Is A Condition In Which The Hemoglobin Concentration In The

is a condition in which the hemoglobin concentration in the blood is below a defined level, resulting in a reduced oxygen-carrying capacity of red blood cells. It is the most common hematologic disorder.

(1) inadequate production of RBC’s or RBC

components (2) Increased destruction of RBCs, and (3) excessive loss of RBCs (Hockenberry and Wilson, 2007). It occurs at all stages of the life cycle, but is more prevalent in pregnant women and young children (WHO Worldwide prevalence of anaemia 1993-2005).

is caused by an inadequate supply or loss of iron. It is the most prevalent nutritional disorder and the most preventable mineral disturbance. It is generally assumed that 50% of the cases of anemia are due to iron deficiency, but the proportion may vary among population groups and in different areas according to the local conditions. The main risk factors for IDA include a low intake of iron, poor absorption of iron from diets high in phytate or phenolic compounds, and period of life when iron requirements are especially high

I.

Inadequate supply of iron  Deficient dietary intake Rapid growth rate Excessive milk intake; delayed addition of solid foods Poor general eating habits Exclusive breast-feeding of infant after 6 months of

age  Inadequate iron stores at birth Low birth weight, prematurity, multiple births Severe iron deficiency in mother Fetal blood loss at or before delivery

Impaired iron absorption  Presence of iron inhibitors Phytates, phosphates or oxalates Gastric alkalinity  Malabsorption disorders Lactose intolerance Inflammatory bowel disease  Chronic diarrhea iii. Blood loss  Acute or chronic hemorrhage  Parasitic infestation  Excessive demands for iron required for growth  Prematurity  Adolescence  Pregnancy II.

Visible severe wasting – severe wasting of the

shoulders, arms, buttocks, and legs, with ribs easily seen, and indicates presence of marasmus. Edema of both feet Weight for age - weight for age indicator is a standard growth chart that helps identify children with low or very low weight for age and who are at increased risk of infection and poor growth and development Palmar pallor

• • • • •

Visible severe wasting or Severe palmar pallor or Edema of both feet

• SEVERE MALNUTRITION OR • SEVERE ANEMIA

Give first dose of vitamin A Needs urgent referral to a hospital

Some palmar pallor or (Very) low weight for age

ANEMIA OR (VERY) • LOW WEIGHT •

Assess the child’s feeding and counsel the mother accordingly on feeding If there is a feeding problem, follow up in 5 days If pallor is present, give iron (1 dose daily) Syrup to a child 12 months of age Iron tablets if the child is 12 months or older If the child is receiving antimalarial sulfadoxine-pyrimethamine, do not give iron/folate tablets until a follow up visit in 2 weeks, as this can interfere with the action of the antimalarial In areas where hookworm or whipworm is a problem, give mebendazole if the child is 2 years or older and has not had a dose in the previous 6 months Follow up in 14 days If very low weight for age, give vitamin A Follow up in 30 days Advise mother when to return immediately

• • • •

•

• • • •

•

NOT (very) low weight for age and no other

NO ANEMIA AND NOT • (VERY) LOW WEIGHT

If the child is less than 2 years old, assess the child’s feeding and counsel

VITAMIN A Treatment: Give one dose in the health center    Supplementation: Give one dose in health center if: Child is six months of age or older, Child has not received a dose of vitamin A in the past 6 months

AGE

Vitamin A capsules

100,000 IU

200,000 IU

6 months up to 12 months

1

½ capsule

12 months up to 5 years

-

1 capsule

Give one dose daily for 14 days AGE OR WEIGHT IRON/FOLATE TABLE Ferrous Sulfate 200mg+250mcg Folate (60mg elemental iron) 3 months up to 4 months (4 - <6 kg) 4 months up to 12 months (6 - <10 kg) 12 months up to 3 years (10 - < 14 kg) 3 years up to 5 years (14 – 19 kg)

IRON SYRUP Ferrous sulfate 150mg per 5ml (6mg elemental iron per ml)

IRON DROPS Ferrous sulfate 25mg (25mg elemental iron per ml)

2.5 ml (1/2 tsp)

0.6 ml

4 ml (3/4 tsp)

1.0 ml

½ tablet

5 ml (1 tsp)

1.5 ml

1 tablet

10 ml (1 ½ tsp)

2.0 ml

de Benoist, Bruno, Erin McLean, Ines Egli, and Mary

Cogswell, Worldwide prevalence of anaemia 119932005 WHO Global Database on Anaemia  http://www.who.int/en/

Food and Nutrition Research Institute (FNRI)  http://www.fnri.dost.gov.ph Hockenberry, Marilyn J. and David Wilson. 2007

Wong’s Nursing Care of Infants and Children, 8th ed. pp. 1516-1517. Elsevier Pte. Ltd. Singapore. Model Chapter for Textbooks IMCI (Integrated Management of Childhood Illnesses), World Health Organization, 2001