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Nutritional anemia
- 1. NUTRITIONAL ANEMIANUTRITIONAL ANEMIA AND VITAMIN AAND VITAMIN A DEFICIENCYDEFICIENCY PRESENTED BY: Samjhana Shrestha M.Sc Nursing 1st year Dept Of Community Health Nursing PION
- 2. HIDDEN HUNGER The term was coined by WHO in 1986 & refers to the problems associated with the deficiency of 3 essential micronutrients: Iron Vitamin A Iodine
- 3. NUTRITIONAL ANEMIA DEFINITION It is a disease syndrome caused by Malnutrition. • Acc to WHO – • A condition in which haemoglobin content of blood is lower than normal, as a result of deficiency of one or more essential nutrient, specially iron.
- 4. Nutritional Anemia • Deficiency of A. Iron B. Folate C. Vitamin B12 D. Protein • corrected by supplementation
- 5. ANAEMIA • ANAEMIA - Insufficient Hb to carry out O2 requirement by tissues. • WHO definition : Hb conc. < 11 gm % • CDC definition : Hb conc. < 11gm % in 1st and 3rd trimesters and < 10.5 gm% in 2nd trimester • For developing countries : cut off level suggested is 10 gm % - WHO technical report Series no. 405, Geneva 1968
- 6. WHO cut off criteria OF hb% (in venous blood) Adult man 13 gm/dl Adult woman (non pregnant) 12 gm/dl Adult woman (pregnant) 11 gm/dl Child above 6 yrs 12 gm/dl Child below 6 yrs 11 gm/dl
- 7. Prevalence –Widespread public health problem with major consequences for human health and socio-economic development –WHO estimates 2 billion people are affected worldwide –>50% due to iron deficiency
- 9. INTRODUCTION Iron deficiency (ID) is one of the most frequent nutrition deficiency all round the world.( In India - 50%) Its prevalence is higher in children and childbearing age women. Iron deficiency anemia (IDA) mainly affects child behavior and development, work performance and immunity.
- 10. • WORLD It is a world wide problem with highest prevalence in developing countries. • It affect nearly 2/3 of pregnant and ½ of non pregnant. • INDIA- • Overall , 72.7 % of children up to age of 3 year in urban and 81.2% in rural are anaemic . • It was found that , except for Punjab , all other state had more than 50% prevalence of anaemia among pregnant women. PROBLEM STATEMENT
- 11. % OF IDA IN INDIA IN VULNERABLE GROUPS Vulnerable groups % of Population with Anemia Adult male 20 children 40 Adolescent girls 56 Adult female 60 Pregnant mothers 60
- 12. WHO Classification of Anaemia Degree Hb% Haematocrit (%) Moderate 7-10.9 24-37% Severe 4-6.9 13-23% Very Severe <4 <13% Degree Hb% Haematocrit (%) Moderate 7-10.9 24-37% Severe 4-6.9 13-23% Very Severe <4 <13%
- 13. Iron requirements (RDA) Females 11 – 14 15 15 – 18 15 19 – 24 15 25 – 50 15 51 + 10 Pregnant 30 Lactating 1st 6 months 15 2nd 6 months 15 Category Age (years) RDA – Iron (mg) Infants 0 – 0.5 6 0.5 – 1 10 Children 1 – 3 10 4 – 6 10 7 – 10 10 Males 11 – 14 12 15 – 18 12 19 – 24 10 25 – 50 10 51 + 10
- 14. Sources of Iron There are 2 types of iron in the diet; haem iron and non-haem iron Haem iron is present in Hb containing animal food like meat, liver & spleen Non-haem iron is obtained from cereals, vegetables & beans Milk is a poor source of iron, hence breast-fed babies need iron supplements
- 18. Causes of IDA • Increased demand for iron – Rapid growth in infancy or adolescence – Pregnancy – Erythropoietin therapy • Increased iron loss – Chronic blood loss – Menses – Acute blood loss – Blood donation – Phlebotomy as treatment for polycythemia vera •Decreased iron intake or absorption -Inadequate diet -Malabsorption from disease (sprue, Crohn's disease) -Malabsorption from surgery (post- gastrectomy) -Acute or chronic inflammation
- 20. Adolescent Anaemia Adolescent Anaemia Reduced physical development Reduced physical development Reduced cognitive development Reduced cognitive development Impaired sexual and reproductive development Impaired sexual and reproductive development Decreased work output Decrease d work capacity Diminished concentration Poor learning ability Disturbance in perception Irregular menstruation Low pre- pregnancy iron stores LBW babies and preterm delivery
- 23. Clinical Presentation Iron-deficiency anemia can cause: • brittle nails • cracks in the sides of the mouth
- 24. Extreme fatigue (tiredness) chest pain
- 25. • Pale skin • Dizziness or lightheadedness
- 26. • Fast heart rate • Headache
- 27. Pale conjunctiva an enlarged spleen Cold hands and feet frequent infections. shortness of breath swelling or soreness of the tongue
- 28. • An unusual craving for non-nutritive substances such as: Ice Dirt Paint or starch. This craving is called pica. • Some people who have iron-deficiency anemia develop restless legs syndrome (RLS). RLS is a disorder that causes a strong urge to move the legs.
