Anaemia in relation to low bioavailability of dietary iron among school-aged children in the Aral Sea region, Kazakhstan

Health consequences of the Urmia Lake crisis: the baseline study protocol

INTRODUCTION

Climate change may affect human health due to various mechanisms including overexposure to environmental pollution or dispersed particles. Lake Urmia (LU) drying in recent years has turned into a crisis with particle distribution as its main manifest. It is told that this crisis may affect the health of neighbouring residents. In this paper, we elaborate on a research protocol developed to assess the potential health consequences of LU drying (LUD) by investigating the distribution of physical and mental health conditions/disorders among residents of LU's surrounding provinces with different exposure levels to LUD outcomes.

METHODS AND ANALYSIS

The target population of this study is the residents of the LU basin from East Azerbaijan and West Azerbaijan provinces of Iran. A total of 803 households and 2783 people are studied in 86 clusters. Cluster sampling is applied. The weighting of the samples is based on a satellite map of the density of suspended particles such that people living in areas with higher risk have a higher chance of selection. Various types of measurements are done in three major groups including self-reported health, clinical interview/examination and paraclinical assays.

ETHICS AND DISSEMINATION

In this project, all procedures are in accordance with the ethical standards of the Ethics Committee of Tabriz University of Medical Sciences. Moreover, an informed consent letter is obtained from all participants included in the study. The results from this study will be disseminated in international journals and implemented in the primary care guidelines and national policy documents on managing the potential health consequences of LUD.

The application of machine learning approaches to determine the predictors of anemia among under five children in Ethiopia

Health professionals need a strong prediction system to reach appropriate disease diagnosis, particularly for under-five child with health problems like anemia. Diagnosis and treatment delay can potentially lead to devastating disease complications resulting in childhood mortality. However, the application of machine learning techniques using a large data set provides scientifically sounded information to solve such palpable critical health and health-related problems. Therefore, this study aimed to determine the predictors of anemia among under-5 year's age children in Ethiopia using a machine learning approach. A cross-sectional study design was done using the Ethiopian Demographic and Health Survey 2016 data set. A two-stage stratified cluster sampling technique was employed to select the samples. The data analysis was conducted using Statistical Package for Social Sciences/SPSS version 25 and R-software. Data were derived from Ethiopian Demographic and Health Survey. Boruta algorism was applied to select the features and determine the predictors of anemia among under-5 years-old children in Ethiopia. The machine learning algorism showed that number of children, distance to health facilities, health insurance coverage, youngest child's stool disposal, residence, mothers' wealth index, type of cooking fuel, number of family members, mothers' educational status and receiving rotavirus vaccine were the top ten important predictors for anemia among under-five children. Machine-learning algorithm was applied to determine the predictors of anemia among under- 5 year's age children in Ethiopia. We have identified the determinant factors by conducting a feature importance analysis with the Boruta algorithm. The most significant predictors were number of children, distance to health facility, health insurance coverage, youngest child's stool disposal, residence, mothers' wealth index, and type of cooking fuel. Machine learning model plays a paramount role for policy and intervention strategies related to anemia prevention and control among under-five children.

Changing Food Consumption and Nutrition Intake in Kazakhstan

Food resource is an important bond that connects human beings and nature. In this study, we investigated the changes in food consumption and nutrition intake in Kazakhstan from a spatial and temporal perspective, from 2001 to 2018. The data were obtained from the Bureau of Statistics, international organizations and our social interview work. After the start of the 21st century, it was found that per capita food consumption significantly increased; however, the consumption of crop, vegetables and milk decreased. Per capita meat consumption was similar in both urban and rural areas. However, some food consumption showed differences between urban and rural areas. Changes of food consumption quantity and structure also had some effects on nutrient intake and the proportion of nutrients. Per capita energy intake in the national, urban and rural areas all increased remarkably. The energy intake changes in eastern states increased much more than that in western states. Protein intake in rural and urban areas was similar; however, the gap between carbohydrates and fat intake in urban and rural areas increased. The intake of protein, carbohydrates and fat in different states showed the same trend. Food consumption and nutrition intake are affected by economic, social and ecological factors.

