Time trends of haemoglobin levels and anaemia prevalence in infancy in a total community

Iron deficiency anemia status in Iranian pregnant women and children: an umbrella systematic review and meta-analysis

BACKGROUND

Iron deficiency anemia (IDA) is a global health challenge, especially affecting females and children. We aimed to conduct an umbrella systematic review of available evidence on IDA's prevalence in Iranian pregnant women and children.

METHODS

We searched the Web of Science, Science Direct, PubMed, Scopus, and Google Scholar databases for articles published by April 2023. Meta-analyses investigating the status of IDA in Iran were included. The findings of seven meta-analyses comprising 189,627 pregnant women with a mean age of 26 and 5,890 children under six years old were included in this study. The methodological quality of each study was evaluated with the Assessment of Multiple Systematic Reviews (AMSTAR2) instrument.

RESULTS

We estimated the prevalence of IDA at 15.71% in pregnant women and 19.91% in young children. According to our subgroup analysis of pregnant women, IDA's prevalence in urban and rural regions was 16.32% and 12.75%; in the eastern, western, central, southern, and northern regions of Iran, it was estimated at 17.8%, 7.97%, 19.97%, 13.45%, and 17.82%, respectively.

CONCLUSION

IDA is common in young children and pregnant females and is a significant public health concern in Iran. The present umbrella review results estimated that Iran is in the mild level of IDA prevalence based on WHO classification. However, due to sanctions and high inflation in Iran, the prevalence of anemia is expected to increase in recent years. Multi-sectoral efforts are required to improve the iron status of these populations and reduce the burden of IDA in the country.

Application of the PRECEDE Model for Controlling Iron-deficiency Anemia among Children Aged 1-5, Kerman, Iran

Iron-deficiency anemia (IDA) is one of the most common nutritional problems in the world. In the Islamic Republic (IR) of Iran, about 30 to 50 percent of women and children have IDA. The purpose of this study was to determine the effect of applying the PRECEDE educational model as a framework for controlling IDA among children aged one to five years old. One hundred and sixty children, aged one to five years, who were diagnosed as belonging to one of the unhealthy three stages of IDA, along with their mothers, participated in the study. The study subjects were divided randomly into four groups: I) Traditional educational, II) Iron supplementation, III)PRECEDE Model, and, IV)a control group who received the usual health center care. Data collection included use of questionnaires, observation (physical examination) and interviews, and pre-and post-tests (the former was conducted four months prior to the intervention). The research results demonstrated that mean scores of the knowledge and attitudes of mothers about controlling IDA were increased significantly in Group I and Group III, but, the changes in Group III were greater than in the other groups. A comparison of IDA stages in the three groups indicated that the rate of recovery was significantly different (p<0.0001). Group differences were: Group I 40.5%, Group II 50%, and Group III 82.5%; Group III had the highest changes. Therefore, the PRECEDE Model education program was more effective in modifying nutritional behaviors of mothers in order to control the IDA of their children.

Estimation of iron deficiency anemia in Iranian children and adolescents: a systematic review and meta-analysis

OBJECTIVES

Iron deficiency anemia (IDA) is a major health issue in those aged less than 18 years old with high impact on their development. There are several reports from Iran with variable results. Systematic review and met analysis of these data would reveal a more realistic view of the prevalence of iron deficiency (ID).

METHODS

We conducted a systematic search of national and international databases from December 1990 to 31 January 2016 for population-based studies providing estimates on the prevalence of IDA in Iran. From the extracted crude prevalence rates, the heterogenic index of the studies was determined using the Cochran's test (Q) and I₂. Then, based on the heterogenetic results, a random effects model for estimate pooled prevalence of IDA was used. Meta-regression was applied to determine heterogeneity suspected factors.

RESULTS

The overall prevalence of IDA in Iranian population with age less than 18 years was estimated to be 13.9% (95% CI: 10.8-17.1) and the overall prevalence of ID was 26.9% (95% CI: 19.7-34.1). The prevalence of IDA was 7.9% (95% CI: 4.1-11.7) in males and 8.5% (95% CI: 6.1-10.8) among females aged under than 18 years.

DISCUSSION

Despite the efforts of ministry of health and medical education of Iran in implementing free iron supplements for infants and for girls, the prevalence of ID and resultant anemia is considerable. Further interventions to increase use of supplements when they are provided and special programs for non-covered groups including boys under six are in great need.

