الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Iron deficiency anemia (IDA) is the most common form of nutritional deficiency
both in developing and developed countries. Infants and young children are at higher risk
for developing IDA especially those who aged six to twenty four months due to rapid
growth and low intake of iron rich complementary food. Iron deficiency anemia in early
childhood has a negative effect on the cognitive, motor and behavioral function with
evidence of long lasting effect that persists till adolescent.
The main risk factors for IDA among infants include poor maternal nutritional
status, low birth weight, prolonged exclusive breast feeding, early consumption of cow
milk and poverty. Prevention of IDA among infants and young children can be achieved
through healthy dietary practices, iron supplementation, targeted fortification and
nutritional education.
The aim of the present study was to estimate the prevalence of IDA among infants,
to identify the determinants of IDA, to assess the knowledge and practices of mothers
regarding factors leading to IDA among infants, to construct an educational program and
evaluate its effect in improving the knowledge and practices regarding IDA.
The study was conducted in two phases:
1. Phase one: Cross-sectional design was conducted in thirty villages that was
selected randomly from Nablus Governorate fifty nine villages, West Bank on 660
randomly selected infants aged between nine to twelve months. This phase was
considered as a pre- test for the second phase.
2. Phase two: Intervention design (randomized pre-test post-test control group
design) targeting infants with IDA. Iron deficient infants were randomly assigned
into either intervention or control group, mothers in the intervention group attended
two education sessions, each of one hour duration. Sessions were held in
associations, municipalities and villages’ councils. Post-test data were obtained
three months after the intervention using the same data collection methods that had
been used in the pre-test.
Data were collected using the following tools:
· A pre-designed structured interviewing questionnaire: Include sociodemographic
data regarding mothers, pregnancy and birth characteristics,
infants demographic, medical and dietary history, mothers’ knowledge and
practices regarding IDA.
· Laboratory test: a complete blood count was performed. The level of
hemoglobin and mean corpuscular volume were used to assess IDA among
infants.
· Anthropometric measurements: Infants’ weight and length were measured, and
WHO Anthro software was used to calculate z-scores for weight for age, weight
for length and length for age.
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· Intervention program: An educational program was designed according to the
results obtained from the preliminary phase which was considered as a pre-test
for the intervention and control groups.
The collected data were revised, coded and analyzed using SPSS. Binary logistic
regression, t-test and MANOVA test were used as tests of significance.
The study revealed the following results:
A. The prevalence of anemia and IDA among rural infants:
· The prevalence of anemia among infants was 34.6%, among them 71.7% had
mild anemia, 28.3% had moderate anemia and no cases of severe anemia.
· The prevalence of IDA among infants was 32.6%.
B. Determinants of IDA among infants:
· The main risk factors of IDA among studied infants were infants’ age, anemia
during the third trimester, less than three years spacing between deliveries, type
of feeding during the first six months, time of introducing the complementary
feeding and lack of mothers’ adherence to iron supplements during pregnancy
in the correct frequency and duration.
C. Assessment of the knowledge and self reported practices of mothers regarding
IDA:
· With respect to mothers’ general knowledge regarding IDA, the study showed
that 61.9% of mothers had fair level of knowledge and only 2.8% had good
level of knowledge.
· MANOVA test indicated a significant impact of mother age, level of education,
employment status, villages region and spacing between deliveries on the
mothers’ level of knowledge regarding IDA.
· Slightly more than half of mothers had fair level of practice, 37.5% had good
level of practice and 10.2% had poor level of practice regarding IDA.
D. Evaluation of the intervention program:
· There was a dramatic increase in the level of knowledge among mothers in the
intervention group from 23.09+5.88 to 33.68+5.37. Independent t-test showed a
significant difference in the mean of knowledge between intervention and
control groups.
· The mothers’ level of knowledge before the intervention and the education
program were the factors that affect the mothers’ knowledge after the
intervention.
· Regarding mothers practice, there was no significant difference between two
groups. However, the mothers practice in the intervention group was
significantly better after implementing the intervention.
· The logistic regression model showed that the mothers’ practices before the
intervention and the village region were the predictors for the mothers’
practices after the intervention.
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· The education program was significantly effective in reducing the risk of IDA
among infants in the intervention group by 33% compared with the control
group.
It can be concluded from the study that:
· The planned health education program was effective in improving the
knowledge of mothers regarding IDA and in reducing the risk of IDA among
their infants.
· Hemoglobin measurement can be used as a screening test for IDA among
infants and young children.
Based on the results of the study, the following items are recommended:
· Early administration of iron supplements for infants born to anemic mothers.
· Start the routine screening for anemia among infants from nine months instead of
twelve months, for early discovery and prevention of anemia and IDA.
· Further tests for infants with Hb less than 11g/d, if Hb concentration was not
corrected after dietary changes and/or iron supplements.
· Change the type of iron distributed free of charge at nine months of age by the
Ministry of Health to combat anemia, to another type with more acceptable taste.
· Awareness and education programs for nurses working in child health clinics about
time of introducing the complementary feeding, types of food rich in iron with
emphasis on animal protein, and the correct way of giving iron supplements to
ensure that mothers are given the correct dietary advice and feeding instructions at
the same time as being given the iron supplements.
· Awareness programs for pregnant females regarding iron rich food and importance
of iron supplements during pregnancy and after delivery, with emphasis on relation
between maternal anemia and infants’ anemia.
· Engage media sector to improve public awareness about negative impact of anemia
on growth and development and to disseminate messages about prevention of
anemia through dietary modification. Messages should also target pregnant females
and mothers of infants about the importance of iron supplements.
· School curricula should include topics to improve nutritional habits of students
through increase dietary iron intake in order to prevent IDA before secondary level.
· Assess the knowledge of nurses who work at the child health clinics regarding
lactation, complementary feeding practice in term of time, quantity and quality;
anemia; iron rich food; iron enhancers and inhibitors.