|Year : 2017 | Volume
| Issue : 1 | Page : 213-220
Iron deficiency anemia among preschool children (2–6 years) in a slum area (Alexandria, Egypt): an intervention study
Gafar M Abdel-Rasoul1, Fady M Elgendy2, Mostafa L Abd Elrazek MBBCh 3
1 Department of Public Health and Community Medicine, Menoufia University, Shebin Elkom, Egypt
2 Department of Pediatric Medicine, Menoufia University, Shebin Elkom, Egypt
3 Department of Family Medicine, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
|Date of Submission||05-Mar-2015|
|Date of Acceptance||07-Jun-2015|
|Date of Web Publication||25-Jul-2017|
Mostafa L Abd Elrazek
Mitt Damses, Aga, Dakhlia
Source of Support: None, Conflict of Interest: None
The aim of this study was to assess the prevalence of iron deficiency anemia (IDA) among preschool children in a slum area of Alexandria governorate.
According to the WHO, anemia due to iron deficiency is the most common nutritional disorder in the world. Two billion people – over 30% of the world's population – are anemic, mainly due to iron deficiency.
Participants and methods
A cross-sectional comparative study was carried out on 90 children living in a slum area in the east district of Alexandria governorate.
Mother's age, mother's education, socioeconomic standard, and family size were significantly different between healthy and anemic children. Parasitic infestations were significantly higher among anemic children than among healthy children.
Prevalence of IDA among preschool children was 52.2%. Prevalence of IDA was higher in girls than in boys but did not reach a significant level. On the other hand, there was a significant association between the prevalence of IDA and mother's age and family size.
Keywords: attitude an practice of mothers, iron deficiency anemia, knowledge, parasitic infestation, preschool children
|How to cite this article:|
Abdel-Rasoul GM, Elgendy FM, Abd Elrazek ML. Iron deficiency anemia among preschool children (2–6 years) in a slum area (Alexandria, Egypt): an intervention study. Menoufia Med J 2017;30:213-20
|How to cite this URL:|
Abdel-Rasoul GM, Elgendy FM, Abd Elrazek ML. Iron deficiency anemia among preschool children (2–6 years) in a slum area (Alexandria, Egypt): an intervention study. Menoufia Med J [serial online] 2017 [cited 2019 Jun 20];30:213-20. Available from: http://www.mmj.eg.net/text.asp?2017/30/1/213/211534
| Introduction|| |
Anemia is one of the most widespread public health problems, especially in developing countries. It has important health, social, and economic consequences . According to the WHO, anemia due to iron deficiency is the most common nutritional disorder in the world. Two billion people – over 30% of the world's population – are anemic, mainly due to iron deficiency . UNICEF estimates suggest that the number of children with iron deficiency anemia (IDA) is greater than 750 million . According to the WHO (2008), 66% of children in Southeast Asia, 63% of children in the eastern Mediterranean region, 60% of children in Africa, 46% of children in Latin America, and 7% of children in North America suffer from IDA . According to the Egyptian Demographic and Health Survey for the year 2005, about half of the Egyptian children under 6 years of age were anemic (48.5%), and rural children are more likely to be anemic than urban children (51 vs. 44%, respectively) .
IDA is linked with depressed mental and motor development during infancy and early childhood, which may be irreversible . It also results in decreased physical activity and decreased interaction with the environment, with negative consequences on learning and school achievements . One possible cause of IDA is increased iron requirements as seen during infancy and in young children . The highest prevalence is found among infants born preterm or with low birth weight, who have limited store, and among children between 6 and 24 months of age when the iron store they are born with have depleted ,. Another cause is iron loss due to intestinal parasites, although some have shown that the majority of parasitic diseases have secondary importance in the etiology of IDA in children under 6 years of age ,.
