Anaemia in Primary Health Care

Introduction

Primary health care is a concept that is set to ensure quality healthcare for everyone and the WHO provide five elements to enable achievement of this goal. Reduction of social disparities, increasing stakeholder involvement, integration of medical services in all sectors, pursuing collaborative program and tailoring health services based on the needs of the people.¹

Management of anaemia should follow the same trend. Anaemia is a medical condition that is characterised by less blood components, especially the red blood cells than usual. The normal level is 12-13.5mg/100ml and carried in men and women.¹ Two pathways form the main means of anaemia process.² One is decreased production of RBCs and the second is their increased destruction. Iron which forms haemoglobin is critical for body function as its through this that the blood can transport oxygen to every tissue in the body.¹ Lack of iron in blood results in clinical symptoms that are indicative of possible anaemia, However Mean Corpuscular Volume (MCV) distinguishes anaemia from other medical conditions. ³ It is a measure of the RBCs in whole blood. It is hence important to be certain when making a diagnosis by use of invasive technique rather than rely on physical symptoms. ²

Purpose of Study

This study will seek to provide proper information on the validity and accuracy of observation of anaemia symptoms in making diagnosis. The study will also seek to assess whether prescribing iron supplements is a valid measure following suspicion of anaemia without confirming by invasive techniques.

Significance of Study

This study will seek to provide information that will fill this gap and provide categorical conclusion on why iron supplements should or should not be prescribed. A profile of symptoms observed in anaemia and the possibility of giving an accurate diagnosis rated. ^2-3

Literature Search

Anaemia means that the blood is deficient in haemoglobin that makes up the RBCs. ³ Iron deficiency is the commonest type of anaemia and it is common in women and children. Normally, people get this iron from food and recycling it from RBC degradation and this condition can develop when the iron is insufficient. The causes include insufficient iron in the diet; poor body absorption of iron due to intestinal disorders like celiac disease, bleeding both internal and external and pregnancy. ^4-5

Symptoms of Anaemia

The symptoms develop from mild to severe as the anaemia progresses. The most common signs that depict iron deficiency include pale skin, irritability, general weakness, fatigue, headache and breathlessness. Other diseases like malaria also portray such symptoms and sometimes these symptoms are not conclusively used to determine presence of anaemia.¹ However, there are other accompanying symptoms that practitioners use to ascertain the presence of anaemia. Lack of appetite, sore tongue, strange craving of food, pallor nails and uncomfortable feeling in legs are some of the symptoms. ^5-6

Consultation is the best thing to do because it helps to determine the actual cause of the symptoms because several other illness and deficiencies can cause similar profile of symptoms. However, blood test is the surest way of determining iron deficiency anaemia. ¹ It is only after this test that a doctor can prescribe the best kind of iron supplement. Sometimes excess iron can cause similar symptoms and hence it would be problematic to prescribe more iron intake inform of supplement. ⁶ This is the reason why only qualified physicians can make prescription following the results of the test. Iron deficiency then develops as the body utilizes more iron than it gets from dieting. Children are prone to anaemia because of their rapid growth that makes their body system to use more iron. ⁷

Consequences of Iron Deficiency

Circulation of blood around the body from the lungs allows oxygen flow from the lungs. Reduced iron means that less oxygen will be carried in blood and this can cause a cascade of reactions in the body. ⁵ Reduced haemoglobin formation will be the first problem leading to deficient oxygen transport. ⁴ Tissues will then be deprived of oxygen and their function would be inefficient. This is why the patients suffer fatigue, irritation, shortness of breath and low temperature in extremities. It takes at least two weeks to correct the condition. ⁷

Possible Anaemia Complications

If left untreated, anaemia can be exacerbated so much that it can interfere with the daily lives of the patient. ⁸ When children in their very tender age suffer anaemia, they could develop learning difficulties in future as they grow up. However, there is some good news because anaemia can be managed before its effects escalate by use of iron therapy. ^9-10 It is still important to know the cause of anaemia since the cause could be an indication of more serious health problem. This is because diseases like celiac disease, malaria and other diseases that cause internal bleeding can cause anaemic condition. ⁹ By just administering iron supplement based in the symptoms would then not be as effective as it would have been when the underlying cause is addressed. ^11-13 Without treating the cause, managing symptoms would not take away the problem. Anaemia can relapse hence after treatment with iron supplements, there needs to be a follow-up process that would seek to find out the progress f the patient. Anaemic children are also prone to other diseases because their immune system is affected. ^10,13

Treatment and Prevention

The objective of treatment is to remove the cause of iron deficiency and to correct iron level in blood. These goals need to be addressed simultaneously but correcting the deficiency even before the cause has been accurately determined. ⁷

Diets that are rich in iron are recommended for patients of anaemia but this alone cannot be used for full treatment. ¹⁰ Oral iron supplements are used alone the proper diet to return the level back to normal. Injection can also be used when the anaemia is severe. Treatment of the cause is the ultimate objective of treatment regime but supplements help to restore the normal iron level in blood faster. ^12-14

Study Design

The study will be a mainly a qualitative research that will employ experimental design to amass data from the participants who will be randomly selected from the study area. The reason for using qualitative analysis will be to compute the information obtained so as to inform the currently existing knowledge that links diagnosis of anaemia based on observation of symptoms and their validity as well as the decision to prescribe iron supplements before invasive confirmation of the condition. ¹⁴ The techniques that will be used for the study will be questionnaires. The researcher will fill the questionnaire after observing and asking questions.

