Insufficient iron intake affects one-third of Malaysian children’s health.


For children to grow and develop to their full potential, iron is a necessary mineral.

It is particularly necessary for the synthesis of haemoglobin, the protein found in red blood cells that carries oxygen throughout the body.

The youngster may experience anaemia, which is the body’s lack of red blood cells and the haemoglobin they contain, if their diet is deficient in iron.

If the mother absorbed enough iron during her 36–40 week pregnancy, the baby’s iron reserves can endure for around four to six months after birth.

This is the time of iron endowment, which is the total amount of iron in a newborn at birth.

Consequently, the baby’s iron endowment should increase with the length of time they spend in the womb.

However, the mother is more likely to give birth to a low-birth-weight child or have a preterm delivery if she has considerable anaemia throughout the first two trimesters of her pregnancy.

Additionally, the infant runs the risk of developing iron deficiency anaemia (IDA) in the future.

IDA is a significant worldwide health issue, with poor nations bearing a disproportionately high burden compared to wealthier nations.

In children under five, the global prevalence of anaemia in 2019 was 39.8% (269 million children).

According to the 2022 National Health and Morbidity Survey (NHMS) conducted in Malaysia, anaemia affected 46.5%, or over half, of the country’s children under five.

Children with IDA may show a variety of symptoms, such as pale skin, brittle nails, weakness, exhaustion, and difficulty focusing.

If the illness is not treated right away, serious health issues, such as organ failure, may result.

First Local Information

A third of Malaysian children under four are at risk of developing IDA, according the results of the Iron Strong Study.

This multi-site, first-of-its-kind clinical trial addressed IDA particularly with a non-invasive technique.

The local study, which comprised 1,201 Malaysian children under four, was carried out by the Clinical Investigation Centre at Universiti Malaya Medical Centre (UMMC) in collaboration with the Health Ministry.

It was conducted at randomly chosen government maternal and family medical clinics in Alor Setar, Kedah; Kota Baru, Kelantan; Mersing, Johor; Klang, Selangor; and Kota Kinabalu, Sabah, from July to December of last year (2022).

Researchers showed that all children, male or female, from rural or urban settings, had the same risk (Prof Dr Muhammad Yazid Jalaludin, senior consultant paediatric endocrinology at UMMC).

We discovered that, overall, 30.3% of people had haemoglobin levels below 10 grammes per deciliter, putting them at risk of anaemia.

We used a cut-off value of 12g/dL for this investigation.

“Our study found that individuals who are underweight are more likely to have IDA than those who are obese or overweight, contrary to research conducted overseas.”

According to the American Academy of Family Physicians, children should have average (mean) haemoglobin levels of 12 g/dL for ages six months to two years, 12.5 g/dL for ages two to six years, and 13.5 g/dL for ages six to twelve.

Additionally, the study discovered that younger Malaysian kids are more likely than older kids to be anaemic.

Prof. Yazid continues, “Our children’s iron deficiency is also a result of the fact that our supplemental feeding is mostly composed of carbs rather than animal protein.

“IDA is greatly exacerbated by malnutrition, which leads to permanent growth difficulties.

“All of these babies who took part in the study also had a 24-hour diet recall, but the data hasn’t been analysed yet.”

A need for screening

Anaemia is checked for in all pregnant women in Malaysia.

The body makes extra blood during pregnancy in order to sustain the growing foetus.

Insufficient amounts of iron, vitamin B12, and folate may result in insufficient production of red blood cells to fulfil the required amount.

Because it is believed that all full-term newborns have adequate haemoglobin at delivery, we solely check this cohort.

Therefore, unless infants are prematurely delivered, in which case their haemoglobin level is examined in the initial weeks following delivery, we do not monitor their levels.

According to Prof. Yazid, “a baby’s haemoglobin level changes as they grow towards four to six months.”

Our modest anaemia levels may be due in part to the lack of screening because all screening procedures require pricking the youngster on the finger or heel.

Additionally, it is expensive. It is possible to accomplish this while administering vaccinations, but the proper personnel must be present to draw blood, fill equipment, and do testing.

He says, “We need to do a proper blood test to confirm the diagnosis if the haemoglobin level is low.”

The group was able to locate a non-invasive device for this investigation.

He states: “We spoke with the machine maker to see whether it could be applied to our population, and the answer is that it could, but only to infants who are six months old and older.

The test is known as the saturation haemoglobin test, and the instrument is comparable to the oxygen saturation monitor (pulse oximeter).

“Some kids couldn’t stay still, so we had to play with them to keep them occupied and take them somewhere that wasn’t too hot or cold.”

In addition, Prof. Yazid is conducting a second study to determine the iron storage capacity of babies delivered at term at three, four, and five months of age.

Although the research is still being reviewed, we discovered that iron levels had decreased even though haemoglobin levels had not.

These newborns will develop iron deficiency anaemia (IDA) by the time they are six months old.

However, he adds, “it is not necessary to pump them with additional iron supplement because the milk has already been fortified with iron for babies on infant formula.”

According to the American Academy of Paediatrics, iron supplements of one milligramme of elemental iron per kilogramme per day should be given to all exclusively breastfed term infants beginning at four months of age. These supplements can be iron drops or multivitamin drops that combine iron and vitamin D.

Beyond a child’s physical development, IDA has an impact on their immune system and cognitive development.

“We may greatly lessen the effects of nutritional deficits on children by detecting and treating risk factors early via periodic screenings.

Prof. Yazid adds, “So, bring your child in for screening.”

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