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ORIGINAL ARTICLE
Year : 2016  |  Volume : 29  |  Issue : 4  |  Page : 1005-1011

Epidemiology of iron-deficiency anemia among pregnant women in menoufia governorate, Egypt and Taiz Governorate, Yemen: Acomparative study)


Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt

Date of Submission01-Apr-2015
Date of Acceptance25-Jul-2015
Date of Web Publication21-Mar-2017

Correspondence Address:
Samar H. A. Al-oshari
Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Al-glaa al-bahary Street, Shebin El-Kom 32111, Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.202491

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  Abstract 

Objectives
The aim of this study was to estimate and compare the prevalence of iron-deficiency anemia (IDA) and identifying its possible risk factors among pregnant women in Menoufia Governorate, Egypt and Taiz Governorate, Yemen.
Background
Iron deficiency is the most prevalent nutritional disorder in the world. Nearly 2 billion people experience anemia. Iron deficiency is the most frequent cause of anemia especially in pregnant women.
Participants and methods
A cross-sectional case–control study was carried out in Shebin El-kom district and Taiz city in Menoufia Governorate, Egypt and Taiz Governorate, Yemen. The study sample consisted of 365 pregnant women (177 Egyptian pregnant women and 188 Yemeni pregnant women). Women were asked to complete a predesigned questionnaire. Blood samples were collected for complete blood count, and stool analysis was done.
Results
The prevalence of IDA was higher among Egyptian pregnant women than Yemeni pregnant women (52.5 and 32.9%, respectively). IDA was higher in second trimester among Egyptian pregnant women (65.7%) and higher in third trimester among Yemeni pregnant women (51.7%). IDA was higher in low socioeconomic standard families in Egyptian and Yemeni pregnant women (68.1 and 47.5%, respectively). Increased parity and lack of iron supplementation during pregnancy increase the risk of anemia among both studied groups There were significant relationships between pregnant women without anemia and those with anemia regarding dietary habits and other hematological values.
Conclusion and recommendations
The prevalence of iron deficiency is high among pregnant women, and the results of the present study could aid in the development of an IDA program that emphasizes iron supplementation and improved diet, including the consumption of iron-rich diet, among pregnant women in Egypt and Yemen. It should also encourage women for antenatal care during pregnancy.

Keywords: anemia, epidemiology, iron deficiency, pregnant women


How to cite this article:
Abu Salem ME, Mahrous OA, El Shazly HM, Ibrahem RA, Al-oshari SH. Epidemiology of iron-deficiency anemia among pregnant women in menoufia governorate, Egypt and Taiz Governorate, Yemen: Acomparative study). Menoufia Med J 2016;29:1005-11

How to cite this URL:
Abu Salem ME, Mahrous OA, El Shazly HM, Ibrahem RA, Al-oshari SH. Epidemiology of iron-deficiency anemia among pregnant women in menoufia governorate, Egypt and Taiz Governorate, Yemen: Acomparative study). Menoufia Med J [serial online] 2016 [cited 2020 Feb 27];29:1005-11. Available from: http://www.mmj.eg.net/text.asp?2016/29/4/1005/202491


  Introduction Top


Iron-deficiency anemia (IDA) is a decrease in the total hemoglobin levels caused by a lack of sufficient iron. It is the most common cause of anemia worldwide [1].

Globally, anemia affects 1.62 billion people. The highest prevalence is in preschool-age children (47.4%) and the pregnant women (41.8%), with the lowest prevalence in men (12.7%) [2].

The WHO defines anemia during pregnancy as a hemoglobin level of less than 11 g/dl or hematocrit level less than 33%, at any point during pregnancy [3].

According to the WHO 2008 report, the prevalence of IDA among pregnant women in Egypt and Yemen was 45 and 58%, respectively [2].

IDA has both physiologic and pathologic causes. Physiologic causes relate to the greater iron demands during periods of growth and development, whereas pathologic causes refer to iron losses secondary to a chronic medical condition. The etiology of IDA is certainly multifaceted [4].

