Analysis of the causes and prevalence of anemia in children of the Voronezh region

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Introduction. The problem of the prevalence of anemia is relevant for doctors of all specialties. Deficiency anemia is a clinical and hematological syndrome, the origin of which is associated with deficiency of vitamins, trace elements or protein in the process of child development. The extremely high prevalence of these diseases is mainly related to the period of intrauterine development, the health of the expectant mother, the organization of the child's life and nutrition in the first year of life, as well as concomitant diseases at an older age. According to WHO estimates, 40% of children aged 6-59 months worldwide suffer from anemia [1].
The purpose of the work is to analyze the probable causes (according to literature data) and the age-related prevalence of anemia among children hospitalized in the VODKB No. 1 over a 3-year period.
Materials and methods of research. A retrospective analysis of scientific articles and publications and cases of anemia deficiency among children hospitalized in VODKB No. 1 from 2020 to 2023 was carried out.
The results of the study. During the three-year period at VODKB No. 1, 5,580 children were examined, and it was found that among them, IDA accounted for 99.48% (n=5,550) of all patients (p<0.05). The proportion of B-12 folate deficiency anemia was 0.26% (n=15) and polydeficiency anemia was 0.26% (n=15) (see Figure 1).

Figure 1. Distribution of morbidity
by type of anemia in children for the period from 2020-2023.

Our data are consistent with a number of other authors [2-4], as the problem of iron deficiency is one of the most significant, due to the adverse effects of iron deficiency conditions on the child's body. JV negatively affects the cognitive development of both young and adolescent children, damaging immune mechanisms, which leads to an increase in the incidence of infectious diseases. It is known that the prevalence of IDA depends on age, gender, physiological characteristics, the presence of concomitant pathology, socio-economic conditions and the ecological environment of the children's place of residence.
By age, all patients with IDA were divided into 3 groups: Group I - children under 3 years old (n=2849, 51.3%); group II-from 3 to 9 years old (n=1307, 23.5%); Group III-from 9 to 17 years old (n=1394, 25.2%) (see fig. 2).

Figure 2. Age composition of children suffering from IDA

According to the data obtained, the group of children of the younger age group prevailed (n=2849, 51.3%). The root causes of IDA are disorders of the uteroplacental circulation, fetal transfusion syndrome in multiple pregnancies, prematurity, and prolonged pregnancy in pregnant women. In infancy, the risk of JH increases due to the increased need for iron as a result of rapid growth, which confirms the high incidence in children under 3 years of age, as revealed in our study (n=2849, 51.3%).
Iron is present in small amounts in both breast and cow's milk, but about 50% of the iron is absorbed from breast milk, whereas only 10% of the iron is absorbed in cow's milk. Consumption of cow's milk during the first year of life can also lead to IDA through gastrointestinal blood loss due to colitis caused by cow's milk proteins [5].
The prevalence of JD among school-age children is lower than in other age groups. IDA can be the result of causes that lead to blood loss, such as nosebleeds and gastrointestinal losses. In teenage girls, menstrual bleeding is the most common cause of pregnancy. Factors that reduce stomach acidity, including H2-receptor blockers, surgical procedures such as gastrectomy, reduce iron absorption. Celiac disease and malabsorption syndromes also lead to JD [6].
The effects of prolonged exposure in young children lead to impaired cognitive functions, delayed development of speech, motor skills, and movement coordination. School-age children experience stunted growth and mental development, impoverishment of the emotional sphere with a predominance of bad mood, lethargy, irritability, fatigue increases, and the ability to concentrate significantly decreases, which leads to lower academic performance [7].
All patients with B12-deficient folic anemia were also divided into 3 groups (see Fig.3).

Figure 3. Age group of children with B12-folate deficiency anemia

It turned out that the older age group of children significantly prevailed (n=13, 86.7%), since folic acid deficiency is usually a secondary cause of insufficient food intake. Human and cow's milk are sufficient sources of folic acid, which indicates a low incidence of this anemia in pre-school children.
Depending on the etiology, B12 deficiency anemia is distinguished, which develops as a result of insufficient intake of vitamin B12 as a result of malnutrition or a strict vegetarian diet more often in adolescent children, which was also revealed in our study (n=13, 86.7%). This may be due to improper eating habits and socio-cultural factors. Also, this type of anemia can occur as a result of a decrease in the absorption of vitamin B12 (in patients with resection of the ileum, with malabsorption syndrome of various origins). As a result, an abnormal amount of homocysteine is formed in the body, which has a neurotoxic effect on the nervous system [8].
Vitamin B12 deficiency more often leads to neurological manifestations in childhood: loss of previously acquired skills, apathy, ataxia, drowsiness, seizures are described. In older children, the leading neurological symptoms are paresthesia, impaired deep sensitivity, muscle weakness and muscle atrophy. Vitamin B12 deficiency can lead to impaired synthesis of ethanolamine, phospholipids, and sphingomyelin, which leads to a violation of the integrity of myelin, followed by a delay in neuromotor development [9].
Patients with polydeficiency anemia were also divided into 3 groups (see Fig. 4).

Figure 4. Age composition of children with polydeficiency anemia

It is known that the etiology and pathogenesis of anemia deficiency are more often associated with nutrition, the following macro- and micronutrients have proven importance: iron, calcium, zinc, vitamin C, vitamin B12, folic acid, vitamin B2, vitamin B6, copper, cobalt, vitamin B1 [10].
In this case, the group of school-age children prevailed (n=8, 53.3%). School-age children belong to the most sensitive age group of the population, reflecting the influence of environmental factors. This type of anemia is largely determined by the level of sanitary and epidemiological well-being in educational institutions, depends on the proper organization of the educational process, nutrition of students. This proves that an incorrect physiological interval between meals does not contribute to the prevention of alimentary-dependent diseases [11].
Conclusion. During the analysis, it turned out that IDA significantly prevails among anemia in children; J is more often detected in younger children; vitamin B12 and folic acid deficiency prevails in the older age group. Anemia deficiency in children remains a significant medical and social problem in the Voronezh Region. Solving this problem requires an integrated approach, including epidemiological monitoring, preventive measures, improved diagnosis and treatment, as well as active public awareness.

About the authors

Alina Valeryevna Bogatikova

Voronezh State Medical University named after N. N. Burdenko

Email: albogatikova2004@mail.ru
ORCID iD: 0000-0003-4217-831X
Russian Federation, 10 Studencheskaya str., Voronezh, 94036, Russia.

Natalya Borisovna Yudina

Voronezh State Medical University named after N. N. Burdenko

Email: n.yudina@list.ru
ORCID iD: 0000-0002-7305-6959

Ph.D., Assistant Professor of the Department of Faculty and Palliative Pediatrics 

Russian Federation, 10 Studencheskaya str., Voronezh, 94036, Russia.

Irina Valeryevna Grebennikova

Voronezh State Medical University named after N. N. Burdenko

Author for correspondence.
Email: i.v.grebennikova@inbox.ru
ORCID iD: 0000-0003-0213-9383

Ph.D., Associate Professor of the Department of Pathological Physiology

Russian Federation, 10 Studencheskaya str., Voronezh, 94036, Russia.

References

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