iron deficiency anemia among preschooi

children (2-5) years in gaza striP

 Prepared by

Rojena el Hadad

Supervisor
Mr. Ayman Elsous

Graduation Project Submitted in Partial Fulfillment

of the Requirements for the Bachelor Degree in
Nursing Sciences
Abstract

Anemia is a major public health problem

worldwide, with adverse consequences on child
growth, development, and survival. This deficiency
has affected approximately a quarter of the world
population. This study Iwill aimed to determine
the prevalence of anemia and the associated
factors among preschool children in the Gaza Strip.
I will conducte this study To determine the
prevalence of IDA among preschool age children
living in Gaza strip and To observe mild and
moderate cases among children, whereas severe
anemia was not observed A cross-sectional study
1 will conduct in 2020. A total of 400 preschool
children I will select and I will using multistage
sampling method from Jabalya refuge camp, El
Remal urban area, and Al Qarara rural area.
Hemoglobin level I will measure, and anemia
diagnosis was confirmed at a level <11.0 g/dL. In
this study, 1 will utilize a pretested questionnaire
for face to face interview with mothers.
Anthropometric indicators for children I will
measure using the WHO guideline. Descriptive and
multivariate analyses I will conduct to determine
the prevalence and associated factors of anemia

Keywords
Anemia Hemoglobin Prevalence Associated
factors
.
:Introduction
Overview.1.1
Globally, 1.62 billion people are affected by
anemia, and more than 293 million children of
preschool age are anemic. Although anemia has a
varicty of causes, it is generally estimated that 50%
of cases are caused by iron deficiency (Black et
.al,2003)
Anemia is a clinical condition associated with
multiple causes, the most common of which is
nutritional causes, such as iron, folate, vitamin
B12, and protein deficiencies. Non-nutritional
causes, such as congenital factors and parasitic
diseases, also exist(OlivaresM,WalterT,Hertrampf
E, Pizarro:1999)
In addaition to nutritional factors, several studies
have shown that socioeconomic factors such as
low parental education levels, low household
incomes (Hashizume et al.,2003& El Hioui et al.,
2008) According to the World Health Organization
database on anemia for 1993- 2005, the global
estimated prevalence of anemia was 25.0%, in
which 47.4% of preschool children were anemic
(WHO :World Health Organization, 2008) Children
and women of reproductive age have the highest
risks of anemia because of their physiological
vulnerability .( McLean E, Cogswell M, Egli I,
Wojdyla D, De Benoist,2009)

Nutritional deficiency anemia is the most

prevalent deficiency in the world. with
approximately one billion cases of iron deficiency
anemia.(Müller 0, Krawinkel,2005)
In children, iron deficiency is primarily due to
increased iron requirement as they grow;
meanwhile, the major causes of iron deficiency
among women of reproductive age are menstrual
blood loss and pregnancy .(Milman N.2011)
Justification Iron deficiency anemia (IDA) is .1.1.1
the most common type of nutritional anemias. and
is recognized as an important health problem in
Palestine and gaza strip and large numbers of
children are suffering from IDA according to
previous studies. The Iron deficiency anemia it is
.considered to be the main cause of anemia

Objectives .1.2
General aim of the study.1.2.1
Will I aim of this work is to study the IDA among
children in pre-school age who live in the Gaza
Strip will be held appropriate management which
include iron supplements formula by mouth to
correct anemia and to renew iron stores in iron
.deficient anemic children plan

:Specific objectives of the study .1.2.2

To determine the prevalence of IDA among .1
preschool age children living in Gaza strip
To evaluate the level of knowledge, awareness .2 .
and practices of parents of the study population
concerning the significance of iron for children
health
To observe mild and moderate cases among .3 .
children, whereas severe anemia was not
.observed
To provide the baseline information on -4
.anemia

Qustion.1.2.3
How many the prevalence of IDA among .1
preschool age children living in Gaza strip
What arethe level of knowledge, awareness .2 .
and practices of parents of the study population
concerning the significance of iron for children
.health
What aremild and moderate cases among .3
preschool children, whereas severe anemia was
.not observed
Is there enough information when people .4 ?
around the anemia

Literature review

Iron supplementation in children is recommended

by WHO when prevalence of anaemia is above
40%. In Palestine, due to the emergency situation
caused by the outburst of the second intifada, the
nutritional situation of children is worsening and
iron deficiency anaemia represent one of the most
serious problem An emergency project which
included universal iron supplementation (for
12,300 children), free treatment for common
diseases and food supplementation to vulnerable
families (for 3,275 children found anacmic orland
malnourished) and community health education
was implemented in part of Hebron governorate.
To evaluate project's impact we performed two
random surveys: one before and one after the
project. Before the project 30.1% of children (Cl
95%-24.5-35.6%) were found anacmic (<II g/dl).
while after the prevalence was 18.8% (CI 95% 14.8-
22.8%, decrease of 38%, P0 001) Levels and
reduction in anacmia prevalence were different
according to geographical areas: where prevention
activities had been implemented in previous years,
prevalence of anaemia was 17.1% and remained
stable at lower levels (14.7%). In other areas it
sharply declined from 47.4 to 21.7% (p<0.0005):
the declined was present only for children who
received iron supplementation. Comparison of
anthropometrics index before versus after the
project showed that low "weight for age" declined
from 10.9 to 3.8% (p-0.0006), low "weight for
height" declined from 6.0 to 1.4% after (p-0.0025).
With simple epidemiological tools we could
demonstrate and measure the effectiveness of our
interventions on the health status of the general
population: a 50% reduction of anaemia and a 70%
reduction of global acute malnutrition.(Magoni M.
Jaber M. Piera R.2008)

