Prevalence of anemia and iron deficiency among women in rural Nepal - A cross-sectional cohort study

Abstract

Abstrakt Mål: Det er lite kunnskap om prevalens av anemi blant kvinner i rurale Nepal, og denne studien ønsket å utvide kunnskapsgrunnlaget. Vi ville også undersøke forekomsten av jernmangel.

Metode: Data ble samlet inn i 2019-2020 fra ikke-gravide, gifte kvinner i Bolde. Kvinnene bodde på 1800 meters høyde over havet. Som anbefalt av WHO, brukte vi grenseverdi på 12.7 g/dL for hemoglobin, i stedet for 12.0 g/dL for å definere anemi. For å finne jernstatus hos kvinnene brukte vi markørene ferritin, jern og TIBC, i tillegg til å kalkulere transferrinmetning.

Resultater: Totalt bestod studien av 714 kvinner fra 21 til 82 år. Median hemoglobin var 14.4 g/dL (10.4-18.2 g/dL). Den vanligste etniske gruppen var Adhivasi/Janajati (82.8%), de fleste hadde månedlig inntekt under NPR 24 000 (65.7%) og manglet formell utdanning (84.9%). Prevalensen av anemi var 5.7%, og varierte fra 5.4% til 6.1% blant henholdsvis postmenopausale kvinner og kvinner i reproduktiv alder. Kvinner fra 21-30 år hadde en høyere prevalens med 13.2%, men forskjellen var ikke signifikant. Median jernverdi var 110 µg/dL (15-301 µg/dL) og median transferrinmetning var 27.1% (3.9-79.4%). Basert på ferritin ≤15 ng/mL og ≤30 ng/mL, hadde henholdsvis 4.1% og 18.3% jernmangel. Blant kvinnene med anemi var det 20% som hadde jernmangelanemi. Vi fant hemoglobinverdier over referanseområdet (>16 g/dL) blant 7.0% av kvinnene.

Konklusjon: Vi fant en lavere forekomst av anemi sammenlignet med landsgjennomsnittet, men funnene våre var sammenlignbare med studier fra samme område. I tillegg fant vi en proporsjonalt lavere forekomst av jernmangelanemi sammenlignet med andre studier fra regionen.

Abstract Objective: There are few data on the prevalence of anemia among women in rural Nepal, and the study aimed to expand the knowledge on the subject. We also wanted to examine the frequency of iron deficiency, as well as study the risk factors associated with anemia.

Methods: Data were collected in 2019-2020 from non-pregnant, married women in Bolde. The women were residing at an altitude of about 1890 meters above sea level. To adjust for altitude, we used a cut-off of 12.7 g/dL for hemoglobin instead of 12.0 g/dL to define anemia, as recommended by WHO. Ferritin, iron and TIBC were analyzed, and transferrin saturation was calculated to assess iron status.

Results: Altogether, 714 women aged 21-82 years were included. The median hemoglobin was 14.4 g/dL (10.4-18.2 g/dL). Most of the study population belong to the Adhivasi/Janajati ethnicity (82.8%), had a monthly income less than NPR 24 000 (65.7%) and did not have any formal education (84.9%). The prevalence of anemia was 5.7%, and the frequency varied from 5.4% to 6.1% among postmenopausal women and women of reproductive age respectively. Women aged 21-30 displayed the highest prevalence of anemia (13.2%), but the difference was not significant. Median iron level was 110 µg/dL (15-301 µg/dL), and the median transferrin saturation was 27.1% (3.9-79.4%). Based on ferritin levels of ≤15 ng/mL and ≤30 ng/mL, 4.1% and 18.3% had iron deficiency. Among those with anemia, 20% had iron deficiency anemia. We found that 7% of the population exhibited hemoglobin levels above the upper reference range (>16 g/dL).

Conclusion: The prevalence of anemia among women in rural Nepal was low compared to the nationwide rate, however in line with previous studies from the same area. Furthermore, we found the frequency of iron deficiency anemia to be proportionally lower compared to other studies from the region.