviour of how eager students are for learning. Implementing school-based initiatives that teach children about the importance of iron in their diet can be very effective. Providing iron rich snacks, as mentioned earlier such as fortified cereals, nuts, or dried fruits, at schools can also help ensure that children receive essential nutrients while promoting healthy eating habits. This approach not only addresses iron deficiency but also fosters awareness from a young age about nutrition and health. These children that come to school every day, ready to learn are the future of that country. Anything and everything must be done to ensure these students leave school every day feeling healthy and be able to kick a soccer ball without almost breaking their hand due to being fatigue. (Yes, this happened to me)  

By educating children of iron-rich foods, such as leafy greens, legumes, and fortified cereals, will and have positive effects. Although challenging, increasing awareness and knowledge about locally available iron sources can help reduce dependency on external supplements. 

 

Case study: In Kenya, community-led gardening programs have been set up to grow iron-rich vegetables like spinach and amaranth. The program educates mothers and caregivers on the importance of iron-rich foods, improving both food security and nutrition for children.  

Cas study: The Ministry of Agriculture, Fisheries and Mining in Jamaica is actively working to enhance agricultural education at the primary level. Minister Floyd Green emphasized the importance of introducing practical, agriculture-based curricula in primary schools to foster early understanding and appreciation for the sector (Thomas, 2024). 

"We are trying to ensure that we have given this school the resources to, firstly, teach the students how vegetables are grown and their importance," said Forbes Patrick. "Secondly, we are ensuring that they actually have calaloo and other vegetables to eat."" (Jamaica Gleaner, 2018).

 

1. Pelto, Gretel H, and Margaret Armar-Klemesu. “Identifying interventions to help rural Kenyan mothers cope with food insecurity: results of a focused ethnographic study.” Maternal & child nutrition vol. 11 Suppl 3,Suppl 3 (2015): 21-38. doi:10.1111/mcn.12244 

2. Scotiabank plants vegetable garden at primary school. (2018, May 25). News | Jamaica Gleaner. https://jamaica-gleaner.com/article/news/20180525/scotiabank-plants-vegetable-garden-primary-school

3. Green: Agriculture education in school to get more focus. (2024, January 27). Lead Stories | Jamaica Gleaner. https://jamaica-gleaner.com/article/lead-stories/20240127/green-agriculture-education-school-get-more-focus?utm_source=chatgpt.com

 

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