Prevalence of anemia among pregnant women and adolescent girls in 16 districts of India

BACKGROUND: Nutritional anemia is one of India's major public health problems. The prevalence of anemia ranges from 33% to 89% among pregnant women and is more than 60% among adolescent girls. Under the anemia prevention and control program of the Government of India, iron and folic acid tablets are distributed to pregnant women, but no such program exists for adolescent girls. OBJECTIVE: To assess the status of anemia among pregnant women and adolescent girls from 16 districts of 11 states of India. METHODS: A two-stage random sampling method was used to select 30 clusters on the basis of probability proportional to size. Anemia was diagnosed by estimating the hemoglobin concentration in the blood with the use of the indirect cyanmethemoglobin method. RESULTS: The survey data showed that 84.9% of pregnant women (n = 6,923) were anemic (hemoglobin < 110 g/L); 13.1% had severe anemia (hemoglobin < 70 g/L), and 60.1% had moderate anemia (hemoglobin > or = 70 to 100 g/L). Among adolescent girls (n = 4,337)from 16 districts, the overall prevalence of anemia (defined as hemoglobin < 120 g/L) was 90.1%, with 7.1% having severe anemia (hemoglobin < 70 g/L). CONCLUSIONS: Any intervention strategy for this population must address not only the problem of iron deficiency, but also deficiencies of other micronutrients, such as B12 and folic acid and other possible causal factors.     

Infection and anemia in Canadian aboriginal infants.

The prevalence of anemia in Aboriginal children is high, but, given the high burden of infection in these children, the extent to which anemia is due to iron deficiency and/or infection is unclear. To determine the contribution of iron deficiency to anemia, we screened 144 Aboriginal infants (70 boys, 74 girls) who were free from infection. The prevalence of anemia (hemoglobin <105 g/L) was 18.8%; caregivers reported that 53.5% of infants had had an infection in the two weeks before screening. Anemic infants were more likely than non-anemic infants to have had an infection before screening (74.1% versus 48.7%, p = 0.02), and anemic infants had a higher prevalence of iron deficiency revealed by low serum iron concentrations (<7 micromol/L) (73.7% versus 38.3%, p <0.01). Iron deficiency measured using serum ferritin concentration tended to be less marked in infants who had had an infection (13% versus 30.3%, p = 0.06); this is probably because serum ferritin is a positive acute-phase protein. This study indicates the difficulty of isolating the contribution of infection to anemia from the separate effects of dietary iron deficiency.     

Anemia prevalence and risk factors in pregnant women in an urban area of Pakistan

BACKGROUND: Anemia affects almost two-thirds of pregnant women in developing countries and contributes to maternal morbidity and mortality and to low birthweight. OBJECTIVE: To determine the prevalence of anemia and the dietary and socioeconomic factors associated with anemia in pregnant women living in an urban community setting in Hyderabad, Pakistan. METHODS: This was a prospective, observational study of 1,369 pregnant women enrolled at 20 to 26 weeks of gestation and followed to 6 weeks postpartum. A blood sample was obtained at enrollment to determine hemoglobin levels. Information on nutritional knowledge, attitudes, and practice and dietary history regarding usual food intake before and during pregnancy were obtained by trained interviewers within 1 week of enrollment. RESULTS: The prevalence of anemia (defined by the World Health Organization as hemoglobin < 11.0 g/dL) in these subjects was 90.5%; of these, 75.0% had mild anemia (hemoglobin from 9.0 to 10.9 g/dL) and 14.8% had moderate anemia (hemoglobin from 7.0 to 8.9 g/dL). Only 0.7% were severely anemic (hemoglobin < 7.0 g/ dL). Nonanemic women were significantly taller, weighed more, and had a higher body mass index. Multivariate analysis after adjustment for education, pregnancy history, iron supplementation, and height showed that drinking more than three cups of tea per day before pregnancy (adjusted prevalence odds ratio [aPOR], 3.2; 95% confidence interval [CI], 1.3 to 8.0), consumption of clay or dirt during pregnancy (aPOR, 3.7; 95% CI, 1.1 to 12.3), and never consuming eggs or consuming eggs less than twice a week during pregnancy (aPOR, 1.7; 95% CI, 1.1 to 2.5) were significantly associated with anemia. Consumption of red meat less than twice a week prior to pregnancy was marginally associated with anemia (aPOR, 1.2; 95% CI, 0.8 to 1.8) but was significantly associated with lower mean hemoglobin concentrations (9.9 vs. 10.0 g/dL, p = .05) during the study period. A subanalysis excluding women with mild anemia found similar associations to those of the main model, albeit even stronger. CONCLUSIONS: A high percentage of women at 20 to 26 weeks of pregnancy had mild to moderate anemia. Pica, tea consumption, and low intake of eggs and red meat were associated with anemia. Women of childbearing age should be provided nutritional education regarding food sources of iron, especially prior to becoming pregnant, and taught how food choices can either enhance or interfere with iron absorption.     

