Anemia
CHAPTER ONE
Objectives of the study
- To establish the prevalence of Anaemia through haemoglobin and complete blood count
- Toestablish the nutritional status of children aged 6-23
- To establish complementary feeding practices alongside intake of iron rich foods inchildren aged 6-23 months.
- To determine whether the Anaemia status of the children aged 6-23 months is related totheir dietary intake and socio-demography.
- To establish the relationship between Anaemia and sanitation of households with children aged 6-23 months.
- To determine whether the Anaemia status of the children aged 6-23 months is related to their health status as influenced by malaria, immunization, and helminthic infestation.
CHAPTER TWO
LITERATURE REVIEW
Global picture of Anaemia
Iron deficiency is the most common nutritional deficiency in the world (Grobois et al., 2005). Severe or prolonged iron deficiency can cause Anaemia. The prevalence of Anaemia is sensitive to the age at testing and the diagnostic criteria used (Leal et al., 2011). Haemoglobin concentration and hematocrit are the principal screening tests for detecting anemia. Hemoglobin can be measured quickly and accurately on a few drops of blood (Conway et al., 1998).
Despite the fact that haemoglobin and hematocrit are used in determining iron-level, diagnosis of Anaemia requires laboratory confirmed evidence of Anaemia as well as evidence of anaemia and low iron stores. A complete blood count can be useful in determination of the mean corpuscular volume or red cell width. Although iron deficiency is the most common cause of microcytic anaemia, up to 40 percent of patients with Anaemia will have normocytic erythrocytes. The current strategy to identify iron deficiency anemia relies on markers involving high costs. Red cell width >14% with hemoglobin ≤11.0 g/dl identifies iron-deficient anemic children without the need for the iron status markers which could help reduce the cost of management, especially in poor settings ≤11.0 g/dl (WHO, 2001).
Data on infants and children aged 6-23 months use a cut off value of ≤11.0 g/dl of haemoglobin for iron deficient children. These cut-off values were chosen by consensus and statistical analysis of the distribution of laboratory values in the population. Some experts argue that the normal limits for haemoglobin and for iron should be based on
analysis of the response to iron therapy, but efforts to define cut-off values in this manner have not yielded definitive results (WHO, 2001; White, 2005).
CHAPTER THREE
Study design
The study adopted a cross-sectional analytical design to investigate the prevalence and determinants of Anaemia among children aged 6-23 months attending Thika level-5 Hospital, Cross River State, Nigeria. This design facilitated and enabled collection of quantitative and qualitative data, identification of associations between the dependent and independent variables of the study (Katzenellenbogen et al., 2002). This design was preferred because it provided a snapshot of the frequency and the characteristics of the study population at a particular point in time.
Study variables
Dependent variables
Anaemia, haemoglobin levels (HB Levels), mean cell volume (MCV) and red cell width (RCW).
CHAPTER FOUR: FINDINGS
Introduction
This study was designed to establish the prevalence of Anaemia and its determinant factors in children aged 6-23 months attending a well-baby clinic at Thika level 5 Hospital, Nigeria. A total of 241 children were recruited to the study, in the month of May 2013. The response rate was (94%). The remaining respondents (6%), although previously having given consent to participate in the study, declined to allow their children to undergo blood testing hence their data were not included in this study. The economic, socio-demographic characteristics, health assessment, as well as nutrition assessments of the children and caregivers were done. Dietary data were assessed by the 24-hour dietary recall and 7-day food frequency questionnaire to obtain minimum meal frequency, minimum dietary diversity, minimum acceptable diet and quantity of nutrient intakes. Food types consumed by the children were converted into metric values and then into values of energy, carbohydrate, protein, iron and vitamin C. Children’s health and demographic characteristics were analyzed using descriptive statistics of (mean, standard deviation, frequencies and percentages). Anaemia was assessed through haemoglobin determination and complete blood count indices of mean cell volume and red cell width.
CHAPTER
SUMMARY, CONCLUSION AND RECOMMENDATIONS
Summary of findings
This study aimed at establishing the prevalence of Anaemia and its determinant factors in children aged 6- 23 months attending a well-baby clinic at Thika level 5 Hospital, Cross River State, Nigeria.
