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Gupta A, Sachdev HS, Kapil U, Prakash S, Pandey RM, Lal PR. Etiology of Mild and Moderate Anaemia Among Rural Adolescent Girls in India. Indian J Hematol Blood Transfus 2024; 40:255-260. [PMID: 38708172 PMCID: PMC11065834 DOI: 10.1007/s12288-023-01707-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/04/2023] [Indexed: 05/07/2024] Open
Abstract
A cluster randomized control trial study was conducted in Ballabgarh block of Faridabad District, Haryana, India. Baseline data of a total of 198 non-anemic and 202 anemic adolescent girls (12-19 years) was analyzed for hemoglobin and serum level of hepcidin, ferritin, folate acid, soluble transferrin receptor, vitamin B12 and CRP. Deficiency of iron (p < 0.001), folate (p < 0.01) and their mixed deficiency (p < 0.001) significantly increased with increasing severity of anaemia and contributed to 48.7% mild anaemia and 66.9% moderate anaemia. Anaemia of inflammation contributed to 16.2% of mild anaemia and 11.7% of moderate anaemia. More than one third of mild anaemia is caused by other causes. Current iron and folic acid program can alleviate around more than 2/3rd moderate anaemia and around half of mild anaemia among adolescent girls. Unknown causes of anaemia need further investigation.
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Affiliation(s)
- Aakriti Gupta
- Department of Food and Nutrition, Lady Irwin College, New Delhi, 110001 India
| | - Harshpal Singh Sachdev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Umesh Kapil
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam Prakash
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra Mohan Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Priti Rishi Lal
- Department of Food and Nutrition, Lady Irwin College, New Delhi, 110001 India
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Young MF, Nguyen P, Tran LM, Khuong LQ, Martorell R, Ramakrishnan U. Long term association between of maternal preconception hemoglobin and anemia and child health and development in Vietnam. J Nutr 2023; 153:1597-1606. [PMID: 36925072 PMCID: PMC10367189 DOI: 10.1016/j.tjnut.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/10/2023] [Accepted: 03/10/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND The long-term association between preconception maternal hemoglobin (Hb) concentrations and child health and development is unclear. OBJECTIVE We examined associations between maternal preconception Hb concentrations and anemia with: a) birth outcomes (weight, length, preterm, gestational age, small-for-gestational-age); b) child Hb at 3 mo, 6 mo, 12 mo, and 24 mo; c) motor and mental development at 12 mo and 24 mo (Bayley scales for infant development) and cognitive functioning at 6-7y (Wechsler Intelligence Scale for Children). METHODS We used data from a randomized controlled trial (PRECONCEPT) conducted in Vietnam. Over 5000 women who were intending to conceive were recruited and offspring were prospectively followed from birth (n=1599) through 6-7y (n=1318). Multivariable linear and logistic regressions were used to assess the association between preconception Hb or anemia (Hb < 11g/dL) on child health and development outcomes, adjusted by supplementation group (tested for interactions) and confounding at maternal, child and household levels. RESULTS At preconception enrollment, 20% of the women were anemic. Maternal preconception Hb was positively associated with child Hb at 3 mo (0.06; 95% CI: 0.01,0.12), 6 mo (0.08; 95% CI: 0.03,0.13), 12 mo (0.10; 95% CI: 0.04-0.15) and 24 mo (0.07; 95% CI: 0.02,0.12). Likewise, maternal preconception Hb was associated with reduced risk of child anemia at 6mo (0.89; 95% CI: 0.81-0.98), 12 mo (0.81; 95% CI: 0.74-0.89) and 24 mo (0.87; 95% CI: 0.79-0.95). Maternal preconception anemia was negatively associated with cognition (-1.64; 95% CI: -3.09, -0.19) and language development (-1.61; 95% CI: -3.20, -0.03) at 24mo. Preconception Hb was not associated with birth outcomes or cognitive outcomes at 6-7y. CONCLUSION Maternal preconception Hb was associated with child Hb across the first 1000 days of life. However, preconception Hb was not a significant predictor of birth outcomes or cognitive outcomes at 6-7y in this cohort from Vietnam.
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Affiliation(s)
- Melissa F Young
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Phuong Nguyen
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, USA; Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | - Lan Mai Tran
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Young MF, Nguyen P, Tran LM, Khuong LQ, Tandon S, Martorell R, Ramakrishnan U. Maternal hemoglobin concentrations across pregnancy and child health and development from birth through 6-7 years. Front Nutr 2023; 10:1114101. [PMID: 36875831 PMCID: PMC9978095 DOI: 10.3389/fnut.2023.1114101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/31/2023] [Indexed: 02/18/2023] Open
Abstract
Background The role of changes in maternal hemoglobin (Hb) across pregnancy on child health and development (CHD) remains unclear. Objective We examined the association between maternal Hb trajectories and CHD outcomes: (a) birth outcomes (birth weight, length, gestational age, preterm, and small for gestational age); (b) child Hb at 3, 6, 12, and 24 months; and (c) motor and mental development at 12 and 24 months and cognitive functioning at age 6-7 years. Methods We used data from a randomized controlled trial (PRECONCEPT) conducted in Vietnam (N = 1,175 women enrolled during preconception with offspring follow-up through 6-7 years). Maternal Hb trajectories were developed using latent class analysis with Hb data at preconception, early (≤20 weeks), mid (21-29 weeks), and late (≥30 weeks) pregnancy. Multivariable linear and logistic regression models were used to assess the association between maternal Hb trajectories on CHD outcomes, adjusting for confounding variables at the maternal, child and household levels. Results Four distinct maternal Hb trajectories were identified. Track 1 (low initial Hb-decline) was associated with lower child Hb at 3 months (β [95% CI] -0.52 [-0.87, -0.16]), 6 months (-0.36 [-0.68, -0.05]), 12 months (-0.46 [-0.79, -0.13]), and 24 months (-0.44 [-0.72, -0.15]) and motor development at 12 months (-3.58 [-6.76, -0.40]) compared to track 4 (high initial Hb-decline). After adjustment for multiple testing, relationships remained robust with the exception of associations with child Hb at 6 months and motor development at 12 months. Track 2 (low initial Hb-improve) was the only Hb trajectory to increase across pregnancy; however, it was insufficiently powered. Track 3 (mid Hb-decline) was associated with lower child Hb at 12 months (-0.27 [-0.44, -0.10]) and 24 months (-0.20 [-0.34, -0.05]) compared to track 4 (high initial Hb-decline). Maternal Hb trajectories were not associated with birth outcomes or child development at 24 months or 6-7 years. Conclusion Maternal Hb trajectories during pregnancy are associated with child Hb concentrations across the first 1,000 days, but not with birth outcomes or later cognitive functioning. More work is needed to better understand and interpret changes in Hb levels during pregnancy especially in resource poor settings.
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Affiliation(s)
- Melissa F Young
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States.,Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Phuong Nguyen
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States
| | - Lan Mai Tran
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States.,Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | | | - Sonia Tandon
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States.,Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Reynaldo Martorell
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States.,Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States.,Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
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Scott S, Lahiri A, Sethi V, de Wagt A, Menon P, Yadav K, Varghese M, Joe W, Vir SC, Nguyen PH. Anaemia in Indians aged 10–19 years: Prevalence, burden and associated factors at national and regional levels. MATERNAL & CHILD NUTRITION 2022; 18:e13391. [PMID: 35719126 PMCID: PMC9480897 DOI: 10.1111/mcn.13391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Samuel Scott
- International Food Policy Research Institute New Delhi India
| | - Anwesha Lahiri
- MRC Epidemiology Unit, Institute of Metabolic Science University of Cambridge School of Clinical Medicine Cambridge UK
- Population Research Centre, Institute of Economic Growth New Delhi India
| | - Vani Sethi
- Nutrition Division, UNICEF New Delhi India
| | | | - Purnima Menon
- International Food Policy Research Institute New Delhi India
| | - Kapil Yadav
- Centre for Community Medicine, All India Institute of Medical Sciences New Delhi India
| | | | - William Joe
- Population Research Centre, Institute of Economic Growth New Delhi India
| | - Sheila C. Vir
- Public Health Nutrition and Development Centre New Delhi India
| | - Phuong Hong Nguyen
- International Food Policy Research Institute Washington District of Columbia USA
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Muchomba FM. Effect of Schooling on Anemia and Nutritional Status Among Women: A Natural Experiment in Ethiopia. Am J Epidemiol 2022; 191:1722-1731. [PMID: 35762153 DOI: 10.1093/aje/kwac111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/28/2022] [Accepted: 06/23/2022] [Indexed: 01/29/2023] Open
Abstract
This study estimates the effect of length of schooling on anemia and nutritional status and evaluates the cost-effectiveness of primary schooling as an anemia intervention for women of childbearing age in Ethiopia. In 1994-1995, Ethiopia abolished primary school tuition fees and embarked on a large-scale educational investment program, which increased primary school enrollment and retention. An instrumented regression-discontinuity design was used to examine the effect on anemia risk and body mass index (BMI) of an increase in length of schooling resulting from the reforms, as a natural experiment. Anemia and BMI biomarkers and demographic data for 13,984 women were obtained from the 2011 and 2016 Ethiopia Demographic and Health Surveys, with the 2019 Mini Demographic and Health Survey used for robustness checks. Results indicate that each additional year of schooling reduced anemia risk by 3 percentage points (9.2%-11.2% reduction) and increased BMI (weight (kg)/height (m)2) by 0.26-0.42. Primary education was cost-effective-based on World Health Organization cost-effectiveness thresholds-as an anemia intervention, with a cost per anemia case averted of US$1,654. The findings suggest that investment in education reduces anemia risk later in life.
