| Research Article |
Open Access |
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| The Prevalence of Anaemia among Reproductive Age Group (15-45 Yrs)
Women in A PHC of Rural Field Practice Area of MM Medical College,
Ambala, India |
| Prabhaker Mishra1*, S.K.Ahluwalia2, P.K.Garg3, Ranjana Kar4 and G.K.Panda5 |
| 1Assistant Professor (Bio-statistics), Department of Community Medicine, M.M. Institute of Medical Sciences & Research, Mullana, Ambala, Haryana-133203, India |
| 2Professor & Head, Department of Community Medicine, M.M. Institute of Medical Sciences & Research, Mullana, Ambala, Haryana-133203, India |
| 3Associate Professor, Department of Community Medicine, M.M. Institute of Medical Sciences & Research, Mullana, Ambala, Haryana-133203, India |
| 4Lecturers in Statistics, Rural Health Center, Jagatsinghpur, Orissa-754103, India |
| 5Professor & Deputy Director, Population Research Centre, Vani-vihar, Bhubaneswar, Orissa-751004, India |
| *Corresponding author: |
Prabhaker Mishra
Assistant Professor (Bio-statistics)
Department of Community Medicine
M.M. Institute of Medical Sciences & Research
Mullana, Ambala, Haryana-133203, India
Tel: 9896888169
E-mail:
mishrapk79@gmail.com |
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| Received February 07, 2012; Accepted July 19, 2012; Published July 21, 2012 |
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| Citation: Mishra P, Ahluwalia SK, Garg PK, Kar R, Panda GK (2012) The
Prevalence of Anaemia among Reproductive Age Group (15-45 Yrs) Women
in A PHC of Rural Field Practice Area of MM Medical College, Ambala, India. J
Women’s Health Care 1:113. doi:10.4172/2167-0420.1000113 |
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| Copyright: © 2012 Mishra P, et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited. |
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| Abstract |
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| Background: Anaemia is one of the most common causes of malnutrition and it has a great public health
significance affecting children, adolescents and women of reproductive age worldwide. Thus, there is a need to
investigate the prevalence of anaemia particularly among females in their reproductive aged 15 to 45 years in The
magnitude of anaemia in the general population of Ambala district has not yet been well documented. |
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| Objective: To estimate the magnitude of anaemia among women of reproductive age in a PHC of Ambala district
of Haryana. |
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| Methods: A cross-sectional study of analytical nature was conducted in one cluster (village) namely Barara drawn
from a PHC Barara of the Ambala district between May to July 2010. A total of 598 women of reproductive age (15-45
years) were clinically examined. Sahli´s Haemoglobinometer method was used to examine the level of hemoglobin
(Hgb). |
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| Results: The prevalence rate of any anaemia was 96.8%. The majority of anaemic women were in the category
of mild (75.3 %) to moderate (16.9%) and severe Anaemia was 7.8%. A significantly higher proportion of anaemia
96.8% (95% CI: 78.0 to 98.0%)]. Though the most affected age group was 21-25 years but the difference noted was
not statistically significant. |
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| Conclusion: The study substantiates the existence of mild to moderate form of anaemia among women of
reproductive age and underlines the need for iron supplementation to all reproductive women especially during the
antenatal period with more attention to the most affected regions. |
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| Keywords |
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| Anaemia among reproductive age; Nutritional problem;
Hemoglobin; Mild; Moderate; Severe |
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| Introduction |
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| Anaemia is one of the most common nutritional disorders and it
has public health importance in developing countries like India where
it is the most widespread nutritional problem and common cause of
anaemia in adolescents and women of reproductive age. WHO has
estimated that prevalence of anaemia in pregnant women is 14%
in developed and 51% in developing countries while it is 65-75% in
India [1,2]. As a result, about one-third of the global population (over
2 billion) is anaemic [3]. The economic and social consequences
of anaemia, as yet un-quantified, are thought to be enormous
including a significant drain on health care, education resources
and labour productivity, and reduced physical and mental capacity
of large segments of the population. Although the most important
determinant factor of anaemia is poor bioavailability of dietary iron in
most developing countries, intestinal parasites, especially hookworm
infestation are reported to be a major cause [4,5]. Other causes include
malaria and congenital hemolytic diseases. The etiology of anaemia in
India is not well established and the information available is limited
in representativeness of the whole country. Various researchers
have come up with different conclusions despite the problems.
Because large proportion of population is under poor economic
status it results into shortage of minerals and vitamins implying that
the bioavailability of much of the iron in the average Indian diet is
restricted, presumably affecting the iron status of the community [6].