IDA in pregnancy may have a serious effect on the health of both the mother and the baby. Anemia can increase maternal and infant morbidity and mortality [5].

Iron transport in the plasma is carried out by transferrin, which donates iron to cells through its interaction with a specific membrane receptor [6].

A full blood count is taken routinely in pregnancy and may show low hemoglobin, mean cell volume (MCV), mean cell hemoglobin (MCH), and mean cell hemoglobin concentration (MCHC); a blood film may confirm presence of microcytic hypochromic red cells and characteristic 'pencil cells' [7].

There are four basic approaches for the prevention and control of iron deficiency [8]: nutrition education and diet modification, iron supplementation, control of infection through public health activities, and fortification of a suitable staple food with iron.

In 1989, the WHO recommended universal supplementation of all pregnant women with 60 mg ferrous iron twice daily in populations where gestational anemia is common and once daily in populations where overall iron nutrition is better [9].

The motivation behind this study is to present the importance of IDA and its expected adverse effect on pregnancy and pregnancy outcome and to also show the lack of sufficient information about its prevalence and risk factors among pregnant women in Menoufia Governorate, Egypt and Taiz Governorate, Yemen.


  Participants and Methods Top


This study was conducted during the period from 1 December 2013, to the end of October 2014. It was carried out in Menoufia Governorate, Egypt and Taiz Governorate, Yemen, at primary health care centers. The Menoufia Faculty of Medicine Committee for Medical Research Ethics reviewed and formally approved the study before it began. Approval from Ministry of Health was obtained, and all participants gave oral consent.

Multistage random sampling was conducted. Of nine districts in Menoufia Governorate, one district (Shebin El-Kom) was chosen randomly. From that district, one urban primary health care center (Shebin El-kom bahary center) and one rural (AL-batanon PHC center) primary health care center were chosen randomly. Then, the studied population was chosen randomly 2 days/week in the selected primary health care centers. Of the 22 districts in Taiz Governorate, two (Sala and Mawia) were chosen randomly. Of those districts, one rural primary health center (Mawia PHC center) and one urban primary health center (14 October pHC) were chosen randomly, and then the studied population were chosen randomly every other day in the selected primary health care centers.

All participants were subjected to a predesigned questionnaire that includes personal and sociodemographic data, medical and obstetric history, food frequency questionnaire, general examination, and blood investigations.

Blood samples were taken to the laboratory and were processed and examined immediately for complete blood count, including hemoglobin percent, RBC count, hematocrit, MCH, MCV, and MCHC, for the diagnosis of anemia. Stool analysis was also done, with a response rate of 57% among Egyptian pregnant women and 87.2% among Yemeni pregnant women.

The total sample size included 177 Egyptian pregnant women and 188 Yemeni pregnant women.

Statistical analysis

Data were collected, tabulated, and statistically analyzed using IBM personal computer with Statistical Package of Social Science (SPSS Inc., Chicago, IL, USA), version 16 and Epi Info 2000 programs, where the following statistics were applied: student's t-test, Z-test, c 2-test, and odds ratio (a measure of association between an exposure and an outcome). P less than 0.05 was considered statistically significant.


  Results Top


This study shows that the prevalence of IDA among studied Egyptian pregnant women was significantly higher than studied Yemeni pregnant women (52.5 vs. 32.9%) ([Table 1]).
Table 1 Comparison between Egyptian and Yemeni pregnant women regarding the prevalence of iron-deficiency anemia

