IRON DEFICIENCY ANAEMIA IN THE FEMALES AND CHILDREN OF THE NORTHERN AREAS OF PAKISTAN

Iron deficiency is believed to affect 20-50% of the world's population, making it the most common nutritional deficiency in the world. Iron deficiency, anaemia or both are associated with a wide variety of adverse health outcomes, including delayed child development, lower IQ, poor school achievement, decreased active play in children, lethargy and fatigue, decreased physical work capacity, decreased work productivity in repetitive tasks, preterm birth, low birth weight, perinatal mortality, infant and young child mortality, and maternal mortality. Many reports of investigation in Pakistan also consider IDA as the most prevalent among female and children. The present study was a community based cross-sectional survey conducted in the Gilgit and Ghizer districts of the Northern Areas of Pakistan. A two-staged stratified sampling technique was used for selection of 606 subjects including 416 females and 190 children. Blood was drawn from antecubital vein by means of vacuette to determine Hb, PCV, RBC count, and serum ferritin levels. Peripheral smears were also made at the spot. Physical examination was done for all respondents. Age was noted and weight, height and MUAC were measured to assess the nutritional status of the subjects. Additional information regarding food composition was elicited through the questionnaire. The results of the study showed that 22% women were underweight and 17% were short stature. It was found that caloric consumption on average in the adult non-pregnant non-lactating females, pregnant females and lactating females were 49.61 %, 46.92% and 32.31 % of their daily recommended allowance. Similarly, the iron intake in these groups was 15%, 14%, and 17%, respectively. Of the total children 29.84% children of 2-12 years were underweight. There were 5.62% severely malnourished children. By calculating their caloric intake it was found that on average the children of age group 2-5 years consumed 40.69% of their recommended allowance, while children of age group 6-12 years consumed 30.3% of their recommended allowance for daily caloric intake. Children (both male and female) of age group 2-5 years were having 2.6 mg of iron per day. Female children of age group 6-12 years were consuming 2.8 mg of iron per day. Likewise, male children of age group 6-12 years were consuming 2.9 mg of iron per day. Consumption of tea was higher at high altitudes. Using four different criteria for estimation of prevalence, it has been found that by applying the WHO method 22.20% of pregnant and 15.71% of non-pregnant female were anaemic. According to the CDC method 24% of pregnant and 17% of non-pregnant women were anaemic. Using the ±2SD method 27% of pregnant and 10.34% of non-pregnant females were considered anaemic. On the basis of serum ferritin levels 42.85% of pregnant and 38.24% of non-pregnant women were anaemic. In case of children, 21 % of children were anaemic according to WHO and CDC methods. On the basis of ±2SD 18.38% of children were anaemic. By using serum ferritin level as an index of anaemia 27.01 % of children were considered anaemic. Prevalence of IDA was also analyzed separately in female land male children. There were 11 (11.22 %) females with normal RBC morphology out of 98 female children. In the case of male children there were 16 (17.39%) children with normal RBC morphology out of 92 male children. Owing to variations in altitude and other physiological and environmental features it is hard to record the exact figures for prevalence of anaemia in the region. This calls for more specific and in-depth studies in the Northern Areas on the model followed by Cohen and Haas in their study of pregnant women residing at high altitude in Bolivia. Such studies will not only be helpful in revising the cut-off values for more accurate estimation of anaemia in the Northern Areas but will also provide a baseline for implementation of anaemia prevention programme in the regio