Дисертації з теми "Iron deficiency anemia in children Tanzania"

Limited information is available about iron deficiency and iron deficiency anemia (IDA) among preschool-aged Inuit children. A cross-sectional survey was conducted with 388 Inuit children, aged 3 to 5 years, from 16 Nunavut communities. Interviews were conducted on dietary and household characteristics. Height, weight and biomarkers of iron status and Helicobacter pylori (H. pylori) exposure were measured. The prevalence of iron deficiency and IDA was calculated and risk factors were examined. The prevalence of iron deficiency was 19.2%, of IDA was 4.5% and of anemia was 20.3%. Only 0.3% of chil dren had usual iron intakes below the Estimated Average Requirement. H. pylori exposure, food insecurity and household crowding were not associated with iron deficiency or IDA. Three to four year olds were more likely to be iron deficient than 5 year olds. Boys were more likely to be iron deficient than girls.<br>Peu d'informations sont disponibles sur la carence en fer et l'anémie due à une carence en fer (ACF) chez les Inuits d'âge pré-scolaire. Un sondage transversales a été conduit avec 388 enfants Inuit âgés de 3 à 5 ans, dans 16 communautés du Nunavut. Des interviewers ont conduit des entrevues alimentaires et des questionnaires à propos des caractéristiques des ménages. La taille, le poids, ainsi que des marqueurs biologiques du niveau de fer et de l'exposition à Helicobacter pylori ont été mesurés. La prévalence de la carence en fer et de l'ACF a été calculée et les facteurs de risque ont été examinées. La prévalence de la carence en fer a été 19.2%, de l'ACF a été 4.5% et de l'anémie a été 20.3%. Seulement 0.3% des enfants avaient des apports habituels en fer sous le besoin moyen estimatif. L'exposition à H. pylori, l'insécurité alimentaire et le nombre d'habitants par ménage n'étaient pas associés à une carence en fer ou à de l'ACF. La carence en fer était plus élevée chez les enfants âgés de 3 à 4 ans que chez ceux de 5 ans. La carence en fer était aussi plus élevée chez les garçons que chez les filles.

Corrigenda tipped to title page. Bibliography: leaves 313-353. This study investigated the iron status and dietary intakes in 6-24 month old children in Australia and Ghana and assessed the effects of dietary calcium on intestinal iron absorption. The true prevalence of non-anaemic iron deficiency (NAID) and iron deficiency anaemia (IDA) and dietary intakes in infants and toddlers from a broad socio-economic background were assessed by haematological and biochemical parameters, semi-quantitative diet recall and anthropometric measurements. The high prevalence of iron deficiency and anaemia found in Australian and Ghanaian children can be attributed to the low intake of bioavailable iron in weaning diets which are often ingested with large amounts of calcium. While calcium has been shown to inhibit the absorption of iron, its mechanism of interaction with iron absorption at the intestinal level is not known. The rat was used as an experimental model to investigate the effects of dietary calcium on duodenal iron uptake. The results indicate there is a critical period during weaning when the consumption of high dietary calcium with low iron can retard growth potential. Dietary calcium significantly inhibits non-haem iron absorption at the intracellular level by up-regulating villus enterocyte ferritin concentrations under iron deficiency conditions.

Half a billion school aged children suffer from anemia, with the majority of anemia caused by iron deficiency. Researchers have shown a strong correlation between low hemoglobin levels and presence of intestinal parasites in children with anemia. Childhood anemia has profound negative effects on physical growth, maturation, and cognitive development leading to poorer educational achievement. Using hemoglobin as a measure of anemia, this quasi-experimental study investigated impact of either iron supplementation or an antiparasitic medication on hemoglobin levels in two groups of children in a rural region of Eastern Ghana. Surprisingly, after a 6-month intervention period, hemoglobin levels in both groups significantly decreased. Further research is needed toinvestigate other factors impacting nutrition and incidence of anemia in pediatric populations in developing countries.

An important physiological role in the body of the child has a normal intestinal micro flora, which in connection with person’s microorganism is regarded as a kind of extracorporeal organ. According to several authors, 88.6 % of children with acute respiratory diseases reveal disbiotic changes of intestinal micro flora. Among patients with pneumonia revealing frequency of the third level dysbiosis is 44.4 %, and besides quantitative violations there occurs also a high-quality disintegration of components of micro ecological system.

Background and Objectives: It is estimated that over 40% of children in Ecuador are anemic. Anemia in children can influence physical and cognitive development and have lasting effects on adulthood productivity and quality of life. The objectives of this study were to: (1) evaluate the relationship of anemia and cognitive function, and (2) determine the influence of demographic factors on cognitive function. Population and Setting: The sample consisted of 175 school-aged children between 5 to 11 years old attending a school in a poverty stricken area of Guayaquil, Ecuador. Methods: A descriptive correlational cross sectional design was used to study the relationship between the level of anemia and the level of cognitive function. Other demographic factors were evaluated to determine their influence on cognitive function. Data were collected at the school using the Raven's Coloured Progressive Matrices to measure cognitive function and the STAT-Site MHgb Meter to measure hemoglobin levels. Results: No significant correlation was found between the level of anemia and cognitive function. Multiple regression analysis of demographic variables and cognitive function found age (Beta=0.56, t=8.6, p=0.000) and income (Beta=0.16, t=2.5, p=0.01) to be significant predictors of cognitive function. Interpretation and Conclusion: Many factors influence cognitive function and development. Additional research is needed to determine the effect of income level and related factors, such as parental time spent with the child doing homework, value placed on education in the home, education level of the parents, and quality of nutrition. Interventions to improve socioeconomic level, enhance parenting styles that foster cognitive development, and improve nutrition should be implemented.