- 29. • Some signs and symptoms of iron- deficiency anemia are related to the condition's causes. A sign of intestinal bleeding is bright red blood in the stools or black, tarry-looking stools. Very heavy menstrual bleeding, long periods, or other vaginal bleeding may suggest that a woman is at risk for iron-deficiency anemia.
- 30. • Consequences of Iron Deficiency Increase maternal & fetal mortality. Increase risk of premature delivery and LBW. Learning disabilities & delayed psychomotor development. Reduced work capacity. Impaired immunity (high risk of infection). Inability to maintain body temperature. Associated risk of lead poisoning because of pica.
- 31. •Assessment of IDA I. Clinical and II. Laboratory indices. • Laboratory indices are the most common methods used to assess iron nutrition status.
- 32. I. Clinical Indices •Pallor of the: •Conjunctiva, •Tongue, •Nail bed and palm
- 33. Unique Physical Exam findings – Koilonychia -Cheilosis ..spooning of the ..fissures at the corners fingernails of the mouth
- 34. II. Laboratory Indices 1. Low Hemoglobin 2. Low Hematocrit 3. Low Mean Corpuscular Volume 4. Serum Ferritin <10ng/ml 5. Transferrin Saturation<15% 6. TIBC>350µg/dl 7. Increased free erythrocyte protoporphiryn
- 37. 1. Adequate nutrition 2. Nutrition education to improve dietary habit 3. Breast feeding and appropriate weaning diet 4. Iron rich food 5. Increase ascorbic acid 6. Health education 7. Periodical deworming specially among children and at least once during IInd trimester of pregnancy 8. Nutritional supplementation 9. Foot wear use 10. Safe drinking water • I. HEALTH PROMOTION Prevention of nutritional anemia
- 38. Contd… II. SPECIFIC PROTECTION 1.Food fortification 2.National nutritional anemia prophylaxis program (NNAPP) 3.National nutritional anemia control program (NNACP): The elemental iron was increased from 60 mg to 100 mg per tablet in 1992
- 41. GRADE (WHO) DEGREE OF ANAEMIA TREATMENT 11-14 gm/dl Normal Nothing required 9-11 gm Mild Oral iron therapy required 7-9 gm Moderate Parenteral iron therapy Less than 7 gm Severe Blood transfusion GRADING & T/t OF ANAEMIA
- 43. 1. Treat underlying cause (hook worm etc) 2. Oral iron therapy: 3-6mg/kg in 3 divided doses ( Hb rises by 0.4g/day) 3. Vit C, empty stomach or in between meals: For 6-8 wks after Hb is normal 4. Parental iron therapy ( Iron in mg=wt in kg× Hb deficit in gm/dl×4) 5. Blood transfusion –rarely when Hb<4gm/dl, CCF, severe infection with poor iron utilisation Treatment OF IDA
- 44. B) Folic acid deficiency 1. Necessary for DNA synthesis. 2. SOURCES: Liver, soya bean, dark green leafy vegetables 3. CAUSES: Strict vegetarian, Tape worm anemia, Repeated Pregnancy, Chronic diarrhea, malabsorption and recurrent infections 4. Cooking destroys folic acid 5. Deficiency disease: Megaloblastic anemia in children & pregnant mothers 6. Treatment with phenytoin / antimetabolites 7. T/T: Folic acid 2-5 mg/day 8. RDA: 500 mcg/day for pregnant mother
- 46. C) Vitamin B12 deficiency • Necessary for DNA synthesis. • SOURCES: Foods of animal origin only (fish, egg, meat) • DISEASES: Megaloblastic anemia, parasthesia of fingers & toes. • It is observed in breast fed infants of vit. B12 deficient mother & delayed weaning child • RDA: Vit. B12 1µg/day
