Iron Deficiency in Aboriginal Children in Australia

This research paper discusses iron deficiency in indigenous aboriginal children in Australia and its impact on their health. It explores the prevalence of iron deficiency anemia in this population and the potential causes and risk factors. The paper also discusses public health nutrition approaches to address iron deficiency in aboriginal children, including food-based strategies and fortification.

Running head: IRON DEFICIENCY IN ABORIGINAL CHILDREN IN AUSTRALIA 1
IRON DEFICIENCY IN ABORIGINAL CHILDREN IN AUSTRALIA
Name of Student
Institution Affiliation
Public Health Nutrition
Date

IRON DEFICIENCY IN ABORIGINAL CHILDREN IN AUSTRALIA 2
Iron deficiency in aboriginal children in Australia
Inadequate or overexposure of various elements in the body has noticeable impacts on the
general health of a human being. The effect of a component is determined by multiple factors,
including metabolism, absorption, as well as the level of interaction with the psychological
processes of the body. Iron is an essential mineral needed by the body of almost every living
creature for various metabolic activities, for instance, transport of oxygen, deoxyribonucleic acid
(DNA) synthesis as well as electron transport (Baird-Gunning & Bromley 2016). Iron
concentration in the body tissues must be maintained as it can form free radicals and in excess
which is attributed to tissue damage. Iron metabolism disorders are among the most common
diseases of humans and involve a broad spectrum of illnesses that have various clinical
manifestations which range from anemia to excess iron and the possibility of neurodegenerative
diseases. This research paper will discuss iron deficiency in indigenous aboriginal children in
Australia.
In Australia, malnutrition is a significant public health issue which is known to affect at
least 35-43 % of patients in the country. Iron deficiency is one of the micro-nutrition
malnutrition that is evident in Australia (Baird-Gunning & Bromley, 2016). Indigenous
Australians, for instance, the aboriginal have poor health results in comparison to the other
communities. Iron deficiency in infants is considered a significant health challenge, and the most
common form of micro-nutrition deficiency in the world. The worldwide prevalence of anemia
in infants between the ages of 5-60 months is approximated to be 43%, and approximately half
of the condition is due to iron deficiency anemia (Bar-Zeev, Kruske, Barclay, Bar-Zeev &
Kildea, 2013). Iron deficiency anemia is attributed to the cause of childhood morbidity and

IRON DEFICIENCY IN ABORIGINAL CHILDREN IN AUSTRALIA 3
mortality; it is linked to defective brain development and cogitative functions. Iron deficiency
anemia a significant cause of disability in the whole world.
For a long time, Children from remote indigenous families are known to suffer from iron
deficiency when the rates are contrasted to other Australian infants. In a recent report, by The
Early Childhood Nutrition and Anemia Prevention Project, the rate of anemia in the indigenous
communities has increased double from the previously reported (Aquino et al., 2013). Based on
the report, at least 90% of the children in the marginalized communities of Northern Territory,
Western Australia, and Queensland had been anemic at least ones when they were between six
and twenty-four months(Aquino et al., 2013). The report also identified that approximately fifty-
six percent of the infants were anemic at their first hemoglobin between six to nine months.
Based on the data from Queensland, there is an increased rate of iron deficiency anemia during
the pregnancy period among indigenous communities than other women in Australia, which in
the end is attributed to low birth weight babies.
Iron deficiency is evident when iron losses or requirements surpass the absorption and is
often multifactorial. The situation is common in children, mainly when they are undergoing rapid
growth and erythroid expansion, which leads to increased iron needs (Gorczyca, Prescha,
Szeremeta & Jankowski, 2013). Majorly low birth weight and premature infants, preschool kids
as well as in adolescence teenagers are high risks of iron deficiency. Without interventions,
children whose diets do not contain adequate iron may, in the end, develop iron deficiency
anemia(Aquino et al., 2013).. Various major risk factors are attributed to the contraction of iron
deficiency in infants including, prematurity and low birth weight, vegetarian and vegan eating,
exclusive breastfeeding past six months without the introduction of solid foods, gastrointestinal
problems, as well as little or no meat consumption (Tulchinsky, 2010). Untreated iron deficiency