O presente estudo teve como objetivo descrever a prevalência de anemia ferropriva em crianças matriculadas em duas creches municipais de Guarapuava – PR, no ano de 2005. Caracteriza-se como seccional ou corte transversal, de prevalência e de base populacional, envolvendo 156 crianças com idade inferior a seis anos, matriculadas nas creches municipais da zona urbana da cidade. Para caracterizar a população estudada foram obtidas informações junto às fichas cadastrais nas creches sobre variáveis relativas à criança: data de nascimento e sexo. Para mensuração da dosagem de hemoglobina sangüínea, foram coletadas amostras de sangue na ponta do dedo médio, para leitura em hemoglobinômetro portátil (Hemocue). A prevalência da anemia nas creches estudadas foi de 42,9%, ou seja 67 das 156 crianças em que se determinou a concentração de hemoglobina com valores inferiores a 11 g/dl. A prevalência para o sexo feminino foi de 42,3%, ou seja, entre as 71 meninas, 30 delas apresentaram concentração de hemoglobina com valores inferiores a 11g/dl e, para o sexo masculino igual a 43,5%, ou seja, entre os 85 meninos, 37 deles apresentaram concentração de hemoglobina com valores inferiores a 11g/dl. Dentre as 67 crianças com anemia, 25 (37,3%) crianças apresentaram anemia grave, sendo que no grupo das 30 meninas com anemia, 10 ( 33,3%) apresentaram anemia grave e, no grupo dos 37 meninos com anemia, 15 (40,5%) apresentaram anemia grave. Ainda nas 67 crianças com anemia 45 (67,2%) apresentavam idade inferior a 24 meses, sendo que no grupo das 30 meninas com anemia, 21 (70%) apresentavam idade inferior a 24 meses e para o grupo das 37 meninos com anemia, 24 (64,9) apresentavam idade inferior a 24 meses. Dentre as 25 crianças com anemia grave, 17 (68,0%) apresentavam idade inferior a 24 meses, sendo que para o grupo de 10 meninas com anemia grave, 9 (90%) apresentavam idade inferior a 24 meses e, para o grupo de 15 meninos com anemia grave, 8 (53,3%) apresentavam idade inferior a 24 meses. Alguns fatores podem ter contribuído para esse resultado. Um deles é o estado nutricional das crianças antes de ingressarem nas escolas infantis, o qual poderia já estar comprometido. Outro importante fator a ser considerado é a baixa inserção sócio-econômica das crianças que freqüentam as creches municipais, a qual impõe condições de vida que as tornam mais vulneráveis à diarréia, às infecções respiratórias e às parasitoses intestinais, podendo comprometer, de forma marcante, o consumo de alimentos por redução do apetite e por diminuição da absorção de nutrientes entre eles o ferro. Espera-se que os resultados forneçam subsídios para um melhor conhecimento e acompanhamento da situação nutricional destas crianças, já que constituem instrumento essencial para a aferição das condições de saúde da população infantil, além de oferecer medidas objetivas das condições de vida da população em geral.<br>The present study it had as objective to describe the prevalence of iron deprive anemia in children registered two municipal day-care centers of Guarapuava - PR, in the year of 2005. Transversal cut is characterized as seccional or, of prevalence and population base, involving 156 children with lower age the six years registered the municipal day-care centers of the urban zone of the city. To characterize the studied population information together to the fiches had been gotten register in cadastre in the day-care centers on relative variable the child: date of birth and sex. For measuring of the dosage of sanguine hemoglobin, samples of blood in the tip of the average finger had been collected, for portable reading in hemoglobinometer (Hemocue). The prevalence of the anemia in the studied daycare centers was of 42.9%, or either 67 of the 156 children where if determined the concentration of hemoglobin with the lower values 11 g/dl. The prevalence for the feminine sex was of 42.3%, or either, between the 71 girls, 30 of them had presented concentration of hemoglobin with lower values 11g/dl and for equal the masculine sex 43.5%, or either, between the 85 boys, 37 of them had presented concentration of hemoglobin with lower values 11g/dl. Amongst the 67 children with anemia, 25 (37.3%) children had presented serious anemia, being that in the group of the 30 girls with anemia, 10 (33.3%) had presented serious anemia and in the group of the 37 boys with anemia, 15 (40.5%) had presented serious anemia. Still in the 67 children with anemia 45 (67.2%) they presented lower age the 24 months, being that in the group of the 30 girls with anemia, 21 (70%) presented lower age the 24 months and for the group of the 37 boys with anemia, 24 (64.9%) presented lower age the 24 months. Amongst the 25 children with serious anemia, 17 (68.0%) presented lower age the 24 months, being that for the group of 10 girls with serious anemia, 9 (90%) presented lower age the 24 months and, for the group of 15 boys with serious anemia, 8 (53.3%) presented lower age the 24 months. Some factors can have contributed for this result. One of them is the nutricional state of the children before entering the infantile schools, which could already be engaged. Another important factor to be considered is low the partnereconomic insertion of the children who frequent municipal day-care centers, which imposes life conditions that become them more vulnerable the diarrhea, to the respiratory infections and the intestinais parasatisms, being able to compromise, of marcante form, the food consumption for reduction of the appetite and reduction of the absorption of nutrients between them the iron. One expects that the results supply to subsidies one better knowledge and accompaniment of the nutricional situation of these children, since they constitute essential instrument for the gauging of the conditions of health of the infantile population, besides offering in general measured objective of the conditions of life of the population.

