Experts Rally to Tackle the Hidden Crisis of Childhood Iron Deficiency Anaemia

WORDS LIM TECK CHOON

A multidisciplinary team of 28 clinicians from Malaysia, Thailand, Laos, Myanmar, Cambodia, and India recently presented an independent expert consensus on the screening and management of iron deficiency anaemia (IDA) in young children across Southeast Asia and India. Their efforts were sponsored by Danone.

The consensus comes in response to the concerning findings of the Iron Strong Study 2023, which highlighted that 1 in 3 Malaysian children are at risk of anaemia.

It presents 12 evidence-based recommendations to guide healthcare practitioners and policymakers in decision making related to screening, prevention and management of IDA in young children.

FEATURED EXPERT
PROFESSOR DR MUHAMMAD YAZID JALALUDIN
Senior Consultant Paediatric Endocrinologist
Faculty of Medicine, Universiti Malaya

Professor Dr Muhammad Yazid Jalaludin tells us: “The release of this expert consensus represents a significant advancement in managing IDA in children. By bringing together leading experts from the region, evidence-based recommendations have been established that can greatly benefit child health.”

A CALL FOR ANNUAL NON-INVASIVE SCREENING FOR YOUNG CHILDREN

According to Professor Dr Muhammad Yazid Jalaludin:

  • Iron deficiency anaemia (IDA) in children is often underdiagnosed because mild cases often show no visible symptoms.
  • However, this undetected deficiency can significantly impact growth and even irreversible consequences on a child’s brain development and future learning abilities.
  • In light of this, the panel of experts has advocated for annual non-invasive anaemia screening for all children aged 1 to 5.
  • The panel also emphasizes the importance of nutritional intervention, particularly the fortification of food and milk to help reduce the risk of IDA in all children.
  • Additionally, the panel calls for more efforts to be made o actively educates parents and caregivers on IDA risks and prevention.
NUTRITIONAL INTERVENTION IS ESSENTIAL
FEATURED EXPERT
PROFESSOR DR HAMID JAN JAN MOHAMED
Professor, Nutrition Programme
School of Health Sciences
Universiti Sains Malaysia

Professor Dr Hamid Jan shares the following:

  • Addressing IDA in children requires a multifaceted approach that combines early detection with comprehensive nutritional interventions.
  • Incorporate a variety of iron-rich foods into a child’s diet. Such foods include lean meats, poultry, beans, and dark leafy vegetables like spinach.
  • Additionally, fortified milk and foods play an important role in ensuring adequate iron intake, especially for children who may have limited access to diverse diets.
  • Pairing iron-rich foods with enhancers like vitamin C-rich foods can significantly improve absorption, making it easier for a child to benefit from their iron intake.
AN ONLINE QUESTIONNAIRE

Following the recommendations in the expert consensus, Danone has introduced the Iron Strong Screening Questionnaire, an online self-assessment tool developed in collaboration with a panel of paediatric and nutrition experts. This questionnaire, available in Bahasa Melayu, allows parents to assess their child’s iron intake based on age and can be found at the Danone website (links open in a new tab).

Does Height Matter for Girls? A Paediatric Endocrinologist Weighs In

WORDS ASSOCIATE PROFESSOR DR AZRIYANTI ANUAR ZAINI

FEATURED EXPERT
ASSOCIATE PROFESSOR DR AZRIYANTI ANUAR ZAINI
Consultant Paediatrician and Paediatric Endocrinologist
Department of Paediatrics
Faculty of Medicine
University Malaya

Many people are under the impression that it is alright for girls to be short or petite.

While being a few centimetres shorter than the norm may not have much of an effect on a girl or woman, being abnormally short or stunted could have serious psychosocial consequences.

THE RAMMIFICATIONS OF ABNORMAL GROWTH

Mental repercussions. Girls that are too short may face bullying and discrimination, especially among their peers, or they themselves may constantly compare themselves negatively to their normal-height friends.

This can result in psychological distress, low self-esteem, and social isolation.

