Determinants of Anaemia Among Women of Reproductive Age In South Africa: A Healthy Life Trajectories Initiative (HeLTI)

Abstract Background – Anaemia continues to be a major public health problem among women of reproductive age (WRA). A thorough understanding of anaemia risk factors is necessary to design better interventions. This paper examines the determinants of anaemia among WRA in South Africa.Methods- We included baseline data from 480 women participating in the pilot-phase of a randomized controlled trial (HeLTI). We measured haemoglobin (Hb) status using the Hemocue. Plasma iron status markers (ferritin and soluble transferrin receptor (sTfR)), markers of inflammation (C-reactive protein (CRP)) and alpha-1-acid glycoprotein (AGP)) and retinol binding protein (RBP) were assessed using the multiplex method. We used multivariate logistic regression to describe associations with anaemia and structural equation modelling (SEM) to characterise direct and indirect pathways influencing haemoglobin concentrations.Results- The prevalence of anaemia, iron deficiency (ID), and iron deficiency anaemia (IDA) was 39.4%, 38.1% and 21.6% respectively. The multiple logistic regression showed that ID (OR: 2.62, 95% CI: 1.72, 3.98), iron deficiency erythropoiesis (IDE) (OR: 1.62, 95% CI: 1.07, 2.46), and elevated CRP (OR: 1.69, 95% CI: 1.04, 2.76), increased the odds of being anaemic. SEM analysis revealed Hb was directly and positively associated with adjusted ferritin (0.0031 per mg/dl; p≤0.001), and CRP (0.015 per mg/dl; p≤0.05), and directly and negatively associated with soluble transferrin receptor sTfR (-0.042 per mg/dl; p≤0.001). While contraception use had both a direct (0.34; p≤0.05) and indirect (0.11; p≤0.01) positive association with Hb. Additionally, chicken and beef consumption had a positive indirect association with Hb concentrations (0.15; p≤0.05) through adjusted ferritin.Conclusion-A key driver of anaemia in our setting is ID, however the presence of inflammation also increases the risk of anaemia. To address anaemia, interventions should aim to improve the diet quality of women, in particular access to iron rich foods. We recommend the use of multi-micronutrient supplements with a lower dose of iron and other micronutrients which would ensure that women receive the same benefits as with iron folic acid, while alleviating anaemia of inflammation.

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Prevalence of Anemia and Its Associate Factors among Women of Reproductive Age in Lao PDR: Evidence from a Nationally Representative Survey

Anemia ◽

10.1155/2021/8823030 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Sengtavanh Keokenchanh ◽

Sengchanh Kounnavong ◽

Akiko Tokinobu ◽

Kaoru Midorikawa ◽

Wakaha Ikeda ◽

...

Keyword(s):

Public Health ◽

Logistic Regression ◽

Associated Factors ◽

Lao Pdr ◽

Reproductive Age ◽

Major Public Health Problem ◽

Women Of Reproductive Age ◽

Sanitation Facility ◽

Increased Risk ◽

Prevalence Of Anemia

Introduction. Anemia continues to be a major public health problem significant among women of reproductive age (WRA) in developing countries, including Lao People’s Democratic Republic (Lao PDR), where the prevalence of anemia among women remains high. This study aimed to assess the prevalence of anemia and its associated factors among WRA 15–49 years in Lao PDR. Methods. We conducted a cross-sectional study, using the Lao Social Indicator Survey II, 2017 dataset. A total of 12,519 WRA tested for anemia were included in this study, through multistage sampling approaches. Binary logistic regression was used to determine the associated factors of anemia. Results. Of 12,519 women, 4,907 (39.2%) were anemic. Multivariate logistic regression revealed that living in central provinces (aOR: 2.16, 95% CI: 1.96–2.38), rural area (aOR: 1.1, 95% CI: 1.00–1.20), large family size with more than 6 persons (aOR: 1.14, 95% CI: 1.01–1.29), pregnancy (aOR: 1.46, 95% CI: 1.22–1.74), having any adverse pregnancy outcomes (aOR: 1.14, 95% CI: 1.03–1.25), poor drinking water (aOR: 1.24, 95% CI: 1.10–1.39), and poor sanitation facility (aOR: 1.15, 95% CI: 1.03–1.28) were significantly associated with an increased risk of anemia. Conversely, four factors were associated with anemia preventively, including being aged 25–34 years (aOR: 0.81, 95% CI: 0.74–0.90), postsecondary education (aOR: 0.76, 95% CI: 0.60–0.97), Hmong-Mien ethnicity (aOR: 0.48, 95% CI: 0.39–0.59), and watching television almost daily (aOR: 0.84, 95% CI: 0.75–0.95). Conclusion. Anemia continues to be a major public health challenge in Lao PDR. Interventions should be considered on geographic variations, improving safe water and sanitation facility, promoting of iron supplements during pregnancy, and health education through mass media for women in rural areas.

