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Here is why the way we measure iron deficiency in children need to change

A study shows that 52% of the African children were iron deficient

| THE INDEPENDENT | A deficiency of iron for normal body function is the most common nutritional disorder in the world. Iron deficiency is the main cause of anaemia and is associated with poor brain development and long-term impairment of behavioural and cognitive performance in children.

Common symptoms of iron deficiency include pallor of the skin, eye and beds of nails, weakness, difficulty breathing, dizziness, headache, hair loss, dry or rough skin and cravings for non-food items such as ice, paper, dirt, or clay.

Iron deficiency is commonly diagnosed using laboratory blood tests that mainly measure levels of ferritin, a protein that stores iron. In Africa, the tests can be misleading because ferritin levels go up in a person’s body during inflammation or infections such as malaria. This means that a person who is iron deficient may appear iron replete if they’re carrying an infection.

It is therefore challenging to estimate the burden of iron deficiency in settings such as sub-Saharan African where infections are common.

But accurate estimates of the burden of iron deficiency are important for designing public health interventions dealing with nutritional iron levels. Giving iron supplements based on poor data can lead to the wrong children being targeted. This could include children who should be getting supplements but aren’t, and those who don’t need them being given supplements with possible adverse effects.

To help overcome this problem we set out to calculate more reliable estimates of the burden of iron deficiency in African children.

Our study highlighted that a huge burden of iron deficiency may be missed out given the current tools used to measure it. This is important for governments to properly plan, monitor, and target effective interventions to deal with iron deficiency on the continent.

We analysed data for 4,853 children from communities in Kenya, Uganda, South Africa, Burkina Faso and The Gambia. We used statistical modelling to correct for the effects of malaria and inflammation on iron biomarkers. We found that over half (52%) of the African children were iron deficient.

We also found that transferrin saturation, an indicator of transferrin-bound iron in the bloodstream, may more accurately estimate the burden of iron deficiency in African children. This is because transferrin saturation was the iron biomarker least influenced by infections. We found that transferrin saturation below 11% may indicate iron deficiency in African children. Transferrin saturation is easy to measure in routine laboratory tests.

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