Cognitive Development in Anemic Infants of Different Prakriti

Cognitive Development in Anemic Infants

of Different Prakriti

(Based on the doctoral thesis of Banaras Hindu University)

Dr. Stuti Usha

B.A., M. A., Ph.D.

Banaras Hindu University,

Assistant Professor in DMPG, Varanasi-221005

Dr. Prem Shanker Upadhyay

Assistant Professor

Department of Kaumārbhritya/Bālroga,

Institute of Medicall Sciences,

Banaras Hindu University, Varanasi-221005

Publisher: www.lulu.com, Releigh, N.C. USA

Cognitive Development in Anemic Infants of Different Prakriti

(Based on the doctoral thesis of Banaras Hindu University)

Publisher: www.lulu.com, Releigh, N.C. USA

First Edition

Copyright @2020, by authors

All rights reserved. Without limiting the rights under copyright reserved above, no part of thispublication may be reproduced, stored in or introduced into a retrival system, or transmitted inany form or by any means (electronic, mechanical, photocopying, recording or otherwise) without the prior written permission of the copyright owner of this book.

ISBN: 978-1-71670-835-0

Printed in United State of Ameica

DEDICATED TO MY FATHER

LATE ARUN KUMAR MISHRA

PREFACE

This book entitled Evaluation of Growth and Cognitive Development in Infants of Different Prakriti (Physical Constitution), Suffering from Iron Deficiency Anemia will contribute to the more basic knowledge of existing literature in Nutrition and Ayurveda.

Worldwide, iron deficiency anemia is the most common nutritional disorder, which effects 1/3 of the population globally. Many researchers had conducted in reference of anemia and cognition but in any research, Prakriti (physical constitution) of infant was not considered in relation with anemia and cognition. In this study maximum infants were found to have Pitta-Kapha and Kapha Prakriti. As in infancy period Kapha is found to be a dominant constitution. Infants show significant difference in anthropometrical examination as increasing age whereas anemic infants showed lower values than prescribed standards. The cognitive developmental delay persists even after treatment if the condition of anemia is severe and chronic. In this study, the infants of Kapha-Vata and Vata-Pitta Prakriti shows lower performance in developmental scale in comparison to other prakriti infants.

I thank the mighty lord and my parents Late A. K. Mishra and Mrs. Punam Mishra for rendering me the previlage to enlighten the topic with my study. I thank my supervisor Dr. P. S. Upadhyay for his noble suggestions and research plans of present work. I am also thankful to my teachers Prof. B.M. Singh and Prof. Sangeeta Gehlot for their inspiration and support.

Date : 25/07/2020                                                       Stuti Usha   

Place: Varanasi

CONTENTS

Page No.

1            Introduction                        7-16

2            Review of Literature            17-57

3            Material and Methods            58-70

4             Observation and Results            71-133

5            Discussion                        134-147

6            Summary and Conclusion            148-152

7            Bibliography                        153-165

ABBREVIATION

Wt.                  -            Weight

CHL                  -            Crown Heel Length

HC                  -            Head Circumference

CC                  -            Chest Circumference

MAC                  -            Mid Arm Circumference

RBC                  -            Red Blood Cell

Hb                  -            Hemoglobin

WBC                  -            White Blood Cell

PLT                  -            Platelets

GBP                   -            General Blood Picture

A.H. Ni.            -            Ashtang Hriday, Nidan Sthan

A.H. Sha.            -            Ashtang Hriday, Sharir Sthan

A.H. Su.            -            Ashtang Hriday, Sutra Sthan

A.S. Sha.            -            Ashtang Samgrah, Sharir Sthan

Ch. Chi            -            Charak Samhita, Chikitsa Sthan

Ch. Sha.            -            Charak Samhita, Sharir Sthan

Ch. Su.                  -            Charak Samhita, Sutra Sthan

Ch. Vi.                  -            Charak Samhita, Viman Sthan

Ch. Ind.            -            Charak Samhita, Indriya Sthan

Su. Su.                  -            Sushrut Samhita, Sutra Sthan

Su. Sha.            -            Sushrut Samhita, Sharir Sthan

Su. Chi.            -            Sushrut Samhita, Chikitsa Sthan

SR. Ir                  -            Serum Iron

SR. Ferr            -            Serum Ferritin

TIBC                  -            Total Iron Binding Capacity

WHO                  -            World Health Organization

NFHS                  -            National Family Health Survey

INTRODUCTION

Science is the thoughtful action to utilize all of the psychological and physical resources available in order to better understand, explain comprehend and forecast usual as well as unusual natural phenomena. Thus, the scientific access to perceive anything involves surveillance, quantification of existence that can be quantify the gathering of data, and analysis of the findings differentiated from an instinctive perspective.

