Anemia Control Research Articles

Impact of Community Based Nutrition Intervention in the Prevention and Control of Anaemia Among Reproductive Aged Women of India.

Maternal and child under-nutrition is particularly widespread in low and middle-income nations, increasing the overall disease burden due to poor nutritional status. The aim of this study was to develop nutrition intervention for the prevention and control of anaemia among women of reproductive age. Community-based intervention study was conducted among 443 women of reproductive age group (15-49 years) to determine the effectiveness of a 6-month nutrition intervention package. The nutrition intervention was developed by using Precede-Proceed model and the trans-theoretical model of behavior change. Multi-channel communication approach was adopted and nutrition intervention package was provided. Assessment of haemoglobin, red blood cells, platelet, ferritin, folate, vitamin B12, haematocrit test, mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, red cell distribution width and total leucocyte count was compared at the baseline and endline after the intervention among the participants. The chi-square test of independence and t-test were performed. The only mean ferritin level shows significant improvement (p < 0.001). A significant decrease (~ 15%, p = 0.027) in anaemia was observed after the intervention. Improvement in anaemic status of women was observed. National schemes and programs require a more robust strategical implementation like food fortification/bio fortification and behaviour change communication at village level to enhance the availability and accessibility of fortified food.

A Case-Control Study of the Factors Associated with Anemia in Chinese Children Aged 3-7 years Old.

Anemia in children is still an important public problem in China and can have a profound impact on the physical and mental health of children. The purpose of this study was to explore the risk factors for anemia among Chinese children aged 3-7 years old and to provide some basis for the prevention and control of anemia. A matched case-control study was conducted and 1104 children (552 cases and 552 controls) were recruited in this study. Cases were children who were diagnosed with anemia by the doctor of physical examination and checked by one deputy chief physician of pediatrics, and controls were healthy children without anemia. Data were collected using a self-designed structured questionnaire. Univariable and multivariable analyses were used to identify independent determinants of anemia. P values less than 0.05 were used to declare statistical significance. In the multivariable analyses, maternal anemia before or during pregnancy and lactation (OR = 2.14, 95% CI: 1.10∼4.15; OR = 2.86, 95% CI: 1.66∼4.94; OR = 2.51, 95% CI: 1.13∼5.60), gestational weeks (OR = 0.72, 95% CI: 0.53∼0.96), having G6PD deficiency or thalassemia (OR = 8.12, 95% CI: 2.00∼33.04; OR = 36.25, 95% CI: 10.40∼126.43), having cold and cough in previous two weeks (OR = 1.56, 95% CI: 1.04∼2.34), family income (OR = 0.80, 95% CI: 0.65∼0.97), and being a picky eater (OR = 1.80, 95% CI: 1.20∼2.71) were determinants of anemia in children aged 3-7 years old. Some of the identified factors are modifiable and could be targeted to reduce childhood anemia. More emphasis should be given by the concerned bodies to intervene in the anemia problem by improving the maternal health education, screening for disease-related anemia, requesting medical services in a timely manner, improving the economic status of households, promoting dietary habits, and improving sanitation and hygiene practices.

FACTORS INFLUENCING ON THE HEMOGLOBIN LEVELOF PREGNANT WOMEN-A CROSS SECTIONAL STUDY IN RURAL AREA OF LATUR DISTRIST.

Background: Anaemia is a global public health problem, affecting both developing and developed countries. WHO estimates that prevalence of anaemia as 65-75% in India. Most common form of anaemia in pregnant women is iron deciency anaemia. The etiology of anaemia during pregnancy among women in developing countries is multifactorial. Hence this study was done to asses factors affecting haemoglobin level in pregnant women in rural area. Objectives : To study the prevalence of anaemia among pregnant women and various sociodemographic, dietary and obstetric factors associated with anaemia in pregnant women in rural area. in rural area. Methods:A community based cross sectional study was done in rural blocks of Latur district. Sociodemographic, obstetric and dietary data was collected from pregnant women. Hemoglobin was calculated by Sahli's method and classied according to the WHO classication for pregnant women. Chi square test and crude Odds ratio were estimated .p&lt;0.05 considered as signicant. Results: Mean age of study subjects was 22.34 ± 0.498 years. Prevalence of anaemia was 62%. Mild , moderate and severe anaemia contributed 30%,29% and 3% respectively .A statistical signicant association was seen between anaemia and religion (Muslim COR-2.98 and Buddist COR- 5.81 ) and Socioeconomic class (COR-3.19). Also, anaemia was signicantly associated with age at menarche, gestational age , average spacing, IFA consumption and deworming status during pregnancy. (p&lt;0.05) Prevalence of anaemia was signicantly high among vegetarians , pregnant women with decient daily calories and protein intake and lack of daily Green leafy vegetables and fruits consumption.(p&lt;0.05) Conclusion: Anemia continues to be a public health problem. Although iron–folic acid supplementation is available under the national health program to address this issue, it is important for primary care physicians to consider and address other risk factors when designing and implementing target interventions for anemia control in selected populations

