IRON DEFICIENCY AND ANAEMIA (IDA)

                   IRON DEFICIENCY AND ANAEMIA (IDA)

Iron deficiency is the world’s most widespread nutritional disorder, affecting both industrialized and developing countries. In the former, iron deficiency is the main cause of anaemia. In developing countries, the risk of anaemia is worsened by the fact that iron deficiency is associated with other micronutrient deficiencies (folic acid, vitamins A and B12), parasitic infestations such as malaria and hookworm, and chronic infections such as HIV. In the poorest populations, the usual diet is not only monotonous but also based on cereals which are low in iron and contain high levels of absorption- inhibitors. In these cases, iron stores are characteristically low, particularly in young children and pregnant women. Iron deficiency has profound negative effects on human health and development. In infants and young children, it results in impaired psycho- motor development, coordination and scholastic achievement, and decreased physical activity levels. In adults of both sexes, iron deficiency reduces work capacity and decreases resistance to fatigue. In pregnant women, iron deficiency leads to anaemia that is associated with an increased risk of maternal mortality and morbidity, foetal morbidity and mortality, and intrauterine growth retardation. While anaemia affects nearly 2000 million people worldwide, or about a third of the world’s population, iron deficiency may affect over twice as many. Overall, 39% of preschool children and 52% of pregnant women are anaemic, of whom more than 90% live in developing countries. In addition, many school-aged children are also anaemic. Iron deficiency and anaemia thus affect all age groups, and their far- reaching impact presents a true major hurdle to national development.

Measures to prevent iron deficiency

Measures to prevent iron deficiency should be part of an overall strategy to control anaemia. That strategy should be based on a combination of iron supplementation, dietary approaches, food fortification, and more general public health measures to address the other causes of anaemia. At present, the chief measure to control iron deficiency and anaemia in most countries consists of providing iron supplements to pregnant women and, less frequently, to young children. With regard to dietary improvement strategies, these are not often included in IDA control programmes. Their practical implementation is not always easy, since increasing the amount of bioavailable iron in the diet implies ensuring access to foods which are usually unaffordable or even frequently unavailable to population groups at risk of iron deficiency. These sources include, for example, animal foods and fresh fruits and vegetables. As a result, it is encouraging to note that more and more countries are embarking on iron fortification programmes.

HEPATITIS

                            HEPATITIS

                     

Hepatitis is a medical condition defined by the inflammation (swelling) of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. It can occur as a result of a viral infection or because the liver is exposed to harmful substances such as alcohol. Some types of hepatitis will pass without causing

Permanent damage to the liver. Other types can persist for many years and cause

Scarring of the liver (cirrhosis). In the most serious cases, it may lead to loss of liver function (liver failure) or liver cancer, which can both be fatal. These types of long-lasting hepatitis are known as chronic hepatitis.

SYMPTOMS OF HEPATITIS

Hepatitis may occur with limited or no symptoms, but often leads to jaundice (a

Yellow discoloration of the skin, mucous membrane, and conjunctiva), poor appetite, depression and malaise. Hepatitis is acute when it lasts less than six months and chronic when it persists longer. In many cases, hepatitis causes no noticeable symptoms, so when hepatitis is caused by a virus, many people are unaware they are infected. Similarly, many people with hepatitis caused by

Alcohols are unaware that their drinking is harming their liver.

Types of hepatitis

The most common types of hepatitis are described below.

Hepatitis A

This is caused by the hepatitis A virus; it’s the most common type of viral hepatitis. It is more common in countries where sanitation and sewage disposals are poor.

Around 350 cases are reported each year in England, with most cases occurring in people who have travelled abroad. Hepatitis A is usually caught by putting something in your mouth that has been contaminated with the faeces, sweat or saliva of someone with hepatitis A. It is usually a short-term (acute) infection and symptoms will pass within three months. There is no specific treatment for hepatitis A other than to relieve symptoms. A vaccination can protect you against hepatitis A. Vaccination is recommended if you are travelling to countries where the virus is common, such as the Indian subcontinent, Africa, Central and South America, the Far East and Eastern Europe.

Hepatitis B

Hepatitis B is caused by the hepatitis B virus. This can be found in blood and body fluids, such as semen and vaginal fluids, so it can be spread during unprotected sex, by sharing needles to inject drugs, and from pregnant women to their babies. Hepatitis B is uncommon in England and cases are largely confined to certain groups, such as drug users. Most people infected with hepatitis B are able to fight off the virus and fully recover from the infection within a couple of months.

