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Nova Explore Publications Nova Journal of Medical and Biological Sciences Vol. 3(1), 2014:1-4 PII: S2292793X1400001-3 www.novaexplore.com

Assessment of Iron Deficiency Anemia in Endogenous Sudanese Children Faroug Bakheit Mohamed Ahmed1, Nagah A.A.Mohamed2

In this a community survey, one hundred twenty four children (56 boys & 68 girls) from rural area in Sudan, mainly Elshagalwa

village in Nile state, were invited to take a part in this study. Aiming to assess blood Iron status and investigate the presence of Iron

deficiency anemia, this study was conducted. The sample was selected on the basis of children age 6-7 years.

The laboratory measurements (mean ± standard deviation) for children in the study sample were Hemoglobin (13.2± 1.3 g/dl), packed

cell volume (40.6±5.7%), mean corpuscular hemoglobin concentration (33.3±2.0 g/dl), serum iron (72.4±28.9µg/dl), and total iron

binding capacity (346.0±8.18 µg/dl,) and transferrin saturation (21.6±1.08 µg/dl).

The study revealed that the mean values of measured parameters fell in the normal range. However, only 7.2% of the study samples

were found suffering from anemia according to World Health Organization [1]. Child sex showed no effect on Iron status among

study population.

Iron deficiency anemia (IDA) is health concern worldwide. It is one most prevalent micronutrient deficiencies particularly in the

developing countries [2, 3].

In the absence of a feasible, noninvasive gold standard, iron deficiency (ID) is best measured by the use of multiple indicators [4].

Anemia is defined as reduction in red blood cells volume or hemoglobin below the range of values occurring in healthy person. The

average of hemoglobin /dl in infants female is 14g/dl and 16g/dl for infant male [5]. Anemia is Heamoglobin concentration <11 g/dl

whereas, iron deficiency is elevated transterrin >4.7 nmol/L[3]). Low serum ferritin, a low serum iron level, an elevated serum

transferrin and a high total iron binding capacity. A low serum ferritin is the most sensitive lab test for iron deficiency anemia [6].

Clinical symptoms and signs of iron-deficiency anemia include anxiety, irritability or a low feeling, constipation, sleepiness/

Hypersomnia, palpitations, hair loss, feeling faint, depression, breathlessness, twitching muscles, pale yellow skin [7]

The main predictors for Hemoglobin concentration are plasma concentrations of transferrin, folate, vitamin B12, in addition to length-

for-age Z score and family income [3]. Loss of blood from circulation (external or internal hemorrhage), increased destruction of red

blood cell (heamolysis) and reduction production of erythrocyte and hemoglobin (dys hemopoiesis) [8].

Anemia is sometimes treatable, but certain types of anemia may be lifelong. If the cause is dietary iron deficiency, eating more iron-

rich foods, or taking iron supplements, will usually correct the anemia. Alternatively, intravenous iron can be administered [9].The

impact of oral iron supplementation for three months noted in children with Iron deficiency anemia [2].

There is lack of information regarding iron deficiency anemia among endogenous Sudanese children who depend upon traditional

food as main source for dietary Iron. So this study aims to assess the nutritional status reflected in presence of Iron deficiency anemia

in Sudanese children in their first– year basic school, by determining blood heamoglobin(Hb),heamatocrit(PCV)and mean corpscular

hemoglobin concentration(MCHC), serum iron, total iron binding capcity, transferrin saturation. In addition, to detect of some related

clinical signs that could present.

Elshagalwa is small village lies in Nile state two hundred kilometer North Khartoum the capital city. It is agricultural district with dry

hot weather all year around, rainy months expand from June to September. Elshagalwa is rural community occupied with less than two

thousand people, who depend on some agricultural products.

One hundred twenty four children (56 boys: 68 girls) aged 6-7 years, from Elshagalwa basic school Nile state –Sudan, were invited to

take part in this cross sectional community based study. All participants lived whole their live in this rural area.

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Those who lived whole their life in the rural area and their dietary habit completely depend upon traditional food recipes.

Those under medical treatment, has body weight fluctuation more than three kilos three months prior the study and those who live

with single parent were excluded.

An informed consent, aims and benefits of this study were explained to the participants. Authors declare that there is no conflict of

interest.

Four ml of blood was collected from each child participated in this study. Then each specimen of blood was divided into two, whole

blood was collected in EDTA container for estimation of Hemoglobin (Hb) (Gowenlock) by using cyanomethaemoglobin method and

spectrophotometer. While, packed cell volume (PCV) concentration or red blood cells was measured in a given blood sample and

expressed as the volume of erythrocyte. Anticoangulated blood is placed in a glass capillary, centrifuged in a microhaematocrit

centrifuge at RCF12000- 15000g for 5 minutes. The PCV value is read from the scale of microhaematocrit reader.

