IRON DEFICIENCY ANEMIA AMONG SCHOOL AGE CHILDREN IN KSA

1. Prince Mohamed Bin Abdul Aziz Hospital. 2. Alfarabi College. 3. King Faisal University. 4. Dar Al. Uloom. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 07 April 2020 Final Accepted: 10 May 2020 Published: June 2020 Background: Iron-deficiency anemia is the most common cause of anemia worldwide; it affects about half of school-age children around the world. Objectives: toidentify prevalence of iron deficiency and iron deficiency anemia in relation nutritional habits among school students and to identify common signs and symptoms of iron deficiency anemia. Methods: This is a cross sectional study conducted in a representative sample of schools in KSA during the period from 1 January to 31 July 2020.Data collected by filled a predesigned online questionnaire, included questions about socio-demographic characteristics of the children, nutritional habits and risk factors, causes and complications of anemia. Results: the study included 1558 school student, 89.8% were females, and 79.6% aged more than 15 years. 26.8% of the studied students had iron deficiency anemia. There was a significant correlation between iron deficiency anemia and age, sex, educational level (P< 0.05). It was most prevalent among females more than 15 years. The most common manifestations were easy fatigability 63.8%, drowsiness 52.5%, loss of concentration 45.6%, continuous headache 43.6%, fainting attacks 41.2%, tachycardia 34.3%, joint pain 33.8%, chest pain 19.7% and back pain in 18.9%. The majority (74.3%) takes oral treatment containing iron and 34.5% had vitamin C of cases. Improvement occurred in 53.5% of cases. Conclusion:in our study, the total prevalence of iron deficiency anemia was 26.8%. It was most prevalent among females more than 15 years. In spite of treatment, only 53.5% of cases were improved. So we recommend nutritional education to all levels of school children and their mothers. Schools must keep the mid-day school meal rich in iron and vitamin C sources. Copy Right, IJAR, 2020,. All rights reserved.


Introduction:-
Anemia is a problem characterized by reduction of the number of red blood cells or decrease in blood hemoglobin concentration [1]. Iron deficiency is the world's most common nutrient deficiency, and a major risk to public health in both developing and industrialized countries. More than one billion people of different age groups around the world are affected [2]. About 1.62 billion people worldwide are affected by anemia that accounts for more than 24.8% of the world's population and 30 to 50% of anemia were caused by iron deficiency [3]. Studies have shown that rapid physical and physiological development makes children of school age more vulnerable to anemia, particularly IDA [4]. Anemia affects 45.7% to 49.1% of school-age children around the world, according to the WHO report [3].
The cause of iron-deficiency anemia varies based on age, gender, and socioeconomic status. Iron deficiency may result from insufficient iron intake, decreased absorption, or blood loss. Iron-deficient anemia is most often from blood loss, especially in older patients. The main risk factors for iron deficiency among young children in developing countries are malnutrition (low intake) and high requirement of iron during child growth. Risk factors also include malaria, renal disease and dietary deficiency [5]. Infection with schistosomiasis, hookworm infection, and inherited diarrhea disorders was associated with the risk of developing anemia [6]. Socio-economic factors such as poor sanitation, low income, monotonous diet, parent education levels and neighborhood factors are also associated with anemia prevalence [7].
Anemia in schoolchildren leads to reduced disease resistance, increased vulnerability to infection, poor cognitive development, impaired physical development, poor school performance and reduced capacity for function with country social and economic development impaired [8]. While ID cannot be isolated as the only problem that causes deficient initial reading skills (DIRS), it should be considered one of the elements involved in learning deficiency. Faced with this reality, investigations should be undertaken to analyze and reduce the effects of ID [9].
The load of iron deficiency anemia in school students appears high especially among school girls those between 10-12 years of age. Unhealthy feeding habits of high fast food intake with low intake of vegetables and fruits appear to be prevalent among school girls [10].
Laboratory evaluation will identify anemia. Hemoglobin indices in iron deficiency will demonstrate low mean corpuscular hemoglobin and mean corpuscular hemoglobin. Serum levels of ferritin, iron, and transferrin saturation will be decreased [11]. The treatment of iron-deficient anemia includes treating the underlying cause, such as gastrointestinal bleeding, and oral iron supplementation. Iron supplementation should be taken without food to increase absorption [12].
A previous study conducted in Saudi Arabia to assess the prevalence of iron deficiency and iron deficiency anemia in relation to variables such as: age, weight, height, mother s education, number of family members, and nutritional habit s among female elementary school children (age 6 -12 years) in the western province of Saudi Arabia. Overall, the prevalence of iron deficiency and iron deficiency anemia in this study was 23.0%. Data showed that the majority of anemia cases in this study were normocytic type. Anemia was more prevalent among students of age 10-12 years as compared to younger age group. In addition, there was no relationship between iron deficiency anemia and number of family members or mother s education. Anemic students were not aware of their nutritional habits [12].
Few population-based studies have been conducted in Saudi Arabia specially on iron deficiency anemia in school girls; therefore, there is a need for a detailed analysis of nutritional habits and common signs and symptoms in this age group in the different geographical regions of the country such as Riyadh, Makkah and Madinah Munawara.