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The prevalence of IDA was higher in second trimester among studied Egyptian pregnant women (65.7%) and higher in third trimester among studied Yemeni pregnant women (51.7%) ([Table 2]). IDA prevalence was high among low socioeconomic standard families among both studied groups and among low educational level individuals in studied Egyptian pregnant women group only. The study showed that Egyptian women were of statistically significant higher age than Yemeni women (29.46 ± 5.4 vs. 24.67 ± 4.9, respectively). As for working status, working Egyptian pregnant women had a higher rate of IDA (50%) than working Yemeni pregnant women 28.5% ([Table 3]).
Table 2 Duration of gestation and prevalence of iron-deficiency anemia among studied pregnant women

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Table 3 Sociodemographic characteristics of the studied pregnant women

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Parity of at least 3 and lack of iron supplementation during pregnancy were significantly associated with increase risk of IDA among both studied groups ([Table 4]). The prevalence of IDA was significantly lower among pregnant women who more frequently consume red meat, white meat, eggs, fresh fruits, and green vegetable in both studied groups.
Table 4 Distribution of studied pregnant women according to obstetric and medical history

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The prevalence of IDA was higher among pregnant women who more frequently consumed tea in both studied groups. In comparison of anemic groups (Egyptian and Yemeni) according to type and frequency of food intake more than twice per week, the study showed that there was statistically significant difference between them regarding frequency of intake of red meat, egg, fresh fruit, and vegetable respectively ([Table 5]). Concerning the mean hematological values of hemoglobin, hematocrit and MCV were low in pregnant women with anemia in both studied groups [Figure 1]. Parasitic infestation was more among women with IDA than those without IDA in Egyptian and Yemeni pregnant women [Figure 2]. Regarding the type of parasitic infestation, this study showed the presence of Entamoeba histolytica and Giardia lamblia among Egyptian pregnant women with anemia and E. histolytica, G. lamblla, or both, and Hymenolepis nana among Yemeni pregnant women with anemia [Figure 3].
Table 5 Number and percent distribution of studied pregnant women regarding dietary habits per week

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Figure 1: Hematological values among pregnant women with iron-deficiency anemia and those without in both studied groups.

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Figure 2: Iron-deficiency anemia and parasitic infestation among Egyptian and Yemeni pregnant women.

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Figure 3: Comparison between Egyptian and Yemeni pregnant women with iron-deficiency anemia regarding types of parasitic infestation.

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  Discussion Top


In this study, the prevalence of IDA among Egyptian pregnant women was 52.5%; this result is less than that obtained by Fahamy et al. [10], who found that the prevalence of IDA was 66%. Moreover, the study found the prevalence among Yemeni pregnant women was 32.9%, and this result is in contrast with that stated by WHO [2], which reported that the prevalence among Yemeni pregnant women was 58%. The current study shows that prevalence of IDA was higher in second trimester in Egyptian pregnant women (65.7%) and higher in third trimester in Yemeni pregnant women (51.7%); this finding is similar to that found by Salahat and Abdallah [11], who found a statistically significant increase (P < 0.01) between the prevalence of anemia during the second and third trimesters versus the first trimester.

The present study showed that there was an insignificant difference between Egyptian and Yemeni pregnant women with IDA and those without regarding maternal age, a result that differs from the one by Hassan et al. [12], who found that maternal age is an independent risk factor for anemia. The current study reveals that prevalence of IDA was not influenced by the residence areas of Egyptian and Yemeni pregnant women with IDA and those without; this finding was inconsistent with that found by Husni [13], who analyzed various regions in Jordan and reported a rural area to have a higher prevalence rate of IDA.

Regarding socioeconomic standard, the prevalence of IDA was high among low socioeconomic status (SES) in both studied groups; this result is in agreement with that obtained by Scholl and Hediger [14], who reported that IDA in pregnancy was reported to be often associated with low SES. This can be explained, as poverty is a contributing factor to IDA, because families living at or below the poverty level may not be getting enough iron-rich foods. In the current study, illiteracy was higher among Egyptian women with IDA than those without (66.1 and 33.9%, respectively); similar findings have been shown in studies from several areas, including Al-Oraini [15], Saudi Arabia and Aikawa and Khan [16], Vietnam. This is may be because increased educational level is expected to improve knowledge and hence is expected to reflect more awareness regarding health problems.

