Meandros Med Dent J Original Article / Özgün Araştırma The Prevalance of Anemia and Nutriotional Anemia in Primary School Children in the City of Aydın Aydın İl Merkezi İlköğretim Okulu Öğrencilerinde Anemi ve Nütrisyonel Anemi Prevalansının Saptanması Emine Pektaş1, Yusuf Ziya Aral2, Çiğdem Yenisey3 1Adnan Menderes University Faculty of Medicine, Department of Child Health and Diseases, Aydın, Turkey 2Adnan Menderes University Faculty of Medicine, Department of Pediatric Hematology, Aydın, Turkey 3Adnan Menderes University Faculty of Medicine, Department of Biochemistry, Aydın, Turkey Abstract Objective: To determine the prevalence of anemia and nutritional anemia in primary school children in the city of Aydın. Materials and Methods: In Aydın, the central town of Aydın province, a total of 496 students (56% were female) were enrolled into the study by using stratified random sampling method. The students were from the primary schools located in socio-economically low, medium, and high areas of primary health care centers. The avarage age of the students was 10.2±2 years. Statistical analysis was performed using the Kolmogorov-Smirnov test, Student’s t-test, Mann-Whitney U-test and Chi-Square test. Results: The prevalence of anemia, iron-deficiency (ID), iron-deficiency anemia (IDA), vitamin B12 deficiency and vitamin B12 deficiency anemia was 15.7%, 38.7%, Keywords 8.3%, 9.1%, 0.8%, respectively. No folic acid deficiency was detected. Among the Anemia, prevalance, school age children, anemias, 42% of them were microcytic, 58% of them were normocytic and the iron, B12, folic acid 45.5% of the microcytic anemias were IDA. Among the females, the rate of ID was 45.1% and the rate of IDA was 11.6%, while in boys the same rates were 30.6% Anahtar­Kelimeler and 4.1%, respectively (p<0.05). Microcytosis was present in 36.5% of subjects with IDA. The Mentzer index was <13 in 13.3% of subjects with microcytic anemia Anemi, prevalans, okul çağı çocukları, demir, and IDA, and in 77.7% of children with microcytic anemia and no IDA (p<0.001). B12, folik asit Regarding socio-demographic characteristics of children; the only statistically significant difference was in the parameters of mother education and anemia. Received/Geliş­Ta­rihi : 09.11.2015 Conclusion: The prevalence of anemia represents a minor public health problem Accepted/Ka­bul­Ta­ri­hi : 10.11.2015 according to the World Health Organization criteria among the primary school students in the central town of Aydın province. Exploration of the reason of anemia among pre-school children, proper treatment of nutritional anemia cases doi:10.4274/meandros.2479 with adequate duration and dose, dietary organizations and proper follow-up will lower the incidence of anemia and nutritional anemia among primary school children. Our study showed that thalassemia trait is defined as a major problem Ad­dress­for­Cor­res­pon­den­ce/Ya­zış­ma­Ad­re­si: in the differential dignosis of IDA in our region. Diagnosing of these cases with Yusuf Ziya Aral MD, thalassemia will prevent the unnecessary iron therapy and will provide a genetic Adnan Menderes University Faculty counseling to the family. of Medicine, Department of Pediatric Hematology, Aydın, Turkey E-mail: [email protected] Öz Amaç: Aydın ili Merkez İlköğretim Okulu öğrencilerinde anemi ve nütrisyonel © Meandros Medical And Dental Journal, published by Galenos Publishing. anemi sıklığını belirlemektir. Gereç ve Yöntemler: Aydın il merkezinde, 2008-2009 öğretim yılında, sosyo- ©Meandros Medical And Dental Journal, Galenos Yayınevi tarafından basılmıştır. ekonomik düzeyi iyi, orta ve düşük sağlık ocağı bölgelerinde bulunan ve tabakalı Meandros Medical Journal 2015;16:97-107 97 98 Pektaş et al. The Prevalance of Anemia in Primary School Children in the City of Aydın rastgele örnek seçim yöntemine göre belirlenen ilköğretim okullarında eğitim gören 1-8. sınıf öğrencilerini kapsayan toplam 496 (%56’sı kız) öğrenci çalışmaya alındı. Çocukların yaş ortalamaları 10,2±2 idi. İstatistiksel analizler için Kolmogorov-Smirnov testi, Student t-testi, Mann Whitney U testi ve ki-kare testi uygulandı. Bulgular: Anemi, demir eksikliği (DE), demir eksikliği anemisi (DEA), B12 eksikliği ve B12 eksikliği anemisi prevalansı sırasıyla %15,7, %38,7, %8,3, %9,1, %0,8 saptandı. Folik asit eksikliğine rastlanmadı. Tüm anemilerin %42‘si mikrositer, %58’i normositer; mikrositer anemilerin %45,5’i DEA idi. Kızlarda DE oranı %45,1, DEA oranı %11,6 iken, erkeklerde bu oranlar sırasıyla %30,6 ve %4,1 idi (p<0,05). DEA’sı olanların %36,5‘inde mikrositoz mevcuttu. Mikrositik anemisi ve DEA olan olguların %13,3’ünde, mikrositik anemisi olup DEA olmayan olguların ise %77,7’sinde Mentzer indeksi <13 idi (p<0,001). Daha önce anemi saptanması ve demir ilacı verilmesi