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Ascaris lumbricoides infection: Still a threat for iron deficiency anaemia in 2-year-old Bangladeshi slum-dwelling children

The Journal of Infection in Developing Countries ◽

10.3855/jidc.11340 ◽

2019 ◽

Vol 13 (10) ◽

pp. 933-938

Author(s):

Md. Shabab Hossain ◽

Subhasish Das ◽

Md. Amran Gazi ◽

Mustafa Mahfuz ◽

Tahmeed Ahmed

Keyword(s):

Logistic Regression ◽

Iron Deficiency ◽

Ascaris Lumbricoides ◽

Transferrin Receptor ◽

Iron Deficiency Anaemia ◽

Strong Association ◽

Parasitic Infections ◽

Soluble Transferrin Receptor ◽

Intestinal Parasitic Infections ◽

Deficiency Anaemia

Introduction: Although parasitic infections lead to extracorporeal iron loss resulting in iron deficiency anaemia (IDA), data associating IDA with parasitic infections in the first two years of life are limited. We sought to evaluate the prevalence and severity of anaemia and IDA during this period and to investigate the association between intestinal parasitic infections and IDA. Methodology: Data was collected under MAL-ED study protocol in Bauniabadh slum of Dhaka, Bangladesh. The presence of parasites in stool was detected using wet preparation microscopy at 7, 15, and 24 months. Anaemia was defined as serum haemoglobin < 11 g/dL and IDA was defined by serum haemoglobin < 11 g/dL, serum ferritin < 12 g/L and soluble transferrin receptor > 8.3 mg/L. Logistic regression was done to quantify the relation between stool parasite and IDA separately on samples collected at 7, 15 and 24 months. Results: 265 children were enrolled after birth and samples were collected at 7, 15 and 24 months. Anaemia was detected at 7, 15 and 24 months in 117 (48.8%), 106 (44.2%) and 67 (27.9%) cases whereas IDA was found in 15 (6.3%), 47 (19.6%) and 39 (16.3%) cases, respectively. Iron deficiency anaemia at 24 months was significantly associated with Ascaris lumbricoides infection (OR 3.76; 95 % CI, 1.08-13.11). Conclusions: The prevalence of anaemia and IDA in slum dwelling children of Dhaka is high and Ascaris lumbricoides infection was found to have a strong association with IDA at 24 months of age.

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Prevalence of Anaemia, Iron Deficiency, and Iron Deficiency Anaemia in Women of Reproductive Age and Children under 5 Years of Age in South Africa (1997–2021): A Systematic Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182312799 ◽

2021 ◽

Vol 18 (23) ◽

pp. 12799

Author(s):

Eunice Turawa ◽

Oluwatoyin Awotiwon ◽

Muhammad Ali Dhansay ◽

Annibale Cois ◽

Demetre Labadarios ◽

...

Keyword(s):

South Africa ◽

Systematic Review ◽

Iron Deficiency ◽

Iron Deficiency Anaemia ◽

Reproductive Age ◽

Health Concern ◽

Pool Data ◽

Women Of Reproductive Age ◽

Deficiency Anaemia ◽

Children Under 5

Using a systematic review method, the prevalence of anaemia, iron deficiency (ID), and iron deficiency anaemia (IDA) in women of reproductive age (WRA) and children under 5 years of age was obtained to inform priorities in health planning and policy in South Africa. We searched electronic databases for articles published between 1997 and 2021. A total of 713 articles were identified, of which 14 articles comprising 9649 WRA and 4085 children were included. Since most of the included studies were of low quality, we did not pool data in a meta-analysis due to heterogeneity (I2 > 75%). In WRA, anaemia prevalence ranged from 22.0% to 44.0%; ID from 7.7% and 19.0%; and IDA from 10.5% to 9.7%. The prevalence of anaemia in pregnancy was 29.0% to 42.7%; and 60.6% to 71.3% in HIV-infected pregnant women. Three national surveys reported anaemia in children at 28.9%, 10.7%, and 61.3%, respectively. Overall, among the children under 5 years old, anaemia was more prevalent in 1-year-olds (52.0%) compared to the other age groups. Between 2005 and 2012, ID increased by 3.8% and IDA decreased by 83.2% in children. Anaemia in WRA and children under 5 years in South Africa was a moderate public health concern. Therefore, interventions addressing anaemia should be intensified, and policies on iron supplementation and food fortification need to be revised and aligned to the WHO multiple micronutrient supplementation recommendations.