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Assessment of Micronutrient Situation among Reproductive-Age Women (15-49) and Under-Five Children in Sudan. Nutrients 2021; 13:nu13082784. [PMID: 34444943 PMCID: PMC8399272 DOI: 10.3390/nu13082784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Micronutrient malnutrition is a form of undernutrition that causes diseases, and this is mainly due to insufficient intake of nutrients in daily foods. The status of micronutrients for people in Sudan remains scarce, and information is limited. The aim of this study is to highlight the status of micronutrients among women of reproductive age (15–49 years of age) and their children in Sudan. Methods: This manuscript is a quantitative descriptive study, based on the data from Sudan Micronutrient Survey (SMS); it is part of the second round of the Simple Spatial Survey Method (S3M II) in Sudan (a total of 93,882 households). Results: The level of consumption of vitamin A-rich foods was found to be moderate at 67.36% for reproductive-age women and low at 23.44% for under-five children. Similarly, consumption rate of vitamin B-rich foods among reproductive-age women was 62.13%, and low for children at 11.02%. The consumption of iron-, calcium-, and zinc-rich foods was moderate among women (66.75%, 47.69%, 69.72%, respectively) and very low in children (12.28%, 17.62%, 14.99%, respectively). The iron deficiency prevalence was 47% in non-pregnant women, 58% in pregnant women, and 54% in children. The prevalence of anemia was 30% in non-pregnant women, 37% in pregnant women, and 48% in children. Generally, urinary iodine concentration was inadequate in lactating and non-pregnant women as well as in pregnant women. Most indicators of micronutrients in Sudan for children and women of reproductive age were highly significant. Sudan needs more efforts to create an enabling environment through legislation, policies, and strategies to strengthen the nutrition-sensitive and specific interventions and improving status of micronutrients among women and children, focusing on food fortification, food supplements, and counseling on micronutrients intake for mothers during antenatal and postnatal services as well as raising community awareness.
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Yada TA, Dessie Y, Darghawth R, Wilfong T, Kure MA, Roba KT. Magnitude of Intestinal Parasitosis, Malnutrition, and Predictors of Anemia Among Nonpregnant Reproductive-Age Women Attending Healthcare Services in Olenchity General Hospital, Central Ethiopia. FRONTIERS IN TROPICAL DISEASES 2021. [DOI: 10.3389/fitd.2021.655690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BackgroundAnemia and malnutrition remain a public health challenge in developing worlds. Anemia during a nonpregnant state is one of the neglected medical conditions affecting reproductive-age women around the world. Globally, it is estimated that one-third of all reproductive-age women are anemic. Although it has negative consequences and extensive burden, anemia in nonreproductive-age women is rarely studied in Africa. In Ethiopia, studies investigating anemia and malnutrition among nonpregnant reproductive-age women are limited. Therefore, this study was aimed to assess intestinal parasitic infection, malnutrition, and predictors of anemia among nonpregnant reproductive-age women in Olenchity General Hospital, central Ethiopia.MethodsA facility-based cross-sectional study design was employed among 405 nonpregnant reproductive-age women in Olenchity General Hospital, central Ethiopia from February 14 to March 24, 2018. Data were collected using a pretested interviewer-administered questionnaire. Blood samples were collected and tested to determine hemoglobin levels by using a hematology analyzer machine. Collected data were entered into EpiData version 3.02 and exported to SPSS version 20 (IBM SPSS Statistics, 2012) for further analysis. Multivariable logistic regression analysis was done to identify factors independently associated with anemia after controlling for possible confounders. Statistical significance was declared at p-value <0.05.ResultOverall, the magnitude of anemia was found to be 47.4% [95% CI (42.7, 52.6)], of which 34.8% were mild, 11.4% were moderate, and 1.2% were severely anemic. The prevalence of intestinal parasitic infection, wasting, and overweight was 34.6%, 26.2%, and 8.1%, respectively. Having no formal education [AOR=2.25, CI (1.02, 4.97)], using three to five sanitary pads per day during menses [AOR=1.66 CI (1.02, 2.68)], history of chewing khat [AOR= 4.45, CI (1.18, 16.83)], being from households with mild food insecurity [AOR=3.41, CI (1.10, 10.58)], and intestinal parasitic infection [AOR=2.28, CI (1.39, 3.47)] were factors independently associated with anemia.ConclusionThe magnitude of anemia, malnutrition, and intestinal parasitic infection among nonpregnant reproductive-age women was found to be a considerable public health problem. Therefore, attention should be given to nonpregnant reproductive-age women visiting different healthcare services to reduce risks of anemia and malnutrition for possible future pregnancies and to ensure women’s health. Deworming of nonpregnant reproductive-age women is also very crucial to reduce the risks of anemia.
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Yuniati T, Judistiani RTD, Natalia YA, Irianti S, Madjid TH, Ghozali M, Sribudiani Y, Indrati AR, Abdulah R, Setiabudiawan B. First trimester maternal vitamin D, ferritin, hemoglobin level and their associations with neonatal birthweight: Result from cohort study on vitamin D status and its impact during pregnancy and childhood in Indonesia. J Neonatal Perinatal Med 2021; 13:63-69. [PMID: 31609704 DOI: 10.3233/npm-180043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Vitamin D deficiency and anemia are examples of nutritional problems of global health significance. When these health issues effect pregnant women, they may become a threat to the fetus' potention for intrauterine growth. It has been known that the first trimester is the golden period of fetal programming which influences the fetuses and their life after birth. This study was aiming to analyze the association between first trimester maternal vitamin D, serum ferritin, hemoglobin level and neonatal birth weight. METHODS From July 2016 a prospective cohort of pregnant women had been observed in four cities in West Java, Indonesia. Two hundred ninety four pregnant women were recuited in the first trimester and 203 of them had complete follow up until delivery. Collected data included maternal demography, blood analysis for ferritin, 25(OH) vitamin D in the first trimester of pregnancy and the birth weight of neonates. Associations were analyzed with multiple regression models. RESULTS Vitamin D deficiency was highly prevalent among pregnant women in this study (approximately 75%) while anemia was found in 7.5 %, a little above the target of 5 %. However, no significant association was found between maternal serum vitamin D, serum ferritin, hemoglobin level in the first trimester and birth weight of the neonates, before and after adjustment for maternal age, pre-pregnancy body mass index, and parity. CONCLUSION There were no associations found between vitamin D, ferritin, and hemoglobin level in the first trimester and neonatal birth weight. The negative results in this study should not diminish the benefit of nutritional supplementation during pregnancy. The possibility of other explanatory variables that influence these associations warrants further studies.
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Affiliation(s)
- T Yuniati
- Department of Child Health, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia /dr Hasan Sadikin Hospital, Bandung, Indonesia
| | - R T Dewi Judistiani
- Public Health Department-Centre for Immunology Studies, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia
| | - Y Adelwin Natalia
- Public Health Department-Centre for Immunology Studies, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia
| | - S Irianti
- Obstetric and Gynecology Department, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia/dr Hasan Sadikin Hospital, Bandung, Indonesia
| | - T Husnitawati Madjid
- Obstetric and Gynecology Department, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia/dr Hasan Sadikin Hospital, Bandung, Indonesia
| | - M Ghozali
- Department of Biomedical Sciences, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia
| | - Y Sribudiani
- Department of Biomedical Sciences, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia
| | - A Rengga Indrati
- Clinical Pathology Department, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia/dr Hasan Sadikin Hospital, Bandung, Indonesia
| | - R Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy Universitas Padjadjaran, Sumedang, Indonesia
| | - Budi Setiabudiawan
- Department of Child Health, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia /dr Hasan Sadikin Hospital, Bandung, Indonesia
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Predictors of anaemia among adolescent schoolchildren of Ghana. J Nutr Sci 2020; 9:e43. [PMID: 32983426 PMCID: PMC7503182 DOI: 10.1017/jns.2020.35] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023] Open
Abstract
Anaemia is a public health problem in Ghana. We sought to identify factors associated with haemoglobin concentration (Hb) and anaemia among school-attending adolescents. We analysed data from 2948 adolescent girls and 609 boys (10-19 years) selected from 115 schools from regions of Ghana as a secondary analysis of baseline surveys conducted at two time-points. We measured Hb, malaria from capillary blood, anthropometry and used a modified food frequency questionnaire to assess diet. Multivariable linear and Poisson regression models were used to identify predictors of Hb and anaemia. The prevalence of anaemia, malaria and geophagy were 24, 25, and 24 %, respectively, among girls and 13, 27 and 6 %, respectively, among boys. Girls engaging in geophagy had a 53 % higher adjusted prevalence of anaemia and 0⋅39 g/dl lower Hb. There were similar results among those who tested positive for malaria (+52 % anaemia; -0⋅42 g/dl Hb). Among girls, lower anaemia prevalence and higher Hb were associated with consumption of foods rich in haeme iron (-22 %; +0⋅18 g/dl), consumption of iron-fortified cereal/beverages consumed with citrus (-50 %; +0⋅37 g/dl) and being overweight (-22 %; +0⋅22 g/dl). Age was positively associated with anaemia among girls, but negatively associated among boys. Boys who tested positive for malaria had 0⋅31 g/dl lower Hb. Boys who were overweight or had obesity and consumed flour products were also more likely to be anaemic (119 and 56 %, respectively). Factors associated with Hb and anaemia may inform anaemia reduction interventions among school-going adolescents and suggest the need to tailor them uniquely for boys and girls.