However, a small minority of people develop a long-term infection. This is known as chronic hepatitis B. In some people, chronic hepatitis B can cause cirrhosis and liver cancer. Chronic hepatitis B is treatable with antiviral medication. A vaccination is available for preventing hepatitis B, which is recommended for people in high-risk groups, such as injecting drug users or healthcare workers.

Hepatitis C

Hepatitis C is the most common type of viral hepatitis. It is estimated that around

215,000 people in the UK have chronic hepatitis C. Hepatitis C is caused by the hepatitis C virus. This can be found in the blood and, to a much lesser extent, the saliva and semen or vaginal fluid of an infected person. It is particularly concentrated in the blood, so it is usually transmitted through blood-to-blood contact. Hepatitis C often causes no noticeable symptoms, or symptoms that are mistaken for the flu, so many people are unaware they are infected. Around one in four people will fight off the infection and will be free of the virus. In the

remaining three out of four people, the virus will stay in their body for many years. This is known as chronic hepatitis C. In some people, chronic hepatitis C can cause cirrhosis and liver failure. Chronic hepatitis C can be treated by taking antiviral medications, although there can be unpleasant side effects. There is currently no vaccination for hepatitis C.

Alcoholic hepatitis

Drinking excessive amounts of alcohol over the course of many years can damage the liver, leading to hepatitis. This type of hepatitis is known as alcoholic hepatitis.

It is estimated that as many as one in four moderate to heavy drinkers has some degree of alcoholic hepatitis. The condition does not usually cause any symptoms and is often detected with a blood test. If a person with alcoholic hepatitis continues to drink alcohol, there is a real risk that they will go on to develop cirrhosis and possibly liver failure.

RARER TYPES OF HEPATITIS

Hepatitis D

Hepatitis D, caused by the hepatitis D virus, is only present in people already infected with hepatitis B (it needs the presence of the hepatitis B virus to be able to survive in your body). Chronic hepatitis D can increase the risk of cirrhosis developing. Cirrhosis is more likely to develop in someone with chronic hepatitis B becoming infected with hepatitis D (superinfection). It is much rarer when both infections occur together (co-infection).

Hepatitis E

This is caused by the hepatitis E virus, It is contacted by putting something in your mouththat has been contaminated with the faeces of someone with hepatitis Person to-person transmission is rare.

Autoimmune hepatitis

Autoimmune hepatitis is a very rare cause of chronic (long-term) hepatitis. The white blood cells attack the liver, causing chronic inflammation and damage. This can lead to more serious problems, such as liver failure. The reason for this reaction is unknown. There are an estimated 10 to 17 cases of autoimmune hepatitis for every 100,000 people in Europe. Between the ages of 15 and 25, women are around three to four times more likely to be affected than men. However, in older age groups, both men and women are similarly affected.  Treatment for autoimmune hepatitis involves medicines that help suppress the immune system and reduce inflammation (immunosuppressant), and gradually reduce the swelling over several weeks and can then be used to control your symptoms.

when it comes to nutrition education, accentuate the positive.

MATERNAL AND NEONATAL TETANUS

              MATERNAL AND NEONATAL TETANUS

Neonatal tetanus is a form of generalized tetanus that occurs in newborns. Infants who have not acquired passive immunity because the mother has never been immunized are at risk. It usually occurs through infection of the unhealed umbilical cord, particularly when the cord is cut with a non-sterile instrument. In many countries, deliveries take place in unhygienic circumstances, putting mothers and their new-born babies at risk for a variety of life-threatening infections. Neonatal tetanus mostly occurs in developing countries, particularly those with the least developed health infrastructure. It is rare in developed countries. When tetanus develops, mortality rates are extremely high, especially when appropriate medical care is not available.

Symptoms:

A new-born infected with tetanus may appear perfectly healthy. The first sign usually comes two to three days later, when the baby’s jaw and facial muscles may tighten due to the tetanus poison. The baby’s mouth will continue to grow more rigid so that it becomes “locked” (thus the name “lockjaw” given to tetanus) and the new-born will no longer be able to breastfeed. The new-born’s body may stiffen or arch and he or she may convulse when stimulated by light, sound or being touched. Finally, the new-born may no longer be able to breathe and may die. Between 70 and 100 per cent of deaths occur between three days and 28 days after birth.

PREVENTION OF MATERNAL AND NEONATAL TETANUS

The Maternal and Neonatal Tetanus (MNT), Elimination Initiative aims to reduce MNT cases to such low levels that the disease is no longer a major public health problem. Unlike polio and smallpox, tetanus cannot be eradicated (tetanus spores are present in the environment worldwide), but through immunization of pregnant women and other women of reproductive age (WRA) and promotion of more hygienic deliveries and cord care practices, MNT can be eliminated (defined as less than one case of neonatal tetanus per 1000 live births in every district).

