Iron Defieciency Anaemia-DAMBAR
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Transcript of Iron Defieciency Anaemia-DAMBAR
8/3/2019 Iron Defieciency Anaemia-DAMBAR
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IRON DEFICIENCY ANAEMIA:
PROBLEM, CAUSE AND SOLUTION
By Dambar B. Khadka
EM Food science, Technology and Nutrition, KaHo sint- Lieven
Gent, Belgium
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INTRODUCTION
Anaemia affects one-quarter of the world
population (Mclean, 2008)
Anaemia is defined as decrease in
concentration of circulating red blood cell (RBC)
or in haemoglobin concentration and related to
impaired capacity to transport oxygen (WHO
2004)
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IRON DEFICIENCY ANAEMIA (IDA)
One of the major factor associated with the
global burden disease (WHO 2004)
Is a most prevalence Micronutrient deficiency
Major contributor for anaemia
Mostly deals with Iron deficient
Other contribution factor for anaemia: VitaminA, Vitamin B12 and Folic Acid deficiency
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WHO CUT OFF VALUE FOR IRON DEFICIENCY
Iron store directly related to the haemoglobin and
Haematocrit concentration
Population
category Threshold
Haemoglobin
concentration Haematocrit
concentration Children 0.50 – 4.99
years 110 g/l 6.83 mmol/l
Pregnant Women 110 g/l 6.83 mmol/l Children 5-11.99 years 115 g/l 7.13 mmol/l Children 12-15 years 120 g/l 7.45 mmol/l Non Pregnant Women
>15 years 120 g/l 7.45 mmol/l
Men >15 years 130 g/l 8.07 mmol/l Source : WHO (2001)
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RECOMMENDED IRON INTAKE
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PREVALENCE IRON DEFICIENCY ANEMIA
Source: WHO 2004 update databaase
World wide 1.2 billion people is affected by IDA (WHO
Estimate 2004)
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PREVALENCE OF ANAEMIA ( POPULATION SUB
GROUP)
Source: WHO 2008
Anaemia is commonly take as a indicator for
iron deficiency anaemia (WHO 2002)
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PREVALENCE OF ANAEMIA
NEPAL
v
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DISTRIBUTION AND STORAGE OF IRON
Hemoglobin
70%
Myoglobin
10%
Ferritin andHaemosiderin
17%
essential for transfer
oxygen via blood stream
from the lungs to tissue
Transport and stores
oxygen for use in muscle
contraction
Major iron storage compound mainly
located in liver, reticuloendothelial cells
and erthroid precursor
Iron containing enzyme & Transport iron 3% Cytochrome C – ETC and ATP production
Cytochrome P450- oxidative degradation
of foreign compound and endogenous
substrate
Other iron containing Enzymes
and iron dependent enzymes
Source: Dallman1986
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IRON ABSORPTION AND REGULATION IN
BODY
Source: steele et al 2005
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PROBLEMS ASSOCIATED WITH IDA
Reducing Working productivity
Reducing Cognitive, Intellectual capacity and
Behaviour
Reduce Immune system and resistant to
infection
Premature birth and low birth weight
Mortality in children and women
Others
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PROBLEM ASSOCIATED WITH IDA
decrease the fitness and aerobic working
capacity (Beard 2001) reduced oxygen transport and respiratory
efficiency (ATP Formation)
normally accepted problems of IDA (Dallman1986).