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Prevalence and determinants of anemia among women of reproductive age in Thatta Pakistan: Findings from a cross-sectional study. PLoS One 2020; 15:e0239320. [PMID: 32970719 PMCID: PMC7514090 DOI: 10.1371/journal.pone.0239320] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/04/2020] [Indexed: 12/25/2022] Open
Abstract
Background Anemia is a major public health concern among women of reproductive age leading to high maternal mortality in low- and middle-income countries. Of the prior studies conducted in Pakistan, most focused on large urban areas and did not explore the determinants of anemia among women of reproductive age (WRA) across socio-demographic, dietary, reproductive, and biological domains. Thus, we aimed to study the prevalence and determinants of anemia among WRA in rural Pakistan. Methods We conducted a cross-sectional study in the Thatta district of Pakistan from September 2018 to January 2019 and enrolled 150 non-pregnant, married women. Data collectors administered a structured questionnaire to collect sociodemographic, reproductive and dietary data from women, who also provided stool and blood samples. We classified all WRA as anemic if their hemoglobin was <12.0 g/dl. We performed logistic regression analysis to calculate adjusted odds ratios (aOR) and their respective 95% CIs to assess the determinants of anemia. Results In our study, 61.3% of the enrolled women were anemic. In the multivariable analysis, we found that factors such as serum iron levels of less than 50 μg/dl (aOR: 7.17; 95% CI (2.94, 17.47)), history of breastfeeding (aOR: 2.43; 95% CI (1.04, 5.72)), living in a katcha house (aOR: 6.61; 95% CI (2.21, 19.87)), no consumption of meat (aOR: 4.18; 95% CI (1.66, 9.96)) were significantly associated with anemia among WRA. A history of more than one abortion (aOR: 0.06; 95% CI (0.01, 0.33) appeared protective for its association with anemia. Conclusion Our findings demonstrate a high burden of anemia and its complex determinants among WRA in rural Pakistan. A combination of nutritional and educational strategies should be designed to encourage rural women to consume iron-rich foods in their diet with an access to adequate food. Breastfeeding women should be encouraged to consume extra calories with sufficient intake of the food to continue exclusive breastfeeding and reserve the iron stores through amenorrhea to prevent themselves from becoming anemic.
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Sosa-Moreno A, Reinoso-González S, Mendez MA. Anemia in women of reproductive age in Ecuador: Data from a national survey. PLoS One 2020; 15:e0239585. [PMID: 32970743 PMCID: PMC7514054 DOI: 10.1371/journal.pone.0239585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 09/09/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Anemia is a condition characterized by a decline in the number of functional red blood cells or hemoglobin. Women of reproductive age from low- and middle-income countries are at higher risk of anemia, which could lead to prenatal, obstetric and perinatal complications. The aim of our study was to explore associations between anemia status and a set of demographic, socio-economic and reproductive factors, among Ecuadorian women of reproductive age (WRA). METHODS We used data from non-pregnant, WRA (≥12 and ≤49 years) women enrolled in the nationally representative cross-sectional Ecuadorian National Health and Nutrition Survey 2012 (ENSANUT-ECU 2012). Anemia and moderate-severe anemia were assessed using hemoglobin concentrations cutoffs of <12 g/dL and <11 g/dL, respectively. Logistic regression was used to obtain unadjusted and adjusted prevalence odds ratios (aOR). All analyzes were adjusted for multi-stage sampling, stratification and clustering. RESULTS The study population included a subset of 7415 non-pregnant WRA. Mean hemoglobin concentration was 12.84 g/dL (95% CI = 12.8-12.9). The overall prevalence of anemia and moderate-severe anemia was 16.8% and 5.0%, respectively. Some factors were associated with an increase in anemia prevalence odds: living in Guayaquil (aOR 1.82, 95% CI 1.16-2.84) and Quito (aOR 1.84, 95% CI 1.17-2.90) compared to living in the rural Amazon, having given birth to more than four alive children compared with being nulliparous (aOR 1.85, 95% CI 1.00-3.43), currently taking contraceptives compared with former use (aOR 1.46, 95% CI 1.09-1.97). In addition, moderate-severe anemia was associated with age and region of residence. CONCLUSION In 2012, the prevalence of anemia among Ecuadorian WRA was considered a mild public health concern. However, we identified groups with higher anemia prevalence. Thus, emphasizing the importance of analyzing the prevalence in sub-populations of WRA and identifying populations where more frequent surveillance may be helpful.
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Affiliation(s)
- Andrea Sosa-Moreno
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
| | - Sharon Reinoso-González
- Grupo de Química Computacional y Teórica, Departamento de Ingeniería Química, Colegio de Ciencias e Ingenierías, Politécnico, Universidad San Francisco de Quito, Quito, Ecuador
| | - Miguel Angel Mendez
- Grupo de Química Computacional y Teórica, Departamento de Ingeniería Química, Colegio de Ciencias e Ingenierías, Politécnico, Universidad San Francisco de Quito, Quito, Ecuador
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Cyriac S, Haardörfer R, Neufeld LM, Girard AW, Ramakrishnan U, Martorell R, Mbuya MNN. High Coverage and Low Utilization of the Double Fortified Salt Program in Uttar Pradesh, India: Implications for Program Implementation and Evaluation. Curr Dev Nutr 2020; 4:nzaa133. [PMID: 32885134 PMCID: PMC7455457 DOI: 10.1093/cdn/nzaa133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Double fortified salt (DFS) is efficacious in addressing iron deficiency, but evidence of its effectiveness is limited. The few published evaluations do not include details on program implementation, limiting their utility for programmatic decisions. OBJECTIVES We sought to characterize the coverage of a DFS program implemented through the Public Distribution System (PDS) in Uttar Pradesh, India, and understand the drivers of DFS adherence. METHODS After 8 mo of implementation, we surveyed 1202 households in 5 districts and collected data on sociodemographic characteristics, asset ownership, food security, and regular PDS utilization. We defined DFS program coverage as the proportion of PDS beneficiaries who had heard of and purchased DFS, and we defined DFS adherence as DFS use reported by households. We used principal component analysis to create an asset-based index of relative wealth, and we categorized households into higher/lower relative wealth quintiles. We conducted path analyses to examine the drivers of DFS adherence, particularly the mediated influence of household wealth on DFS adherence. The evaluation is registered with 3ie's Registry for International Development Impact Evaluations (RIDIE-STUDY-ID-58f6eeb45c050). RESULTS The DFS program had good coverage: 83% of respondents had heard of DFS and 74% had purchased it at least once. However, only 23% exclusively used DFS. Respondents had low awareness about DFS benefits and considered DFS quality as poor. Being in a lower household wealth quintile and being food insecure were significant drivers of DFS adherence, and regular PDS utilization acted as a mediator. Adherence was lower in urban areas. CONCLUSIONS We observed significant heterogeneity in DFS implementation as reflected by high coverage and low adherence. Findings from this process evaluation informed the design of an adaptive impact evaluation and provided generalizable insights for ensuring that the potential for impact is realized. Efforts are needed to increase awareness, improve product quality, as well as mitigate against the sensory challenges identified.
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Affiliation(s)
- Shruthi Cyriac
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
- Global Alliance for Improved Nutrition, Washington, DC, USA
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Amy Webb Girard
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Usha Ramakrishnan
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Reynaldo Martorell
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Fischer JA, Pei LX, Goldfarb DM, Albert A, Elango R, Kroeun H, Karakochuk CD. Is untargeted iron supplementation harmful when iron deficiency is not the major cause of anaemia? Study protocol for a double-blind, randomised controlled trial among non-pregnant Cambodian women. BMJ Open 2020; 10:e037232. [PMID: 32801202 PMCID: PMC7430471 DOI: 10.1136/bmjopen-2020-037232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The WHO recommends daily oral iron supplementation for 12 weeks in women and adolescents where anaemia prevalence is greater than 40%. However, if iron deficiency is not a major cause of anaemia, then, at best, untargeted iron supplementation is a waste of resources; at worst, it could cause harm. Further, different forms of iron with varying bioavailability may present greater risks of harm. METHODS AND ANALYSIS A 12-week three-arm, double-blind, randomised controlled supplementation trial was conducted in Cambodia to determine if there is potential harm associated with untargeted iron supplementation. We will recruit and randomise 480 non-pregnant women (ages 18-45 years) to receive one of three interventions: 60 mg elemental iron as ferrous sulfate (the standard, commonly used form), 18 mg ferrous bisglycinate (a highly bioavailable iron amino acid chelate) or placebo. We will measure ferritin concentrations (to evaluate non-inferiority between the two forms of iron), as well as markers of potential harm in blood and stool (faecal calprotectin, gut pathogen abundance and DNA damage) at baseline and 12 weeks. Mixed-effects generalised linear models will be used to assess the effect of iron on ferritin concentration and markers of potential harm at 12 weeks. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of British Columbia Clinical Research Ethics Board (H18-02610), the Children's and Women's Health Centre of British Columbia Research Ethics Board (H18-02610) and the National Ethics Committee for Health Research in Cambodia (273-NECHR). Findings will be published in peer-reviewed journals, presented to stakeholders and policymakers globally and shared within participants' communities. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04017598).