Efficacy of iron-fortified Ultra Rice in improving the iron status of women in Mexico

BACKGROUND: Universal fortification of staple foods with iron has been widely promoted as a cost-effective strategy to reduce iron deficiency in developing-country populations. Nonetheless, relatively few efficacy trials have been reported to date to demonstrate impact on iron status. The Ultra Rice technology provides a means of delivering fortificant iron via rice. OBJECTIVE: The objective of this study was to test the efficacy of rice fortified with microencapsulated, micronized iron pyrophosphate to improve the iron status of women in Mexico in a randomized, controlled intervention trial. METHODS: Nonpregnant, nonlactating women 18 to 49 years of age were recruited from six factories. The women received a daily portion of cooked rice 5 days per week for a period of 6 months, before and after which iron status indicators were determined in venous blood samples. RESULTS: The average intake of iron from the fortificant was 13 mg/day. Mean plasma ferritin concentration and estimated body iron stores were significantly higher, and transferrin receptors were lower, in the iron-fortified rice group following the intervention. Mean hemoglobin concentration also increased in the treatment group, but the increase was significant only when the analysis was restricted to those with baseline hemoglobin < 12.8 g/dL. The absolute reduction in anemia and iron deficiency was 10.3 and 15.1 percentage points, respectively. Total iron intake from fortificant was a significant covariate of change in body iron stores. The overall prevalence of anemia was reduced by 80%. CONCLUSIONS: Fortification of rice with iron using this technology is an efficacious strategy for preventing iron deficiency.     

Iron deficiency anemia following prenatal nutrition interventions.

PURPOSE: Iron deficiency anemia (IDA) during pregnancy and infancy is still common in developed countries, especially in low-income groups. We examined the prevalence of anemia and IDA in healthy low-income pregnant women participating in the Early Childhood Initiatives (ECI) program, and in their infants when they reached six months of age. METHODS: Pregnant women were recruited by nutritionists. In mothers, hemoglobin (Hb), mean corpuscular volume, and serum ferritin (SF) were measured at 36 +/- 2 weeks of gestation. In infants, Hb, mean corpuscular volume, SF, serum iron, total iron binding capacity (TIBC), and transferrin saturation (TS) were measured at six months of age. Thirty-one mother-infant pairs participated. RESULTS: Among the 31 pregnant women participating in the ECI program, six (19.4%) were anemic (Hb <110 g/L) and five (16.1%) suffered from IDA (Hb <110 g/L and SF <10 microg/L). Among infants, seven of 23 (30.4%) were anemic (Hb <110 g/L) and five of 23 (21.7%) suffered from IDA (Hb <110 g/L plus two of the following: TIBC >60 micromol/L, SF <10 microg/L, serum iron <5.3 micromol/L, TS < or = 15%). CONCLUSIONS: The prevalence of anemia in this group of low-income pregnant women is comparable to that in privileged women. The prevalence of IDA in infants is comparable to that observed in other high-risk groups. Effective strategies are needed to prevent IDA in vulnerable groups.     

