Assessment and Management of Anemia in a Population of Children Living in the Indian Himalayas: A Student-Led Initiative

Diala El-Zammar, Matthew Yan, Cindy Huang, Dianne Fang, Fiona Petigara, Luke Bornn, Tyler Ngai, Sanja Brkanovic, Jaspreet Khangura, Noah Alexander, Saelle Hendry, Jonathan Lubin, Christopher Wallis, Jason Ford, Videsh Kapoor. UBCMJ 2011 2(2):12-18.
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OBJECTIVE: To determine the prevalence and etiology of anemia among school-aged children in Spiti Valley, India, and implement an appropriate management plan. METHODS: Hemoglobin (Hb) levels were measured in 382 children (3 to 18 years old) living in the Indian Himalayas for three consecutive years. Blood smears from the 200 most severe cases of anemia were analyzed. Iron treatments were provided for three months, and hemoglobin levels were measured after six weeks. RESULTS: Pre-treatment, 88.4% were anemic in 2007, 78.3% in 2008, and 71.3% in 2009. Analysis of the hemoglobin concentration curve over the three years demonstrated an overall shift to the right. Blood smear results showed that 57% of the samples displayed normocytic, normochromic red blood cells; 30% were hypochromic only; and 11% hypochromic, anisocytic. Post-iron treatment prevalence of anemia was found to be 82.9% in 2007, and 84.9% in 2008. CONCLUSION: There is a significant prevalence of anemia in the Spiti Valley children, which is multifactorial in etiology. A three-year evaluation of Hb levels combined with interventions addressing linked causes of anemia, such as iron supplementation, deworming, and enhanced nutrition through greenhouses, have demonstrated a significant year-to-year improvement in anemia. The hypochromic anisocytic anemia suggests iron deficiency or thalassemia. The normocytic normochromic anemia may be due to 1) mixed iron, B12, and folate deficiencies from a low animal protein and fresh vegetable diet in winter months; 2) early iron deficiency; or 3) genetic adaptation in oxygen transport at high-altitude. Due to the multifactorial nature of the anemia, an integrated prevention and treatment approach is warranted. Future goals include administration of iron, multivitamins, and zinc supplements, improvements in water and sanitation, and evaluation of the impact of greenhouses on anemia status.
KEYWORDS: anemia, hemoglobin, children, iron treatment, Spiti Valley