In comparison of anemic groups regarding sociodemographic data, the study showed that there was statistically significant difference in working status, where Egyptian pregnant women who work had a higher rate of IDA (50%) than working Yemeni pregnant women (28.5%). Regarding SES, Egyptian pregnant women with low SES had higher incidence of IDA than Yemeni pregnant women with low SES (68.1 and 47.5%, respectively).

This study showed that parity of at least 3 seemed to be an important risk factor for anemia among Egyptian (69.1%) and Yemeni pregnant women (79%). This result is in accordance with that obtained by Looker et al. [17], who found that risk of IDA is increased with parity. This can be explained by the fact that iron stores get depleted and exhausted owing to frequent pregnancies and deliveries. However, the result disagrees with that obtained by Adam et al. [18], who found that there was no significant association between anemia and parity. The prevalence of IDA was high among Egyptian pregnant women without iron supplementation during pregnancy (63.5%) versus those who use iron during pregnancy (43.1%). Moreover, similar results were seen in Yemeni pregnant women who did not take and those who took iron supplementation during pregnancy (48.5 vs. 23.7%, respectively). This is in agreement with the findings by Ketut et al. [19], who found that the prevalence of IDA was higher in the group without iron pills intake compared with the group who take iron pills among pregnant Indonesian women.

Regarding type and frequency of food intake, this study showed that decreased frequency of eating red meat, white meat, eggs, and liver per week significantly increase risk for IDA among Egyptian and Yemeni pregnant women. This is in agreement with the findings by Mamdooh [20], whose study revealed that there was a significant association between eating food rich in iron and IDA. This can be explained as liver and meat are very rich in heme iron. There was a significant association between increased consumption of tea and IDA among studied Egyptian and Yemeni pregnant women. This is in agreement with the findings by Belgnaoui and Belahsen [21], who found that consumption of tea was significantly higher among anemic pregnant women. This can be explained as tea contains polyphenols, which inhibit nonheme iron absorption.

In comparison with type and frequency of food intake between Egyptian and Yemeni pregnant women with anemia, this study showed that Egyptian pregnant women with anemia more frequently consumed green vegetable, fresh fruit, and tea more than twice per week (45.5, 35.5, and 59.7%, respectively) than Yemeni pregnant women with anemia (21.6, 18.7, and 44.2%, respectively). Moreover, Yemeni pregnant women with anemia more frequently consumed red meat and egg than Egyptian pregnant women with anemia.

Regarding parasitic infestation among studied pregnant women, this study shows that parasitic infestation among Egyptian and Yemeni pregnant women with IDA is more than those without IDA; however, this increase was not significant among Egyptian pregnant women (P = 0.78) but was significant among Yemeni pregnant women (P < 0.001). We found that the parasite load in the sample was low. In this study, no hookworms were detected in stool analysis among the studied pregnant women. This result was support by Binetou and Robert [22], who found no association between parasitic infestation and prevalence of anemia, and it explains the finding that worm burden was low among studied pregnant women. However, this is in contrast to Shah and Baig [23], who found a strong association between anemia and helminthes infestations.


  Summary and Recommendations Top


There is a high prevalence rate of IDA among pregnant women in Menoufia and Taiz. Socioeconomic factors, multigravidity, and bad dietary habits are the main contributing factors of IDA among both studied groups. Therefore, it is recommended to increase awareness among women, their families, and communities about the risk of anemia in pregnancy, provide iron or iron folic acid supplements to pregnant women, counsel women about the importance of taking the full dose of iron folic acid supplements, and encourage women for early registration during pregnancy and also to attend postnatal visits during lactation for close supervision and effective follow-up.

Acknowledgements

The authors are grateful to all participants who generously agreed to participate and the administrator of primary health care centers who facilitated access to the study group.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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