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Reducing iron deficiency anaemia due to heavy menstrual blood loss in Nigerian rural adolescents

Published online by Cambridge University Press:  01 December 1998

Fiona Barr ,
Loretta Brabin ,
Shola Agbaje ,
Fiekumo Buseri ,
John Ikimalo  and
Nimi Briggs
Fiona Barr
Affiliation:
Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
Loretta Brabin*
Affiliation:
Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
Shola Agbaje
Affiliation:
Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
Fiekumo Buseri
Affiliation:
Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
John Ikimalo
Affiliation:
Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
Nimi Briggs
Affiliation:
Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
*
*Corresponding author: E-mail [email protected]
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Abstract

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Objective:

Menstrual disorders are common in young women, and heavy menstrual blood losses (MBL) are an important cause of anaemia. Menstrual morbidity normally goes untreated in developing countries where cultural barriers also serve to mask the problems. We investigated the prevalence of menstrual morbidity, and measured MBL and its relationship to iron deficiency in a rural adolescent population. The rationale was to assess whether or not reducing heavy MBL could be part of a strategy to reduce iron deficiency anaemia.

Setting:

Rural village in south-east Nigeria.

Design:

Cross-sectional survey.

Subjects:

The study included all non-pregnant, unmarried nulliparous girls (< 20 years) who had menstruated, and who lived in K'Dere village.

Methods:

A field worker allocated to each girl completed a questionnaire, and supervised recovery and collection of soiled pads and ensured blood sampling. MBL was measured using the standard alkaline haematin method. Haemoglobin (Hb), serum iron, transferrin saturation and protoporphyrin levels (ZPP) were also measured.

Results:

307 girls completed MBL measurements; 11.9% refused to participate. 12.1% had menorrhagia (> 80 ml); median MBL was 33.1 ml. Menorrhagia was more frequent in girls who had menstruated for > 2 years (P = 0.048), and had longer duration of menses (P < 0.001). Iron status as measured by haematocrit, serum iron, transferrin saturation and ZPP values was inversely related to MBL. Neither height nor body mass index for age was associated with current iron status.

Conclusions:

The level of menorrhagia detected (12%) may be an ‘expected’ level for a condition which often has no underlying pathology. Heavy MBL is one of the most important factors contributing to iron deficiency anaemia. Measures are needed to alleviate menstrual disorders, and improve iron status. Oral contraceptives can be part of a strategy to reduce anaemia, particularly for adolescents at high risk of unwanted pregnancies.

Keywords

MenotrhagioAdolescentsNueriaIron statusOral contraceptives
Type
Research Article
Information
Public Health Nutrition , Volume 1 , Issue 4 , December 1998 , pp. 249 - 257
Copyright
Copyright © The Nutrition Society 1998