IRON DEFICIENCY IN ABORIGINAL CHILDREN IN AUSTRALIA 4
is the major contributor to iron deficiency anemia. Many incidents of iron deficiency are mild
however if not treated they can contribute to problems such as fast heartbeat, pregnancy
complications, delayed growth in children as well as impact the cognitive development and
behavior of children(Tulchinsky, 2010).
Public health nutrition approach
Iron deficiency, like other nutrition deficiencies of health concern, is majorly attributed to
poverty. Even in developed nations, a considerable number of people are vulnerable. In
preventing iron deficiency, public health nutrition strategies need to be sustainable therefore
should have the input and resources of many sectors either in the public or private programs.
Therefore programs ranging from the health, agriculture, industry, education as well as
communication sectors should be added in the approach (Tulchinsky, 2010). There are essential
elements of any plan to improve nutritional wellbeing but are mainly relevant in the
improvement of iron status.
Food-based approaches
Extensive use of multicomponent interventions that do not include the utilization of
medicinal iron supplementation in the reduction of iron deficiency is more recommended. The
interventions involve the delaying of cord clamping past three minutes, which increase the iron
store at birth. The responses are required to be adopted early and include food-based strategies
and integration of iron deficiency anemia alleviation with another basic prevention program for
instance immunization and micronutrient supplementation for infants (Thompson & Amoroso,
2010). The various interventions can be given via local healthcare practitioners, for instance,

IRON DEFICIENCY IN ABORIGINAL CHILDREN IN AUSTRALIA 5
aboriginal health practitioners, general medical practitioners, and nurses, as well as through the
state-funded nutritional supplementation programs.
Food-based strategies are among the most applicable and sustainable method that is used
in alleviating micronutrient malnutrition. The policies are meant to increase the intake through
the food intake. Therefore the food-based strategies should be designed to increase the annual-
round availability of iron-rich diets, assure the access of households mainly to the aboriginal
groups in Australia which are at risk (Thompson & Amoroso, 2010). The strategy should change
the feeding practices concerning the foods. Dietary diversification approach helps families’
access a significant number of micronutrient-rich diet. The method will involve teaching
caregivers on the most appropriate young children feeding practices and improving the
utilization of foods that are available locally(Aquino et al., 2013).. Young children and infants
depend on complimentary meals to offer most of their iron needs in the first six months.
However, iron-rich diet is, in most cases, inaccessible for children and families in poor setting,
for instance, the aboriginal in Australia (Khambalia, Aimone & Zlotkin, 2011). Incorporation of
home-based fortification with micronutrient powders (MNPs) is effective in controlling anemia
in indigenous communities of developed countries.
The greatest strengths of the food-based approach are its potential to result in numerous
nutritional advantages as the benefits can consequently acquire both the short term effect and
long term sustainability. It should mainly resolve the production, preservation, processing,
marketing as well as preparation of foods (Pasricha, Drakesmith, Black, Hipgrave & Biggs,
2011). The approach should also address feeding practices, including intra-family distribution
and care of the aboriginal children who are a vulnerable minority group in Australia. Therefore
to be applied iron deficiency, efforts should be centered towards increasing the presence and

IRON DEFICIENCY IN ABORIGINAL CHILDREN IN AUSTRALIA 6
access to foods that are rich in iron including animal foods, organs, and meat, i.e., fish, fowl
poultry, etc. and non-animal diets such as, legumes and vegetables(Dugdale, 2011). However,
efforts should be made on diets that ensure the utilization and absorption of iron in the body,
mainly those of animal origin and non-animal origin. In the approach, teaching and information
on health and nutrition should be incorporated.
The food-based approach should be centered on the needs and activities of women as
they are the ones mandated in ensuring that children acquire nutrition with all the required
nutrients. The centering of the approach around women is essential in recognition of the various
role played by women to just as food providers to the children but also as caregivers (McMahon,
2011). Therefore this can be implemented by supporting home gardens and small animal
husbandry and increasing food preservation, and community-based technologies are mainly
important in alleviating the iron deficiency (Dugdale, 2011). The interventions are promoted by
the efforts to create more resources for mothers and by practical nutrition education. The
fundamental objective of diet modification is to develop and maintain the iron status of the
community including change in behavior, contributing to a rise in the selection of iron-rich diet
and meal patterns that are favorable to increase bioavailability(Aquino et al., 2013). The dietary
changes can offer the necessary sustainable improvements not just in iron status but also for
nutrition health.
Exclusive breastfeeding until the infant is about six months is proven to be beneficial and
is recommended in Australia and the world in general. However, there are issues that exclusive
breastfeeding may not offer enough iron to infants, making them be at risk of developing iron
deficiency anemia(McMahon, 2011). Therefore in the approach, providing oral iron supplements
to low birth weight and premature children from at least one month of age is recommended.