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Affiliation(s)
- Jordie Aj Fischer
- Department of Food, Nutrition and Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Healthy Starts, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Lulu X Pei
- Department of Food, Nutrition and Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Healthy Starts, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - David M Goldfarb
- Healthy Starts, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arianne Albert
- Department of Biostatistics, Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Rajavel Elango
- Healthy Starts, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Hou Kroeun
- Helen Keller International Cambodia, Phnom Penh, British Columbia, Cambodia
| | - Crystal D Karakochuk
- Department of Food, Nutrition and Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Healthy Starts, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
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14
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Prevalence and Associated Factors of Anemia among Reproductive-Aged Women in Sayint Adjibar Town, Northeast Ethiopia: Community-Based Cross-Sectional Study. Anemia 2020; 2020:8683946. [PMID: 32832149 PMCID: PMC7429757 DOI: 10.1155/2020/8683946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 06/21/2020] [Accepted: 07/06/2020] [Indexed: 11/17/2022] Open
Abstract
Background Globally, anemia affects one-fourth of the world population including 30% of nonpregnant reproductive-aged women. It has a number of causes including micronutrient deficiencies and chronic infections, inherited or acquired disorders of hemoglobin synthesis and red blood cell production, or survival alterations. The aim of this study was to assess the prevalence and associated factors of anemia among reproductive-aged women in Sayint Adjibar town, South Wollo Zone, Northeast Ethiopia. Methods A community-based cross-sectional study was conducted from February to April among 359 reproductive-aged women (RAW). Systematic random sampling technique was implemented to select study participants. Sociodemographic, socioeconomic, and reproductive histories of study participants were collected using the structured and pretested questionnaire. Capillary blood and stool samples were collected from each study participant for hemoglobin and parasitological analysis, respectively. Data were entered into Epi Info version 7 and transferred to SPSS version 20 for analysis. Both bivariable and multivariable binary logistic regression models were fitted to identify associated factors of anemia. p value <0.05 was considered as statistically significant. Result The median age of the study participants was 25 years. The overall prevalence of anemia was 24.2%. Among those anemic individuals, 49 (56.3%) were mildly anemic. Age category 36–49 years (AOR = 2.64; 95% CI: 1.05, 6.60), no formal educational status (AOR = 2.28; 95% CI: 1.06, 4.92), food insecurity (AOR = 1.92; 95% CI: 1.01–3.65), and body mass index of above 25 kg/m2 (AOR = 0.27; 95% CI: 0.08–0.87) were found to be statistically significant with anemia. Conclusion The prevalence of anemia in this study was found as a moderate public health problem. The prevalence was significantly associated with women who had no formal education and were of older age group and those women living with household food insecurity and with higher body mass index. Therefore, it is better to design appropriate interventional strategies to reduce reproductive-aged women anemia. These include information, education, and communication activities focused on reproductive-aged women with no formal education and life-cycle-focused food security rather than targeted to only infants and young children or pregnant women.
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15
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Anemia in patients with Takayasu arteritis: prevalence, clinical features, and treatment. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2019; 16:689-694. [PMID: 31645854 PMCID: PMC6790956 DOI: 10.11909/j.issn.1671-5411.2019.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Anemia is a common comorbidity of patients with Takayasu arteritis (TA). This study evaluated the prevalence, clinical characteristics, and treatment in Chinese TA patients with anemia. Methods This retrospective study included 533 consecutive patients hospitalized for TA from January 2009 to April 2018. Anemia was diagnosed on the basis of hemoglobin level, according to World Health Organization criteria. Results A total of 194 patients (36.4%) were diagnosed with anemia. Most had mild anemia (177, 91.2%). Female patients were predominant (92.8% of anemic patients). Normocytic anemia (62.9%) was the most common pattern. Anemic patients were more likely than non-anemic patients to have dizziness (29.4% vs. 21.2%), low body mass index (22.0 ± 3.6 vs. 22.9 ± 3.4 kg/m2), and active disease stage (64.9% vs. 50.1%); pulmonary involvement (12.4% vs. 26.8%), pulmonary hypertension (12.9% vs. 20.1%) and pulmonary hypertensive-target drugs (2.8% vs. 11.6%) were less common among anemic than non-anemic patients (all P < 0.05). Larger left ventricular end-diastolic diameter and lower left ventricular ejection fraction were observed in anemic patients. Over a median follow-up of four months, the increase of hemoglobin in anemic patients was associated with the use of iron supplementation. Conclusions Anemia is a very common concurrent condition in TA, especially in young, female patients. Patients with anemia are more likely to be in the active disease stage. Iron supplementation helps increase hemoglobin.
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Wendt AS, Waid JL, Gabrysch S. Dietary Factors Moderate the Relation between Groundwater Iron and Anemia in Women and Children in Rural Bangladesh. Curr Dev Nutr 2019; 3:nzz093. [PMID: 31620671 PMCID: PMC6785699 DOI: 10.1093/cdn/nzz093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/30/2019] [Accepted: 08/05/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Anemia affects ∼1.6 billion people worldwide, often owing to iron deficiency. In Bangladesh, high levels of anemia have been observed alongside little iron deficiency. Elevated concentrations of groundwater iron could constitute a significant source of dietary iron. OBJECTIVE We aimed to quantify the effect of groundwater iron on anemia in nonpregnant women and young children in Bangladesh, taking into account dietary factors that may affect iron absorption. METHODS We analyzed data on 1871 nonpregnant women and 987 children (6-37 mo) from the 2015 baseline survey of the Food and Agricultural Approaches to Reducing Malnutrition cluster-randomized trial in Sylhet, Bangladesh. We used logistic regression with robust standard errors to assess effects of self-reported groundwater iron, dietary intake, and sociodemographic characteristics on anemia, considering interactions between groundwater iron and dietary factors. RESULTS Groundwater iron presence was associated with less anemia in women (OR: 0.74; 95% CI: 0.60, 0.90) and children (OR: 0.58; 95% CI: 0.44, 0.76). This effect was modified by dietary factors. In women, the effect of groundwater iron on anemia was stronger if no vitamin C-rich or heme-iron foods were consumed, and there was a clear dose-response relation. In children, intake of vitamin C-rich foods strengthened the effect of groundwater iron on anemia, and there was no evidence for interaction by intake of iron-rich foods. CONCLUSIONS Heme-iron and vitamin C consumption reduced the effect of groundwater iron on anemia among women but not children in Bangladesh, which may be due to higher levels of iron deficiency and lower levels of iron intake among children. Vitamin C consumption appears to enhance iron absorption from groundwater in children and they may thus benefit from consuming more vitamin C-rich fruits and vegetables. Even among women and children consuming heme-iron or vitamin C-rich foods and groundwater iron, anemia prevalence remained elevated, pointing to additional causes of anemia beyond iron deficiency.This trial was registered at clinicaltrials.gov as NCT02505711.
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Affiliation(s)
- Amanda S Wendt
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Research Department 2, Potsdam Institute for Climate Impact Research, Potsdam, Germany
| | - Jillian L Waid
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Research Department 2, Potsdam Institute for Climate Impact Research, Potsdam, Germany
- Helen Keller International, Dhaka, Bangladesh
| | - Sabine Gabrysch
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Research Department 2, Potsdam Institute for Climate Impact Research, Potsdam, Germany
- Heidelberg Center for the Environment, Heidelberg, Germany
- Institute of Public Health, Charité—Universitätsmedizin Berlin, Berlin, Germany
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Williams AM, Addo OY, Grosse SD, Kassebaum NJ, Rankin Z, Ballesteros KE, Olsen HE, Sharma AJ, Jefferds ME, Mei Z. Data needed to respond appropriately to anemia when it is a public health problem. Ann N Y Acad Sci 2019; 1450:268-280. [PMID: 31267542 DOI: 10.1111/nyas.14175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/20/2019] [Accepted: 05/31/2019] [Indexed: 12/17/2022]
Abstract
Although the proportion of anemia amenable to change varies by population, the World Health Organization (WHO) criteria used to describe the public health severity of anemia are based on population prevalences. We describe the importance of measuring iron and other etiologic indicators to better understand what proportion of anemia could be responsive to interventions. We discuss the necessity of measuring inflammation to interpret iron biomarkers and documenting anemia of inflammation. Finally, we suggest assessing nonmodifiable genetic blood disorders associated with anemia. Using aggregated results from the Global Burden of Disease 2016, we compare population prevalence of anemia with years lived with disability (YLD) estimates, and the relative contributions of mild, moderate, and severe anemia to YLD. Anemia prevalences correlated with YLD and the relative proportion of moderate or severe anemia increased with anemia prevalence. However, individual-level survey data revealed irregular patterns between anemia prevalence, the prevalence of moderate or severe anemia, and the prevalence of iron deficiency anemia (IDA). We conclude that although the WHO population prevalence criteria used to describe the public health severity of anemia are important for policymaking, etiologic-specific metrics that take into account IDA and other causes will be necessary for effective anemia control policies.
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Affiliation(s)
- Anne M Williams
- McKing Consulting Corporation, Atlanta, Georgia.,Department of Global Health, Emory University, Atlanta, Georgia.,Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - O Yaw Addo
- Department of Global Health, Emory University, Atlanta, Georgia.,Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Nicholas J Kassebaum
- The Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington.,Seattle Children's Hospital, Seattle, Washington
| | - Zane Rankin
- The Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Katherine E Ballesteros
- The Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | | | - Andrea J Sharma
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.,The U.S. Public Health Service Commissioned Corps, Atlanta, Georgia
| | - Maria Elena Jefferds
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Zuguo Mei
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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18
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Debaveye S, Gonzalez Torres CV, De Smedt D, Heirman B, Kavanagh S, Dewulf J. The public health benefit and burden of mass drug administration programs in Vietnamese schoolchildren: Impact of mebendazole. PLoS Negl Trop Dis 2018; 12:e0006954. [PMID: 30419030 PMCID: PMC6258429 DOI: 10.1371/journal.pntd.0006954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 11/26/2018] [Accepted: 10/29/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Mass anthelmintic drug administration is recommended in developing countries to address infection by soil-transmitted helminthiases (STH). We quantified the public health benefit of treatment with mebendazole in eight million Vietnamese children aged 5-14 years from 2006 to 2011. This was compared to the environmental impact of the pharmaceutical supply chain of mebendazole, as the resource use and emissions associated with pharmaceutical production can be associated with a public health burden, e.g. through emissions of fine particulate matter. METHODOLOGY Through Markov modelling the disability due to STH was quantified for hookworm, Ascaris lumbricoides and Trichuris trichiura. For each worm type, four levels of intensity of infection were included: none, light, medium and heavy. The treatment effect on patients was quantified in Disability-Adjusted Life Years (DALYs). The public health burden induced by the pharmaceutical supply chain of mebendazole was quantified in DALYs through Life Cycle Assessment. PRINCIPAL FINDINGS Compared to 'no treatment', the modelled results of five-year treatment averted 116,587 DALYs (68% reduction) for the three worms combined and largely driven by A. lumbricoides. The main change in DALYs occurred in the first year of treatment, after which the results stabilized. The public health burden associated with the pharmaceutical supply chain was 6 DALYs. CONCLUSIONS The public health benefit of the Mass Drug Administration (MDA) averted substantially more DALYs than those induced by the pharmaceutical supply chain. These results were verified in a sensitivity analysis. The starting prevalence for each worm was the most sensitive model parameter. This methodology is useful for policymakers interested in a holistic approach towards the public health performance of MDA programs, enveloping both the treatment benefit received by the patient and the public health burden associated with the resource consumption and environmental emissions of the pharmaceutical production and supply chain.