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Adjusting Haemoglobin Values for Altitude Maximizes Combined Sensitivity and Specificity to Detect Iron Deficiency among Women of Reproductive Age in Johannesburg, South Africa

Nutrients ◽

10.3390/nu12030633 ◽

2020 ◽

Vol 12 (3) ◽

pp. 633

Author(s):

Takana Mary Silubonde ◽

Jeannine Baumgartner ◽

Lisa Jayne Ware ◽

Linda Malan ◽

Cornelius Mattheus Smuts ◽

...

Keyword(s):

South Africa ◽

Iron Deficiency ◽

Receiver Operating Characteristic ◽

South African ◽

Sensitivity And Specificity ◽

Operating Characteristic ◽

Reproductive Age ◽

African Women ◽

Women Of Reproductive Age ◽

South African Women

In South Africa, haemoglobin (Hb) is measured to screen for iron deficiency (ID). However, low levels of Hb are only a late stage indicator of ID. Furthermore, Hb values are generally not adjusted for altitude even though recommended by WHO. We determined the Hb threshold with the highest combined sensitivity and specificity for detecting ID among South African women living at 1700 m above sea level. In a cross-sectional study of 492 18–25-year-old women, we measured Hb and iron status biomarkers. Using receiver operating characteristic curves, we determined the Hb threshold with maximum Youden Index for detecting ID. This threshold of <12.35 g/dL resulted in a 37.2% anaemia prevalence (20.9% IDA), and sensitivity and specificity of 55.7% and 73.9%, respectively. The WHO altitude-adjusted threshold of <12.5 g/dL resulted in a 39% anaemia prevalence (21.3% IDA), and sensitivity and specificity of 56.8% and 70.8%, respectively. In contrast, using the unadjusted Hb cut-off of <12 g/dL resulted in a 18.5% anaemia prevalence (12.6% IDA), and sensitivity and specificity of 35.1% and 88.6%, respectively. In this sample of South African women of reproductive age an Hb threshold <12.35 g/dL had the highest combined sensitivity and specificity for detecting ID. The diagnostic performance of this Receiver operating characteristic curve-determined threshold was comparable to the altitude-adjusted threshold proposed by WHO. Thus, clinical and public health practice in South Africa should adopt adjustment of Hb for altitude to avoid underestimation of ID and missing women in need for intervention.

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Effect of Fortification with Multiple Micronutrient Powder on the Prevention and Treatment of Iron Deficiency and Anaemia in Brazilian Children: A Randomized Clinical Trial

Nutrients ◽

10.3390/nu13072160 ◽

2021 ◽

Vol 13 (7) ◽

pp. 2160

Author(s):

Malaine Morais Alves Machado ◽

Mirella de Paiva Lopes ◽

Raquel Machado Schincaglia ◽

Paulo Sérgio Sucasas da Costa ◽

Alexandre Siqueira Guedes Coelho ◽

...

Keyword(s):

Iron Deficiency ◽

Serum Ferritin ◽

Transferrin Receptor ◽

Ferrous Sulfate ◽

Soluble Transferrin Receptor ◽

Standard Drug ◽

Micronutrient Powder ◽

Prevention And Treatment ◽

Multiple Micronutrient ◽

Multiple Micronutrient Powder

Fortification with multiple micronutrient powder has been proposed as a public health intervention able to reduce micronutrient deficiencies in children. Our objective was to compare the effectiveness of fortification with multiple micronutrient powder with drug supplementation in the prevention and treatment of iron deficiency and anaemia. This was a cluster trial with anemic and non-anaemic children between six and 42 months old, in randomization data. Non anaemic children received fortification with multiple micronutrient powder or standard drug supplementation of ferrous sulfate associated with folic acid in a prevention dose. Anaemic children who were randomized to receive multiple micronutrient powder also received the recommended iron complementation for anaemia treatment. A total of 162 children were evaluated. The prevalence of anaemia decreased from 13.58 to 1.85%. Iron deficiency decreased from 21.74% to 7.89% (by serum ferritin) and iron deficiency decreased from 66.81 to 38.27% (by soluble transferrin receptor). No difference was identified between interventions for hemoglobin (p = 0.142), serum ferritin (p = 0.288), and soluble transferrin receptor (p = 0.156). Fortification with multiple micronutrient powder was effective in preventing iron deficiency and anaemia in children aged six to 48 months. In anaemic children; it was necessary to supplement the dose of multiple micronutrient powder with ferrous sulfate.

