Deficiency eradication

When advising potential travelers on prophylaxis for malaria, be aware of the incidence of chloroquine-resistant P. falciparum malaria and the countries where it is prevalent. In patients who have P. vivax or P. ovale malaria (note that some patients can have P. falciparum and one of these species), following the treatment of the acute phase of malaria and screening for glucose-6-phosphate dehydrogenase deficiency, patients should receive a regimen of primaquine for 14 days to ensure eradication of the hypnozoite stage of P. vivax or P. ovale. For detailed recommendations for prevention of malaria go to www.cdc.gov/travel/. 

Iron-deficiency anaemia results from a discrepancy between iron availability and the amount required for production of red blood cells. The causes of acquired iron deficiency in so-called underdeveloped and developed countries must be differentiated. In underdeveloped countries, the main causes of iron deficiency are (a) the poor availability of iron in the diet due to low haem and high fibre and phytate content (D Souza et ah, 1987), and (b) chronic blood loss due to hookworm, schistosomiasis and malaria (Stoltzfus et ah, 1997 Olsen et ah, 1998 Dreyfuss et ah, 2000). Inflammation and vitamin A deficiency often interfere with the above causes of iron deficiency, causing a mixed type of anaemia. In underdeveloped countries diet improvement, iron fortification of natural foods and eradication of parasites will have a much higher impact than will refinement of diagnostic procedures and therapy of iron-deficiency anaemia. 

Patients who are immunosuppressed (e.g., granulocytopenia from chemotherapy, acquired immune deficiency syndrome) may respond poorly to therapy because their own defenses are inadequate to eradicate the infection despite seemingly adequate drug regimens. 

DeLuca, L. M., Glover, J., Heller, J., Olson, J. A. and Underwood, B. 1979. Guidelines for the Eradication of Vitamin A Deficiency and Xerophthalmia. VI. Recent Advances in the Metabolism and Function of Vitamin A and Their Relationship to Applied Nutrition. Nutrition Foundation, New York. 

The eradication of vitamin A deficiency in Thailand did not arise from a government program focused specifically on vitamin A deficiency but rather from a comprehensive national program to promote primary health care in local communities. Vitamin A supplements were administered only to children who showed eye symptoms but not to all children deemed to be at risk of vitamin A deficiency. The program was... 

The precursors of vitamins D2 and D3 are ergosterol and 7-dehydrocholesterol, respectively. These precursors or provitamins can be converted into the respective D vitamins by irradiation with ultraviolet light. In addition to the two major provitamins, there are several other sterols that can acquire vitamin D activity when irradiated. The provitamins can be converted to vitamin D in the human skin by exposure to sunlight. Because very few foods are good sources of vitamin D, humans have a greater likelihood of vitamin D deficiency than of any other vitamin deficiency. Enrichment of some foods with vitamin D has significantly helped to eradicate rickets, which is a vitamin D deficiency disease. Margarine and milk are the foods commonly used as carrier for added vitamin D. 

Rickets was more or less eradicated as a nutritional deficiency disease dur-ingthe 1950s, as aresultofwidespread enrichment ofinfantfoods with vitamin D. The level of supplementation was reduced as a result of the development of hypercalcemia caused by vitamin D intoxication (Section 3.6.1) in a small number of especially susceptible infants. As a result, rickets has reemerged, especially in northern cities in temperate countries. 

Although now largely eradicated, beriberi remains a problem in some parts of the world among people whose diet is especially high in carbohydrates. A different condition, affecting the central rather than peripheral nervous system, the Wemicke-Korsakoff syndrome, is also due to thiamin deficiency. It occurs in developed countries, especially among alcoholics and narcotic addicts. 

Rickets was more or less eradicated as a nutritional deficiency disease during the 1950s, as a result of widespread enrichment of infant foods with vitamin... 

Goiter is the human pathology of hyperplasia of the thyroid gland induced by the deficiency of dietary iodine. The disease is localized in those regions where soils are low in iodine or where seafood is not consumed. Fortification of fable salt with sodium iodide, where applied, has practically eradicated this disease. Unfortunately, many regions of the world do not practice this public health policy. 

Iodine deficiency is closely associated with the iodine content of the soils used in agriculture in the affected areas. Although iodine supplementation programs have eradicated iodine deficiency in many areas of the world, serious deficiencies still occur in certain regions-... 

Anon. INACG Report Guidelines for the Eradication of Iron Deficiency... 

Jenner s speckled monster (smallpox) has been defeated, but AIDS will be with us for many years to come. While smallpox was eradicated by means of a worldwide vaccination campaign, prevention of acquired immune deficiency syndrome or AIDS will require new drugs and more careful sexual behaviour. Both diseases do share a common feature - they are caused by Nature s most successful parasites - the viruses. In the developed world, it is not uncommon for a person to survive to a ripe old age without experiencing a serious bacterial infection or contracting one of the many forms of cancer. They will, however, have suffered from the effects of numerous viral infections of the respiratory tract, i.e., colds and flu, and most probably, from the common childhood virus-inflicted disease of chicken pox. It is unlikely that any of these afflictions will have been life-threatening, but they will have caused many days to be lost from school or work. In other words, the morbidity due to the common viral diseases is high, but the mortality is low. 

Since the fortification of cattle fodder started in 1950, iodine deficiency has been assumed to be eradicated in Norway (Frey, 1986). Although there never has been systematic monitoring of iodine nutrition, several studies in the last decade have shown that the iodine intake in the majority of the population is in the range considered to be sufficient. The majority of studies conducted in Norway have focused on urinary iodine concentrations in selected groups of the population. Calculation of iodine intake based on a food-frequency questionnaires covering the habitual diet in a representative sample of adult Norwegians confirmed that milk and dairy products are a very important iodine source in the diet. The study showed... 

Table 47.1 (left column) lists some health problems that may become less common with eradication of iodine deficiency. We have indicated our evaluation of the validity of the documentation for the associations ftom possibly true to evident. As indicated, we consider the evidence to be good. 

Based on such evidence on iodine-induced disease in individual patients, it would be expected that an increase in population iodine intake would lead to an increase in the incidence and prevalence of certain thyroid disorders. To evaluate this in more detail, and to obtain information on the level of iodine intake where such an increase will take place, epidemiological studies are necessary. As shown in Table 47.1 there is evidence to suggest that a number of abnormalities may be more common when iodine intake becomes high. However, in general the evidence is less strong, compared with the evidence for less disease with eradication of iodine deficiency (Table 47.1), and the sum of burdens is lower (Figure 47.1). 

Iodine deficiency is still a major pubfic health problem worldwide, although substantial progress has been made towards its eradication in many countries. It is of particular importance in the pregnant woman, because of the sequelae that may be observed in the fetus and the neonate (Table 49.1). Epidemiological demonstration of the association... 

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