Incidence of Anemia in the Population of Dir (Lower) Khyber Pakhtunkhwa

Imran, Sardar Azhar Mehmood, Wali Khan, Shabir Ahmed, Ikram Khan, Ahmed Zia 1Department of Zoology Hazara University Mansehra, Khyber Pakhtunkhwa, Pakistan. 2 Department of Zoology University of Malakand, Dir (Lower), Khyber Pakhtunkhwa, Pakistan. 3Department of Botany Govt Degree College Samar Bagh, Dir (Lower) Khyber Pakhtunkhwa, Pakistan. 4National Insect Museum, National Agriculture Research Center Islamabad Pakistan.


I N T R O D U C T I O N
Iron deficiency anemia is one of the most common nutritional problems of the globe affected 40% of the world population mostly found in children and pregnant women of the developing countries [1]. Anemia is an iron deficient blood disease due to lower concentration of hemoglobin (Hb) than normal for each sex, age, physiological situation and altitude. [2]. Across the globe approximately 43% of the young children have iron deficient anemia and the highest rate are at age of 1 -2 years. Although in pre-school and school going children the percentage of anemia is estimated 50% and 46% respectively [3]. In Pakistan on the prevalence of anemia no statistical data is present. However its prevalence is documented in children 61.9% and is slightly higher in non-pregnant women 50.4% than pregnant women 49.6% during National Nutritional Survey (2011) [4]. World faces numerous nutritional problems including anemia which leads to severe health problems, such as poor cognition, delay development and some behavioral problems [5]. Work ability, performance, body health and physical fitness are associated with parasitic infection and enrichment of iron [6]. Cancer, obesity, low dietary intake, inherited blood disease, chronic infections and chronic non-communicable diseases are also the major causes of anemia [7][8]. Many extensive adverse effects of iron deficiency anemia are infants' poor development, and poor cognitive performance in preschool and school-aged children, while loss of physical capacity, decline in work performance in young's and adults weekend immune system and enhance morbidity in all age groups [9]. Moreover, education, place of residence, breastfeeding, consumption of vegetables and fruits and pregnancy are associated with anemia [10]. Pakistan faces many nutritional and challenging diseases like anemia. It may require intake of iron rich foods in sufficient amount, attention of government, uses of balance diet on daily basis, population awareness and facilitation of population with proper nutrition and education. Low socioeconomic status, lack of health facilities and proper nutrition are the chief causes of iron deficiency anemia in Pakistan. To save population from different diseases related to iron deficiency, knowledge about iron, its importance and role in regulation and physiology of many body functions are required. The aim of this study is to explore the incidence of anemia related to iron deficiency in district Lower Dir Khyber Pakhtunkhwa Pakistan.

M A T E R I A L S A N D M E T H O D S Study area
Lower Dir district lies 71.8097° E and 34.9161°N its border is linked with district Swat, Dir (Upper), Bajaur, and Afghanistan on its east, south, north and west. The weather of this district is moderate. Its winter is cold and summer is hot in some areas of this district. Temperature in summer reaches to 42.5 C 0 and in winter its range is -1 C 0 with annual rainfall from 116mm to 243mm. Agriculture and rearing livestock is the main profession adopted by the peoples.

Data collection
The present study was carried out from July 2019 to November 2019 for the analysis of anemia in the population of Dir (Lower) Khyber Pakhtunkhwa. The total of 263 peoples were enrolled, out of these, 200 participants were contributed. The participants were at every age belonging to both the genders.

Socio-economic profile of the inhabitants
Socioeconomic status, environmental factors, comorbidities and occupation were noted. Animals rearing such as cow, buffalo, goat and sheep were in common practice. Agriculture is the main life style of the residents. Most of the residents were employed as unskilled laborers in construction sites.

Collection of Blood Sample
Venous blood was taken and carefully drawn into Potassium EDTA containing tubes. Through syringe blood samples were collected from Vein and kept it in the EDTA tubes. Each EDTA was labeled with name, age and sex. Hemoglobin concentration was determined by the help of Hematology analyzer. Following the guidelines of WHO, the value of a hemoglobin (Hb) was <11.5 gm/dl the cut-off for anemia for the school going children.

Data analysis
All the data collected were analyzed by using SPSS (16 version) for require parameters. For significance of various factors, analysis by logistic regression was done.

D I S C U S S I O N
Anemia is one of the public health nutritional problem of the globe which is commonly effected the population of developing countries. Iron rich foods as well as iron element in adequate amount is very essential for normal physiological function and fitness of the body. Around 40% of the world population have iron deficiency anemia which is mostly common in pregnant women and children.
[1]. Iron deficiency anemia is mostly due to many infections like malaria dengue, diabetics, nutritional deficiencies, lack of proper foods, and low socio-economic status etc. Like other developing world Pakistan is also still facing many nutritional deficiencies issues like anemia. According to the recent National Nutritional Survey (2018) the prevalence of anemia in children is documented is 53.1% which is slightly higher in boys than girls however 56.6% of the adolescent girls and 47.7% women aged 15-49 years were found anemic in Pakistan [11]. Present study indicates that the iron deficiency anemia is still the principle health problem in the population of Lower Dir Khyber Pakhtunkhwa, Pakistan. The research work in our country is very rare on iron deficiency anemia and risk factors regarding to some studies. The current work shows the overall prevalence of iron deficiency anemia is n=80 (40%) which is higher in males n= 57 (28.5%) age 1-20 years n=31 (15.5%), farmers n=28 (14%), house wives 20 (10%) and malarial patients n=7 (3.5%) respectively. Our finding is very similar to the study conducted by Khan [22]. Iron deficiency occurs due to low intake of iron. Various foods are the best sources of iron but due to low intake not satisfying the requirements. Many factors like poverty, diseases, infections, pregnancy, and food habits are the main causes of anemia. Anemia is a principle health issue more efforts are needed to aware population from the requirements, advantages of iron with its sources. Knowledge about iron rich nutrition, supplementation, developing programs on health issues and proper diet plan to fulfill the requirement of the population is needed.

C O N C L U S I O N
It is concluded that iron plays a vital role in our normal body function so the knowledge about iron, iron rich foods and nutrition, specific diet plan, use of healthy and alternate nutrition with proper education and knowledge in population about requirement and importance of iron and its sources are needed to save population from many diseases like anemia. Commonly women and children are more effected so awareness in women is very necessary about nutritional deficiencies and diet plan to prevent herself, her infants, children and family from anemia.

Conflict of interest:
Nill.