In view of the discrepancies and non-conclusive results available in the country, we have examined the magnitude of anaemia among women
of reproductive age in Ambala district of the Haryana. |
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| What is Anaemia? |
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| Anemia is a condition characterized by a decrease in the
concentration of hemoglobin in the Blood [7]. Hemoglobin is necessary
for transporting oxygen to tissues and organs in the body. The reduction
in oxygen available to organs and tissues when hemoglobin levels are
low is responsible for many of the symptoms experienced by anemic
people. The consequences of anemia include general body weakness,
frequent tiredness, and lowered resistance to disease. Anaemia can be a
particularly serious problem for pregnant women, leading to premature
delivery and low birth weight. Overall, morbidity and mortality risks
increase for individuals suffering from anaemia. Hemoglobin testing
is the primary method of anaemia diagnosis. Based on concentration of hemoglobin in the blood, anaemia is classified into three groups as
mild, moderate or severe [8-10]. |
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| Mild anaemia |
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| Mild anemia corresponds to a level of hemoglobin concentration
of 9.0-10.9 gm/dl for pregnant women and 9.0-11.9 gm/dl for nonpregnant
women. Women with mild anaemia in pregnancy have
decreased work capacity. They may be unable to earn their livelihood if
the work involves manual labour. |
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| Moderate anaemia |
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| Moderate anaemia corresponds to a level of 7.0-9 gm/dl; women
with moderate anaemia have substantial reduction in work capacity
and may find it difficult to cope with household chores and child
care. Available data from India and elsewhere indicate that maternal
morbidity rates are higher in women with Hb below 8 gm/dl. They
are more susceptible to infections and recovery from infections may
be prolonged. Premature births are more common in women with
moderate anaemia. They deliver infants with lower birth weight and
perinatal mortality is higher in these babies. |
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| Severe anaemia |
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| For all of the tested groups, severe anaemia (<7.0 gm/dl) is more
dangerous. Severe anaemia is important because it indicates that there
may be one or more serious nutritional deficiencies or an underlying
medical problem that requires thorough assessment and treatment. |
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| The purpose of our study is to determine the frequency of different
causes of anemia in female patients of reproductive age group and to
determine the association between attributes. |
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| Materials and Methods |
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| This was a cross-sectional study of the prevalence of anaemia in
females of reproductive aged 15-45 years old. Study was conducted
during May to July 2010. Sample size of 598 female from the Barara
village of the Ambala district selected for the study. For this purpose,
two-stage cluster-sampling approach was adopted. In First stage we
selected one rural PHC namely Barara, out of three PHC using simple
random sampling. In second stage, we selected one village also namely
Barara among the entire village under this PHC. All the reproductive age
group women who were eligible and agree to participate have included
in the study. The study protocol was approved by the Institutional
Review Board of the MM institute of medical sciences & research,
Mullana, Ambala. Written informed consent was obtained from each
subject for their participation after the nature of the study was fully
explained to them in their local languages. From all the participants,
prior to enrolment, hemoglobin concentration was measured using
portable Sahli´s Haemoglobinometer method. Anaemia was defined as
Hgb <11 gm/dl in pregnant women and <12 gm/dl for non-pregnant
women. Adjustment was made for pregnancy and then converted into
the international cut-off recommended by International Nutritional
Anaemia Consultative Group (INACG). Severe, moderate, and mild
anaemia was defined as Hgb below 7 gm/dl, 7-9 gm/dl and 9-11.9 gm/
dl respectively. Data were entered and compiled to avoid human errors. |
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| Statistical analysis |
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| Statistical Package for Social Science (SPSS) version 11.5.
Descriptive statistics were used to show the socio-demographic
characteristics of the anaemic patients. One way ANOVA have been
used to find out whether mean difference of hemoglobin level among
three anaemic groups are significant. Cross tabulations were used to see the association between different attributes. Univariate analysis has
been used to calculate the odds ratio. At minimum 95% confidence
intervals & p-value of less than 0.05 has been considered significance. |
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| Results |
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| Out of 598 respondents, 579 respondents have identified as
anaemic cases (96.8%) therefore the analysis was based on these
figures. Out of total anaemic cases, 27 were pregnant. The mean age
of the anaemic patients was 27.7 years and about 25%, 50% and 75%
patient’s age was less than 21 years, 27 years and 34 years respectively.
Number of females was highest in 21-25 year age group (25%) followed
by age 15-20 years (21%). Considering economic status, mean monthly
income was Rs 9643 per month, about 25%, 50% and 75% patients
income was less than Rs 6000/- , Rs 8500/- and Rs 12000/- respectively.
For hemoglobin status, mean hemoglobin level was 9.5 and, about
25%, 50% and 75% patients it was less than 9.02, 9.24 and 10.4 gm/dl
respectively (Table 1). Table 2 shows the distribution of anaemia and its
severity as determined by hemoglobin level. When the level of anaemia
is disaggregated by severity, the majority of anaemic cases were of
mild (75.5%) followed by moderate (16.9%). The mean difference of
hemoglobin levels among mild, moderate and severe anaemic group
was significant (P<0.05). When we see the association between grades
of anaemia with attributes, we find that age category is not showing
significant association with grades of anaemia (P>0.05) while income
was highly significantly associated with grades of anaemia (P<0.05).
