Environmental risk factors for iron deficiency anemia in children 12-24 months old in the area of Thessalia in Greece

Hippokratia 2008, 12(4):240-250

E. Tympa-Psirropoulou, C. Vagenas, O. Dafni, A. Matala, F. Skopouli


Background and aim: Iron deficiency anemia (IDA) is a common problem all over the world, which attacks mainly pregnant women, infants and children. The aim of the study was to estimate the prevalence of IDA in children 12-24 months old in a specific area of Thessalia, located in the central part of Greece, and to identify the environmental risk factors associated with it. Patients and Methods: In the first part of this cross-sectional and case-control study, the hemoglobin (Hb) levels of 938 children were estimated by a mobile photometer analyzer. In the second part of the study, children with Hb <11 gr/dl were compared with matched random selected controls in hematological, anthropometric and environmental parameters. The estimated laboratory values were Hb, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, zinc protoporphyrin, serum iron, serum ferritin, transferring saturation, total iron binding capacity and Hb electrophoresis. Finally 75 children (34 boys, 41 girls, mean age 17.51+3.5 months), who were found with IDA, constituted the case group while 75 healthy children constituted the control group.Results: The prevalence of IDA in the region was 7.99%. At the same time, a number of children with stigma of bthalassaemia (2.13%) was discovered, something that had escaped identification. There were no differences due to the method of determination (mobile or laboratory) in the values of Hb between the two groups. Significant differences were recorded (p <0.001) in all hematological and anthropometric parameters except for head circumference.Regarding environmental factors, significant differences were found in the following parameters: ratio rooms/number of family members (p=0.01), number of family members (p=0.01), number of children in the family (p <0.001), birth rate (p<0.001), education and profession of the parents (p<0.001), source of drinking water and sewage system (p<0.001), duration of breast feeding (p<0.001), milk consumption by the child during the period of the reported research (p<0.001), child’s health status according to the mother (p<0.001), and frequency of seeking pediatric care(p=0.02).Conclusions: Although the prevalence of IDA in this area of Greece is similar to the one observed in the rest of the developed world, it still consists a public health problem. The mobile method for Hb estimation should be introduced in Greece since its reliability to detect IDA has been, once more, confirmed. The application of simple questionnaires for the detection of the environmental IDA risk factors could help in the prognosis and prevention of anemia. Further improvement of the IDA status in Greece could be achieved through the dissemination of information about iron rich foods, the amelioration of environmental conditions and the application of reliable, easy to use and cheap methods for Hb estimation.