NutritionNutrition

Iron deficiency in children

Author/s: Lizette Berry & Katharine Hall (CI) & Michael Hendricks (Child Health Unit, UCT)
Date: Updated: July 2010

Definition

This indicator reflects the percentage of children aged 1 - 9 years who are iron deficient (have a low serum ferritin level) or suffer from anaemia due to iron deficiency.

Data

Graph
Data Source Labadarios D (ed) (2007) The National Food Consumption Survey – Fortification Baseline (NFCS-FB): The knowledge, attitude, behaviour and procurement regarding fortified foods, a measure of hunger and the anthropometric and selected micronutrient status of children aged 1 – 9 years and women of child bearing age: South Africa, 2005. Pretoria: Department of Health, Nutrition Directorate.
Notes
  1. Iron deficiency is defined as less than 12 ug/dL of ferritin in the blood. If haemoglobin levels also drop to less than 11 g/dL, this is defined as iron deficiency anaemia.
  2. The figures for the Free State and Northern Cape in 2005 should be regarded with caution as confidence intervals for those provinces were very wide.
  3. Additional data and confidence intervals can be found in Labadorios (2007).
Insufficient iron intake in children can lead to iron deficiency anaemia, which can inhibit children’s cognitive development and increase their vulnerability to infections and cardiac failure. 1 This indicator reflects the percentage of children aged 1 – 9 years who are iron deficient or who suffer from anaemia due to iron deficiency.  [Children with a serum ferritin level less than 12 ug/dL are iron deficient. Children with a serum ferritin level less than 12 ug/dL and a haemoglobin level less than 11 g/dL for children aged 1 – 5 years (or 11.5 g/dL for older children) suffer from iron deficiency anaemia.]
  
The 2005 NFCS found 6% of children aged 1 – 9 years to be iron deficient. Children who lived in formal rural areas (13%) were worse off. The Free State province (19%) had the highest proportion of children with iron deficiency. Iron deficiency levels were highest for children aged 1 – 3 years. Overall, the iron status of children aged 1 – 5 years appears to have deteriorated since 1994. 
 
The national prevalence rate of 8% for iron deficiency anaemia in children aged 1 – 9 years is considerably low according to international standards 2. However, a prevalence rate of 17% in the 1 – 3 years age group – more than double the overall rate for children aged 1 – 9 years – is concerning. The Limpopo and Free State provinces share the highest prevalence rate for children aged 1 – 9 years, at 12%. Children living in formal urban areas (9%) were most affected by iron deficiency anaemia.  
 
The causes of iron deficiency and iron deficiency anaemia are multi-faceted, and are described in the NFCS report. For example, worm infestations are known to cause blood loss. Infants are prone to iron deficiency because their iron requirements often outweigh their iron intake. As children younger than four years are most at risk, it is crucial to target interventions to this age group.
Iron deficiency is determined by the ferritin concentration in the blood. Children with ferritin levels of less than 12 ug/dL and haemoglobin levels of greater than or equal to 11g/dL (for children between 6 months and 5 years) or 11.5 g/dL (for children older than 5 years) were considered to be iron deficient. Children with haemoglobin levels of less than 11 g/dL (for children between 6 months and 5 years) or 11.5 g/dL (for children older than 5 years) and ferritin levels of less than 12 ug/dL were regarded as suffering from iron deficiency anaemia. 
The 2005 National Food Consumption Survey3 consisted of a cross-sectional survey of a nationally representative sample of children aged 1 – 9 years in South Africa, using the Census 2001 data. The survey population consisted of all the children aged 1 – 9 years (12 – 108 months) and women of reproductive age living in the same households in South Africa. This initial sample was adapted by means of 25% over-sampling to accommodate for children and women who would not be home at the time of the survey. A total of 226 enumerator areas (EAs) were included in the survey, 107 of which were urban-formal, 23 urban-informal, 15 rural-formal and 81 tribal areas. All qualifying EAs were selected with a known probability. A qualifying household for inclusion in the survey was defined as any household with at least one child aged between 1 – 9 years and at least one woman of reproductive age living in it.
 
Validated questionnaires were administered by trained fieldworkers and a blood and urine sample was taken from the respondents of each household to assess micronutrient status. Samples of tap water and maize were collected from each household and tested for iodine and vitamin A respectively, the latter at the household level. All questionnaires were translated in the country’s official languages for use as appropriate. Quality assurance measures were employed throughout the survey.
1 Schrimshaw NS (1991) Iron deficiency. Scientific American, October 1991. 
2 Swart R, Sanders D & McLachlan M (2008) Nutrition: A primary health care perspective. In: Barron P & Roma-Reardon J (eds) South African Health Review 2008. Durban: Health Systems Trust.
3 Labadarios D (ed) (2007) The National Food Consumption Survey – Fortification Baseline (NFCS-FB): The knowledge, attitude, behaviour and procurement regarding fortified foods, a measure of hunger and the anthropometric and selected micronutrient status of children aged 1 – 9 years and women of child bearing age: South Africa, 2005. Pretoria: Department of Health, Nutrition Directorate. 
 
 
RELATED LINKS
 
The Social and Economic Impact of South Africa's Social Security System 
Samson M, Lee U, Ndlebe A, Mac Quene K, van Niekerk I, Gandhi V, Tomoko, H & Abrahams C 2004 
Economic Policy Research Institute (www.epri.org.za/rp37.htm)
 
Food for Thought: A review of the National School Nutrition Programme 
Kallman K 2005
In: Leatt A & Rosa S (eds) Towards a Means to Live: Targeted poverty alleviation to make children’s rights real. Children’s Institute, University of Cape Town [CD-ROM]
 
South African HealthInfo™ network
Medical Research Council