- 47. Clinical features 1. Pale 2. Very sick 3. Irritable 4. Severe anorexia 5. Failure to thrive 6. Knuckle pigmentation (hands and nose) 7. Tremor and developmental regression
- 50. 2. National nutritional anaemia2. National nutritional anaemia Prophylaxis programmeProphylaxis programme •Initiated in 1970 being taken up by Maternal and Child Health (MCH) Division of Ministry of Health and Family Welfare. Now it is part of RCH programme. •Available studies on prevalence of nutritional anemia in India show that 65% infant and toddlers, 60% 1-6 years of age, 88% adolescent girls and 85% pregnant women
- 51. OBJECTIVESOBJECTIVES 1.1. Assess prevalenceAssess prevalence 2.2. Give anti anemic treatmentGive anti anemic treatment 3.3. Give prophylaxisGive prophylaxis 4.4. MonitoringMonitoring 5.5. EducationEducation
- 52. BENEFICIARIESBENEFICIARIES Children age group 1 to 10,Children age group 1 to 10, Pregnant and nursingPregnant and nursing mother,mother, Acceptors of familyAcceptors of family planning,planning, Adolescent girls.Adolescent girls. ORGANIGATIONORGANIGATION PHC and sub centersPHC and sub centers
- 53. Contd…Contd… ♦ Pregnant women : 100 mg Fe & 0.5mg folic acidPregnant women : 100 mg Fe & 0.5mg folic acid ♦ Children 6 to 60 months : 20mg Fe & 0.1 mg folicChildren 6 to 60 months : 20mg Fe & 0.1 mg folic acid Should be given 100 daysacid Should be given 100 days ♦ 6 to 10 years of age : 30 mg iron and 0.25 mg folic6 to 10 years of age : 30 mg iron and 0.25 mg folic acidacid ♦ Adolescent girls : 100 mg Fe & 0.5mg folic acidAdolescent girls : 100 mg Fe & 0.5mg folic acid ♦ Iron fortification in saltIron fortification in salt ♦ Screening test for anaemia done at 6 months,1 andScreening test for anaemia done at 6 months,1 and 2 years of age.2 years of age.
- 54. IRON FORTIFICATIONIRON FORTIFICATION Developed by National Institute of Nutrition, HyderabadDeveloped by National Institute of Nutrition, Hyderabad Addition of ferric ortho phoshate or ferrous sulphateAddition of ferric ortho phoshate or ferrous sulphate with sodium bisulphate was enough to fortify salt withwith sodium bisulphate was enough to fortify salt with iron.iron. When consumed for 12-18 monthsWhen consumed for 12-18 months --reduce prevalence of anaemia.--reduce prevalence of anaemia. Commercial production since 1985.Commercial production since 1985.
- 55. Improving human capacity and productivity Increase school attendance & learning capacity Increase school attendance & learning capacity Elimination of gender disparity in secondary education Elimination of gender disparity in secondary education Adequate infant iron & Vit A store – improved infant survival and health Adequate infant iron & Vit A store – improved infant survival and health Reduce anemia related maternal deaths Reduce anemia related maternal deaths Halt and begin to Reverse the incidence of malaria and other major diseases Halt and begin to Reverse the incidence of malaria and other major diseases
- 57. INTRODUCTIONINTRODUCTION • Vitamin A deficiency (VAD) is a major nutritional concern in poor societies, especially in lower income countries like INDIA. • Vitamin A is an essential nutrient needed in small amounts for the normal functioning of the visual system, and maintenance of cell function for growth, epithelial integrity, red blood cell production, immunity and reproduction.
