Anemia in association to iron deficiency continues to be a pervasive problem in the world According to the World Health Organization (WHO), at least a third of the world’s population is anemic with greater prevalence in developing countries like Latin America. The most alarming issue is that a high number of the population suffering from anemia is largely children and women Anemia is a detrimental condition that can result in serious health and functional consequences, which will be addressed later in this paper Anemia is often caused by iron deficiency further complicated by chronic malnutrition experienced in certain populations For instance, indigenous people are considered the most marginalized group in all regions of Latin America therefore they suffer from poverty and malnutrition with limited access to nutritionally diverse food and proper health care services For the purpose of this paper, the indigenous people of interest are the Quechua. They are the largest indigenous population in Latin America located predominantly in Peru, Ecuador and Bolivia so I will also be focusing mainly in these areas when investigating the prevalence of anemia We will explore how their standard of living may be affected by malnutrition. Most people will agree that children are our future and should therefore be treated with the highest regard. If we hope to reduce the consequences of poverty and malnutrition, every expense should be made to improve the situation these children grow up in so that they are given greater advantage that their predecessors lacked when striving to build a brighter future. By focusing on the effects of anemia on the chronically malnourished indigenous children in Latin America, I want to investigate why anemia continues to be a problem, what factors contribute to its prevalence, what has been done to resolve it, and what must be further implemented.
The nutritional status of children is determined by their access to food and clean water, health care, sanitary conditions and education. These are often influenced by the socioeconomic conditions in the area that they reside in. Therefore, children from rural areas are more likely to develop malnutrition than those living in urban areas Similarly, “indigenous children are four time more likely to be underweight than urban children”At present, most indigenous groups live in isolated communities, further restricting the availability of services that would promote improved growth for their children Chronic malnutrition can affect a child’s overall growth and development, as seen with stunting, which is when a child experiences low height compared to what is expected for their ageIn addition to stunting, infant mortality rates (IMR) also act as an indicator of the socioeconomic conditions indigenous people have to endure due to poverty. According to the United Nations Children’s Fund (UNICEF), child deaths are usually caused directly or indirectly by malnutrition 50% of the time, which directs us to the strong correlation between stunting and infant mortality For example, Bolivia has the greatest percent (71%) of indigenous people in their total population compared to other countries. Due to poor living conditions and insufficient care for these children, Bolivia has the highest IMR of indigenous children nationally with 67 deaths (between birth and 1 years old) per 1,000 live births
In order to better understand and explain the living conditions that the indigenous people live in, I had to do additional research on a specific indigenous group. The Quechua are especially interesting because of the diverse conditions their people have chosen to establish for themselves These people have learned to thrive and adapt in some of the most demanding environments. For instance, most of them have adapted to the high-altitude, cold temperatures, and low oxygen levels while living in the Andes Mountains Most of these communities have built their livelihoods and economical survival solely based upon agriculture and domestication of animals alone to survive, primarily in the Andes Mountains This limits their access to clean water, as most of them depend on rivers and streams. Furthermore, their isolation and overall poverty restricts their ability to trade for food that adds variety to their diet There are multiple studies in the literature exploring how the Quechua people are affected by living in the typical environment of the Andes Mountains A prominent adaptation these studies observed involved the body proportions found in indigenous groups living in the mountains. These people tend to be smaller and exhibit shorter limbs than their neighboring communities that reside in low-altitude areas It is often assumed that overtime, acclimatization in the mountains resulted in their inability to grow as tall due to the biological advantage and necessity to retain heat better over a smaller surface area However, later studies indicate that this is in fact a sign of high levels of stunting as a result of poverty and limited resources This brings us back to the issue of how poverty and malnutrition go hand in hand as the cause of poor growth and increased mortality rates in indigenous children.
