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Medicine is to heal from the inside

Iron Deficiency Anemia Treatment

As stated in my previous post about anemia, Anemia is common condition that affected population, especially in developing countries. The commonest cause of anemia is iron deficiency.

Iron deficiency anemia can be caused by: low intake of iron or excessive loss of iron. Low Intake of Iron means that dietary iron is insufficient related to demand, thus impacts the blood formation. Increased demand of iron can be found in conditions such as during pregnancy or breastfeeding, and growing children. Therefore, iron intake should be increased to fulfill iron demand. Another condition that often correlates with low iron intake is vegetarian. Even, iron also can be found in green leaf vegetables, but iron absorption from vegetable is lower or more difficult than from meat or animal sources.

Iron Deficiency anemia

Iron metabolism in our body is very effective, iron is being recycle to prevent depleted iron storage. But, some pathological conditions especially bleeding whether from menstruation, bleeding piles, gastric ulcer, etc. lead to loss of iron. The more chronic and severe that pathological conditions, the more iron is lost.

Iron deficiency not only effects blood formation but also in cognitive development, endocrine function, and immune system. Based on WHO publications about iron deficiency, iron deficiency can impair cognitive performance at all stages of life. These children will have delayed psychomotor development, and when they reach school age they will have impaired performance in tests of language skills, motor skills, and coordination, equivalent to a 5 to 10 point deficit in IQ.

Iron supplementation and milk or cereal fortification among deficient children
has been reported to reduce morbidity from infectious disease. Iron deficiency alters the production of triiodothyronine (T3) and thyroid function in general, and the production and metabolism of catecholamines and other neurotransmitters. This results in impaired temperature response to a cold environment.

Treatment of Iron Deficiency Anemia
Prior to treat the anemia, someone have to be evaluated about the cause of iron deficiency. Then the management of iron deficiency can be divided into two:
1. Increasing Iron Intake
There are several ways in order to increase iron intake, such as using iron fortifier food, promoting diversified food, and taking iron supplementation.
Another way is by avoiding iron absorption inhibitors while consuming high iron content food, such as tea, coffee, and milk. And promoting the usage of iron enhancer such Vitamin C, to help iron absorption.
High Iron contained Foods

2. Stop or Control Abnormal Bleeding
Identify the bleeding source is important in order to minimized iron lost. Heavy periods, bleeding piles, gastric ulcer, etc. have to be consulted to the experts.

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Vaccination as Primary Prevention

Qualtiy of a nation or welfare of a nation is related to its productivity. Health of society will impact the productivity. One of the indicators of society health is child death ratio. With the demographic transition that caused lower amount of child in family, then the productive ages population is increasing.
From the research, we can see that there is an inverese correlation between amount of livebirth and life expectancy, that the lower birth incidence the higher live expectancy of a nation.

Prevention of infection is important task in oder to create conducive situation for child growth and development. Besides that, prevention of infection far more effective and cheaper than treatment of infection.

Primary prevention of disease is all the efforts in order to prevent or avoid the disease before it occurs. Such as, exercise regularly, having a healthy diet, and having vaccination. Secondary prevention is early treatment of disease in order to prevent the complication of the disease. Tertiary prevention is aimed to minimize the complication and improving the quality of life.

Vaccination or immunization is the most precious technology that been developed in medicine field. Katz in 1999 said that vaccination is the best contribution by scientist for human life. Vaccine is the most effective and efficient health efforts compare to others.

With aggressive WHO program of immunization, child death is decreasing significantly, escpecially in disease that can be prevented by vaccination.
child vaccination

Immunity from infection is an aim of the immunization. Basically, immunity can be achieve passively and actively. Passive immunity can be achieve naturally, during intrauterine growth in third semester since there is transplacental transfer of immunoglobulin from maternal to fetal.

While active immunity can be achieved if someone get infection and achieve cure. This mechanism is adopted in vaccine induction of immunity.

