Prevalence of anemia and deficiency of iron, folic acid, and zinc in children younger than 2 years of age who use the health services provided by the Mexican Social Security Institute.

Ximena Duque,María E Mendoza,Sergio Flores-Hernández,Rosa I Ramos,Samuel Flores-Huerta,Ignacio Méndez-Ramírez,Marco González-Unzaga,Gloria Martínez-Andrade,Sergio Muñoz,Bernardo Turnbull,Homero Martínez

doi:10.1186/1471-2458-7-345

Abstract

BackgroundIn Mexico, as in other developing countries, micronutrient deficiencies are common in infants between 6 and 24 months of age and are an important public health problem. The objective of this study was to determine the prevalence of anemia and of iron, folic acid, and zinc deficiencies in Mexican children under 2 years of age who use the health care services provided by the Mexican Institute for Social Security (IMSS).MethodsA nationwide survey was conducted with a representative sample of children younger than 2 years of age, beneficiaries, and users of health care services provided by IMSS through its regular regimen (located in urban populations) and its Oportunidades program (services offered in rural areas). A subsample of 4,955 clinically healthy children was studied to determine their micronutrient status. A venous blood sample was drawn to determine hemoglobin, serum ferritin, percent of transferrin saturation, zinc, and folic acid. Descriptive statistics include point estimates and 95% confidence intervals for the sample and projections for the larger population from which the sample was drawn.ResultsTwenty percent of children younger than 2 years of age had anemia, and 27.8% (rural) to 32.6% (urban) had iron deficiency; more than 50% of anemia was not associated with low ferritin concentrations. Iron stores were more depleted as age increased. Low serum zinc and folic acid deficiencies were 28% and 10%, respectively, in the urban areas, and 13% and 8%, respectively, in rural areas. The prevalence of simultaneous iron and zinc deficiencies was 9.2% and 2.7% in urban and rural areas. Children with anemia have higher percentages of folic acid deficiency than children with normal iron status.ConclusionIron and zinc deficiencies constitute the principal micronutrient deficiencies in Mexican children younger than 2 years old who use the health care services provided by IMSS. Anemia not associated with low ferritin values was more prevalent than iron-deficiency anemia. The presence of micronutrient deficiencies at this early age calls for effective preventive public nutrition programs to address them.

Highlights

In Mexico, as in other developing countries, micronutrient deficiencies are common in infants between 6 and 24 months of age and are an important public health problem
The sampling frame from which primary sampling units were selected was drawn from a list of all primary health care units in the country, which included 1,160 family medicine units (FMU) for regular regimen (RR) and 3,367 rural medical units (RMU) for IO
More than half the anemia cases were not accompanied by low ferritin levels, reflecting that they may be from causes other than iron deficiency

Summary

Introduction

In Mexico, as in other developing countries, micronutrient deficiencies are common in infants between 6 and 24 months of age and are an important public health problem. Micronutrient deficiencies have received much attention as it has been demonstrated that even subclinical states, such as mild iron deficiency or low concentrations of zinc, are associated with functional outcomes [1] These include, among others, impaired psychomotor development [2,3], decreased work capacity, diminished immunological response, and linear growth retardation [4,5,6]. During the first year of life, another risk factor for nutritional deficiencies occurs from inadequate complementary feeding practices These are characterized by consumption of foods with low amounts of bioavailable micronutrients as well as with inhibitors of their absorption, and the practices often extend up to the age of 2 years. In the cases of iron and zinc, risk of inadequate intake is increased in countries where diets at this age include cereals with a high content of phytic acid coupled with low intake of animal foods [1,7]

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