Stunting is a simple, overly generalized way for us to measure malnutrition. It leads us to a more concerning issue. Further complications from malnutrition develop from nutrient deficiencies, with iron deficiency being the most widespread of them all throughout the world Iron is the key nutrient that allows the body to produce red blood cells that can carry oxygen to the tissues throughout our body. A secondary function is its involvement in energy production As a result, having iron deficiency anemia presents with symptoms including shortness of breath and easily fatigued. Some studies also indicate that iron deficiency in children affects their intellectual development, mood regulation and overall school performance of the child A further complication with this condition is having a weaker immune system so the individual becomes more vulnerable to infections When a body is unable to produce healthy red blood cells, the individual has a condition termed as iron deficiency anemia (IDA)
In regards to the places often populated by the Quechua in Latin America, the following data show the prevalence of anemia In 2008, the national nutrition survey reported that Bolivia had a prevalence of anemia found in 61% of children aged 6-59 months, 35% in non-pregnant women, and in 50% in pregnant women. In 2007, Ecuador had a prevalence of 60% in children 12-59 months old, 48% in non-pregnant women, and 57% in pregnant women. Lastly, Peru reported 37.2% of children aged 6-59 months, 20% of non-pregnant women, and 26% of pregnant women with anemia The limitations to this data are that the numbers varied and didn’t account for indigenous groups due to the lack of data regarding the complete number of their population, as well as infant birth and mortality.
There is an increased requirement of iron in relation to the increased formation of new body mass during times of accelerated growth Therefore, small infants and pregnant women are especially susceptible to developing iron deficiency anemia due to low dietary intake of iron, low intake of other nutrients that promotes iron bioavailability, and poor iron absorption in the body According to studies on iron deficiency anemia, the health and functional consequences of anemia includes, “increased risk of maternal, fetal, and neonatal death; low birth weight and preterm birth in infants; delayed cognitive development and reduced learning capacity in children; and decreased productivity in adults which can result in significant economic losses in countries with high percentages of anemia” These are significant reasons that anemia should become a greater concern, especially by countries where the prevalence of anemia is so high. So why is anemia still such a low priority in the public health agenda?
IDA typically results from having significantly low intake of bioavailable iron in one’s diet. As such, it would seem that prevention and treatment of anemia is as simple as providing sufficient amounts of iron supplements and food fortification to the vulnerable groups Unfortunately, this is not the case for indigenous people because iron deficiency only accounts for half of all cases of anemia. Therefore, we must consider the other causes of anemia in indigenous populations. Quechuan children are especially at high risk of developing anemia from being exposed to parasitic and bacteria infections that may become chronic or recurring, poor sanitation, and limited access to clean water due to dependence on unsafe sources
Another cause of anemia is severe protein deficiency Severe malnutrition can also develop into kwashiorkor, a condition where the malnourished child has a distended abdomen due to an uncontrolled accumulation of fluid in that area. This condition is very disturbing to see in a child because the enlarged abdomen looks very out of place from their small stature and sunken faces while their limbs are thin and bony There have been studies on stunted Latin American children that have normal weight for their present height but show large abdominal circumferenceThe child presents with normal weight because the weight they have lost is replaced by the fluid retention in their abdomen. The distention or abnormal swelling of their abdomen is a key sign implicating that the child has kwashiorkor and suffers from extreme malnourishment This condition puts them at greater risk of infection and death. Anemia is associated with kwashiorkor because it develops in contingence to the protein deficiency because, along with iron and folic acid, it is an important component in blood production The interventions for treating this condition is more focused on preventing protein deficiency and have been shown to be much more successful. Kwashiorkor is mostly found in areas suffering from extreme famine, so it is not as common as anemia in Latin America Therefore, it is not a condition most people would be as aware of. In truth, the most probably reason anemia may not receive as much attention or priority is because its health and survival implications are not as readily visible as kwashiorkor
The very first survey on the prevalence of anemia among indigenous children was conducted in 2008-2009 utilizing a sample size of indigenous and non-indigenous children in Latin America for comparison In 2013, they found that anemia had an overall prevalence of 51.2% in indigenous people. Indigenous children had twice the pervasive rate for anemia than non-indigenous children Furthermore, they associate anemia with the socioeconomic factors that contributed to a high risk for anemia such as “lower maternal schooling, lower household socioeconomic status, poorer sanitary conditions, presence of maternal anemia, and anthropometric deficits” The fact that there is a family history of anemia demonstrates that the child will inevitably pass on their deficiencies to their future children How can they rise from poverty and improve their standard of living when the conditions caused by malnutrition cripples them from growing to their full potential?