Prevalence of anemia and its associated factors among under-five age children in Shanan gibe hospital, Southwest Ethiopia

BACKGROUND

Anemia is a major health problem in the worldwide. Because of health and socioeconomic problems, the prevalence of anemia is higher in developing countries. However, there was a limited finding in our study area. Therefore, the aim of this study was to determine the prevalence of anemia and its associated factors among under-five age children in Shanan Gibe Hospital (SGH), Southwest Ethiopia.

METHODS

Institution based cross sectional study was conducted at SGH, Ethiopia using consecutive convenient sampling technique during 1 January to 30 April, 2021. Data was collected by interviewing and capillary blood was taken from the fingertip for hemoglobin determination by using HaemoCue digital photometer. Additionally, stool sample was processed using wet mount and formal-ether concentration technique. Then after, the data were entered to Epidata version 3.1 and analysed with Statistical Package for the Social Sciences (SPSS) version 20. Factors associated with anaemia were assessed by bivariable and multivariable logistic regression model by considering P < 0.05 as statistical significance.

RESULTS

A total of 368 under five children were recruited to the study and the current prevalence of anemia was 48.9%. Of this anemia, 25.0% mild, 15.8% moderate and 8.2% were severely anemic. More ever, being rural resident (AOR = 6.11; 95% CI = 1.49-8.99, P = 0.002), family low income (AOR = 6.27, 95% CI = 1.35-11.43, P = 0.004), family size greater than five (AOR = 3.12; 95% CI =1.47-7.11, P = 0.002) and intestinal parasite infections such as Enteameoba histolytica (AOR =3.37; 95%CI = 2.16-11.31, P = 0.005), Hookworm (AOR = 6.09; 95%CI = 2.37-11.56, P = 0.001), and Trichuris trichuria (AOR = 2.79; 95%CI = 1.45-9.13, P = 0.002) (P < 0.05) were factors significantly associated with anemia among under five children.

CONCLUSION

The current prevalence of anemia among under five age children is relatively high. On the other hand, the rural residence, large family size, low family income, infection with Enteameoba histolytica, hookworm and Trichuris trichuria were the identified factors associated with anemia among under five children. Therefore, there should be massive and routine deworming program in addition to imperative targeting anemia prevention, and nutritional supplementation to reduce the burden of anemia.

Effect of Entonox for pain management in labor: A systematic review and meta-analysis of randomized controlled trials

Background and aim

Entonox was one of the important methods for pain management in the delivery process. In previous years some studies have assessed the effect of this method in Iran. In this regard, the aim of this study was to systematically review studies addressing the effect of Entonox for pain management in labor.

Methods

This systematic review and meta-analysis study was conducted in 2016. The required data was collected using keywords such as ”Entonox”, “nitrous oxide”, ”vaginal delivery”, ”pain relief”, “obstetric”, “labor pain”, and “labor analgesia”, from databases including Google scholar, PubMed, Science Direct, Magiran, SID, and Scopus, and hand-searching of related and valid journals and references of articles. Articles published from 2000 to 2016 were searched. To conduct meta-analysis, CMA:2 (Comprehensive Meta-analysis) was used.

Results

Finally, 14 articles were included in the study. Pain relief standard difference in mean between-groups was −1.01 (95% CI: −1.59 to −0.43, Q=148.5, df=8, p=0.02, I²=76) this difference was significant (p<0.05). The overall Apgar score standard difference in mean between-groups (Entonox vs. comparison) was 0.12 (95% CI: 0.01 to 0.23, Q=109.4, df=16, p=0.00, I²=85.3) this difference was significant (p<0.05). The results of mothers’ satisfaction rate show that mothers in Entonox group has a high level of satisfaction rate.

Conclusion

According to results of studies published in Iran, it seems that Entonox is an effective method for pain relief in vaginal delivery, as well as for improving infant Apgar score and mothers’ satisfaction rate. Pain relief through Entonox can be used as a strategy for cesarean section reduction plan in Iran.