Impact of fortification of flours with iron to reduce the prevalence of anemia and iron deficiency among schoolchildren in Caracas, Venezuela: a follow-up

In Venezuela, a severe economic crisis starting in 1983 provoked a progressive reduction in the quantity and quality of food consumed by people from the low socioeconomic strata of the population. This situation resulted in a continuous increase in the prevalence of iron deficiency in the 1980s and 1990s. In 1993, an iron-fortification program was started, in which precooked corn and white wheat flours were enriched with iron, vitamin A, thiamine, niacin, and riboflavin. White wheat flour was enriched with the same nutrients, except for vitamin A. In 1996 we published the results of the impact of fortification of precooked corn and white wheat flours on the prevalence of anemia and iron deficiency in the population. A survey carried out in Caracas in 307 children aged 7, 11, and 15 years showed that the prevalence of iron deficiency measured by serum ferritin concentration dropped from 37% in 1992 to 16% in 1994, only one year after the iron-fortification program began. The prevalence of anemia, as measured by the hemoglobin concentration, diminished from 19% to 10% during the same period. This article reports the results of three other surveys carried out in 1997, 1998, and 1999 on children of the same age and socioeconomic groups that were evaluated in 1990, 1992, and 1994. There were no significant differences in anemia or iron deficiency among the last three surveys. The prevalence results from the last seven years seem to indicate that, after a dramatic reduction in 1994, iron deficiency tended to stabilize, while the prevalence of anemia increased to the same level found in 1992, before the fortification program started.     

The Role of Diet in Predicting Iron Deficiency Anemia in HIV-Positive Women

Purpose: The association between medical, social, and nutritional factors and iron deficiency anemia was examined in adult women who had tested positive for human immunodeficiency virus (HIV) and were living in the Greater Vancouver Area. Methods: This was a cross-sectional observational study of 102 HIV-positive women, aged 19 or older, who were patients of one of three chosen community health clinics in Vancouver, British Columbia. Information on usual dietary intake and other nutrition-related factors was collected with a short diet survey, while medical information and laboratory data were obtained from each participant's medical chart. Results: Of the predictors studied, a CD4 cell count below 200 cells/μL, a regular menstrual pattern, and African ethnicity were associated with an increased risk of iron deficiency anemia. Dietary intake was not independently associated with iron status. Conclusions: Iron deficiency anemia in HIV-positive women has multifactorial and complicated causation, but is strongly associated with poorer immune status and greater menstrual losses. Health disparities in Aboriginal and African women may lead to a higher risk for iron deficiency anemia. Routine screening and ongoing nutrition education are necessary for the prevention and management of iron deficiency anemia. Further research into factors associated with iron deficiency anemia is essential to improve prevention and management efforts.     

Magnitude of zinc deficiency among nulliparous nonpregnant women in a rural community of Haryana State, India

Zinc deficiency during pregnancy affects the outcome of pregnancy. A high prevalence of zinc deficiency (55.5%) has been reported among pregnant women. It is not known whether pregnancy leads to zinc deficiency due to the increased fetal needs or whether the women are zinc deficient when they become pregnant. No data are available on the zinc status of nulliparous nonpregnant women from India. To assess the magnitude of zinc deficiency among nulliparous nonpregnant women in a rural community of Haryana State, India. A community-based cross-sectional survey was conducted in six villages of a rural area in a district of Haryana State, India. All nulliparous nonpregnant women aged 18 years or over who were willing to participate in the study were enrolled. Each woman was questioned about her age, socioeconomic status, and dietary pattern with the use of a pretested semistructured questionnaire. Blood from the antecubital vein was drawn to assess the serum zinc levels using an atomic absorption spectrophotometer. Serum zinc levels less than 70.0 micrograms/dl were considered to indicate zinc deficiency. The dietary intakes of zinc, protein, and calories were assessed by the 24-hour dietary recall method. Two hundred eighty-eight nulliparous nonpregnant women were enrolled. Forty-one percent had zinc deficiency, and 75.7%, 1.4%, and 7.3% of the women consumed less than 50% of the recommended intake of zinc, protein, and calories, respectively. Women who consumed less than 50% of the recommended intake of calories (1,875 kcal) were at a 4.9 times higher risk of zinc deficiency than women who consumed more than 50% of the recommended intake. A high prevalence of zinc deficiency was found among the nulliparous nonpregnant women in the area studied.     