Introdução - A anemia ferropriva, um importante problema de saúde pública tanto nos países em desenvolvimento quanto nos desenvolvidos, afeta principalmente as crianças menores de cinco anos de idade e as mulheres em idade reprodutiva. Objetivo - Analisar a taxa de hemoglobina e a prevalência de anemia em mães cujos filhos menores de 5 anos de idade frequentam creches públicas de um município de elevado Índice de Desenvolvimento Humano. Métodos - Estudo de corte transversal. A amostra foi constituída por 230 pares de mães biológicas com idade entre 15 e 49 anos e seus filhos, menores de cinco anos de idade, que frequentavam creches públicas no município de Taubaté-SP. A coleta de dados foi realizada por meio de questionário preenchido pelos responsáveis pela criança e de formulário aplicado às mães, para obter informações sobre fatores socioeconômicos e de saúde da mulher e da criança. Da mãe e de seu respectivo filho foram verificados o peso, a estatura e dosagem da concentração da hemoglobina do sangue capilar, com leitura imediata por hemoglobinômetro portátil. Foram feitas análises descritivas por meio de medidas de tendência central e dispersão, testes de proporções além de uma análise binária logística de múltiplas variáveis. Resultados - A prevalência de anemia nas mães foi de 9,6 por cento e nas crianças de 16,9 por cento. Para as mães, as variáveis analisadas que mostraram associação com anemia foram a idade, ter alguma doença, ter tido intercorrências obstétricas e ser atendida pela Estratégia de Saúde da Família, esta última aparecendo como fator de proteção para a mãe. Na análise multivariada apenas a Estratégia de Saúde da Família se manteve associada, enquanto as demais variáveis não mantiveram associação estatisticamente significante com a anemia. Paradoxalmente, a anemia materna não teve relação com a anemia do filho, bem como não houve correlação entre o nível de hemoglobina de mães anêmicas ou não anêmicas com o nível de hemoglobina de seus filhos. Conclusões - Apesar da anemia, nessa população de elevado Índice de Desenvolvimento Humano, ter prevalência baixa, segundo critério da Organização Mundial da Saúde, a mesma afetava uma em cada dez mães e uma em cada seis crianças. Isso evidencia que ainda há necessidade de atenção direcionada para esse agravo nas mulheres em idade reprodutiva e nas crianças com menos de cinco anos. Embora no grupo populacional haja semelhanças quanto às variáveis analisadas, é preciso um olhar atento às necessidades, principalmente em relação às crianças, com reforço na manutenção de ações intersetoriais entre saúde e educação, voltadas para a prevenção da anemia ferropriva.<br>Introduction - The iron deficiency anemia, an important public health problem in both developing and developed countries, affects mainly under five-year-old children and women of reproductive age. Objective - to analyze the prevalence of anemia in women with children under 5 years-old enrolled in municipal day care centers in a municipality with a high Human Development Index. Methods - cross-sectional study. Sample consisting of 230 pairs of biological mothers aged 15-49 years and their under five-year-old children, who attended public day care centers in the city of Taubaté-SP. The data collection was performed through a questionnaire completed by those responsible for the child and a form applied to the mothers, to obtain information on socioeconomic and health factors of the woman and the child. The weight, height, and blood hemoglobin concentration of the capillary blood were verified from the mother and her respective son, with an immediate reading by the portable hemoglobinometer. Descriptive analyzes were made through measures of central tendency and dispersion proportions test, also a binary logistic analysis of multiple variables. Results - the prevalence of anemia in women was 9,6 per cent and in children 16.9 per cent. For women, the analyzed variables that showed an association with anemia were: age, being a carrier of disease, having had obstetric intercurrences and being attended by the Family Health Strategy, the latter appearing as a protection factor for the woman. In the multivariate analysis, only Family Health Strategy remained associated, while the other variables did not maintain a statistically significant association with anemia. Paradoxically, maternal anemia is not related to childhood anemia, and there was no correlation between the hemoglobin level of anemic and non-anemic mothers with their children\'s hemoglobin level. Conclusion - Although anemia in this high Human Development Index population was of low prevalence, according to World Health Organization criteria, it affected one in ten mothers and one in six children. This shows that there is still a need for targeted attention to this condition in women of reproductive age and in children under five years old. Although in the population group there are similarities to the analyzed variables, it is necessary to look closely at the needs, especially in relation to children, with a reinforcement in the maintenance of intersectoral actions between health and education aimed at the prevention of iron deficiency anemia.

Thesis (M.S.)--West Virginia University, 2003.<br>Title from document title page. Document formatted into pages; contains vii, 56 p. Vita. Includes abstract. Includes bibliographical references (p. 41-45).

A eficácia de uma suplementação semanal com sulfato ferroso foi avaliada em uma coorte controlada de 1015 crianças de 4 a 59 meses de idade, divididos em dois grupos: Controle e Intervenção. No Grupo Controle (n=583 crianças), após avaliação da hemoglobina inicial, a mãe era informada do resultado e, no caso de diagnóstico de anemia a mãe era orientada a procurar serviço de saúde para tratar. As crianças do Grupo Intervenção (n=432 crianças) receberam solução com sulfato ferroso, acompanhado de colher-medida para ingestão de uma quantidade de solução com aproximadamente 4 mg/kg/semana, suficiente para 6 meses de suplementação. Após período aproximado de 7 meses, a variação da concentração média de hemoglobina (delta) do Grupo Intervenção era significativamente maior do que do Grupo Controle. O risco do delta variar foi proporcional ao grau de adesão à suplementação, exceto para adesão \"nula\". A concentração média de hemoglobina do Grupo Intervenção foi significativamente maior do que no Grupo Controle após os 30 meses de idade. Além disso, a incidência de anemia a partir dos 14 meses de idade foi significativamente menor entre as crianças que receberam intervenção, mas a incidência de superação de um quadro anêmico independeu da intervenção proposta. A suplementação semanal foi eficaz para prevenir, evitando o declínio e estabilizando os níveis de hemoglobina, mas não esteve associada com elevação desse indicador. A adesão plena e parcial somou 62% das crianças e foi semelhante entre os anêmicos e eutróficos. A ocorrência de efeitos benéficos foi quase o dobro (58%) do observado de efeitos deletérios (31%). Esses efeitos secundários, no entanto, podem ter sido superestimados pela forma de indagação. Além disso, os efeitos negativos, quando observados, não estavam relacionados à diminuição da adesão. A intervenção proposta apresenta-se, portanto, como uma alternativa viável no cumprimento do compromisso do Brasil junto às Nações Unidas com vista ao controle da anemia ferropriva.<br>The efficacy of a weekly ferrous sulfate supplementation was evaluated in a controlled cohort of 1015 children 4 to59 months of age assigned into two groups - Control and Intervention. At Control Group (n = 583), after an initial hemoglobin evaluation, the mother was informed of the result and, if the child was anemic, instructed to seek a health service for treatment. The children in the Intervention Group (n = 432) were given a ferrous sulfate solution, together with a measure-spoon, for the ingestion of an amount of solution equal to approximately 4 mg Fe / kg / week, enough for a 6-month treatment. After approximately 7 months, the mean hemoglobin variation (delta) of the Intervention Group was higher than the Control. The risk of delta variation was proportional to the degree of treatment compliance, except for the \"null\" compliance. The mean hemoglobin concentration of the Intervention Group, after 30 months of age, was significantly higher than the Control. In addition, the anemia incidence after 14 months of age was significantly lower among the children who received intervention, but the reversion of a inicial anemia status did not depend on the proposed treatment. The weekly supplementation was efficient as prevention, avoiding the hemoglobin declining and stabilizing it levels, but was not associated with the rise of this indicator. The \"broad\" or \"partial\" compliance was observed in 62% of the children, and was similar among anemics and eutrophics. The occurrence of beneficial effects was almost double (58%) the deleterious observed (31%). The type of questioning, however, may have overestimated these secondary effects. Even so the negative effects, when observed, were not related to any reduction of compliance. The proposed intervention seems to be, in fact, as a viable alternative in accomplishment with Brazil commitment vis-à-vis the United Nations to control iron deficiency anemia.