Magnitude, Severity, and Morphological Types of Anemia in Hospitalized Children Under the Age of Five in Southern Tanzania

Introduction Anemia is a significant public health problem among children and women globally. It is one of the most common causes of deaths among children admitted to hospitals in sub-Saharan Africa. Case fatality rates of 6 percent to 18 percent have been reported even in facilities that have blood transfusions services. The purpose of this study was to evaluate the magnitude, severity, and morphological types of anemia among hospitalized children under five years of age in the southern part of Tanzania. Methods A cross-sectional, hospital-based, retrospective analysis was conducted in February 2016 using hospital records of 303 children aged 0-59 months admitted to St. Benedict Ndanda Referral Hospital, Mtwara, Tanzania between 1 July 2015 and 31 December 2015.  Results The mean hemoglobin (Hb) level of the study population was 7.87 ± 2.84 g/dL, the median was 8.00g/dL, the interquartile range (IQR) was 4.40g/dL, and the prevalence of anemia was 83.17 percent. The magnitude of mild, moderate, and severe anemia was 9.13 percent, 44.84 percent, and 46.03 percent, respectively, and about half of all anemic children had normocytic anemia. Conclusion Severe anemia is a common health problem among hospitalized children under five years of age in the study area. We recommend screening all admitted children under the age of five for anemia, and clinicians should pay attention to and put more emphasis on intervention strategies for anemia when treating children admitted for other diseases.

Association between nutrient intake and anemia in Brazilian adolescents

AIMS

The association between the intake of iron, vitamins A and C and calcium and the prevalence of anemia and hemoglobin (Hb) levels was investigated in adolescents.

METHODS

A cross-sectional study was developed with 529 Brazilian students. Anemia was defined in terms of Hb concentration. Nutrient intake was assessed by a 3-day food record. The association between the prevalence of inadequate nutrient intake and anemia was estimated by the χ(2) test, and that between nutrient intake and Hb by linear regression.

RESULTS

The prevalence of inadequate nutrient intake did not differ between nonanemic and anemic subjects. Anemic adolescents had a lower mean intake of iron than nonanemic adolescents. Among boys aged 11-13 years, the anemic subjects had lower vitamin C intake than those who were nonanemic (41.1 vs. 62.6 mg, p < 0.01), and among those aged 14-19 years, there was a tendency for a positive association between Hb and heme iron intake (β = 0.64, p = 0.06) and a negative association with calcium intake (β = -0.003, p = 0.02). In females, daily nutrient intake did not differ between anemic and nonanemic individuals.

CONCLUSIONS

Heme iron and vitamin C are possible protective factors against anemia in boys. However, the lack of association between inadequate iron intake and anemia, especially in girls, suggests that other factors beyond diet could explain anemia in this age range.

Prevalence and severity of anemia among school children in Jimma Town, Southwest Ethiopia

BACKGROUND

Anemia is a major health problem worldwide. Because of health and socioeconomic problems, the prevalence of anemia is higher in developing countries. Children and pregnant women are the most vulnerable groups to anemia. The aim of the present study was to determine the magnitude of anemia among school children.

METHODS

A cross-sectional household survey was conducted in January 2011 on 423 children, aged 6-14 years, selected through systematic random sampling method. Sociodemographic and anthropometric data were collected using a pre-tested questionnaire. Capillary blood was taken from the fingertip of each child and hemoglobin was measured using HaemoCue digital photometer. All the necessary safety measures were taken during blood collection. Anthropometric indicators were measured using WHO's guideline. Data analysis was made using SPSS Version 16.0 for Windows. The association between predictors and outcome variables were measured by a stepwise logistic regression model. Ethical permission was obtained; consent of the parents/guardian was taken and confidentiality was maintained.