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Affiliation(s)
- Sam Debaveye
- Department of Green Chemistry and Technology, Ghent University, Campus Coupure, Ghent, Belgium
| | | | - Delphine De Smedt
- Department of Public Health, Ghent University, Campus UZ, Ghent, Belgium
| | - Bert Heirman
- Johnson & Johnson EHS&S, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Shane Kavanagh
- Health Economics, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Jo Dewulf
- Department of Green Chemistry and Technology, Ghent University, Campus Coupure, Ghent, Belgium
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19
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Kang E, Lee J, Kim HJ, Han M, Kim SW, Lee KB, Sung S, Yoo TH, Chung W, Ahn C, Oh KH. The association between socioeconomic disparities and left ventricular hypertrophy in chronic kidney disease: results from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD). BMC Nephrol 2018; 19:203. [PMID: 30115015 PMCID: PMC6097450 DOI: 10.1186/s12882-018-1005-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 08/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Left ventricular hypertrophy (LVH) is one of the risk factors for cardiovascular (CV) disease and mortality. However, the relationship between socioeconomic status (SES) and LVH in chronic kidney disease remains unclear. Methods Data were collected from the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD, NCT01630486 at http://www.clinicaltrials.gov). Subjects with CKD and aged ≥50 were included. SES was characterized based on monthly income and educational attainment, each of which was divided into three strata. LVH was defined as LV mass/height2.7 ≥ 47 g/m2.7 in female and ≥ 50 g/m2.7 in male. Age, sex, diabetes, CKD stage, body mass index, blood pressure and physical activity were included as covariates. Results A total of 1361 patients were included. Mean age was 60.9 ± 6.9 years, and 63.2% were men. Higher education level was associated with higher monthly income (P for trend < 0.001). The lowest education level was independently associated with LVH (lower than high school, adjusted odds ratio [OR] 1.485, 95% CI 1.069–2.063, P = 0.018; completed high school, adjusted OR 1.150, 95% confidence interval [CI] 0.834–1.584, P = 0.394; highest education level as the reference). Monthly income level was marginally associated with LVH after adjusting for covariates ($1500-4500, adjusted OR 1.230, 95% CI 0.866–1.748, P = 0.247; < $1500, adjusted OR 1.471, 95% CI 1.002–2.158, P = 0.049; > $4500; reference). Conclusions In the CKD population, lower SES, defined by educational attainment and low income level exhibited a significant association with LVH, respectively. Longitudinal follow-up will reveal whether lower SES is associated with poor CKD outcomes.
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Affiliation(s)
- Eunjeong Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Joongyub Lee
- School of Medicine, Inha University, Incheon, Korea.,Department of Prevention and Management, Inha University Hospital, Incheon, Korea
| | - Hyo Jin Kim
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Miyeun Han
- Department of Internal Medicine, Pusan National University Hospital, Pusan, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kyu-Beck Lee
- Division of Nephrology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suah Sung
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Wookyung Chung
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Abstract
OBJECTIVE Increasing evidence has suggested an association between food insecurity and the risk of anaemia. Therefore, a systematic review and meta-analysis were performed to examine the associations between food insecurity and anaemia risk. SETTING Pertinent studies were identified by searching PubMed and EMBASE databases up to August 2017. Data were available from nineteen studies; seventeen studies were cross-sectional and two studies were longitudinal. Risk ratios of 95993 individual participants from twelve different countries in these studies were pooled for the meta-analysis. RESULTS The results showed that there was an overall positive relationship between food insecurity and anaemia risk (OR=1·27; 95 % CI 1·13, 1·40). Similar results were observed for Fe-deficiency anaemia (OR=1·45; 95 % CI 1·04, 1·86). These results revealed that food insecurity at two levels, including mild food insecurity (OR=1·15; 95 % CI 1·00, 1·31) and moderate food insecurity (OR=1·36; 95 % CI 1·23, 1·48), increased the risk of anaemia. In addition, it was found that age had an impact on the associations between food insecurity and anaemia risk (OR=1·22; 95 % CI 1·09, 1·36). Age subgroup analysis indicated that food insecurity significantly increased the risk of anaemia among infants/toddlers (OR=1·17; 95 % CI 1·05, 1·29) and adult women (OR=1·35; 95 % CI 1·16, 1·54). CONCLUSIONS It seems that infants, toddlers and adult women in food-insecure households are at a higher risk of anaemia. To prevent anaemia in food-insecure households, these age groups may require more nutritional support.
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Smith MR, Golden CD, Myers SS. Potential rise in iron deficiency due to future anthropogenic carbon dioxide emissions. GEOHEALTH 2017; 1:248-257. [PMID: 32158990 PMCID: PMC7007116 DOI: 10.1002/2016gh000018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 05/01/2017] [Accepted: 05/05/2017] [Indexed: 05/19/2023]
Abstract
Iron deficiency reduces capacity for physical activity, lowers IQ, and increases maternal and child mortality, impacting roughly a billion people worldwide. Recent studies have shown that certain highly consumed crops-C3 grains (e.g., wheat, rice, and barley), legumes, and maize-have lower iron concentrations of 4-10% when grown under increased atmospheric CO2 concentrations (550 ppm). We examined diets in 152 countries globally (95.5% of the population) to estimate the percentage of lost dietary iron resulting from anthropogenic CO2 emissions between now and 2050, specifically among vulnerable age-sex groups: children (1-5 years) and women of childbearing age (15-49 years), holding diets constant. We also cross-referenced these with the current prevalence of anemia to identify most at-risk countries. We found that 1.4 billion children aged 1-5 and women of childbearing age (59% of global total for these groups) live in high-risk countries, where the prevalence of anemia exceeds 20% and modeled loss in dietary iron would be in the most severe tertile (>3.8%). The countries with the highest anemia prevalence also derive their iron from the fewest number of foods, even after excluding countries consuming large amounts of unaccounted wild-harvest foods. The potential risk of increased iron deficiency adds greater incentive for mitigating anthropogenic CO2 emissions and highlights the need to address anticipated health impacts via improved health delivery systems, dietary behavioral changes, or agricultural innovation. Because these are effects on content rather than yield, it is unlikely that consumers will perceive this health threat and adapt to it without education.
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Affiliation(s)
- M. R. Smith
- Exposure, Epidemiology and Risk Program, Department of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - C. D. Golden
- Exposure, Epidemiology and Risk Program, Department of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Harvard University Center for the EnvironmentCambridgeMassachusettsUSA
| | - S. S. Myers
- Exposure, Epidemiology and Risk Program, Department of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Harvard University Center for the EnvironmentCambridgeMassachusettsUSA
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Haile ZT, Kingori C, Teweldeberhan AK, Chavan B. The relationship between history of hormonal contraceptive use and iron status among women in Tanzania: A population-based study. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 13:97-102. [PMID: 28844365 DOI: 10.1016/j.srhc.2017.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 06/29/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Approximately 30% of the Tanzanian women in the reproductive age group are iron deficient. At population-level, there is a dearth of research on the relationship between hormonal contraceptive use and iron deficiency. The study objective was to examine the relationship between history of hormonal contraceptive use and iron status among women in Tanzania. STUDY DESIGN We conducted a cross-sectional study analysis including 4186 women who participated in the population-based 2010 Tanzania Demographic and Health Survey. MAIN OUTCOME MEASURE Iron status determined by iron deficiency, anemia, and iron deficiency anemia. RESULTS Almost 19.0% women reported history of hormonal contraceptive use. Nearly, 30.0%, 39.5%, and 14.3% women had iron deficiency, anemia and iron deficiency anemia respectively. History of hormonal contraceptive use was negatively associated with iron deficiency, anemia and iron deficiency anemia, independent of potential confounders. Compared to non-users, the multivariable-adjusted odds ratio OR (95% CI) among hormonal contraceptive users was 0.73 (0.56-0.94, p<0.05) for iron deficiency, 0.58 (0.46-0.72, p<0.001) for anemia, and 0.53 (0.37-0.74; p<0.001) for iron deficiency anemia. Longer duration of hormonal contraceptive use (>2years) had lesser odds of iron deficiency 0.63 (0.43-0.91, p for trend 0.005), anemia 0.51 (0.36-0.73, p for trend <0.001) and iron deficiency anemia 0.35 (0.19-0.65, p for trend <0.001). CONCLUSION Our finding has important implications for educating healthcare providers and women about additional nutritional benefits of the use of hormonal contraceptives.
