Prévenir et combattre l' anémie ferriprive dans le cadre des soins de santé primaire : guide à l' usage des administrateurs de la santé et des responsables de programme / E. M. DeMaeyer, avec la collaboration de P. Dallman ... [et al.] / Preventing and controlling iron deficiency anaemia through primary health care : a guide for health administrators and programme managers

Cet ouvrage fait le point sur l'ensemble des aspects techniques et pratiques à prendre en considération pour l'élaboration de stratégies directes, efficaces et de faible coût destinées à lutter contre l'anémie ferriprive. Notant que cette affection touche plus de 700 millions de personnes dans le monde, les auteurs se sont efforcés de montrer comment les nouvelles connaissances sur les moyens techniques de prévention et de lutte pouvaient être utilisées pour atteindre le plus grand nombre possible de personnes au moindre coût. Tout au long de cette étude, l'accent est mis sur les problèmes et les écueils dont il faut tenir compte, notamment dans les pays en développement, pour choisir les mesures de lutte les plus appropriées

Preventing and controlling iron deficiency anaemia through primary health care : a guide for health administrators and programme managers / E. M. DeMaeyer, with the collaboration of P. Dallman ... [et al.] / Prévenir et combattre l' anémie ferriprive dans le cadre des soins de santé primaire : guide à l' usage des administrateurs de la santé et des responsables de programme

A guide to the full range of technical and practical considerations required for the design of direct, inexpensive, and effective strategies to combat iron deficiency anaemia. Noting that this condition impairs the lives of over 700 million persons worldwide, the book makes a special effort to show how new knowledge about the technical means for prevention and control can be used to reach the largest numbers at the lowest possible costs. Throughout, emphasis is placed on problems and pitfalls, particularly in developing countries, that need to be considered when selecting the most appropriate measures for control. The opening chapters provide essential background information about the complex causes of iron deficiency anaemia, the many factors that influence its etiology, and the corresponding implications for assessment and treatment. A chapter devoted to etiology and epidemiology includes a thorough explanation of iron requirements, intake, and bioavailability useful in understanding why some individuals are at greater risk than others. Details range from a table indicating recommended daily iron intakes to examples of dietary combinations, commonly found in developing countries, that either enhance or inhibit iron absorption. Against this background, the book turns to the practical problems of assessment, treatment, and prevention. A chapter concerned with anaemia screening and the detection of iron deficiency critically compares available laboratory tests, pointing out advantages and drawbacks likely to be encountered under field conditions in developing countries. Readers are then given detailed information on treatment options using iron tablets, liquid preparations, or tablets including folate or ascorbic acid, on he recommended dosage and duration of therapy, and on side-effects associated with specific preparations and known to cause poor compliance. Information on prevention concentrates on four basic approaches involving supplementation with medicinal iron, education and associated measures to increase dietary iron intake, the control of parasitic and other infections, and the fortification of a staple food with iron. The book concludes with a discussion of the costs and benefits of prevention and a guide to the components, goals, and logistics of an anaemia control programme

SCE frequency in malnourished mice.

The effect of induced protein deficiency on sister chromatid exchange (SCE) frequency in experimental protein energy malnutrition (PEM) was investigated. Malnourished mice exhibited significantly elevated SCE levels in their bone marrow cells. A step-wise increase in this frequency was also observed with decreasing protein content.

Effect of polyunsaturate-rich vegetable oils on blood pressure in essential hypertension.

A group of essential hypertensives were treated for a period of six weeks with groundnut oil or safflower oil compared with a control group who were given a placebo medication. A significant drop in diastolic pressure occurred in the groups receiving the polyunsaturated fatty acid (PUFA) preparation. In another group of eight patients, who were already receiving traditional antihypertensive therapy, supplementation with PUFA rich oil resulted in a significant reduction in blood pressure. Further, after the end of the treatment period, an increase in diastolic pressure was found six to eight weeks later with return of pressures to approximately the pre-treatment level. These preliminary observations suggest that PUFA rich vegetable oils may be useful in the control of mild-to-moderate hypertension.

Copper, zinc, and magnesium content of breast milk of Indian women.

