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SHORT COMMUNICATION
Year : 2011  |  Volume : 55  |  Issue : 4  |  Page : 317-320  

Nutritional anemia and its epidemiological correlates among women of reproductive age in an urban slum of Bhubaneswar, Orissa


1 Assistant Professor, Department of Community Medicine, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
2 MBBS Student, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India

Date of Web Publication30-Jan-2012

Correspondence Address:
Ansuman Panigrahi
Assistant Professor, Department of Community Medicine, Kalinga Institute of Medical Sciences, Campus -5, KIIT University, Bhubaneswar, Orissa
India
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DOI: 10.4103/0019-557X.92415

PMID: 22298143

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   Abstract 

The present cross-sectional study involving 240 women of reproductive age as the study population was carried out in the beneficiary slum area, the field practice area of Community Medicine department to find out the burden of nutritional anemia and study its epidemiological correlates. The prevalence of anemia was found to be 60.8%, of which 39.6, 20.0 and 1.2% women had mild, moderate and severe anemia, respectively. Almost 63, 21.2 and 15.7% of the study subjects had microcytic hypochromic picture, indicative of iron deficiency anemia, normocytic hypochromic picture suggestive of early stage of iron deficiency anemia and dimorphic/ macrocytic hypochromic anemia implying iron deficiency anemia and or folate/vitamin B12 deficiency respectively. Statistical analyses have shown that epidemiological factors like age, education of respondents, socioeconomic status, history of excessive menstrual bleeding and inadequate intake of green leafy vegetables and pulses were found to be significantly associated with anemia.

Keywords: Anthropometric measurement, Hemoglobin estimation, Microcytic hypochromic, Nutritional anemia, Reproductive age


How to cite this article:
Panigrahi A, Sahoo PB. Nutritional anemia and its epidemiological correlates among women of reproductive age in an urban slum of Bhubaneswar, Orissa. Indian J Public Health 2011;55:317-20

How to cite this URL:
Panigrahi A, Sahoo PB. Nutritional anemia and its epidemiological correlates among women of reproductive age in an urban slum of Bhubaneswar, Orissa. Indian J Public Health [serial online] 2011 [cited 2014 Oct 22];55:317-20. Available from: http://www.ijph.in/text.asp?2011/55/4/317/92415

Nutritional anemia is a major public health problem worldwide particularly in developing countries among women of reproductive age. National Family Health Survey data shows that the prevalence of anemia among women of reproductive age in India is 56.1% whereas that in Orissa is 62.8%. [1] Nutritional anemia is defined by WHO as "a condition in which the hemoglobin content of blood is lower than normal as a result of deficiency of one or more essential nutrients regardless of the cause of such deficiency. The priority target groups, who are at high risk, are women of reproductive age (15-49 years), young children, during pregnancy and lactation. Nutritional anemia attributes to high maternal mortality, high incidence of low-birth weight babies, high perinatal mortality and fetal wastage. Also, iron deficiency may impair cellular immune response and increase susceptibility to infection. [2] Further, various factors like poverty, lower literacy, poor living condition, repeated births, and limited access to health care facilities make the women living in slums more prone to suffer from this disorder. Keeping in mind the above facts and in the light of scarcity of such studies done in this region, the present study is undertaken to find out the burden of nutritional anemia and study its epidemiological correlates among women of reproductive age in an urban slum of Bhubaneswar.

The present cross-sectional study was carried out in the beneficiary slum area under the purview of Urban Health and Training Center, field practice area of department of Community Medicine over the period July-August 2009. This slum is about 4 km away from the institution and was chosen as the study area for the convenience and easy accessibility of the investigators. Considering the prevalence of anemia in women of reproductive age as 62%, [1] allowable error 10% at 95% level of significance, the estimated sample size was calculated as 235.