RESULT

A total of 404 children were studied. The mean age was 10.21(SD ± 1.89) years. The proportion of females was 217(53.7%). The mean hemoglobin level for both sexes was 11.59(SD ± 1.97 g/dl). The current prevalence of anemia was 152(37.6%), out of which, 73(18.1%) had mild while 79(19.6%) of them had moderate anemia. The prevalence of anemia among the age group of 6-11 years was 118(40.5%) while the prevalence among the group of 12-14 years old children was 34(30.1%). Among the selected variables in the logistic regression analysis, low family income [OR = 4.925, 95% CI(1.063,22.820)], mothers' education [OR = 4.621, 95% CI(1.383,15.439)], intake of plant food [OR = 3.847, 95% CI(2.068, 7.157)] and intake of animal food [OR = 2.37, 95% CI(1.040,5.402)] were significantly and independently associated with anemia.

CONCLUSION

Anemia is a moderate public health problem in the study area. Family income, educational status of parents and inadequate plant and animal food intake are the predictors of anemia. Improving the economic status of the family, women education and health education about balanced animal and plant food consumption are recommended strategies to reduce the burden of anemia.

What have we learned? A review of the literature on children's health and the environment in the Aral Sea area

Objectives

To review the published literature examining the impacts of the Aral Sea disaster on children’s health.

Methods

A systematic review of the English language literature.

Results

The literature search uncovered 26 peer-reviewed articles and four major reports published between 1994 and 2008. Anemia, diarrheal diseases, and high body burdens of toxic contaminants were identified as being among the significant health problems for children. These problems are associated either directly with the environmental disaster or indirectly via the deterioration of the region’s economy and social and health care services. While links between persistent organic pollutant exposures and body burdens are clear, health impacts remain poorly understood. No clear evidence for the link between dust exposure and respiratory function was identified.

Conclusion

While important questions about the nature of the child health and environment relationships remain to be answered, the literature unequivocally illustrates the seriousness of the public health tragedy and provides sufficient evidence to justify immediate action. Regrettably, international awareness of the crisis continues to be poor, and the level of action addressing the situation is wholly inadequate.

Effectiveness of communication campaign on iron deficiency anemia in Kyzyl-Orda region, Kazakhstan: a pilot study

Background

In 2004, wheat flour fortification (WFF) with iron was implemented in Kazakhstan as a public health strategy to increase the iron intake of all women of childbearing age and of children. In 2003, before starting the flour fortification program, a communication campaign on health education took place in a region with a high prevalence of iron deficiency anemia (IDA). The present study aimed to evaluate the prevalence of anemia, iron deficiency and IDA before and after the campaign. In addition, knowledge about IDA and its prevention, as well as awareness about fortified wheat flour, was assessed.

Methods

The subjects of the study were women aged 15-49 years and children aged 2-14 years. The study was carried out in urban and rural areas of Kyzyl-Orda region in 2003 before (March) and after (December) the campaign. Blood samples were collected in order to measure hemoglobin and serum ferritin. In March 80 women and 57 children in the urban area, and 41 women and 41 children in the rural area, participated in the IDA testing. The corresponding participants in December numbered 62, 52, 52, and 57, respectively. The impacts of the communications and information received by participants during the campaign was surveyed with a questionnaire for 195 women in March and 198 women in December including some who participated in the IDA testing.

Results

In March, the prevalence of anemia was 52.0% among 121 women and 58.1% among 98 children, and those with low iron reserve were 63.6%, 49.1% and IDA 40.5%, 11.0%, respectively. In December, the prevalence of anemia had significantly decreased among rural women (from 65.9% to 48.0%, p < 0.05) and among urban children (from 63.1% to 11.5%, p < 0.001). The prevalence of iron deficiency was significantly reduced among the children (from 51.1% to 24.8%, p < 0.001). IDA prevalence was meaningfully decreased among women in urban and combined areas (from 37.5% to 15.0% and 40.5 to 14.8%, respectively, p < 0.001) and among urban children (from 7.1% to 2.1%, p < 0.05). The surveys found that most women knew about IDA and its prevention and that the numbers were similar both in March and in December. The knowledge of the anti-anemic effect of wheat fortified flour improved significantly over the period of the campaign among women both in urban (from 48.5% to 80.9%, p < 0.001) and rural (from 69.8% to 88.6%, p < 0.001) areas.