oranları anemi saptanan çocuklarda %33,3 ve %29,5, anemi saptanmayan çocuklarda %18,2 ve %15,6 idi. DEA saptanan öğrencilerin %19,8’i, saptanmayan öğrencilerin ise %19,5’i daha önce demir ilacı almıştı. Sosyo-demografik özelliklerden sadece anne eğitim düzeyi ile anemi arasında anlamlı ilişki bulundu. Sonuç: Aydın il merkezi ilköğretim okulu öğrencilerindeki anemi prevalansı Dünya Sağlık Örgütü’ne göre hafif düzeyde sosyal sağlık problemi oluşturmaktadır. Okul öncesi dönemde anemi saptanan çocuklarda nedenin aydınlatılması, tedavi verilen nütrisyonel anemili olguların uygun süre ve dozda tedavi almalarının sağlanması, beslenmelerinin düzenlenmesi ve izlemlerinin yapılması ilköğretim öğrencilerindeki anemi ve nütrisyonel anemi oranlarını düşürecektir. DEA saptanan çocukların yaklaşık 1/5’inin önceden tedavi alması, tedavi ve izlemlerin iyi yapılmadığını düşündürmektedir. Bu nedenle okul çocuklarında tarama programları yapılmalıdır. Introduction Materials and Methods Anemia is a disease having high prevalence This is a cross-sectional study which is performed worldwide. Anemia can occur at all stages of life between April and June 2009 on 496 children who mostly in pre-school age of children and pregnancy were students of 1st to 8st grades of primary schools. period (1). Iron deficiency (ID) is the most common Schools, which were selected by stratified random nutritional deficiency in childhood and affects 20-50% sampling method, are located in various areas of of world’s population (2-4). ID is a condition which primary health care centers with high, medium and causes growth retardation and cognitive development low socio-economic status. Sellection of schools was retardation, therefore, reduces performance capacity performed after categorizing them into three areas. of the country and causes damages on country’s Then, the schools ans classes were selected by using economic sources. Iron deficiency anemia (IDA) random number table. Children, who underwent is observed 36% and 8% of people in developing acute infection during the study and whose parents countries and economically advanced countries, did not give permission for blood tests, were excluded. respectively. The World Health Organization (WHO) Data Collection considers that it is an important health problem in The aim of the study was explained to the Turkey with a rate of above 40% (5). Directorate of National Education of Aydın province In childhood, adequate level of vitamin B12 and and to the school administrations and necessary folate are vital for the development of organ systems, permissions were obtained. After that, the study such as central nervous system, hematopoetic system, was explained to parents and their written consent and cardiovascular system. When deficiency takes were taken. The research group whas composed of place, particularly the tissues with fast regeneration paediatricians and nurses. A questionnaire has been capacity are affected (6). Childhood is the period when prepared and was distributed to the students in growth and development have the highest spead, order for their parents to answer. The questionnaire therefore, problems of childhood are significantly included socio-demographic information about the important (7). students, alimentation conditions, anemia history and If we take the clinical effects of all nutritional their medications. Development of participants were anemia into the consideration, it is important that assessed by a paediatrician using a marked length we should provide necessary precautions for public scale and weighing machine with minimum intervals health-care instead of just individual therapies. of one mm and 100 g, respectively. Two mililiters of To produce this data, screening investigations are blood was drawn by a paediatric nurse to an EDTA tube needed. This research was performed in order to for hemogram, and 3 mililiters in order to measure evaluate the prevalence of anemia an nutrirional serum iron, serum iron binding capacity, ferritin, B12 anemia among the students of Aydın primary schools. and folic acid to a regular test-tube by pediatric nurse. Meandros Medical Journal 2015;16:97-107 Pektaş et al. The Prevalance of Anemia in Primary School Children in the City of Aydın 99 Description its descriptive statistics were shown as mean ± SD. For the diagnosis of anemia, the lowest limit of Student’s t-test was used for independent groups. hemoglobin (Hb) level was defined as as 11.5 g/dl for The variables did not exhibit normal distribution, children aged 5-7 years, 12 g/dl for those aged 8-11 therefore, their descriptive statistics were shown as years, 12 g/dl for females aged 12-14 years, and 12.5 median (25-75%). The Mann-Whitney U-test was g/dl for males aged 12-14 years. ID was diagnosed