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Mr. Bob Laxton (Derby, North) (Lab): I am glad to be given the opportunity this evening to speak about the incidence and importance of detecting childhood anaemia. Anaemia is a condition where the level of haemoglobin in blood is lower than normal. Haemoglobin plays an essential role in the body, carrying oxygen to every living cell. Lowered levels can have a profound effect on health in both adults and children, producing a range of symptoms. In children, these symptoms can seriously impede mental and physical development. Anaemic children perform poorly in the classroom and are unable to participate in many physical activities. The problems become compounded as anaemic children develop into teenagers who fail to benefit from education.
In 1988, one of the first studies looking into iron deficiency anaemia discovered the extent to which pre-school children had this condition. Over a 17-year period, study after study has also demonstrated the extent of iron deficiency anaemia in children. For instance, 52 per cent. of pre-school inner-city children are anaemic, as are 34 per cent. of female undergraduates. Anaemia does not differentiate between social classes either, with 9 per cent. of teenagers being diagnosed as anaemic, irrespective of which social class they come from. This level of anaemia in children is comparable to that of developing countries.
In its last health survey for England in 1994, the Department of Health found that 4.1 per cent. of men and 10.8 per cent. of women were classified as anaemic, using the World Health Organisation's definition of anaemia. When the national diet and nutrition survey looked into iron deficiency anaemia in children, it found that 10 per cent. of children aged one and a half to two and a half years of age were anaemic. This fell to 6 per cent. for those aged two and a half to three and a half years. However, the percentage did not continue to fall into the rest of childhood. Instead, an absolutely staggering 50 per cent. of young women between 15 and 18-years-old were found with iron intakes well below the recommended amounts.
In 1998, a separate study was carried out by HemoCue, a name that I am sure is familiar to both doctors and nurses. Its aim was to determine the prevalence of anaemia and to assess and improve the diets of children of pre-school age in the Pear Tree district of Derby. Pear Tree is an area just outside my constituency of Derby, North, falling in the neighbouring constituency of my right hon. Friend the Secretary of State for Environment, Food and Rural Affairs.
Nevertheless, the results of the study demonstrate the terrifying level of anaemia in an area of economic deprivation, with a high number of Asian immigrants. For instance, 54 per cent. of Asian Muslim children referred to the study were anaemic. In Asian Sikh and caucasian children this figure was 32 per cent. and 30 per cent. respectively. A similar study that HemoCue carried out in north Birmingham, in south Birmingham
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and in Bradford yielded similar results. In north Birmingham, for instance, 45 per cent. of children aged 21 months old were anaemic.
Until the issue of anaemia, and particularly childhood anaemia, was raised with me by John Clague, the director of HemoCue, I had, like many non-medical people, no idea of the incidence of anaemia in children, particularly in the UK's inner-city areasin spite of the fact that many health professionals are aware of the existence and prevalence of iron deficiency anaemia. However, we have not seen a great deal of change in the last 15 years or so, except where specific programmes have been introduced by health care professionals with a particularly strong interest in the subject. The conventional attitude, in the meantime, is that childhood anaemia is self-correcting and does not have too serious longer-term consequences for a child. That is of course untrue. Persistent anaemia causes sores; spare hair; brittle, flattened nails; pallor and general debility. In other words, an anaemic child could well make for an unhealthy adult.
I understand that the Scientific Advisory Committee on Nutrition's working group on iron is expected to make its draft report available for comment in summer this year, with finalisation in spring 2006. I look forward to reading its findings and recommendations. However, childhood anaemia is not remotely high enough on the Government's health agenda. Indeed, due to the nature of the problem, childhood anaemia is the responsibility of both the Department of Health and the Department for Education and Skills. I urge the Minister to use the planned publication as a more than timely opportunity to address childhood anaemia and perhaps approach the problem from a new angle and build the identification of childhood anaemia into primary care provision. I also hope to start to do something about it now.
According to the World Health Organisation, anaemia is the most common evidence of nutritional deficiency in the world. As it happens, anaemia is not a specific disease, but a symptom of many conditions that result from a lack of haemoglobin in the blood. Several causes underpin anaemia. It could be due to the body's failure to produce red blood cells, which carry haemoglobin. It could be caused because red blood cells are being destroyed unusually quickly, or simply because someone is bleeding. Such bleeding is often brisk and obvious, but can be hidden in the case of a slow-bleeding gastrointestinal ulcer, or a tumour.
The WHO study focused on anaemia due to nutritional deficiency. As one would expect, it was most common among children in the third world. However, even in the western world, nutritionally induced anaemia is not as rare as one might think. A survey showed that 10 to 15 per cent. of women of reproductive age were anaemic.