Conclusion

The study demonstrated that the communication campaign before implementation of WFF program was effectively carried out, giving a biological impact on hematological indices.

Burden of anemia and its socioeconomic determinants among adolescent girls in India

BACKGROUND

Anemia is still one of India's major public health problems, especially among adolescent girls.

OBJECTIVE

To investigate the severity and distribution of anemia among Indian adolescent girls aged 10 to 19 years and its association with socioeconomic and sociodemographic factors.

METHODS

The study used data from the District Level Household Survey, round 11, 2002-04, conducted under the Reproductive and Child Health Project. Data were collected on hemoglobin along with socioeconomic and sociodemographic factors of the households. The survey covered rural and urban areas of 35 states or union territories. Data from 177,670 adolescent girls were analyzed.

RESULTS

The highest prevalence of anemia (99.9%) was observed in Jharkhand in eastern India. The prevalence in the northeastern states was relatively low. The highest prevalence rates were observed among older girls (15 to 19 years), illiterate girls living in rural areas, girls in illiterate households, girls from households with a low standard of living, non-Christian girls, girls from Scheduled Tribes, girls living in west India, and married girls. The highest percentages of girls with normal hemoglobin were reported among Christian Scheduled Tribes (39.4%) and among girls in northeastern India (40.1%). Analysis by binary ordered logistic regression showed that anemia status did not depend on urban or rural residence or on age.

CONCLUSIONS

Enhancement of the economic status of families, especially poor families, is a prerequisite to the amelioration of anemia among adolescent girls. The level of education of the girls is also a major factor.

Seasonal variation in food pattern but not in energy and nutrient intakes of rural Beninese school-aged children

BACKGROUND

Inadequate energy and nutrient intakes are a major nutritional problem in developing countries. A recent study in Beninese school-aged children in different seasons revealed a high prevalence of stunting and poor iron status that might be related to the food pattern.

OBJECTIVE

To analyse the food pattern and resulting energy and nutrient intakes of rural Beninese school-aged children in relation to season and school attendance.

SUBJECTS AND METHODS

The study was performed in northern Benin in eighty randomly selected children aged 6-8 years. Dietary intake was assessed using observed weighed records. Food, energy and nutrient intakes were measured in post- and pre-harvest seasons. Complete food consumption data sets were available for seventy-five children.

RESULTS

Food pattern showed seasonal variations. Cereals, roots and tubers were the main staple foods. Contributions of animal products to the diet were very small. The food pattern was not different for either boys v. girls or for children attending v. not attending school. Median daily energy intakes were 5.0 and 5.3 MJ in the post- and pre-harvest season, respectively. Only fat and vitamin C showed seasonal differences (P < 0.05). Energy and nutrient intakes were different for boys and girls but, unexpectedly, not for children attending v. not attending school.

CONCLUSIONS

Seasonal variations in food pattern did not result in seasonality in energy and nutrient intakes. Because the children's diet was low in animal products, protein, fat and vitamin C and high in fibre, the absorption of fat, fat-soluble vitamins, carotenoids, Fe and Zn might be low. Fe and Zn bioavailability from such a diet needs further investigation.

The impact of airborne dust on respiratory health in children living in the Aral Sea region

BACKGROUND

Anecdotally, people living in the Aral Sea region report an increase in the prevalence of respiratory illnesses, particularly in children, and there is widespread belief that this is due to dust from the Aral Sea bed.

METHODS

We conducted a survey of respiratory symptoms and lung function in children aged 7-10 years living in 18 communities in 6 geographical regions in the Aral Sea area. We monitored dust deposition rates monthly for the duration of the study.

RESULTS

The overall prevalence of recent wheeze was low at 4.2%, but this figure varied with region and was higher in the more accessible urban and delta regions and lower in the more remote regions. We found no evidence of an association between local annual dust deposition and specific respiratory symptoms. Lung function results also showed variation between geographical regions not explained by annual dust deposition. After allowing for region of residence, however, there was some evidence of an inverse association between percentage predicted forced expiratory volume in 1 s(FEV1) and dust exposure during the summer months (change in percentage predicted FEV1 per 1,000 kg/ha annual dust deposition -1.465) (95% confidence interval -2.519 to -0.412); however, in winter, the reverse was true.