- 58. EPIDEMIOLOGYEPIDEMIOLOGY • Is a major public health problem in developing countries • 250,000 preschool children become blind each year worldwide due to vit.A deficiency • Improving vit.A status reduce young child mortality by 23% or more • Infants and young children under 5 year of age are at highest risk because - poor stores at birth - milk and supplementary food( low vit.A) - infection including diarrheal disease and - growth sets requirement high
- 62. • Inadequate consumption of vitamin A rich food • Problem of absorption, like disorders associated with fat malabsorption, such as cystic fibrosis, cholestatic liver disease, small bowel crohn’s, and pancreatic insufficiency • Problem in conversion or utilization of vitamin A • Repeated infections or diseases such as measles or diarrhea • Absence of food containing oil or fat in the diet
- 63. • Night blindness. • Keratomalacia. • Conjunctival dryness, corneal dryness, xerophthalmia. • Bitot’s spots. • Corneal perforation. • Blindness due to structural damage to the retina.
- 64. • Conjunctival dryness owing to vitamin A deficiency. • Follows chronic conjunctivitis and vitamin A deficiency diseases. • Eyes fail to produce tears in this condition.
- 65. Classification of xerophthalmiaClassification of xerophthalmia • XN Night blindness • X1A Conjunctival Xerosis • X1B Bitot’s spot • X2 Corneal Xerosis • X3A Corneal ulceration/keratomalacia (< 1/3 corneal surface) • X3B Corneal ulceration/keratomalacia (≥ 1/3 corneal surface) • XS Corneal scar • XF Xerophthalmic fundus
- 66. Night BliNdNess • Lack of vitamin A causes night blindness or inability to see in dim light. • night blindness occurs as a result of inadequate pigment in the retina. • It also called tunnel vision. • Night blindness is also found in pregnant women in some instances, especially during the last trimester of pregnancy when the vitamin A needs are increased.
- 67. Night blindness
- 68. Bitot’s spot • These are foamy and whitish cheese-like tissue spots that develop around the eye ball, causing severe dryness in the eyes. • These spots do not affect eye sight in the day light.
- 69. CoNjuNCtival Xerosis• Conjunctiva becomes dry and non wettable. • Instead of looking smooth shiny it appears muddy &wrinkled.
- 70. KeratomalaCia • One of the major cause for blindness in India. • Cornea becomes soft and may burst • The process is rapid • If the eye collapses vision is lost.
- 71. • An anomaly in the cornea due to a damage in the corneal surface.
- 72. Other Symptoms of VAD • Alteration of skin and mucous membrane • Hepatic dysfunction • Headache • Drowsiness • Peeling of skin about the mouth and elsewhere
- 74. • Treatment for subclinical vitamin A deficiency includes the consumption of vitamin A-rich foods. • For clinically evident vitamin A deficiency, treatment includes daily oral vitamin A supplements.
- 76. Eating at least 5 servings of fruits and vegetables per day is recommended in order to provide a comprehensive distribution of carotenoids. A variety of foods, such as breakfast cereals, pastries, breads, etc., are often fortified with vitamin A.
- 77. • Increase consumption of dark green leafy vegetables. Egg, livers, fat of fish and meat and cod liver oil can be provided • Vitamin A should be supplemented in malnutrition, diarrhea, measles and acute respiratory infection. • Distribution of vitamin A capsule should be given to the community. – One capsule every 6 months up to 6 year of age • One drop of vitamin A (25,000IU) for every child with immunization schedule
- 80. vitamiN a prophylaXisvitamiN a prophylaXis programmeprogramme • Initiated in 1970 • Implemented through RCH Programme. • Age group 6 months-6 year • Priority to Vitamin A deficient geographical area • OBJECTIVE Prevent blindness due to Vitamin A Deficiency • ORGANIGATION PHC and subcenter
- 81. • Beneficiary group –preschool children (6 months to 6 years) • A single massive dose of oily preparation of Vitamin A 200,000 IU (retinol palmitate 110mg) orally every 6 months for every preschool child above 1 year half the amount in < than 1 year children
- 82. Sick Children: • All children with xerophthalmia are to be treated at health facilities. • All children having measles, to be given 1 dose of Vitamin A if they have not received it in the previous month. • All cases of severe malnutrition to be given one additional dose of Vitamin A.