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Affiliation(s)
- Zelalem T Haile
- Ohio University Heritage College of Osteopathic Medicine, Department of Social Medicine, 6775 Bobcat Way, Room-450, Dublin, OH 43016, USA.
| | - Caroline Kingori
- Department of Social and Public Health, Grover Center W347, Ohio University, Athens OH 45701, USA.
| | - Asli K Teweldeberhan
- College of Health Sciences and Profession, Grover Center W379, Ohio University, Athens, OH 45701, USA.
| | - Bhakti Chavan
- Ohio University Heritage College of Osteopathic Medicine, Department of Social Medicine, 6775 Bobcat Way, Room-454, Dublin, OH 43016, USA.
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Karakochuk CD, Barker MK, Whitfield KC, Barr SI, Vercauteren SM, Devlin AM, Hutcheon JA, Houghton LA, Prak S, Hou K, Chai TL, Stormer A, Ly S, Devenish R, Oberkanins C, Pühringer H, Harding KB, De-Regil LM, Kraemer K, Green TJ. The effect of oral iron with or without multiple micronutrients on hemoglobin concentration and hemoglobin response among nonpregnant Cambodian women of reproductive age: a 2 x 2 factorial, double-blind, randomized controlled supplementation trial. Am J Clin Nutr 2017; 106:233-244. [PMID: 28490515 DOI: 10.3945/ajcn.116.140996] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 04/10/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Despite a high prevalence of anemia among nonpregnant Cambodian women, current reports suggest that iron deficiency (ID) prevalence is low. If true, iron supplementation will not be an effective anemia reduction strategy.Objective: We measured the effect of daily oral iron with or without multiple micronutrients (MMNs) on hemoglobin concentration in nonpregnant Cambodian women screened as anemic.Design: In this 2 × 2 factorial, double-blind, randomized trial, nonpregnant women (aged 18-45 y) with hemoglobin concentrations ≤117 g/L (capillary blood) were recruited from 26 villages in Kampong Chhnang province and randomly assigned to receive 12 wk of iron (60 mg; Fe group), MMNs (14 other micronutrients; MMN group), iron plus MMNs (Fe+MMN group), or placebo capsules. A 2 × 2 factorial intention-to-treat analysis with the use of a generalized mixed-effects model was used to assess the effects of iron and MMNs and the interaction between these factors. Results: In July 2015, 809 women were recruited and 760 (94%) completed the trial. Baseline anemia prevalence was 58% (venous blood). Mean (95% CI) hemoglobin concentrations at 12 wk in the Fe, MMN, Fe+MMN, and placebo groups were 121 (120, 121), 116 (116, 117), 123 (122, 123), and 116 (116, 117) g/L, with no iron × MMN interaction (P = 0.66). Mean (95% CI) increases in hemoglobin were 5.6 g/L (3.8, 7.4 g/L) (P < 0.001) among women who received iron (n = 407) and 1.2 g/L (-0.6, 3.0 g/L) (P = 0.18) among women who received MMNs (n = 407). The predicted proportions (95% CIs) of women with a hemoglobin response (≥10 g/L at 12 wk) were 19% (14%, 24%), 9% (5%, 12%), 30% (24%, 35%), and 5% (2%, 9%) in the Fe, MMN, Fe+MMN, and placebo groups, respectively.Conclusions: Daily iron supplementation for 12 wk increased hemoglobin in nonpregnant Cambodian women; however, MMNs did not confer additional significant benefit. Overall, ∼24% of women who received iron responded after 12 wk; even fewer would be likely to respond in the wider population. This trial was registered at clinicaltrials.gov as NCT02481375.
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Affiliation(s)
- Crystal D Karakochuk
- Food, Nutrition, and Health and Departments of.,British Columbia Children's Hospital Research Institute, Vancouver, Canada
| | - Mikaela K Barker
- Food, Nutrition, and Health and Departments of.,British Columbia Children's Hospital Research Institute, Vancouver, Canada
| | | | | | - Suzanne M Vercauteren
- British Columbia Children's Hospital Research Institute, Vancouver, Canada.,Division of Hematopathology, Children's and Women's Health Centre of British Columbia, Vancouver, Canada
| | - Angela M Devlin
- Pediatrics and.,British Columbia Children's Hospital Research Institute, Vancouver, Canada
| | - Jennifer A Hutcheon
- Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada.,British Columbia Children's Hospital Research Institute, Vancouver, Canada
| | - Lisa A Houghton
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Sophonneary Prak
- National Maternal and Child Health Center, Cambodian Ministry of Health, Phnom Penh, Cambodia
| | - Kroeun Hou
- Helen Keller International, Phnom Penh, Cambodia
| | - Tze Lin Chai
- Helen Keller International, Phnom Penh, Cambodia
| | - Ame Stormer
- Helen Keller International, Phnom Penh, Cambodia
| | - Sokhoing Ly
- Helen Keller International, Phnom Penh, Cambodia
| | - Robyn Devenish
- Laboratory Department, National Pediatric Hospital, Phnom Penh, Cambodia
| | | | | | | | | | - Klaus Kraemer
- Sight and Life Foundation, Basel, Switzerland.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Tim J Green
- Discipline of Paediatrics, University of Adelaide, Adelaide, Australia; and .,Healthy Mothers, Babies, and Children's Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
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Michalski ES, Nguyen PH, Gonzalez-Casanova I, Nguyen SV, Martorell R, Tangpricha V, Ramakrishnan U. Serum 25-hydroxyvitamin D but not dietary vitamin D intake is associated with hemoglobin in women of reproductive age in rural northern Vietnam. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2017; 8:41-48. [PMID: 29067258 PMCID: PMC5651337 DOI: 10.1016/j.jcte.2017.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/02/2017] [Accepted: 05/02/2017] [Indexed: 02/06/2023]
Abstract
Background and objectives Hypovitaminosis D and anemia are both prevalent in Vietnam, and low vitamin D status may be a risk factor for anemia. This study aimed to 1) describe vitamin D intake and its determinants, and 2) examine the associations of vitamin D intake and serum 25(OH)D concentrations with hemoglobin and anemia. Methods and study design We used data from the baseline survey of a pre-conceptual micronutrient supplementation trial in women of reproductive age (WRA) in Thai Nguyen, Vietnam (N = 4961). Vitamin D intake was estimated using a semi-quantitative food frequency questionnaire (FFQ). Multivariable regression models were used for the analyses. Results Median vitamin D intake was 0.2 µg/d (8.0 IU) [IQR: 0.4]. Age, being a farmer, food insecurity, and body mass index (BMI) were inversely associated with vitamin D intake, while socioeconomic status (SES), total energy intake, and education were positively associated with vitamin D intake. Vitamin D intake was not associated with hemoglobin concentration or anemia after adjusting for age, BMI, total energy intake, transferrin receptor, C-reactive protein, α1-acid glycoprotein, SES, occupation, education, ethnicity, and food insecurity (P = 0.56 and P = 0.65 for hemoglobin and anemia, respectively). Controlling for the same covariates, 25(OH)D <50 nmol/L (vs. ≥50 nmol/L) was associated with decreased hemoglobin concentrations (β = −0.91 (SE:0.42), P = 0.03), but not with anemia (P = 0.11). Conclusions Low vitamin D status may be linked to reduced hemoglobin concentrations, but the role of diet in this association was not evident in this population of WRA in Vietnam where dietary vitamin D intake was very low.
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Key Words
- 25(OH)D, 25-hydroxyvitamin D
- AGP, α1-acid glycoprotein
- AMDR, acceptable macronutrient distribution range
- Anemia
- CRP, C-reactive protein
- Dietary intake
- EAR, estimated average requirement
- Hemoglobin
- IOM, Institute of Medicine
- IQR, interquartile range
- RBP, retinol binding protein
- SD, standard deviation
- SE, standard error
- SES, socioeconomic status
- Vietnam
- Vitamin D
- WHO, World Health Organization
- WRA, women of reproductive age
- sTfR, soluble transferrin receptor
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Affiliation(s)
- Ellen S Michalski
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA 30322, USA
| | - Phuong H Nguyen
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Viet Nam.,International Food Policy Research Institute, Washington, DC 20006, USA
| | | | - Son V Nguyen
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Viet Nam
| | - Reynaldo Martorell
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA 30322, USA.,Hubert Department of Global Health, Emory University, Atlanta GA 30322, USA
| | - Vin Tangpricha
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA 30322, USA.,Division of Endocrinology, Metabolism & Lipids, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Usha Ramakrishnan
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA 30322, USA.,Hubert Department of Global Health, Emory University, Atlanta GA 30322, USA
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Saydam BK, Genc RE, Sarac F, Turfan EC. Prevalence of anemia and related factors among women in Turkey. Pak J Med Sci 2017; 33:433-438. [PMID: 28523051 PMCID: PMC5432718 DOI: 10.12669/pjms.332.11771] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine the prevalence of anemia and related factors among women in Turkey. Methods: This descriptive study was conducted at the outpatient clinics of the Department of Internal Medicine, Ege University Medical School. Randomly selected women were given questionnaires regarding their socio-demographic and obstetric characteristics. The data were coded and analyzed using SPSS version 17.0 software. Statistical analyses with 95% confidence intervals were considered to be significant if p<0.05. Results: The study results showed an anemia prevalence of 27.8% in the study sample. Among all anemia diagnoses among the participants, 56.0% were determined to have iron deficiency, 37.1% iron-deficiency anemia, and 6.9% severe anemia. It was observed that anemia was detected among women who were 15-49 years of age (p<0.05), menstruating (p<0.05), had a history of Cesarean section (p<0.05), and had not entered menopause (p<0.05). Based on forward-stepwise-logistic regression analysis, the most important parameter was concluded to be age group, which was followed by menopausal status. Conclusions: The study results suggest that the anemia prevalence rate is specifically higher among women of reproductive age. To prevent anemia at a low cost, it is recommended to provide women with relevant information and well-planned interactive educational programs.