Effect of vitamin A supplementation on iron status in humans: A systematic review and meta-analysis

Anemia is a worldwide public health problem that can be related to many causes, including vitamin A deficiency. The aim of this study was to assess and estimate the effect of vitamin A supplementation (VAS) on iron status biomarkers and anemia in humans. Six databases, including Cochrane, EMBASE, LILACS, Pubmed, Scopus and Web of Science, were searched for clinical trials and cohort studies that investigated the effect of vitamin A supplementation alone on iron status and anemia, without time-restriction. The search yielded 23 eligible studies, 21 clinical trials and 2 cohort studies, with children, teenagers, pregnant or lactating women. The meta-analysis of the clinical trials showed that VAS reduces the risk of anemia by 26% and raises hemoglobin levels, compared to non-treated group, independent of the life stage. VAS did not alter the prevalence of iron deficiency among the clinical trials conducted with children and teenagers (RR 0.82, 95% CI 0.60 to 1.12, p = 0.204), whereas a significant increase in serum ferritin levels was observed in trials conducted with pregnant and lactating women (WMD 6.61 μg/L; 95% CI 6.00 to 7.21 μg/L; p < 0.001). Therefore, vitamin A supplementation alone may reduce the risk of anemia, by improving hemoglobin and ferritin levels in individuals with low serum retinol levels.     

The iron status of Canadian adolescents and adults: current knowledge and practical implications.

OVERVIEW: Iron is an essential nutrient, playing a central role in oxygen transport and cellular energy metabolism. The importance of ensuring adequate bioavailable dietary iron stems from the severe consequences associated with iron deficiency (ID) and anemia, including reduced immune function and resistance to infection, developmental delays and irreversible cognitive deficits in young children, impaired physical work performance, and adverse pregnancy outcomes. SPECIFIC POPULATIONS: Poor dietary iron intake and ID exist in Canada, particularly in women of reproductive age. Data from the provincial nutrition surveys suggest that the prevalence of inadequate iron intakes (and low intakes of absorbable iron) among women under 50 years of age is over 10%, which may reflect poor iron status. Teenage girls are at risk for low iron stores because of the adolescent growth spurt and the onset of menstruation; those who are vegetarian are at even greater risk. CONCLUSIONS: The Canadian diet has changed so that grain products are now the main source of dietary iron for all age groups. The public must be educated to ensure the consumption of adequate quantities of bioavailable iron and enhancing factors such as vitamin C. Industry, government, and health professionals must work together to promote healthy eating patterns and the selection of appropriate foods.     

Bioavailability of iron in goat milk compared with cow milk fed to anemic rats

Bioavailabilities of iron from dehydrated whole and skim goat milk were investigated using iron-deficient rats. Hemoglobin regeneration efficiencies were determined as the percent conversion of dietary iron into hemoglobin. The respective hemoglobin regeneration efficiencies for groups fed whole goat milk, whole cow milk, skim goat milk, and skim cow milk were 50.6, 13.1, 26.0, and 13.0%, indicating that iron bioavailability of goat milk was greater than cow milk. However, rats fed each milk had negative net increases in hemoglobin concentrations, implying that the iron contents of each milk were not adequate. For animals consuming whole goat milk supplemented with ferrous sulfate, the slope relating hemoglobin iron gained versus iron intake was .95. Respective bioavailabilities relative to ferrous sulfate were 54, 14, 28, and 14% for the four sources of milk. Iron bioavailability of goat milk is superior to cow milk when fed to anemic rats.     