Severe Hemolytic Anemia and Metabolic Acidosis at Birth with Glutathione Synthetase Deficiency and Progressive Neurological Symptoms on Follow-Up.

BACKGROUND Glutathione synthetase deficiency (GSD) is a rare autosomal recessive disorder caused by glutathione synthetase (GSS) gene variants that occur in 1 in 1 million individuals. The severe form of GSD is characterized by hemolytic anemia, metabolic acidosis with 5-oxoprolinuria, progressive neurological symptoms, and recurrent bacterial infections. This case report presents a male Japanese infant with severe hemolytic anemia and metabolic acidosis at birth caused by GSD, who developed progressive neurological symptoms on follow-up. CASE REPORT A Japanese male term infant developed severe hemolytic anemia and metabolic acidosis in the early neonatal period. We suspected GSD based on his symptoms and a high 5-oxoproline urine concentration. We began correcting his metabolic acidosis and administering vitamins C and E supplements. The patient required blood transfusion twice during the acute phase for hemolytic anemia. After age 1 month, he maintained good control of metabolic acidosis and hemolytic anemia. A definitive diagnosis of GSD was made based on high concentrations of 5-oxoproline in urine, low concentrations of glutathione and GSS activity in erythrocytes, and genetic testing. Several episodes of febrile convulsions were started at age 11 months, but none occurred after 2 years. At the last follow-up at age 25 months, metabolic acidosis and hemolytic anemia were well controlled, but he had mild neurodevelopmental delay. CONCLUSIONS This case report shows that GSD can present with severe hemolytic anemia and metabolic acidosis at birth, and manifest with subsequent neurological impairment despite early diagnosis and treatment. Therefore, a careful long-term follow-up that includes neurological evaluation is essential for patients with GSD.

Prevalence of anemia and associated risk factors among pregnant women in Sana’a, Yemen

Objectives: Anemia in pregnancy is a serious public health problem in developing countries. The aim of this study was to determine the prevalence of anemia and associated risk factors among pregnant women in Sana’a, Yemen. Materials and Methods: This cross-sectional study included 260 pregnant women attended some government and private hospitals in Sana'a from November 2021 to January 2022. Sociodemographic data were collected using structured questionnaires Blood samples were collected and analyzed for hemoglobin (Hb) concentrations using a hematology Sysmex analyzer. The data was analyzed using SPSS version 26 software. Descriptive, bivariate chi-square and logistic regression analyses were done. Results and discussion: The prevalence of anemia among pregnant women was 44.2%. The prevalence of mild, moderate and severe anemias were 18.8%, 25.0%, and 0.4%., respectively. Moderate anemia was the most common anemia. Risk factors associated with anemia were low family monthly income, the presence of health problems, and lack of supplements taken. Conclusion: The prevalence of anemia was high and represents a severe problem among pregnant women. Identification of risk factors may help in the prevention and control of anemia.

Critical Analysis of Pathya in Pandu Roga

Desire of life is the most important one to lead qualitative life. To fulfil this desire a healthy diet and regimen or lifestyle should be followed. Wholesome (Pathya) and unwholesome (Apathya) diet plays an important role to maintain health of healthy individual as well in treatment field to get relief from the diseased state. Ayurveda emphasizes upon the concept of Pathya-apathya along with medicine to complete the treatment procedure. Panduroga (anaemia) is a clinical condition represented with the reduction of haemoglobin concentration of blood according to the age, sex, and physiological condition of an individual. In developing countries, it becomes a global problem. In India more than 50% among the vulnerable groups such as pregnant women, infants, young children and adolescents are suffering from anaemia. Government of India has launched different types of programs, like National Nutritional Anaemia Control Program, National Iron Plus Initiative for Anaemia Control program, ICDS etc in different time according to prevalence of anaemia as a preventive measure. To reduce the prevalence of anaemia government has launched POSHANA ABHIYAN in march 2018 to make ANAEMIA MUKTA BHARAT. Prevention and control of anaemia is one of the key strategies of health sector which can be fulfilled by following different guidelines and comprehensive actions in terms of Pathya. Therefore, in this article we are trying to draw a concept of Pathya in relation to Pandu (haemoglobin level- below the 10gm/dl and above 7gm/dl, through diet and regimen) which may helpful to eradicate prevalence of IDA.