Discrimination. As they grow up and enter the workforce, this can also translate into discrimination at the workplace, with many studies revealing that shorter people tend to earn less and be viewed as less powerful or influential.

Childbirth issues. Shorter women tend to have smaller pelvises, which may result in difficulties during childbirth. Indeed, research indicates that shorter women tend to have shorter pregnancies, smaller babies and a higher risk of needing a caesarean section.

Practical consequences. Examples include needing a booster seat or car modifications in order to drive and being unable to reach higher items on supermarket shelves or grasp the hanging strap on public transport.

IS YOUR DAUGHTER ABNORMALLY SHORT?

The expected height for a girl or woman is assessed according to their age, population and parents’ heights.

In Malaysia, we use the World Health Organization (WHO) length/height-for-age growth charts to measure the growth of children from birth to the age of 19.

You can get these charts at the WHO website (link opens in a new tab). Note that there are different charts for different sexes and age range, so pick the right one for your child!

A girl whose height is shorter than the average by 10 cm or more on the age-appropriate growth chart should be considered a red flag, and they should be brought to see a doctor as soon as possible.

WHY DO SOME CHILDREN EXPERIENCE STUNTED GROWTH?

Stunting is defined as having a height that was more than two standard deviations from the average height, while risk of stunting was having a height that was between one and two standard deviations from the average.

A nationwide study led by Universiti Malaya, involving over 15,300 children, found that 16.1% of Malaysian children aged 1 to 5 were stunted, while a further 20% were at risk of stunting.

The most common general cause for stunting in Malaysia is malnutrition. This can range from poor nutritional intake due to a low-quality and/or low-quantity diet, to poor behaviour towards nutrition such as slow or picky eating.

Children with a chronic disease, such as congenital heart disease, respiratory illnesses, cancer, or malabsorption disorders, can also suffer from stunting due to factors related to their disease.

In addition, babies born at term and small-for-gestational-age (SGA)–usually less than 2.5kg–can also be abnormally short. Although they may be otherwise healthy, small-for-gestational-age babies that do not catch up in growth by their fourth or fifth birthday are at risk of being stunted.

More specific causes for stunting include hormonal conditions, such as growth hormone deficiency, and genetic conditions such as Turner’s syndrome in girls.

WHAT PARENTS SHOULD PAY ATTENTION TO WHEN IT COMES TO THEIR CHILDREN’S GROWTH

Nutrition. Good nutrition can make a big difference in a child’s growth. It is, in fact, the main driver of linear growth during the first 5 years of life. Even if a child has a hormonal deficiency or genetic condition that causes stunting, ensuring that they receive good nutrition in the early years can go a long way in helping them achieve an optimum height.

Sleep. Many Malaysian children have an unfortunate tendency to go to bed late before having to wake up early in the morning to go to school. Growth hormone tends to be released during the deep, uninterrupted periods of sleep in the middle of the night. Therefore, children who have shorter amounts of such undisturbed sleep may have their growth compromised.

Physical activity. Lastly is our children’s increasingly sedentary lifestyle, which was particularly exacerbated during the movement control order over the last two years. The lack of exercise and tendency to just sit and play with electronic gadgets have a negative effect on a child’s growth. Research has shown that not only is the risk of obesity increased with such a lifestyle, but the child’s growth is also jeopardized.

CAN ABNORMAL GROWTH BE TREATED?

There are definitely ways to treat and manage girls who are abnormally short, but the key influencing factor is the age at which they are diagnosed and when treatment can be commence.

This is because there is only a small window of opportunity to help these girls achieve their maximum potential height.

Despite most parents noticing their daughter’s unusual shortness, many of them only tend to bring their daughter to see the doctor when she fails to have her period by her early teens (primary amenorrhoea).

This is because there is a myth that girls only start their growth spurt after menarche, or their first period. However, the fact is that menarche marks the last stage of puberty. By this time, there is only potential for another 3 to 5cm of growth!

So, while we can still treat such girls, the window of opportunity to help them achieve a more normal height is much more limited.