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Affiliation(s)
- Birsen Karaca Saydam
- Dr. Birsen Karaca Saydam, BKS. Ege University Faculty of Health Sciences, 35100 Bornova, Izmir, Turkey
| | - Rabia Ekti Genc
- Dr. Rabia Ekti Genc, REG. Ege University Faculty of Health Sciences, 35100 Bornova, Izmir, Turkey
| | - Fulden Sarac
- Prof. Dr. Fulden Sarac, FS. Department of Internal Medicine, Ege University Medical School, 35100 Bornova, Izmir, Turkey
| | - Esin Ceber Turfan
- Prof. Dr. Esin Ceber Turfan, ECT. Ege University Faculty of Health Sciences, 35100 Bornova, Izmir, Turkey
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Prevalence of anaemia, deficiencies of iron and vitamin A and their determinants in rural women and young children: a cross-sectional study in Kalalé district of northern Benin. Public Health Nutr 2017; 20:1203-1213. [PMID: 28120735 DOI: 10.1017/s1368980016003608] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To identify the magnitude of anaemia and deficiencies of Fe (ID) and vitamin A (VAD) and their associated factors among rural women and children. DESIGN Cross-sectional, comprising a household, health and nutrition survey and determination of Hb, biochemical (serum concentrations of ferritin, retinol, C-reactive protein and α1-acid glycoprotein) and anthropometric parameters. Multivariate logistic regression examined associations of various factors with anaemia and micronutrient deficiencies. SETTING Kalalé district, northern Benin. SUBJECTS Mother-child pairs (n 767): non-pregnant women of reproductive age (15-49 years) and children 6-59 months old. RESULTS In women, the overall prevalence of anaemia, ID, Fe-deficiency anaemia (IDA) and VAD was 47·7, 18·3, 11·3 and 17·7 %, respectively. A similar pattern for anaemia (82·4 %), ID (23·6 %) and IDA (21·2 %) was observed among children, while VAD was greater at 33·6 %. Greater risk of anaemia, ID and VAD was found for low maternal education, maternal farming activity, maternal health status, low food diversity, lack of fruits and vegetables consumption, low protein foods consumption, high infection, anthropometric deficits, large family size, poor sanitary conditions and low socio-economic status. Strong differences were also observed by ethnicity, women's group participation and source of information. Finally, age had a significant effect in children, with those aged 6-23 months having the highest risk for anaemia and those aged 12-23 months at risk for ID and IDA. CONCLUSIONS Anaemia, ID and VAD were high among rural women and their children in northern Benin, although ID accounted for a small proportion of anaemia. Multicentre studies in various parts of the country are needed to substantiate the present results, so that appropriate and beneficial strategies for micronutrient supplementation and interventions to improve food diversity and quality can be planned.
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Impact of Preconception Micronutrient Supplementation on Anemia and Iron Status during Pregnancy and Postpartum: A Randomized Controlled Trial in Rural Vietnam. PLoS One 2016; 11:e0167416. [PMID: 27918586 PMCID: PMC5137891 DOI: 10.1371/journal.pone.0167416] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/05/2016] [Indexed: 11/22/2022] Open
Abstract
Objective Preconception micronutrient interventions may be a promising approach to reduce anemia and iron deficiency during pregnancy, but currently we have limited data to inform policies. We evaluated whether providing additional pre-pregnancy weekly iron-folic acid (IFA) or multiple micronutrient (MM) supplements compared to only folic acid (FA) improves iron status and anemia during pregnancy and early postpartum. Methods We conducted a double blind randomized controlled trial in which 5011 Vietnamese women were provided with weekly supplements containing either only 2800 μg FA (control group), IFA (60 mg Fe and 2800 μg FA) or MM (15 micronutrients with similar amounts of IFA). All women who became pregnant (n = 1813) in each of the 3 groups received daily IFA (60 mg Fe and 400 μg FA) through delivery. Hematological indicators were assessed at baseline (pre-pregnancy), during pregnancy, 3 months post-partum, and in cord blood. Adjusted generalized linear models were applied to examine the impact of preconception supplementation on anemia and iron stores, using both intention to treat and per protocol analyses (women consumed supplements ≥ 26 weeks before conception). Results At baseline, 20% of women were anemic, but only 14% had low iron stores (ferritin <30 μg/L) and 3% had iron deficiency (ferritin <12 μg/L). The groups were balanced for baseline characteristics. Anemia prevalence increased during pregnancy and post-partum but was similar among intervention groups. In intention to treat analyses, prenatal ferritin was significantly higher among women receiving MM (geometric mean (μg/L) [95% CI]: 93.6 [89.3–98.2]) and IFA (91.9 [87.6–96.3]) compared to control (85.3 [81.5–89.2]). In per protocol analyses, women receiving MM or IFA had higher ferritin 3 months postpartum (MM 118.2 [109.3–127.8]), IFA 117.8 [108.7–127.7] vs control 101.5 [94.0–109.7]) and gave birth to infants with greater iron stores (MM 184.3 [176.1–192.9]), IFA 189.9 [181.6–198.3] vs control 175.1 [167.9–182.6]). Conclusion Preconception supplementation with MM or IFA resulted in modest increases in maternal and infant iron stores but did not impact anemia. Further research is needed to characterize the etiology of anemia in this population and identify effective interventions for reducing prenatal anemia. Trial Registration ClinicalTrials.Gov NCT01665378
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Ramakrishnan U, Nguyen PH, Gonzalez-Casanova I, Pham H, Hao W, Nguyen H, Truong TV, Nguyen S, Harding KB, Reinhart GA, Neufeld LM, Martorell R. Neither Preconceptional Weekly Multiple Micronutrient nor Iron-Folic Acid Supplements Affect Birth Size and Gestational Age Compared with a Folic Acid Supplement Alone in Rural Vietnamese Women: A Randomized Controlled Trial. J Nutr 2016; 146:1445S-52S. [PMID: 27281806 DOI: 10.3945/jn.115.223420] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/26/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Maternal nutritional status before and during early pregnancy plays a critical role in fetal growth and development. The benefits of periconception folic acid (FA) supplementation in the prevention of neural tube defects is well recognized, but the evidence for preconception micronutrient interventions for improving pregnancy outcomes is limited. OBJECTIVE This study aimed to evaluate whether preconception supplementation with weekly iron and folic acid (IFA) or multiple micronutrients (MMs) improves birth outcomes compared with FA alone. METHODS We recruited 5011 women of reproductive age in a double-blind, randomized controlled trial in Vietnam and provided weekly supplements containing either 2800 μg FA, 60 mg Fe and 2800 μg FA (IFA), or the same amount of FA and iron plus other MMs until they conceived (n = 1813). All pregnant women received daily IFA through delivery, and were followed up for birth outcomes, including birth weight, gestational age, preterm delivery and small for gestational age (SGA). Group comparisons were done with the use of ANOVA or chi-square tests for both intention-to-treat (n = 1599) and per-protocol analyses (women consumed supplements ≥26 wk before conception; n = 824). Effect modification by baseline underweight or anemia status was tested with the use of generalized linear models. RESULTS The mean age of the women was 26 y, 30% were underweight, and <10% were nulliparous. The groups were similar for most baseline characteristics. The mean ± SD duration of the preconception intervention was 33 ± 25 wk and compliance was high (>90%). Infants born to the 3 groups of women did not differ (P ≥ 0.05) on mean ± SD birth weight (3076.8 ± 444.5 g) or gestational age (39.2 ± 2.0 wk), or prevalence of SGA (12%), low birth weight (5%) and preterm delivery (10%). There were no significant differences in women who consumed supplements ≥26 wk before conception or by baseline underweight or anemia. CONCLUSION Weekly supplementation with MMs or IFA before conception did not affect birth outcomes compared with FA in rural Vietnamese women. The trial was registered at clinicaltrials.gov as NCT01665378.