References

1Rees, MCP. Menstrual problems. In: McPherson, A, ed. Women's Problems in General Practice. Oxford: Oxford University Press, third edition, 1993: 170–97.Google Scholar
2Van Eijkeren, MA, Christiaens, GCML, Sixma, JJ, Haspels, AA. Menorrhagia: a review. Obstet. Gynecol. surv. 1989; 44: 421–9.CrossRefGoogle ScholarPubMed
3Southam, AL. Dysfunctional uterine bleeding in adolescence. Clin. Obstet. Gynecol. 1960; 3: 241–51.CrossRefGoogle ScholarPubMed
4Hallberg, L, Nilsson, L. Determination of menstrual blood loss. Scand. J. Clin. Lab. Invest. 1964; 16: 244–8.CrossRefGoogle ScholarPubMed
5Hurskainen, R, Teperi, J, Turpeinen, UI et al. Combined laboratory and diary method for objective assessment of menstrual blood loss. Acta Obstet. Gynecol. Scand. 1998; 77: 201–4.CrossRefGoogle ScholarPubMed
6Magos, AI. Management of menorrhagia. Br. Med. J. 1990; 300: 1537–8.CrossRefGoogle ScholarPubMed
7Hallberg, L, Höghdahl, AM, Nilsson, L, Rybo, G. Menstrual blood loss – a population study. Acta Obstet. Gynecol. Scand. 1966: 45: 320–51.CrossRefGoogle ScholarPubMed
8Rybo, G. Menstrual blood loss in relation to parity and menstrual pattern. Acta Obstet. Gynecol. Scand. 1966; 45: 25–45.CrossRefGoogle ScholarPubMed
9Kennedy, S. Primary dysmenorrhoea. Lancet 1997; 349: 1116.CrossRefGoogle ScholarPubMed
10Van Eijkeren, MA, Christiaens, GC, Geuze, HJ, Haspels, AA, Sixma, JJ. Effects of mefenamic acid on menstrual hemostasis in essential menorrhagia. Am. J. Obstet. Gynecol. 1992; 166: 1419–28.CrossRefGoogle ScholarPubMed
11Preston, JT, Cameron, IT, Adams, EJ, Smith, SK. Comparative study of tranexamic acid and norethisterone in the treatment of ovulatory menorrhagia. Br. J. Obstet. Gynecol. 1995; 102: 401–6.CrossRefGoogle ScholarPubMed
12Bonnar, J, Sheppard, BL. Treatment of menorrhagia during menstruation: randomised control trial of ethamsylate, mefenamic acid and tranexamic acid. Br. Med. J. 1996; 313: 579–82.CrossRefGoogle ScholarPubMed
13Chuong, CJ, Brenner, PF. Management of abnormal uterine bleeding. Am. J. Obstet. Gynecol. 1996; 175: 787–92.CrossRefGoogle ScholarPubMed
14Barrington, JW, Bowens-Simpson, P. The levonogestrel intrauterine system in the management of menorrhagia. Br. J. Obstet. Gynaecol. 1997; 104: 614–16.CrossRefGoogle Scholar
15Hallberg, L, Rossander-Hultén, L. Iron requirements in menstruating women. Am. J. Clin. Nutr. 1991; 54: 1047–58.CrossRefGoogle ScholarPubMed
16Brabin, L, Kemp, J, Obunge, OK, et al. Reproductive tract infections and abortion among adolescent girls in rural Nigeria. Lancet 1995; 345: 300–4.CrossRefGoogle ScholarPubMed
17Odujinrin, OM, Ekunwe, EO. Epidemiologic survey of menstrual patterns amongst adolescents in Nigeria. West Afr. J. Med. 1991; 10: 244–9.Google ScholarPubMed
18Fakeye, O, Adegoke, A. The characteristics of the menstrual cycle in Nigerian schoolgirls and the implications for school health programmes. Afr. J. Med. Sci. 1994; 23: 13–17.Google ScholarPubMed
19Newton, J, Barnard, G, Collins, W. A rapid method for measuring menstrual blood loss using automatic extraction. Contraception 1977; 16: 269–82.CrossRefGoogle Scholar
20Van Eijkeren, MA, Scholten, PC, Christiaens, GCML, Alsbach, GPJ, Haspels, AJ. The alkaline hematin method for measuring menstrual blood loss – a modification and its clinical use in menorrhagia. Eur. J. Obstet. Gynecol. Reprod. Biol. 1986; 22: 345–51.CrossRefGoogle ScholarPubMed
21Gibson, RS. Principles of Nutritional Assessment. New York: Oxford University Press, 1990.Google Scholar