CONCLUSIONS

The prevalence of asthma is low in the Aral Sea area and appears to be unrelated to dust exposure. Exposure to dust did not explain the main variations in lung function between geographical regions but high levels of dust exposure during the summer may have an adverse effect on lung function.

[Dietary iron and iron deficiency anemia among adolescent girls from Benin]

BACKGROUND

Iron deficiency anemia affects a large number of women in developing countries, especially during childbearing years. Few studies determined the association between estimated absorbable iron intakes and iron deficiency.

METHODS

The association between dietary iron intake and iron status was studied in 100 adolescent girls aged 14-16 years from Benin. Fifty adolescents were boarding at the school, while 50 lived at home. Biochemical indices of iron status included: hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, serum iron, total iron-binding capacity and % transferrin saturation. Dietary intakes were obtained by two 24-hour recalls and absorbable iron intakes were estimated using Monsen's model. The probability approach was used to estimate inadequacy in iron intake.

RESULTS

While 73% of adolescents met the recommendations for dietary iron intake, only 27% had estimated absorbable iron intake above the average requirement for absorbed iron. Non-heme iron represented 97.2% of the total iron intake. Forty three percent of subjects were anemic (hemoglobin<120 g/l). Iron deficiency defined by a four-model index based on > or =2 abnormal values in the four independent indicators of iron status used (serum iron, total iron-binding capacity, mean corpuscular volume, mean corpuscular hemoglobin concentration) was present in 14% of the subjects, while 13% had iron deficiency anaemia (hemoglobin<120 g/l+four-model index). Using a multiple regression analysis, total absorbable iron intakes (including iron supplements) were highly and positively associated with hemoglobin and hematocrit concentrations (P=0.000001 and P=0.00007 respectively).

CONCLUSION

In this group of adolescents, total absorbable iron intakes were related to iron deficiency. Efforts should be made to increase the heme iron content of the diet and the bioavailability of non-heme iron by promoting affordable local foods rich in iron and promoters of iron absorption (Vitamin C and meat, poultry and fish factor).

Anaemia, iron deficiency and vitamin A status among school-aged children in rural Kazakhstan

OBJECTIVES

To investigate the prevalence of anaemia and iron deficiency and vitamin A status among school-aged children in rural Kazakhstan and identify factors associated with anaemia in this population.

DESIGN

A cross-sectional design.

SETTING

School-aged children in rural Kazakhstan.

SUBJECTS

Socio-economic and anthropometric information was collected from 159 school-aged children living in the Kzyl-Orda region of Kazakhstan. Blood samples were collected and the concentrations of haemoglobin (Hb), serum iron, serum ferritin (SF), erythrocyte protoporphyrin (EP), serum retinol and beta-carotene, total iron binding capacity (TIBC), transferrin saturation (TS) and other haematological indices were measured.

RESULTS

Among the 159 children, the prevalence of anaemia and iron deficiency defined by the multiple criteria model (SF, TS and EP) was 27% and 13%, respectively. Nine per cent had iron-deficiency anaemia and 21% had serum retinol value < 1.05 micromol l(-1). Mean SF and serum iron concentrations and TS were significantly lower in anaemic children than in their non-anaemic peers, while TIBC and EP were significantly higher in children with anaemia. Hb was significantly correlated with serum iron and retinol concentrations. Serum retinol and SF concentrations and mean corpuscular volume were significantly correlated with Hb by multiple regression analysis.

CONCLUSIONS

Anaemia among school-aged children in rural Kazakhstan appears to be related to iron indices and vitamin A status.