Ideally, girls with short stature should be referred to a paediatric endocrinologist by the ages of 7 to 10.

This would allow sufficient time for diagnosis, monitoring and treatment.

IN CONCLUSION

It is very important that parents monitor their child’s growth and development.

There are many simple ways parents can keep track of their child’s height at home, including annual measurements—tip: use a cereal box, which has a nice 90⁰ angle, rather than a bendable ruler or paperback book—and digital tools such as apps.

Small for Gestational Age: When Baby Is Born Smaller Than Normal

WORDS PROFESSOR DR MUHAMMAD YAZID JALALUDIN

FEATURED EXPERT
PROFESSOR DR MUHAMMAD YAZID JALALUDIN
Senior Consultant Paediatrician and Paediatric Endocrinologist
UM Specialist Centre

Most babies seem small when they first come into the world, but for some, they truly are smaller when compared to their fellow babies-in-arms.

This condition is known medically as small for gestational age (SGA for short).

Gestational age, by the way, is the length of time a baby spends growing in their mother’s womb.

Small for gestational age babies that weigh below 2,500 g at birth are additionally considered to have low birth weight.

SMALL FOR GESTATIONAL AGE CAN BE MEASURED AND DETECTED AFTER A BABY IS BORN

After a mother has given birth in a hospital or clinic, nurses will clean the newborn and giving them a quick check for any abnormalities. The nurses will also measure the length and head circumference of the baby as well as weigh.

These measurements inform healthcare professionals whether or not a baby is small for their gestational age.

POSSIBLE CAUSES OF SMALL FOR GESTATIONAL AGE

Pregnant women should go for their antenatal check-ups to monitor for and manage any problems that might result in a small for gestational age baby

The mother’s health during pregnancy
  • Presence of infections or medical conditions such as heart disease, uncontrolled diabetes, thyroid disease, or high blood pressure
  • Drinking alcohol or smoking
  • Poor nutrition during pregnancy
The mother’s age

The risk of having a small for gestational age baby is significantly higher for women aged 30 and above that have never given birth before, as well as all women aged 40 and above, compared to women in their 20s.

The mother’s height

Women that are short are at risk because their smaller wombs and shorter birth canals influence the growth of their foetus.

Family history

Interestingly, research has shown that the risk of having a small for gestational age baby can be influenced as far back as two generations.

If the pregnant woman and/or her own mother were small for gestational age babies, the foetus has a higher chance of being born small for gestational age.

Issues with the placenta during pregnancy
  • Placental insufficiency, which happens when the blood vessels in the uterus that are supposed to transform into the blood vessels of the placenta do not change as they should, can lead to placental infarction
  • Placental infarction sees the disruption of the blood supply to the placenta, resulting in the death of placental cells, placental abruption (the placenta partially or completely separates from the uterus before childbirth), and structural abnormalities of the placenta
  • All these conditions cause the foetus to receive insufficient nutrients and oxygen from their mother, thus affecting their growth
Chromosomal or genetic abnormalities

These abnormalities include those that give rise to Down syndrome and congenital abnormalities such as structural defects of the heart, kidneys, lungs, or intestines.

Other possible causes

Catching an infection while in the womb or being part of a multiple pregnancy (twins, triplets, etc) can also negatively affect a foetus’s growth.

SMALL FOR GESTATIONAL AGE COMPLICATIONS AFTER DELIVERY
  • As they have only small amounts of fat or energy stored away, they may have a low body temperature at birth. This can result in hypothermia, where the body loses heat faster than it can produce it. If this condition is prolonged, the baby can die as their heart and brain cannot function well at these sub-optimal temperatures.
  • The lack of fat and glycogen stored in a small for gestational age baby’s liver can cause hypoglycaemia, where they have low blood sugar levels that are unable to match their body’s needs. This can cause the baby to have seizures and/or brain damage. If the hypoglycaemia is prolonged, the baby may die or develop long-term neurodevelopmental deficits, including cerebral palsy.
  • As they are deprived of sufficient nutrients in the womb, small for gestational age babies become ‘programmed’ to hoard whatever nutrients and calories they receive. This means that after birth, they can very easily put on weight if their caloric intake is not carefully monitored. Thus, these babies are prone to obesity and its associated conditions (diabetes, high blood pressure, high cholesterol, osteoarthritis, heart disease, etc). This “programming” lasts throughout their lifetime.
  • Their growth rate can influence when they achieve puberty. Small for gestational age babies that catch up in their growth very quickly might experience early puberty. On the other hand, if they are slow in growing, their puberty might be delayed.
  • Persistent short stature.
SMALL FOR GESTATIONAL AGE, FORTUNATELY, CAN BE MANAGED

