Practices of Introduction of Complementary Feeding and Iron Deficiency Prevention in the Middle East and North Africa

Background: Iron deficiency (ID) with or without anemia is associated with impaired mental and psychomotor development. Given the paucity of information on physicians' knowledge and practices on iron (Fe) supplementation and impact of ID in the Middle East and North Africa (MENA), it was felt important to conduct a survey. Method: A group of expert physicians developed a questionnaire that was randomly distributed among MENA doctors to assess their knowledge and practices on introduction of complementary feeding, impact of ID, its prevention and their impression on prevalence of ID. Descriptive statistics were used. Results: We received 2,444 completed questionnaires. Thirty nine percent of physicians do not follow the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines regarding age of introduction of complementary feedings. Almost 62% estimate the prevalence of ID anemia to be 40–70%, however, only 17% always monitor hemoglobin (Hb) between 9–12 months of age, 43% do so "almost" always while 36% do so "rarely" or (4%) never". For the prevention of ID in infants > 6 months of age, almost all recommend introducing Fe supplements. Ninety seven percent agree that untreated ID during infancy may have long-term negative effects on cognitive function while 53.26% consider that Fe enriched infant cereals result in staining of the baby teeth, constipation and dark stools. Conclusion: Although there is awareness of the impact of ID, there are some misconceptions regarding age of introduction of complementary feedings, surveillance of Fe status and side effects of Fe-enriched infant cereals. There is a need for educational initiatives focusing on Fe deficiency prevention. Address correspondence and reprint requests to Carlos H. Lifschitz, Hospital Italiano de Buenos Aires. Servicio de Gastroenterologia, Hepatologia y Trasplante Infantil. Tte. Gral. Juan Domingo Perón 4230, C1199ABH CABA, Argentina (e-mail: carlos.lifschitz@hiba.org.ar). Received 3 February, 2018 Accepted 25 May, 2018 Collaborators: Sanaa Youssef, Amira Edris, Maher Al-Hatlani, Sheikh Aly, Wafaa Ayesh, Dema Abo Saleh, Soliman Al Saad. Funding: Authors attending the meeting for questionnaire development received support and honoraria from Nestl, Nutrition Institute, Middle East. OPEN Health Dubai and Clinnex CRO were funded by the Nestle Nutrition Institute, Middle East. Contributors: All authors and collaborators developed the survey questionnaire. Leris D'Costa and CL wrote the first draft of the paper. All authors contributed to discussion of the results, review of the manuscript and approved the final manuscript. The authors report no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.jpgn.org). © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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