Jalal Ud Din  ( Department of Zoology, Islamia College Peshawar )
Ali Muhammad Yousafzai  ( Department of Zoology, Islamia College Peshawar )
Rahmat Ali Khan  ( Department of Biotechnology, University of Science and Technology Bannu )
Manzoor Ullah  ( Department of Botany, University of Science and Technology Bannu )
Saad Ullah Khan  ( Department of Botany, University of Science and Technology Bannu )
Samiullah Khan  ( Department of Biotechnology, University of Science and Technology Bannu )
Razi Ullah  ( Institute of Chemical Sciences Gomal University, Dera Ismail Khan, KPK, Pakistan )

In the current study the occurrence and severity of iron deficiency anemia (IDA) was recorded from September, 2014 to April, 2015 in children of school age in District Tank. Random sampling of blood and questionnaires were planned to record general information while blood was analyzed through automatic haematological analyzer model Sysmex Kx- 21 Stromatolyser- WH, Cell Pack (Merck). Total prevalence of anaemia in school age children was 37.1% with 63.8% in boys and 64.3% in girls.

Keywords: Iron deficiency anemia, School going children, District Tank. doi:10.5455/JPMA.266926

Introduction

Across the entire world iron deficiency anaemia is an important dietary disorder.1,2 Anaemia occurs due to insufficient iron ingestion, decreased absorption of iron, amplified iron requirement, and increased loss of iron out of the body.3 Anaemia leads to dysfunction of immune, cognitive and motor systems. 4-7 Out of all types of anaemia about half are due to the deficiency of iron worldwide and women are most affected than male individuals.8 It is estimated that the proportion of anaemia in non-pregnant and pregnant women is 50% while 42% in children globally. According to a WHO report about 46% children in the world are anaemic, while the greatest percentage is present in less developed countries. The incidents may increase with time due to malnutrition and instability in various parts of the world. Iron-deficiency anaemia can lead to reduced muscle function and work capacity 9,10 and less explorative behaviour in school-aged children. 11 Iron deficiency or iron-deficiency anaemia is also consistently associated with impaired cognitive function and lower school performance in school- aged children.12,13 In rural areas of Pakistan most of the children are suffering from malnutrition that usually results in serious health disorders. The present study was conducted in district Tank with the aim to check the incidences of Iron deficiency anaemia in school age children.

Methodology

The current study was accomplished in Tank, the southern District of Khyber Pakhtunkhwa province of Pakistan, extended over 1,679 km2 areas with an altitude of 265 meters (869 feet). There are three clusters (a subgroup of population)i.e. Cluster Mullazai, Garwakai and Tank city and sixteen union councils in the district. Random sampling was used where blood samples were collected randomly from school age children having different ages, gender, food habits and socio-economic conditions. Survey was carried out to collect relevant data about children. Samples size or number of individuals selected from each cluster randomly was calculated using formula

(n = N/ 1+ Ne2), where n = sample size, N = population and e represents confidence level.

Questionnaires were set to collect data about age, black tea intake, gender, education, and social classes based on monthly income 14, use of unfortified cow milk, vitamin supplementation drugs and dietary intake. The principle author validated the Pashto version of questionnaire by involving two independent bilingual translators who performed forward and back translation and expert committee at Mission hospital Tank produced the final version of the translation. Samples were carried to the haematology department of District Headquarter Hospital Dera Ismail Khan during September 2015. For this analysis the automatic haematological analyzer model Sysmex Kx- 21 Stromatolyser- WH, Cell Pack (Merck) made in Germany, was used.

Data Analysis

After collecting information from the selected sites of the study area through questionnaires, and the completion of laboratory tests, the Statistical analysis of data was carried out through software known as SPSS (software Package for the Social Sciences).