The purpose of the study was to determine what nutritional, demographic, and behavioral differences existed between children one year of age from two similar WIC clinics with different prevalences of anemia. Children from the higher-prevalence site were found to consume significantly (p < .05) more B12, C, copper, fiber, folate, total kilocalories, and riboflavin than did children from the lower-prevalence site. Family income and maternal weight gain were significantly (p < .05) higher in the lower-prevalence group as compared to the higher-prevalence group. In addition, children from the higher-prevalence site were enrolled in the WIC program at a significantly (p < .05) younger age than were children from the lower-prevalence site.

Негоспітальна пневмонія (НП) залишається одним із найпоширеніших захворювань бронхолегеневої системи у дітей та с однією з актуальних медико-соціальних проблем педіатрії. Щорічна захворюваність на дану патологію становить близька 15-20 на 1000 дітей перших трьох рокі# життя і приблизно 5-6 випадків на 1000 дітей старше трьох років. Летальність від пневмонії в різних регіонах України коливається від 1,5 до 6 на 10000 дітей . При цитуванні документа, використовуйте посилання http://essuir.sumdu.edu.ua/handle/123456789/32629<br>Негоспитальная пневмония (НП) остается одним из самых распространенных заболеваний бронхолегочной системы у детей и с одной из актуальных медико-социальных проблем педиатрии. Ежегодная заболеваемость данной патологией составляет близка 15-20 на 1000 детей первых трех роки # жизни и примерно 5-6 случаев на 1000 детей старше трех лет. Летальность от пневмонии в различных регионах Украины колеблется от 1,5 до 6 на 10000 детей При цитировании документа, используйте ссылку http://essuir.sumdu.edu.ua/handle/123456789/32629<br>Community acquired pneumonia (NP) is one of the most common diseases of the bronchopulmonary system in children and with one of the pressing health and social problems of Pediatrics. The annual incidence of this pathology is around 15-20 per 1000 children during the first three years of life # and about 5-6 cases per 1000 children over three years. Mortality from pneumonia in different regions of Ukraine ranges from 1.5 to 6 per 10,000 children When you are citing the document, use the following link http://essuir.sumdu.edu.ua/handle/123456789/32629

Актуальність: Дана проблема актуальна не тільки в зв'язку з зростаючою частотою народження, але і високою ймовірністю розвитку ускладнень. За даними статистики, понад 700 тисяч дітей народилися з діафрагмальної килою з 1 січня 2000 року. Діафрагмальний кили у дітей спостерігаються відносно часто (1 на 1700). Летальність при цьому захворюванні становить 1-3% загальної смертності новонароджених, а протягом першого року життя - 10% смертності серед дітей, що вмирають у зв'язку з вадами розвитку. Показовим є дані про те, що 147 дітей кожен день народжуються з цією патологією, тобто кожні 10 хвилин в світі народжується дитина з діафрагмальної килою. У старшому віці частіше зустрічаються кили стравохідного отвору діафрагми, потім кили купола діафрагми, і рідше - ретростернальние кили.

INTRODUÇÃO: A anemia carencial pode ser definida como um estado em que a concentração de hemoglobina no sangue está anormalmente baixa, possivelmente em consequência da carência de um ou mais nutrientes essenciais, sendo o ferro, dentre todos, a mais presente. A anemia precoce pode alterar a fisiologiado hipocampoem desenvolvimento,a região do cérebro responsável pelo aprendizado e memóriade reconhecimento e fatores de crescimento como o fator neurotrófico derivado do cérebro (BDNF).O estudo objetivou identificar a prevalência de anemia ferropriva em crianças do município de Vicente Dutra-RS e investigar possíveis alterações nos níveis séricos do BDNF em crianças com ferropenia. METODOLOGIA: Desenvolveu-se um estudo transversal quali-quatitativo, com crianças de 6 a 76 meses de idade, sendo a seleção dos participantes por conveniência. O estudo consistiu na aplicação de um questionário estruturado, contendo informações socioeconômicas, gestacionais, história médica pregressa e atual e dados antropométricos seguido por coleta de sangue através de punção. Nas amostras de sangue, foram analisadas as variáveis hemograma completo (hemoglobina, hematócrito, volume corpuscular médio e red cell distribution width), ferro, ferritina, transferrina, capacidade ferropéxica, saturação da transferrina e dosagem de BDNF. RESULTADOS: O estudo desenvolveu-se no período de junho de 2014 a junho de 2015 com a participação de 255 crianças com idade entre 7 a 76 meses de ambos os sexos, sendo excluídas do estudo 11 crianças, totalizando 244 crianças com informações suficientes para a análise dos dados. Considerou-se 4 estágios de estoques de ferro no organismo sendo o primeiro considerado como normal apresentando 76,66 % (N=184), o segundo como depleção dos estoques sem a anemia estabelecida apresentando 7,91 % (N=19), considerados anêmicos 10 % (N=24) e anemia ferropriva 5,41% (N=13). A verificação dos dados do BDNF ocorreu com amostras de soro de 165 crianças consideradas válidas no estudo. Observou-se que nos 4 grupos não ocorreu diferenças significativas nas amostras, o que demonstra a não associação dos níveis de BDNF com os estágios de ferropenia no organismo. Também analisando a associação das variáveis hemoglobina, hematócrito, ferritina, transferrina e capacidade ferropéxica com o BDNF, não observou-se significância estatística, porém ferro (p=0,017), saturação da transferrina (p=0,048), VCM (p=0,014) e RDW (p=0,043) apresentaram-se significativas as associações. CONCLUSÃO: Esse estudo considerado pioneiro em humanos até o momento, detectou associações com parâmetros sanguíneos e BDNF. Os nossos resultados aqui apresentados refinam a nossa compreensão da função do ferro no desenvolvimento do cérebro. Sugere-se também que o estudo possa ser adaptado em futuras pesquisas para explorar os diferentes papéis do ferro no neurodesenvolvimento infantil.<br>INTRODUCTION: Anemia deficiency can be defined as a condition manifested by an abnormally low concentration of blood hemoglobin possibly that may be due to the lack of one or more essential nutrients, the most prevalent of which is iron. Early anemia can alter the developing hippocampal physiology, the brain region responsible for learning and recognition memory, and growth factors such as the brain-derived neurotrophic factor (BDNF). This study aimed to identify the prevalence of iron deficiency anemia in children from the municipality of Vicente Dutra-RS and to investigate possible changes in serum levels of BDNF in children with iron deficiency. METHODOLOGY: We conducted a cross-sectional qualitative and quantitative study with children between 6-76 months of age, in which participant selection was based on convenience. The study consisted on the administration of a structured questionnaire including socioeconomic and pregnancy information, medical history and current medical status, and anthropometric data followed by blood sample collection through puncture. The blood samples were analyzed for CBC (hemoglobin, hematocrit, mean corpuscular volume and red cell distribution width), iron, ferritin, transferrin, total iron-binding capacity, transferrin saturation and BDNF dosage. RESULTS: The study was conducted in the period from June 2014 to June 2015 with comprised 255 children aged 7-76 months of both sexes, 11 of which were excluded from the study, totaling 244 children with sufficient information for data analysis. We considered four stages of body iron storage: normal, present in 76,66% (N = 184), depleted stores without anemia, present in 7,91% (N = 19), anemic, present in 10% (N = 24) and iron deficiency anemia, present in 5,41% (N=13). The analysis of BDNF data was performed on serum samples from 165 children considered valid in the study. We observed that the 3 groups did not show significant differences in the samples, which demonstrates a lack of association between BDNF levels and the stage of body iron deficiency. In addition, the association between hemoglobin, hematocrit, ferritin, transferrin, and total iron-binding capacity and BDNF was not statistically significant, however, iron (p = 0.017), transferrin saturation (p = 0.048), MCV (p = 0.014) and RDW (p = 0.043) showed significant associations with BDNF. CONCLUSION: This study, currently regarded as a pioneer study in humans, has found weak associations between blood parameters and BDNF. The presented results refine our understanding of the role of iron in brain development. It also suggests that the study can be adapted to future research to explore the different roles of iron in children's neurodevelopment.