IRON DEFICIENCY IN ABORIGINAL CHILDREN IN AUSTRALIA 7
Infants with a history of iron deficiency are prone to recurrence of the same at a time in their life.
This has significant implications for an extended follow up of infants describing the benefits of
iron deficiency anemia prevention plans being controlled not only by the caregiver but also at
the health service level (McMahon, 2011). Based on the guidelines, it is evident that there is a
link between poverty and malnutrition. In low-income settings for instance in the aboriginal
communities nutrition counseling alone is not recommended, the advice may only be practical
when put in combination with government and organizational funded nutritional support plans
that do away with financial challenges to improved nutrition.
Fortification is an essential public health intervention when the foods to be fortified are
primarily taken in adequate levels by the individuals who are vulnerable if the fortifications lack
a toxic impact on the foods or raise their costs(Aquino et al., 2013).. The target for food
fortification should involve commonly available foods, including maize and wheat flour as well
as in condiments such as salts, soy sauces, and curry powder(McMahon, 2011). Fortification can
be undertaken at the central point of food processing or near to the community consuming the
food products. The government and other relevant stakeholders can make fortification of staple
food mandatory by regulation.
The challenge of the food-based approach towards dealing with iron deficiency in control
of quality, which can be challenging in big nations with numerous food producers(Aquino et al.,
2013). Centralization of the fortification is limiting to the individuals with the greatest needs; for
instance, the small scale farmers in the local areas end up consuming the least amount of the
fortified foods (Lopez, Cacoub, Macdougall & Peyrin-Biroulet, 2011). Therefore local
fortification of foods is preferred if quality control can be guaranteed. Maize and wheat flour us
the most practicable for fortification in the local areas since it is accessible to almost everyone.

IRON DEFICIENCY IN ABORIGINAL CHILDREN IN AUSTRALIA 8
Iron deficiency through food-based approach should be sustainable, given the availability
of resources. The strategy should involve all the relevant agencies ranging from government and
nongovernment health and no health agencies, for instance, education and agriculture. The
approach should include consultation and partnership with the related groups and food sector and
should involve monitoring as well as evaluation to guarantee its safety and efficacy. The plan
should consist of sufficient community and food sector training and marketing to maximize the
uptake of interventions. The food-based strategies that include food production, food
fortification, as well as dietary diversification are sustainable for improvement of all the essential
micronutrients status of communities and also in increasing their levels of nutrition (Li, Gray,
Guthridge &Pircher, 2009). The approach majors on practical, sustainable activities for
overcoming iron deficiencies through additional availability, access to and taking in of adequate
amounts and appropriate varieties of safe, quality foods.
In conclusion, iron deficiency is a prevalent and crucial disorder that needs immediate
attention in the indigenous communities, i.e., the aboriginal in Australia. In solving the disease,
long term solution, including changes in food security and diet, is of the essence. The
interventions will only benefit the children and parents who are iron deficient and hence should
be centered at communities where iron deficiency is highly prevalent. In early pregnancy, iron
should be provided to improve both the maternal and child results. Besides, offering iron
supplements to infants can follow together with other long and medium-term approaches that are
centered on food production and fortification.

IRON DEFICIENCY IN ABORIGINAL CHILDREN IN AUSTRALIA 9
Critical appraisal
Early Childhood Nutrition and Anemia Prevention Project study was a project carried out
across Northern Australia with the aim of determining the acceptability and feasibility of a
community based program to aid in solving nutrition problems mainly iron deficiency among the
aboriginal infants and children aged between six months and two years. The study involved the
use of home based micronutrient fortification. Pilot study was carried out in six communities
across northern Australia including Ngukurr, Borroloola, Jilkminggan, Ti Tree.
The study brought to light the additional understanding of the level of anemia in
aboriginal children and infants and the potential approaches that can be undertaken to treat the
condition. The study also got insights in the dietary patterns of the infants in the remote areas.
The study identified that adequate supply of fortification diet maintained the hemoglobin levels
on non-anemic infants and children and infants had a higher risk at an earlier age than normal.
The communities lacked nutrition counseling and education and the follow up on children health
and ammonia treatment was poorly followed. Therefore the project proposed central food
fortification which will promote consumption of iron rich diet among the aboriginal
communities. In addition the food based fortification approach was found to be sustainable both
in the long and short term.
The second study Diagnosis and management of iron deficiency anemia indicates that
iron deficiency anemia is highly prevalent in Australia mainly among high risk groups(children
and pregnant women). The study identified the major causes of iron deficiency that are attributed
to psychological demands in growing children and pregnant women. The study highlighted, that
consumption of limited types of food among the communities, the foods consumed were low in
almost all nutrients required.

