7.5.7 Strategies for the control of iron deficiency anaemia
The strategy for the reduction of iron deficiency anaemia should be holistic and sustainable. For this to happen there is a need to involve relevant stakeholders from agriculture, education, information and other relevant sectors in planning and implementation of priority programs. The main strategies are the following:
Supplementation of iron and folic acid for pregnant and lactating women
Pregnant women require a much higher amount of iron than is met by most diets and therefore it is important that they routinely receive iron supplements. In places where anaemia is high, supplementation should continue into the postpartum period to enable them to acquire adequate stores of iron. Table 7.5 sets out the correct dosage and duration for iron and folic acid for pregnant and lactating women.
| Iron-folic acid doses | Duration |
|---|---|
Iron: 60 mg/day Folic acid: 400 mcg/day |
|
Supplementation for children and adolescents
Many children from six to 24 months of age need more iron than is available in breastmilk and common complementary foods. Infants with low birth weight have fewer iron stores, and are thus at a higher risk for deficiency after two months of age. In areas where iron fortified complementary foods are not available for regular consumption, children should routinely receive supplements in the first year of life. In areas where anaemia prevalence in young children is 40% or more, delivery of iron supplements should continue through the second year of life, and also be given to adolescent girls. Look at Table 7.6, which sets out the correct doses of iron and folic acid according to the age of the child.
| Group | Iron-folic acid doses | Duration |
|---|---|---|
| Low-birth weight infants (under 2500 g) | Iron: 2 mg/kg body weight/day Folic acid: 50 mcg/day | Two-24 months of age |
| 6-24 month old children | Iron: 2 mg/kg body weight/day Folic acid: 50 mcg/day |
|
| 24-59 month old children | Iron: 20-30 mg iron | At least once a week for three months |
| School-age children (6-11 years) | Iron: 30-60 mg/day | At least once a week for three months |
| Adolescents | Iron: 60 mg/day Folic acid: 400 mcg/day | At least once a week for three months |
Generally there are no side effects to supplementation if protocols are followed.
When might you deliver iron supplementation for children and adolescents?
There are a number of points in a child’s or adolescent’s development when you can encourage the mother, or the older child, to ensure that children and adolescents take iron supplements. For example early on, during postnatal care and the well baby visits, you can talk to the mother about this. You can also talk to the mother about iron supplements during a sick child visit. Other opportunities include school health programmes that you might advise on, or when you are providing family planning services and doing home visits.
Treatment of severe anaemia
Children with severe acute malnutrition should be assumed to be severely anaemic. Oral iron supplementation should be delayed until the child starts eating again and gains weight, usually after 14 days.
If anaemia is diagnosed by clinical examination (extreme pallor of the palms of the hands) or by laboratory tests at health centre, treatment is as set out in the table below.
| Group | Iron-folic acid dose | Duration |
|---|---|---|
| Children under two years old | Iron: 25 mg/day Folic acid: 100-400 mcg/day | Three months |
| Children two-12 years old | Iron: 60 mg/day Folic acid: 400 mcg/day | Three months |
| Adolescents and adults, including pregnant women | Iron: 120 mg/day Folic acid: 400 mcg/day | Three months |
Dietary diversification
Food diversification is an important strategy for prevention of iron deficiency. Populations should be encouraged to produce and consume iron-rich foods throughout the country at all times. Health Extension Practitioners can play a significant role in promoting the introduction of iron-rich foods and improving consumption and storage of such foods. As you know by now, the best source of iron for infants is breastmilk. Look at Table 7.8 overleaf. It describes the best animal and plant sources of iron. As you can read, the way food is processed and cooked has an impact on how well iron is absorbed.
| Animal sources of iron | Plant sources of iron |
|---|---|
| Animal products (meat, organs and blood) provide the best food sources of dietary iron. If these are available, children six to 24 months of age and pregnant women should have priority to include small amounts in their diet. Animal products provide iron that is absorbed easily. Animal products are also the only source of vitamin B12, an important micronutrient for preventing anaemia. | The best plant sources of iron include dark green leafy vegetables and legumes. Legumes are also excellent sources of folic acid. Consumption of foods which are rich in vitamin A will also prevent anaemia. Food processing techniques such as cooking, germinating, fermenting and soaking of grains should be encouraged as they reduce factors that inhibit iron absorption. |
Control of malaria and worms
To control non-iron deficiency anaemia it is also critical to coordinate action with the malaria control and worms control programmes. Pregnant and lactating women and children should sleep under insecticide-treated bed nets.
Children between one and five years of age should receive de-worming drugs. The correct dosage is set out in Table 7.9
| Drugs | Dose for each age group | Comments | ||
|---|---|---|---|---|
| 0-1 year | 1-2 years | 2-5 years | ||
| Albendazole | No treatment | ½ tablet | 1 tablet | These two are particularly attractive because they are single dose and there is no need to weigh the children |
| Mebendazole 500 mg tablet | No treatment | 1 tablet | 1 tablet | |
- De-worming drugs are extremely safe and have no significant side effects
- Minor side effects like nausea and abdominal discomfort are rare usually well tolerated by the children
- Children under one year old are not treated, as they are not exposed to infection
- Accidental repeated treatment with several doses of de-worming drugs is not dangerous.
No special training is needed to administer de-worming drugs. Non-health workers with minimal training can easily and safely give them. Training someone on how to administer the drugs and the benefits of de-worming can be done in a few hours. In addition, it is important to encourage hygiene and environmental sanitation to prevent women, children, or people living with HIV and AIDS from getting parasites such as worms.
7.5.6 Strategies for the control of Iodine deficiency