Résumé généralIntroductionL’anémie est un problème majeur de santé publique particulièrement fréquent dans les pays à faible revenu, dont la RDC, et qui affecte avec prédilection les femmes enceintes et les enfants d’âge préscolaire. Elle est associée à un risque élevé de morbidité et de mortalité. Au cours de la grossesse, l’anémie peut entraver le développement du fœtus et peut affecter négativement la santé maternelle. Chez l’enfant, l’anémie peut en plus altérer le développement physique et mental si elle n’est pas rapidement corrigée. Il est généralement admis que la carence en fer est la première cause d’anémie et les stratégies de lutte suggérées par l’Organisation mondiale de la santé en découlent. Cependant dans la région du Kivu, il n’existe que très peu d’information sur les étiologies de l’anémie et sur la contribution du paludisme et de celle de la carence en fer dans sa genèse. L’objectif global de ce travail de thèse était de contribuer à l’étude de l’anémie et de sa relation avec le paludisme et la carence en fer, en milieu rural au Sud-Kivu.Méthodes Ce travail a consisté en trois études épidémiologiques menées entre 2010 et 2014 dans la zone de santé rurale de Miti-Murhesa dans la province du Sud-Kivu à l’est de la RDC. Il s’est agit de deux études transversales et d’une étude longitudinale prospective. Cette dernière a concerné des femmes enceintes enrôlées depuis le deuxième trimestre de la grossesse à leur première consultation prénatale (CPN1) jusqu’à l’accouchement. L’une des deux études transversales a aussi recruté des femmes enceintes au deuxième trimestre de la grossesse à leur CPN1 et la deuxième a consisté en une étude en grappes à deux degrés chez des enfants d’âge préscolaire en bonne santé apparente dans la communauté. Résultats La prévalence de l’anémie chez les femmes enceintes était de 17,6% et celle de la carence en fer (ferritine ajustée) de 8%. Le paludisme était présent chez 7,5% et l’hypoalbuminémie chez 44% des sujets. La concentration plasmatique du récepteur soluble de la transferrine était plus élevée en présence du paludisme. Les facteurs significativement associés à l’anémie étaient le paludisme [ORa: 11.24 (4.98-25.37); P < 0.001], l’hypoalbuminémie [ORa: 2.14 (1.27-3.59); P = 0.004] et des valeurs élevées de la protéine C réactive [ORa: 1.94 (1.10-3.45); P = 0.022]. La carence en fer n’était pas fréquente et n’était pas significativement associée à l’anémie.La valeur médiane (EIQ) de la concentration sérique de ferritine (ajustée pour l’inflammation) était plus élevée en présence de paludisme comparée aux femmes non impaludées [82.9 μg/L (56.3-130.4) vs 39.8 μg/L (23.6-60.8); P < 0.001]. Le paludisme était plus fréquent chez les femmes sans carence en fer [ORa 6,25 (1,47-26,57); P=0,021] et chez celles n’ayant pas utilisé de moustiquaire imprégnée d’insecticide [ORa 2,24 (1,12-4,51); P=0,024].A l’admission dans l’étude prospective, 9,5% de femmes de la cohorte présentaient une infection palustre. Après régression logistique, la fréquence du paludisme était plus élevée chez les primigestes, chez les femmes avec niveau socioéconomique bas et chez celles vivant à moins de 1683 m d’altitude ;les rapports de cote ajustés (IC 95%) étaient respectivement de [2,55 (1,05-6,19) ;P=0,039] ;[4,78 (1,36-16,76) ;P=0,033] et [2,34 (1,10-5,02) ;P=0,029]. Toujours à l’admission dans la même étude, la prévalence de l’anémie était de 32%. Celle-ci était plus fréquente chez les femmes impaludées [ORa :4,20 (2,00-8,80); P<0,001] et chez celles qui n’avaient pas bénéficié d’un déparasitage dans les 3 mois avant leur admission dans l’étude [ORa :2,33 (1,25-4,35)]. A l’accouchement, le petit poids de naissance (PPN) était présent chez 6,5% des nouveau-nés. Les prédicteurs du PNN étaient l’absence d’utilisation de la MII [ORa :4,17 (1,15-14,28); P=0.030], une faible taille (<150 cm) de la mère [ORa :5,56 (2,01-15,33); P=0.001] et la présence d’anémie chez la mère à la CPN1 [ORa :4,08 (1,50-11,10); P=0.006]. Chez les enfants d’âge préscolaire, l’anémie était présente dans 46,6% des cas et la prévalence de l’anémie ferriprive chez les enfants anémiques était de 16,5%. Chez les enfants sans inflammation, la carence en fer était de 4,4% (ferritine non ajustée). Les résultats de la régression logistique ont révélé que l’anémie était significativement et indépendamment associée à la carence en fer [ORa :4,10 (2,41-6,96) ;P<0,001], à une histoire de fièvre pendant les deux semaines avant l’enquête [ORa :1,58 (1,00-2,50); P=0,049] et à un faible périmètre brachial [ORa :1,87 (1,18-2,94) ;P=0,006]. Dans un deuxième modèle ayant exclu les enfants avec carence en fer, ce sont une histoire de fièvre dans les deux semaines avant l’enquête [ORa :1,62(1,00-2,62); P=0,05] et un faible périmètre brachial [ORa :1,96(1,24-3,13); P=005] qui étaient associés significativement et indépendamment à l’anémie.Conclusion L’anémie est fréquente en milieu rural au Sud-Kivu mais la contribution de la carence en fer est faible. Néanmoins, d’autres carences nutritionnelles lui sont associées :une hypoalbuminémie chez les femmes enceintes et un faible périmètre brachial chez les enfants de moins de 5 ans. Le paludisme, d’autres infections, des états inflammatoires ainsi que le manque de déparasitage sont également d’autres facteurs qui étaient associés à l’anémie. Chez les femmes enceintes, l’absence de prévention contre le paludisme par les MII, la présence d’anémie et une faible taille de la mère étaient des prédicteurs du PPN.Une lutte intégrée contre le paludisme et d’autres maladies infectieuses ainsi que l’amélioration de l’état nutritionnel sont des facteurs vulnérables à court et moyen termes pour réduire la charge de l’anémie. Ce qui, par conséquent, contribuera à la réduction de l’incidence du PPN.Il y a une nécessité à poursuivre la recherche pour (i) identifier d’autres causes d’anémie en incluant la recherche des hémoglobinopathies et autres anomalies génétiques, (ii) améliorer les connaissances sur les meilleures stratégies de lutte contre l’anémie en intégrant la prévention contre le paludisme dans un milieu où il y a une prévalence relativement élevée d’hémoglobinopathies et autres anomalies génétiques pouvant altérer l’érythropoïèse et/ou le métabolisme du fer.<br>Executive summary IntroductionAnemia is a worldwide public health concern, which is particularly prevalent in low and middle-income countries, including the Democratic Republic of the Congo (DRC). It affects mostly pregnant women and preschool children and is associated with a higher risk of morbidity and mortality. During pregnancy, anemia is associated with poor birth outcomes and can negatively affect maternal health. In children, anemia can also alter physical and mental development if not corrected quickly. It is generally assumed that iron deficiency is the leading cause of anemia, thus that assumption had influenced control strategies suggested by the World Health Organization. However, in the Kivu region, there is little information on the aetiologies of anemia and the contribution of malaria and that of iron deficiency in the aetiology of anemia is unknown. The overall goal of this thesis was to contribute to the study of the burden of anemia and its relationship with malaria and iron deficiency in rural South Kivu.MethodsThe data are from three epidemiological studies carried out between 2010 and 2014 in the rural health zone of Miti-Murhesa in the South Kivu province in eastern DRC. There were two cross-sectional studies and one longitudinal prospective study. In the latter, pregnant women were enrolled during the second trimester of pregnancy at their first prenatal visit (ANV1) and followed-up until delivery. One of the two cross-sectional studies also enrolled pregnant women in the second trimester of pregnancy at their ANV1 and the second consisted of a two-stage cluster study at community level in apparently healthy preschool children.ResultsThe prevalence of anemia in pregnant women was 17.6% and that of iron deficiency (adjusted ferritin) was 8%. Malaria was present in 7.5% and hypoalbuminemia in 44% of subjects. Soluble transferrin receptor concentration was higher in the presence of malaria. Factors significantly associated with anemia were malaria [ORa: 11.24 (4.98-25.37); P < 0.001], hypoalbuminemia [ORa: 2.14 (1.27-3.59); P = 0.004] and high values of the C reactive protein [ORa: 1.94 (1.10-3.45); P = 0.022]. Iron deficiency was not common and was not significantly associated with anemia.The median value (IQR) of serum ferritin concentration (adjusted for inflammation) was higher in the presence of malaria compared to non-infected women [82.9 μg/L (56.3-130.4) vs 39.8 μg/L (23.6-60.8 ); P < 0.001]. Malaria was more common in women without iron deficiency [ORa 6.25 (1.47-26.57); P = 0.021] and in those who did not use insecticide-treated mosquito nets [ORa 2.24 (1.12-4.51); P = 0.024].At admission in the prospective study, 9.5% of women in the cohort had malaria infection. After logistic regression, malaria was higher in primigravidae, among women with low socioeconomic status and those living at an altitude of less than 1683 m; the adjusted odds ratios (95% CI) were [2.55 (1.05-6.19); P = 0.039]; [4.78 (1.36-16.76); P = 0.033] and [2.34 (1.10-5.02); P = 0.029], respectively.Still at admission in the same study, the prevalence of anemia was 32%. This was more common in malaria-infected women [ORa: 4.20 (2.00-8.80); P < 0.001] and in those who were not dewormed within the last 3 months prior to admission into the study [ORa: 2.33 (1.25-4.35); P = 0.008]. At delivery, low birth weight (LBW) was present in 6.5% of new-borns. Predictors of LBW were the lack of use of ITN [ORa: 4.17 (1.15-14.28); P = 0.030], a low height (< 150 cm) of the mother [ORa: 5.56 (2.01-15.33); P = 0.001] and the presence of maternal anemia at ANV1 [ORa: 4.08 (1.50-11.10); P = 0.006].In pre-school children, anemia was present in 46.6% and the prevalence of iron deficiency among anemic children was 16.5%. In children without inflammation, iron deficiency was 4.4% (unadjusted ferritin). Logistic regression analysis revealed that anemia was significantly and independently associated with iron deficiency [ORa: 4.10 (2.41-6.96); P < 0.001], with fever during the last two weeks before the survey [ORa: 1.58 (1.00-2.50); P = 0.049] and with a low mid-upper arm circumference (MUAC) [ORa: 1.87 (1.18-2.94); P = 0.006]. In a second model that excluded children with iron deficiency, history of fever in the last two weeks before the survey [ORa: 1.62 (1.00-2.62); P = 0.05] and a low MUAC [ORa: 1.96 (1.24-3.13); P = 005] were significantly and independently associated with anemia.ConclusionAnemia is common in rural South Kivu but the contribution of iron deficiency is low. However, other nutritional deficiencies are associated: hypoalbuminemia in pregnant women and low MUAC in preschool children. Malaria, other infections, inflammatory conditions as well as lack of deworming are also other factors that were associated with anemia. In pregnant women, lack of prevention against malaria by ITNs before ANV1, presence of anemia at ANV1, and low maternal height were predictors of LBW.Integrated control of malaria and other infectious diseases as well as improving nutritional status are among vulnerable factors in the short- and middle-term to reduce the burden of anemia in South Kivu. This, in turn, will help to reduce the incidence of LBW.There is need for further research to (i) identify other causes of anemia including hemoglobinopathies and other genetic disorders, (ii) improve knowledge of the best strategies for controlling anemia by integrating prevention of malaria in an environment where there is a relatively high prevalence of hemoglobinopathies and other genetic abnormalities that may alter erythropoiesis and/or iron metabolism.<br>Doctorat en Sciences de la santé Publique<br>info:eu-repo/semantics/nonPublished