Effects of iron supplementation versus dietary iron on the nutritional iron status: Systematic review with meta-analysis of randomized controlled trials

ABSTRACT

This meta-analysis compared the effects of dietary intervention versus iron supplementation on biochemical parameters related to the iron nutritional status in humans. The PubMed, CENTRAL, LILACS, SCIELO, OPENGREY.EU and ClinicalTrials.gov databases were searched for randomized clinical trials that assigned individuals to a dietary intervention or to an iron supplementation regimen, for 12 weeks or more. The primary outcome was the hemoglobin concentration, and secondary outcomes were ferritin, RDW, mean corpuscular volume, soluble transferrin receptor, total iron binding capacity, serum iron, and transferrin saturation. From the 6095 records identified, twelve studies were included, six with children, five with adolescents/adults, and one with pregnant women. In the subgroup of studies that included anemic/iron deficient children, supplementation significantly increased the hemoglobin concentration (weighted mean difference (WMD): 3.19 g/L [95% CI: 1.31, 5.07]) and induced a significantly greater reduction of the soluble transferrin receptor (WMD: ?0.46 mg/L [95% CI: ?0.70, ?0, 21]), when compared to dietary intervention. It also induced a greater reduction of the total binding capacity of iron in adolescents/adults (WMD: ?6.96 μmol/L [95% CI: ?12.70, ?1.21]). Supplementation showed a better effect on hemoglobin recovery in anemic/iron deficient children, while no differences were observed between supplementation and dietary intervention in treating adolescents/adults.     

The connection between vitamin and iron status indexes of school-age children

The analysis of vitamin and iron indexes of 95 children sufficiently supplied with vitamin C and vitamin B2 and carotenoids deficiency has been carried out. Vitamin E deficit takes place among anemic children (with decreased hemoglobin blood level) 2 fold more often than among healthy children. From another side, decreased hemoglobin blood level, erythrocyte quantity and erythrocyte indexes have been determined 1.7-2.4 fold more often in insufficiently supplied with vitamin E children. Tocopherols serum level had tendency to the decrease and vitamin E deficit took place 2 fold more frequently in children suffering from iron deficiency anemia that is with decreased hemoglobin and serum ferritin concentrations. Marked positive linear correlation between these iron indexes and vitamin E serum level has been revealed. These results give evidence concerning significant role of this vitamin in the body iron supplying. The results obtained give evidence for multi-deficient anemia presence among children, which are not always caused by iron deficit. High frequency of vitamin E and B group vitamins deficiency proves expediency of these vitamins inclusion in complex therapy of iron deficiency.     

Food frequency questionnaire for assessing infant iron nutrition.

A food frequency questionnaire (FFQ) was developed and tested for assessing iron nutrition in infants through comparison with a three-day food record (3d-FR) and measures of iron status. Parents of 148 infants aged eight to 26 months completed a 3d-FR and an FFQ. Blood was collected for measures of hemoglobin (Hgb), ferritin, and transferrin receptor (sTfR). Iron deficiency anemia and iron depletion (ferritin < or =12 microg/L) were found in 9% and 26% of infants, respectively. The intakes of energy, total iron, heme and non-heme iron, vitamin C, and dietary fibre determined by the FFQ were associated with the intakes of the same nutrient determined by the 3d-FR (p<0.05). The intakes of energy, total iron, non-heme and heme iron, vitamin C, and fibre were significantly higher when estimated by the FFQ than by the 3d-FR. Total and heme iron intakes determined by the FFQ were significantly associated with serum ferritin, sTfR, and the sTfR:ferritin ratio (p<0.05). However, iron intakes explained <10% of the variability in iron status. Despite relative validity of the FFQ for evaluating differences in energy, iron, vitamin C, and fibre intake compared with a 3d-FR, FFQs need further development before they can be used to advance assessment of iron intake and status in infants.     

Iron, folate, and vitamin B12 stores among pregnant women in a rural area of Haryana State, India

BACKGROUND: Iron, folate, and vitamin B12 deficiencies have adverse effects on pregnancy outcome. In India, data on the concomitant prevalence of these deficiencies among pregnant women are meager. OBJECTIVE: We conducted a community-based study to assess the prevalence of deficiencies of iron, folate, and vitamin B12 among pregnant women in a rural block of Haryana State. METHODS: The study was approved by the ethics committee of the All India Institute of Medical Sciences, New Delhi. A total of 283 pregnant women were enrolled in the study. After oral informed consent had been obtained from the women, blood was drawn from the antecubital vein for estimation of the levels of serum ferritin by enzyme-linked immunosorbent assay (levels < 12 ng/ mL were considered as indicative of poor iron stores); serum folate was determined by radioimmunoassay (levels <3 ng/mL were considered as indicative of poor folate stores); and serum vitamin B12 was estimated by the microbiologic method (levels < 200 pg/mL were considered as indicative of poor vitamin B12 stores). RESULTS: The results indicated that 67.7%, 26.3%, and 74.1% of the women had poor iron, folate, and vitamin B12 stores, respectively. Concomitant deficiencies of iron, folate, and vitamin B12 occurred in 16.2% of the women. We found that 59.9% of the women were consuming less than 75% of the recommended daily caloric allowance (2175 kcal), indicating an overall poor food intake. This could be one of the predominant reasons for poor iron, folate, and vitamin B12 stores among the women. CONCLUSIONS: Our findings suggest that apart from iron and folate, vitamin B12 deficiencies may play an important role in causing anemia.     

