Iron deficiency in the tropics.
Clin Haematol 1982 Jun;11(2):365-88
Iron in food is classified
as belonging to the haem pool, the nonhaem pool, and extraneous sources.
Haem iron is derived from vegetable and animal sources with varying bioavailability.
Hookworm infestation of the intestinal tract affects 450 million people
in the tropics. Schistosoma mansoni caused blood loss in 7 Egyptian patients
of 7.5- 25.9 ml/day which is equivalent to a daily loss of iron of .6-7.3
mg daily urinary loss of iron in 9 Egyptian patients. Trichuris trichiura
infestation by whipworm is widespread in children with blood loss of 5
ml/day/worm. The etiology of anemia in children besides iron deficiency
includes malaria, bacterial or viral infections, folate deficiency and
sickle-cell disease. Severe infections cause profound iron-deficiency
anemia in children in central American and Malaysia. Plasmodium falciparum
malaria-induced anaemia in tropical Africa lowers the mean haemoglobin
concentration in the population by 2 g/dI, causing profound anaemia in
some. The increased risk of premature delivery, low birthweight, fetal
abnormalities, and fetal death is directly related to the degree of maternal
anemia. Perinatal mortality was reduced from 38 to 4% in treated anemic
mothers. Mental performance was significantly lower in anemic
school children and improved after they received iron. Supplements of
iron, soy-protein, calcium, and vitamins given to villagers with widespread
malnutrition, iron deficiency, and hookworm infestation in Colombia reduced
enteric infections in children. Severe iron-deficiency anemia
was treated in adults in northern Nigeria by daily in Ferastral 10 ml,
which is equivalent to 500 mg of iron per day. Choloroquine, folic acid,
rephenium hydroxynaphthoate, and tetrachlorethylene treat adults with
severe iron deficiency from hookworm infestation in rural tropical Africa.
Blood transfusion is indicated if the patient is dying of anaemia or is
pregnant with a haemoglobin concentration 6 gm/dl. In South East Asia,
mg per day prevented iron-deficiency anaemia in pregnancy. Field-trials
on nutritional iron deficiency include an acidified milk formula plus
ferrous sulphate for infants; biscuits with added bovine hemoglobin for
children in Chile; sugar plus sodium ferric EDTA in Guatemala; salt with
ferric orthophosphate and sodium acid sulphate in India; and Salt with
ferrous sulphate plus sodium hexametaphosphate.