HEALTH EFFECT OF ADOLESCENT PREGNANCY

            

               HEALTH EFFECT OF ADOLESCENT PREGNANCY

     In low- and middle-income countries, almost 10% of girls become mothers by age16years, with the highest rates in sub-Saharan Africa and south-central and south-eastern Asia. The proportion of women who become pregnant before age 15 years varies enormously even within regions. Births to unmarried adolescent mothers are

Far more likely to be unintended and are more likely to end in induced abortion. Coerced sex, reported by 10% of girls who first had sex before age 15 years, contributes to unwanted adolescent pregnancies.

Dangers of adolescent pregnancy

Many health problems are particularly associated with negative outcomes of pregnancy during adolescence. These include anaemia, malaria, HIV and other sexually transmitted infections, postpartum haemorrhage and mental disorders, such as depression. Although adolescents aged 10-19 years account for 11% of all births worldwide, they account for 23% of the overall burden of disease (disability- adjusted life years) due to pregnancy and childbirth. Fourteen percent of all unsafe abortions in low- and middle-income countries are among women aged 15–19 years. About 2.5 million adolescents have unsafe abortions every year and adolescents are more seriously affected by complications than are older women. Up to 65% of women with obstetric fistula develop this as adolescents, with dire consequences for their lives, physically and socially.

Adolescent pregnancy is dangerous for the child

Stillbirths and death in the first week of life are 50% higher among babies born to

mothers younger than 20 years than among babies born to mothers 20–29 years old.

Deaths during the first month of life are 50–100% more frequent if the mother is an Adolescent versus older, and the younger the mother, the higher the risk. The rates of preterm birth, low birth weight and asphyxia are higher among the children of adolescents, all of which increase the chance of death and of future health problems for the baby. Pregnant adolescents are more likely to smoke and use alcohol than are older women, which can cause many problems for the child before and after birth.

Adolescent pregnancy adversely affects communities

Studies have shown that delaying adolescent births could significantly lower population growth rates, potentially generating broad economic and social benefits, in addition to improving the health of adolescents. Many girls who become pregnant have to leave school. This has long-term implications for them as individuals, their families and communities.

Progress to date

Rates of adolescent childbearing have dropped significantly in most countries and

regions in the past two to three decades. Age at first marriage is increasing in many Countries, as are rates of contraceptive use among both married and unmarried Adolescents. Educational levels for girls have risen in most countries, and job opportunities have expanded. Low education levels are closely associated with early childbearing.

COMPLEMENTARY FEEDING PRACTICE

               COMPLEMENTARY FEEDING PRACTICE

Complementary feeding is defined as the process starting when breast milk alone is no longer sufficient to meet the nutritional requirements of infants, and therefore other foods and liquids are needed, along with breast milk. The transition from exclusive breastfeeding to family foods referred to as complementary feeding,   typically covers the period from 6 - 24 months of age, even though breastfeeding may continue to two years of age. This is a critical period of growth during which nutrient deficiencies and illnesses contribute globally to higher rates of undernutrition among children under- five years of age.

A number of successful strategies have been developed to improve complementary feeding practices in low and middle-income countries, where practical difficulties can limit adherence to complementary feeding guidelines.

A period of vulnerability and opportunity÷

Greatest vulnerability to malnutrition and infection: Nutritional needs for growth and development between 6-24 months of age are greater per kilogram of body weight than at any other time of life. Growth faltering occurs mainly in the first two years of life in all regions of the world. Insufficient nutrient intake and illness resulting from the introduction of pathogens in contaminated foods and feeding bottles are major causes of malnutrition.

Brain and body development: Good nutrition is essential at this time to ensure healthy brain and body development.

Long-term, irreversible consequences.

Poor feeding practices and low quality food can affect future learning ability, economic productivity, immune response, and reproductive outcomes. Children who are undernourished before they reach their second birthday and later gain weight rapidly after the age of two years are at high risk of nutrition-related chronic disease as adults.

Window of opportunity: Nutrition interventions during this period can lead to great benefits. Feeding practices appropriate for the child’s age, nutritionally adequate foods, and continued breastfeeding can ensure optimal growth and development

Poor complementary feeding practices.              

     ·      Poorly timed introduction of complementary  foods (too early or too late)

·        Infrequent feeding (children need to be fed frequently throughout the day because of their small stomach size)

·        Poor feeding methods, hygiene, and child care practices

·        Unsupervised feeding

·        Lack of interaction between caregiver and child

·        Unhygienic food preparation storage and unclean feeding utensils

·        Bottle-feeding

WHO recommendations

Infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods, while continuing to breastfeed for up to two years.