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Anaemia and iron deficiency during pregnancy in rural Bangladesh

Published online by Cambridge University Press:  02 January 2007

SM Ziauddin Hyder ,
Lars-Åke Persson ,
Mushtaque Chowdhury ,
Bo Lönnerdal  and
Eva-Charlotte Ekström
SM Ziauddin Hyder*
Affiliation:
Research and Evaluation Division, BRAC, Dhaka, Bangladesh Division of Gastroenterology and Nutrition, Hospital for Sick Children and Center for International Health, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8
Lars-Åke Persson
Affiliation:
International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
Mushtaque Chowdhury
Affiliation:
Research and Evaluation Division, BRAC, Dhaka, Bangladesh
Bo Lönnerdal
Affiliation:
Department of Nutrition, University of California, Davis, CA, USA
Eva-Charlotte Ekström
Affiliation:
International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
*
*Corresponding author: Email [email protected]
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Abstract

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Objective:

To study the prevalence of anaemia and its association with measures of iron deficiency (ID) among a group of pregnant women.

Design:

Cross-sectional survey.

Setting:

Pregnant women identified through house-to-house visits and participating in community-based antenatal care activities in a rural location of Mymensingh, Bangladesh.

Subjects:

The estimates are based on 214 reportedly healthy pregnant women in their second trimester. Information on socio-economic status and reproductive history were obtained through home visits and venous blood samples were collected at antenatal care centres. Haemoglobin concentration (Hb) was measured by HemoCue, serum ferritin (sFt) by radioimmunoassay and serum transferrin receptor (sTfR) by enzyme-linked immunosorbent assay methods. ID was defined as presence of either low sFt (<12 μg l−1) or high sTfR (>8.5 mg l−1).

Results:

The prevalence of anaemia (Hb <110 g l−1) was 50%, but severe anaemia (Hb >70 g l−1) was absent. Low sFt was observed in 42%, high sTfR in 25%, either low sFt or high TfR in 54% and both low sFt and high TfR in 13% of the pregnant women. Two out of three anaemic women had an indication of ID, which was present in 80% of women with moderate (Hb 70–99 g l−1) and 50% with mild (Hb 100–109 g l−1) anaemia. Four out of 10 non-anaemic women (Hb >110 g l−1) also had ID, but the prevalence was significantly lower than that observed in anaemic women (P=0.001).

Conclusions:

Despite the high prevalence of anaemia, severe cases were absent. The prevalence of ID increased at lower Hb. However, an increased prevalence was also found among women in the highest category of Hb.

Keywords

AnaemiaIron deficiencySerum ferritinTransferrin receptorsPregnancyBangladesh
Type
Research Article
Information
Public Health Nutrition , Volume 7 , Issue 8 , December 2004 , pp. 1065 - 1070
Copyright
Copyright © The Authors 2004

