Iron Deficiency Anemia in Southern Jordanian Adolescent Girls: A Study of Prevalence and Contributing Factors

Background: Infants are the most at risk from iron deficiency (ID) and iron deficiency anemia (IDA), but the prevalence of the latter in this group is unclear. Estimation as to the prevalence of IDA using Hb of less than 11 g/dL may have been exaggerated due to thalassemia and hemoglobinopathies. On the other hand, iron studies are costly and not routinely available in low resource settings. In the present research, the authors estimated the prevalence of IDA in 9-month-old infants at the authors’ well-baby clinic by improving the post-iron-treatment criteria of Hb and defined the risk factors of IDA in infants. Objective: To estimate the prevalence of IDA in 9-month-old infants at the well-baby clinic and to define the risk factors of IDA. Materials and Methods: A retrospective cohort study of 391 children who had complete blood count (CBC) screening at 9-month-old at the well-baby clinic. Anemia was defined according to the WHO criteria (hemoglobin of 11 g/dL or less for children aged six months to five years). IDA was defined as an increase of at least Hb 1 g/dL after receiving iron treatment for one to two months. Mean levels of hematological parameters were compared between groups using independent samples t-test. The characteristics with potential risk factors for IDA were compared with iron non-responder and normal group. Multivariable adjusted odd ratios and 95% confidence intervals (CIs) of IDA were calculated using multinomial logistic regression with control for risk factors. Results: One hundred fourteen children (29.1%) were anemic. There was no difference between anemic and non-anemic children in baseline characteristics. Seventy children in the anemic group were diagnosed with IDA. The prevalence of IDA in the present study was 17.9%. The IDA group showed significant improvement in Hb, Hct, MCV, MCH after receiving iron treatment, but there were no significant changes in the iron non-responder group. The risk factor for IDA was exclusive breastfeeding for at least six months (odds ratio 3.14, 95% CI 1.67 to 5.90, p<0.001). Conclusion: The prevalence of IDA and anemia in the present study was 17.9% and 29.1%, respectively. The risk factor for IDA was exclusive breastfeeding for at least six months. Keywords: Anemia, Iron deficiency anemia, Prevalence of anemia in infants, Complete blood count screening, Thai infants

BackgroundAnemia remains a public health problem in Rwanda, affecting 38% of young children and 17% of reproductive-aged women (Demographic and Health Survey [DHS] 2010). The importance of iron deficiency (ID) as a cause of anemia in Rwanda is not known.ObjectiveWe aimed to estimate the prevalence of ID and iron deficiency anemia (IDA) among young children and women in 2 provinces of Rwanda.MethodsWe conducted a cluster randomized survey, selecting 408 rural households each in the Northern and Southern Provinces of Rwanda in 2010. Anemia was defined as hemoglobin <110 g/L in children and <120 g/L in nonpregnant women after correction for altitude. We defined ID as (1) serum transferrin receptor (TfR) >8.3 mg/L or (2) serum ferritin (SF) <12 µg/L in children and <15 µg/L in nonpregnant women after correction for inflammation.ResultsThe prevalence of anemia was 30.9% (95% confidence interval [CI], 26.4-35.8) in children (n = 577) and 11.2% (95% CI, 8.4-14.7) in women (n = 595). The prevalence of ID in children was 3.1% (95% CI, 1.8-5.1) as defined by high TfR and 5.9% (95% CI, 4.0-8.4) as defined by low SF. Similarly, 3.0% (95% CI, 1.8-4.8) of women had high TfR and 4.8% (95% CI, 3.2-7.2) had low SF. The prevalence of IDA (low SF with concurrent anemia) ranged from 1.4% (95% CI, 0.5-3.6) among women in the North to 5.6% (95% CI, 3.1-10.0) among children in the South.ConclusionsID is likely not an important contributor to anemia in the Northern and Southern Provinces of Rwanda. This finding warrants further investigation into other causes of anemia.

