IBN AL- HAITHAM J. FOR PURE & APPL. S CI. VOL.24 (2) 2011 Effect of Ferrous Sulphate on Prevalence of Anemia Among Students o f Technical and Medical Institute, Al-Mansoor, Baghdad H. T. Al-Kaisey, S. A. muhamme d * , A. H. Saaed * , F. M. Al-Sadi * Departme nt of Pharmacy, Technical and Medical Institute, Al-Mansoor, Baghdad * Departme nt of Pathological Analysis, Technical and Medical Institute, Al- Mansoor, Baghdad Received in: 7, April, 2010 Accepte d in: 14, December, 2010 Abstract This st udy was conducted to invest igate the p revalence of anemia among st udents (males and females) of the Technical and M edical Inst itut e/ Al-M ansoor, Baghdad. 135 students aged 20 -22 y ears were subjected. Twenty -one st udents were found to be anemic. The p revalence of anemia among st udents was 15.55%, with no significant difference to sex. Then, the anemic st udents were treated with tablets of ferrous sulfate twice daily for 60 days. The treatment markedly elevated the hemoglobin concentration of both males and females and decreased the p revalence of anemia from 15.55% to 5.92%. The decrease in p revalence of anemia tended to be higher in anemic females as than anemic males (15.51% and 15.58% before treatment and 3.44% and 7.79% after treatment, resp ectively). So, treatment with ferrous sulfate tablets can effectively , reduce the p revalence of anemia among st udents and may reduce the comp lications of anemia among st udents. Key words: anemia, hemoglobin, ferrous sulfate. Introduction Anemia is a p ublic health p roblem all over the world. The burden of this disease observed mainly in develop ing countries. Conservative estimations indicate that about 1500 million p eople are anemic worldwide, with about 1400 million in South Asian and African countries (1). In addition, the World Health Organization (WHO) estimates and other hosp ital based st udies revealed that two-fifth of non-p regnant women and about half of p regnant women in developing countries have anemia (2, 3). Studies have shown that clinical assessment of anemia is very unreliable when comp ared to other standard methods of hemoglobin estimation. One of the most crucial asp ect management of anemia is determination of hemoglobin concentration. This affords to health care p roviders the op p ortunity to determine severity of the disease and the likely methods of p rompt treatment (4). Iron deficiency anemia (IDA) remains t he most common single nutrient disorder worldwide. It is associated with several deleterious consequences, including anemia, reduced work cap acity in adult, increased suscep tibility to infection and imp aired cognitive development and learning ability in children (5, 6). Iron deficiency anemia could be caused by p arasites infections, such as hookworm which lead to intest inal bleeding and fecal blood loss and heme/iron deficiency (7). It occurs when the dietary or absorp tion of iron is insufficient and cannot be formed (8). Iron is an IBN AL- HAITHAM J. FOR PURE & APPL. S CI. VOL.24 (2) 2011 essential component of p roteins involved in oxy gen transp ort (9). Plant foods contain most of the minerals and organic nutrients which are established as essential for human nutrition in addition to a number of unique organic phy tochemicals that have been linked to p romotion of good health (10). Dietary iron is available in two forms:- 1. Heme iron which is found in the animal sources like red meats, fish and p oultry . It is well absorbed and minimally affected by dietary factors. 2. Non-heme iron which is found in p lant sources like legumes, leafy vegetables, fruits, molasses blackstrap and dairy foods. The bioavailability of non-heme requires acid digestion and varies depending on the concentration of enhancers (ascorbic acid and meat) and inhibitors (calcium, fiber, tea, coffee and wine) found in the diet (6, 11). Animal sources are good sources of iron but for a financial reason the plant sources are the starkest source of iron (6). Subjects and Methods One hundred thirty five st udents (males and females) of Technical and M edical Institut e/ Al- M ansoor, Baghdad were involved in this st udy which was conducted during the p eriod from November 2008 to M arch 2009. Their age ranged from 20 -22 y ears. They were diagnosed as anemic with cut off p oint of hemoglobin as less