Generally speaking, small for gestational age babies should be able to catch up in their growth within the first six months to two years of their life with good nutrition.

In fact, 85% of these babies achieve normal height and weight for their age and gender by two years of age.

Some children require a longer time and there is still some leeway until the age of five to allow them to catch up in growth to their peers.

However, by five years of age, 8-10% of small for gestational age babies would still be smaller than normal, and this is the time that parents and doctors need to start discussing treatments for the child.

Growth hormone therapy
  • The main treatment for small for gestational age babies that do not manage to catch up in growth by the time they are four to five years old
  • Will enable them to achieve their optimal final height as adults, through improving muscle and bone growth
  • Helps increase the breakdown of fats, to address the tendency of small for gestational age babies to accumulate fat and become obese
Good nutrition
  • Nutrition plays a critical role in the first two years of life in promoting a child’s growth
  • Their diet must be carefully monitored as they are prone to becoming overweight; on the other hand, when they are not fed enough, they might become stunted
  • Parents need to do a careful balancing act when it comes to feeding their small for gestational age baby
Regular physical activity
  • As the child grows, parents also need to encourage and allow their child to be active
  • Doing so will prevent excessive weight gain and help stimulate the natural production of serotonin and growth hormone to help the child grow
  • Such physical activity must be vigorous enough that the child’s heartbeat increases and they sweat.
Proper sleep
  • It is critical that children are asleep at the latest by 9 pm, as the peak time for the body to produce its natural growth hormones is between 10 pm to 12 am.
  • Sleeping later, as many Malaysian children tend to do, will cause them to miss this critical period of growth hormone secretion.

Why You Need to Dispose Unwanted and Unused Meds Properly, and One Convenient Solution to Do This

WORDS LIM TECK CHOON

ARE YOU DISPOSING YOUR UNWANTED OR UNUSED MEDICINES CORRECTLY?

If you gather all these medications and dump them into the trash bin, you’re not exactly doing it properly.

SO, HOW SHOULD YOU DO IT?

Well, the best way to dispose of unwanted or unused meds is to drop them off at a proper facility—a facility that is equipped to dispose of these medications in a manner that will not cause possible harm to other people as well as the environment.

HMM, WHERE IS THE NEAREST FACILITY TO DO THIS, THEN?

Well, as of the time of writing, there is a convenient drop-off point for all your unused and unwanted medications: the nearest CARiNG Pharmacy outlet.

This is made possible through the Do It Right programme, a collaboration between the Faculty of Pharmacy of Universiti Malaya and the pharmacy retail chain.

CARiNG Pharmacy outlets will operate as a drop-off point for these medications, which will then be transported to Kualiti Alam Incineration Centre for further processing and proper disposal.

“Unwanted medicines left at home are a safety issue. Over 10,205 people required hospitalization because of medicine poisonings across Malaysia. Unwanted medicines in homes pose a health hazard especially to children,” Loo Jooi Leng, the Marketing Director of CARiNG Pharmacy, says to us in order to explain the rationale of this programme.

YES, YOU CAN NOW DROP OFF YOUR UNUSED & EXPIRED MEDS AT ANY CARiNG OUTLET
Do It Right programme logo

  1. READ
    Read the labels of the medicines in your cabinet and check which are expired and no longer needed.
  2. REMOVE
    Remove the expired or unwanted medicines from your cabinet and place them into a bag.
  3. RETURN
    Return the bag to any CARiNG Pharmacy near you and their staff will place it in a secure bin for safe disposal.

