Iron Deficiency in Young Children in Low-Income Countries and New Approaches for Its Prevention

17.06 |

Abstract

Anemia resulting from severe iron deficiency (ID) is the most prevalent and widespread nutrition-related health problem in infants and young children in low-income countries and has proven very resistant to prevention through public health interventions. Accumulative evidence from animal and human studies suggests that such deficiencies are associated with large adverse effects on child cognitive and motor development. Therefore, effective interventions to improve iron status will have large health benefits. Action to reduce young child ID would benefit from overarching policy and programmatic guidance that informs decision makers about what to do, when to do it, and how to do it. The impetus for new approaches to prevent ID in young children reflects growing recognition of the need to intervene early and often and for better vehicles to deliver iron. Prevention of ID requires strong delivery systems that enhance consumer demand and promote compliance. When this occurs, the prevalence of anemia is greatly reduced.

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Introduction

Anemia resulting from severe iron deficiency (ID)³ is the most prevalent and widespread nutrition problem in infants and young children in the developing world (1) and has proven very resistant to prevention through public health interventions. Accumulated evidence from animal and human studies suggests that such deficiencies are associated with adverse effects on child cognitive and motor development (2–4). Therefore, effective interventions to improve iron status will likely have important health benefits.

Action to reduce young child ID would benefit from overarching policy and programmatic guidance that informs decision makers about appropriate intervention(s) or what to do, when to do it, and also addresses appropriate delivery models or how to do it. Most policies do not consider the role of maternal iron status or birth practices in the etiology of ID; supplementation for pregnant women is recommended for maternal health and not as a broader strategy to also improve newborn iron status. Interventions that could protect iron status at birth and during the first 6 mo of life, such as delayed umbilical cord clamping (5) and promotion of exclusive breast-feeding are rarely considered. In some settings, deworming is also a useful intervention to consider (6). The opportunities for different and mutually reinforcing interventions to prevent ID in young children need to be harnessed.

In this introductory article, I discuss how ID and iron deficiency anemia (IDA) are defined and present anemia prevalence and trend data. I also summarize how new approaches to prevent ID in young children reflect a number of factors, including the recognition of the multiple opportunities where intervention is possible and the development of new vehicles to deliver iron. I close with a description of why attention to delivery systems and monitoring and evaluation is so important and a success story to illustrate how the prevalence of young child anemia can be greatly reduced.

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