Copper, zinc, and magnesium contents were determined in samples of breast milk obtained from 412 women in a low income group, from 100 women in a high income group of an urban population, and from 22 women from a low income group living in a rural area. Paired samples of milk and serum were collected from 152 women and the concentrations of copper and zinc in these two fluids were estimated. Copper levels fell from 0.46 microgram/ml in colostrum to 0.17 microgram/ml at 7 to 12 months of lactation; zince levels fell from 5.32 to 1.12 microgram/ml by 7 months. Magnesium level in colostrum was 40 micrograms/ml and reached a stable level of around 30 micrograms/ml in mature milk samples. Concentrations of copper and zinc in serum were not correlated with those in milk. Day to day and diurnal variations in the concentrations of these elements in milk were not significant indicating thereby that analysis of one sample provides satisfactory information of the trace element content in milk. There were no differences in the levels of these elements in milk between rural and urban low income groups of women. However significant differences were noted in the copper and zinc contents of milk of women from low and high income groups of the urban population, from the 1st to 3rd month of lactation.

Sister chromatid exchanges in protein-energy malnutrition.

The frequency of sister chromatid exchanges in children suffering from severe protein-energy malnutrition was investigated by the fluorescent-plus-Giemsa method. Children suffering from kwashiorkor had significantly higher mean SCEs per circulating lymphocyte than did normal children. A small but statistically significant decrease in these levels was observed following nutritional rehabilitation.

The use of common salt (sodium chloride) fortified with iron to control anaemia: results of a preliminary study.

1. Iron-deficiency anaemia continues to be a major public health problem in all developing countries. Fortification of commonly consumed food items has been suggested as an effective method of preventing anaemia. Common salt (sodium chloride) has been identified as a suitable vehicle to be fortified with Fe in India. 2. Common salt was fortified with ferric orthophosphate (3500 mg/kg) and sodium hydrogen sulphate (5000 mg/kg) to provide an additional 1 mg elemental Fe/g common salt consumed. 3. After ascertaining the acceptability of the fortified salt with respect to its colour, taste and bioavailability a pilot feeding trial was conducted among residential schoolchildren in Hyderabad. Feeding of the fortified salt for a period of 1 year resulted in a significant increase in the haemoglobin level of these children. There was also a significant reduction in the prevalence of anaemia among children given the fortified salt. 4. Before the same fortified salt is recommended as a public health measure to prevent Fe-deficiency anaemia among our population it is necessary that further large-scale community trials with this fortified salt are carried out particularly among the rural population.

Use of fats and oils in child feeding.

The nutritional status of mal- or undernourished children can be improved by increasing their dietary intake of calories. Where this is liable to be restricted by the sheer bulk of the diet, alternative feeding programmes may be called for. A more fundamental solution is to increase the calorie density of the diet by the addition of fat. Cost may, however, be an overriding factor.

Anaemia and immune response.

Nutritional anaemia is a major public-health problem in many parts of the world, and iron deficiency appears to be the most important cause. The immune response is believed to be impaired in anaemia. The results of the present study, carried out in young children, indicate that both the cell-mediated immune response and the bactericidal activity of leucocytes are impaired when levels of haemoglobin fall to 10 g/dl or less.

Availability of folates from some foods.

Availability of folic acid from seven commonly used Indian foods and from yeast was studied in normal human subjects. The method consisted of measuring urinary excretion of folate after the ingestion of a known amount of food folate. The mean availiability of folic acid from different foods was more than 50%, except from brewer's yeast wherein approximately only 10% of folate was available.

Effect of vitamin B6 on leucine-induced changes in human subjects.

Distrubances in the tryptophan-niacin pathway seen in endemic pellagra among sorghum eaters have been ascribed to high dietary intake of leucine. Vitamin B6 plays an important role in several steps of this pathway. Therefore, studies on possible metabolic interrelations between excess dietary leucine and vitamin B6 were undertaken in normal healthy human subjects. The results indicated that vitamin B6 could successfully counteract the effects of leucine on quinolinic acid excretion in urine, and on in vitro nicotinamide nucleotide synthesis by erythrocytes, and also could correct the abnormalities of 5-hydroxytryptamine metabolism induced by excess leucine. These observations suggest that vitamin B6 nutritional status may have a contributory role in the pathogenesis of endemic pellagra.

Functional significance of growth retardation in malnutrition.

Various functional parameters involved in resistance to infection were investigated in children suffering from varying grades of protein-calorie malnutrition. It was observed that the phagocytic function was impaired in children whose weights were below 80% of the Indian Council of Medical Research standard, whereas the cell-mediated immune response was altered in those with weights below 70% of the standard. Antibody response to typhoid antigen was impaired in children with severe protein-calorie malnutrition, while the response to diphtheria and tetanus toxoids was normal in all. These observations suggest that malnourished children whose weights are below 80% of the Indian standard are likely to suffer from at least one functional handicap which may increase the risk of infection. In any action-oriented program, priority should, therefore, be given to this group of children.