Ayurveda is one of the ancient systems, functions on the foundation of integrated assumption, primarily concentrating on individualized well-being. It is mentioned as ‘science of life’ due to the Sanskrit explanation of Ayu is life and Veda is science or knowledge. The necessity for systematic assessment of Ayurveda has been acknowledged for elongated period. It has customized outlook implicate fundamental evaluation, which can lead to certain preclusion, detection and curative function.

Anemia is a complication in which lack of enough healthy red blood cells occurs in the body. Oxygen is carried by Red blood cells to body tissues. Iron assists in making red blood cells, so a dearth of iron in the body may signal to anemia. The medical term of this complication is iron deficiency anemia. Throughout phase of expeditious growth, even additional iron is required. Newborns are born with iron reserved in their bodies. Since they grow swiftly, infants need to draw in a great extent of iron every day.

As maintained by Ayurvedic prototype, sign and symptom of Pandu roga are immensely similar to iron deficiency anemia. Panduroga is outlined with minimal features in Ayurvedic texts like Ashtanga Hridaya, Charak Samhita, Sushruta Smhita etc. As per Ayurvedic science, Panduroga is Rasa-pradoshaj vikara and according to Charak, Rakta dhatu kshaya is the prevalent manifestation. Symptoms such as Panduta, daurbalyata, Bhrama, etc are so commonly noticed in such cases that clinical characteristic in addition are considered the leading traits of Panduroga.

Prakriti is the distinctive feature of Ayurveda. It can be contemplated as psycho-somatic constitution of an individual. Modern era is the span of personalized or customized medicine. In ancient time entire populace was classified into seven type of Prakriti (Vata, Pitta, Kapha, Vata-Pitta, Vata-Kapha, Pitta-kaph, and sama Prakriti) based on the physiological predominance of doshas (Vata, Pitta & Kapha) for the purpose of health management.

Physical growth is indicated as an elevation in body size (length or height and weight) and in the size of body parts. After birth, most body aspect, for instance stature, body circumferences, and weight follows alike influence of growth. Infancy is a span of very swift growth. From birth to around age of 1 or 2 years, children grow rapidly. Subsequently, growth slows down. The distinct stages of postnatal growth can be acknowledged more easily by considering the growth velocity, moreover to attained size.

Cognitive development is an arena of study in neuroscience and psychology. this field of development targets on a child's development with reference to information processing, conceptual resource, perceptual expertise, language learning, and other additional aspects of the developing or developed brain and cognitive psychology of a human being.

Reason for selection of this topic:

Anemia is exemplified as the assemblage of hemoglobin in blood which is beneath the bottom margin of the regular extent for the age and sex of individual. There are atypical types of anemia termed in modern medicine like iron deficiency anemia, thelasamia, magaloblastic anaemia, hemolytic anemia along with others. Out of which Iron deficiency anemia is the ‎prevalent nutritional inadequacy deformation exist all through the world but its pervasiveness is greater in developing nations such as India. Females and children are mainly pompous by this. National Family Health Survey (NFHS) IV data indicates that 56% urban, 59.5% rural and overall 56.8% infants are suffering from iron deficiency anemia.

Early growth and development of a child’s life is paramountly significant. They are the foundation which forms ‎future health, happiness, contentment, growth, development and learning achievement of child at school, in the family and in life athwart the life span. Infancy and early childhood are contemplated to be a ‎foremost phase in life. Studies observed lower performance outcome among infants who were anemic for eventually three months in compare to those anemic for less than three months. Any remarkable deficit was not detected in infants with intermediate amount of iron shortage or pre-anemic iron insufficiency.

One of the most worrying upshots of iron deficiency in children is the dissimilarity of behavior and cognitive performance. Iron-deficiency anemia has shown to have a persistent negative influence on the attainment in tests of cognitive development in infancy. Many researchers who conducted study related to Iron Deficiency Anemia. Many associated studies reported correction in iron deficiency anemia and impaired motor and cognitive performance and behavioural problems.

Worldwide, one of the most common nutritional disorder, which effects 1/3 of the population globally, is iron deficiency anemia. Studies have reported lower performance scores among infants who had been anemic compared to non-anemic infants. A treasure of clinical, biochemical and neuro-pathological research shows that iron deficiency can negatively affect on learning and this can occur with normal haemoglobin levels against the astound impact of socioeconomic factors.