Several studies proved that children younger than 6 years living in densely populated and poor areas have greater health problems ,. The nutritional status of slum children is the worst among all urban groups and is even poorer than the rural average . Globally, nearly one billion people live in slums, and this number is projected to double to two billion in the next 30 years. The United Nations Center of Human Settlements (UNCHS/UN-HABITAT) defines a slum as an urban area with a lack of basic services (sanitation, potable water, electricity), substandard housing, overcrowding, unhealthy and hazardous locations, insecure tenure, and social exclusion . Sub-Saharan Africa has the highest proportion (71.8%) of urban dwellers living in slums . According to the Egyptian Ministry of Local Development (2001), as many as 1105 squatter and informal settlements exist in Egypt, housing a total of 15.7 million inhabitants (23% of Egypt's population). Almost 30% of such areas are located in Greater Cairo, at a density exceeding 2000 persons per hectare .
| Participants and Methods|| |
The study was conducted in an unserved slum area in the east district of Alexandria governorate between November 2013 and October 2014. All participants gave written informed consent before inclusion. The consent form was developed according to the international ethical guidelines for biomedical research involving human subjects, as prepared by the Council for Health International Organizations of Medical Sciences in collaboration with the WHO (2002) .
From 82 families having children aged 2–6 years, only 61 mothers agreed to be included with their children in the study, making up a total of 90 children.
Data collection methods
The study was divided into three phases:
- First phase (preintervention phase)
- Second phase (intervention phase)
- Third phase (postintervention phase).
A predesigned structured interview questionnairewas administered to study the 90 children from the 61 mothers. Exclusion criteria included the presence of any chronic illness (e.g., renal, cardiac, liver, diabetes mellitus, etc.) and history of treatment for anemia within the 3 months preceding the study.
Participants were interviewed by means of the questionnaire and the following data were collected from the mothers: personal data, social data, knowledge, attitude, and practices of mothers regarding anemia.
The questionnaire was prepared and validated by the researchers and was pilot-tested on 10 mothers. Modifications were made according to the results obtained.
In addition, anthropometric assessment [weight (kg) and height and mid-arm circumference (cm)] and clinical examination (general and laboratory investigations including complete blood count, urine, and stool analysis) were carried out at the service center of a nongovernmental organization, which housed a medical clinic, children's nursery, and Trico workshop.
On the basis of the results of the interview questionnaire, clinical examination, and the preintervention laboratory investigations, the intervention program was designed with the following objectives:
Treatment of parasitic infestation (if present) after identifying the causative parasite.
Iron supplementation at a therapeutic dose of 4–6 mg/kg/day for 4 months for anemic children and at a preventive dose of 2 mg/kg/day for high-risk (24–30 months) nonanemic children.
A health education program was directed at mothers to improve their knowledge and promote their compliance with anemia preventive and curative behaviors.
The postintervention tests were carried out 4 months after the beginning of the intervention program: Its components involved the following:
- Complete blood count for the studied group
- Urine and stool analysis for the studied group
- Knowledge, attitude, and practices of mothers towards sound nutrition combating IDA.
Data were collected, tabulated, and statistically analyzed by an IBM compatible personal computer with SPSS statistical package (SPSS Inc., Chicago, IL, USA), version 20.
Two types of statistics were analyzed:
- Descriptive statistics in the form of n (%) for qualitative data, and mean (X–) and SD for quantitative data.
- Analytic statistics:
- Student's t-test is a test used for comparison between groups having quantitative variables
- The χ2 is used to study the association between two qualitative variables
- Z-test is a significance test for testing proportions.
P-values greater than 0.05 were considered statistically insignificant. P values less than and equal to 0.05 were considered statistically significant. P values less than and equal to 0.001 were considered statistically highly significant.
| Results|| |
The mean value of mother's age, mother's education, socioeconomic standard, and family size were significantly different between healthy and anemic children (P < 0.05) [Table 1].
