The term ‘nutritional anemia’ encompasses all pathological conditions in which the blood hemoglobin concentration drops to an abnormally low level, due to a deficiency in one or several nutrients. The main nutrients involved in the synthesis of hemoglobin are iron, folic acid, and vitamin B12. In public health terms, iron deficiency is by far the first cause of nutritional anemia worldwide. Folic acid deficiency is less widespread and is often observed with iron deficiency. Vitamin B12 deficiency is far rarer. Therefore, the focus in this article is on Iron-deficiency anemia in children.
Worldwide, at any given moment, more individuals have iron-deficiency anemia than any other health problem.(1
) Anemia is the most common morbidity among micronutrients and affects health, education, economy, and productivity of the entire nation. Anemia, like fever, is a manifestation and not a disease per se
. The most common group among the causes for anemia is malnutrition and among that group, iron deficiency makes up the bulk of it. A large portion of iron deficiency is preventable with appropriate and timely intervention. Iron deficiency is the most common nutritional disorder in the world. The numbers are staggering: two billion people – over 30% of the world's population – are anemic, mainly due to iron deficiency; and in developing countries this figure is frequently exacerbated by malaria and worm infections.(2
) Iron deficiency affects more people than any other condition, constituting a public health epidemic. It exerts the heaviest overall toll in terms of ill-health, premature death, and lost earnings. The effects of anemia on children are the most dire because their bodies are still developing, including the brain, which is the fastest developing organ in infancy and early childhood.
Iron deficiency, and the anemia that results from it, is a major health problem affecting more than 3.5 billion people in developing countries, reducing vitality for the young and old alike, and impairing the cognitive development of children. Anemia is most often a hidden deficiency, with a few overt symptoms.(3
) Policy makers often fail to recognize the massive economic costs, service providers often fail to recognize the significant health consequences, and societies are too often ignorant of anemia's capability to cause permanent cognitive defects, denying children their right to full mental and emotional development, before they ever reach a classroom.
Often programs and projects to prevent and control anemia have been constrained by the erroneous perception that effective and practical interventions are not available. These perceptions have their origin in poor implementation, rather than the availability of the interventions. It adds to the burden on the health systems, affects learning and school performance, and reduces adult productivity.
Iron-deficiency anemia can usually be prevented at a low cost, and the benefit/cost ratio of implementing preventive programs is recognized as one of the highest in the realm of public health. This information has equipped everyone in public health to take action against this longstanding problem and to do whatever is needed to be done.
Because anemia is the most common indicator used for screening iron deficiency, the terms ‘anemia,’ ‘iron deficiency,’ and ‘iron-deficiency anemia’ are often used interchangeably. However, prior to the development of iron-deficiency anemia, there have been mild-to-moderate forms of iron deficiency, where various cellular functions are impaired. We need to differentiate between, iron deficiency, anemia, and iron-deficiency anemia, to put each of them in their proper perspective.