Lozoff, B. et.al (2000), found remarkable distinction in cognitive development outcome at haemoglobin percentage less than 10.5 g/dl. Children who were dearth in iron during infancy, however they have been kept under treatment for the condition at that time, after 10 years, were found to score significantly lower than controls on measures of mental functioning.

Epidemiology department has obvious evidence that psycho-motor development and immune capability reduces and steer to poor mental and physical development which causes mental alteration in children who have anemia, and escalated their mortality and morbidity in the study of Grantham-McGregor S, Ani C (2001).

Dawd Gashu et.al. (2016) revealed that in preschool children from rural Ethiopia were having poor cognitive performance which were associated with retardation and anemia.

Harish Rotti ()evaluated the Body Mass Index of individual Prakriti and construe the conclusion that higher than 25 Body Mass Index is more in Kapha Prakriti then Pitta and then Vata, and Moderate Body Mass Index (20-25) was also superior in Kapha Prakriti followed by Vata and Pitta less than 20 Body Mass Index was found more in Vata Prakriti followed by Pitta and Kapha. 

A study on different parameters as biological acts and biochemical parameters in adult revealed that among all the three group, remarkably distribution of hematological parameter such as Hemoglobin and RBC count where, compared to Vata or Kapha Prakriti, Pitta Prakriti males had higher values. (Bhavana Prasher et al. 2008)

Tomas Walter, (2015) concluded in his study that behavioral researches have coherently revealed that IDA has unfavorable consequence. Hence, these studies propose new, positive directions for comprehending more specific Central Nervous System mechanisms by which IDA could improve infant behavior and development. There is a strong evidence that deficiency of iron is the leading cause of anemia in developing and many developed countries. Medication and treatment under trial can interfere with some, but not all deformity of iron deficiency. Iron Deficiency Anemia conduces to tissue iron inadequacy as well as reduction in flow of hemoglobin and triggers the most severe functional fault. Children who were suffering with acute and persistent iron deficiency in infancy had lower score in evaluations of mental and motor functioning.

Betsy L., Dand S., W. Jacobson, (2006) specified that poorer object persistence and impermanent memory encryption and/or retrieval in infants with Iron Deficiency Anemia at 9 months.

Robert D. Baker, Frank R. Greer, (2010) stated that during the time of infancy iron-deficiency anemia can have long-lasting, enduring detrimental effects on neurodevelopment.

Walter T. (1994), assessed the permanent adverse effect on cognitive performance may be corelated with the influence of IDA during infancy period.

Lozoff, B., Brittenham, G. M. & Wolf, A. W. (1987) mentioned four studies from India and in each the children were randomly assigned to treatment or control, regardless of hemoglobin level. However, the iron-treated group was significantly better than the control group at the end in the second study. At the end of third study, the treated groups had higher scores than the non-treated groups. Only the fourth study reported difference between the groups in change of scores, but they restricted the analysis to anemic children only, thus breaking the paired randomized design.

Batra J. and Sood A. (2005), reported that the effect of iron shortage on Central Nervous System, which primarily leads to the obstruction in the perception, awareness, cognition and learning activity in humans.

Earlier, there have been a considerable number of studies on the relationship between iron status and cognition, but the topic remains controversial.

Lacuna in present knowledge

Many researchers had conducted study in this field but in any research Prakriti (physical constitution) of infant was not considered.

Statement of the problem

The above facts provoked to initiate the research work on this topic. Hence the present statement of the problem "Evaluation of Growth and Cognitive Development in Infants of Different Prakriti (Physical Constitution), Suffering from Iron Deficiency Anemia" was determined.

OBJECTIVE OF THE STUDY

To assess the evaluation of growth and cognitive development of infants in reference to anemia and to establish a relation in anemia and Prakriti in view of growth and cognitive development individually the objectives to be attained were:

To access the Prakriti of infants and distribute them in different prakriti groups through the preformed questionnaire.

To find out the effect of iron deficiency anemia on growth of infants.

To find out the effect of iron deficiency anemia on cognitive development of infants.

To investigate the effect of hematological parameters (Hb, Red Blood Cell, White blood Cells, Platelets, General Blood Picture, Serum Iron, Serum Ferritin, Total Iron Binding Capacity) on iron deficiency anemia in infants of different Prakriti (physical constitution).

To access the relationship of infants of different Prakriti (physical constitution) with growth and cognitive development.

To find out the impact of different Prakriti (physical constitution) if any, on iron deficiency anemia in infants.

To assess the evaluation of growth and cognitive development of infants in reference to anemia.

INCLUSION CRITERIA-

Infants (till 1