Ferropenic Anaemias as a Problem of Public Health

Ferropenic Anaemias as a Problem of common headspringnessThere be several directs of consideration when analysing the problem of the ferropenic anaemias. firstly there is the overall prevalence in the tribe, which is quite low in the UK when compared to the ariseing innovation (see on). Secondly we compulsion to differentiate between the physiological ferropenic anaemias such(prenominal)(prenominal) as those which occur in pregnancy, those which occur as a chair of disease deposits such as the various forms of malabsorbtion and those which occur by neglect or mal keep (in the widest possible sense).(Allen, L et al. 2001)The physiological anaemias are non a major public health grapple as they are almost invariably screened for in the routine ante-natal clinics and when found, are generally treat on an dwellant basis. press out stores may be depleted after pregnancy and during the breast feeding menstruation, but again, one could reasonably expect that these conditi ons would be detected and treated as a matter of course. (Ramakrishnan, U. 2001)The identical comments generally apply, although with not quite such universal accuracy, in the malabsorbtion states. such(prenominal) states are generally found as part of another (usually to a great extent clinically obvious) pathophysiological process or as part of a post-operative syndrome. (I M 2001)One would hope that, as such, they would be part of the general focal paint a picture of the overall condition and accordingly do not pose a particular public health issue.Another area where the customary wellness is a potential concern is that where the ferropenic anaemias occur as a result of malnutrition, poor feed or neglect.One way of considering these issues is to analyse the agency in circumstances where the prevalence of ferropenic anaemias is greater than in the UK (where it is relatively unusual). (Gibson, R. S et al. 2001)In the developing world, the ferropenic anaemias are a major P ublic Health issue and some countries look at instituted government notes to directly combat them.(Yip, R. 1994)The first issue to address is to consider the notion that the commonly measured index of hemoglobin concentration is actually a good measure of constrict stores. The render standstill here is quite clear that in essential countries where the level of nutrition is generally good, there is a reasonable (but not exact) correlation. In countries with less good nutritional values, there is a marked variation between haemoglobin levels and campaign levels.Haemoglobin distributions of a subset of compress lacking(p) U.S. children (dotted line) and children who are not urge deficient (solid line). The key observation is the secure overlapHaemoglobin distributions of Palestinian refugee children (dotted line) and U.S. children (solid line). The key observation is the relatively humiliated overlap.(after Yip et al. 2002)Secondly we should note that as a matter of intro ductory pathophysiology, not all anaemia is due to crusade need and not all iron deficiency will be reflected in anaemia. so uncritical use of the haemoglobin index as a measure of the ferropenic anaemias is raw materialally flawed. These charts suggest that the linkage between haemoglobin and serum iron is closer in developed countries than in developing ones.We commode point to other indicators of iron status including transferring saturation, serum ferritin, free erythrocyte protoporphryn (FEP) or the more(prenominal) technologically advanced transferrin receptor levels . (Gimferrer E et al. 1997) which can be utilised to give indicators of iron levels either in a specific patient or on a population level. (Lynch, S et al. 2001). There is another consideration here and that these indicators, although probably accurate on an individual level, may not be so helpful on the population level as, particularly in the developing countries, their laboratories may not bewilder a suf ficient level of sophistication to perform the assays and alike these tests are less accurate in populations where there is a heights prevalence of infectionsOne of the main areas of concern to the Public Health is that of the ferropenic anaemias in children. There is a relative period of physiological anaemia in the child which occurs between 6 and 18 months. The word physiological is in parenthesis because it is not strictly accurate. It is physiological insofar as this is the season when the childs body has its mellowedest levels of iron requirement (almost 10 times high than in the adult in comparison to body weight) and the comparative depletion is generally