There are several ways in which anaemia caused by nutritional deficiency can be treated. The obvious solution would be to ensure that children eat foods that contain the best sources of iron, namely red meat, offal, such as liver and kidneys, and eggs. From personal experience, an average child will probably eat red meat and eggs, perhaps in the form of a hearty steak and an omelette, but trying to get an eight-year-old to eat liver, kidneys or leafy green vegetables is a battle of parental wits over a child's intransigence. Of course, there is also
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iron in cereals, lentils, soya and beans. As some die-hard chocoholics will no doubt be pleased to hear, chocolate is also a source of iron, although I suspect that one would have to eat more than a box of Mars bars or KitKats a day to reach the optimum level of iron intake.
If it is difficult to address the problem through the daily diet, the next best option is to treat it with iron supplements, but there are possible problems with that approach if a full analysis is not completed. For example, if there is no true iron deficiency, the excess iron supplements hinder the absorption of calcium and zinc.
A lack of iron is not the only cause of anaemia. A shortage of vitamin B12 and folic acid can also slow down the production of red blood cells. Vitamin B12 is found in meat and dairy products, and if a person consumes sufficient quantities of it over time, it is stored in the liver for a good five years. Like iron, folic acid is obtained from green vegetables, cereals and liver, but it is not stored in the body for long.
When it comes to babies, the biggest form of anaemia is encountered when breast milk is replaced by cow's or formula milk. Babies who are moved too quickly from breast milk to fruit juices or sugary concoctions miss out on the iron in milk. In a strange irony, one study found that middle-class babies from the so-called muesli eating classes, as well as those from immigrant homes, were most likely to have anaemia. Indeed, the Department of Health found similar results when it examined differences by household benefit status for men and women.
What are the effects of anaemia? Even mild anaemia can lead to extreme fatigue and interfere with a child's ability to perform at school and participate in social activities. There are even more severe consequences in the long term, such as an irreversible delay in mental or psychomotor development. The Government are doing good work through Sure Start and children's centres to ensure that children growing up in deprived communities receive the additional support that they need. As recently as last Tuesday, my right hon. Friend the Minister for Industry and the Regions, who also happens to be the Deputy Minister for Women and Equality, came to my constituency and we visited Sure Start programmes and a children and families centre there.
We were both extremely impressed by the engagement of nurses and a range of professionals in dealing with children. Vulnerable children from families in receipt of the welfare food scheme are already provided with supplements, including vitamin C, which helps to aid absorption of iron from the diet. The publication of last year's White Paper "Choosing Health" reflects the Government's continued commitment to improving the diet and health of our children. However, the scattergun approach is not sufficient. The consequences of childhood anaemia are long lasting; more can and should be done to tackle it. If we succeed, we lay another solid brick for the future of each deprived inner-city child.
If we set aside discussions of education in nutritional awareness, ethnic weaning practices and poverty, the basic conclusion is simple: to reduce the incidence of
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anaemia in children in UK inner cities, we must, first and foremost, ensure that we can identify the individual children at risk. The Government have, rightly, concentrated on childhood obesity, which has to be tackled, but it is not the only problem affecting the development of young children that needs our attention. It is equally important that anaemia is tackled.
Companies such as HemoCue, which provides testing apparatus for anaemia, have to establish closer links with community health organisations and with Sure Start programmes. HemoCue is a Derbyshire-based firm and global leader, whose technology is used in many NHS hospitals throughout the UK. With just a single drop of blood and in less than a minute, HemoCue technology can give a precise haemoglobin analysis.
If a positive identification of iron deficiency is found in a child, two immediate courses of action can be taken to remedy the situation. One is to inform the child's parents that dietary changes must be made. As I have said, that might mean the inclusion of more iron-rich food in the child's dietfor example, red meat, eggs, leafy vegetables and, dare I say, chocolate. The iron fortification of food such as bread, milk and cereals can also help to reduce iron deficiency. Several studies have shown that because the recommendation being made is based on a scientific test, parents accept more readily advice that might otherwise be dismissed as nannying or hectoring.
In addition, it is important that regular screening is offered to all children as part of their routine development check. We must first harness the expertise of the health care professionals who know the extent of the problem and work at the sharp end in the communitymidwives, nurses, community nurses and community-based paediatricians. In primary care trusts and the priorities determined within health action zones, there is a mechanism to empower those professionals to screen for anaemia in domiciliary visits. Bradford community health NHS trust has led the way in that respect. We must ensure that other NHS trusts seize the opportunity. Well woman clinics and well person clinics have become part of the health-speak vocabulary in recent years. It is not time that we extended the terminology across the board to include well woman and child clinics in inner-city areas, and systematically provided anaemia screening for both mother and child?
The development of such links and services in primary care take us a long way toward our goal of reducing anaemia in children. At the same time, it will create the right framework that will move us closer to our longer-term goal of better health for future generations. I trust that my hon. Friend the Minister appreciates the problem of childhood anaemiaI am sure that he doesbut will he assure me that his Department will take the necessary steps toward tackling that serious health problem, and do so as soon as possible?
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