Work productivity and performance
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PROBLEMS ASSOCIATED
WITH IDA
In infants a lower PDI and MDI on short term
and long term observation
But no Improvement in most cases of
intervention trials in both short term andLong Term
Preschool and Adolescent
Improvement in most of
intervention Trials
Cognitive
and
Behaviour
loss
•Good association but still need to verify
• Iron deficiency decrease energy , O2
supply, can impaired myelination in CNS
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PROBLEM ASSOCIATED WITH IDA
Impaired cell mediated immune responses
-decreasing the capacity of netrophills
- impairment in T cell proliferation
No improvement on iron supplementation
-influence may be due to excess iron or
Multiple factors
Plausible evidence is not sufficient
Immune response and Resistance to pathogen
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PROBLEMS ASSOCIATED WITH IDA
Risk factor for preterm delivery and low birth
weight and possibility to affects the neonatal
health
- e g.Women having Hb< 104g/l at 13-24 week of
gestation had a 1.18-1.75 times higher risk or preterm
birth and low birth weight ( Murphy et al., 1986)
Pregnancy Outcome
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PROBLEM ASSOCIATED WITH IDA
CFR in children higher (<50g/l) than children (>50g/L) for aspecific cases
CFR ranges 2-29%
No dose specific Hb and CFR Might be influence of other factor.(Brabin et al 2001a)
Child and Maternal Mortality
Brabin et al. 2001a & b ,
Maternal mortality, with 5% severe anaemia (Haemoglobin<70g/l), Estimated death
9 per 100,000 live birth due to severe-malarial-anaemia
41 due to non-malarial (mostly nutritional) anaemia relateddeath per 100,000 live birth.
(Brabin et al 2001b)
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PROBLEM ASSOCIATED WITH IDA
Most of the studies related with malarialanaemia and mortality
Most of data from developing country, malariaendemic area
Subjects are from hospital cases, containmore than one health problems
no clear relationship between IDA andmortality.
Limited on Iron Interventional trials
No solid conclusion up to now
Child and Maternal Mortality
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WHO ESTMATED DEATH,2004
WHO Region Male Death per 100000
0-4 yr 5-14 yr Total
AFR 8.9 0.7 3.1
AMR 1.2 0.3 1.4EMR 6.5 0.3 1.4
EUR 1.8 0.1 0.7
SEAR 0.5 0.0 0.7
WPR 1.2 0.1 0.4YLL 836 641 207 960 2 274 179
WHO Region Female Death per 100000
0-4 yr 5-14 yr 15-29 yr 30-44 yr 45-59 yr Total
AFR 7.9 1.2 2.7 2.3 6.3 4.4
AMR 1.0 0.3 0.3 0.4 1.2 1.7
EMR 6.6 0.6 0.3 0.6 2.1 1.8
EUR 1.3 0.1 0.2 0.4 0.3 1.0
SEAR 0.6 0.2 0.8 3.9 9.1 3.0
WPR 1.3 0.1 0.1 0.4 0.5 0.7
YLL 777 073 267 182 381 939 621 482 1 102 982
3 578
453
Overall
Total
3.7
1.5
1.6
0.9
1.8
0.5
5 852 632
10 per
100,000
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PROBLEM ASSOCIATED WITH IDA
Heavy metal Absorption e.g. Lead poisoning
Economy loss for
o Intervention and treatment
o Disability or mortality (YLL AND DALY orQALY)
Others problems
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ETIOLOGY AND CAUSES IDA
Physical factor
Life stage
Iron absorption
Iron loss
Health conditions
Genetics
Socio-cultural and
Demographic factor•Health Education, Family
•Region
•Culture
•Food habit and Taboos
•Poverty
Dietary factor
Low iron
Low vitamin C
Excess phyatate
Excess Tea/Cofee
Calcium rich diet
Fad diets
High
Risk
High
Risk High
Risk
VeryHigh
Risk
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PREVENTION AND CONTROL
Development of Food based Preventive approach and implementation Dietary intervention & management according to RDA
Supplementation and fortification
Integration with local community based health and Nutritionprogram
Education to community worker and community people
In severe risk and complexes situations
Medical intervention
Therapeutic Food
Development of effective Surveillance system
simple and fast tool for assessing and monitoring of
programme and intervention
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CONCLUDING REMARKS
one of the major micro nutrient deficiency Multifactor cause
Major risk group Children and women (menstutrating and pregnant)
affect working productivity and perforformance, growth
can also affect brain and behaviour development, pregnancy outcomes and
neonatal health Possibility of major cause of the anaemic mortality in children and maternal
woman
Food based approach along with integration of community programmeessential
Effective surveillance and monitoring needed Further research for true assessment of IDA and its impacts; with citing the
all the possible factor – helpful for strategy and intervention development
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Question?
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