References

1United Nations Administrative Committee on Coordination, Sub-committee on Nutrition (ACC/SCN). Fourth Report on the World Nutrition Situation: Nutrition throughout the Life Cycle, Geneva: ACC/SCN in collaboration with International Food Policy Research Institute, 2000.Google Scholar
2Scholl, TO, Hediger, ML, Fische, RL, Shearer, JW. Anaemia vs. iron deficiency: increased risk of preterm delivery in a prospective study. American Journal of Clinical Nutrition 1992; 55: 985–8.CrossRefGoogle ScholarPubMed
3Godfrey, KM, Redman, CWG, Barker, DJP, Osmond, C. The effect of maternal anaemia and iron deficiency on the ratio of fetal weight to placenta weight. British Journal of Obstetrics and Gynaecology 1991; 98: 886–91.CrossRefGoogle Scholar
4Lieberman, E, Ryan, KJ, Monson, RR, Schoenbaum, SC. Risk factors accounting for racial differences in the rate of premature birth. New England Journal of Medicine 1987; 317: 743–8.CrossRefGoogle ScholarPubMed
5Bothwell, TH, Charlton, RW, Cook, JD, Finch, CA. Iron Metabolism in Man. Oxford: Blackwell Scientific Publications, 1979.Google Scholar
6World Health Organization (WHO)/United Nations Children's Fund/United Nations University. Iron Deficiency: Indicators for Assessment and Strategies for Prevention. Geneva: WHO, 1998.Google Scholar
7United Nations Administrative Committee on Coordination, Sub-committee on Nutrition (ACC/SCN). Controlling Iron Deficiency. Geneva: ACC/SCN, 1991.Google Scholar
8Helen Keller International (HKI)/Institute of Public Health Nutrition (IPHN). Iron Deficiency Anaemia throughout the Lifecycle in Rural Bangladesh. Dhaka: HKI/IPHN, 1999.Google Scholar
9Jahan, K, Hossain, M. Bangladesh National Nutrition Survey, 1995–96. Dhaka: Institute of Nutrition and Food Science, University of Dhaka, 1998.Google Scholar
10BRAC. Baseline Survey Report: BRAC-ICDDR, B Joint Research Project in Matlab. Dhaka: Research and Evaluation Division, BRAC, 1994.Google Scholar
11Bangladesh Bureau of Statistics (BBS). Report of the Poverty Monitoring Survey. Dhaka: BBS, 1998.Google Scholar
12van Schenck, H, Falkensson, M, Lundberg, B. Evaluation of ‘HemoCue’, a new device for determining hemoglobin. Clinical Chemistry 1986; 32: 526–9.CrossRefGoogle Scholar
13Institute of Medicine, Committee on Nutritional Status during Pregnancy and Lactation. Nutrition During Pregnancy. Washington DC: National Academy Press, 1990; 272–98.Google Scholar
14Carriaga, MT, Skikne, BS, Finley, B, Culter, B, Cook, JD. Serum transferrin receptor for the detection of iron deficiency in pregnancy. American Journal of Clinical Nutrition 1991; 54: 1077–81.CrossRefGoogle ScholarPubMed
15Brooks, GF, Butel, JS, Morse, SA. Medical Microbiology, 21st ed. Stamford, CA: Prentice Hall, 1995.Google Scholar
16Grover, V, Usha, R, Kalra, S, Sachdeva, S. Altered fetal growth: antenatal diagnosis by symphysis – fundal height in India and comparison with western chart. International Journal of Gynaecology and Obstetrics 1991; 35: 231–4.CrossRefGoogle Scholar
17Indian Council of Medical Research (ICMR). Evaluation of the National Nutritional Anaemia Prophylaxis Programme – An ICMR Task Force Study, New Delhi: ICMR, 1989.Google Scholar
18Dreyfuss, ML, Stoltzfus, RJ, Shrestha, JB, Pradhan, EK, LeClerq, SC, Khatry, SK. et al. Hookworms, malaria and vitamin A deficiency contribute to anemia and iron deficiency among pregnant women in the plains of Nepal. Journal of Nutrition 2000; 130: 2527–36.CrossRefGoogle ScholarPubMed
19Atukorala, TMS, de Silva, LDR, Dechering, WHJC, Dassenaeike, TS. Evaluation of effectiveness of iron-folate supplementation and anthelmintic therapy against anemia in pregnancy – a study in the plantation sector of Sri Lanka. American Journal of Clinical Nutrition 1994; 60: 286–92.CrossRefGoogle ScholarPubMed