BACKGROUND: Iron-deficiency anemia (IDA) is caused by inadequate intake of iron or impaired erythrocyte formation due to chronic blood loss. AIM: This study aimed to obtain data on the prevalence of iron deficiency and IDA in the pandemic COVID-19 era and to investigate the relationship of infant nutritional status, maternal education, maternal occupation, maternal parity, and family income with the prevalence of iron deficiency and IDA in infants 9–12 months at the Cempaka Banjarbaru Community Health Center. METHODS: A cross-sectional analytic descriptive approach was used with a consecutive sampling technique to conduct this study. The sample consisted of 50 infants between 9 and 12 months old that had completed blood count and peripheral blood smear at measles immunization in May–September 2020 at the Cempaka Banjarbaru Community Health Center. RESULTS: The results showed that the prevalence of iron deficiency, IDA, and hemolytic anemia was 16%, 28%, and 22%, respectively. Meanwhile, the data analysis was conducted using Chi-square and Fisher’s exact test. The results showed a significant relationship between family income factors and the prevalence of iron deficiency and IDA (p = 0.023). CONCLUSION: Infants at the age of 9–12 months need to have a complete blood count examination to detect an earlier iron deficiency and IDA.

1. Ann Chen Wu, MD* 2. Leann Lesperance, MD, PhD* 3. Henry Bernstein, DO*† 1. *Pediatric Health Associates, Hunnewell Ground Children’s Hospital 2. †Associate Professor of Pediatrics, Harvard Medical School, Boston, MA After completing this article, readers should be able to: 1. Determine the most common cause of iron deficiency in the United States. 2. Describe the pathogenesis of iron deficiency. 3. List populations at high risk for iron deficiency. 4. Outline the common signs and symptoms of iron deficiency. 5. Specify the American Academy of Pediatrics recommendations for screening for iron deficiency. In the March and April issues of Pediatrics in Review, we published a two-part article on managing anemia in a pediatric office practice. This article expands on the various tests for iron deficiency, including some relatively new ones. These articles should be read as complementary.—RJH Iron deficiency is the most common nutritional deficiency in the world, responsible for a staggering amount of ill health, lost productivity, and premature death. Although its prevalence in the United States has declined since the late 1960s, iron deficiency with or without anemia still is seen frequently in infants, toddlers, adolescent females, and women of childbearing age. In fact, iron deficiency anemia remains the most common hematologic disease of infants and children. Anemia is defined as a low hemoglobin (Hgb) concentration or red blood cell (RBC) mass compared with age-specific norms. Anemia may be caused by decreased RBC production, increased RBC destruction, or blood loss. Based on the size of the RBC, hematologists categorize anemia as macrocytic, normocytic, or microcytic. Iron is found in different compartments within the body. Total body iron (measured by ferritin), transport iron (measured by transferrin saturation), serum iron, and other hematologic and biochemical markers are used to describe the degrees of iron deficiency. Iron depletion refers to the earliest stage of diminishing iron stores in the setting of insufficient iron supply. Iron deficiency (without anemia) develops as these iron stores are depleted further and begin to impair Hgb synthesis. Finally, iron deficiency anemia results …

Background: Iron deficiency is the most prevalent micronutrient deficiency disease in the world and occurs in young women in the United States. Female military personnel represent a unique population faced with intense physical and cognitive demands.Objective: The objective of this study was to determine the prevalence of iron deficiency and iron deficiency anemia among three populations of female military personnel in the US Army.Methods: Iron status was assessed in 1216 volunteers. Volunteers were recruited from three groups: immediately following initial entry to the Army (IET), immediately following basic combat training (AIT), or following at least six months of permanent assignment (PP). Iron deficiency was determined using a three variable model, including cut-off values for serum ferritin, transferrin saturation, and red cell distribution width (RDW). Iron deficiency anemia was categorized by iron deficiency and a hemoglobin (Hgb) value of <12 g/dL.Results: The prevalence of iron deficiency was greater in women in the AIT group (32.8%) than in the IET and PP groups (13.4 and 9.6%, respectively). The prevalence of iron deficiency anemia was greater in the AIT group (20.9%) than in the IET and PP groups (5.8 and 4.8%, respectively). Furthermore, the prevalence of iron deficiency anemia was greater in Hispanic (21.9%) and African-American military personnel (22.9%) than in Caucasian military personnel (10.5%).Conclusions: These data indicate that female military personnel experience diminished iron status following training, and that iron nutriture is an important issue facing females in the military.