Corrigenda tipped to title page.<br>Includes bibliographical references (leaves 313-353).<br>xxvii, 353 leaves : ill. (some col.) ; 30 cm.<br>Title page, contents and abstract only. The complete thesis in print form is available from the University Library.<br>Investigates the iron status and dietary intakes in 6-24 month old children in Australia and Ghana and assesses the effects of dietary calcium on intestinal iron absorption. The true prevalence of non-anaemic iron deficiency (NAID) and iron deficiency anaemia (IDA) and dietary intakes in infants and toddlers from a broad socio-economic background were assessed by haematological and biochemical parameters, semi-quantitative diet recall and anthropometric measurements. The high prevalence of iron deficiency and anaemia found in Australian and Ghanaian children can be attributed to the low intake of bioavailable iron in weaning diets which are often ingested with large amounts of calcium. While calcium has been shown to inhibit the absorption of iron, its mechanism of interaction with iron absorption at the intestinal level is not known. The rat was used as an experimental model to investigate the effects of dietary calcium on duodenal iron uptake. The results indicate there is a critical period during weaning when the consumption of high dietary calcium with low iron can retard growth potential. Dietary calcium significantly inhibits non-haem iron absorption at the intracellular level by up-regulating villus enterocyte ferritin concentrations under iron deficiency conditions.<br>Thesis (Ph.D.)--University of Adelaide, Dept. of Animal Science, 1998