Regarding the number and percentage distribution of the chosen preschool children according to parasitic infestation (n = 90), 44.3% of the study population was suffering from parasitic infestations. Among them, stool analysis revealed that 53.8% were infested with ascaris, 20.6% were infested with enterobius vermicularis, 15.4% were infested with giardia, and 10.2% were infested with ancylostoma duodenal. Less than one-half (41.2%) of the infested children were suffering from multiple infestation. The response of parasitic infestation to treatment was 74.2% [Table 2] and [Figure 1).
|Table 2 Distribution of chosen preschool children according to parasitic infestation (n=90)a|
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|Figure 1: Number and percentage distribution of the chosen preschool children according to type of parasitic infestation.|
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The mean value of parasitic infestations was significantly higher by 3.65 times in anemic children compared with healthy children (P < 0.05) [Table 3].
|Table 3 Comparison between healthy and anemic children according to parasitic infection|
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Regarding the studied parameters between healthy and anemic children according to anthropometric measurement and hemoglobin% there was a nonsignificant increase in BMI between healthy and anemic children (P > 0.05) but there was a significant difference in weight and height between healthy and anemic children in this study [Table 4].
|Table 4 Anthropometric measurement and hemoglobin% among healthy and anemic children|
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There was a significant difference between pretest and post-test results with respect to mother's knowledge of, attitude towards, and practices undertaken in anemic children (P < 0.001) [Table 5],[Table 6],[Table 7].
|Table 5 Pretest and post-test results for mother's knowledge about anemia|
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|Table 6 Pretest and post-test results for mother's practices in relation to anemic childrena|
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|Table 7 Pretest and post-test results for mother's practices in all children*|
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There was a significant difference in pretest practices among mothers with anemic children and those with healthy ones [Table 8].
| Discussion|| |
In this study more than one-half (52.2%) of the children younger than 6 years were anemic.
These results are in agreement with those of Beard , who showed that the prevalence of anemia among preschool children was 53.9% in Ethiopia (2005) and 50.4% in Nepal (2006).
In this study prevalence of IDA was higher in girls than in boys but did not reach significance.
These results are in agreement with those of Abdel-Rasoul et al.  and Mohamed et al. , who showed that there were no sex-related differences in anemia.
In this study illiteracy and low educational level of the mother was found to be a highly significant risk factor for IDA.
These results are in agreement with those of Mamdooh  and Mohamed et al. . However Mamdooh  reported no significant difference.
In this study big family size of more than four members increased the risk for IDA.
These results are in agreement with those of Mamdooh , Ahmed and Adnan , and Mohamed et al. .
In this study the prevalence of anemia among infected children was higher than that among noninfected children.
These results are in agreement with those of USAID  and Walker et al. , who reported that high prevalence of intestinal parasitic infestation was associated with anemia.
In this study there was a nonsignificant increase in BMI among healthy and anemic children.
These results are in agreement with those of Mamdooh  and Mohamed et al. .
In this study there was a significant difference in pretest practices among mothers with anemic children and those with healthy children.
These results are in agreement with those of El-Nmer et al. , who reported that there was a significant correlation between nutritional practice of parents and healthy food intake of their children.
| Conclusion|| |
- Prevalence of IDA among preschool children was 52.2%
- Prevalence of IDA was higher in girls than in boys but did not reach a significant level
- Low socioeconomic standard, illiteracy, and low educational level of mothers and fathers significantly increased the risk for IDA
- Infected children with intestinal parasitic infestation significantly increased the risk for IDA
- Prevalence of IDA was significantly higher among children with low dietary iron intake
- The post-test situation of the current program revealed considerable improvement in the nutritional knowledge, attitudes, and practices of the mothers.
To all the workers and the participants who generously agreed to participate, and the administrator of the service center of the nongovernmental organization (NGO).
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
International Nutritional Anemia Consultative Group (INACG). Anemia, iron deficiency, and iron deficiency anemia. A report of the International Nutritional Anemia Consultative Group. Vol. 92. Washington, DC: INACG 2002;147–211.
World Health Organization. Battling iron deficiency anemia: the challenge
. Geneva: WHO; 2003. Available at: http://www.who.int/nut/ida.html
. [Last accessed date 2015 Feb 09].
WHO/Center for Disease Control and Prevention (CDC). Worldwide prevalence of anemia 1993–2005: WHO global database on anemia
. Vol. 61
. Geneva: WHO; 2008. 37–39.