Results

A total of 318 children of school age with between ages 5-12 years, both genders were questioned and examined clinically in the entire District of Tank. From cluster, Mullazai 67 girls and 39 boys, from cluster Garwakai 66 girls and 40 boys and Tank city 70 girls and 36 boys were observed for the presence of anaemia. The anaemia occurrence in school children of cluster Tank city was (31.1%) while in cluster Garwakai & cluster Mullazaiit was (34.0%) and (46.2%) respectively. Haemoglobin value in three clusters was; Tank city 31.3% girls and 30.8% boys, Garwakai 39.4% girls and 25.0% boys and highest in cluster Mullazai 47.1% girls and 44.4% boys were anaemic.













Data analysis shows that the sum fraction of anaemia was 39.4% in female and 33.0% in male children. The percentage of anaemia was higher (42.6%) in age group of 10-12 years than the other two age groups (33.6%) and (35%) of 5-8 years and 8-10 years respectively. Clinical symptoms and signs data show that 47.5% out of total anaemic children were pale; weakness was in 33.9% and fatigue in 18.6% children and pale conjunctiva was detected in 4.2% children. The occurrence of anaemia was high (38.4%) in the children of lower class followed by 36.1% anaemic children belonging to middle and 36% belonging to upper class parents. The anaemic percentage was 82.2% of mild anaemic children, while that of moderate and severe anaemia in children was 14.4% and 3.4% respectively.

Discussion

It is estimated that 25% of the world population is affected by iron deficiency. The age groups most affected are infants between 4 and 24 months, school age children, female adolescents, pregnant women and nursing mothers. The current study showed the prevalence of Iron Deficiency anaemia in children between ages of 5 and 12 years, of both genders, living in District Tank was 37.1%. The reason was a high dietary requirement for this growth period. A study by Ullah I, et.al. 15  carried out in District Karak, found the prevalence of IDA to be 34.0%. However the National Health Survey of Pakistan (1990-1994). 16  showed dietary anaemia in children under five years of age was 62.9%. The urban school children of Punjab province showed a figure of 51.5% for IDA. The frequency of anaemia was higher in girls (39.4%) compared to boys (30.0%). The reason was that the mothers preferred to give more nutritious food to the boys than the girls. Karak district yielded comparable results with 39.4% girls having iron deficiency anaemia compared to 31.0% boys, both of school going age. These results are however comparable to results of the study by Ullah I. et.al. 15  showing IDA in girls being 38,9% and in boys 31.0%. The study done in Dera Ismail Khan in 2009 had results of 70% in girls and 58.8% in boys. 17  Researchers in Iran and Yemen have reported similar results with girls of school age to have a higher prevalence of IDA compared to boys.18,19 .Similar results were obtained from Karak district (40%), Pakistan. In Rishikesh, area of Uttrakhand state, India, the prevalence of anaemia was (48%) at age 9-12 years and (15.5%) in 5-8 years children.20 It was also observed that anaemia in low income class (38.4%) was comparable to that of district Karak, Pakistan (55.8%).15 In Rishikesh area of the Uttrakhand state of India the proportion of anaemic children was (65.2%) with (90.90%) of lower socio-economic group, while 37.5% in upper and middle class.20 Although at field level, estimation of haemoglobin is the only method available for diagnosis of anaemia, besides clinical assessment. However other methods viz; serum ferritin estimation, transferrin saturation and Erythrocyte Protoporphyrin are used but due to financial limitations common people of society have no access.

Conclusion and Recommendations

It is concluded that in rural areas of district Tank most of the school age children are suffering from iron deficiency anaemia. This indicates that nutritional problems are increasing in the rural area of Pakistan with rapid population growth and socio-economic problems. The following four strategic means should be adopted for prevention of iron deficiency anaemia: nutritional education and improvement of diet quality, including breast-feeding, medicine supplementation, food fortification and control of infections.

