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Abstrict
To determine the frequency of iron deficiency anaemia (IDA) in children who present with clinical pallor. The study was conducted at a tertiary care hospital, Hayatabad Medical Complex, between August 2018 and July 2022. We utilized laboratory information and took blood samples of 5ml to check for haemoglobin and ferritin levels. The criteria for IDA diagnosis were the presence of low haemoglobin levels (<11gm/dl) and low ferritin levels (<30ng/ml). The data were analyzed using SPSS version 26. The study contained 492 children (1 to 15 years). The total number of anaemic was 467 (94.9%) and Iron Deficiency Anemia was found to be present in 28.8% of the patients. Our study concludes that the frequency of iron deficiency is high in children presenting with pallor. Initiatives like National programs incorporating short-term measures like iron supplements and long-term ones like fortifying wheat flour could decrease the burden of IDA.
Keywords
Iron Deficiency Anemia; Pallor; Children; Prevalence
Introduction
Iron deficiency anaemia (IDA) is a significant public health concern among young children and is the most common type of micronutrient deficiency globally (Habib et al., 2016). It is estimated that over 1.2 billion people worldwide suffer from anaemia, with children under 5 years the most affected. Pallor, characterized by the paleness of the skin, is a usual presenting symptom in children with different underlying health conditions, including IDA. It is the most common cause of nutritional anaemia.
IDA is defined as having a haemoglobin level below 11 g/dL and a ferritin level below 30/?g/L (Li et al., 2020). It has an important effect on the mortality and morbidity of children. It is also linked to compromised cognitive and brain development (Lee, Chao, Huang, Chen, & Yang, 2020; McClorry et al., 2018). IDA is the 13th most important risk factor for global disability-adjusted life years and the third most prevalent cause of impairment globally (Wang et al., 2022). Most of the workload for IDA is concentrated in regions of Africa and Asia that lack sufficient resources (Organization). Understanding the frequency of IDA in children presenting with pallor is essential for early detection, appropriate management, and prevention of potential long-term consequences(Turawa et al., 2021).
In Pakistan, it has been reported that 40-70% of children suffer from IDA. Many clinical and socioeconomic factors, including widespread micronutrient deficiencies, are thought to be the primary causes of IDA in Pakistan (Khan, 2021; Mahmood & Nasir, 2001). There is a lack of prevalence data on this topic, and many studies are outdated or based on small sample sizes from non-representative groups. In simpler terms, IDA is a condition where a person has both low haemoglobin and low ferritin levels. However, most studies in Pakistan have only focused on low haemoglobin levels, but this study emphasizes ferritin levels. Pakistani children with iron deficiency anaemia (IDA) need more data for effective local IDA prevention and treatment initiatives need this information.
This study was conducted in a tertiary care hospital between August 2018 and July 2021 to find out IDA frequency in local children with the aim of analyzing the frequency of low ferritin-based anaemia and summarising the findings from selected studies that investigate the frequency of iron deficiency anaemia in children presenting with pallor. Furthermore, it discusses screening methods, diagnostic criteria, and available treatment options to guide clinical practice and public health interventions.
Materials and Methods
The study included children of both genders, aged 1 to 15 years. The inclusion criterion in this study was children with pallor. All the children with pallor and associated hepatosplenomegaly, lymphadenopathy, bleeding tendencies and children with chronic medical and surgical conditions were excluded from the study.
After informed consent, 5 ml of venous blood was collected and sent to a laboratory for estimation of haemoglobin and ferritin levels. The reference range of our laboratory was 11.5 to 17.5g/dl, with any haemoglobin level less than 11.5 g/dl considered low. Similarly, the serum ferritin level ranges of our laboratory were 13-150ng/ml. The concentration of Serum Ferritin was measured to detect iron deficiency in individuals because it has the highest sensitivity and specificity (Baker, Greer, & Nutrition, 2010; JM, 2007; Lozoff, 2007).
Statistical Analysis
To adapt the sampling strategy, all data analyses were done in SPSS version 26 utilizing a convenience sample technique. The study provided the mean outcomes along with their 95% confidence intervals. Univariate analysis preceded multivariate logistic regression. The analysis of two variables provided odds ratios without any adjustments, along with 95% confidence intervals. The used model included variables with a p-value of less than 0.25. Statistical and theoretical factors determined the model. 0.05 type 1 errors. Model estimates give adjusted odds ratios and 95% CI.
Results
This study examined 490 children between the ages of 1 to 15 years. The analysis of blood samples from children showed that 95.3% of them were anaemic with hemoglobulin of less than 11.5 g/dl and 29.5% were iron depleted (ferritin of less than 30 ng/ml). Out of these children, 141 (28.8%) were found to have IDA due to low levels of haemoglobin and ferritin according to the definition. The individuals with IDA had an average haemoglobin concentration of 8g/dL.
Table 1
Hemoglobulin and ferritin level cross-tabulation (Ferritin Value * HB)
| Crosstab | > Count | > width="44%" colspan="2"> HB width="21%" rowspan="2">Total | > Normal (11.5-16) width="21%">Less Than 11.5 | > Ferritin Value width="18%">Normal (30-400) width="23%">19 width="21%">326 width="21%">345 | > Less Than 30 width="23%">4 width="21%">141 width="21%">145 | > Total width="23%">23 width="21%">467 width="21%">490 | ||||||||||
| width="13%"> Value width="26%">Df width="33%">Asymptotic Significance (2-sided) | > Pearson Chi-Square width="13%">1.724a width="26%">1 width="33%">.189 | > Continuity Correctionb width="13%">1.164 width="26%">1 width="33%">.281 | > Likelihood Ratio width="13%">1.901 width="26%">1 width="33%">.168 | > Fisher's Exact Test width="13%">width="26%"> width="33%">
| > Linear-by-Linear Association width="13%">1.721 width="26%">1 width="33%">.190 | > N of Valid Cases width="13%">490 width="26%">width="33%">
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