Anaemia, goitre and other micronutrient deficiencies

24 min

Let's begin

Uwimana, a Senior 3 student, falls asleep in afternoon lessons, gets out of breath climbing the hill to school, and her palms look pale beside her friends'. She eats enough to feel full: tea and bread in the morning, rice and potatoes at lunch, ugali and cabbage at night. The problem is not the amount of food but what is missing from it: iron. A diet can fill the stomach and still lack the micronutrients, the vitamins and minerals needed in small amounts. Worldwide, the most common deficiencies are of iron, iodine and vitamin A.

Definition

Micronutrients: vitamins and minerals that the body needs in small amounts (milligrams or micrograms a day), such as iron, iodine and vitamin A.

Anaemia: a condition in which the blood has too few red blood cells or too little haemoglobin, the iron-containing protein that carries oxygen. Iron deficiency is its most common cause.

Goitre: a swelling at the front of the neck caused by an enlarged thyroid gland, most often because the diet lacks iodine.

Food fortification: adding micronutrients to common foods, such as iodine to salt or iron to flour.

Iron-deficiency anaemia

Worldwide, an estimated 40% of children aged 6–59 months, 37% of pregnant women and 30% of women aged 15–49 have anaemia (WHO, 2025). In Rwanda, the 2019–20 Demographic and Health Survey found anaemia in 37% of children aged 6–59 months.

Causes	Signs	Groups most at risk
too little iron in the diet; tea or coffee with meals; blood loss from heavy periods, hookworm or injury; malaria, which destroys red blood cells	tiredness and weakness; pale palms, nails and inner eyelids; breathlessness; headaches; poor concentration; frequent infections	children under 5; adolescent girls; pregnant women; people with malaria or worms

Preventing anaemia: eat iron-rich foods daily, with a vitamin C food at the same meal; drink tea and coffee between meals; sleep under a treated mosquito net; wear shoes and wash hands (hookworm larvae enter through bare feet); deworm as advised by the health centre; and take iron tablets in pregnancy if the health worker prescribes them.

Iodine deficiency and goitre

The thyroid gland in the neck uses iodine to make hormones that control how fast the body uses energy, and how the brain develops before birth and in early childhood. Without enough iodine the gland swells into a goitre. In pregnancy, iodine deficiency can harm the baby's brain for life. Most soils in hilly, inland regions contain little iodine, so crops grown there are low in it. The answer is iodised salt, which WHO recommends, together with fish and milk. Use iodised salt, but keep total salt below 5 g a day for adults (WHO, 2026), about one level teaspoon. Keep the packet closed and dry, because iodine is lost from salt left open in damp or heat.

Vitamin A deficiency

Vitamin A is needed for seeing in dim light and for fighting infection. Deficiency causes night blindness, dry eyes and, in severe cases, blindness, and makes measles and diarrhoea more dangerous. Good sources: orange-fleshed sweet potatoes, carrots, pumpkin, ripe mango and papaya, dark green leaves, red palm oil, eggs, milk and liver.

Deficiency	Main sign	Foods that prevent it
Iron	anaemia: tiredness, pallor	liver, meat, fish, beans, dark green leaves (+ vitamin C)
Iodine	goitre	iodised salt, fish, milk
Vitamin A	night blindness	orange-fleshed sweet potato, carrots, mango, green leaves, palm oil

FuseSchool: an animated lesson on iron deficiency: why the body needs iron, what happens to red blood cells without it, and which foods supply it. Watch for the link between haemoglobin and oxygen.

Worked example

Worked example 1: improving Uwimana's day. Her meals: tea and bread; rice and Irish potatoes; ugali and cabbage. Plan changes that cost little.

Breakfast: replace the tea with porridge made with soybean flour, or drink the tea later in the morning, not with the food.
Lunch: add a scoop of beans to the rice, with a tomato and onion sauce (vitamin C helps absorb the beans' iron).
Supper: replace cabbage with amaranth or cassava leaves cooked with small dried fish, and a piece of fruit such as an orange or passion fruit.
She should also visit the health centre: the signs may need a blood test and iron tablets, and malaria or worms must be ruled out.

Worked example

Worked example 2: an iron-rich meal for a family of four. Prepare beans with amaranth and a passion-fruit drink.

Soak 500 g of dry beans overnight; discard the water; boil until soft, about 1 to 2 hours.
Fry a chopped onion and two tomatoes in 2 tablespoons of oil; add the beans and a little of their cooking water; season with a pinch of iodised salt.
Wash a large bunch of amaranth leaves, chop, and add in the last 5 minutes so they stay green.
Serve with rice or ugali, and a drink of fresh passion-fruit juice. Serve tea later, not with the meal.

Warning

Do not take iron tablets without advice. Too much iron is poisonous, especially to small children, who may think the tablets are sweets: keep them locked away. Iron tablets and vitamin A doses should be given only as a health worker directs.

Tip

Memory hook: "Iron likes C, hates tea." Pair beans and greens with fruit or tomatoes, and move tea and coffee away from meals.

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Practice

Define anaemia and haemoglobin.
Give four signs of iron-deficiency anaemia.
Explain why adolescent girls and pregnant women are at greater risk of anaemia.
How does vitamin C affect iron absorption, and what does this mean for planning a meal?
What is a goitre, and how can it be prevented?
Name three foods rich in vitamin A and say which deficiency sign they prevent.
A school serves tea with every meal "because students like it". Evaluate this practice in terms of anaemia and suggest an improvement.

Show answersHide answers

Anaemia: too few red blood cells or too little haemoglobin in the blood. Haemoglobin: the iron-containing protein in red blood cells that carries oxygen.
Tiredness or weakness; pale palms, nails or inner eyelids; breathlessness; headaches; poor concentration; frequent infections (any four).
Girls lose iron in menstrual blood and need extra iron for growth; pregnant women need extra iron for the baby and the larger blood volume.
Vitamin C increases the absorption of iron from plant foods. Plan an iron food and a vitamin C food (fruit, tomatoes) in the same meal.
A swelling of the thyroid gland in the neck, usually from iodine deficiency. Prevent it by using iodised salt (in small amounts), and eating fish and milk.
Orange-fleshed sweet potato, carrots, mango, papaya, pumpkin, dark green leaves, red palm oil, eggs, liver (any three); they prevent night blindness.
Tea with meals reduces iron absorption, so it raises the risk of anaemia, especially for girls. Better: serve water or fruit juice with meals, and tea at break time between meals; add beans, green leaves and fruit to the menu.

Sources and credits

Lesson text, Figure 2, tables, worked examples, recipe and practice: written by Ganzaa.
Facts: Anaemia, fact sheet, WHO, 2025; Healthy diet, fact sheet, WHO, 2026; Rwanda Demographic and Health Survey 2019–20, Final Report, NISR, Ministry of Health and ICF, 2021. Summarised in Ganzaa's own words.
Photo: Ibishyimbo byeze mu Rwanda, IGANZE, Wikimedia Commons, CC BY-SA 4.0.
Video: Iron Deficiency | Cells | Biology, FuseSchool - Global Education, embedded from YouTube.

1Iron-deficiency anaemia

2Iodine deficiency and goitre

3Vitamin A deficiency

Iron-deficiency anaemia

Iodine deficiency and goitre

Vitamin A deficiency