The prevalence of Anaemia from the study was high (73.2%) hence a concern for public health action. The mean haemoglobin values from the present study were found to be (8.3 ± 2.3g/dl) which were below the recommended threshold. The high prevalence of Anaemia indicates that the Anaemia condition was severe in children attending the well-baby clinic at University of Port Harcourt Hospital being far above the national level of (34.5 %). There is, therefore, a concern for public health action concerning iron status in Thika west Sub State. A greater proportion of children failed to meet the cutoff values for red cell indices of MCV and RCW.
The magnitude of under-nutrition was very high among the children based on wasting, stunting and underweight and it increased with age for all the three indices. Prevalence of wasting was (18%) and stunting (6%) which were above the WHO acceptable threshold levels for developmental areas. Consumption of iron rich foods together with complementary feeding practices from this study fell below the recommendations. The frequency of feeding of the children was appropriate, however, the dietary diversity of the meals was inadequate in terms of variety (of 4 or more out of 7 food groups) and composition of iron-rich foods making many children not to attain the minimum acceptable diet. Additionally, the consumption vitamin A-rich foods was low. On the whole, the complementary feeding practices in University of Port Harcourt Hospital fell below the recommendations because of the relatively low percentage of children who attained the minimum dietary diversity and the low prevalence of minimum acceptable diet among children 6-23 months old. Despite the fact that a larger percentage of caregivers attained secondary school education and above, one of the gap identified included maternal caregiver knowledge related to iron rich foods and also inadequate finances among the caregivers to purchase nutritious food.
The common occupation of participants was wage employment and small scale businesses resulting in low-income levels and consequently improper feeding practices due to lack of adequate income to purchase appropriate food. Sanitation in this area was unsatisfactory with a larger proportion disposing of their waste in the open near their homesteads and also living in areas containing stagnant water. Significant gaps identified under sanitation were a lack of knowledge regarding treatment of stagnant water and also inadequate knowledge regarding proper waste disposal methods.
The health of the participants in terms of the immunization coverage was satisfactory with only a few children who were not immunized. Morbidity burden in terms of malaria and helminthic infection was evident. The high burden of morbidity could be linked to most participants residing near stagnant water sources, inadequate waste disposal practices such as disposal of household rubbish in the open close to the homesteads and human waste disposal in the bushes with close proximity to human surroundings. Determinants of Anaemia from the study included; age of the child, education of the mother or caregiver, the occupation of the caregiver, complementary feeding practices, dietary intake of iron-rich foods, rubbish waste disposal, human waste disposal, the presence of stagnant water, malaria infection, deworming practice, helminthic infection and immunization.
Conclusions
The recommended dietary allowance of iron in the background diet and complementary feeding practices fell below the recommendations. A greater percentage of children consumed non-heme iron sources without iron absorption enhancers such as vitamin C- rich fruits and vegetables which might have resulted in decreased iron bio-availability and consequently low HB levels evident among most children in this study. Heme iron sources such as meat, poultry, fish and eggs considered to be excellent sources of bioavailable iron were the least consumed. A low percentage of children attained the minimum dietary diversity and minimum acceptable diet among children 6-23 months old.
The magnitude of under-nutrition was also high among children 6-23 months old based on weight for age. Sanitation in the area was unsatisfactory; in terms of health, an average proportion of children had malaria and helminthic infection. A child with malaria was 2.95 times at risk of becoming iron-deficient compared to one without malaria. Mean haemoglobin values from the present study was found to be (8.3± 2.3g/dl) whereas the overall Anaemia prevalence was (73.2%) indicating severe Anaemia among children attending the well-baby clinic at University of Port Harcourt Hospital. Other determinants of Anaemia from the study included age of the child, education of caregiver, occupation of the caregiver, inappropriate foods, presence of stagnant water, deworming practices and immunization.
Recommendations for policy and practice
Since the crisis in Thika west, Sub State is of access other than availability, food stamps to offset the high food prices should be prioritized. Also, Thika west sub state government should recruit nutritionists to provide nutrition education targeting mothers with under five year children attending WBC in all hospitals and markets in Thika west sub state on issues like intake of affordable but nutrient adequate meals. There should be also an intensification of food fortification with iron.
