The iron factor

Education and awareness, along with the provision of safe iron fortificants by the government, can help alleviate deficiency of iron in income-poor households

Ayesha, a frail young woman working as a house maid in Lahore, often has bouts of severe weakness and body aches. Not having reached the age of 30, she is a mother of three children, who keep her on her toes.

“Sometimes I get nauseated, at other times, my limbs feel shaky and my entire body gets feverish,” Ayesha complains. Occasional blood tests have shown that she has iron deficiency, although she isn’t anaemic. “Doctors say that the blood level in my body is very low,” she explains.

Iron deficiency is a major cause of anaemia and is common in developing countries like Pakistan. Its prevalence is greater in females and children.

Iron is an essential mineral required by our body to carry out the important function to transport oxygen from lungs to cells in our body. If the iron supply is not adequate, the haemoglobin production does not take place and the number of red blood cells decreases. This condition is known as anaemia.

In a 2016 report, the World Health Organisation (WHO) estimated that anaemia affected over 1.62 billion people worldwide. The most affected group was pre-school-age children, with a prevalence of 47 percent, followed by women, school-age children and people older than 60 years of age. Men with a prevalence of 12 percent were the least affected group. The most affected regions were Southeast Asia and Africa.

In the same year, a report by Aga Khan University quoted statistics showing a prevalence of around 45 percent iron deficiency anaemia in Pakistan, including 26 percent married women aged 15 to 44 reported to be anaemic in urban areas and 47 percent in rural areas.

The same report, Iron Deficiency anaemia among Women of Reproductive Age, an Important Public Health Problem: Situation Analysis, listed the most common cause of anaemia as malnutrition and poor dietary intake.

“Increased iron needs may be due to the increasing needs of the body as part of development, blood loss, worms, pregnancy, infections, inflammatory bowel disease or donations. Furthermore, women with gynaecological diseases or having heavy blood losses at menstrual periods are at an additional higher risk of developing anaemia……The problem increases with repeated pregnancies as body iron stores get depleted,” says the report.

A news feature published last month in The News quoted Amina Mujib Khan, a nutrition consultant at Ziauddin Hospital, Karachi, as saying that dietary intake in poorer households is limited to staple foods, such as rice and bread. “The average family in rural areas or urban slums is made up of 6-7 persons. Often women are left with the short end of the stick, and overlooked,” Khan had said.

“In children, either inadequate intake of iron through nutrition or loss of iron through some bleeding disorder may cause the iron deficiency,” Dr Areeba Farrukh, a Pediatric Resident at National Institute of Child Health (NICH), Karachi, explains.

“Most people are unaware that bottle feeding toddlers in excess with cow’s milk, actually leads to iron deficiency. Cousin marriages are also a big reason for diseases like thalassemia and faulty haemoglobin build-up, ultimately leading to iron deficiency and anaemia.”

Iron deficiency can cause fatigue, decreased motor abilities, impaired memory and can also cause delays in mental development. Anaemia in pregnancy can increase the risk of having a preterm delivery. Such preterm babies may have health concerns ranging from low birth weight and neural tube defects to death.

“Children with an iron deficiency suffer from slow mental and physical growth. They take little interest in daily activities and do not participate well in studies and outdoor sports. They may also be restless during sleep,” says Dr Areeba Farrukh.

The generation before the millennials is mostly aware of the cartoon character, Popeye the Sailorman, who when in need of an energy dose, would quickly gulp a tin of spinach – a vegetable rich in iron. Although the character was eagerly used by the then mothers to encourage their children in consuming spinach, in real life, overcoming deficiency in iron is not so simple.

Doctors suggest food intakes which are rich in iron. Good sources of iron are fruits, vegetables, whole grains, milk and milk products, lean meat, fish, dry beans, eggs and nuts. Patients with iron deficiency are prescribed iron supplements, with the prescription of the supplement for pregnant women highly recommended.

Iron fortified foods are also now seen on store shelves, with a recent advancement being the development of a variety of “in–home fortificants”, ranging from small packets of encapsulated micronutrients that can be mixed with any complementary food.

In developing countries, overcoming iron deficiency can be a challenging problem because iron rich foods – liver, meat, eggs, legumes etc, may not be affordable for most families. With nutrition being determined by the socioeconomic status of an individual, experts suggest coordinated effort by all the stakeholders.

Last year, the government of Pakistan launched the EHSAAS Programme. The primary aim of this programme is “to alleviate poverty by combining data with technology.” Similarly, Benazir Income Support Programme (BISP) working under EHSAAS, although addressing poverty by conditional and unconditional cash transfers, is also working towards reducing malnutrition. It has partnered with a corporate entity as well as with the Scaling Up Nutrition (SUN) movement, a global initiative aimed to end malnutrition. Using BISP data, SUN aims to educate the beneficiaries on nutrition.

Education and awareness along with provision of safe iron fortificants by the government could prove to be good measures to help alleviate deficiency of iron in particularly poorer households. Such programmes should be directed mainly towards women. Awareness programmes would also help remove many misconceptions, where especially women usually mistake their conditions as a temporary state, rely on street doctors for quick measures like injectables and never undergo a medical test to determine the real status of their condition.

“My doctor gives me a taaqat ka teeka (energy-boosting injection) and it makes me feel a lot better. I have tried taking some vitamin pills, but my heart burns when I consume them,” complains Ayesha. Little does she know that her temporary measures are not going to improve her health in the long term. Surely, she and many other women of the poorer households of Pakistan are in need of education as well as improved dietary intakes.

Names have been changed to protect privacy

The iron factor: Anaemia in Pakistan