1. GROUP 5
DR ASMAH JOHARI DR HUZAIMAH HUSIN
DR HASLINA HASSAN DR NORALIZA RADZALI

2.  INTRODUCTION
 DEFINITION
 PREVALENCE & EPIDEMIOLOGY
 CAUSES
 SIGNS & SYMPTOMS
 INVESTIGATION
 TREATMENT
 PREVENTION
 PROGRAMME ( CHINA)
 RECOMMENDATION
 CONCLUSION
 REFERENCES

3. Iron Deficiency Anemia (IDA) is a global public health problem with major
consequences for human health , social and economic development.
It is more prevalent in pregnant women and young children.
Indicator of both poor nutrition and poor health. Severe health effects lead to
increase risk of maternal and child mortality.
Major concern: negative consequences of anemia on cognitive and physical
development of children and physical performance in work productivity in
adults.
In 2002, IDA was considered to be among the most contributing factors to the
global burden of disease.

6.  In 2005, a study showed the prevalence of anemia among antenatal mothers
from 56 MOH health clinics was 35% (Hb<11.0 g/dl), higher in the teenage
group, Indians, grandmultiparas, the third trimester and from urban residence
( Jamaiyah et al.,2007)
 The prevalence of IDA in pregnant women who attending their first antenatal
clinic at a Maternal and Child Health Clinic in Kubang Kerian was 21.2%,
which is similar to other developing countries( Roseline et al., 2007)
 A study done in 2008 among pregnant women, attended health clinics in
Johor Baharu, prevalence of anemia : (Hb<11.0 g/dl) was 36.6% and majority
in mild category (Hb 9-<11 g/dl). The associated factors were birth spacing,
dietary intake with low iron content and poor iron pill consumption (Siti Khatijah et
al.,2010)

7.  Preschool children in Kota Bharu, Kelantan showed that 38.9%
had IDA (Siti-Nor et al. 2006).
 Prevalence of IDA in the male and female adolescents were 5.4%
vs. 26.4%, respectively (Foo et al. 2006)

8. Age
Most common in the preschool years and during puberty. Another peak - in old age,
when diets frequently deteriorate in quality and quantity.
Gender
Adolescent females following menarche, often do not consume sufficient iron to
offset menstrual losses.
Physiological state
Substantial amounts of iron are deposited in the placenta &fetus during pregnancy,
results in increased need about 700-850 mg in body iron over the whole pregnancy.
Pathological state
Common infections may impair haematopoiesis eg; Malaria by haemolysis and
parasitic infections, e.g.hookworm & schistosomiasis cause blood loss directly.
Socioeconomic conditions.

9. Decreased Iron Intake and
Increased Iron Needs
Absorption
• Rapid growth • Lack of heme iron sources in
(childn,adoles) the diet (e.g., vegetarian
diets)
• Pregnancy
• Low absorption
• Blood loss
o Taking antacids beyond the
o Heavy menstrual
recommended dose or
periods
medicine used to treat
o Frequent blood peptic ulcer disease and
donation acid reflux can reduce the
amount of iron absorbed in
o Some stomach and
the stomach.
intestinal conditions
(food sensitivity,
hookworms)

12.  2 categories:-
screening .
 reduced supply of plasma iron or poor haemoglobinization of
circulating red blood cells
 Hb, MCH, sr Transferrin, Zinc protoporphyrin
definitive measurement.
 identify IDA by measuring iron-related proteins derived from
either the iron storage compartment in macrophages or the
iron utilization compartment in red-cell precursors.
 Sr. Ferritin, bone marrow iron, TIBC

13.  Serum iron: poor indicator, highly variable day to
day and during the day
 Ferritin - most sensitive—chief storage form of
iron; directly proportional to iron stored in cells

14.  Zinc protoporphyrin/heme ratio (ZPPH):
 protoporphyrin binds iron to form heme or zinc to form
zinc protoporphyrin
 In the presence of iron deficiency, ratio will rise (iron
deficiency defined as ratio>1:12,000)
 Not affected by hematocrit or other causes of anemia;
highly specific to iron deficiency

15.  Total iron binding capacity (TIBC)—capacity of
transferrin to bind iron
 Transferrin—globulin that binds/transports Fe from gut
wall to tissues
 Percent saturation of transferrin (calculate by dividing
serum iron by the TIBC)
 TIBC increases in iron deficiency

16.  3 main strategies for correcting iron deficiency,
alone or in combination:
Education combined with dietary modification or
diversification, or both, to improve iron intake and
bioavailability.
Iron supplementation or pharmacological treatment.
Iron fortification of foods.

17. I. Assessing the iron status of populations
i. Screening of IDA in vulnerable group (eg infants,
toddlers, school age children )
ii. The school health program is a potential strategy to
increase the iron status as well as improving the
general health and nutritional status of school children.
iii. Measurements of serum ferritin and transferrin
receptor provide the best approach to measuring the
iron status of populations.

18. II. Evaluating the impact of interventions
to control iron deficiency in populations
i. Serum ferritin is the best indicator of a response to an
intervention to control iron deficiency and should be
measured with the haemoglobin concentration in all
programme evaluations.

19.  REAP( Rural Education Action Plan)
 Harvest Plus

20.  High prevalence of iron deficiency anemia
school going children in China.
39% of fourth grade students in Shaanxi Province are
anemic.(REAP 2008)
40% of 5 to 9 year old students rural junior high school
in Shaanxi Province (Wang, 2008).
36% in Qinghai and Ningxia Provinces (REAP 2009).
 50 to 60% Guizhou (Chen et al., 2005).

21. Intervention
Supplementing lunches with animal based (heme)
protein through existing school feeding programs;
Giving iron and multivitamin supplements directly to
children in schools;
Delivering school-level and household-level nutritional
education campaigns;
Providing deworming medication;

22.  The mission of the program is to use plant breeding (bio-
fortification) to reduce and prevent global deficiencies of
micronutrients (iron, zinc, and vitamin A) in humans, in particular in
developing countries.
 has been found by the World Bank, Gates Foundation, and other
donors with more than $50 million dollars during 2003-2007.
◦ Development of rice breeding lines with low phytic acid
and enhanced iron content
◦ Breeding of Iron-dense Rice Variety and Its Evaluation
of Biological Effect on Human Body
◦ Iron Dense and Bioavailability in Rice Grains and the
Regulation in Soil-Crop System

23. Fortified food commodities consumed: NutriRice (B1, B2, FA, niacin, Zn, Fe,
BC), NaFeEDTA-fortified soy sauce, VA-fortified cooking oil
 Malnutrition rate -50%
 Vitamin B deficiencies 
 VAD -51%, iron deficiency anemia -82%, zinc deficiency -58%
 Improved school attention, cognitive & academic performance and
physical strengths including aerobic capacity
23

24.  Iron deficiency anemia is a worldwide problem impairing
the health and economy of the population.
 Affected more in young women and children, esp in
developing countries.
 Need to treat underlying cause of IDA such as blood
loss, worm infestation.
 Management include dietary modification, iron
supplementation ,iron fortification of foods, as
combination or alone.
 Highest benefit-to-cost ratio is attained with iron food

25. THANK YOU