than 12 g/dl and 13 g/dl for females and males, resp ectively (12). Hemoglobin concentration was determined by using hemiglobincyanide method (1). The blood was collected by cap illary action and used for measurement of hemoglobin concentration. The absorbance of sample and st andard were measured in sp ectrop hotometer at 540 nm. All subjects had no p eptic ulcer and none of them was on hem tonic agent. Two hundred mg of ferrous sulp hate, p roduced in form of tablets by Sammara Drug Indust ries Company (Sammara-Iraq) was administ ered to each p atient twice daily for 60 days. Hemoglobin concentrations were determined for all, p re and p ost treatment. Re sults and Discussion Table (1) shows that the p revalence of anemia among male and female st udied was 15.58% and 15.51%, resp ectively. No significant differences were noted. One of the key causes of Iron deficiency anemia is p oor bioavailability of iron in the diet. M ost of anemic students in the p resent st udy were from low socioeconomic levels. T hey depend mostly on p lant sources as source of iron, which are of a low biological value and low iron absorp tion, with litt le consumption of animal diet (meat or fish) which has a high biological value and easily iron absorp tion in comp arison with p lant sources (6). Their dependence on p lant sources is due to a financial reason rather than habit. Anot her factor that may contribute to iron deficiency anemia is the bad dietary habits, whereas a high consumption of tea and coffee directly after meals as well as the low consumption of vegetables (which are rich in ascorbic acid) affecting the bioavailability of non-heme iron found in p lant sources and thus cause anemia (6, 11). Also, vitamin A deficiency may be a common cause of anemia as iron deficiency (13). Table (2) shows that the administ ration of ferrous sulfate tablets to all of anemic st udents twice daily for 60 days markedly decreased the number of anemic students from 21 to 8 st udents and hence the prevalence of anemia among anemic st udents from 15.55% to 5.92%. The decrease in prevalence of anemia after treatment was t ended to be higher in females as comp ored to males (15.51% and 15.58%, resp ectively) before treatment and became 3.44% and 7.79%, after treatment, resp ectively. The present subjects were treated with 200 mg of ferrous sulp hate tablet. Oral iron therapy is usually considered as the first-line therap y for p atients with IDA (14). Iron sulfate in a dose of 300 mg p rovides 60 mg of elemental iron, whereas 325 mg of iron gluconate p rovides 36 mg of IBN AL- HAITHAM J. FOR PURE & APPL. S CI. VOL.24 (2) 2011 elemental iron. Indication for intravenous iron is only indicating in case of chronic bleeding, intolerance to iron or hemoglobin level below 6 g/dl (15). Improvement of Hb concentration in anemic st udents and thus decrease in p revalence of anemia was clear. However, it was more remarkable in female than male st udents (table 2). Differences that had been encountered might be due to noncomp liance of male st udents given oral iron (16), intest inal malabsorp tion and concomitant deficiencies of vitamin B12 and folic acid (13) that might have a retard resp onse. Iron deficiency anemia is the most common nutritional deficiency worldwide. It causes p oor work p erformance, decreased immunity and mental development in children and adolescents (5, 6). So, to reduce the p revalence of anemia, the p resent st udy recommended screening for iron deficiency in st udents at the beginning of academic y ear. Therefore, iron sup p lementation is given for anemic st udents. Re ferences 1. Ojengbede, O. A.; Okonkwo, S.N. and M orbason-Bello, I.O. (2008). Comparative evaluation of hemoglobin estimation amongst p regnant women in Ibadan: Hemocue-B hemoglobin analyzer versus hemiglobincyanide (Standard) method as the gold st andard. Afr. J. Reprod. Health, 12(2): 153-158. 2. Ojengbede, O.A. (1999). Anemia in p regnancy . In: Akuse, J.T . (Ed.). Safe motherhood at the local govt. level in Nigeria. The proceedings of the workshop on st rategies for reduction of high maternal mortality , Sogon.: 130-134. 3. Aimakhu, C.O.; Afolabi-Brown, O.; Lamikanra, O. and Op urum, A. (2001). Anemia in p regnancy . Dokita. 28(1): 56-62. 