Corrigenda tipped to title page.<br>Includes bibliographical references (leaves 313-353).<br>xxvii, 353 leaves : ill. (some col.) ; 30 cm.<br>Investigates the iron status and dietary intakes in 6-24 month old children in Australia and Ghana and assesses the effects of dietary calcium on intestinal iron absorption. The true prevalence of non-anaemic iron deficiency (NAID) and iron deficiency anaemia (IDA) and dietary intakes in infants and toddlers from a broad socio-economic background were assessed by haematological and biochemical parameters, semi-quantitative diet recall and anthropometric measurements. The high prevalence of iron deficiency and anaemia found in Australian and Ghanaian children can be attributed to the low intake of bioavailable iron in weaning diets which are often ingested with large amounts of calcium. While calcium has been shown to inhibit the absorption of iron, its mechanism of interaction with iron absorption at the intestinal level is not known. The rat was used as an experimental model to investigate the effects of dietary calcium on duodenal iron uptake. The results indicate there is a critical period during weaning when the consumption of high dietary calcium with low iron can retard growth potential. Dietary calcium significantly inhibits non-haem iron absorption at the intracellular level by up-regulating villus enterocyte ferritin concentrations under iron deficiency conditions.<br>Thesis (Ph.D.)--University of Adelaide, Dept. of Animal Science, 1998

Iron deficiency anemia (IDA) and calcium deficiency affect millions of children globally. Sprinkles is a multi-micronutrient powder (MNP) that has successfully treated anemic infants and can be modified to include additional micronutrients. The efficacy for treating IDA and preventing calcium deficiency requires evaluation due to potential nutrient interactions. We assessed the efficacy of Sprinkles MNP including iron with and without calcium on hemoglobin (Hb) response in 100 anemic rural Bangladeshi infants for 2 months. Sprinkles MNP with and without calcium resulted in a significantly higher Hb concentrations in both groups (P<0.0001 and P<0.0001). However, infants who received Sprinkles MNP without calcium had a significantly higher change in Hb concentration (P=0.024) and rate of recovery from anemia (P=0.008). No differences in socio-demographic or dietary characteristics were documented between groups. Although both groups had an improvement in Hb status, the antagonistic interaction between iron and calcium requires further study.

Background: The Zanzibar Infant Nutrition Campaign is a large-scale randomised control trial investigating the effects of iron and zinc supplementation on the morbidity and mortality of infants and young children on Pemba Island, Zanzibar, Tanzania. The Child Development Study is a substudy of the larger ZINC control trial assessing the effects of 12 months of iron and zinc supplementation on motor and language development. The Caregiver-Infant Interaction Study is a substudy of the Child Development Study, assessing the effects of 1 to 3 months of iron and zinc supplementation on caregiver-infant interaction among 9-month-old dyads. This thesis reports on the dyads enrolled in the Caregiver-Infant Interaction Study. While not examining treatment effects1 • Formulate behavioural and developmental hypotheses specific to a population of 9-month-old caregiver-infant dyads affected by a history of IDA , hypothesised disturbances in the behaviour and development of infants affected by a history of iron deficiency anaemia (IDA) are examined. Objectives: • Develop a hypothesis-driven observational coding system and establish the psychometric properties of this measure • Test hypotheses about the relationship between a history of IDA and the behaviour and development of 9-month-old caregiver-infant dyads Rationale: Iron deficiency anaemia is the most common nutritional disorder in the world. Prevalence is especially high among women, young children and infants in developing countries. As a public health concern, the effects of IDA are various and insidious, however the relationship between IDA and infant behaviour and development is not known. The majority of studies concerned with the impact of IDA in infancy have relied on global developmental scales, such as the Bayley Scales of Infant Development (Bayley, 1969, 1993). While infants with IDA consistently score worse than non-anaemic comparisons on mental and motor subscales, the value of this form of assessment is known to be limited. Apart from being of questionable validity as indices of abilities or functions (e.g., Fagan & Singer, 1983), the scores and ratings produced by traditional developmental scales are not designed to assess the specific functions hypothesised to be affected by IDA (Lozoff, De Andraca, Castillo, Smith, Walter & Pino, 2003). Over-reliance on this kind of measure thus rules out meaningful hypothesis-driven research. Recently, malnutrition researchers have begun to made use of systematic behavioural observation as a means of assessment. While a promising approach, extant research is limited to only two studies (see Footnote 6), and both of these have been conducted by the same research group. Moreover, these studies have relied on fairly rudimentary behavioural coding to examine a version of the ‘Functional Isolation Hypothesis', originally proposed some time ago in the infrahuman literature (Levitsky & Barns, 1972, 1973). More sophisticated hypotheses are available, especially given the ready availability of insights from developmental psychobiology and cognitive science. Design: A correlational design was used to examine the behaviour and development of 9-month old caregiver-infant dyads with a history of IDA. Setting: Wete District, Pemba Island, Zanzibar, Tanzania. Participants: 160 Caregiver-infant dyads assessed observationally at 9-month of age. Main Outcome Measure: Systematic observational coding. Main Findings: Infants with a history of more severe IDA spent significantly less time in high energy states during free play, and their caregivers made less physically demanding requests. A history of IDA also correlated with developmental disturbances in postural control. Affectively, IDA infants were hypo-responsive, and caregivers showed more (overt) positive affect for healthy males, but not females. Caregivers coordinated actions and vocalizations less often during interaction with infants affected by a history of IDA. Conclusion: A history of IDA among 9-month old infants is related to behavioural and developmental disturbances in both motor and socio-cognitive domains. Note to reader: The present research was first submitted as a Masters dissertation in 2008. The author was subsequently offered the opportunity rather to upgrade to a Doctoral thesis and resubmit the work as PhD. Chronologically then, studies which did not inform the design and development of the coding system used for data collection, or which published findings after the first submission of the present work, are discussed in the final chapter.<br>Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2009.

