Have you ever experienced fatigue, hair loss, brittle fingernails and loss of appetite? It is quite likely that you have. Have you also found the cause of these symptoms? This is where it gets tricky. As all of these symptoms are very unspecific and sometimes even aren’t recognized as the symptoms of an underlying health problem, like in this case anaemia, it’s difficult to name and diagnose the possible cause: Iron Deficiency (ID). There is not an exclusive causal connection between ID and anaemia but ID can in fact provoke anaemia (TDHS 2010).
Iron plays a major role in the energy production for the body as it is found in the hemoglobin of red blood cells and helps transporting oxygen throughout the body. It is also important for proper immune function (Curis 2013). Recommended iron intake depends on age and gender. Infants, especially at the age of 4-6 months, have an increased need for iron supply due to their rapid growth as well as pregnant women and women with heavy menstrual bleeding, as the body discards certain amounts of iron through the menstrual blood (NIH 2016). This is why it is important to have a closer look at these high-risk groups: In Tanzania, more than 1/3 of children age 6-59 months and 3 in 10 women age 15-49 years suffer from ID (TDHS 2010) which in 24% respectively 14% appears jointly with anaemia. Also, the Tanzanian National Nutrition Survey 2014 revealed that over 30% of women 15-49 years of age with children under five years were not taking iron supplementation during their pregnancy.
While supplementation is of course not the only way how to ensure iron intake (see below), it is a widespread method of how ID is addressed. Regarding this, a very important interaction which is not to be neglected in tropical countries like Tanzania is the one that iron supplementation has with malaria. A study on this matter shows that “iron supplementation appears to increase individuals’ susceptibility to malaria infections in vulnerable populations, which lack sufficient malaria surveillance, prevention and treatment facilities” (Spottiswoode et al. 2012). The study therefore concludes that “it may be premature to conclude that iron supplementation is safe enough to implement in an area without consideration of malaria control and treatment facilities” (Spottiswoode et al. 2012). Interfering illnesses, like in this case malaria and ID, pose outstanding challenges to health programs. Fighting one is likely to pave the way for an increased risk of the other. While of course providing increased malaria treatment is very important, the treatment of a detected ID should also be taken seriously.
Let’s also keep in mind, as stated at the beginning of this article, that the symptoms of an ID and anaemia are rather unspecific and often the deficiency is even asymptomatic. Therefore ID is seldomly detected and as a consequence not treated. This is why it is crucial to not lose sight of prevention of Iron Deficiency through the way we eat. As the human body is not able to produce iron on its own and iron stores will eventually be depleted, sufficient supply with iron has to be ensured through food intake. Iron rich foods that are available in Tanzania are legumes, nuts and leaf vegetables besides fish, liver and various types of meat. When it comes to bio-availability, even though the plant based iron providers perform worse than their animal product counterparts, the absorption of iron of plant foods can be enhanced by combining the iron source with a source of Vitamin C like citrus fruits, mangoes and pineapples (NIH 2016), all of them available in Tanzania. On top of that, the plant alternatives are cheaper.
Iron is not the only micro-nutrient that is lacking in the diet of many Tanzanians. So is for example Vitamin A, as an earlier article in this series explored. Having this in mind, the aim of any food related health program should be to secure not only energy but also macro- and micro-nutrient needs of the affected public (Thompson). And as people in countries in the global north don’t completely rely on micro-nutrient supplements, so shouldn’t people in the global south. This means that besides offering supplementation and fortification strategies for short term relief and in cases of urgency, a focus of health programs should be put on improving food security which will eventually make supplementation redundant in many cases. This approach is also pursued by SAT by promoting the cultivation of a variety of plant foods and spreading knowledge about different nutrient contents and health benefits of plants through their daily work.
Curis Céline. Iron supplementation in nutritional programs: pathophysiological basis and correlations with health in developing countries, in: http://biologie.ens-lyon.fr/ressources/bibliographies/pdf/m1-12-13-biosci-reviews-curis-c-2c-m.pdf?lang=fr, 03.05.2016.
National Institutes of Health (NIH). Health Information. Iron – Dietary Supplement Fact Sheet, in: https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/, 03.05.2016.
Spottiswoode Natasha, Michal Fried, Hal Drakesmith and Patrick E. Duffy. Implications of Malaria On Iron Deficiency Control Strategies, in: American Society for Nutrition, 3 (2012), 570-578.
Thompson Brian. Food-based approaches for combating iron deficiency, in: Brian Thompson and Leslie Amoroso (ed.), Micronutrient Deficiencies: Food-based Approaches, Rome 2011, 268-288.