4. Gies, S.; Barbin, B.J.; Yassin, M .A. and Cuevas, L.E. (2003). Comparison of screening methods for anemia in pregnant women in Awassa, Ethiopia. Trop . M ed. Int. Health, 8(4): 301- 309. 5. Halterman, S.; Kaczorowski, J. M .; Aligne, C. A.; Auinger, P. and Szilagy i, P.G. (2001). Iron deficiency and cognitive achievement in school-aged children and adolescents in the United States. Pediatrics, 107: 1381-1386. 6. Abdel-Rahman, M . K.; Aboul Anein, A. and Hussien, A.M . (2008). Effect of iron-food intake on anemia indices; hemoglobin, iron, and ferritin among childbearing Egy p tian females. World J. Agric. Sci., 4(1): 7-12. 7. Calis, J. S.; Phiri, K. S. and Faragher, E. B. (2008). Severe anemia in M alawian children. N. Engl. J. M ed., 358(9): 888-899. 8. Brady, P.G. (2007). Iron deficiency anemia: A call for aggressive diagnost ic evaluation. South M ed. J., 100(10): 966-972. 9. Dallman, P.R. (1986). Biochemistry basis for the manifestations of iron deficiency. Ann. Rev. Nut r., 6: 13-40. 10. Grusak, M . A. (2006). Plant sources of dietary iron: Diversity in tissue iron concentration. In Proceedings of the 13 th International Sy mposium on Iron Nut rition and Interactions in Plants. M ontp ellier: 3-7 July . 11. Gabrielli, G. B. and De Sandre, G. (1995). Excessive tea consumption can inhibit t he efficacy of oral iron treatment in iron-deficiency anemia. Haematologica, 80: 518-538. 12. Killip, S.; Bennett, J.M . and Chambers, M .D. (2007). Iron deficiency anemia. Am. Fam. Phy s., 75(5): 671-682. 13. Oski, F. A. (1995). Anemia due to other nutritional deficiencies. In: Beutler, E.; Lichtman, M .A.; Coller, B.S. and Kip p s, T.J. (Eds.). Williams Hematology , 5 th edition, M cGraw-Hill, New York: 511-515. 14. Crosby , W.H. (1984). The rationale for treating iron deficiency anemia. Arch. Intern. M ed., 144: 471-472. IBN AL- HAITHAM J. FOR PURE & APPL. S CI. VOL.24 (2) 2011 15. Hamstra, R.D.; Blook, M .H. and Schocket, A.L. (1980). Intravenous iron dextran in clinical medicine. JAM A, 243: 1726-1756. 16. Komolafe, J.O.; Kut i, O.; Ijadunola, K.T . and Ogunniyi, S.O. (003). A comp arative st udy between intramuscular iron dextran and oral ferrous sulp hate in the treatment of iron deficiency anemia in p regnancy . J. Obst et. Gy naecol., 23(6): 628-631. Table (1) Mean ± S D of hemoglobin concentration (g/dl) and prevalence of ane mia among students. Gender Studied Subjects Anemic Subjects Prevalence of anemia (%) Number Hb ± SD Number Hb ± SD Males 77 15.02 ± 2.46 12 10.03±1.02 15.58 Females 58 13.03 ± 2.51 9 9.91±1.36 15.51 T otal 135 14.16 ± 2.66 21 9.98±1.28 15.55 Table (2) Effect of admini stration of i ron on hemoglobin concentration of anemic subjects and prevalence of the ir anemia. Gender No. of anemic subjects before treatment No. of anemic subjects after treatment Prevalence of anemia (%) before treatment Prevalenceof anemia (%) after treatment Males 12 6* 15.58 7.79 Females 9 2** 15.51 3.44 T otal 21 8 15.55 5.92 * Hb level for treated anemic males < 13 g/dl. ** Hb level for treated anemic females < 12g/dl. 2011) 2( 24مجلة ابن الهیثم للعلوم الصرفة والتطبیقیة المجلد / إنتشار فقر الدم بین طلبة المعهد الطبي التقني تأثیر كبریتات الحدید في المنصور، بغداد *، فاطمة محمد السعدي*أیاد حازم سعید، *حسین ضمد القیسي، شذى عبد الرزاق محمد المنصور، بغداد/ قسم الصیدلة، المعهد الطبي التقني المنصور، بغداد/ قسم التحلیالت المرضیة، المعهد الطبي التقني* 2010، نیسان، 7: استلم البحث في ,2010كانون االول ، 14: قبل البحث في الخالصة / سـنة مـن المعهـد الطبـي التقنـي 22-20أجریت الدراسة الحالیـة لتقصـي إنتشـار فقـر الـدم بـین طلبـة تراوحـت أعمـارهم بـین كانت نسبة إنتشار فقر الـدم بـین . طالبا مشمولین بالدراسة یعانون من فقر الدم 135طالبا من بین 21وجد أن. المنصور، بغداد ریتـات الحدیــد المصـابین بفقـر الـدم بـأقراص كب عــولج الطلبـة. ود فـرق معنـوي بـین الجنسـینمـع عـدم وجـ% 15.55الطلبـة تعـادل كبریتـات الحدیـد إلـى إرتفـاع واضـح بتركیـز الهیموكلـوبین لـدى الجنسـین أدت المعالجـة بـأقراص. یومـا 60مـدة بواقـع مـرتین یومیـا اذاإلنخفاض واضحا لدى اإلناث مقارنـة بالـذكور، كان %. 5.92إلى % 15.55خفض إنتشار فقر الدم بین الطلبة من من ثمو . بعـد المعالجــة% 7.79و % 3.44قبــل المعالجـة وأصـبحت % 15.58و % 15.51نتشـار فقــر الـدم علـى التـوالي إكانـت نسـبة قـد مـن ثـمو وبهذا فان المعالجة الفمویة بكبریتات الحدید أخفضت بصورة فعالة إنتشار فقر الدم بین الطلبة المعـانین مـن فقـر الـدم .تقلل من مضاعفات فقر الدم علیهم .فقر الدم، الهیموكلوبین، كبریتات الحدید :المفتاحیة الكلمات