All 782 households in the slum constituted the sampling frame. Using systematic random sampling; every 3 rd household was selected for the study purpose and only one eligible, willing respondent from each household was included in the study. Overall, 240 women from 240 households were interviewed and examined after obtaining the written informed consent. Women aged between 15 and 49 years and willing to participate in the study were included whereas non volunteers, pregnant and lactating women and those having chronic illness, infection, mental disorder, chronic alcoholism were excluded from the study. In case of presence of two or more study subjects in one household, only one respondent was randomly chosen and if no woman was found in the selected household, the next adjacent household was approached. Using the predesigned and pretested schedule, all relevant information including socio demographic characteristics, dietary habits and medical history etc. was collected. Socioeconomic status was estimated according to the modified Kuppuswamy's scale. [3] Clinical examination for the signs of anemia and anthropometric measurement of height and weight of the study respondents was done. For hematological investigations, 2 ml of venous blood from each study respondent was taken in a prenumbered vial containing EDTA (anticoagulant). All the sample vials were sent to the central laboratory, where the hemoglobin estimation was done by the cyanmethemoglobin method using photoelectric colorimeter. For interpretation of anemia, cutoff point for hemoglobin level taken was <12 g/dl. [4] The severity of anemia was graded as mild (10 - <12 g/dl), moderate (7 - <10 g/dl) and severe (<7g/dl). [5] For typing of anemia, a thin blood smear was prepared on a prenumbered clean glass slide and allowed to dry. Smear was stained with Leishman's stain and examined under the high power of the microscope. Complete blood count and Sickling test were done to exclude other pathological conditions. Expert opinion of a pathologist was sought while doing the hematological investigations. For dietary history, the diet taken by the women respondents during the last week was ascertained. Adequate intake of non vegetables like fish, meat, egg etc. / green leafy vegetables / pulses / milk and milk products was considered when the respondents had taken either of these at least three days during the last week. All information collected were compiled and analyzed using standard statistical analysis comparing proportions and continuous variables by the use of SPSS version-11 software.

A total of 240 women aged between 15 and 49 years were recruited in the study. Majority of the study respondents i.e., 103 (42.9%) were in the age group of 21 to 30 years. About 164 (68.7%) women were either illiterate or attended primary education. Out of 240 women, 83(34.6%), 81(33.7%) and 76 (31.7%) belonged to socio economic strata III (lower middle), II (upper middle) and IV (upper lower) respectively. When last week's dietary pattern was ascertained, it was revealed that 187 (77.9%) women consumed non vegetables like fish, meat, egg etc., 208 (86.7%) leafy greens, 151 (62.9%) legumes and 114 (47.5%) women had taken milk / milk products adequately in their meals.

The overall prevalence of anemia among studied women was 60.8%, of which 39.6, 20.0 and 1.2% had mild, moderate and severe anemia respectively. According to NFHS III data, the prevalence of anemia among married women aged 15-49 years in Orissa was 62.8%, [1] which is in consistent with the finding of the present study. Bentley and Griffiths analyzed the data from NFHS II for the state of Andhra Pradesh and observed that 58.8% married women aged 15-49 years were anemic of which 32.4, 14.2 and 2.2% had mild, moderate and severe anemia respectively. [6] Another cross-sectional study conducted by Brihan Muncipal Corporation in slum areas of Mumbai reported high prevalence (82.2%) of anemia among non pregnant women of reproductive age. [7] Among the women with anemia, the most common symptom complained was headache (67.3%) followed by weakness (61.7%), paraesthesia (46.3%), dyspnoea (45.6%), blurring of vision (37.7%) and syncope (22.4%).

The peripheral smear examination showed that 63% of subjects with anemia had microcytic hypochromic anemia which is indicative of iron deficiency anemia, whereas 21.2% subjects had early stages of iron deficiency reflected by normocytic hypochromic picture. Further, 7.5% of subjects had dimorphic anemia which is suggestive of the presence of iron deficiency anemia and folate / vitamin B12 deficiency. Another 8.2% women had macrocytic hypochromic anemia which results due to folate / B12 deficiency.

