Anaemia in Asians in London

Coeliac disease in South Asians resident in Britain: comparison with white Caucasian coeliac patients

BACKGROUND

The catchment population of our hospital is ethnically diverse and we have seen a number of patients of South Asian origin with coeliac disease. We have suspected that there are differences compared with white Caucasian coeliacs, especially with respect to iron-deficiency anaemia and vitamin D deficiency at presentation.

AIMS

To compare the clinical and laboratory features of South Asian adult coeliac patients with adult white Caucasian coeliacs.

METHODS

We reviewed the notes of patients attending the adult coeliac clinic over the past 10 years. All patients were older than 16 years at diagnosis. There were 40 South Asians and 90 white Caucasians. Symptoms, haematology, biochemistry, endomysial antibody status, HLA alleles and small bowel histology at presentation were compared between the two racial groups.

RESULTS

There were significant differences between the racial groups. South Asians were younger at presentation than the Caucasian patients (mean age 27 years compared with 47 years respectively, P<0.0001); they were less likely to have 'irritable bowel syndrome' symptoms (P<0.01), but more likely to have features of vitamin D deficiency (P<0.03). Their haemoglobin (P<0.05), mean cell volume (P<0.0004), serum iron (P<0.01), transferrin saturation (P<0.05), serum 1,25-dihydroxyvitamin D3 (P<0.002), and levels were lower, while serum alkaline phosphatase levels were higher (P<0.04) than in white Caucasian coeliac patients. There were no differences with respect to serum folate, vitamin B12, serum calcium, alanine aminotransferase and small bowel histology. IgA class endomysial antibody positivity was similar in the two groups (88.5% for South Asians compared with 73.5% for white Caucasians). White Caucasian patients were significantly more likely to be DQ2-positive than the South Asian patients (97.2% compared with 83.3%, P=0.02).

CONCLUSION

South Asians with coeliac disease are less likely to present with 'irritable bowel syndrome' symptoms, but more likely to have features of vitamin D deficiency and iron deficiency, and have a higher alkaline phosphatase than white Caucasians. The differences in HLA alleles seen in South Asians with coeliac disease compared with white Caucasian patients suggests that among the South Asians, non-HLA regions may play a stronger role in disease susceptibility and presentation.

Iron deficiency anaemia in women of South Asian descent: a qualitative study

OBJECTIVE

Menorrhagia is thought to be the commonest cause of iron deficiency anaemia in women of reproductive age living in Britain. However, it has been suggested that the high prevalence of iron deficiency anaemia in women of South Asian descent living in Britain is due to religious and cultural restrictions on certain foods. While lack of iron in the diet, or poor iron absorption may well be reasons for this prevalence of iron deficiency anaemia, there may be other complex reasons why South Asian women suffer particularly from this complaint. This study aimed to explore reasons for the relatively high level of iron deficiency anaemia found in South Asian women living in Britain.

METHOD

A qualitative study using semi-structured interviews with women of Indian and Pakistani descent living in a town in North West England.

FINDINGS

It appears that some South Asian women value a relatively heavy menstrual blood flow because such blood is thought to be 'dirty' and 'impure' and because a scanty period is thought to result in abdominal weight gain and pain. When menstrual blood loss is thought to be 'excessive', women tend to avoid 'hot' foods such as meat, fish and eggs, thus denying themselves a valuable source of iron. When South Asian women believe that they have a serious problem of menorrhagia they may not seek medical help because of the shortage of female general practitioners. Poor communication with doctors and other health care professionals may also affect illness behaviour.

CONCLUSION

This study suggests that attitudes to menstruation and menstrual blood may help to account for the relatively high levels of iron deficiency anaemia found in women of South Asian descent living in Britain. Since most of the women interviewed during this research had families who came from Gujarat in Western India, more research is needed to explore the values and beliefs of women coming from other parts of Southern Asia.

Reproductive health of Asian women: a comparative study with hospital and community perspectives

A comparative study of Asian and non-Asian women's reproductive health was performed. The hospital case notes of 48 Asian and 51 non-Asian women, matched for age, were examined. Asian women had shorter stature, bigger families, booked later for antenatal care, and were less likely to have a cervical smear taken. Of the above, 30 Asian and 24 non-Asian women were interviewed in their homes. Many Asian women had difficulties with the English language and a low literacy rate which gave rise to communication barriers during health care. Their knowledge of procedures and tests such as amniocentesis, self examination of the breast etc. was comparatively low. Fewer Asians attended parent-craft classes or did post-natal exercises. Many disliked, and some refused, vaginal examination by male doctors. Despite equal access, Asian women were less well informed and made lesser use of services. Lack of knowledge and difficulties of communication, rather than negative attitudes, may explain Asian women's lesser use of services and to some extent the poor outcome of pregnancy observed in many studies.