The clinical characteristics of anemia in native adults living at different altitudes of the Tibetan Plateau

To provide evidence-based medicine references for formulating prevention and control policies in plateau areas, we explore the characteristics of anemia patients in Tibet (the plateau areas of China), especially those located at an altitude above 4500 m. We collected clinical data from 379 Tibetan anemia patients over the age of 18 years. We found those female patients accounted for the majority of Tibetan anemia patients. Almost half of the anemia patients aged from 28 to 47 years. The percentage of severe anemia and extremely severe anemia was 45.4% and 2.4%, respectively. 88.7% of patients are engaged in agriculture and animal husbandry, and 81.5% of patients just graduated from primary school or below. The most common causes of anemia were nutritional anemia, especially iron-deficiency anemia. At high-altitude localities, folic acid-deficiency anemia needs more attention. Overall, this study showed that altitude influences the incidence, severity, and cause of anemia. Peasants and herdsmen, low education levels, young and middle-aged women, and nutrition status should be paid attention to in future anemia control.

Prevalence of Anemia Among Pregnant Women in Rural Village of Sindhupalchowk District of Nepal - A Cross-Sectional Study

Background: Anemia is a global public health problem all around the world, principally the developing countries like Nepal. Anemia results in maternal mortality alongside low birth weight which contributes to an increased infant mortality rate. The prevalence of anemia ranges from 27% to 42% among pregnant women depending on geographical regions. Iron and folic acid tablets are supplied free of charge to pregnant women as part of the Nepal government's National Anemia Control Strategy and Iron Intensification Program. Methods: A cross-sectional study was carried out among pregnant women attending Manekharka health center for an antenatal checkup. Hemoglobin levels of pregnant women from April 2018-2020 were obtained and analyzed. Hemoglobin level was determined using the indirect cyanmethemoglobin method. Results: We used the World Health Organization (WHO) standard classification of hemoglobin levels below 11 gm/dl to determine the prevalence of anemia in pregnant women. The result suggested that a total of 30.7%, (n=63) of the pregnant women were anemic. Among which 4.76% had moderate anemia (hemoglobin 7-9.9gm/dl) and 96.58% had mild anemia (hemoglobin ≥9.9mg/dl to &lt;11gm/dl). Conclusion: The study and its results suggest that the women in the age group 16-19 had a higher prevalence of anemia whereas the age group 25-29 had the lowest prevalence of anemia. Moreover, the study revealed that the prevalence of anemia in hills is substantial.

Factors associated with anemia among children in South and Southeast Asia: a multilevel analysis

BackgroundSouth and Southeast Asian countries (SSEA) account for the highest burden of anemia globally, nonetheless, progress towards the decline of anemia has almost been stalled. This study aimed to explore the individual and community- level factors associated with childhood anemia across the six selected SSEA countries.MethodsDemographic and Health Surveys of SSEA countries (Bangladesh, Cambodia, India, Maldives, Myanmar, and Nepal) conducted between 2011 and 2016 were analyzed. A total of 167,017 children aged 6–59 months were included in the analysis. Multivariable multilevel logistic regression analysis was used to identify independent predictors of anemia.ResultsThe combined prevalence of childhood anemia across six SSEA countries was 57.3% (95% CI: 56.9–57.7%). At the individual level, childhood anemia was significantly higher among (1) mothers with anemia compared to non-anemic mothers (Bangladesh: aOR = 1.66, Cambodia: aOR = 1.56, India: aOR = 1.62, Maldives: aOR = 1.44, Myanmar: aOR = 1.59, and Nepal: aOR = 1.71); (2) children with a history of fever in the last two weeks compared to those without a history of fever (Cambodia: aOR = 1.29, India: aOR = 1.03, Myanmar: aOR = 1.08), and; (3) stunted children compared to those who were not (Bangladesh: aOR = 1.33, Cambodia: aOR = 1.42, India: aOR = 1.29, and Nepal: aOR = 1.27). In terms of community-level factors, children with mothers in communities with a high percentage of community maternal anemia had higher odds of childhood anemia in all countries (Bangladesh: aOR = 1.21, Cambodia: aOR = 1.31, India: aOR = 1.72, Maldives: aOR = 1.35, Myanmar: aOR = 1.33, and Nepal: aOR = 1.72).ConclusionChildren with anemic mothers and stunted growth were found vulnerable to developing childhood anemia. Individual and community-level factors identified in this study can be considered to develop effective anemia control and prevention strategies.

