is a condition in which the hemoglobin

concentration in the blood is below a defined

level, resulting in a reduced oxygen-carrying
capacity of red blood cells. It is the most
common hematologic disorder.
(1) inadequate production of RBC’s or RBC
components
(2) Increased destruction of RBCs, and
(3) excessive loss of RBCs (Hockenberry and
Wilson, 2007).

It occurs at all stages of the life cycle, but is

more prevalent in pregnant women and young
children (WHO Worldwide prevalence of
anaemia 1993-2005).
is caused by an inadequate supply or loss of iron. It is
the most prevalent nutritional disorder and the most
preventable mineral disturbance. It is generally
assumed that 50% of the cases of anemia are due to
iron deficiency, but the proportion may vary among
population groups and in different areas according to
the local conditions. The main risk factors for IDA
include a low intake of iron, poor absorption of iron
from diets high in phytate or phenolic compounds, and
period of life when iron requirements are especially
high
I. Inadequate supply of iron
 Deficient dietary intake
Rapid growth rate
Excessive milk intake; delayed addition of solid foods
Poor general eating habits
Exclusive breast-feeding of infant after 6 months of
age
 Inadequate iron stores at birth
Low birth weight, prematurity, multiple births
Severe iron deficiency in mother
Fetal blood loss at or before delivery
II. Impaired iron absorption
 Presence of iron inhibitors
Phytates, phosphates or oxalates
Gastric alkalinity
 Malabsorption disorders
Lactose intolerance
Inflammatory bowel disease
 Chronic diarrhea
iii. Blood loss
 Acute or chronic hemorrhage
 Parasitic infestation
 Excessive demands for iron required for growth
 Prematurity
 Adolescence
 Pregnancy
Visible severe wasting – severe wasting of the
shoulders, arms, buttocks, and legs, with ribs easily
seen, and indicates presence of marasmus.
Edema of both feet
Weight for age - weight for age indicator is a
standard growth chart that helps identify children
with low or very low weight for age and who are at
increased risk of infection and poor growth and
development
Palmar pallor
• Visible severe wasting SEVERE • Give first dose of vitamin A
or MALNUTRITION OR • Needs urgent referral to a hospital
• Severe palmar pallor or SEVERE ANEMIA
• Edema of both feet

• Some palmar pallor ANEMIA OR (VERY) • Assess the child’s feeding and counsel
or LOW WEIGHT the mother accordingly on feeding
• (Very) low weight • If there is a feeding problem, follow up in
for age 5 days
• If pallor is present, give iron (1 dose
daily)
• Syrup to a child 12 months of age
• Iron tablets if the child is 12 months or
older
• If the child is receiving antimalarial
sulfadoxine-pyrimethamine, do not give
iron/folate tablets until a follow up visit in
2 weeks, as this can interfere with the
action of the antimalarial
• In areas where hookworm or whipworm
is a problem, give mebendazole if the
child is 2 years or older and has not had
a dose in the previous 6 months
• Follow up in 14 days
• If very low weight for age, give vitamin A
• Follow up in 30 days
• Advise mother when to return
immediately

• NOT (very) low weight NO ANEMIA AND NOT • If the child is less than 2 years old,
for age and no other (VERY) LOW WEIGHT assess the child’s feeding and counsel
 VITAMIN A
Treatment:
Give one dose in the health center
  
Supplementation:
Give one dose in health center if:
Child is six months of age or older,
Child has not received a dose of vitamin A in
the past 6 months
 AGE Vitamin A capsules

100,000 IU 200,000 IU

6 months up to 1 ½ capsule
12 months

12 months up to - 1 capsule
5 years
Give one dose daily for 14 days
AGE OR WEIGHT IRON/FOLATE IRON SYRUP IRON DROPS
TABLE Ferrous Ferrous sulfate Ferrous sulfate
Sulfate 150mg per 5ml 25mg (25mg
200mg+250mcg (6mg elemental elemental iron
Folate (60mg iron per ml) per ml)
elemental iron)
3 months up to 4 2.5 ml (1/2 tsp) 0.6 ml
months (4 - <6
kg)
4 months up to 12 4 ml (3/4 tsp) 1.0 ml
months (6 - <10
kg)
12 months up to 3 ½ tablet 5 ml (1 tsp) 1.5 ml
years (10 - < 14
kg)
3 years up to 5 1 tablet 10 ml (1 ½ tsp) 2.0 ml
years (14 – 19 kg)
de Benoist, Bruno, Erin McLean, Ines Egli, and Mary
Cogswell, Worldwide prevalence of anaemia 11993-
2005 WHO Global Database on Anaemia
 http://www.who.int/en/
Food and Nutrition Research Institute (FNRI)
 http://www.fnri.dost.gov.ph
Hockenberry, Marilyn J. and David Wilson. 2007
Wong’s Nursing Care of Infants and Children, 8th ed.
pp. 1516-1517. Elsevier Pte. Ltd. Singapore.
Model Chapter for Textbooks IMCI (Integrated
Management of Childhood Illnesses), World Health
Organization, 2001