Mean corpuscular haemoglobin concentration (MCHC)

Was calculated with the formula

MCHC g/dl = Hb / PCV X100

Serum separated by centrifuging blood for 10 minutes at 3000RPM.Then,decanted into 5ml plain plastic tube, labeled with date,

name, time of collection, identification number of the volunteer participating in this study and stored frozen at –4Cfor biochemical

analysis of Serum iron and Total iron binding capacity (TIBC).

Serum Iron and Iron binding capacity (TIBC) was estimated under the guidance of (Biosystem, Spain, 2001) company instruction.

Spectrophotometer absorbance was read at560 nm.

For quality assurance some samples were duplicated.Data collection was conducted during January-March 2014.

The data was analyzed by using Statistical Package for Social Sciences (SPSS), Windows version16, 2012 SPSS, Inc, Chicago, IL,

and USA. Percentage in addition to mean and standard deviation were calculated.

Results

Table1: Base line characteristic for study population

Anthropometric

measurements

Males(N=56) Females(N=68)

˂ 5th 5th 10th 50th 90th ˂ 5th 5th 10th 50th 90th

Weight (kg) 3 5 15 25 8 2 5 19 34 8

Height (cm) 2 8 12 24 10 1 5 17 37 8

The hematological measurements (Mean ± standard deviation) for children in the study sample were Heamoglobin (13.2± 1.3 g/dl),

packed cell volume (40.6±5.7%), mean corpuscular heamogobin concentration (33.3±2.0 g/dl), serum iron (72.4±2.89µg/dl), total iron

binding capacity (346.0±8.18 µg/dl,) and transferrin saturation (21.6±1.08 µg/dl).(Tables2,3)

Table 2: Blood Hemoglobin, Heamatocrit and Mean cell hemoglobin concentration Mean±standard deviation

Standard deviation Mean Biochemical Parameter

1.30 13.2 Heamoglobin (g/dl)

5.70 40.6 Heamatocrit (%)

2.00 33.3 MCHC (g/dl)

Table 3: Serum iron, total iron binding capacity and transferrin saturation Mean±standard deviation of

Standard deviation Mean Biochemical Parameter

2.89 72.4 Serum iron (µg/dl)

8.18 346.0 Total iron binding capacity (µg/dl)

1.08 21.6 Transferrin saturation (%)

No clinical signs of malnutrition observed in the study group. Most of children had no signs of malnutrition indicated as hair; skin

changes with percentage over ninety three. Other symptoms like hair thinness and dyspigmentation had 3.2%and 2.4% respectively.

On the other hand skin pigmentation countered for 6.5% of study population. No significant differences found in iron deficiency status

between both sexes. (Tables 4, Fig1)

Discussion

With the populations there are significant differences for hemoglobin, red blood cell count, platelet count and heamatocrit. There were

differences between men and women, and between younger and older men. According to WHO [1] 7.2% of our study sample had

hemoglobin level less than 12 g/dl and fill in the range of mild anemia. The village where the study was conducted is self-sufficient of

vegetables, many sorts of legumes, fish and milk. Children consumed food constituents such as carbohydrates, legumes, milk, meat

and vegetables on their daily basis. This could be said to attributable to lack of iron deficiency observations or its related clinical signs.

On the other hand village location near Shendi town put it on communication with Shendi university in the field of maternal and child

care, reproductive health and nutrition programs and this lead to spread of health education among endogenous population. These

results were lower than those reported by Suliman [10], in El,Rahd rural council, who found 57.6% of his sample were anemic. Also

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these results disagreed with those documented by Miller et al.,[11] who said in United Arab Emirates 45% of UAE school children

had haemoglobin level below 11g/dl. And those reported by Musaiger [12]who cited in Bahrain 32% of their school children were

anemic.

Table 4: Iron deficiency clinical signs of children in study sample

Signs %

Hair changes

None 94.4

Thinness 3.2

Dyspigmentation 2.4

skin changes

none 93.5

pigmentation 6.5

other deficiency signs

none 96.8

angular stomatitis 3.2

Fig1: Iron deficiency status according to children sexes

Only 7.2% of Iron deficiency anemia was detected in Children at Elshagalwa rural area. Consumption of traditional food in addition to

contribution of Shandi University in population health promotion is the potent factors behind this finding.

The importance of population specific haematological parameters and supports the need for local guidelines rather than adoption of

generalized reference intervals and cut-offs.

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