Renal control of life-threatening malarial anemia.

Iron recycling prevents the development of anemia under homeostatic conditions. Whether iron recycling was co-opted as a defense strategy to prevent the development of anemia in response to infection is unclear. We find that in severe Plasmodium falciparum malaria, the onset of life-threatening anemia is associated with acute kidney injury (AKI), irrespective of parasite load. Using a well-established experimental rodent model of malaria anemia, we identify a transcriptional response that endows renal proximal tubule epithelial cells (RPTECs) with the capacity to store and recycle iron during P. chabaudi chabaudi (Pcc) infection. This response encompasses the induction of ferroportin 1/SLC40A1, which exports iron from RPTECs and counteracts AKI while supporting compensatory erythropoiesis and preventing the onset of life-threatening malarial anemia. Iron recycling by myeloid cells is dispensable to this protective response, suggesting that RPTECs provide an iron-recycling salvage pathway that prevents the pathogenesis of life-threatening malarial anemia.

Effect of PKM2 on Osteogenic and Adipogenic Differentiation of Bone Marrow Mesenchymal Stem Cells in Myeloma Bone Disease

To investigate the expression of pyruvate kinase M2 (PKM2) in bone marrow mesenchymal stem cells (BMSCs) in myeloma bone disease (MBD) and its effect on osteogenic and adipogenic differentiation of BMSCs. BMSCs were isolated from bone marrow of five patients with multiple myeloma (MM) (MM group) and five with iron deficiency anemia (control group) for culture and identification. The expression of PKM2 protein were compared between the two groups. The differences between osteogenic and adipogenic differentiation of BMSCs were assessed by using alkaline phosphatase (ALP) and oil red O staining, and detecting marker genes of osteogenesis and adipogenesis. The effect of MM cell line (RPMI-8226) and BMSCs co-culture on the expression of PKM2 was explored. Functional analysis was performed to investigate the correlations of PKM2 expression of MM-derived BMSCs with osteogenic and adipogenic differentiation by employing PKM2 activator and inhibitor. The role of orlistat was explored in regulating PKM2 expression, osteogenic and adipogenic differentiation of MM-derived BMSCs. Compared with control, MM-originated BMSCs possessed the ability of increased adipogenic and decreased osteogenic differentiation, and higher level of PKM2 protein. Co-culture of MM cells with BMSCs markedly up-regulated the expression of PKM2 of BMSCs. Up-regulation of PKM2 expression could promote adipogenic differentiation and inhibit osteogenic differentiation of MM-derived BMSCs, while down-regulation of PKM2 showed opposite effect. Orlistat significantly promoted osteogenic differentiation in MM-derived BMSCs via inhibiting the expression of PKM2. The overexpression of PKM2 can induce the inhibition of osteogenic differentiation of BMSCs in MBD. Orlistat can promote the osteogenic differentiation of BMSCs via inhibiting the expression of PKM2, indicating a potential novel agent of anti-MBD therapy.

Artificial Intelligence and Machine Learning in Dialysis: Ready for Prime Time?

Artificial Intelligence and Machine Learning in Dialysis: Ready for Prime Time?

Iron status and anemia control are related to peritoneal membrane properties in peritoneally dialyzed patients.

