Iron Deficiency Anemia in Tennessee among Rural Poor Children

Abstract

STUDIES of the incidence of iron deficiency anemia among infants in rural areas of the United States have not been reported (1). This paper describes an anemia survey among rural children of Tennessee and a program of primary and secondary prevention. The widespread cause of iron deficiency anemia in infancy include (a) deficient stores of iron at birth, (b) relatively rapid increase in weight after birth, (c) a deficient intake of iron, and (d) blood loss. Although 10 gm. of hemoglobin per 100 cc. of blood (3) is often selected as the critical level (4), iron depletion exists in many children who are normal by currently accepted hematologic standards (5). Experts who accept the hemoglobin and hematocrit values found among exceptionally favored children as the desirable levels set the optimum hematocrit value for children from 3 months to adolescence at more than 36 percent of the packed cell volume (5, 6). Such a high level is obtainable with either a good diet or iron supplementation. The averages and the ranges of hemoglobin given in some texts include values which are far from desirable when viewed as indices of nutrition (6). Since experts disagree about the precise dividing line for anemia in children, the tables in this paper have been constructed to show the proportion of children falling under different dividing lines. Anemia of infection is probably rare in infants, but many infants with iron deficiency anemia develop infection (5). Probably most infants diagnosed as having anemia of infection have had anemia first and infection second. Although the incidence of iron deficiency anemia of infants varies from one group to another, the illness may reach alarming proportions in underprivileged groups (7). Thirty percent of the year-old children were anemic in one population of ill babies (2) and more than 24 percent in another (8). According to studies done in the 30's, 40's, and 60's, ithe incidence of iron deficiency anemia in low economic groups has differed little over the years. Apparently, iron deficiency anemia predisposes to infection. Andelman has shown that infants who do not become anemic have fewer respiraltory infections than (those who do (3). He quotes several authors, including McKay, Salmi, Shaw, Moe, and Helmendinger, who observe that prevention of anemia prevents illness in infants. Sturgeon is quoted as showing that infants from low-income families clearly benefited from iron supplementation (7). Many physicians argue that iron therapy is not needed in mild anemia. However, against this view and in favor of prophylactic and therapeutic iron, are the observations of Guest (6) that (a) mild anemia followed by infection often results in a precipitous fall in hemoglobin to a severe degree of anemia, (b) anemic infants are less resistant to infection, (G) pica is often associated with iron deficiency anemia, and (d) infection in anemic babies often follows a stormy course with complications. AlDr. Hutcheson is director of maternal and child health for the Tennessee Department of Public Health, Nashville.