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CC BY-NC-ND 4.0 · Avicenna J Med 2018; 8(03): 92-103
DOI: 10.4103/ajm.AJM_169_17
ORIGINAL ARTICLE

Prevalence, diagnosis, and management of iron deficiency and iron deficiency anemia among Syrian children in a major outpatient center in Damascus, Syria

Issam N Albaroudi
Program of Clinical and Hospital Pharmacy, Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, Damascus University, Damascus, Syria
,
Majed Khodder
Department of Hematology, Children's Hospital; Department of Pediatrics, Faculty of Medicine, Damascus University, Damascus, Syria
,
Tareq Al Saadi
Department of Internal Medicine, Damascus University, Damascus, Syria
,
Tarek Turk
Department of Internal Medicine, Damascus University, Damascus, Syria
,
Lama A Youssef
Program of Clinical and Hospital Pharmacy, Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, Damascus University, Damascus, Syria
› Author Affiliations Financial support and sponsorship The study was entirely supported by the Faculty of Pharmacy, Damascus University, Damascus, Syria.
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Abstract

Background: Given the public health significance of anemia, the long-term sequelae of iron deficiency anemia (IDA) on children, the expected effect of war on the trends of anemia in Syrian society, and the lack of assessment on the national burden of anemia and/or iron deficiency (ID) data, there is a vital need to investigate all-cause anemia, ID, and IDA in Syria during the crisis. Objective: To investigate the prevalence of ID and IDA in Syrian children, the effectiveness of oral iron supplements in the management of ID, and the diagnostic effectiveness of conventional iron markers. Methods: We conducted a retrospective study on hemoglobin (Hb) levels in 4-month-old to 14-year-old children and a prospective study on hematological (complete blood count, reticulocytes, and reticulocyte Hb content) and biochemical iron indices (serum ferritin, iron, and total iron-binding capacity) of infants visiting the primary care clinic at Children's Hospital in Damascus, Syria. Results: Of the 1128 children in the retrospective study, 648 children (57%) were found to be anemic, with 417 (37%) moderately-severely anemic. The prevalence of ID and IDA in the 135 children of the prospective study was 71.85% and 55.55%, respectively. Infants with ID who underwent a 4–8-week course of oral iron supplementation demonstrated good responsiveness. Except mean corpuscular hemoglobin (MCH), conventional iron markers (i.e., ferritin) routinely used to assess iron status proved unreliable. Conclusion: This study reveals a high prevalence of anemia, ID, and IDA among a group of apparently healthy Syrian children. Our findings necessitate a framework of urgent public health interventions that can address two major limitations; the poor follow-up by the parents and unreliability of the conventional iron diagnostic markers. MCH may represent a simple and cheap ID screening index in children.