Background: Iron deficiency anemia (IDA) in adolescent girls has strong health implications during re-productive years. Current research aimed to assess prevalence and determinants of iron deficiency anemia in adolescent girls of low income families residing in semi urban communities of Lahore, Pakistan.Method: This cross sectional analytical study selected 116 unmarried adolescent girls between the ages of 13 – 19 years from low income families through convenience sampling from semi-urban communities. Dietary data was collected using 3 – day recall, whereas a self-constructed, structured questionnaire was used to collect data on socio-demographic factors. Hemoglobin and serum Ferritin levels were assessed along with an assessment of clinical signs and symptoms of folate and iron deficiency. Data was enteredand analyzed using SPSS version 21.Results: IDA was present in 68.8% of adolescent girls, of which 40.2% were moderately (8 – 10 gm/dl) and 28.8% were mildly (10.9 – 11.9 gm/dl) anemic. Working status (p &lt; 0.041), source of dietary iron (p &lt; 0.001), frequency of heme iron consumption (p &lt; 0.001), protein consumption/day (p &lt; 0.001) and HEI score (p &lt; 0.001) showed statistically significant association with IDA. Binary regression analysis showed frequency of heme iron consumption [AOR = 29.13, 95% CI (9.627 to 88.203)] and HEI score [AOR = 6.877, 95% CI (.065 to 44.405]) to be the most significantly associated determinant of IDA. Mean Hb level was also significantly different between working and nonworking adolescents (p = 0.001, 95% CI = -1.124 to -0.322). Significant mean difference in serum Ferritin levels between working and nonworking adolescents (p = 0.04 [95% CI = -21.89 to -0.50]) was also observed. 94% and 91% girls showed signs and symptoms of iron and folate deficiency respectively. How-ever BMI, age, educational status of the girls and their parents were not found to be associated with IDA.Conclusion: Prevalence of IDA was alarmingly high in adolescent girls of low socioeconomic class. Working status, source of dietary iron, frequency of heme iron consumption, protein consumption/day and HEI score were found to be determining anemia. Nutrition education targeting IDA is the need of the day to control and prevent this public health epidemic.

A method to estimate prevalence of iron deficiency and iron deficiency anemia in adolescent Jamaican girls

The present study aimed to determine the prevalence of anaemia, iron deficiency (ID) and iron-deficiency anaemia (IDA) among female adolescents in the Gaza Strip, Palestine, as well as the risk factors involved in these conditions. The study was conducted using the quantitative descriptive method with a cross-sectional design. Data were collected using an FFQ and sociodemographic, sedentary behaviour and physical activity questionnaires. Anthropometric measurements and blood analyses were also conducted. The study population included all Palestinian female adolescents enrolled in secondary schools in the academic years 2015-2016. Five female secondary schools were selected randomly from five governorates of the Gaza Strip. Female adolescents (n 330) aged 15-19 years in the selected secondary schools were enrolled randomly. Prevalence of anaemia, ID and IDA among female adolescents in the Gaza Strip, Palestine, was 35·8, 40·3 and 26·0 %, respectively. A significant association (P<0·05) existed between ID, anaemia and IDA and dietary habits, including skipping breakfast and amount of junk food intake. Also, low consumption of fruits and vegetables was associated with IDA in the female adolescents. A statistically significant association was found between mother's education and ID but not with the other sociodemographic factors. The study shows that there is an alarming problem of anaemia and IDA in the Gaza Strip, Palestine. This may indicate that there are insufficient nutrition education programmes, particularly inside schools or by the mass media.

Background and Objective: Iron deficiency anemia (IDA) is the most common type of micronutrient deficiency in the world. Numerous reports indicated that adolescence is a period which has an increased risk of development of IDA. Given the importance of IDA and lack of studies in Saravan, a city of Iran, this study was performed to assess the prevalence of IDA among adolescent girls.Methods: In this cross-sectional study, 460 high-school girls were randomly selected. Demographic data was collected using a questionnaire. Knowledge, attitude and practice of participants with regard to iron deficiency anemia was measured at the beginning of the interview. Accordingly, five cc of blood sample was drawn from each student to determine the prevalence of anemia, which was defined by a hemoglobin level lower than 12 mg / dL. The level of ferritin was analyzed to confirm the IDA for students diagnosed with anemia. Ferritin level lower than 12 ?g / dl was considered as IDA. Data was analyzed using SPSS software version 22.Results: Prevalence of anemia and IDA was 24% (n = 111) and 12.6% (n = 58), respectively. Results showed that 37 % of students had good knowledge, 45. 5 % good attitude, and 6.7 % had good practice. Also, there was no significant association between IDA and socio-economic status including parental education, job, and household income (P&gt;0.05).Conclusion: The findings of this study showed that the prevalence of IDA was moderate in Saravan city. Given the importance of IDA and its complications, further studies are needed, especially in high risk populations for IDA such as children.