Effectiveness of intermittent iron treatment of two- to six-year-old Jordanian children with iron-deficiency anemia

BACKGROUND: Iron deficiency is a common nutritional problem in young children among vulnerable populations in Jordan. Several studies have shown the effectiveness of intermittent iron supplementation in improving iron status. Such a study has not been carried out in 2- to-6-year-old Jordanian children diagnosed with iron deficiency anemia in a clinical setting. OBJECTIVE: To study the effectiveness of intermittent versus daily iron treatment in a clinical setting in 2- to 6-year-old Jordanian children with iron-deficiency anemia. METHODS: About 4400 children aged 2 to 6 years who visited Prince Hashim Military Hospital in Zarqa, Jordan, from August 2000 to June 2001 were screened for age, general health, and birthweight. About 10% of these children were screened for anemia, using complete blood count (defined as a hemoglobin level < or = 10.5 g/dL, and a mean corpuscular volume < or =75 ft). Anemic children underwent further screening for iron deficiency, defined as serum ferritin level < or =12 microg/L. Children with iron-deficiency anemia, as indicated by hemoglobin < or = 10.5 g/dL, mean corpuscular volume < or =75 fL, and serum ferritin < or =12 microg/L, or as indicated by mean corpuscular volume < or =75 fL and hemoglobin < or = 10.5 g/dL, were enrolled in the study after informed oral consent by their parents. Study children (n=134) were assigned randomly to one of three groups. Subjects in group 1 (n=45), group 2 (n=45), and group 3 (n=44) received iron treatment daily, weekly, and twice weekly, respectively. Out of 134 children recruited for the study, only 63 (39 boys and 24 girls) completed the 3-month treatment period. All of the children received medicinal iron drops at a dosage of 5 mg elemental iron as ferrous sulfate per kilogram of body weight. The parents also received nutritional counseling. RESULTS: At the end of treatment, hemoglobin, serum ferritin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration increased significantly in all groups with no significant differences between groups. The increases in hemoglobin in groups 1, 2, and 3 were 2.47 +/- 0.17, 2.12 +/- 0.18, and 2.18 +/- 0.18 g/dL, respectively. Measurements of final serum ferritin concentration were available for only 12, 12, and 10 children in groups 1, 2, and 3, respectively. In all children who completed the study, except for one in group 1, hemoglobin, mean corpuscular volume, and serum ferritin reached normal values in response to iron treatment. CONCLUSIONS: Weekly and twice-weekly iron therapy with 5 mg elemental iron as ferrous sulfate per kilogram of body weight accompanied by nutritional counseling was as effective as daily iron therapy in correcting iron-deficiency anemia in 2- to 6-year-old children under the clinical conditions of this study.     

Bioavailability of a Heme-Iron Concentrate Product Added to Chocolate Biscuit Filling in Adolescent Girls Living in a Rural Area of Mexico