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Role of husband’s attitude towards the usage of contraceptives for unmet need of family planning among married women of reproductive age in Pakistan

BMC Women s Health ◽

10.1186/s12905-021-01314-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Muhammad Farhan Asif ◽

Zahid Pervaiz ◽

Jawad Rahim Afridi ◽

Ghulam Abid ◽

Zohra S. Lassi

Keyword(s):

Family Planning ◽

Unmet Need ◽

Wealth Quintile ◽

Married Women ◽

Reproductive Age ◽

Women Of Reproductive Age ◽

Family Planning Programs ◽

Contraception Use ◽

Wide Range

Abstract Background Family planning services deliver a wide range of benefits to the well-being of females and the community. It can curtail the risk of maternal and neonatal mortality through the reduction in abortions and pregnancies. The government of Pakistan has been struggling to convince people about the usefulness of family planning programs. However, different factors related to social norms, values, and culture are important to determine the success of these programs. One such factor is the patriarchal structure of Pakistani society where most of the household decisions are made by men. The objective of this research is to examine the role of the husband’s attitude towards the usage of contraceptives for the unmet need of family planning (UMNFP) among married women of reproductive age (MWRA) in Pakistan. Method The dataset of Pakistan Demographic and Health Survey 2017–18 is utilized to examine the role of the husband’s attitude towards the usage of contraceptives in UMNFP among MWRA in Pakistan. Results The UMNFP was considerably lower among MWRA between 40 years and above compared to women 15–19 years. The odds of UMNFP were higher among women and men who were educated up to the primary level compared to those with no education. Odds of UMNFP were higher among women from the poor wealth quintile compared to the poorest wealth quintile; similarly, it was significantly lower among women who were from the richer and the richest wealth quintile compared to the poorest wealth quintile. The odds of UMNFP were lower among women who were employed compared to those who were not employed. Lastly, the odds of UMNFP were higher among women whose husbands opposed to using contraceptives, who perceived that there was a religious prohibition for such use and when a decision on the contraception use was solely made by the husband. Conclusions Husband’s attitude towards the usage of contraceptives is an important predictor of UMNFP. Liaising with the community and religious leaders to persuade people particularly men about the usefulness of family planning programs and encouraging men to understand their women’s say in using contraceptives should be encouraged.

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Prevalence of Goiter and Associated Factors among Women of Reproductive Age Group in Demba Gofa Woreda, Gamo Gofa Zone, Southwest Ethiopia: A Community-Based Cross-Sectional Study

Journal of Nutrition and Metabolism ◽

10.1155/2020/5102329 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Befikaduwa Zekarias ◽

Frehiwot Mesfin ◽

Bezatu Mengiste ◽

Adane Tesfaye ◽

Lemma Getacher

Keyword(s):

Logistic Regression ◽

Iodine Deficiency ◽

Associated Factors ◽

Sampling Technique ◽

Iodized Salt ◽

Reproductive Age ◽

Age Group ◽

Women Of Reproductive Age ◽

Cross Sectional ◽

Reproductive Age Group

Background. Iodine deficiency disorder is a major public health problem in Ethiopia that is more common in women of reproductive age. However, it is not well addressed and there is a lack of information on its prevalence and associated factors in women of reproductive age group. Therefore, the objective of this study was to assess goiter prevalence and associated factors among women of reproductive age in the Demba Gofa woreda, Gamo Gofa Zone, Southwest Ethiopia. Methods. A community-based cross-sectional study was used among 584 randomly selected women in the reproductive age group from February 05 to April 20, 2016. A simple random sampling technique was used to select the study kebeles, and a systematic random sampling technique was used to select the study samples. Data were collected through a pretested questionnaire, and the goiter examination was done clinically for each participant. The collected data were coded and entered into a computer for statistical analysis using EpiData version 3.2 and analyzed using SPSS version 20. Variables with a P value ≤0.25 in bivariate logistic regression analysis were entered into multivariate logistic regression analysis, and finally, variables with a P value <0.05 in multivariate logistic regression were considered significantly associated with the dependent variable. Results. The total goiter rate was 43%, 95% CI = 39.2–46.9. Cassava consumption (AOR: 2.02, 95% CI: 1.03–4), salt wash before use (AOR: 3.14, 95% CI: 1.1–11.3), salt use after >2 months of purchase (AOR: 11, 95% CI: 5–26), family history of goiter (AOR: 4.6, 95% CI: 1.4–15.8), and poor knowledge of iodized salt (AOR: 2.7, 95% CI: 1.4–5.5) were significant factors associated with goiter. Conclusion. Iodine deficiency was found to be severe in women of reproductive age in the study area. This showed that women of reproductive age, especially during pregnancy, are exposed to iodine deficiency and its adverse effects at delivery. Thus, they need urgent supplementation with iodine, improved access to foods rich in iodine, and intake of iodized salt. Additionally, health education should focus on the importance of iodized salt, the proper method of use, and the prevention of iodine deficiency, which are highly recommended to minimize the problem.

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