Both qualitative and quantitative methods of data collection will be employed will be used in the study. The objective of integrating data collection method is ensures that study results are properly translated into logical and sensible findings. The research design selected should contribute towards the study being of a high degree of accuracy. Some data will be collected from earlier reports from medical journal databases. A screening interview will be used to find out why and how private practitioners reach the decision to prescribe iron supplements and validity of symptoms in accurate diagnosis.

Ethical Issues

The research study will adhere to the ethical processes set by the American Psychological Association. The study will adhere to the voluntary participation and parents will have to accept participation of their children without coercion. ¹⁵ The research will also uphold the needs of informed consent where participants will have to be fully informed or the research process and risks that they could face and would only be allowed to take part after the parent’s accent to informed consent form. ¹⁵ the Confidentiality principle will be assured, in that the researcher and no one else will access information. Anonymity will be ensured by not allowing names on the research questionnaires and this will at least guarantee privacy. ¹⁵ Rights to services will be upheld and the participants diagnosed with anemia will be treated accordingly as the right to medication requires.

Timeline

Research Timeline and Project Milestones

The research will be conducted between February and June. Specific event are recorded in the table below with the time limit

At every stage the investigator will be consulting with the supervisor

Budget: Resources required conducting research

Reference List

1. DeMaeyer EM., Dallman P, Gurney JM, Hallberg L, Sood SK, & Srikantia SG. Preventing And Controlling Iron Deficiency Anaemia Through Primary Health Care: A Guide For Health Administrators And Programme Managers, WHO Geneva, Switzerland, WHO; 1989:5-58.
2. Thaver HI, Baig, L., Inam-ul-Haq, & Iqbal, R., Anaemia in Children: Part II. Should Primary Health Care Providers Prescribe Iron Supplements By The Observation And Presence Of Assumed Symptoms? J Pak Med Assoc,1994, 44 (12): 284-5.
3. Stoltzfus RJ. Defining Iron-Deficiency Anemia in Public Health Terms: A Time for Reflection, Journal of Nutrition, 2001;131.
4. Yip R. Prevention and Control of Iron Deficiency: Policy and Strategy Issues J. Nutr. 2002; 132: 4 802S-805.
5. Clark SF. Iron Deficiency Anemia, Nutr Clin Pract 2008, 23: 2 128-141.
6. Thaver HI, & Baig L, Anaemia in Children: Part I. Can Simple Observations By Primary Care Provider Help In Diagnosis? J Pak Med Assoc,1994, 44 (12): 284-5.
7. Stoltzfus RJ & Dreyfuss ML. Guidelines for the Use of Iron Supplements to Prevent and Treat Iron Deficiency Anaemia, Washington DC, ILSI Press 1998:1-39.
8. Ali NS, & Zuberi RW. Association Of Iron Deficiency Anaemia In Children Of 1-2 Years Of Age With Low Birth Weight, Recurrent Diarrhoea Or Recurrent Respiratory Tract Infection–A Myth Or Fact? J Pak Med Assoc. 2003; 53(4):133-6.
9. Sullivan KM, Mei Z, Grummer-Strawn L, & Parvanta I. Haemoglobin Adjustments To Define Anaemia. Trop Med Int Health. 2008; 13(10):1267-71.
10. Samba, R. Nutrition And Health In Developing Countries, Totowa, NJ, Humana Press; 2001.
11. Earl, RO., & Woteki, CE. Iron Deficiency Anemia: Recommended Guidelines For The Prevention, Detection and Management, Washington DC, National Academic Press; 1993.
12. Hillman, RS., Ault, KA., & Rinder, HM. Hematology In Clinical Practice: A Guide To Diagnosis And Management, New York, McGawhill Professional, 2005. p. 137-50.
13. Uthman, E. Understanding Anemia, Jackson MS,University Press Of Mississipi; 2010.
14. Edmund, K., Peterson, B., & White, A. Anemia In Children, New York, Mcgrawhill Professional; 2001.
15. Burnard P & Chapman T. Professional and Ethical Issues in Nursing. (3^rd Ed), Edinburg, Ballière Tindall; 2003.