Michael Brizzee and Professor Sondra Heaston, College of Nursing

Introduction:

According to the World Health Organization, anemia affects over 30% of children in Ecuador and in surrounding countries and has been directly linked to decreased test scores, educational performance, and job proficiency. This study is aimed at finding a nutrition correlation and possible causation of anemia in Ecuadorian children ages 7-15. The research is done in conjunction with an anemia study done through the college of nursing looking at other possible causes of anemia including parasites and deficient vitamin intake. Together, these studies have helped to identify possible causes of anemia which can in turn help agencies find economical and practical solutions to the problem.

Methodology:

5 schools were selected in rural communities who agreed to participate in the study. Working with a charitable organization “Hogar de Cristo” we were able to contact the schools and obtain permission from the parents of the students to participate in the study. Students from 4th -7th grade (7 to 15 years old) were asked for a 24 hour dietary recall after their hemoglobin had been tested. They were asked what they had eaten for breakfast that morning, dinner the night before and lunch the day before. They were also asked if they had eaten anything between meals. If students were unable to remember their diet recall was not included in the study. A nutritional data base developed by Dr. Paul Johnston of BYU using the USDA and Ecuadorian government databases, scholarly journal articles, and published literature was used to perform a nutritional breakdown of each child’s diet. Specific nutrients were identified as lacking in each child’s diet and averaged for each school. If the diet did not include 40% or more of the required daily intake (RDI) of energy, their 24 hour recall was not included.

Results:

Anemia results were very similar to the study conducted by the WHO. We found that 31.8% of the students tested were found to be anemic. There were some schools that had close to 10% anemia and others that were 68% anemic. Each child’s nutritional intake was analyzed and averaged for each school. 18.7% of the 31.8% of children who were anemic had an iron deficient diet, 6.2% had a thiamine deficient diet. 45.9% had a folate deficient diet, 24.7% had a vit. B12 deficient diet and 13.8% had a vitamin C deficient diet. Other nutritional components were measured but not included because they have little or no connection with the development of the different types of anemia. These findings were compared to the nutritional analysis of spring 2009 where more than 30% of children were anemic. The only nutritional components relating to anemia that were lacking in the children’s diet in both 2009 and 2013 was Folate. In both studies iron intake was nearly at or above 100% the daily recommended intake (DRI).

Discussion:

Using different interventions in 5 different schools we were able to identify a role fortified with iron rich flour, Thiamine, folate, and soy milk had the greatest improvement in anemia rates. Many of the children had nutritional supplements that had vitamins and iron but did not show a statistically significant improvement in anemia rates. These findings have different variables that should be considered. The first is the time of data collection for the different studies. The 2009 results were not collected from the same school. 2 of the 5 dropped out and were replaced by 2 new schools from similar socioeconomic backdrops. The data was also collected in our spring time or their fall when students are coming back to school. This data is a reflection of what the students are eating at home over several months during their summer break. All the schools tested were deficient in multiple nutritional components related to anemia but no one school was lacking in all anemia related nutrition. The most glaring hole in the student’s diet was eating folate and thiamine rich diets mainly leafy greens. Most students are eating foods prepared in the home using fresh ingredients. There are very few who eat fortified foods such as milk, breads, fats and oils, and beverages. This increases the bioavailability of the natural nutritional elements but other essential nutrients can be missing.

Interestingly the diets of the children have remained very similar from 2009 to 2013. The nutritional components of carbohydrates, proteins, vitamin B12 and vitamin C are all well above the daily recommended intake for children ages 7-15 for the two years. The discrepancies come with iron, thiamine, and folate. Folate was the most deficient at 55.6 % DRI in 2009 and 58.9% DRI in 2013 among all students and most likely the cause of high anemia rates. The reported diets lacked beans, lentils, and leafy greens which are high in folate. Iron intake was 127.4% DRI in 2009 and 96.4% DRI in 2013

Conclusion:

Having a well balanced diet is crucial to child development. Anemia is only one problem that results from poor nutrition but has a large impact including poor neural functioning and growth and physical development. Similarly to the United States, having a well balanced diet in Ecuador takes effort and costs more. The staple to Ecuadorian children’s diet in Guayaquil is rice. As parents have less money they substitute a more balanced diet with rice. Empowering parents with knowledge is essential to solving this problem. Anemia is not well understood by most of the world especially the effects and causes. Anemia and iron are commonly associated but iron is only one cause of anemia. The results of anemia in Ecuador show thiamine and folate are possible causes of anemia so education is paramount. It will allow them to make more health conscious food selections for themselves and their families. Anemia is a difficult problem to educate parents and bring to light because many children may still be performing at a high level but not to their potential.