Characteristics of peritoneal membrane is unique and individually different in peritoneal dialysis patients. Relationship between specific nature of peritoneal transport, anemia and inflammation has not yet been extensively studied. We attempted to outline the complex interplay of several biomarkers of iron status and their association with peritoneal transport, degree of inflammation and residual renal function. A total of 58 patients treated with peritoneal dialysis either CAPD or APD for at least 3 months were enrolled in this study. Full blood count, traditional markers of iron status (transferrin saturation-TSAT and ferritin), serum erythroferrone-ERFE, soluble transferrin receptor (sTfR), hepcidin, zonulin, growth differentiation factor -15 (GDF15), IL-16, hsCRP and hypoxia-inducible factor-α (HIF-1-α; in serum and dialysate) were measured using commercially available tests. We also performed Peritoneal Equilibrium Test and assessed GFR level. Hb levels above 10 g/dL was found in 74% of patients. Hb levels positively correlated with residual renal function and nutritional status. Adequate iron status was diagnosed in 69% of subjects, only in 9% of patients, criteria for absolute iron deficiency were met. Serum ERFE correlated inversely with hepcidin levels but was not associated with erythropoietin stimulating agent dose. Peritoneal transport had strong correlation with dialysate sTfR (p < 0.05), dialysate hepcidin (p < 0.05), dialysate GDF15 (p < 0.01) and dialysate zonulin (p < 0.001) levels, as well as serum IL6 (p = 0.03), serum hs-CRP (p = 0.04) and dialysate hs-CRP (p = 0.04). Residual kidney function contributes considerably to better control of anemia. Various degree of inflammation is inherent to PD patients. Additionally, fast-average peritoneal transport is associated with greater degree of inflammation and higher concentration of markers of iron status, GDF15 and zonulin in dialysate. This finding may indicate more effective clearance of higher-range middle molecules in fast-average transporters. The role of ERFE as a marker of erythropoiesis in PD patients requires further investigation.

Unravelling the Gaps in Anaemia Control among Pregnant Women- A Qualitative Study from an Urban Setting

Introduction: Nutritional anaemia is one of the biggest public health problems of our country. Inspite of anaemia control being one of the oldest National Health Programmes, the prevalence of anaemia among the pregnant women has practically remained the same since the last five decades. This implies that something critical is being missed in the entire chain of operations of the programme. Aim: To explore the missing links and real factors impacting the success of anaemia control among pregnant women. Materials and Methods: A qualitative study was conducted among currently pregnant women attending the antenatal clinic of a Tertiary Care Hospital in urban Chennai, India from June 2022 to August 2022. In-depth interviews were conducted with the pregnant women to discover the pregnant mothers’ perspectives and challenges in cmpliance with the anaemia control initiatives. Results: A total of 25 pregnant mothers were interviewed in the study. The mean age was 28.3±4.07 years. Eight mothers were primiparous, and seventeen multiparous. Twelve mothers were anaemic as per their last Hb estimation. Though there was reasonably good knowledge among the pregnant mothers regarding anaemia and its treatment, there was a significant gap in compliance to the anaemia prophylaxis/treatment. Several common critical issues surfaced in the study which was related to the social norms, family dynamics, health system and support related to management of side-effects. Conclusion: It is essential to address the operational gaps and the unique issues of treatment compliance in our society. Behavioural change communication needs to be specific and targeted, mothers need a better health and social support system to manage the side-effects of Iron-Folic Acid (IFA) and the healthcare system needs to involve other key decision makers in the household like husbands, mother in laws to provide a supportive environment.

Exacerbation of Pica as a Precursor of Psychosis

Abstract Pica is a sustained, compulsive eating behavior of nonedible substances. Pica has been described as sequelae of psychosis due to its state of disorganization; however, temporal and causal relationship between the two has not been reported in the context of exacerbation of pica before psychosis. Various causes of pica have been identified including malnutrition, iron-deficiency anemia, zinc deficiency, intellectual disability, and obsessive and impulse control disorders. Here, we describe a case of worsening pica which preceded exacerbation of psychosis in an 18-year-old female which was managed with antipsychotics along with complete remission of psychosis and improvement in the severity of pica. The present case highlights the association between psychosis and pica. There has been a rising voice in academia to reclassify pica alongside obsessive–compulsive disorder (OCD) with no absolute consensus. In conclusion, our findings suggest that the exacerbation of pica preceded psychosis and can be construed as an indicator for an upcoming psychotic episode or as a prodromal aspect of psychosis and may be useful for early identification and initiation of treatment in cases of relapsing psychosis.