rectified by dietary means once the period of high usage is over. (IM 2001). The second factor in this situation is that the ordinary diet of this age range tends to be low in bio on tap(predicate) iron when compared to that of an adult. (ODonnell, A. M et al. 1997)In the UK it is rare for a child to develop a ferro penic anaemia because those at happen (underweight and malnourished) are generally picked up by routine Health Visitor screening and also because of the collapse dietary quality of the average diet which is high in middle with a high iron content. Specifically designated infant food in the UK is commonly bastioned with additional iron in any event. (Hall, A et al. 2001). We should not overlook that fact that breast draw has a high content of bio available iron and is a useful source of security department (although not universally effective) against the ferropenic anaemias in the young childWe should note however, that in studies that devour compared breast fed children, with normal diet children and compared them also against those with a fortified diet (defined by being primarily fed on artificial milk) there was virtually no significant incidence of ferropenic anaemias in those children who were given the fortified diet suggesting that those countries who still utilise the fortified milk system as a Public Health measure are spending their money in a cost effective way. (Walter T et al. 2001)Because of the substantial evidence base that supplementation of iron in the diet of the young child is both cost effective and demonstrably workable, (Bothwell T H et al. 1999)One should really also to consider the additional call into question as to whether there is a case for supplementing other micronutrients as well as iron. This is a question that is outside the strict parameters of the essay championship set here so we will not consider it barely except to observe that there is a substantial evidence base to support this as well. (Solomons N W et al. 1993)If we now expand the arguments to women of productive age, we note that the risk of developing a ferropenic anaemia during pregnancy is greater than during virtually any other stage of life. In approximate values, a pregnant wo homosexual can expect her circulating blood pot to expand by intimately 35% during pregnancy. She would expect to have a total pregnancy requirement of around 590 mg of elemental iron for the foetus and physiological RBC turn over. Routine prophylaxis in the UK supplies about 750 mg during a pregnancy which leaves about 160 mg for erythropoesis. Studies have suggested that the typical woman needs about 1100 mg of elemental iron throughout her pregnancy to avoid a natural ferropenic anaemia . (Viteri F E 1999)There is considerable evidence that a pre-pregnancy ferropenic anaemia increases the risk of developing further anaemia during a first (and progressively greater in subsequent) pregnancies as it suggests that the iron stores in the body are already depleted.There is evidence to suggest that, in women in the reproductive old age in the developed world, ferropenic anaemia is more likely to be associated with increase blood loss (menorrhagia or polymenorrhoea) than it is to be associated with poor diet.Lennartsson, (J et al. 1999) made a substantial study of ferropenic anaemias in women and identified a substantial sub-set whose catamenial loss was such that a normal diet could not oblige up with their iron requirements.In the context of our essay we can state that iron deficits that are due to menstrual loss appear to have the greatest effect on women in the developing world as they tend to have diets which are already comparatively poor in both overall iron content and bioavailability. Paradoxically, women in the developed world who do develop ferropenic anaemias due to excessive blood loss, are more likely to suffer from multiple micronutrient dietary deficiencies as well, most notably zinc, copper, calcium and vitamin A, (Hall, A et al. 2001). It is also the case that in the developing world, intercurrent infections such as helminthic infestations and malaria may also result in change magnitude levels of blood loss and therefore the underlying causes will also need to be addressed as well as simply correcting the iron def iciency.The nutritional iron requirements of the pregnant woman are typically double that of the non-pregnant woman, who, in turn, has approximately twice the requirement of the same aged man (corrected for appropriate expertness expenditure). Recent studies have shown that 50% of women in developed countries do not have sufficient iron stores for pregnancy