Anemia as a risk factor for infectious diseases in infants and toddlers: results from a prospective study

Anemia due to iron deficiency is the most prevalent form of micronutrient malnutrition in the world, however, the causal relationship between anemia and infection remains unclear. We examined prospectively, the association between anemia and infection among Bedouin infants. We recruited 293 families and newborns from the Bedouin population, which is ongoing major lifestyle changes, during the periods of 1989-1992 and 1994-1997 and followed them to age 18 months. The number of diarrhea and respiratory disease episodes as well as total days of diarrhea were ascertained weekly. Hemoglobin levels were obtained at age 6 months. Additional data on feeding practices, environmental, household and demographic characteristics were obtained throughout the 18 months. Diarrhea before 6 months of age was found to be a risk factor for diarrhea after that age. After controlling for early morbidity < 6 months, anemia (Hb < 11 g/dl) at 6 months was an independent risk factor for diarrhea and respiratory illness from 7 to 18 months of age. This associations remained significant even after controlling, in addition, for environmental and socio-economic factors. In the multivariable models, anemia at age 6 months increased the risk for diarrhea after that age by 2.9-fold (95% confidence interval 1.6 - 5.3; p = 0.001) and that of respiratory disease by 2-fold (1.1 - 3.7; p = 0.03). Our findings suggest that anemia may increase the rates of infections in toddlers. The possibility that reducing anemia in infants may be a preventive measure to lower disease burden from infectious disease in this and other vulnerable populations should be tested in further studies.

Plasma selenium status in children with iron deficiency anemia

Iron and selenium are trace elements necessary for the maintenance of life and health. Iron deficiency is the most common nutritional deficiency among children in the world. The purpose of this study was to evaluate plasma selenium concentrations in children with iron deficiency anemia (IDA). Plasma selenium levels were investigated in 56 children with IDA and in 48 control subjects aged 1-8 years. A spectrofluorometric method was used for the determination. Plasma selenium concentrations in children with IDA (33.6+/-8.2 microg/l) were significantly lower than in the control group (56.0+/-17.0 microg/l) (p<0.001). However, there was no relation between plasma selenium, iron and hemoglobin concentrations.

The Jerusalem experience: three decades of service, research, and training in community-oriented primary care

Community-oriented primary care (COPC) developed and was tested over nearly 3 decades in the Hadassah Community Health Center in Jerusalem, Israel. Integration of public health responsibility with individual-based clinical management of patients formed the cornerstone of the COPC approach. A family medicine practice and a mother and child preventive service provided the frameworks for this development. The health needs of the community were assessed, priorities determined, and intervention programs developed and implemented on the basis of detailed analysis of the factors responsible for defined health states. Ongoing health surveillance facilitated evaluation, and the effectiveness of interventions in different population groups was illustrated. The center's international COPC involvement has had effects on primary health care policy worldwide.

Factors associated with anemia in refugee children

A nutrition survey was performed in 1990 among children 6 through 35 mo of age living in Palestinian refugee camps in Syria, Jordan, the West Bank, Gaza Strip and Lebanon. Overall, 67% [95% confidence interval (CI): 66, 68] were anemic (hemoglobin <110 g/L), ranging from 54% in the West Bank to 75% in Syria. The following factors were significantly associated with anemia in one or more of three age groups (6-11.9, 12-23.9 and 24-35.9 mo) by logistic regression: living in Syria, Lebanon, or Gaza [with prevalence odds ratios (POR) in the range of 1.4-2.6 depending on the age group and area, relative to children living in Jordan]; never having been breast-fed (POR = 1.7); male sex (POR = 1.2); maternal illiteracy (POR = 1.4 relative to those with >/=6 y of education); having a recent (within 2 wk) or current episode of fever or diarrhea; and stunting. Recent or current illness and stunting interacted in two age groups with the general trend of stunted children with recent or current illness having high POR. Early childhood anemia is associated with factors reflecting poor socioeconomic status and recent diarrheal and febrile illnesses in Palestinian refugee camps.

Injury prevention program in primary care: process evaluation and surveillance

OBJECTIVES

To carry out process evaluation and surveillance in a community oriented primary care program for injury prevention among children 0-2 years old (n = 306).

SETTING

Mother and child health clinic in a defined area of Western Jerusalem.

METHODS

An injury prevention program was integrated into the routines of the mother and child health clinic. The program consisted of injury surveillance and counselling using a developmental approach, regarding car safety and the prevention of falls, burns, suffocation, poisonings, cuts, drowning, and electrocution. Process evaluation and surveillance were based on records integrated into the child's personal file in the clinic.

RESULTS

Process evaluation indicated that counselling coverage was 73% in the 0-5 month age group and decreased to 48% in the second year of life. The mean number of topics discussed with the parents was 6.6 (out of nine) for the 0-5 months age group, 13.6 (out of 18) for the 6-11 month group, and 15.7 (out of 18) for those 1-2 years old. Injury surveillance activities were complete for 66% of the children, incomplete in 32%, and not done in 2%.

CONCLUSIONS

The results indicate that it is feasible to integrate an injury prevention program into primary care, and that process evaluation is important in detecting problems and improving performance of the program's activities.