A recent survey conducted by a healthcare group in Gharo Sindh found that 60 percent of schoolgoing children aged between five and 15, especially girls, were anaemic. In fact, in some young children, the haemoglobin (Hb) level was below borderline, and immediate blood analysis was needed to rule out any blood disease.

Anaemia is a serious global public health issue that particularly affects young children, menstruating adolescent girls, women, pregnant and postpartum women. The World Health Organisation (WHO) estimates worldwide that 40 percent of children ranging between six and 59 months in age, 37 percent of pregnant women and 30 percent of women aged between 15 and 49 are anaemic.

Anaemia is a condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal. Haemoglobin is needed to carry oxygen and if you have few or abnormal red blood cells, or insufficient haemoglobin, there will be a decreased capacity of the blood to carry oxygen to the body’s tissues.

This results in symptoms such as fatigue, weakness, dizziness and shortness of breath, among others. The optimal haemoglobin concentration required to meet physiologic needs varies by age, sex, elevation of residence, smoking habits and pregnancy status.  

Studies show just how prevalent anaemia is in children but there’s little awareness on how diet can help manage the deficiency better

Anaemia may be caused by several factors such as nutrient deficiencies through inadequate diet or absorption of nutrients, infections (e.g. malaria, parasitic infections, tuberculosis, HIV), inflammation, chronic diseases, gynaecological and obstetric conditions and inherited red blood cell disorders.

However, the most common nutritional cause of anaemia is iron deficiency, although deficiencies in folate and vitamins B12 and A can also cause it. Iron deficiency anaemia simply means there is not enough iron in the blood. Iron is needed to form haemoglobin. This is the most common cause of anaemia and is the most common kind in Pakistan, caused largely by poor nutrition.

Pica (an eating disorder where you want to consume substances with no nutritional value), excessive tea consumption and not enough intake of Hem-Iron sources were identified as the leading causes. Anaemia is also most strongly associated with moderate and heavy hookworm infection. Hookworms reside in the small intestine of infected individuals, where they attach themselves to the villi and feed on the host blood.

People with inadequate iron intake and high physiological demands, or blood loss can result in anaemia. Some studies in Pakistan have even reported a 77 percent prevalence rate among young children.

Data on anaemic children

A study conducted on schoolgoing students in Dera Ismail Khan found that 58.8 percent of boys were anaemic at six years of age, whereas that figure for the same age group of girls was 70 percent. Results from other areas of Pakistan are a depressing read.

Anaemia had a frequency of 64.6 percent in children under 15 years of age at the GDA Hospital in Gwadar. The highest percentage of anaemic children were aged between one month and almost five years old. In our current study, we found 43.1 percent of students were anaemic in district Shaheed Benazirabad.

In another study conducted among schoolgoing children between the age of five and 15, out of 500 students, the most affected group was aged between seven and eight, followed by five to six years, and then nine to 12 years.

Why is anaemia so prevalent?

Poverty plays a vital role in the diet of the family; the lower the income, the poorer the diet, both in quantity and quality. Poverty impacts growth from early childhood, starting with brain development and other body systems.

It is important to recognise how poverty affects the household as a whole. Firstly, parents living below the poverty line often have difficulties meeting the basic economic needs for their families, such as rent, food, utilities, clothing, education, healthcare, transportation and childcare.

Living in poverty often means children having limited access to healthcare, food and housing security, which leads to a greater risk of them dropping out of school, homelessness, unemployment due to lack of education or childcare and not achieving one’s full potential. Most poor children achieve less, exhibit more problematic behaviours and are less healthy than children reared in more affluent families.

In Pakistan most schoolgoing children do not have a proper breakfast. During my research on what Pakistani children have for breakfast, my team recently interviewed 100 young girls, mostly kindergarten students in Lyari, and found that 60 percent did not have breakfast while 23 percent have just tea, 11 percent have tea and a biscuit, and six percent have paratha and tea.

Most of the food such children consumed lacks vital minerals, vitamins and even high-grade proteins, and they are thus likely to suffer from malnutrition, stunted growth and anaemia.

How diet can help

While animal products are known for being rich sources of iron, that doesn’t mean plant-based staples can’t help you meet your goal.

An infant and toddler needs between 7-16 mg of iron every day, depending on the child’s age. Spinach is packed with nutrients, but you’ll absorb more calcium and iron if you consume it cooked. Spinach is loaded with oxalic acid, which blocks the absorption of iron and calcium but breaks down under high temperatures. No matter how you prepare it, spinach is an excellent source of iron.

According to the United States Department of Agriculture (USDA), one cup of this healthy green (frozen and boiled) veggie delivers 3.72mg of iron, as well as some protein, fibre, calcium and Vitamins A and E.

Chickpeas (chholay) provide 3.7mg of iron per cup, according to the USDA, making them also an excellent source of iron and energy. They also deliver lean, plant-based protein — 14.6g per cup, to be exact.

A cup of raw green soybeans (soya ki phalli) contains about 9mg of iron, according to USDA, making them an excellent source of the nutrient. They’re also a good source of minerals such as copper, which helps keep blood vessels and the immune system healthy. A cup of soybeans is also an excellent source of manganese and fibre as well as provides plant-based protein.

Pumpkin seeds are a tasty, portable snack. A one-ounce (28g) serving contains 2.5mg of iron, and is a good source also of Vitamin K, zinc and manganese. Pumpkin seeds are also among the best sources of magnesium, which is a common dietary deficiency.

Fish is highly nutritious and certain varieties are high in iron. Fish is also brimming with Omega-3 fatty acids, which are a type of heart-healthy fat associated with a number of health benefits. In particular, Omega-3 fatty acids have been shown to promote brain health, enhance immune function and support healthy growth and development. The Palla (Tenualosa Ilisha) a type of shad or herring-like fish, is a freshwater fish caught and consumed in Sindh.

How to manage iron deficiency anaemia?

Mothers need to be taught about anaemia and how to manage it. The aforementioned foods mentioned are easily available and more affordable to eat and better for a child’s growth. Schoolteachers should also teach students about their benefits and must discuss anaemia during their parent-teachers meeting and make sure it is managed.

The writer is the director of Shine Humanity and is also head of the Malnutrition Programme, Sindh

Published in Dawn, EOS, October 15th, 2023