Predisposing Factors of Anaemia among Pregnant Mothers with ≤ 12 Weeks of POA Receiving Antenatal Care in the Eastern Province of Sri Lanka

Background: Anaemia in pregnant mothers is associated with increased rates of maternal and perinatal morbidity and mortality. Therefore, identifying predisposing factors of anaemia in pregnant mothers is essential for results based intervention modalities. The aim of this study was to describe the predisposing factors for anemia and its related factors among pregnant mothers. Objectives: To describe the prevalence and the predisposing factors for anemia in pregnant mothers in the Eastern Province. Methods: Simple descriptive cross-sectional study included 1334 pregnant mothers in first trimester. Pre-tested, structured questionnaire and Qualitative components such as Focus group discussion, In-depth interviews, and Key informant interviews were conducted to relevant participants and care providers. Results: The overall prevalence of anemia was 32.9% (439/1334). Among 439 mothers with anaemia, 87.24% had mild level anaemia, 12.53% had moderate level anaemia, and 0.23% with severe anaemia. Following factors were related to the high prevalence of anaemia among pregnant mothers such as recurrent miscarriages three or more, increased number of gravidity, marital age of less than 18 years, and pregnancy after the age of 30, mothers studied up to primary level of education and with body mass index of &lt; 18.5. In-Depth Interview pointed numerous supporting issues such as less value for nutrition and it related diseases among service providers, availability and adequacy of services for nutrition awareness and modification. Discussion: Association of anaemia was found to be more significant in the age group of &lt;20 years and &gt;35 years. Analyzing possible predisposing factors shown, dietary habit, medical condition, number of pregnancy, and miscarriage are some positive contributing factors for anaemia during the pregnancy. Focus group discussion of PHM revealed service related issues such as inadequacy of facilities and manpower, maldistribution of service providers and area specific problems in remote areas. FGD conducted to pregnant mother’s revealed negligence by service provider, lack of communication, and less priority for nutrition enhancement are identified as predisposing factors. Both types of evaluation show the education status of mothers and spouse play key role of iron deficiency anaemia. They gave less priority for control of anaemia, even most of them not bother about their nutritional status.

Prevention and management of Anaemia in Pregnancy in India: Challenges and Opportunities

Seven decades ago, over 80% of Indian pregnant women were anaemic. About 3/4th of anaemia was due to nutritional deficiencies of: iron (most common), folic acid (second) and vitamin B12 (not as common). Anaemia in pregnancy was associated with higher maternal morbidity and mortality, low birth weight and high perinatal mortality. Detection and appropriate management of anaemia, including parenteral iron therapy and intensive care for severe anaemia were important components of antenatal care in India, but only about 10% of women had access to antenatal care. In 1970s the national programme for anaemia in pregnancy focussed on identifying all pregnant women and providing them iron and folic acid (IFA) supplementation. The coverage and compliance with supplementation were low. In 1990 when the primary health care infrastructure was established, the anaemia control programme embarked on testing and providing appropriate treatment to anaemic women. The tertiary care centres operationalised this “test and treat” strategy. In primary and secondary care settings, accurate test for diagnosis of anaemia was not available. In the absence of accurate Hb estimation at all levels of care, it was not possible to provide appropriate treatment based on Hb levels. So, all pregnant women continued to receive one tablet of IFA throughout pregnancy. Over the next two decades, coverage under antenatal care and IFA supplementation improved but compliance with supplementation was low because about a third of pregnant women had gastrointestinal side effects with IFA. Despite these problems, between 2002 and 2015, there had been a decline in the prevalence of severe and moderate anaemia. To accelerate the decline in anaemia in pregnancy the country is focusing on the ‘test and treat’ strategy in pregnant women using an accurate method for Hb estimation and providing appropriate treatment. Nutrition education to improve iron intake prior to and during pregnancy, is focussing on dietary diversification and use of iron fortified salt or cereals. Progress will be monitored through national surveys and locale specific appropriate mid-course modifications in the programme will be made.

Risk factors associated with iron deficiency anemia in children under 5 years of age attending a health center in Chachapoyas, Peru.