For more information on the Do It Right programme, you can visit their website (link opens in a new tab).

A Free App for Women, Especially Marginalized Women

WORDS LIM TECK CHOON

The University of Nottingham Malaysia (UNM) and Hanai Jiwa Ibu Sdn Bhd have developed an app, called Jiwa Ibu, to provide localised and tailored information on mental, women’s, maternal, and children’s health.

This app, developed in collaboration of the two entities with St George’s University of London, Universiti Malaya and Universiti Malaysia Sabah, serves to reduce the great disparity in access to healthcare between those residing in urban and rural communities. This is because rural communities have limited access to quality medical centres and professionals, and residents of those communities have to travel further in search of quality healthcare.

AN APP FOR MARGINALISED WOMEN

“For years, we’ve wanted to shift our focus to the rural and marginalised communities of Malaysia. Since the idea began, our team of eight dedicated women have run focus groups involving doctors, nurses, midwives, community nurses and everyday women, to better learn what the ideal women and maternal healthcare pathway should look like,” explains Hanai Jiwa Ibu Founder and CEO, Shamala Hinrichsen. “We don’t expect to solve the world’s problems, of course, but one tiny step forward is better than no steps at all.”

UNM and Hanai Jiwa Ibu recently inked a Memorandum of Understanding (MoU) to allow for the copyrighting and trademarking of the app, ahead of plans to work alongside Selangkah, Selangor’s healthcare app, to embed part of Jiwa Ibu into the system.

“The Jiwa Ibu app is expected to benefit 15 million women across Malaysia. During its initial alpha-test, the app was downloaded by 3,000 women, with 75% returning to the app within the span of one month from downloading,” shares Associate Professor Dr Joanne Lim Bee Yin of the UNM School of Media Languages and Cultures. “Based on the surveys and interviews that we carried out, 95% of respondents also shared that they wanted the app.

MANY FUNCTIONS FOR EMPOWERMENT & HEALTH SELF-MANAGEMENT

Jiwa Ibu will include a directory for doctors and healthcare centres within the vicinity of the user and other important resources, such as those for violence against women cases.

Users can also store and track their own health records and seek medical assistance through the app.

In an effort to be more accessible, the app will be made available in Bahasa Melayu, English, and other native languages.

Click here to download the app (link opens in a new tab) in the Google Playstore. The app is free.

Free Age Plus App Helps Older Persons Self-Manage Their Own Health

WORDS LIM TECK CHOON

The University Malaya Medical, Business, Computing and Software Engineering teams have launched a free app, called Age Plus.

“The main objective of the project is to develop a health management application for users to self-manage their health,” shares Associate Professor Dr Mumtaz Begum Mustafa, the creator of the Age Plus app.

WHAT DOES THE APP CURRENTLY PROVIDE?
LIFESTYLE
Provides visualization patterns of your daily activities as well as personalized recommendations for a healthier lifestyle

  • Information on healthy foods
  • Calorie calculator to help you plan healthy meals
  • Seat goals for and track your water intake, caffeine consumption, sleep, and exercise

PERSONAL MEDICAL DETAILS
Useful for managing medical information such as medication and consultation detail

  • Record and keep tab on your medications
  • Record and keep track of your medical appointments
  • Find nearby hospitals

HEALTH MANAGEMENT
Improve awareness on disease-related conditions among older persons.

  • Get useful advice and tips on health-related matters
AGE PLUS IS USER-FRIENDLY

Dr Mumtaz explains that the app boasts design solutions to improve its usability especially among older persons. Features of the app that reflect this include:

  • Increased action time and reduction of multiple tasks
  • Simplified in-app navigation/navigation assistance
  • User-friendly interfaces
  • Voice-response technology, with information dissemination through speech
  • Big buttons and simple, static menus

Age Plus is now available for free for Android phone users. Visit this link (link opens in a new tab) to download the app.