Prevalence of Iron Deficiency and Iron Deficiency Anemia in Syrian Infants

Background: Iron deficiency (ID), with or without anemia, is the most common micronutrient malnutrition problem worldwide. Iron deficiency anemia (IDA) in infancy is linked to long-term motor and cognitive deficits. Infants and children in developing countries are particularly vulnerable to ID due to a negative iron balance resulting from increasing demands for growth that surpass dietary supplies. Recently, health reports have emerged on rising child malnutrition due to shortages of children’s foods and medicines in Syria. Nevertheless, factual data on prevalence are lacking.

Objective: To estimate the prevalence of ID and IDA in a cohort of non-displaced Syrian infants living in Damascus between November, 2011 and March, 2013.

Design/Methods: This was a prospective observational study conducted at the Children’s Hospital-based primary care clinic in Damascus. Information on type of feeding milk (maternal, iron-fortified formula or cow milk), and demographic characteristics was collected by face-to-face interviews with the parents of the study subjects. Hematological profile (complete blood count, reticulocytes and reticulocyte hemoglobin content (CHr)), and biochemical tests including serum ferritin and iron, and total iron-binding capacity were carried out. ID and IDA were diagnosed according to the 2010 American Academy of Pediatrics guidelines.

Results: Out of 155 infants assessed for eligibility, 135 infants met the inclusion criteria and were evaluated for iron deficiency. The average age was 12.4 ± 5.5 months (mean ± SD), and female to male ratio was 57:78. Only 31 (23%) of the study subjects were iron sufficient and not anemic, whereas 97 (72%) had ID, 75 (55.5%) had IDA, and 7 (5.2%) had non-iron deficiency anemia (thalassemia, hemolytic anemia, and macrocytic anemia). Prevalence of ID was statistically higher in males than females (85.33% vs. 62.26% respectively) (P=0.003). IDA was more prevalent in infants living in the countryside (76.25%) in comparison with their urban peers (53.84%) (p=0.04). Unexpectedly, ID and IDA were similarly prevalent regardless of the predominant type of milk fed to the infants (P >>0.05).

Conclusion: Our results unveil high prevalence of ID and IDA in Syrian infants between 2011 and 2013. Higher rates are expected in displaced infants and in remote regions of the country. These alarming findings call for immediate national and international collaborative efforts to provide iron supplementation and correct other existing malnutrition in Syrian children.