Respiratory symptoms and pulmonary function among school-age children in the Aral Sea region

The saline Aral Sea in central Asia was once the 4th largest inland lake in the world. Desiccation of the Aral Sea as a result of diversion of inflow for irrigation has resulted in significant adverse health effects among residents of surrounding areas. This study was conducted to examine respiratory symptoms and function among children who lived in "the heavily affected disaster zone" (i.e., within 200 km of the Aral Sea), by comparing them with children who lived in "the slightly affected disaster zone" (i.e., located approximately 500 km from the Aral Sea). A questionnaire-based interview was conducted among 383 students 6-15 yr of age who lived in the study area and 432 students who lived in the reference area. Pulmonary function tests were completed by 337 children in the study area and 417 children in the reference area. Prevalence of current cough and current wheezing was higher among the study group participants. Percentage of predicted forced vital capacity (FVC% predicted) was lower in the study group (median = 96.6%) than in the reference group (median = 100.5%), and prevalence of restrictive pulmonary dysfunction was higher in the study group (10.6%) than in the reference group (2.6%). Multivariate analysis indicated that FVC% predicted was lower among females and in the study area, but was not associated with socioeconomic factors.

Iron deficiency due to consumption of a habitual diet low in bioavailable iron: a longitudinal cohort study in Moroccan children

BACKGROUND

In many developing countries, cereal and legume-based diets contain low amounts of bioavailable iron, which may increase the risk of iron deficiency.

OBJECTIVE

The objective was to measure change in iron status in Moroccan children who consumed their habitual diet containing low amounts of bioavailable iron.

DESIGN

The design was a prospective, longitudinal, free-living cohort study in iron-replete, nonanemic 6-10-y-old children (n = 126). Hemoglobin, serum ferritin, and transferrin receptor were measured at baseline. The children then consumed their habitual cereal and legume-based diet for 15 mo, when their iron status was retested. We used weighed food records and direct food analysis to calculate dietary iron intake and iron bioavailability. On the basis of the change in hemoglobin and body iron stores calculated from the serum transferrin receptor-to-ferritin ratio, iron balance and iron absorption were estimated over the 15-mo period.

RESULTS

Mean daily iron intake was 10.8 mg/d, 97% of which was nonheme iron. Estimated nonheme-iron bioavailability from algorithms was 1.0-4.3% adjusted for low body iron stores. Over 15 mo, the mean change in total body iron was -142 mg, and mean iron absorption was estimated to be 0.22 mg/d, or 2% of dietary iron. Mean hemoglobin concentration decreased 12 g/L. At 15 mo, 75% of the cohort had deficits in tissue iron, and one-third had mild iron deficiency anemia.

CONCLUSION

Low iron bioavailability from legume and cereal-based diets is a cause of iron deficiency anemia in children in rural Africa.

Prevalence of iron deficiency among schoolchildren of different socio-economic status in urban Turkey

OBJECTIVE

To investigate the prevalence of iron deficiency among schoolchildren of different socio-economic status (SES), living in the three largest cities of Turkey.

DESIGN

Cross-sectional study.

SETTINGS

Primary schools of Istanbul, Ankara and Izmir.

SUBJECTS

Schoolchildren aged 12 and 13 y (males: 504; females: 510) from nine primary schools. Inclusion of subjects in the study was on a voluntary basis.

METHODS

Data were obtained on children SES, anthropometry, haematological and biochemical indices of iron status and consumption of food items related to dietary iron bioavailability. One-way analysis of variance was mainly applied, for the evaluation of the tested hypotheses, using Bonferroni correction in order to take into account the inflation of Type I error.

RESULTS

Iron deficiency (serum ferritin <15 microg/l) prevalence was 17.5% among boys and 20.8% among girls. Furthermore, iron deficiency was significantly more prevalent among boys of lower SES, who were also found to have significantly lower levels of serum iron, serum ferritin, transferrin saturation, mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration compared to those of higher SES. In terms of dietary factors affecting iron bioavailability, low SES boys exhibited significantly higher frequency of tea consumption and lower frequency of citrus fruit, red meat and fish consumption, compared to their higher SES counterparts.

CONCLUSION

The prevalence of iron deficiency was relatively high, particularly among lower SES schoolboys. Higher tea and lower citrus fruits, red meat and fish consumption by boys of lower SES may provide an indication about the possible role of certain dietary patterns in the different manifestation of this medical condition among the socio-economic groups. However, further research is needed.