Prevalence of Anaemia Amongst Young Children in Argentina
By Adrian Díaz, Amador Gómez, Nuria Salse and Gabriela Cormick
Adrian Díaz is a physician and Technical Coordinator for ACH in Argentina. He has worked with MSF in Honduras on a nutrition and medical programme with the de Misquitos population and on nutritional projects with Medecins Du Monde in Greater Buenos Aires.
Amador Gomez is Technical Director of Accion Contra el Hambre (ACH). Previously he spent several years working on nutrition and medical programmes in Angola, Somalia, Guinea, Nicaragua and Colombia.
Nuria Salse is a nurse/ nutritionist who has worked with ACH in Angola, Guinea and Argentina.
Gabriela Cormick is a nutritionist who has worked with the ACH team in Santa Fe during this project.
Our most sincere gratitude to Reyes Varella, ACH-Argentina Head of Mission, for her help and support during this project.
This field article outlines the results of a nutritional study carried out by ACH in Argentina, which highlights how anaemia remains a public health issue, impacting on intellectual development in school age children.
Acción Contra el Hambre (ACH) has been working in Argentina for the past three years, implementing relief and development programmes in the nutrition and food security sectors. In April 2003, the City of Santa Fe (390,000 inhabitants) was affected by significant flooding. The impact of the disaster on the population affected more than 130,000 people who were evacuated into public and private buildings (schools, stadiums, parishes, clubs, tents, etc.) and 23 deaths were reported.
Taking blood sample at school for Hb test
In this context of emergency, a nutritional survey was carried out by ACF. The study included assessment of anthropometric status and haemoglobin (Hb) levels in children and also examined a number of socio-economic variables, as well as neurodevelopment in young students. This article focuses on the identification of anaemia and its link with intellectual development, learning capacity and early childhood development in young school age children. Analyses of the anthropometric findings are not included.
The study sampled from three different types of sites covering the most vulnerable population areas: Homes, Centres for Evacuees, and Schools. Selection criteria varied for each type of site (see table 1). Variables assessed in the home and evacuee sites were socio-economic (home structure, conditions of the house prior to floods), prior health (weight at birth, amount and quality of health checks in the past two months), anthropometry (weight and height), and biochemistry (red blood cell Hb). The school survey assessed anthropometric status (weight and height) and red blood cell Hb levels. Students were also evaluated through an academic survey questionnaire completed by the teachers at the end of the schooling cycle.
|Table 1 Sample selection|
|Homes||Children aged between 6 and 71 months||Representative sample, auto-weighted stratified by conglomerates (40 sample Primary Units)||Provincial institute of Statistics and Censuses|
|Centres for Evacuees||Children aged between 6 and 71 months||Exhaustive study, including all centres for evacuees (23)||Secretariat of Communitarian Promotion - Santa Fe Municipality|
|Schools||First-grade students (aged between 6-7 years old)||Exhaustive study, including all flooded schools (14)||Ministry of Education - Santa Fe Municipality|
|Table 2 Academic Survey Questionnaires|
|The Pupil has difficulties in holding the attention during classroom work?|
|Concentration||The Pupil DOES NOT finish a task that he/she has started and goes from one incomplete activity to another one?|
|Memory||The Pupil easily forgets school contents and/or what he/she remembers is deficient, nothing or inexact?|
|Conceptualisation||The Pupil has difficulties in solving problems and comprehending tasks?|
|Anticipation||The Pupil shows difficulties following the required steps to develop a task?|
Prevalence of anaemia
Anaemia was defined as a Hb value lower than the 5th percentile of the normal distribution, as proposed by the WHO1. Hb levels were measured using a portable photometer (Hemocue,). Five areas of intellectual development were explored in the academic survey: attention, concentration, memory, conceptualisation and anticipation. A guiding question was formulated for each of the studied areas (see table 2). Each question required one of three responses, 'Very Frequently', 'Frequently', and 'Rarely', which were given scores of 3, 2 and 1 points, respectively. The sum of these points gave the Global School Performance.
A total of 1089 children were included in the Homes group, 218 children in the Centres for Evacuees, and 626 children in the School group. With regards to the biochemical variable, anaemia was a highly relevant problem in all of the studied groups, significantly more so in Homes and Centres for Evacuees (children aged 6 to 71 months) when compared with the school group (see graph 1). However, it stands out that anaemia in the infantile population prevailed in the Centres of Evacuees compared to the one found in Homes, despite corresponding age groups (p=0.007). The most affected group were children less than 2 years old, where the proportion of anaemia reached 48% in homes and 61.5% in evacuee centres. There was also a statistically significant association in the home sample between anaemia and overcrowding (p=0.02) and anaemia and conditions of the house (p<0.000).
In the School survey, the group of children who were older than the normal age for their course had a higher prevalence of anaemia than the group of normal age for their course (p< 0.009) (see graph 2). Sixty percent of children were classified as having low school performance. The percentage of children with low school performance was significantly greater amongst those with anaemia compared to the non-anaemic ones (p=0.024) (see graph 3). The functions most affected in relation to anaemia were those of conceptualisation (p=0.0009), anticipation (p=0.023) and memory (p=0.032).
This study demonstrates the significance of anaemia as a public health problem in traditionally affected groups, such as children less than 2 years old and pre-schoolers, as well as school-age children. Furthermore, there appears to be a strong linkage between anaemia, learning capacity and school performance.
The findings of this survey support another recent study by ACH in a population of children less than 6 years of age in the province of Tucumán2. Here, nutritional deficiencies, in conjunction with other poverty related factors, are showing to have a significantly adverse impact on neurodevelopment. These preliminary findings in turn, concur with other population studies in Argentina and elsewhere in the Latin America region and argue for types of nutritional interventions which are more oriented towards establishing balanced diets, than many of the current activities which focus largely on satisfying calorific needs.
Flood affected people in one of the camps in Santa Fe
Finally, the use of a rapid method for the determination of haemoglobin levels (Hemocue,) constitutes a highly effective method for detection and treatment of an otherwise hidden form of under-nourishment, i.e. iron deficiency anaemia. The method and study findings should help convince programme designers of the need and feasibility of systematically assessing nutritional anaemia in at risk groups, specifically in relation to growth and neurodevelopment.
With the knowledge of these results, ACH, in coordination with local health and school authorities in Santa Fe, initiated a programme of weekly supplementation with ferrous sulphate for children less than 6 years of age and first-graders. The results of this intervention will be written up and disseminated in the near future.
1WHO: Iron Deficiency Anaemia. Assessment, Prevention and Control. A guide for programme managers. WHO/NHD/01.3. 2001
2At time of writing, the results were not completed but will be available from ACH towards the end of 2005.
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Reference this page
Adrian Díaz, Amador Gómez, Nuria Salse and Gabriela Cormick (2005). Prevalence of Anaemia Amongst Young Children in Argentina. Field Exchange 26, November 2005. p16. www.ennonline.net/fex/26/prevalence