Thesis (M.S.)--West Virginia University, 2004. / Title from document title page. Document formatted into pages; contains v, 54 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 34-36).

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The aims of the present studies were to determine the magnitude of iron deficiency anemia among preschool children in Northern Ethiopia and to evaluate different control strategies. The cross-sectional study showed that anemia was highly prevalent (42%) and that iron deficiency was the commonest cause of anemia. However, the iron deficiency was not due to lack of iron in the diet but to its poor availability and to other non-dietary risk factors. Unsafe water, mother's illness, older child (24--60 months), family not having food reserves and family income below poverty-line were predictors of anemia. Hookworm and malaria were rare and did not account for the anemia. In the iron pot study three types of Ethiopian foods were cooked in three types of pots (iron, aluminum and clay) and assessed for their total and available iron. After adjusting for cooking time and moisture, there were significantly higher total and available iron in all the three types of foods when cooked in iron pots compared to the aluminum or clay pots. The study also showed that the hemoglobin status and length of children improved significantly when they consumed food cooked in iron pots. In the third study, a randomized, placebo-controlled, and double-blind trial, both iron and vitamin A supplemented children showed increased hemoglobin levels. Combined iron and vitamin A supplementation showed the highest rise. Iron-supplemented children showed increase in length, but no increase in weight. They also showed lower rates of c-reactive protein positivity and decreases in the prevalence and frequency of diarrhea. A single dose of vitamin A did not result in any increase in length or weight but a decrease in the prevalence and frequency of diarrhea was observed. Children supplemented with iron only or vitamin A only showed higher ARI rates, but those children who received combined iron and vitamin A showed significantly lower ARI rates. Iron supplementation did not have any effect on either zinc

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This thesis investigates possible mechanisms underlying the decreased kidney size and the development of high blood pressure in the offspring of our model of maternal iron deficiency. This study has demonstrated that a maternal iron deficient diet has no effect on gene expression of either markers of vasculogenesis/angiogenesis or regulators of apoptosis and cell proliferation in the kidneys of the offspring. The effect of maternal iron deficiency on well documented mechanisms involved in blood pressure regulation were investigated in the offspring. The data showed that neither renal sodium transport nor nephron number are involved in hypertension development in our model of maternal iron deficiency. The renin angiotensin system showed significant increase in the renal renin mRNA expression, and pulmonary ACE1 mRNA and activity levels in newborn offspring of iron deficient mothers.  These changes are unique for maternal iron deficiency as they have not been seen in the other models of nutritional programming.  However, they are also temporary and disappear by two weeks after birth and at this stage it is unknown if and how the renin angiotensin system contributes to hypertension development in the offspring of iron deficient mothers. Finally, the whole rat genome arrays were used to identify new genes and pathways affected by maternal iron deficiency in fetal kidneys.  The results of the microarray experiment suggested renal inflammation and increased collagen cross-linking leading to stiffening of vascular walls, as possible causes of hypertension in the offspring of iron deficient mothers.  Further analysis showed, however, that both mechanisms do not appear to be involved.  The microarray study also identified CD36 scavenger receptor as being significantly up-regulated in the kidneys of the fetuses of iron deficient mothers, but its expression significantly decreased in adult animals compared to controls. The data presented in this thesis indicate that the effect of an iron deficient diet on offspring blood pressure is multifactorial and complex.

Transfusion of blood products is a common medical procedure, and maintaining adequate blood supply depends on the unpaid donation of a small share of the general population. The absence of pre-donation testing for iron status allows many donors with iron deficiency to donate blood. This dissertation seeks to enhance our understanding of the causes of iron deficiency among blood donors, the resultant symptoms, and the likely effectiveness of alternate strategies for reducing the risk of iron deficiency. In Study 1, we used data from the REDS-II RISE prospective cohort study, over a 2-year follow-up period, to evaluate whether higher levels of dietary iron protect against incident iron deficiency in blood donors. Responses to a brief checklist of consumption of animal proteins were combined into an Iron Composite Score weighted for iron content and reported frequency. We found that donors reporting the lowest levels of iron consumption were more likely to develop advanced iron depletion during follow-up. In Study 2, we performed an analysis of observational data from the STRIDE study, a randomized trial, to evaluate whether improvements in iron status were associated with improvements in reported fatigue levels. Using linear regression, we found that many donors had sizable changes in both reported levels of fatigue and in measures of iron status, but neither iron status nor changes in iron status was associated with fatigue at the end of 20–24 months follow-up. In Study 3, we conducted a simulation study to evaluate the range of outcomes of different strategies that might be adopted by blood centers to reduce the prevalence of iron depletion in blood donors. Using inputs primarily from the REDS-II program, we simulated approaches that extended the minimum interval between donations, that promoted use of iron supplementation by blood donors, and that performed ferritin testing to determine donor iron stores and extended the donation interval to those with iron depletion. Only extending the current 8-week interval to 26 weeks approached a reduction by half of the proportion of blood donors who were iron deficient, but the estimated impact on blood supply was a 21% drop in blood availability. Those interventions impacting supply less were also less effective in reducing iron depletion.

Maternal and child undernutrition are a significant problem in the developing world, with serious consequences for human health and socio-economic development. In Cambodia, 55% of children, 43% of women of reproductive age, and 50% of pregnant women are anemic. Current prevention and control practices rely on supplementation with iron pills or large-scale food fortification, neither of which are affordable or feasible in rural Cambodia. In the study areas, 97% of women did not meet their daily iron requirements. The current research focuses on the design and evaluation of an innovative iron supplementation technique. A culturally acceptable, inexpensive and lightweight iron ingot was designed to resemble a fish species considered lucky in Khmer culture. The ingot, referred to as ‘try sabay’ or ‘happy fish’, was designed to supply iron at a slow, steady rate. Iron leaching was observed in water and soup samples prepared with the iron fish when used concurrently with an acidifier. More than 75% of daily iron requirements can be met with regular use. Its use in the common pot of soup or boiled water provides supplementation to the entire family. The effectiveness of the iron fish was investigated in a randomized community trial involving 310 women in rural Cambodia. Blood samples were taken at baseline and every three months thereafter, over a 12-month trial period. Significant increases in hemoglobin concentrations were observed in women allocated an iron fish when compared to controls throughout the study, with an endline difference of 11.6 g/L. Significant improvements in serum ferritin concentration were observed at 9 months (6.9 ng/mL) and endline (30.8 ng/mL) in women who used an iron fish regularly when compared to the control group. Overall, use of the iron fish led to a two-fold reduction in the prevalence of anemia. The supplement was used daily by 94% of the households at the end of the trial. The study highlights the acceptability and effectiveness of a fish-shaped iron ingot as a means of improving dietary iron content. It offers a promising, simple solution to iron deficiency anemia if the project can be scaled-up for use throughout the country. / Canadian Institutes of Health Research, University of Guelph, International Development Research Centre (Canada)

Thesis PlanA (M.S.)--University of Wisconsin--Stout, 2009. / Includes bibliographical references.

Thesis--M. Med. Sc., University of Hong Kong, 1984.