Iron deficiency anemia (IDA) in infants and young children remains a significant public health problem in most developing countries. IDA had short and long-term adverse impacts on infants' health and development. We aimed to assess the frequency of IDA and associated risk factors among infants aged between 9-12 months in rural areas of Nablus Governorate. A cross-sectional study. The study was conducted between Jan and Mar 2015. A random sample of 654 infants aged 9-12 months were selected from thirty villages in Nablus Governorate, Central Highlands of the West Bank, north of Jerusalem. Data were collected using pre-designed structured interviewing questionnaire, complete blood count analysis and anthropometric measurements were done. The prevalence of anemia and IDA among infants was 34.6%, and 32.6%, respectively. Predictors of IDA were increased in infants' age OR=1.19 (95% CI: 1.02, 1.40), maternal anemia during the third trimester OR=2.39 (95% CI: 1.55, 3.71), birth spacing less than three years OR=2.86 (95%CI: 1.58, 5.18), exclusive breastfeeding during the first six months OR=2.40 (95% CI: 1.46, 3.95), early OR=1.64 (95%CI: 1.03, 2.613) and late introduction of complementary feeding OR=2.26 (95% CI: 1.27, 4.05), and non-compliance to iron supplement in the correct frequency and duration during pregnancy OR=1.81 (95% CI: 1.19, 2.75). Different dietary and non-dietary risk factors for IDA should be considered for any intervention aimed to reduce the prevalence of IDA among infants.

Background: The aim of this study was to determine the iron status and the prevalence and risk factors of iron deficiency anemia (IDA) among adolescent girls in Central Jakarta, Indonesia. Methods: A cross-sectional study was conducted among 12- to 15-year-old girls studying in junior high schools that were categorized into high and low socioeconomic status (SES). Their menstrual and nutritional status, parents’ education level and income, and iron intake were assessed. Tuberculin test and assessments for C-reactive protein levels and hematologic and iron parameters were also conducted. Results: Iron status was normal in 69.3% of 163 subjects. The prevalence of non-anemic iron deficiency was higher (17.2%; 3.1% iron depletion and 14.1% iron deficiency) than that of IDA (13.5%). The prevalence of IDA was lower among girls from the high SES than that among girls from the low SES (11.5% and 15.8%, respectively). There was no significant relationship among IDA and nutritional status, menstrual status and characteristics, SES, iron intake, and parents’ education level and income; however, bioavailable iron intake in all subjects was found to be less compared to the recommended daily allowance (RDA). Conclusions: The higher prevalence of non-anemic iron deficiency than IDA is a potential risk factor for increasing the prevalence of IDA in the future. No significant relationship was found between IDA and its risk factors; however, iron intake was less compared to the RDA in all subjects, which requires further attention.

Background: Iron deficiency anemia is the most common nutritional deficiency disorder in the world. The present study was conducted to know the prevalence and severity of iron deficiency anemia among of 6 months to 60 months old children. A large proportion of iron deficiency is preventable with appropriate and timely intervention.Methods: This cross-sectional study was done on 100 children clinically suggestive of anemia with hemoglobin level less than 11gm/dl admitted in pediatrics ward of tertiary care hospital. 5 ml of blood sample was taken and complete hemogram, peripheral blood film and serum ferritin estimation was done. Case were studied in reference to history, age, clinical examination, hemoglobin level and confirmation of iron deficiency anemia was done by serum ferritin levels.Results: The prevalence of iron deficiency anemia in present study was 56%. It was most prevalent in the age group of 6 to 24 months. Exclusively breastfed children showed higher prevalence of iron deficiency anemia in present study, however no statistical correlation was found. Low Serum ferritin levels have statistically significant result with socioeconomic status, with as many as 69.4% suffering from iron deficiency anemia belonging to low socioeconomic status.Conclusions: Prevalence of iron deficiency anemia remains alarmingly high and major health problem in our country. All anemia are not iron deficiency anemia. Low socioeconomic status is a huge hurdle in child health and greatly influences prevalence of iron deficiency anemia. Serum ferritin is a most sensitive marker of iron deficiency anemia, helps diagnose it early in its course, which can be missed on clinical or routine blood investigations.