20McDermott, JM, Slutsker, L, Steketee, RW, Steketee, RW, Wirima, JJ, Breman, JG, et al. Prospective assessment of mortality among a cohort of pregnant women in rural Malawi. American Journal of Tropical Medicine and Hygiene 1996; 55: 66–70.CrossRefGoogle ScholarPubMed
21Olukoya, AA, Abidoye, RO. A study of intestinal parasites in antenatal clinic patients in Lagos. Health and Hygiene 1991; 12: 176–9.Google Scholar
22Brabin, BJ, Ginny, M, Sapua, J, Galme, K, Paino, J. Consequences of maternal anaemia on outcome of pregnancy in a malaria endemic area in Papua New Guinea. Annals of Tropical Medicine and Parasitology 1990; 84: 11–24.CrossRefGoogle Scholar
23Birley, MH. An historical review of malaria, kala-azar and filariasis in Bangladesh in relation to the Flood Action Plan. Annals of Tropical Medicine and Parasitology 1993; 87: 319–34.CrossRefGoogle Scholar
24Islam, MM, Karim, E, Mian, MA, Kristensen, S, Chowdhury, MR, Vermund, SH. An update of the prevalence of HIV/AIDS in Bangladesh. Southeast Asian Journal of Tropical Medicine 1999; 30: 246–50.Google ScholarPubMed
25Baynes, RD, Skikne, B, Cook, JD. Circulating transferrin receptors and assessment of iron status. Journal of Nutritional Biochemistry 1994; 5: 322–30.CrossRefGoogle Scholar
26Olivares, M, Walter, T, Cook, JD, Llaguno, S. Effect of acute infection on measurement of iron status: usefulness of the serum transferrin receptor. International Journal of Pediatric Hematology and Oncology 1995; 2: 31–3.Google Scholar
27Lipschitz, DA. The anemia of chronic diseases. Journal of the American Geriatrics Society 1990; 38: 1258–64.CrossRefGoogle Scholar
28Taylor, DJ, Mallen, C, McDougall, N, Lind, T. Effect of iron supplementation on serum ferritin levels during and after pregnancy. British Journal of Obstetrics and Gynaecology 1982; 89: 1011–7.CrossRefGoogle Scholar
29Skikne, BS, Flowers, CH, Cook, JD. Serum transferrin receptor: a quantitative measure of tissue iron deficiency. Blood 1990; 75: 1870–6.CrossRefGoogle ScholarPubMed
30Mejia, LA. Role of vitamin A in iron deficiency anaemia. In: Fomon, SJ, Zlotkin, S, eds. Nutritional Anemias. New York: Raven Press, 1992.Google Scholar
31Helen Keller International (HKI)/Institute of Public Health Nutrition (IPHN). Vitamin A Status throughout the Lifecycle in Rural Bangladesh. Dhaka: HKI/IPHN, 1999.Google Scholar
32Goonewardene, M, Seekkuge, J, Liyanage, C. Iron stores and its correlation to haemoglobin levels in pregnant women attending an antenatal clinic. Ceylon Medical Journal 1995; 40: 67–9.Google ScholarPubMed
33Rusia, U, Flowers, C, Madan, N, Agarwal, N. Serum transferrin receptors in detection of iron deficiency in pregnancy. Annals of Hematology 1999; 78: 358–63.CrossRefGoogle ScholarPubMed
34Åkesson, A, Bjellerup, P, Berglund, M, Bremme, K, Vahter, M. Serum transferrin receptor: a specific marker of iron deficiency in pregnancy. American Journal of Clinical Nutrition 1998; 68: 1241–6.CrossRefGoogle ScholarPubMed
35World Health Organization (WHO). Nutritional Anaemias. Technical Report Series No. 503 Geneva: WHO, 1972.Google Scholar
36International Nutritional Anemia Consultative Group (INAGC)/World Health Organization (WHO). Iron Deficiency in Women. Geneva: INACG/WHO, 1989.Google Scholar
37The World Bank. Staff Appraisal Report. Bangladesh Integrated Nutrition Project. Dhaka: The World Bank, 1995.Google Scholar
38DeMaeyer, EM. Preventing and Controlling Iron Deficiency Anaemia through Primary Health Care. A Guide for Health Administrators and Programme Planners. Geneva: World Health Organization, 1989.Google Scholar
39Yip, R. Iron supplementation during pregnancy: is it effective? American Journal of Clinical Nutrition 1996; 63: 853–5.CrossRefGoogle ScholarPubMed
40Stoltzfus, R. Iron-deficiency anemia: reexamining the nature and magnitude of the public health problem. Summary: implications for research and programs. Journal of Nutrition 2001; 131: 697S–701S.CrossRefGoogle ScholarPubMed