this study was conducted to estimate the -

prevalence of IDA among kindergartens kids living
in the marginalized areas in Gaza Strip, to evaluate
the level of knowledge, awareness and practices of
the parents of the study population regarding the
importance of iron on children health. Morcover,
the study aims to identify the possible risk factors
of IDA ameng the study population, and to
evaluate the effectiveness of oral iron formula
(ferrous carbonate S0mg+ 100mg vitamin C/Sml)
in improving the hemoglobin level in the anemic
children this is a cross sectional study included 735
kids ( 384 males & 351 females) distributed in11
kindergartens Data were collected by a
questionnaire, body weight and height of the
study sample were also measured Complete Blood
Count (CBC) were measured using cell dyne 1700
clectronic counter (Sequoia-Turner Corporation.
Santa Clara. CA). The presence of IDA was
considered in the microcytic (MCV <8on) children
through the Mentzler mathematical formula
MCV/RBC>13 concomitant to reduced hemoglobin
concentration <11.5g'dl All IDA children were
managed by oral iron supplements and were
checked again for the same parameters of CBC
after 3 months of starting the treatment regimen.
The overall prevalence on IDA among the screened
children in the marginalized areas was 33.5% (246:
135 M& 111 F), with no significant dilferences
among males (35.2) and females (31.6). The
majority (68.8%) of the
screened kids in the marginalized areas are
registered refugees at United Nations Relief and
Works Agency (UNRWA). Significantly different
prevalences of IDA were reported among the
different govermorates with highest valucs
reported in Rafan (41.2%) and the Middle (36 2%)
governorates. Also significantly higher prevalence
was reported among refugee camp kids (46.4%) as
compared to rural (30.9%) and city (31.5%)
children. The results also indicated non-significant
differences between the numbers of families
regarding parents' consanguinity cither the anemic
cases or in the overall cases. In regards to the
nutritional habits, most of the kids had good
nutritional habits with no significant differences
between the anemic XIII,and the control groups, as
the ' value > 0,05 Also, It's noticed that most of
them had full ferm pregnancy and natural vaginal
delivery Most of the cases don't suffer from
malnutrition, parasitic infection, chronic or
frequent diarrhea, nor any diseases, Most of their
families don't suffer from anv genetic discases
while most of the cates received multivitamins or
iron in the last two months of pregnancy.
Regardiny the anthropometric and sociocconomic
characteristics of the cases, there were statistically
significant differences between the cases and the
normal control in age and height
where the P value <0.05 and no statistically
significant differences were noticed in the other
parameters. The results revealed also significant
differences between the two groups in all the CBC
parameters except for WBC. It was very clear that
there were high statistically significant differences
between cases before and after treatment in the
hematological parameters, except for MCV where
the differences were not significant. (Abdallah
R.2013)
where the P value <0.05 and no statistically
significant differences were noticed in the other
parameters. The results revealed also significant
differences between the two groups in all the CBC
parameters except for WBC. It was very clear that
there were high statistically significant differences
between cases before and after treatment in the
hematological parameters, except for MCV where
the differences were not significant. (Abdallah
R.2013)

where the P value <0.05 and no statistically

significant differences were noticed in the other
parameters. The results revealed also significant
differences between the two groups in all the CBC
parameters except for WBC. It was very clear that
there were high statistically significant differences
between cases before and after treatment in the
hematological parameters, except for MCV where
the differences were not significant. (Abdallah
R.2013)

Materials and Methods

Study design
Cross sectional study is adopted for the study

Study setting
The study will be conducted in a north of Gaza
strip

Population under study

All preschool children in Gaza strip

Sample size
In this study sample size will be 400 children less
than 5 years distributors bug following three areas
( jebalia " alrmal " qararah )

Sampling procedure

Convenience sampling method will be used to in

the selection of samples, which involves the use of
the most conveniently available study participants
in the study

inclusion and exclusion criteria.

they did nor suier from psychomotor .1
retardation
they did not suffer from hormonal disorders .2
they did not suffer from chronic debilitating .3
diseases
they did not suffer from congenital heart .4
diseases
they did not suffer from acute severe illnesses .5

:Ethical considerations.
are approval from organization, informed from
the patient, his consent participation in the study
must be voluntary, and people being studied will
be Tree from any physical, emotional and mental
harm during the study, privacy and confidentially
of the information that will be obtained by the
questionnaire and we are going to explain the
benefits of study for subjects
Data Collection .
I will collected data by using close-ended
questionnaire, and the questionnaire data will
collecte through home visits and direct interview
with the parents or guardians

:Statistical analysis
After data collection, by questionnaire we will use
Statistical Package for the Social Sciences SPSS
program for data analysis

Referances
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are 10 million children dying every year? Lancet
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Olivares M. Walter T. Hertrampf E. Pizarro E . 
Anaemia and tron deficiency disease in children.
Br Med Bull. 1999,55(3)-534- 43.CrossRefPubMed
World Health Organization. Worldwide prevalence 
of anemia 1993- 2005 WHO global database
anemia. Geneva: World Health on Organization;
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McLean E, Cogswell M. Egli I, Wojdyla D, De Benoist 
B. Worldwide prevalence of anaemia, WHO
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2009:12(4)4- Public Health Nutr. 1993-2005
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Milman N. Anemia-still a major health problem in 
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