Date Published: April 10, 2018
Author(s): Mirza Sultan Ahmad, Hadia Farooq, Sumaira Noor Maham, Zonaira Qayyum, Abdul Waheed, Waqar Nasir.
The objectives of the study were to ascertain frequency of anemia and iron deficiency among children starting first year of school life and test association with height and weight. One in four children starting first year of school life in five schools of Rabwah, Pakistan, was included. Full blood counts and ferritin levels of the children included in the study were checked. Status of their height and weight was determined according to Z-score charts. Chi-square test was used to test association. Two hundred and ninety-five children with median age of 67 months were included in the study. Out of 295, 240 (81.4%) had normal Hb and 55 (18.6%) had anemia. Ferritin levels were found to be below normal level in 242 (82%) children. There was no significant difference between hemoglobin and ferritin levels of children belonging to different categories of height and weight. Spearman test showed that there was very weak correlation between ferritin and hemoglobin levels (rs = .163). Our conclusions were that iron deficiency without anemia is very frequent among children starting first year of school. Regression models show that ferritin levels cannot be predicted by independent variables like status of height and weight on Z-score charts, age, gender, and anemia.
Iron deficiency is the commonest nutrient deficiency in the world and a major public health risk in both the developing and industrialized countries. It affects more than a billion people of different age groups around the world [1–4]. It is the commonest cause of anemia and is also a common deficiency among nonanemic children, especially among children of resource limited countries. A study by Ekwochi et al. showed that iron deficiency was present in 27.5% of nonanemic children under 5 . Iron is necessary for healthy function and development of brain. There is evidence that its deficiency without anemia causes fatigue. It can affect visual and auditory functioning and is weakly associated with poor cognitive development in children [6–9].
Five schools, belonging to the largest school system of the town, that is, Nazarat Taleem school system, out of a total of 11 schools providing primary level education in Rabwah were selected for this study. One in four children was selected by computer randomization. The children having fever and any sign or symptom of infectious disease or inflammation and the children receiving iron therapy were excluded from the study. Names of all children admitted in prep class (first year of school) were entered in software, and one in four children was selected by computer randomization. Five milliliter of the blood of the selected children was drawn for full blood count and ferritin levels. Full blood count (FBC) was checked by Medonic M 20 analyzer, and ferritin levels were checked by Elisa method (Statfox 200). Name, age in months, sex, hemoglobin levels (Hb), and ferritin levels were entered in a data form and pro forma. SPSS 20 was used for data analysis. For children below 5 years of age hemoglobin (Hb) level of <11.0 was categorized as anemia, and for children > 5 years of age Hb level <11.5 gm/dl was labeled as anemia. For children below 5 years of age ferritin levels below 12 ng/ml were labeled as low ferritin levels and for children above 5 years of age ferritin level <10 ng/ml was defined as low ferritin level. Those with both hemoglobin and ferritin levels below normal were categorized as having iron deficiency anemia. One thousand and eighty students got admitted to prep class (first year of school) of five schools of Nazarat Taleem school system, in Rabwah. One in every four students was selected to be included in the study by computer randomization. One child had sore throat, so he was excluded from the study. Full blood count and ferritin levels of the remaining 295 children were checked. Out of these 295 children 164 (55.6%) were female and 131 (44.6%) were male. Among the continuous variables height had normal distribution. And age, weight, ferritin levels, and hemoglobin levels had nonnormal distribution. Median age was 67 (IQR: 9.0) months. Baseline characteristics and hemoglobin and ferritin levels of males, females, and all subjects included in the study are shown in Table 1. Out of 295, 240 (81.4%) had normal Hb and 55 (18.6%) had anemia. The difference between frequency of anemia among male and female subjects was nonsignificant (p = 0.26). See Table 2. Ferritin level was found to be normal in 49 (16.6%) children and it was found to be below normal level in 246 (83.4%) children. The difference between frequencies of low ferritin levels among male and female subjects was found to be nonsignificant (p = 0.47). See Table 2. Among those with anemia 81.8% had low ferritin levels, and among those with normal hemoglobin levels 83.4% had low ferritin levels. See Table 3. According to WHO Z-score weight for age chart 3 (1%), 238 (80.7%), 36 (12.2%), and 18 (6.1%) children were categorized as obese, having normal weight, underweight, and severely underweight, respectively. According to WHO Z-score height for age chart 2 (0.7%), 260 (88.1%), 26 (8.8%), and 7 (2.4%) children were categorized as tall, having normal height, stunted, and severely stunted, respectively. Iron deficiency anemia and iron deficiency without anemia are common nutritional problems in pediatric age group worldwide. A study by Killip et al. showed that, in Pakistan among children from 6 months to five years of age, 62.3% were anemic (hemoglobin levels <110 g/L), while 33.2% had iron deficiency anemia (defined as having both hemoglobin levels <110 g/L and ferritin levels <12 μg/L). Ferritin deficiency (ferritin levels <12 μg/L) was present in 47.1% cases, and 13.9% had ferritin deficiency without anemia [10, 11]. Low ferritin levels are frequent among children starting first year of school life. Low ferritin levels are equally frequent among children with or without anemia. There is weak correlation between ferritin and hemoglobin levels. Source: http://doi.org/10.1155/2018/8906258