22Freeman, JV, Cole, TJ, Chinn, S, Jones, PRM, White, EM, Preece, MA. Cross-sectional stature and weight reference curves for the UK, 1990. Arch. Dis. Child. 1995; 73: 17–24.CrossRefGoogle ScholarPubMed
23Cole, TJ, Freeman, JV, Preece, MA. Body mass index reference curves for the UK 1990. Arch. Dis. Child. 1995; 73: 25–9.CrossRefGoogle ScholarPubMed
24Cole, SK, Billewicz, WZ, Thomson, AM. Sources of variation in menstrual blood loss. Br. J. Obstet. Gynaecol. 1971; 78: 933–7.CrossRefGoogle ScholarPubMed
25Gao, J, Zeng, S, Sun, B, Fan, H, Han, L. Menstrual blood loss and haematologic indices in healthy Chinese women. J. Reprod. Med. 1987; 32: 822–6.Google ScholarPubMed
26Kadir, RA, Economides, DL, Sabin, CA, Owens, D, Lee, CA. Frequency of inherited bleeding disorders in women with menorrhagia. Lancet 1998; 351: 485–9.CrossRefGoogle ScholarPubMed
27Apter, D, Viinikka, L, Vihko, R. Hormonal patterns of adolescent menstrual cycles. J. Clin. Endocr. Metab. 1978; 47: 944–54.CrossRefGoogle ScholarPubMed
28Garden, AS. Problems with menstruation. In Garden, AS, ed. Paediatric and Adolescent Gynaecology. Arnold; 1998: 127–54.Google Scholar
29Hallberg, L, Hultén, L. Iron requirements, iron balance and iron deficiency in menstruating and pregnant women. In: Hallberg, L, Asp, NG, eds. Iron Nutrition in Health and Disease. London, Libbey, 1996: 165–82.Google Scholar
30Cheong, RL, Kuizon, MD, Tajaon, RT. Menstrual blood loss and iron nutrition in Filipino women. SE Asian J. Trop. Med. Publ. Health 1991; 22: 595–604.Google ScholarPubMed
31Brabin, L, Ikimalo, J, Dollimore, N, et al. How do they grow? A study of south-eastern Nigerian adolescent girls. Acta Paediatr.. 1997; 86: 1114–20.CrossRefGoogle Scholar
32Cohen, BJB, Gibor, Y. Anaemia and menstrual blood loss. Obstet. Gynecol. Surv. 1980; 35: 597–618.Google ScholarPubMed
33Fazio-Tirrozzo, G, Brabin, L, Brabin, B, Agbaje, O, Harper, G, Broadhead, R. A community based study of vitamin A and vitamin E status of adolescent girls living in the Shire Valley, southern Malawi. Eur. J. Clin. Nutr. 1998; 52: 1–6.CrossRefGoogle ScholarPubMed
34Shaw, RW. Assessment of medical treatments for menorrhagia. Br. J. Obstet. Cynaecol. 1994; 101: 15–18.CrossRefGoogle ScholarPubMed
35Iyer, V, Farquhar, C, Jepson, R. The effectiveness of oral contraceptive pills versus placebo or any other medical treatments for menorrhagia. In: Farquhar, C, Cooke, I, Barlow, D, eds. Menstnual Disorden and Subfertirity Module of the Cochrane Database of Systematic Reviews. Oxford: the Cochrane Collaboration Issue 4, 1998.Google Scholar
36West, CP. Dysfunctional uterine bleeding. Prescribers J. 1994; 34: 215–20.Google Scholar
37Collaborative Group on Hormonal factors in Breast Cancer. Breast cancer and hormonal contraceptives: collaborative re-analysis of individual data on 53,297 women with breast cancer and 100,239 women without breast cancer for 54 epidemiological studies. Lancet 1996; 347: 1713–27.CrossRefGoogle Scholar
38Hallberg, L, Hultén, L, Bengtsson, C, Lapidus, L, Lindstedt, G. Iron balance in menstruating women. Eur. J. Clin. Nutr. 1995; 49: 200–7.Google ScholarPubMed
39Robinson, JC, Plichta, S, Weisman, CS, Nathanson, CA. Ensminger, M. Dysmenorrhoea and use of oral contraceptives in adolescent women attending a family planning clinic. Am. J. Obstet. Gynecol. 1992; 166: 578–83.CrossRefGoogle ScholarPubMed
40Naeye, RL. Teenaged and pre-teenaged pregnancies. Consequences of the fetal-maternal competition for nutrients. Pediatrics 1981; 67: 146–50.CrossRefGoogle ScholarPubMed