Prevalance of nutritional anemia in middle school children of East Karadeniz Region

Introduction-Aim: Anemia is a global public health issue which effects human health and eventuate important social and economic outcomes in both developing and developed countries. Nutritional deficiency is the most common cause of anemia. Iron deficiency (ID), vitamin B12 deficiency and folic acid deficiency is leading causes of nutritional anemia. In this study we aim to identify the prevalence of nutritional anemias in middle school children of east Karadeniz region. Method: All province and districts in east Karadeniz region were divided into two groups; seaside and interior (high altitude) by location. Each group was aligned by per capita income from lowest to highest. In seaside group median district was Surmene/Trabzon and in high altitude group median district was Tonya/Trabzon. Study was conducted in 5th and 8th grade students in Tonya and Surmene. First, questionnaires were performed to students and later whole blood count, serum iron, serum iron binding capacity, ferritin, vitamin B12, folic acid and CRP levels were measured. Results: Questionarres was performed to 824 students whose parents gave informed consent. Laboratory measurements was done to 337 (55%) female and 271 (45%) male, total of 608 students. Of these students, 378 (62%) were living in seaside and 230 (38%) were living in high altitude. Seaside and high altitude mean hemoglobine values were in normal range and significantly higher in high altitude group (p<0.05). Also mean vitamin B12 levels were significantly lower in high altitude group (p<0.05). Prevalence of anemia, ID, iron deficiency anemia (IDA) mixt anemia and B12 deficiency was higher in 8th grades than 5th grades (p<0.05 for B12 deficiency, p>0.05 for others) and higher in girls than boys (p<0.05). Anemia, ID, IDA and mixt anemia were observed higher in seaside (p<0.05), vitamin B12 deficiency was observed higher in high altitude (p<0.05). Folate deficiency didn't observed in male students and in high altitude. Discussion: In general, our study shows that IDA prevalence was higher in seaside settings and prevalence of vitamin B12 deficiency was higher in high altitude settings. Higher prevalence of IDA in seaside settings could be attributed to widespread fast food style eating habits because of higher life standards. Higher prevalence of vitamin B12 deficiency in high altitude settings could be attributed to livestock breeding and eating habits of livestock products although which might be insufficient, beside vegetable consumption from agriculture in addition to livestock breeding and consequently partial meeting of the iron requirements. In our study, higher prevalence of vitamin B12 deficiency than IDA is an interesting finding and we believe, especially primary care physicians must be careful about this issue. Prophylactic approach is important than treatment in nutritional anemias. Food and nutrition education, fortification of nutrients (water, flour, juice, etc.) and iron supplementation especially age groups under greater risk could be efficient as prophylactic measures and we recommend to make these measures as state policy.