Vaccination is giving vaccine (antigen) in order to stimulate immunity (antibody) from immune system. Antigen from pathogenic microorganism that have been modified, that doesn't cause the disease but its enough to stimulate our immune system in order to achieve immune response to specifiv infection.
Vaccination

Vaccination give several benefits:
a. Long life immunity
b. cost-effective
c. not harmful, serious adverse reaction is very rare, far more rare than the complication of the infection.
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Kangaroo Mother Care

Introduction
Nowadays, with the advanced in medical science and technology especially in perinatalogy. The amount of infant death rate is being reduced significantly. But, we are facing a more complicated newborn e.g. low-birthweight and premature baby. Since most infant deaths occurs in neonatal period about 2/3 total of infant death. And low-birthweight infants have higher risk of death since its related to its immaturity.

Eventhough, better management in hospital can prevent infant mortality especially in developed countries. But the cost in hospital care is high and not applicable in developing nations, so the new method is needed, that is simple, practical and cheap.

Kangaroo Mother Care is introduced by WHO for management of low-birthweight infant, that improved survival of low-birthweight infant.
Kangaroo Mother Care

Definition
Kangaroo Mother care is a special way of caring of low birth weight babies. It fosters their health and well being by promoting effective thermal control, breastfeeding, infection prevention and bonding.

With Kangaroo Mother Care, the baby and the mother is continuously kept in skin-to-skin contact and breastfed exclusively to the utmost extent, KMC is
initiated in the hospital and continued at home.

Two components of KMC:
Skin-to-skin contact
Early, continuous and prolonged skin-to-skin contact between the mother and her baby is the basic component of KMC. The infant is placed on her mother's chest between the breasts.

Exclusive breastfeeding
The baby on KMC is breastfed exclusively. Skin-to-skin contact promotes lactation and facilitates the feeding interaction.

Benefits of KMC
Breastfeeding: Studies have revealed that KMC results in increased breastfeeding rates as well as increased duration of breastfeeding. Even when initiated late and for a limited time during day and night, KMC has been shown to exert a beneficial effect on breastfeeding.

Thermal control: Prolonged skin-to-skin contact between the mother and her preterm/ LBW infant provides effective thermal control with a reduced risk of hypothermia. For stable babies, KMC is at least equivalent to conventional care with incubators in terms of safety and thermal protection.

Early discharge: Studies have shown that KMC cared LBW infants could be discharged from the hospital earlier than the conventionally managed babies. The babies gained more weight on KMC than on conventional care.

Less morbidity: Babies receiving KMC have more regular breathing and less predisposition to apnea. KMC protects against nosocomial infections. Even after discharge from the hospital, the morbidity amongst babies managed by KMC is less. KMC is associated with reduced incidence of severe illness
including pneumonia during infancy.

Other effects: KMC helps both infants and parents. Mothers are less stressed during kangaroo care as compared with a baby kept in incubator. Mothers prefer skin-to-skin contact to conventional care. They report a stronger bonding with the baby, increased confidence, and a deep satisfaction that theywere able to do something special for their babies. Fathers felt more relaxed, comfortable and better bonded while providing kangaroo care.

All stable LBW babies are eligible for KMC. However, very sick babies needing special care should be cared under radiant warmer initially. KMC should be started after the baby is hemo -dynamically stable.

The KMC procedure
• The baby should be placed between the mother's breasts in an upright position.
• The head should be turned to one side and in a slightly extended position. This slightly extended head position keeps the airway open and allows eye
to eye contact between the mother and her baby.
• The hips should be flexed and abducted in a "frog" position; the arms should also be flexed.
• Baby's abdomen should be at the level of the mother's epigastrium. Mother's breathing stimulates the baby, thus reducing the occurrence of apnea.
• Support the baby’s bottom with a sling/binder.
Kangaroo Care

Duration of KMC
Skin-to-skin contact should start gradually in the nursery, with a smooth transition from conventional care to continuous KMC.
Sessions that last less than one hour should be avoided because frequent handling may be stressful for the baby.
The length of skin-to-skin contacts should be gradually increased up to 24 hours a day, interrupted only for changing diapers.
When the baby does not require intensive care, she should be transferred to the post-natal ward where KMC should be continued.


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Breastfeeding: An Ideal food for your Baby

Breast Milk is the ideal food for normal full-term babies, but unfortunately in many Western societies its advantages are not fully utilized. The advantages of breastfeeding can be considered as those for the baby and those for the mother, although these are of course interrelated.
breastfeeding

Advantages to the baby
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