[Table 1] depicts the epidemiological correlates of anemia. Prevalence of anemia was significantly higher (P < 0.05) in women aged 31 to 40 years as compared to women belonging to other age categories. A significantly higher prevalence was noted in women who were illiterate or had only primary education (P < 0.01). Prevalence of anemia was also found to be significantly associated with socioeconomic status as anemia was higher in socioeconomic class IV (71.1%) and significantly reduced with rise in socioeconomic status being minimum (51.9%) in class II (P< 0.05). This might be due to availability and affordability of high-quality food with better socioeconomic status. This finding is in consistent with the findings from other studies. [6],[8] The relationship of poor diet i.e., inadequacy of green leafy vegetables and pulses with anemia was found to be statistically significant (P< 0.05) and this is in conformity with other studies, [6],[9] whereas relationship of anemia with intake of fish, meat, milk and milk products etc. was found to be insignificant. This might be due to the fact that adequacy of intake of these food items was ascertained based upon the frequency of intake i.e, number of days/ week but not the amount of food intake and number of servings/day. Again as dietary assessment was done only on the basis of last week's diet recall method and no blinding procedure was observed at any level in the study, there might be biased results. No significant association was observed between history of worm infestation and anemia which is in contrast with the findings of other studies. [8],[10] Prevalence of anemia was found to be significantly associated with history of excess menstrual bleeding (P=0.01). Other studies have also found significant association of anemia with excessive menstrual bleeding. [8] More number of women having two or more number of pregnancies were found to be anemic as compared to women having either one or no pregnancy. But this difference is not statistically significant whereas the study conducted by Brihan Municipality Corporation reported that those who were pregnant or who had a surviving child were significantly more likely to have lower mean hemoglobin values. [7]
Table 1: Epidemiological correlates of anemia in women of reproductive age

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It is evident from the current study that the burden of nutritional anemia is high among women residing in slum areas and on the basis of important epidemiological correlates, sincere efforts must be initiated adopting specific interventional measures with regard to nutrition education and anemia prophylaxis to reduce the morbidity due to anemia in this vulnerable group. However, further studies should be undertaken involving more number of slum areas to assess the true burden of nutritional anemia in this disadvantaged segment of population and to get more clarifications regarding various issues related to nutritional anemia.


   Acknowledgement Top


We acknowledge the financial grant awarded by the Indian Council of Medical Research (ICMR) to complete the STS project during the year 2009 (Sanction No. 21/OR/KIM-5/09-BMS). We also thank Avinash Rath, Debasis Pathi, Aditya Mishra, Amlan Tapan Mohapatra and Anshuman Das for their help and support rendered throughout the study.

 
   References Top

1.Family Welfare Statistics in India. Statistics division, Ministry of Health and Family Welfare, New Delhi: Government of India; 2006. p. 76.  Back to cited text no. 1
    
2.Park K. Park's Text Book of Preventive and Social Medicine. 17 th ed. Jabalpur, India: M/S Banarasidas Bhanot; 2002. p. 492-93, 509-10.  Back to cited text no. 2
    
3.Available from: http://www.medcosmospsm.blogspot.com. [Last accessed on 2011 May 10].  Back to cited text no. 3
    
4.WHO. Nutritional anaemias. Report of a WHO scientific group. World Health Organ Tech Rep Ser 1968;405:5-37.  Back to cited text no. 4
    
5.WHO. Control of nutritional anaemia with special reference to iron deficiency. Report of an IAEA/USAID/WHO Joint Meeting. World Health Organ Tech Rep Ser 1975;580:5-71.  Back to cited text no. 5
    
6.Bentley ME, Griffiths PL. The burden of anemia among women in India. Eur J Clin Nutr 2003;57:52-60.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Brabin L, Nicholas S, Gogate A, Gogate S, Karande A. Brihan Mumbai Municipal Corporation, Population and reproductive health programme at Liverpool. High prevalence of anemia among women in Mumbai, India. Available from: http://www.unu.edu/unupress/food/v193e/ch03.htm. [Last accessed on 2010 Nov 8].  Back to cited text no. 7
    
8.Kaur S, Deshmukh PR, Garg BS. Epidemiological correlates of nutritional anemia in adolescent girls of rural Wardha. Indian J Community Med 2006;31:255-8.  Back to cited text no. 8
  Medknow Journal  
9.Chandyo RK, Strand TA, Ulvik RJ, Adhikari RK, Ulak M, Dixit H, et al. Prevalence of iron deficiency and anemia among healthy women of reproductive age in Bhaktapur, Nepal. Eur J Clin Nutr 2007;61:262-9.  Back to cited text no. 9
[PUBMED]  [FULLTEXT]  
10.Goel S, Gupta BP. Low anemia prevalence among adolescent of an urban hilly community. Indian J Community Med 2007;32:5.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1]


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