Disclaimer: None
Conflict of Interest: None
Funding Sources: None

References

1. World Health Organization. Iron deficiency anaemia: assessment, prevention and control: a guide for programme managers, 2001.
2. Johnson-Wimbley TD, Graham DY. Diagnosis and management of iron deficiency anemia in the 21st century. Therap Adv Gastroenterol. 2011; 4:177-84.
3. World Health Organization. Weekly Iron-Folic Acid Supplementation (WIFS) in women of reproductive age: its role in promoting optimal maternal and child health, 2009.
4. Bazmamoun H, Razavi Z, H Esfahani A. Evaluation of Iron deficiency anemia and BMI in children suffering from Helicobacter pylori infection. Iran J Ped Hematol Oncol. 2014; 4:167–71.
5. Idjradinata P, Pollitt E. Reversal of developmental delays in irondeficient anaemic infants treated with iron. Lancet. 1993; 341:1-4.
6. Hurtado EK, Claussen AH, Scott KG. Early childhood anemia and mild or moderate mental retardation. Am J Clin Nutr. 1999; X69:115-9.
7. Muhsen K, Ornoy A, Akawi A, Alpert G, Cohen D. An association between Helicobacter pylori infection and cognitive function in children at early school age: a community-based study. BMC Pediatr. 2011; 11:43.
8. Stoltzfus R, Mullany L, Black R. Iron deficiency anaemia. Comparative quantification of health risks: the global and regional burden of disease due to 25 selected major risk factors. World Health Organization/Harvard University Press sulfadoxinepyrimethamine treatment in pregnancy on parasite clearance and risk of low birthweight in rural Malawi. Ann Trop Med Parasitol. 2004;92:141-50.
9. Haas JD, Brownlie T. Iron deficiency and reduced work capacity: a critical review of the research to determine a causal relationship. J Nutr. 2001; 131:676S-88S.
10. Sharp P, Geissler C, Powers H. Minerals and trace elements. In: Sharp P, Geissler C, Powers H, eds. Human Nutrition 11th ed. London: Elsevier Limited, 2005; pp-240.
11. Zimmermann M, Adou P, Torresani T, Zeder C, Hurrell R. Persistence of goiter despite oral iodine supplementation in goitrous children with iron deficiency anemia in Cote d'Ivoire. Am J Clin Nutr. 2000; 71:88-93.
12. 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-68S.
13. Halterman JS, Kaczorowski JM, Aligne CA, Auinger P, Szilagyi PG.Iron deficiency and cognitive achievement among school-aged children and adolescents in the United States. Pediatrics. 2001; 107:1381-6.
14. Pakistan Social and Living Standards Measurement Survey (2012- 13) Pakistan Bureau of Statistics Islamabad. [Online] [Cited 2014 April 14]. Available from: URL: http://www.pbs.gov.pk.
15. Ullah I, Zahid M, Sthanadar AA, Sthanadar IA, Ali PA, Khan MI, et al. Iron Deficiency Anemia in School Age Children in District Karak Khyber Pakhtunkhwa Province, Pakistan. Open J Blood Dis. 2014;4:9.
16. Pakistan Medical Research Council. National Health Survey of Pakistan (NHSP) 1990-94. [Online] 1998 [Cited 2019 July 01]. Available from URL httpswww.aiou.edu.pkfoodsiteNational%20Health%20Survey%20of%20Pakistan%201990%201994.doc
17. Ramzan M, Ali I, Salam A. Iron deficiency anemia in school children of Dera Ismail Khan, Pakistan. Pak J Nutr. 2009; 8:259-63.
18. Keikhaei B, Zandian K, Ghasemi A, Tabibi R. Iron-deficiency anemia among children in southwest Iran. Food Nutr Bull. 2007; 28:406-11.
19. Al-Zabedi EM, Kaid FA, Sady H, Al-Adhroey AH, Amran AA, Al- Maktari MT. Prevalence and risk factors of iron deficiency anemia among children in Yemen. Am J Health Res. 2014; 2:319-26. 20. Jain N, Jain VM. Prevalence of anemia in school children. Med Pract Rev. 2012; 3:1-4.