Iron deficiency anemia is a health condition characterized by a decrease in the number or volume of red blood cells or a decrease in the amount of hemoglobin in the blood. Common symptoms include brittle nails, fatigue, hair loss, headache, rapid heartbeat, shortness of breath or sallow skin. Individuals of low socioeconomic status have a higher prevalence of iron deficiency anemia; especially in children and women of childbearing age.
Prevalence of Iron Deficiency Anemia in Central America
According to 2013 data from the Pan American Health Organization, 44% of children under the age of five, and 30% of pregnant and lactating women in Latin America and the Caribbean have iron deficiency anemia.
Iron deficiency anemia is a serious public health problem throughout Central America, especially in El Salvador, Panama, Guatemala and Haiti. People residing in these countries, particularly in rural areas, may have poor access to iron-rich foods, such as beef, pork and fish, and iron-fortified foods.
Rice, a staple food in Central America, is typically polished and rarely iron-fortified. Beans, the most common iron-rich staple food, contain non-heme iron which is poorly absorbed without a vitamin C source. However, vitamin C-containing foods aren’t often consumed with meals featuring beans.
High-Risk Individuals in Central America
Gastrointestinal infections and parasitic diseases can cause impaired iron absorption and infectious diseases such as malaria, which further increase the risk for iron deficiency anemia. Individuals with a higher risk include:
- Pregnant women and children – due to increased iron needs
- Those who experience acute or chronic inflammation
- Individuals with hematological disorders
Children who are actively growing and women of child bearing age who are pregnant or may become pregnant have increased iron needs and are more susceptible to iron deficiency anemia. Pregnant women have more blood in their bodies due to the developing fetus, thus increasing their iron needs.
Maternal anemia has serious consequences, including increased maternal mortality, adverse birth outcomes, poor mental health, fatigue and delayed child development. Mothers with inadequate iron status, babies with low birth weight, premature births (born at less than 37 weeks gestation) and improper umbilical cord clamping after delivery also increase an infant's risk of developing iron deficiency anemia.
Preventing Iron Deficiency with Breastfeeding and and Proper Complementary Nutrition
Infants, who are exclusively breastfed for the first their six months of life by mothers with normal iron status, generally don't develop iron deficiency anemia at six months of age. Lack of exclusive breastfeeding with introduction of other liquids or solid foods can interfere with the absorption of iron from breast milk. Although breast milk is usually not rich in iron, infants easily absorb the iron it does contain. Substituting coffee with sugar, or other iron-poor grain beverages for breast milk increases anemia risk.
Breast milk is naturally a sanitary beverage, whereas any food or beverage substitutes that may need to be mixed with water or require refrigeration increases the risk of infant diarrhea and its associated risk of malnutrition.
If proper iron-rich foods such as iron-enriched rice, egg yolks, beans and iron-fortified cereals aren't introduced with weaning, children are at a significantly higher risk of developing iron deficiency anemia. Failure to offer solid foods to six-month-old infants can also contribute to anemia and growth failure as iron stores in an infant do not last beyond six months.
Approaches to Educating Central American Populations about Preventing Iron Deficiency
It is essential to educate mothers on the importance of exclusive breastfeeding for six months, good quality breastfeeding experience without distraction where mother and child can bond and appropriate introduction of complementary foods.
Health educators should include lessons on iron-rich foods to help increase understanding of nutrition's relationship to anemia. Nutrition education should include animal sources of iron available in the local food supply, as well as how to pair plant sources of iron with a vitamin C source to promote adequate iron absorption. Similarly, absorption of iron from beans is enhanced if the beans are soaked and the water is discarded to remove phytates, a naturally-occurring compound in plants that inhibits iron absorption. Encouraging women to discard the soaking water and include vitamin C-rich foods with beans can significantly enhance the available iron in a diet with few heme iron sources (such as beef). Examining the types of rice available in a community to identify if enriched rice is available, enables an educator to discuss what role rice can play in preventing anemia.
If the population consumes coffee or tea, the health educator should communicate that these beverages shouldn't be consumed with meals as they inhibit iron absorption. In most areas of Central America, people cook with aluminum pots (instead of cast iron pots) so iron from cooking pots is not as available as it is in some other regions of the world. It is imperative to present foods that are available in the community and are familiar to and commonly eaten by the population. Gaining this information in advance and properly preparing for the lesson is ideal.
Iron supplements are often made available for infants and pregnant women through government or other organizational programs. Sometimes the supplements are not used or are incorrectly used due to misunderstandings. Health educators should inquire about the availability of supplements and their actual use.
Using concise and simple education tools with ample illustrations is an effective method of nutrition education for populations in developing areas of Central America. Due to minimal literacy among this population, text should be limited in health education materials.
Including actual foods and food models are encouraged. Health professionals with experience in these areas note that Central Americans tend to enjoy health education including interactions such as song, dance, plays, skits, and open communication. Concluding with interactions or hands-on activities can improve the effectiveness of health education.
Examples of Foods to Discuss in Lessons on Iron Deficiency Anemia
Animal foods with iron:
- Wild meats such as deer, paca, iguana and other game
- Lamb pelibuey (local sheep)
- Egg yolks (bird, iguana, turtle)
Plant foods with iron:
- Soybean products including soy milk
- Cocoa powder
- Dark green leaves
- Squash seeds
- Potato skins
- Fortified rice
- Fortified cereals
Vitamin C-rich foods to pair with plant sources of iron:
- Citrus fruits
- American Society of Hematology. Iron-Deficiency Anemia. American Society of Hematology. 2016. Accessed February 2, 2016.
- Chaparro CM, Lutter CK. Ensuring a Healthy Start for Future Development: Iron nutrition during the first 6 months of life. Pan American Health Organization. 2008.
- de Romana D, Rios-Castillo I, Coris H, Olivares M. Prevalence of anemia in Latin America and the Caribbean. Food Nutr Bull. 2015;36(2 Suppl): S119-28.
- Martorell R, Ascencio M, Tacsan L, et al. Effectiveness evaluation of the food fortification program of Costa Rica: Impact on anemia prevalence and hemoglobin concentrations in women and children. Am J Clin Nutr. 2015;101(1):210-217.
- Regional Bureau for Latin America and the Caribbean (ODP). United Nations Development Programme in Latin America and the Caribbean. 2012: 447-515. Accessed January 31, 2016.