The purpose of this quasi-experimental study was to measure the effectiveness of a grocery store tour that emphasized sources of iron-rich, kid-friendly foods on the participants’ knowledge about dietary iron and iron-rich food sources. A second purpose was to determine if, three months after the grocery store tour, the serum iron levels of the children who had previously been identified by the WIC (Supplemental Women, Infants, and Children) program as being low was higher as compared to the serum iron levels of the control group. Ten parents of children with low iron levels participated in this study, 5 in the control group and 5 in the treatment group. Data collection took place for this research study over the course of three months. The results of this study indicated that the grocery store intervention seemed to have no impact on the children’s hemoglobin levels. The results of this study also indicated that the grocery store tour intervention seemed to have no impact on children’s consumption of iron rich foods. However, the grocery store tour intervention did have a positive impact on parents’ knowledge of iron rich foods and their ability to use unit pricing.<br>Department of Family and Consumer Sciences

Background Iron deficiency (ID) is the world‟s most prevalent micronutrient deficiency and predominantly affects developing countries, also South Africa. In areas with low fish consumption and high n-6 PUFA vegetable oil intake, there is a risk for having inadequate n-3 PUFA status. Both iron and n-3 PUFA play important roles in the immune response, and supplementation is a strategy to alleviate deficiencies. However, little is known about potential interactive effects between concurrent iron and n-3 PUFA supplementation on the immune system. This is also important in the context that iron supplementation may be unsafe and may increase morbidity and mortality. Aim The overall aim of this thesis was to assess the effects of iron and docosahexaenoic (DHA)/eicosapentaenoic acid (EPA) supplementation, alone and in combination, on the immune system of ID children. More specifically, these effects were investigated on the occurrence and duration of illness and school-absenteeism due to illness, peripheral blood mononuclear cell (PBMC), red blood cell (RBC) and plasma total phospholipid fatty acid composition, iron status, fatty acid-derived immune modulators and targeted PBMC gene expression. Furthermore, association of PBMC, RBC and plasma total phospholipid fatty acid composition with allergic disease, were also examined. Design In a 2-by-2 factorial, randomised, double-blind, placebo-controlled trial, South African children (n = 321, aged 6–11 y) were randomly assigned to receive oral supplements of either 1) iron (50 mg as ferrous sulphate) plus placebo; 2) DHA/EPA (420/80 mg) plus placebo; 3) iron plus DHA/EPA (420/80 mg); or 4) placebo plus placebo for 8.5 mo, four times per week. Absenteeism and illness symptoms were recorded and biochemical parameters for compliance as well as parameters fundamental to immune function were assessed at baseline and endpoint. Furthermore, in a cross-sectional design, associations of allergic disease with baseline fatty acid composition of PBMC, RBC and plasma were examined. Results The combination of iron and DHA/EPA significantly attenuated respiratory illness caused by iron supplementation. DHA/EPA supplementation alone improved respiratory symptoms at school, but increased headache-related absenteeism. DHA/EPA and iron supplementation individually tended to increase and decrease anti-inflammatory DHA and EPA-derived mediators, respectively. Furthermore the anti-inflammatory DHA-derived immune mediator, 17HDHA was higher in the DHA/EPA plus placebo and iron plus DHA/EPA groups than in the iron plus placebo group. Also, the pro-inflammatory arachidonic acid (AA)-derived modulators (5- and 15-hydroxyeicosapentaenoic acid) were significantly lower in the iron plus DHA/EPA group compared to the placebo plus placebo groups. In the study population, 27.2% of the children had allergic disease and AA in PBMC phospholipids was significantly lower in the allergic children than in the non-allergic children. In RBC phospholipids dihomo-gamma-linolenic acid (DGLA) and the ratio of DGLA: linoleic acid (LA) correlated negatively and the n-6:n-3 PUFA ratio positively with total immunoglobulin E (tIgE). Furthermore, trans-C18:1n-9, tended to be higher in the allergic group. Conclusion DHA/EPA prevented respiratory illness caused by iron supplementation and although DHA/EPA on its own reduced respiratory morbidity when the children were present at school, surprisingly it increased the likelihood of being absent with headache and fever. The biochemical findings compliment the clinical results and support previous observations about DHA/EPA supplementation to reduce inflammation, but add to the current knowledge base that a relatively high oral dose of non-haem iron modulates circulating lipid-derived immune modulators and related gene expression. Furthermore, when supplementing with iron and DHA/EPA combined, in this ID population with low fish intake, the anti-inflammatory effect of DHA/EPA is maintained concurrently with attenuation of respiratory morbidity. This finding support the notion that excess iron (probably as non-transferrin bound iron) becomes available for pathogens and is probably why we found that iron increased respiratory infectious morbidity. The improved clinical outcome with combined supplementation seems to be related to increased lipid-mediator synthesis gene expression and the availability of DHA/EPA, leading to a more pro-resolving profile and enhanced immune competence. Overall these results give better insight into immune function and infectious morbidity in relation to n-3 PUFA and iron status and treatment, as well as the possible association of fatty acid status with allergic disease in young South-African school children.<br>PhD (Nutrition), North-West University, Potchefstroom Campus, 2015