Nunavut finds no iron-clad fix for anemia

Here’s what healthy red blood cells look like. Iron-deficiency anemia, which is more prevalent in Nunavut than in any other region of Canada, results when there’s not enough iron to make cells to bring oxygen around the body.

(Updated Nov. 16)

The Government of Nunavut wants to cut its sky-high rates of iron-deficiency anemia among infants in half by 2013, under a plan called the Nunavut Nutrition Framework.

Research now shows anemia is eight times more prevalent in Nunavut than in the rest of Canada.

“There’s nowhere else with a rate that high. Aboriginal populations generally do have higher rates, but this is the highest,” said Dr. Vishal Avinashi of the University of Toronto, who has looked at iron-deficiency anemia among infants in Nunavut.

Iron-deficiency anemia results when there’s not enough iron to make cells to bring oxygen around the body.

The condition produces symptoms like feelings of weakness, dizziness, headaches, low energy, and lethargy.

But even if you can’t see these symptoms, particularly in babies, anemia is serious.

However, “it doesn’t get the attention it deserves,” Avinashi told Nunatsiaq News.

Iron-deficient anemia may cause permanent problems when it affects children during the first years of life, leading to developmental delays, behavioral disturbances, failure to thrive and increased infections.

Severe iron-deficiency anemia can even lead to early death.

Screening in Iqaluit and Igloolik that found about half of babies aged eight to 11 months old suffer from iron-deficiency anemia.

The damage caused by this condition can be permanent if not reversed early, leaving an impact on the economic health of families and whole communities, Avinashi said.

A poor diet is suspected to play a large role in the development of iron-deficient anemia.

Babies can develop iron-deficient anemia when they are weaned early off breast milk to other liquids that lack enough iron or if they don’t start eating foods, which naturally contain iron, such as caribou or seal meat, or foods that are commercially fortified with iron.

But even if Nunavut wants to reduce iron-deficiency anemia, a recent program that delivered $60,000 worth of cereal boxes to iron-fortified infant cereal to babies from six to 12 months of age in 15 Nunavut communities met with mixed success.

“I got it but never opened it… I didn’t know what to do with it” was the comment of a worker with the Canadian Prenatal Nutrition program, whose job it was to hand out the cereal during get-togethers with new mothers.

Mothers didn’t always view the hand-outs well, either, according to a Nunavut health and social services presentation at the last month’s Inuit Studies Conference in Val D’Or.

“Some mothers feel uncomfortable taking the cereal… almost implying they were poor and couldn’t afford the cereal,” said the feedback from one community.

About half of the babies liked the cereal, according to their mothers.

But some mothers said their babies refused to eat the cereal: “My child doesn’t like the flavor, can we get flavored?”

Many mothers admitted sharing the cereal with other children in the household.

Vesselina Petkova, Nunavut’s coordinator for the Canada Prenatal Nutrition Program, admitted it would have been best to distribute country food “because it is rich in iron and it’s what people are used to.”

“The only problem is that it’s hard to make sure it’s available all year long,” Petkova said. “If you don’t have country food available, you have cereal as the second best choice.”

The Government of Nunavut doesn’t know whether the cereal boxes were all distributed.

And, with no Nunavut-wide screening for anemia yet, there’s no way to measure the precise impact of the cereal program.

Avinashi calls the cereal giveaways “the simplest solution for now.”

“I don’t think it’s the best long-term solution,” he said. “Anything that can be locally sustained and fits with local culture and customs — that’s the best solution.”

Handing out iron pills and other supplements haven’t worked well either.

“Parents don’t see a big difference. You tell them ‘your child is normal and healthy, but give this anyway,’” he said. “We have to have more education with parents and families about why this is important.”

Nunavut does plan to start screening for anemia shortly, taking blood samples from women when they are 16 weeks pregnant and from their children until they go to school.

But the screening will just allow a better view of how much anemia there is among women and children and not its causes.

In Nunavut, anemia is likely rooted in the lack of food security.

The percentage of Nunavummiut who experience a lack of food during the year, is seven times higher than the national average, the 2007 Qanuippitali study found: seven in 10 households run short of food and four in 10 experience a “severe” lack of food over the course of a year.

The GN’s Anaana study, which looked at maternal health in the Baffin region, found nearly half of all pregnant women don’t eat enough. Some skip meals and eat only once a day.

Anemia may also be linked to smoking among pregnant women. Eight in 10 smoke, according to the Anaana study, which was carried out from 2005 to 2007.

Smoking also increases prematurity and low-birth weight among babies — which are both risk factors for anemia.

The Anaana study also found more than nine in 10 pregnant women lacked iron, which also ups the chance that their infants will suffer from anemia.

The results of the Qanuippitali study have not been widely circulated, and the Anaana maternal health study was never formally released, although it was discussed at last year’s International Congress of Circumpolar Health in Yellowknife.

As for the cereal program, after running last year with little fanfare, it’s been put on the back shelf.

Communities that liked the program were encouraged to order more of the five-dollar-a-box cereal out with money they get for the prenatal nutrition program.

But they’re not being sent the cereal boxes directly.

In Nunavik, where similar high rates of anemia were noted in the by the 2004 Qanuippitaa health survey, all childcare centres now offer iron-rich menus, with a heavy emphasis on country foods.