ABSTRACT: A heme-iron concentrate product derived from swine hemoglobin was used to enrich the chocolate-flavored filling of biscuits and the bioavailability of this source of heme-iron was assessed in adolescent girls. The placebo control (PC) group consisted of 35 teenagers with the highest baseline hemoglobin concentrations. The supplemented groups were randomized to receive biscuits fortified with iron sulfate (IS, n = 37) or heme-iron concentrate (HIC, n = 40). Both groups were supplemented with 10.3 mg Fe/d for 7 wk. Blood chemistry and hematology analyses were performed at baseline and at the end of the study. The baseline prevalence of anemia (hemoglobin <12g/dl) in the entire group was 3.9% and by the end of the study it had fallen to 2.3%. The hemoglobin levels in both supplemented groups increased (P < 0.05) during the study period from 13.6 and 13.5 g/dl for HIC and IS, respectively, at baseline to 14 g/dl at the end of the study. Serum ferritin concentrations decreased by the end of the study in both the PC and IS groups (P < 0.05), but not in the heme group. In conclusion, iron bioavailability from HIC-fortified biscuits was calculated to be 23.7% higher than that observed for IS, as shown by the differences observed in serum ferritin levels during the study. The iron contained in the heme-iron concentrate was well absorbed and tolerated by the adolescents included in the study.     

Determinants of anemia among pregnant women in Mali

BACKGROUND: Anemia in pregnancy remains a major problem in nearly all developing and many industrialized countries. In Mali, the subpopulation prevalence and etiology of anemia during pregnancy are largely unknown. OBJECTIVE: To examine the prevalence and likely etiologies of anemia in pregnancy in a poor urban population in Bamako, Mali. METHODS: Pregnant women (n = 190) were selected randomly. Hemoglobin, serum iron, and total iron-binding capacity were measured; blood smears were examined for Plasmodium falciparum malaria; and single stool and urine samples were examined for Schistosoma haematobium and hookworm. Gynecologic examinations were performed and interviews conducted to qualitatively assess food consumption and other socioeconomic characteristics. Associations among mild, moderate, and severe anemia; iron and parasite status; erythrocyte sedimentation rates; and the presence of abnormal vaginal discharge were evaluated. Differences in hemoglobin and serum iron concentrations, total iron-binding capacity, and anemia were compared according to trimester of pregnancy and between infected and noninfected women. The relative and attributable risks of anemia were calculated, and adjusted odds ratios for anemia and low serum iron were estimated by multivariate logistic regression. RESULTS: Of the 131 women for whom complete data were available, 47% had hemoglobin concentrations below 110 g/L; 13% had serum iron concentrations below 12 micromol/L; none had transferrin saturation values below 16%; 11%, 23%, and 8% harbored P. falciparum, S. haematobium, and hookworm, respectively; and 82% had an abnormal vaginal discharge. Food restrictions were reported by 45% of the women. Abnormal vaginal discharge correlated significantly with anemia (Pearson chi2 = 62.4; p < .01). Univariate and multivariate analyses found that infections were strongly associated with and predictive of anemia. CONCLUSIONS: Our data suggest that infections and food accessibility contribute to the high rates of anemia during pregnancy in Mali.     

Studies on the effectiveness of NaFeEDTA-fortified soy sauce in controlling iron deficiency: a population-based intervention trial

The objective of this research was to study the effectiveness of NaFeEDTA-fortified soy sauce for controlling iron deficiency in a high-risk population. This was an 18-month, randomized, placebo-controlled intervention trial in 14,000 residents aged three years or older in Bijie City, Guizhou Province, China, using sodium-iron ethylene diamine tetraacetate (NaFeEDTA)-fortified soy sauce (29.6 mg Fe/100 ml). The study data included measurements of food consumption, hemoglobin, serum ferritin, and serum retinol. The results showed that the diet consisted primarily of cereals, fruits, and vegetables, with very little meat. Food consumption remained unchanged during the study period and was similar in the fortified and control groups. The average daily soy sauce consumption of the group consuming the fortified product was 16.4 ml per person, which provided 4.9 mg of iron from NaFeEDTA. At the end of the trial, all age and sex subgroups receiving NaFeEDTA had significantly higher hemoglobin levels, a lower prevalence of anemia, and higher plasma ferritin levels than the controls. The effects became statistically significant after six months of intervention and were maintained throughout the study period. We conclude that NaFeEDTA-fortified soy sauce was highly effective in controlling iron deficiency and reducing the prevalence of iron-deficiency anemia in men, women, and children. NaFeEDTA-fortified soy sauce is affordable and was well accepted by the study population.