- The pipeline of therapeutic nutrition commodities should be secured in Thika west Sub State to provide intervention for all severely and moderately malnourished children, regardless of HIV status. Intensification of growth monitoring where by an infant‘s weight and height measurements, as well as the age, should be taken in all health facilities, (public and private) and the mothers be updated on the infant‘s progress. Those found to be wasted, stunted and underweight should be referred to the nutrition clinic for further monitoring and management.
- Aggressive awareness campaigns should be organized by Thika west sub-state health department together with other organizations working on child survival programmes through recruitment of trained facilitators targeting mothers with under five year children attending a WBC in all Hospitals and markets in Thika west sub Topics to be discussed should include infant and young child feeding practices, promotion of dietary practices that increase iron bioavailability such as soaking, fermentation, sprouting and germination of legumes before cooking. Also encouraging domestication of animals like chicken, goat, and rabbit known for their high bioavailable iron.
- Thika west Sub State in conjunction with Ministry of Industrialization should put up policy on creation of income to enable mothers and caregivers to access microfinance credit facilities that would strengthen their resource base hence meeting their health and nutrition needs.
- Thika west sub state health department should put programmes in place to ensure that public health officers, inspect Thika west sub-state, per homestead to ensure each homestead disposes domestic waste in the proper way and that each homestead has a toilet. In addition, organizing aggressive campaigns through recruitment of trained facilitators who are health workers targeting markets and chiefs barazas to educate mothers and all residents on issues such as proper sanitation, clean water, proper drainage and clearing of bushes.
- Awarenesscampaigns should be organized by Thika west sub state health department through recruitment of trained health workers, targeting mothers attending well baby clinics to educate them on the importance of deworming and how to identify and handle malaria symptoms in young children also, implementing policy to ensure that all children aged 6-23 months should undergo routine screening for Anaemia in well baby clinics and if found iron deficient they should be given iron supplementation until the HB levels return to normal. It is important that childhood diseases are identified and treated. Parents and caregivers should be given education by trained facilitators mainly health workers on the importance of seeking medical care during infant illness.
REFERENCES
- Aamer, M. (2011). Impact of maternal education about complementary feeding and provision of complementary foods on child growth in developing countries. Journal of Health population Nutrition, 32(4), 623-633.
- Abraham, N. K. (2008). Is there any evidence that religion is a risk factor for eating disorders? Eating and Weight disorders-Studies on Anorexia, Bulimia and Obesity. Springer International Journal,13(4), e75-e78.
- Abubakar, A., Uriyo, J., & Msusya, S. (2012). Prevalence and risk factors for poor nutritional status among children in the Kilimanjaro Region of Tanzania. International Journal of Environment, 9(10), 3506-3518.
- Algarin, C. P. (2003). Iron deficiency anemia in infancy: Long-lasting effects on auditory and visual system functioning. Pediatrics Res Journal, 3(2), 217-223.
- Allen, H. (2000). Anemia and iron deficiency effects on pregnancy outcome. American Journal Clinical Nutrition, 71(5), 1280S–4S.
- Blair, M. C & Lynnette, M. N. (2011). Estimating the prevalence of iron deficiency in the first two years of life: Technical and measurement issues. Journal of International Life Sciences Institute, 69(8), 49-56.
- Brunt, D. R., Grant, C. C., Wall, C. R., & Reed, P. W. (2012). Interaction between risk factors for iron deficiency in young children. Journal of Nutrition & Dietetics, 69(10), 1747- 1756.
- Calis, J.C., Phiri, K.J., & Farragher, E.B. (2008). Severe anaemia in Malawian children.
- English Journal of Medicine, 358(9), 888 – 999.
- CDCP. (1998). Recommendations to prevent and control iron deficiency in the United States.
- MMWR Morb Mortal Wkly, 47(3), 1-29.
- Chelimo, L. F. (2008). Assessment of complementary feeding practices in Athi River, Machakos district, Nigeria. Masters Thesis, Nigeriatta University.