El-Zanaty F, Way A. Malnutrition and anemia. In: El-Ghazaly NA, editor.Egypt demographic and health survey 2005 (EDHS-2005)
. Vol. 223. Calverton, NY: Ministry of Health and Population (Egypt), National Population Council and ORC Marco; 2006. 90–93.
Grantham-McGregor S, Ani C. A review of studies on the effect of iron deficiency on cognitive development in children. J Nutr 2001; 131:649S–666SS.
Schauer C, Zlotkin S. Home fortification with micronutrient sprinkles- a new approach for the prevention and treatment of nutritional anemias. Paediatr Child Health 2003; 153:48–53.
Zetterström R. Iron deficiency and iron deficiency anemia during infancy and childhood. Acta Paediatr 2004; 235:78–81.
Soh P, Ferguson E, McKenzie J, Homs M, Gibson R. Iron deficiency and risk factors for lower iron stores in 6-24-month-old New Zealanders. Eur J Clin Nutr 2004; 23:42–46.
Duque X, Flores-Hernández S, Flores-Huerta S, Méndez-Ramírez I, Muñoz S, Turnbull B, et al
. 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. BMC Public Health 2007; 254:66–67.
Al-Zain B. Impact of socioeconomic conditions and parasitic infection on hemoglobin level among children in Um-Unnasser Village, Gaza Strip. Turk J Med Sci 2009; 155:36–39.
WHO/WFP/UNICEF. Preventing and controlling micronutrient deficiencies in populations affected by an emergency
. Vol. 365. Geneva: WHO; 2007. 48–50.
Winocur D, Ceriani J, Imach E, Otasso J, Morales P, Gards A, et al
. Prevalence of iron deficiency anemia in a group of pre-school and school children, living in conditions of poverty. Medicina (B Aires) 2004; 356:123–126.
Hadler M, Colugnati F, Sigulem D. Risks of anemia in infants according to dietary iron density and weight gain rate. Prev Med 2004; 254:96–97.
Oliveira M, Osório M, Raposo M. Socioeconomic and dietary risk factors for anemia in children aged 6 to 59 months. J Pediatr (Rio J) 2007; 421:57–60.
Ghosh S, Shah D. Nutritional problems in urban slum children. Indian Pediatr 2004; 365:57–59.
United Nations Human Settlements Programme (UN-HABITAT). The challenge of slums. Global report on human settlements; 2003. Available at: http://www.unhabitat.org/pmss/get
. [Last accessed on 2015 Mar 21].
Beard J. Why iron deficiency is important in infant development. J Nutr 2008; 265:47–51.
Abdel-Rasoul GM, Al- Bahnasy RD, El-Shazly HM, Gabr HM, Abdel-Aaty NB. Epidemiology of iron deficiency anemia among primary school children (6–11 years), [MSc Thesis]. Public Health and Community Medicine Department, Menoufia Faculty of Medicine; 2014. pp. 68–73.
Mohamed E, Ahmed O, Youssef A. Iron deficiency and anemia in rural school children in a Coastal Area of Morocco. Pak J Nutr 2008; 7:400-403.
Mamdooh A. Prevalence of iron deficiency anemia among female elementary school children in Northern Jeddah, Saudi Arabia. Med Sci 2008; 165:43–45.
Ahmed S, Adnan A. Anemia among school children aged 6–11 years old in Gaza Strip, Palestine. Alqu Med 2011; 265:60–63.
USAID (Asia and Near East Bureau Office). Health of children living in urban slums in Asia and the near East USAID. Vol. 286. USAID 2002:pp. 49–52.
Walker S, Wachs T, Gardner J, Lozoff B, Wasserman G, Pollitt E, et al
. Child development: risk factors for adverse outcomes in developing countries. Lancet 2007; 263:55–57.
El-Nmer F, Salamab A, Elhawaryc D. Nutritional knowledge, attitude, and practice of parents and its impact on growth of their children, MSC, Thesis, pediatric Medicine dep. Menouf Faculty Med 2014; 166:45–47.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]