Study Design: Retrospective case-control study. Objective: To identify risk factors among sociodemographic, nutritional and health characteristics associated with iron deficiency anemia in children under five years of age, attending the growth and development clinic of the Nueve de Enero de Chachapoyas Health Center during 2019. Methods: Two groups were formed, each consisting of 50 children. Group 1 (G1, cases) were children diagnosed with iron deficiency anemia and a control group (CG) of age-matched healthy children residing in the same jurisdiction. Data were collected from the medical records of the health center, in a structured record card based on the study variables: age, birth weight, parasitic diseases or associated symptomatologies such as diarrhea, frequency and type of feeding before and after six months of age. The data were grouped in contingency tables for the calculation of Odds Ratio (OR), and statistical significance was estimated by analysis of variance (ANOVA) with 95% confidence. Results: All the factors considered presented significant association p&lt;0.05, with the exception of sex, with respect to the presence of anemia in children. With OR values of: under 32 months of age (OR=2.26, 95% CI 0.59-2.79), under 2900 g birth weight (OR=2.98, 95% CI 0.43-2.99), prolonged exclusive breastfeeding (OR=3.14, 95% CI 1. 55-3.88), early ablactation (OR=4.96, 95% CI 1.27-5.07), low consumption of foods of animal origin (3.5, 95% CI 1.18-3.61), low consumption of fruits and vegetables (2.33, 95% CI 0.86-2.63), among others. Conclusions: In the population of Chachapoyas, the factors considered in the study increase the risk of developing anemia in children under five years of age by more than 93%. Its probability of occurrence warrants a reevaluation of the strategies applied in the different programs or interventions carried out in the area for the control and prevention of anemia.

Trend of adherence to iron supplementation during pregnancy among Ethiopian women based on Ethiopian demographic and health surveys: A Multivariable decomposition analysis.

Iron deficiency is one of the significant factors of anemia during pregnancy. Iron supplementation is the main method of prevention and control of iron deficiency anemia, and its effectiveness depends on adherence to the iron supplementation. This study was based on a secondary analysis of 2005, 2011, and 2016 EDHS data. After the data was weighted using sampling weight, 696, 1,282, and 3,096 in 2005, 2011, and 2016 EDHS data, respectively, were used for the final analysis. The data were edited, cleaned, coded, managed, and analyzed using StataCorp version 16 software. A logit-based multivariable decomposition analysis was used to identify variables significantly associated with the change in the adherence level during pregnancy. Adherence levels increased from 1.1% (95% CI; 0.4, 2.7) in 2005 EDHS to 12.4% (95% CI; 10.9, 14.1) in 2016 EDHS. About 30.9% of the overall change in the adherence level to iron supplement use during pregnancy was due to the difference in women's sociodemographic-related variables. After adjusting for these compositional changes, ~69.1% of the change in the adherence level was because of the difference in the coefficients (behavior-related variables). Among the behavioral characteristics, women's age-group, rich wealth index, and secondary and above-secondary educational status of their husbands had a statistically significant effect on the positive change in the adherence level of pregnant mothers. The adherence level to iron supplement use during pregnancy has increased significantly over the last decade in Ethiopia. Both the compositional and behavioral characteristics of women play a major role in the increasing trend of adherence levels.

Cervical Necrotizing Fasciitis: An Institutional Experience.

Introduction Cervical necrotizing fasciitis is an acute, progressive, and rapidly spreading soft tissue infection affecting the fascial planes of the head and neck region. It has high morbidity and mortality rate. In this study, we have reviewed cervical necrotizing fasciitis cases treated in our department and analyzed the various risk factors, laboratory indices, and treatment modalities that affect the prognosis of this deadly disease. Design and method This is a retrospective review. We have reviewed the medical records and charts of seven patients hospitalized in our institute with the diagnosis of cervical necrotizing fasciitis between 2015 and 2019. Results Of the seven patients, six were male and one was female. The mean age was 49.8 years (range: 38-70 years). Etiology was found to be odontogenic infection in five (71%) cases. The presenting feature in all cases was tender cervical swelling. Intraoperatively, the submandibular triangle was found to be involved in all cases (100%) followed by the carotid triangle in five (71%) cases and the submental triangle in three (42%) cases. The most common comorbidities associated with cervical necrotizing fasciitis were found to be uncontrolled diabetes mellitus and anemia. All patients underwent emergency aggressive surgical debridement and culture-directed broad-spectrum antibiotics (100%). Additional procedures in the form of tracheostomy were required in two (28%) cases and skin grafting in two (28%) cases. One patient in our series developed sepsis with descending mediastinitis. The average hospital stay was 27 days. All the patients survived with no mortality. Conclusion Cervical necrotizing fasciitis should be diagnosed early. Early initiation of broad-spectrum antibiotics and aggressive surgical debridement are the two key management strategies that can improve survival. Strict glycemic control and correction of anemia result in a favorable outcome.