December 1994, Volume 44, Issue 12

Original Article

Anaemia in Children: Part II. Should Primary Health Care Providers Prescribe Iron Supplements by the Observation and Presence of Assumed Symptoms?

Inayat H. Thaver  ( Baqai Institute of Health Sciences, Karachi. )
Lubna Baig  ( Baqai Institute of Health Sciences, Karachi. )
Inam-ul-Haq  ( The Aga Khan University, Karachi. )
Romaina Iqbal  ( The Aga Khan University, Karachi. )


The dilemma of private practitioners is whether to prescribe or not to prescribe iron supplements on suspicion of anaemia. This cross sectional study was done in an urban squatter settlement with a primary health care centre to assess the significance of symptoms and a history of associated diseases in the diagnosis of anaemia. A total of 321 children were sampled from 1800 children <5 years of age in a population of 11,000, by systematic random sampling. Mothers were asked about the presence of assumed associated symptoms and diseases which were listlessness, irritability, anaemia, pica, poor weight gain, diarrhoea, acute respiratory infection and malaria in last 3 months. There was significant association between anaemia (Hb<11gms%) and irritability (P<.02), anorexia for solid foods (P<.04), pica (P<.001), episode of diarrhoea (P<.001) and poor weight gain (P<.006). There was no significant association between malaria, cold, cough and anaemia. children with these symptoms complex should receive iron supple­ments (JPMA 44:284,1994).


Nutritional deficiency problems are common in chil­dren less than 5 years of age. The figures for malnutrition in 1977 through Micro Nutritient Survey1 were more or less the same as in 1988 National Nutrition Survey2. The same is true for nutritional deficiency anaemia. According to. National Nutri­tional Survey, 19882 , the prevalence of anaemia in children was 65%. Jalil and Khan3 have shown that of all the anaemic children, almost 83% had iron deficiency anaemia. Besides, nutritional deficiency, malaria has been found to be one of the important causes4 of anaemia. Iron deficiency in infants and children is associated with lower weight gain, abnormalities of behaviour and mental performance which improves with treatment of iron5-8. It may also be responsible for a decreased humoral immunity and can lead to a number of infections. Nutritional iron deficiency anaemia is easier to cure, cal status and growth velocity9. The need to supplement iron by a primary health provider in an anaemic child can be justified by identifying the possible associations of anaemia with selective clinical findings and presumed symptoms of diseases.

Subjects, Methods and Results

This was a cross-sectional study in one of the squatter settlements of Karachi. Three hundred and twenty-one chil­dren, age 6-60 months, were randomly selected through 2 stage cluster sampling. Anaemia was labelled many child who had haemoglobin (Hb) less than 11 Grams%. Blood was collected by finger-prick and haemoglobin recorded on site immediately through the Hemocue (a digital instrument). Detailed history of children was taken from the mother or guardian, in case where mother was not alive. Data on demographics, socioeconomic status and morbidity was collected. The diseases of interest in the past history were: malaria, diarrhoea, respiratory tract infections and growth retardation. The symptoms investigated were: listlessness, irritability, pica and anorexia for solid foods. The data was entered on Dbase IV and analyzed through SPSS statistical package.  Of the 321 children, 205 (64%) were anaemic. Fre­quency distribution of the presumed symptoms and/or signs are shown in Table I.

Many children had a past history of cold and cough (79%), diarrhoea (62%) and poor weight gain (3 1%).

Table II shows that diarrhoea, irritability, pica, poor weight gaiti and anorexia for solid food were significantly associated with anaemia.


Clinical detection of anaemia followed by a brief and quick history of symptoms and diseases can help the physician to diagnose anaemia. Our study shows that if a child comes to a general practitioner with history of diarrhoea in the past and is irritable with pica and poor weight gain, anaemia should be suspected and iron supplements should therefore be given without any laboratory tests. However, they should be regularly followed and if no clinical improvement is seen after 6-8 weeks, they should be investigated. Itis recommended that alongwith curative care of anaemic children, prevention of anaemia should also be considered.


The authors would like to acknowledge the support extended to them by the staff and faculty of The Aga Khan University, for conducting this research.


1. Micro-nutritient Survey of Pakistan 1977-78. Nutrition Cell Planning and Development Division, Islamabad, Government of Pakistan. 1978, pp. 38. 55-57.
2. National Nutritional Survey 1985-87. Nutrition Division, National Institute of Health, Islamabad, Govemment of Pakistan, 1988, P. 35.
3. Jalil, F. and Khan, A. Nutritional anaemia, classification and effect of a therapeutic trial for proposed fortification programme. UNICEF Publication, 1988, p. 15.
4. McGregor, I.A. Malaria: nutritional implications. Rev.Infect.Dis., 1982;4:798-804.
5. Galan, P., Danila, M., Mikki, N. et al. Iron deficiency, inflammatory processes and humoral immunity in children. Int.J.Vitam.Nutr.Res. (GTF), 1988 ;58:225-30.
6. Burama, D. tron deficiency in infancy and childhood. Ctin.Hematol., 1981;11:339-51.
7. Oski, F.A. The non-hematologic manifestations of iron deficiency. Am.J.Dis.Child., 1979;133:315-22.
8. Lozoff, B. Behavioural alterations in iron deficiency. Adv. Paediatr., 1988;35:331-59.
9. Chinang, L.C., Soemantric, A.G. and Pollitt, E. Iron supplementation and physical growth of rural Indonesian children. Am. J.Clin.Nutr., 1988;47:496-501.

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