Iron, Folate and Vitamin B12 status among women and children

The available data show that iron deficiency anaemia affects between 19-32% of children under 5 and around a third of mothers, with a higher prevalence among pregnant women.


Summary of data on Anaemia

Subject and sample size

HB values (and % of subjects)

Serum Ferritin (and % of subjects)

Pregnant Women – all (Gombe)

N=146

110 g/L (100%)

Na (100%)

Pregnant women classified as anaemic (Gombe); n=44

<105 g/L (30%)

<10ng/mL (18%)

Under 5s dry savanna region (NFCNS)

Na

<10ng/mL (19.4%)

Under 5s rural all Nigeria (NFCNS)

Na

<10ng/mL (24.4%)

Mothers and pregnant women dry savanna (NFCNS)

Na

<12ng/ml

33.2% mothers;

43.1%pregnant women

Sources: VanderJagt et al (2007); NFCNS (2003)

The NFCNS assessed the status of iron deficiency of children, pregnant women and mothers, using the serum ferritin level (SF). SF levels below 12ng/ml are highly specific for iron deficiency and indicate exhaustion of iron store in adults. In children, a cut off value of 10ng/ml was suggested. 

For children under 5, at the national level, 27.5% were at different stages of iron deficiency: 19.4% had an SF level of less than 10ng/ml.  Disaggregating by AEZ, the proportion of children with varying degrees of iron deficiency was 42.2% in the dry savannah while prevalence of iron deficiency (SF level less than 10ng/ml) was 31.5%, less than in moist savannah but higher than in humid forest). 10.7% had iron store depletion.

Later analysis of data from the NFCNS by Akinyele (2009) found that in the NW zone, 21.7% of under fives were iron deficient (serum ferritin concentration < 10ug/ml) and 11.9% had iron store depletion, the differences presumably being due to the reorganization of data from AEZ to State category.

Approximately 24.3 % of mothers and 35.3% of pregnant women were at different stages of iron deficiency, with 12.7% of mothers and 19.9% of pregnant women already with iron store (SF level <12 ng/ml) indicating iron deficiency. In the dry savannah AEZ 33.2% of mothers and 43.1 of pregnant women were at different stages of iron deficiency.

A survey that tested for nutritional factors associated with anaemia in 146 pregnant women, who attended two antenatal clinics in Gombe, northern Nigeria found that based on a hemoglobin value of <105 g/L, 32% of women were classified as anaemic (Vanderjagt et al (2007)). The major contributing factor to anaemia was iron deficiency based on the SF level (<10 mg/ml). Conclusions from this study were that the most common cause of anaemia in the pregnant women in northern Nigeria was iron deficiency, and the elevated concentrations of homocysteine were most likely due to both their marginal folate and vitamin B12 status, malaria was also present in fifteen (9.4%) women. This conclusion was based on the view that since the diets of the population in the northern region are heavily reliant on grains such as millet and sorghum, both of which contain large quantities of phytates, which are known to interfere with the bio utilisation of iron and other trace minerals such as Zinc and Calcium. The requirements of iron during pregnancy are high, and it was difficult to meet these requirements through diet alone.

Research on the folate and vitamin B12 status of adolescent girls age 12-16 years in Maiduguri, Nigeria found that the mean serum folate concentration for subjects was 15.3+ 5.2nmol/L (Vanderjagt et al, 2000). Only four subjects (2.4%) had serum folate concentrations lower than 6.8 nmol/l, a level indicative of negative folate balance, and 9% of the subjects had serum vitamin B12 concentrations at or below 134pmol/L, the lower limit of the reference range for their age group. Serum homocysteine was measured in 56 of the 162 subjects and the mean level was 15.9+ 5.0, umol/L. The majority of subjects had serum homocysteine concentrations above the upper limit of the reference range for their age group.  It was concluded that the adolescent girls studied were at greater risk for vitamin B12 deficiency than folate deficiency, and this is consistent with the fact that their diet included few foods that contained vitamin.

There is some further research evidence for iron and folate. (Glew et al, 2004). The dietary intakes of folate and vitamin B12 were low for rural Fulani subjects and this was reflected in their significantly lower serum concentrations of these two vitamins.


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