Objective:-
The aim of this study is to identify prevalence of iron deficiency and iron deficiency anemia in relation nutritional habits among school students and to identify common signs and symptoms of iron deficiency anemia.

Participants and Methods:-
This is a cross sectional study conducted in a representative sample of schools in KSA in KSA during the period from 1 January to 31 July 2020.Data collected by filled a predesigned online questionnaire, included questions about socio-demographic characteristics of the children, including age, number of children in the family, mothers' education, father's education, nutritional habits of children and anemia presence among children. In addition, the questionnaire included inquiries about risk factors, causes, and complications of anemia.

Statistical analysis:
Data was compiled and analyzed using statistical package for the social sciences (SPSS, version 16) and results were analyzed with frequencies and Chi-squared test as appropriate. P value considered significant if <0.05.

Ethical consideration:
Ethical approval was obtained from King Fahd Medical City in Riyadh. The questionnaire contains a brief introduction to explain the aim of the study to the participant mothers. Participants will be informed that participation is completely voluntary. No names were recorded on the questionnaires. All questionnaires were kept safe.

Discussion:-
Anemia is a public health problem both in developed and developing countries [13]. It affects the majority of the population of the world in both developed and developing countries with major consequences on human health as well as social and economic development. It is the world's second leading cause of disability of the whole global disease burden [14,15]. The WHO defines anemia as an Hb concentration 2 SD below the mean Hb concentration for a normal population of the same sex and age range [16]. Iron-deficiency anemia (IDA) is a decrease in the total hemoglobin (Hb) levels caused by iron deficiency. It is the most common cause of anemia worldwide [17]. In Saudi Arabia the overall country prevalence of iron deficiency anemia was 30-56% [13]. This is across sectional study was conducted among 1558 of the studied population, KSA. The study aimed toidentify prevalence of iron deficiency and iron deficiency anemia in relation nutritional habits among school students and to identify common signs and symptoms of iron deficiency anemia.
Anemia among school-aged children is known to be a significant global public health problem affecting 305 million people around the world. In developing countries its prevalence ranges from 29.2% to 79.6% [18].
Our study found that 26.8% of cases had iron deficiency anemia. Similar to our findings, a cross sectional survey was carried out in Riyadh region among 1117 children found that prevalence of anemia was 22.3% [19]. In Jeddah, another study was conducted among 123 female studentsbetweentheages of 6 to 12 years old, overall, the prevalence of iron deficiency and iron deficiency anemia was 23% [20]. In accordance to this another community based crosssectional survey that was carried out in Najran city among 240 subjects that aged 13-19 years old reported that the overall prevalence of anemia among teenagers in Najran was 22.5% [21]. In Egypt, A cross-sectional descriptive study was carried out in Menoufia governorate among 497 students; the prevalence of IDA was 25.6% [22]. However, in Ethiopia, a school based cross-sectional study was conducted among 523 of School Children aged 6-14 years reported; 15.5% of cases had anemia which was lower than our findings [23]. In India, Srivastava et al. found anemia in 37.5% of children [24]. Another study was carried out among 750 children reported high prevalence rate of anemia; more than half (53.6%) were anemic [25].
According to relation between Iron deficiency anemia and sex, age, educational level of the studied population, our study reported that there was a significant correlation between Iron deficiency anemia and age, sex, educational level (p< 0.05). It was most prevalent among children more than 15 years and among females. In contrast to our results another study found no statistical significance difference between males and females and prevalence of Iron deficiency anemia (P>0.05) [19]. Also, another study reported that there was no significant difference in the prevalence of IDA between girls and boys [22].
As regards treatment and improvement of Iron deficiency anemia cases our study found that the majority 74.3% had drugs containing iron and 34.5% had vitamin C. 62.4% of cases had drugs in form of tablets of capsules. Improvement occurred in 53.5% of cases.

Conclusion and Recommendations:-
In our study, the total prevalence of iron deficiency anemia was 26.8%. It was most prevalent among females more than 15 years. In spite of treatment, only 53.5% of cases were improved. So we recommend nutritional education to all levels of school children and their mothers. Schools must keep the mid-day school meal rich in iron and vitamin C sources.