IRON DEFICIENCY IN ABORIGINAL CHILDREN IN AUSTRALIA 10
The study indicates that in solving critical conditions of iron deficiency the most effective
way is the use or oral iron therapy in the affected individuals, however the study identified this to
be expensive method and instead supported the administering of formulations in treatment
centers in the affected communities.in alleviating iron deficiency in general the study supports
coming up with a consensus method for administration of available iron products to improve the
utilization of the formulations and therefore evade inappropriate transfusion due to iron
deficiency.
References
1. Aquino, D., Marley, J., Senior, K., Leonard, D., Joshua, J., Huddleston, A., ... & Hobson, V.
(2013). Early childhood nutrition and Anaemia prevention project. Darwin: Fred Hollows
Foundation.
2. Baird-Gunning J, Bromley J. Correcting iron deficiency. Australian Prescriber. 2016
Dec;39(6):193.
3. Bar-Zeev SJ, Kruske SG, Barclay LM, Bar-Zeev N, Kildea SV. Adherence to
management guidelines for growth faltering and anemia in remote dwelling Australian
Aboriginal infants and barriers to health service delivery. BMC health services research.
2013 Dec;13(1):250.
4. Callander EJ, Schofield DJ. Is there a mismatch between who gets iron supplementation,
and who needs it? A cross-sectional study of iron supplements, iron deficiency, and
socio-economic status in Australia. British Journal of Nutrition. 2016 Feb;115(4):703-8.

IRON DEFICIENCY IN ABORIGINAL CHILDREN IN AUSTRALIA 11
5. Chowdhury S, Rahman M, Moniruddin AB. Anemia in pregnancy. Medicine Today.
2014 Dec 25;26(1):49-52.
6. Dugdale, A.E., 2011. Diagnosis and management of iron deficiency anemia: a clinical
update. The Medical journal of Australia, 194(8), p.429.
7. Gorczyca D, Prescha A, Szeremeta K, Jankowski A. Iron status and dietary iron intake of
vegetarian children from Poland. Annals of Nutrition and Metabolism. 2013;62(4):291-
8. Grant CC, Wall CR, Brewster D, Nicholson R, Whitehall J, Super L, Pitcher L. Policy
statement on iron deficiency in pre‐school‐aged children. Journal of pediatrics and child
health. 2007 Jul;43(7‐8):513-21.
9. Hamelin AM, Lamontagne C, Ouellet D, Pouliot N, O'brien HT. Healthful eating: beyond
food, a global concept. Canadian Journal of Dietetic Practice and Research. 2010 May
19;71(2):e21-7.
10. Khambalia AZ, Aimone AM, Zlotkin SH. The burden of anemia among indigenous
populations. Nutrition reviews. 2011 Dec 1;69(12):693-719.
11. Li SQ, Gray NJ, Guthridge SL, Pircher SL. Avoidable hospitalization in Aboriginal and
non‐Aboriginal people in the Northern Territory. Medical Journal of Australia. 2009
May;190(10):532-6.
12. Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anemia. The
Lancet. 2016 Feb 27;387(10021):907-16.
13. McMahon LP. Iron deficiency in pregnancy. Obstetric medicine. 2010 Mar;3(1):17-24.
14. Pasricha SR, Drakesmith H, Black J, Hipgrave D, Biggs BA. Control of iron deficiency
anemia in low-and-middle-income countries. Blood. 2013 Apr 4;121(14):2607-17.

IRON DEFICIENCY IN ABORIGINAL CHILDREN IN AUSTRALIA 12
15. Pasricha SR, Flecknoe‐Brown SC, Allen KJ, Gibson PR, McMahon LP, Olynyk JK,
Roger SD, Savoia HF, Tampi R, Thomson AR, Wood EM. Diagnosis and management of
iron deficiency anemia: a clinical update. Medical Journal of Australia. 2010
Nov;193(9):525-32.
16. Thompson B, Amoroso L, editors. Combating micronutrient deficiencies: food-based
approaches. CABI; 2010 Dec 17.
17. Tulchinsky TH. Micronutrient deficiency conditions: global health issues. Public Health
Reviews. 2010 Jun;32(1):243.