Eating a well balanced diet with the proper amount of nutrients is important in the child’s growth, especially at a critical age when their bones needs nourishment to keep growing. Correcting micronutrient deficiencies is therefore imperative in restoring growth and improving health in children with chronic malnutrition. Certain interventions have been designed with these goals in mindFood fortification is a good example. It involves adding one or more nutrients to food with the objective of correcting or preventing nutritional deficiency. The success of this intervention depends greatly on the food selected for fortification, which can be fruits and vegetables that can be consumed often. This is more effective when targeting special populations at risk of deficiency like infants and pregnant women However, there is not enough evidence in the literature that implicates indigenous people as their targeted population or how the fortified food is provided to them. In order to reduce anemia and malnutrition in those indigenous groups, open trade, transportation and communication would be necessary to provide them with the food and health services they need. I was unable to find sufficient research in the literature investigating how indigenous populations like the Andean Quechua would react to external forces interfering with their standard of living or if they have actively traded with any of their neighboring communities. Future research will need to gather more information about their behavior and interaction with people outside their community.
Iron supplementation is typically the first intervention used to treat IDA More controlled clinical studies support the effectiveness of this intervention. However, there are indications in the literature expressing some unfortunate side effects that come with using the most effective and less expensive iron compounds. These are poorly tolerated by the body and can cause gastric discomfort, diarrhea or constipation, metallic after taste, and dark-green, blackish discoloration of the feces. This explains the poor compliance demonstrated in the following countries In Bolivia, iron supplements are provided to children as young as 6-59 months for 12 weeks a year while pregnant women are prescribed iron and folic acid daily until their delivery. However, according to the national consumption and nutrition in 2002, Bolivia showed that only 24% of children and 28% of pregnant women actually followed this intervention of consuming their iron supplements. In Ecuador, the same intervention was applied but only 32% had followed it. In Peru, infants aged 6-23 months were given iron supplements for 24 weeks daily per year while pregnant women too iron and folic acid daily until delivery, with an extension of supplements for a month after giving birth. In 2004, Peru showed 12% in children and 65% in pregnant women followed this interventionThe data show that there is poor compliance in the countries mentioned, however, there is a significant percent reduction in pregnant women The lack of compliance in children may be further attributed to lack of parental understanding about the importance of treating the condition. This is where proper nutritional education and counseling on anemia and iron supplementation could have the most meaningful effect, especially in high-risk populations like the indigenous groups in Latin America.
The key reasons that there is a lack of progress in reducing anemia in Latin America can be narrowed down to seven factors “1) low awareness of the problem and weak political commitment to solving it; 2) weak management, operational, and support systems; 3) inconsistent efforts to promote behavioral changes; 4) excessive reliance on iron-focused intervention, especially fortification of single food; 5) lack of integrated program intervention that address anemia as a complex problem with multiple causes beyond iron deficiency; 6) sporadic or limited monitoring and evaluation of the coverage or efficacy of intervention.” Most countries implement existing anemia control intervention programs without the full understanding of the problem therefore they lack the commitment to ensure optimal health care services are providedIt is imperative that by making people more aware of this situation, the more likely people from those areas will be motivated to help. These interventions require financial support in order to fund the treatments like iron and folate supplementation, deworming of parasitic or bacterial diseases, food fortification and future interventions There is also the need for behavioral dietary changes, which involves changing preferential attitude towards less nutritious food and increasing micronutrient-rich foods in specific communities systematically by means of educating them
To reiterate, indigenous people tend to be marginalized therefore health problems associated with them are often neglected. However, people like the Quechua may be more inclined to seek health counseling if they were given are proper health care services that would provide them with the trust built through proper communication and a lack of language barrier between the patient and health care provider I strongly believe that preventing and reducing the prevalence of anemia, especially in vulnerable groups like the indigenous people, is highly important because it would only be a matter of time that their population is significantly reduced due to the many complications caused by poverty and malnutrition. Without the proper treatment and acceptance of preventative interventions, their population will keep suffering from large mortality rates. Without their children and women, they are at risk of being deprived of people that would maintain their customs and traditions, as well as future generations that would continue on their legacy. I believe that indigenous people can still maintain their identity while receiving the proper health care in order to to improve their quality of life.
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