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Nutritional Anaemia

  1. Iron
    1. Important Points
      1. Adult human body contains between 3-4g of iron
        1. 60- 70% of iron of human body is present in blood
        2. 1- 1.5g as storage iron
        3. Each gm of Hb contains 3.34 mg of iron.
        4. Average iron content of breast milk is less than 0.2mg/dl and is well utilized.
        5. Iron absorption from normal Indian diet is less than 5%
        6. IUD increase blood loss by 35-146%
        7. Hormonal contraceptives decrease menstrual blood loss by about 50%
    2. Sources of iron:
      1. Haem-iron:
        1. liver
        2. meat
        3. poultry
        4. fish.
          Also improves the absorption of non-haem iron
      2. Non-haem iron: vegetable origin
  1. Iron deficiency Anemia:
    1. India:
      1. Incidence is 60-70 % in women and young children.
      2. Folate deficiency anemia in 25- 50% pregnant women.
      3. 20-40% maternal deaths are contributed by anemia.
    2. Interventions:
      1. National Nutritional Anemia Prophylaxis programme.
      2. Beneficiaries: pregnant, lactating women and children between 1-12 years (at risk).
    3. Eligibility criteria:
      1. Hb 10-12 gdaily supplementation with IFA tablets.
      2. Less than 10 g→refer to nearest PHC.
    4. Daily Recommended Iron Intake:
      1.  Adult Male     = 24 mg/dl
      2. Adult women  = 32mg/dl
      3. Pregnancy      = 40 mg/dl
      4. Lactation        = 32mg/dl
      5. Infants           = 1 mg/dl
Prevalence of anaemia in women of reproductive age is 52% and in pregnant women is 50%. In children aged 6mnth -3 years, it is 74%.
  1. Interventions:
    1. Iron and folic acid supplementation:
      In pregnant women, IFA tablets are given prophylactically containing 100mg elemental iron (ferrous sulphate) and 500 mcg folic acid for 100 days during antenatal and postnatal periods.

      Remember :- Start the intervention only in Second Trimester.
      The dosage for children contains 20 mg iron and 100 mcg elemental iron.
    2. Iron fortification:
      Addition of ferrous sulphate with sodium bisulphate or ferris orthophosphate to salt has been  done. Double fortified salt contains both iodine and iron.
  1. Fluorine
    1. Sources: drinking water, sea fish, cheese, tea
    2. Inadequate intake causes dental caries
    3. Fluorine content of drinking water in fluorosis- endemic area: 3-12 mg/l
    4. Toxic manifestations of fluorosis
      1. Dental fluorosis
        1. Occurs during first 7 years of life
        2. Characterized by mottling of dental enamel
        3. Best seen on upper incisors
        4. First sign: Loss of shiny appearance of teeth and chalky white patches
        5. Reported at levels above 1.5 mg/L
      2. Skeletal fluorosis
        1. Associated with lifetime daily intake of 3.0 to 6.0 mg/L
        2. Crippling fluorosis at concentration above 10 mg/L
  1. Genu valgum associated with sorghum (jowar) based diet. Q
    Recommended content of fluoride in drinking water: 0.5 –0.8 mg/l
    And in temperate countries: 1-2 mg/L
  2. Endemic fluorosis
    1. This occurs in places with high levels of fluorine in water (3 – 5 mg/L)
    2. However the Safe limit of Fluorine in drinking water in India is – 0.5 to 0.8 mg / dl.
    3. Remember:- Dental Fluorosis if F2 above 1-2 mg/l
      1. Skeletal Fluorosis if F2 3-6 mg/l
      2. Crippling if Fluorosis above 10 mg/l
    4. Intervention:-
      1. Change the source of water
      2. Nalgonda technique: For defluridation Lime and alum are added to water followed by flocculation, sedimentation and filtration.
      3. Avoid using Flouride toothpaste in endemic areas.
  1. Zinc
    1. Suggested daily intake for
      1. Adult man: 15 mg/day
      2. Adult woman: 12 mg/day
      3. Children: 10 mg/day
      4. Infant: 5 mg/day
    2. Clinical features of zinc dficiency
      1. Severe maternal zinc deficiency: spontaneous abortion, congenital malformation
      2. Milder zinc deficiency: Low birth weight, IUGR and pre-term delivery.
        Estimated copper requirement for adult: 2.2 mcg/day.
      3. Dietary Antioxidants: vitamins A, C, E and mineral selenium.
  2. ​​Iodine
    1. Adult human contains 50 mg of iodine
    2. Blood level: 8-12 mcg/ dl
    3. Best source of iodine is seafood. Smaller amounts are found in milk, meat, vegetables and cereals.
    4. RDA: 150 microgram / day
  1. Iodine deficency disoders
    1. Spectrum of IDD includes (direct questions are asked over this)
    2. Goitre (most common)
    3. Hypothyroidism
    4. Subnormal intelligentsia including delayed mile stones, Mental deficiency, hearing defect, Speech defect.
    5. Squint (Strabismus)
    6. Nystagmus
    7. Spasticity (Extrapyramidal type)
    8. Neuromuscular weakness
    9. Endemic cretinism
    10. IUD ( Spontaneous abortion)
  2. Indicators for epidemiological assessment of iodine deficiency
    1. Prevalence of goiter.
    2. Prevalence of cretinism.
    3. Urinary iodine excretion: best indicator of surveillance or impact of the control program.
    4. Thyroid function test by determination of serum levels of T4 and TSH.
    5. Prevalence of neonatal hypothyroidism: sensitive indicator of environmental iodine deficiency or measuring IDD in the community.
    6. Iodized salt: level of iodization fixed by PFA; 30 ppm at production point
                                                                          15 ppm at consumer level
  3. One question always debated is
    1. Most common measure on estimating impact of IDD Control Program is Urinary Iodine excretion BUT
    2. Most common method of measuring IDD in a community is Neo-natal hypothyroidism.Q
    3. Control of IDD by
      1. Iodized Salt:- Iodization not less than 30 ppm at production level and 15 ppm at consumer level
      2. Iodized oil:- Intra muscular injection of POPPEY SEED IODIZED OIL 2 ml which provides a pr otection for 4 years.
      3. Iodized oil oral:- Sodium Iodate tablet.

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