Keywords

Anemia - infants - iron deficiency - Syria - Syrian crisis


Publication History

Article published online:
12 August 2021

© 2018. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Kassebaum NJ, Jasrasaria R, Naghavi M, Wulf SK, Johns N, Lozano R. et al. Asystematic analysis of global anemia burden from 1990 to 2010. Blood 2014; 123: 615-24
    CrossrefPubMedGoogle Scholar
  • 2 McLean E, Cogswell M, Egli I, Wojdyla D. de Benoist B. Worldwide prevalence of anaemia, WHO vitamin and mineral nutrition information system, 1993-2005.. Public Health Nutr 2009; 12: 444-54
    CrossrefPubMedGoogle Scholar
  • 3 De Benoist B, McLean E, Egli I, Cogswell M, Cogswell M. WHO Global Database on Anaemia. Geneva: World Health Organization; 2008.p. 1993-2005.
  • 4 World Health Organization Iron Deficiency Anaemia: Assessment, Prevention and Control: A Guide for Programme Managers World Health Organization ; 2001
  • 5 Leung AK, Chan KW. Iron deficiency anemia. Adv Pediatr 2001; 48: 385-408
    PubMedGoogle Scholar
  • 6 Walter T, De Andraca I, Chadud P, Perales CG. Iron deficiency anemia: Adverse effects on infant psychomotor development. Pediatrics 1989; 84: 7-17
    CrossrefPubMedGoogle Scholar
  • 7 DeMaeyer EM, Hallberg L, Gurney JM, Sood S, Dallman P, Srikantia S, et al. Preventing and Controlling Iron Deficiency Anaemia through Primary Health Care: A Guide for Health Administrators and Programme Managers. WHO: Geneva; 1989.
  • 8 Simon-Lopez R. Methods of Determination of Iron Deficiency and Hemochromatosis. Google Patents; 2012.
  • 9 Brugnara C, Zurakowski D, DiCanzio J, Boyd T, Platt O. Reticulocyte hemoglobin content to diagnose iron deficiency in children. JAMA 1999; 281: 2225-30
    CrossrefPubMedGoogle Scholar
  • 10 Yip R, Ramakrishnan U. Experiences and challenges in developing countries. J Nutr 2002;132:827S-30S.
  • 11 Ben Taleb Z, Bahelah R, Fouad FM, Coutts A, Wilcox M, Maziak W, et al. Syria: Health in a country undergoing tragic transition. Int J Public Health 2015;60 Suppl 1:S63-72.
  • 12 Devakumar D, Birch M, Rubenstein LS, Osrin D, Sondorp E, Wells JC, et al. Child health in Syria: Recognising the lasting effects of warfare on health. Confl Health 2015;9:34.
  • 13 Baker RD, Greer FR. Committee on Nutrition American Academy of Pediatrics Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics 2010; 126: 1040-50
    CrossrefPubMedGoogle Scholar
  • 14 World Health Organization Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity World Health Organization ; 2011
  • 15 World Health Organization The Global Prevalence of Anaemia in 2011 World Health Organization ; 2015
  • 16 Chandyo RK, Ulak M, Adhikari RK, Sommerfelt H, Strand TA. Prevalence of iron deficiency and anemia among young children with acute diarrhea in Bhaktapur, Nepal. Healthcare (Basel) 2015; 3: 593-606
    CrossrefPubMedGoogle Scholar
  • 17 Al Hawsawi ZM, Al-Rehali SA, Mahros AM, Al-Sisi AM, Al-Harbi KD, Yousef AM. et al. High prevalence of iron deficiency anemia in infants attending a well-baby clinic in Northwestern Saudi Arabia. Saudi Med J 2015; 36: 1067-70
    CrossrefPubMedGoogle Scholar
  • 18 Heath AL, Tuttle CR, Simons MS, Cleghorn CL, Parnell WR. Longitudinal study of diet and iron deficiency anaemia in infants during the first two years of life. Asia Pac J Clin Nutr 2002; 11: 251-7
    CrossrefPubMedGoogle Scholar
  • 19 Tympa-Psirropoulou E, Vagenas C, Dafni O, Matala A, Skopouli F. Environmental risk factors for iron deficiency anemia in children 12-24 months old in the area of Thessalia in Greece. Hippokratia 2008; 12: 240-50
    PubMedGoogle Scholar
  • 20 Vendt N, Grünberg H, Leedo S, Tillmann V, Talvik T. Prevalence and causes of iron deficiency anemias in infants aged 9 to 12 months in Estonia. Medicina (Kaunas) 2007; 43: 947-52
    CrossrefPubMedGoogle Scholar
  • 21 Zlotkin SH, Ste-Marie M, Kopelman H, Jones A, Adam J. The prevalence of iron depletion and iron-deficiency anaemia in a randomly selected group of infants from four Canadian cities. Nutr Res 1996; 16: 729-33
    CrossrefGoogle Scholar
  • 22 Monajemzadeh SM, Zarkesh MR. Iron deficiency anemia in infants aged 12-15 months in Ahwaz, Iran. Indian J Pathol Microbiol 2009; 52: 182-4
    CrossrefPubMedGoogle Scholar
  • 23 Khan Y, Tisman G. Pica in iron deficiency: A case series J Med Case Rep 2010;4:86.
  • 24 Özdemir N. Iron deficiency anemia from diagnosis to treatment in children. Turk Pediatri Ars 2015; 50: 11-9
    CrossrefPubMedGoogle Scholar
  • 25 Pasricha SR, Flecknoe-Brown SC, Allen KJ, Gibson PR, McMahon LP, Olynyk JK. et al. Diagnosis and management of iron deficiency anaemia: A clinical update. Med J Aust 2010; 193: 525-32
    CrossrefPubMedGoogle Scholar
  • 26 Thurnham DI, McCabe LD, Haldar S, Wieringa FT, Northrop-Clewes CA, McCabe GP. et al. Adjusting plasma ferritin concentrations to remove the effects of subclinical inflammation in the assessment of iron deficiency: A meta-analysis. Am J Clin Nutr 2010; 92: 546-55
    CrossrefPubMedGoogle Scholar
  • 27 Lutter CK. Iron deficiency in young children in low-income countries and new approaches for its prevention. J Nutr 2008; 138: 2523-8
    CrossrefPubMedGoogle Scholar
  • 28 Pasricha SR, Drakesmith H, Black J, Hipgrave D, Biggs BA. Control of iron deficiency anemia in low- and middle-income countries. Blood 2013; 121: 2607-17
    CrossrefPubMedGoogle Scholar