Univariate analysis shows that less than 30 years age group women
have more chances to have moderate & severe anaemia (<9 gm/dl)
comparisons to more than 30 years age group women (Odds Ratio =
1.31, 95% C.I. = 0.88–1.96) while less than Rs 10,000/- income group
women have more chances to having moderate & severe anaemia
comparisons to more than Rs 10,000/- income group women (Odds
Ratio = 4.80, 95% C.I. = 2.96-7.79). |
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Table 1: Descriptive statistics of the studied subjects. |
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Table 2: General information of the studied subjects. |
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| Discussion |
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| It was a community based study in which we included female
patients of reproductive age group. In the sample of 579 respondents,
178 were unmarried. In this study, results showed that 96.8% patients
were found to have anaemia and majority of the patients (63.9%) were
aged 15-30 years. The odds ratio also indicates that 15-30 years women
have chances of having anaemia, hence, the maximum of reproductive
age group women between 15-30 years are under childbearing stage
and they have given births, which is a major sensitive time to cause anaemia. The economic status of most patients in our sample was low;
about 6.4% patients had monthly income of less than Rs 5,000/- and
53.5% patients income was vary between Rs 5000/- to Rs 10000/-.
About 40% patients income was more than Rs 10000/-. This means
that anaemia was more common in low socioeconomic class, the
reasons were varied but the most important was inadequate amount of
food which shown that the nutritional scores also followed the above
pattern and were much less in low income groups (Table 3). Besides
age and income, there are some others factors like parity, awareness
and health services is also a influencing factors for anaemia which is
not observed in this study. In many studies it was found that anaemia
is a common problem in reproductive age group women because due
to low income they are unable to take dietary food, lack of awareness
is also a main cause of anaemia. Iron deficiency is the most common
cause of anaemia worldwide. It frequently occurs due to inadequate
iron intake, chronic blood loss or disease, mal-absorption, or a
combination of all these factors. Similarly data from NNMB surveys
[11] showed that iron and folic acid intake in the country in all the
age groups was very low. It affects one’s development, growth and
resistance to infections, and is also associated with mortality among
children younger than two years old. Iron deficiency usually develops
in a sequential manner over a period of negative iron balance, such as
periods of blood loss and/or prolonged iron-deficient diet, accelerated
growth in children and adolescents as well as during pregnancy and
lactation [12]. Further research is recommended to identify the specific
risk factors for anaemia. It may be helpful to implement measures to
improve nutritional knowledge and awareness among mothers and
health workers. Finally, nutrition education and intervention programs
should address anaemia with a focus on both the dietary quantity. All
of these interventions must be monitored for effectiveness [13]. |
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Table 3: Association of the grade of anaemia with attributes. |
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| Conclusions |
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| It is concluded that the women who were under peak childbearing age as well as low income group have more chances to experience
by anaemia because there is a definite role of nutritional deprivation
in the development of anaemia and lack of balanced diet especially
deficient in protein group has much stronger association with this
type of anaemia. There are some others factors like heavy menstrual
blood loss and parity levels may account for such an effect and thus
calls for iron supplementation to all reproductive women during the
antenatal period Although in the tenth five year Plan [14] suggested
multipronged strategies for the control of anaemia in pregnancy but
there are more attention have required specially in the most affected
regions. |
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| References |
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- Kalaivani K (2009) Prevalence & consequences of anaemia in pregnancy. Indian J Med Res 130: 627-633.
- DeMayer EM, Adiels-Tegman M (1998) Prevalence of anaemia in the World. World Health Stat Q 38: 302-316.
- WHO (2004) Micronutrient deficiency: Battling iron deficiency anaemia: the challenge.
- Gupte S (2000) Recent Advances in Pediatrics. Jaypee Brothers Medical Publishers, New Delhi.
- Kapi I G, Atlee A (1998) Iron deficiency anemia. Recent Advanccs In Pediatrics. Jaypee Brothers 218-235.
- ICMR Evaluation of National Anaemia Prophylaxis Programme (1989) ICMR Task Force Study. Indian Council of Medical Research, New Delhi.
- International Institute for Population Sciences (IIPS) & Macro International (2007) National Family Health Survey 2005-06 (NFHS-3).
- Prema Ramachandran (1989) Nutrition in Pregnancy. Women and nutrition in India, Nutrition Foundation of India 153-193.
- Sood SK, Ramachandran K, Mathur M, Gupta K, Ramalingaswami V, et al. (1974) WHO sponsored collaborative studies on nutritional anaemias in India.1. The effects of supplemental oral iron administration to pregnant women. QJM 44: 241-254.
- Khatry J (2008) Study on sustainability of management of moderate anaemia in pregnant women and its impact on birth weight dissertation for MD CHA submitted. University of Delhi, Delhi.
- National Nutrition Monitoring Bureau (NNMB), 1975-2006 (2008) NNMB Reports. National Institute of Nutrition, Hyderabad.
- World Health Organization. (2002) The World Health Report 2002: Reducing risks, promoting healthy life. Geneva, World Health Organization.
- Iron deficiency anaemia: assessment, prevention, and control. (2001) A guide for programme managers. Geneva, World Health Organization, (WHO/NHD/01.3).
- Planning Commission Five-Year Plan 2002-2007 (2002) Sectoral policies and programmes. Nutrition. Government of India, New Delhi.
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