requirements. (Kim, I et al. 1998). This fact is essentially the rationale behind the fairly routine prescription medicine of iron tablets to pregnant women in the UKIron requirements in relation to energy stirring for infants, men, women and pregnant women. (After IM 2001)We note that different countries consider different strategies fetching account of costs and available resources. Many, including the UK and the USA, adopt a fortification outline as a Public Health measure as not only women but men and children will also benefit. Some countries chose to adopt periodic supplementation under supervision such as in a school or the workplace. (Viteri, F. E. 1999)Many countries, including the UK, choose to fortify basic food ingredients such as wheat flour which is currently fortified to levels of 60 g/g. Basic calculations based on an annual intake of 20 kg/yr (which is fairly low by UK standards) would suggest that this measure alone equates to 3 mg of elemental iron per daytime or about 25% of the recommended daily requirement. (Viteri, F.E. 1997)In terms of Public Heath costs a recent estimate suggests that it costs about 70p ($1.30) to fortify one ton of wheat flour with six micronutrients, including iron. (Lofti, M 1998). If we revert back to the 20 kg per year estimate of token(prenominal) intake, the cost is only a few pence per year ($0.025). Some sources have suggested a programme of plant development and breeding to develop strains of staples such as rice and wheat that have a intrinsically higher micronutrient content. (Gibson, R. S et al. 2001). These measures are certainly within the tec hnological capabilities of the majority of countries and therefore make such measures a viable option.References Allen, L. Casterline-Sabel, J. (2001)Prevalence and causes of nutritional anaemias. Ramakrishnan, U. eds.nutritional Anemias 2001 7-22CRC evoke Boca Raton, FLBothwell T H, Charlton R W, Cook J D, Finch C F, eds. 1999Iron metabolism in man.Oxford, United Kingdom Blackwell Scientific Publications, 1999 21.Gibson, R. S. Hotz, C. (2001)Dietary diversification/modification strategies to enhance micronutrient content and bioavailability of diets in developing countries.Br. J. Nutr. 85 (suppl. 2) S159-SS66.Gimferrer E, J. Ubeda, M.T. Royo, G.J. Marig, N. Marco, N. Fernndez, A. Oliver, R. Padrs, and I. Gich 1997 serum Transferrin Receptor Levels in Different Stages of Iron Deficiency Blood, Aug 1997 90 1332 1333.Hall, A., Drake, L. Bundy, D. (2001)Public measures to control helminth infections. Ramakrishnan, U. eds. Nutritional Anemias 2001 215-240CRC Press Boca Rato n, FL.IM 2001Institute of care for (2001) Dietary Reference Intakes. . Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, Zinc 2001National Academy of Sciences Washington, DC. . 2001Kim, I., Hungerford, D. W., Yip, R., Kuester, S. A., Zyrkowski, C. Trowbridge, F. L. (1998)Pregnancy nutrition surveillance systemUnited assures, 19791990.CDC Surveillance Summary,Morb. Mortal. Wkly. 1998 Rep. 7 25-41.Lennartsson, J., Bengtsson, C., Hallberg, L. Tibblin, E. (1999)Characteristics of anaemic women. The population study of women in Goteborg 19681969.Scand. J. Haematol. 22 17-24Lofti, M. eds. 1998Food Fortification to End Micronutrient MalnutritionState of the Art. Micronutrient Initiative 1998 Ottawa, Canada. .Lynch, S. Green, R. (2001)Assessment of nutritional anemias. Ramakrishnan, U. eds.Nutritional Anemias 2001 23-42CRC Press Boca Raton, FL.ODonnell, A. M., Carmuega, E. S. Duran, P. (1997)Preventing iron defic iency in infants and preschool children in Argentina.Nutr. Rev. 55 189-194Ramakrishnan, U. (2001)Functional consequences of nutritional anemia during pregnancy and early childhood. Ramakrishnan, U. eds.Nutritional Anemias 2001 43-68CRC Press Boca Raton, FL. .Solomons N W, Mazariegos M, Brown K H, Klasing K. 1993The underprivileged, developing country child environmental contamination and growth ill luck revisited.Nutr Rev 1993 51 32732.Viteri, F.E. (1997)Iron supplementation for the control of iron deficiency in populations at risk.Nutr. Rev. 55 195-209.Viteri, F. E. (1999)Iron supplementation as a strategy for the control of iron deficiency and ferropenic anemia.Arch. Latinoam. Nutr. 49 (suppl. 2) 15S-22SWalter, T., Olivares, M., Pizarro, F. Hertrampf, E. (2001)Fortification. Ramakrishnan, U. eds.Nutritional Anemias 2001 153-184CRC Press Boca Raton, FL. .Yip, R. (1994)Iron deficiency contemporary scientific issues and international programmatic approaches.J. Nutr. 124 147 9S-1490SYip R and Usha Ramakrishnan 2002 Experiences and Challenges in Developing Countries J. Nutr., Apr 2002 132 827 830.8.11.06 Word count 2,251 PDG