The aim of this study was to assess the prevalence of iron deficiency and iron deficiency anemia in relation to variables such as: age, weight, height, mother's education, number of family members, and nutritional habits among female elementary school children (age 6-12 years) in the western province of Saudi Arabia. A total of 123 female children were selected for this study. Complete blood count, serum iron, ferritin and total iron binding capacity were measured to assess iron deficiency and iron deficiency anemia. Overall, the prevalence of iron deficiency and iron deficiency anemia in this study was 23.0%. Data showed that the majority of anemia cases in this study were normocytic type. Anemia was more prevalent among students of age 10-12 years as compared to younger age group. In addition, there was no relationship between iron deficiency anemia and number of family members or mother's education. Anemic students were not aware of their nutritional habits. It was concluded that iron deficiency anemia is a problem among young girls, especially among those of age 12 years in western region of Saudi Arabia. It is recommended that the iron-folate supplementation program for pregnant women be expanded to non-pregnant women, including young girls.

Objective: To investigate the prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) in pregnant women in urban areas of China. Methods: The study was a national cross-sectional survey conducted from September 19th, 2016 to November 20th, 2016. According to the classification of the National Bureau of Statistics, all survey sites were set up in 6 regions of the country.Pregnant women were continuously selected using multistage stratified sampling. A total of 12 403 pregnant women were collected and examined for serum ferritin and hemoglobin levels. Results: The median serum ferritin level during pregnancy was 20.60 μg/L (11.78-36.98 μg/L) , the hemoglobin level was (118±12) g/L. With the progress of pregnancy, the levels of serum ferritin and hemoglobin decreased gradually. The median serum ferritin levels in the first, second trimester and third trimester were 54.30 μg/L (34.48-94.01 μg/L) , 28.60 μg/L (16.40-50.52 μg/L) , and 16.70 μg/L (10.20-27.00 μg/L) respectively (P<0.01) . The mean hemoglobin levels were (127±10) g/L, (119±11) g/L and (117±11) g/L respectively (P<0.01) . The prevalence of ID in urban pregnant women was 48.16% (5 973/12 403) , and IDA prevalence was 13.87% (1 720/12 403) . The prevalence of IDA in the first, second trimester and third trimester were 1.96% (20/1 019) , 8.40% (293/3 487) and 17.82% (1 407/7 897) ,respectively (P<0.01) . The prevalence of standardized ID and IDA were significantly different in various regions of China (P<0.01) . The standardized prevalence of ID were relatively higher in East China and Northeast China, 57.37% and 53.41% respectively, while it was the lowest in Southwest China, 30.51%. The standardized prevalence of IDA in South Central, Northwest, and East China were relatively high, 21.30%, 16.97% and 17.53% respectively, and the standardized prevalence of IDA in Southwest China was the lowest, 5.44%, the differents in various regions were significant (all P<0.01) . Conclusion: The current phenomenon of ID and IDA in pregnant women is still very common, and nutrition and health care during pregnancy should be strengthened.

Background Iron deficiency (ID) and iron deficiency anemia (IDA) are significant public health concerns, particularly in low- and middle-income countries. Adolescents, especially girls, are at a heightened risk due to increased iron requirements during growth and menstruation. Objective This study aimed to estimate the hospital prevalence of ID and IDA among adolescent girls attending the Outpatient Department (OPD) at a tertiary care centre in Bihar, India. Methods A hospital-based cross-sectional study was conducted at the All India Institute of Medical Sciences (AIIMS), Patna, India, from June 2019 to October 2021. A total of 169 adolescent girls aged 10 to 19 years were recruited using a non-probability convenient sampling method. Participants with normal C-reactive protein (CRP) levels were included to ensure accurate assessment of iron status, without the influence of inflammation. Serum ferritin, hemoglobin, serum iron, total iron-binding capacity (TIBC), and percentage saturation were measured. The primary outcomes were the prevalence of ID (serum ferritin < 15 µg/L) and IDA (serum ferritin < 15 µg/L and hemoglobin < 12 g/dL). Results The hospital prevalence of ID among the study participants was 17.8% (95% CI: 11.8%-23.5%), while the hospital prevalence of IDA was 15.4% (95% CI: 10.1%-21.7%). The overall hospital prevalence of anemia was 47.9% (95% CI: 40.2%-53.8%). A higher hospital prevalence of ID and IDA was observed in older adolescents (aged 17-19 years) compared to younger ones (aged 10-16 years), though the association was not significant (p = 0.056). Conclusions The findings of this study revealed that almost half of the adolescent girl population had a high hospital prevalence of anemia, with the majority of these cases classified as mild to moderate in intensity, whereas the hospital prevalence of absolute ID and IDA was low. Early screening using serum ferritin and appropriate nutritional strategiesis recommended to address this public health issue.