Anaemia

Anaemia is a condition in which the number of red blood cells or the concentration of haemoglobin in the blood is lower than normal, resulting in reduced ability to carry oxygen to the body's organs and tissues. It is one of the most prevalent nutritional and health problems in Nigeria, affecting millions of people — particularly women of childbearing age, children under five, and pregnant women. The most common cause in Nigeria is iron deficiency, often compounded by malaria, infections, and poor dietary intake. Anaemia ranges from mild (causing only fatigue) to severe (causing heart failure and death). Identifying and treating the underlying cause is essential for effective management.

Symptoms vary with the severity and speed of onset of anaemia: Mild-to-moderate anaemia: • Fatigue and weakness — the most common symptom • Pallor — paleness of the skin, conjunctivae (inner eyelids), palms, and nail beds • Shortness of breath with activity • Dizziness or lightheadedness, particularly when standing up • Headaches • Difficulty concentrating • Cold hands and feet • Palpitations (awareness of a fast or pounding heartbeat) Severe anaemia: • Severe breathlessness at rest • Chest pain • Rapid heart rate (palpitations) • Swelling of the ankles (oedema) from heart strain • Fainting • In children: impaired growth, poor school performance, and irritability Iron deficiency anaemia specifically may also cause: • Pica — craving non-food items (soil, ice, chalk, clay — "eating sand/clay" is a recognised sign in Nigeria) • Brittle nails or spoon-shaped nails (koilonychia) • Sore or swollen tongue

Anaemia results from one or more of three mechanisms: reduced red blood cell production, increased red blood cell destruction, or blood loss. Common causes in Nigeria: Nutritional deficiencies (most common): • Iron deficiency — the most prevalent; caused by inadequate dietary intake, increased requirements (pregnancy, growth), or blood loss (menstruation, worms, peptic ulcer) • Vitamin B12 deficiency — poor dietary intake (vegetarians/vegans), malabsorption • Folate deficiency — poor diet, pregnancy, malabsorption Infections: • Malaria — destroys red blood cells directly and suppresses red cell production • Hookworm and other intestinal worm infestations — chronic blood loss from the gut • HIV and chronic infections Inherited conditions: • Sickle cell disease — chronic haemolytic anaemia • Thalassaemia Chronic diseases: • Chronic kidney disease, chronic infections, cancer, rheumatoid arthritis — anaemia of chronic disease Other: • Aplastic anaemia — bone marrow failure • Blood loss from menstruation, trauma, surgery, or gastrointestinal bleeding

• Female sex — menstrual blood loss increases iron requirements • Pregnancy — greatly increased iron and folate demands • Children under 5 — rapid growth increases iron requirements; complementary feeding may be inadequate • Low dietary intake of iron-rich foods (red meat, dark green leafy vegetables, beans, liver) • Eating clay or sand (geophagy) — common in Nigeria; interferes with iron absorption • Malaria infection • Intestinal worm infestation (hookworm, ascariasis) • Vegetarian or vegan diet without supplementation • Frequent blood donation or blood loss (heavy periods, bleeding peptic ulcer) • Sickle cell disease or thalassaemia • Chronic disease (kidney disease, HIV, cancer)

• Heart failure — the heart works harder to compensate for low haemoglobin; severe anaemia can cause heart failure • Impaired intellectual and cognitive development in children — iron deficiency anaemia in early childhood has lifelong effects on brain development • Poor academic performance in school-age children • Maternal and newborn complications: – Severe maternal anaemia increases risk of maternal death during and after delivery – Preterm birth, low birth weight, and poor infant outcomes • Reduced work capacity and economic productivity • Weakened immune response and increased susceptibility to infections • In sickle cell disease: transfusion-related complications

Dietary measures: • Eat iron-rich foods regularly: liver, red meat, poultry, fish, beans, lentils, dark green leafy vegetables (ugu/pumpkin leaves, bitter leaf, spinach) • Pair iron-rich foods with vitamin C sources (fresh tomatoes, citrus fruits) to improve iron absorption • Avoid drinking strong tea or coffee with meals — tannins reduce iron absorption • Ensure adequate folate intake: green vegetables, legumes, fortified foods Supplementation: • Pregnant women: take daily iron-folic acid tablets throughout pregnancy as prescribed at antenatal care • Children: ensure age-appropriate iron and folate supplementation where needed Infection prevention: • Use insecticide-treated bed nets to prevent malaria (a major cause of anaemia) • Deworm children and adults in endemic areas at least twice yearly ANC attendance: • All pregnant women should attend antenatal care for early detection and treatment of anaemia