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Affiliation(s)
- Usha Ramakrishnan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA;
| | - Phuong H Nguyen
- International Food Policy Research Institute, Hanoi, Vietnam; Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | - Ines Gonzalez-Casanova
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Hoa Pham
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | - Wei Hao
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Hieu Nguyen
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | - Truong V Truong
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | - Son Nguyen
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | | | - Gregory A Reinhart
- The Mathile Institute for the Advancement of Human Nutrition, Dayton, OH; and
| | | | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
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Bhandari S, Sayami JT, Thapa P, Sayami M, Kandel BP, Banjara MR. Dietary intake patterns and nutritional status of women of reproductive age in Nepal: findings from a health survey. ACTA ACUST UNITED AC 2016; 74:2. [PMID: 26823976 PMCID: PMC4730652 DOI: 10.1186/s13690-016-0114-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 01/08/2016] [Indexed: 11/10/2022]
Abstract
Background Improper dietary intake pattern in women of reproductive age in Nepal has resulted in the deficiency of essential nutrients. Adequate nutritional status and proper dietary intake pattern of women improves maternal and child health. The objective of this study was to assess the nutritional status and dietary intake pattern among the women and associated factors. Methods Data collection at households and health check-up camps were conducted in selected Village Development Committees of nine districts in three ecological regions (Mountain, Hill and Terai) of Nepal from September 2011 to August 2012. Women of reproductive age (15 to 49 years) were the study subjects. At the household interview, structured questionnaires were used to obtain information on socio-demographic characteristics, anthropometric measurements, dietary intake pattern, consumption of junk foods, animal rearing, agricultural products, possession of kitchen garden, pregnancy status and anemia. Dietary intake pattern was determined by information collected through the structured questionnaires comprising of food items-cereals, pulses/legumes, vegetables, meat, fruits and milk and milk products. Health check-up camps were conducted in the local health facilities where qualified doctors, nurses and laboratory technicians performed physical examination of the women, confirmed their pregnancy and conducted hematocrit tests. The data was entered and analyzed using SPSS. Results Altogether 21,111 women were interviewed. More than a quarter of the women in Terai were malnourished as indicated by low body mass index (BMI < 18.5 Kg/m2). Among the dietary intake pattern, the majority of women consumed cereals at least once a day in all three ecological regions. The majority of women in Mountain consumed pulses/legumes thrice a week. In Terai, the majority of women consumed vegetables thrice a week. In all three ecological regions, the majority of women consumed meat and meat products and fruits once a week. About thirty percent of women consumed milk and milk products once a day in all three ecological regions. The non-use of iodized salt by Terai women was the highest (5.3 %, n = 303). In all the ecological regions, cereals and vegetables were produced in the majority of the participants’ households in comparison of fruits, poultry and goat/sheep. The women of age 15 to 24 years were 2.7 times more likely to be malnourished than women of 35 to 49 years age (aOR = 2.7, CI = 2.5,3.0). The unemployed women had nearly two times more chances of being malnourished than women doing manual work (aOR = 1.9, 95 % CI = 1.5,2.2). In Terai, women were five times more likely to be malnourished (aOR = 0.2, CI = 0.1,0.2) and 20 times more likely to be anemic (aOR = 0.05, CI = 0.04,0.07) than women in Mountain. The pregnant women were five times more likely to be anemic than non-pregnant women (aOR = 0.2, CI = 0.2,0.3). Conclusions The nutritional status of women of reproductive age is still poor especially in Terai and the dietary intake pattern is not adequate. It suggests improving nutritional status and feeding habits especially intake of meat, fruits and vegetables focusing on reproductive aged women.
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Affiliation(s)
- Shiva Bhandari
- Multivitamin-mineral Supplementation Project, Health Resources Consultancy Pvt. Ltd., Kuleshwor Kathmandu, Nepal ; Public Health and Infectious Disease Research Center (PHIDReC), New Baneshwor Kathmandu, Nepal ; Central Department of Microbiology, Tribhuvan University, Kirtipur Kathmandu, Nepal
| | - Jamuna Tamrakar Sayami
- Multivitamin-mineral Supplementation Project, Health Resources Consultancy Pvt. Ltd., Kuleshwor Kathmandu, Nepal ; National Center for Health Professions Education, Institute of Medicine, Tribhuvan University, Maharajgunj Kathmandu, Nepal
| | - Pukar Thapa
- Department of Internal Medicine, Lumbini Medical College, Kathmandu University, Tansen, Palpa Nepal
| | - Matina Sayami
- Department of Internal Medicine, Maharajgunj Medical College, Institute of Medicine, Tribhuvan University, Maharajgunj Kathmandu, Nepal
| | - Bishnu Prasad Kandel
- Department of Surgery, Institute of Medicine, Tribhuvan University, Maharajgunj Kathmandu, Nepal
| | - Megha Raj Banjara
- Multivitamin-mineral Supplementation Project, Health Resources Consultancy Pvt. Ltd., Kuleshwor Kathmandu, Nepal ; Central Department of Microbiology, Tribhuvan University, Kirtipur Kathmandu, Nepal
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Raiten DJ, Neufeld LM, De-Regil LM, Pasricha SR, Darnton-Hill I, Hurrell R, Murray-Kolb LE, Nair KM, Wefwafwa T, Kupka R, Phall MC, Sakr Ashour FA. Integration to Implementation and the Micronutrient Forum: A Coordinated Approach for Global Nutrition. Case Study Application: Safety and Effectiveness of Iron Interventions. Adv Nutr 2016; 7:135-48. [PMID: 26773021 PMCID: PMC4717873 DOI: 10.3945/an.115.008581] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Paramount among the challenges to our ability to address the role of food and nutrition in health promotion and disease prevention is how to design and implement context-specific interventions and guidance. The Integration to Effective Implementation (I-to-I) concept is intended to address the complexities of the global health context through engagement of the continuum of stakeholders involved in the food and nutrition enterprise. The 2014 Micronutrient Forum (MNF) Global Conference held in Addis Ababa, Ethiopia, in June 2014 offered the opportunity to apply the I-to-I approach with the use of current concerns about the safety and effectiveness of interventions to prevent and treat iron deficiency (ID) as a case study. ID is associated with a range of adverse outcomes, especially in pregnant and nonpregnant women, infants, and primary school-age children. Strategies to combat ID include iron supplementation, multiple micronutrient powders, and food-based interventions to enhance dietary iron intake. Recent reports indicate potential increased adverse risks when iron is provided in areas with high infection burdens (e.g., malaria). This paradox has weakened iron intervention programs. Furthermore, the selection and interpretation of available biomarkers for assessing iron nutrition have been found to be compromised by the inflammatory process. These issues highlight the need for a comprehensive approach that considers basic biology, assessment, interventions, and how these can be translated into appropriate programs and policies. The application of the I-to-I with the use of the MNF offered an opportunity to explore how that might be achieved.
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Affiliation(s)
- Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD;
| | | | | | - Sant-Rayn Pasricha
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Ian Darnton-Hill
- The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Richard Hurrell
- Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology, Zurich, Switzerland
| | | | - K Madhavan Nair
- Department of Biophysics, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | - Terry Wefwafwa
- Division of Nutrition, Ministry of Health, Nairobi, Kenya
| | | | | | - Fayrouz A Sakr Ashour
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD
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Karakochuk CD, Whitfield KC, Rappaport AI, Barr SI, Vercauteren SM, McLean J, Prak S, Hou K, Talukder A, Devenish R, Green TJ. The Homozygous Hemoglobin EE Genotype and Chronic Inflammation Are Associated with High Serum Ferritin and Soluble Transferrin Receptor Concentrations among Women in Rural Cambodia. J Nutr 2015; 145:2765-73. [PMID: 26491125 DOI: 10.3945/jn.115.218636] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 10/02/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Ferritin and soluble transferrin receptor (sTfR) concentrations are commonly used to assess iron deficiency (ID); however, they are influenced by multiple factors. OBJECTIVES We assessed associations between numerous variables and both ferritin and sTfR concentrations in Cambodian women and compared ID prevalence through the use of study-generated correction factors (CFs) for ferritin with those from a published meta-analysis. METHODS Venous blood from 450 women (aged 18-45 y) was assessed for hemoglobin (Hb), ferritin, sTfR, retinol binding protein, folate, vitamin B-12, C-reactive protein, α-1 acid glycoprotein (AGP), and genetic Hb disorders. Linear regression was used to calculate geometric mean ratios (95% CIs) for ferritin and sTfR concentrations. RESULTS The variant Hb EE genotype was associated with 50% (14%, 96%) and 51% (37%, 66%) higher geometric mean ferritin and sTfR concentrations, respectively, than was the normal Hb AA genotype; a 1-g/L increase in AGP was associated with 99% (50%, 162%) and 48% (33%, 64%) higher concentrations in the same variables, respectively. ID prevalence in nonpregnant women (n = 420) was 2% (n = 9) with the use of ferritin <15 μg/L and 18% (n = 79) with the use of sTfR >8.3 mg/L as criteria. ID prevalence with the use of sTfR was higher in women with the Hb EE genotype (n = 17; 55%) than in those with the Hb AA genotype (n = 20; 10%); and in women with the Hb AA genotype and chronic inflammation (n = 10; 18%) than in that group of women without chronic inflammation (n = 10; 7%) (P < 0.05). No differences in ID prevalence were found with the use of ferritin between women with Hb EE and AA genotypes (P = 1.0) or by chronic inflammation status (P = 0.32). There were no differences in mean ferritin concentrations among all 450 women when study-generated CFs were compared with those from the meta-analysis (P = 0.87). CONCLUSIONS Compared with sTfR, ferritin concentrations appear to reflect more accurately true ID in rural Cambodian women. The CFs from a published meta-analysis were appropriate for use in this population with a high prevalence of Hb disorders and inflammation.
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Affiliation(s)
- Crystal D Karakochuk
- Food, Nutrition and Health and The Child and Family Research Institute, Vancouver, Canada
| | - Kyly C Whitfield
- Food, Nutrition and Health and The Child and Family Research Institute, Vancouver, Canada
| | - Aviva I Rappaport
- Food, Nutrition and Health and The Child and Family Research Institute, Vancouver, Canada
| | | | - Suzanne M Vercauteren
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, Canada; The Child and Family Research Institute, Vancouver, Canada; Division of Hematopathology, Children and Women's Health Centre of British Columbia, Vancouver, Canada
| | | | - Sophonneary Prak
- National Maternal and Child Health Center, Ministry of Health, Phnom Penh, Cambodia
| | - Kroeun Hou
- Helen Keller International, Cambodia Country Office, Phnom Penh, Cambodia; and
| | | | - Robyn Devenish
- Laboratory Department, National Pediatric Hospital, Phnom Penh, Cambodia
| | - Timothy J Green
- Food, Nutrition and Health and The Child and Family Research Institute, Vancouver, Canada;
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Marques MR, Silva LMMDOE, Pessoa MLDSB, Araújo MADM, Moreira-Araújo RSDR. Risk and Prevalence of Anemia among Women Attending Public and Private Universities. Ecol Food Nutr 2015; 54:520-8. [DOI: 10.1080/03670244.2015.1037442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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