Iron supplement use among Danish pregnant women

OBJECTIVES: To evaluate compliance with the national recommendation on supplemental iron to all pregnant women in Denmark and to explore differences between compliers and non-compliers with respect to dietary habits and other lifestyle factors. DESIGN: Intake of supplemental iron from pure iron supplements and from multivitamin and mineral preparations was estimated in mid-pregnancy. SETTING: Nationwide cohort study, the Danish National Birth Cohort (DNBC), comprising more than 100,000 women recruited in early pregnancy. SUBJECTS: Information on diet and dietary supplements was available for 54,371 women. Of these, information on lifestyle factors was available for 50,902 women. RESULTS: A high compliance with the recommendation was found, as approximately 77% of the women reported use of iron supplements during pregnancy. However, many of the compliers did not obtain the recommended doses of iron, which can partly be explained by the lack of iron preparations of appropriate doses available on the Danish market. Compliance with the recommendation was associated with age above 20 years, primiparity, body mass index<30 kg m- 2, non-smoking and long education. No major differences were seen in dietary intake between compliers and non-compliers.ConclusionOverall, a high compliance rate was found among participants of the DNBC but a clarification on daily dose is needed, and more concern should be paid to vulnerable groups such as young, smoking women and women with no or short education.     

Iron supplementation compliance among pregnant women in Bicol, Philippines

OBJECTIVE: To quantify factors influencing iron supplementation compliance and haemoglobin (Hb) concentrations among pregnant women participating in an iron supplementation programme under routine field conditions. DESIGN: Cross-sectional interviews and Hb measurements. SETTINGS: Albay and Sorsogon provinces, Bicol, Philippines. SUBJECTS: Three hundred and forty-six pregnant women receiving iron supplements via the Philippine iron supplementation programme. RESULTS: Women had a mean Hb concentration of 10.75 +/- 1.43 g dl-1, and 56.4% were anaemic (Hb < 11.0 g dl-1). On average, the first prenatal visit occurred at nearly 4 months (3.80 +/- 1.56). The ratio of visits to number of months pregnant was 0.51 +/- 0.24. Self-reported consumption of pills received was 85% (0.85 +/- 0.23), although pill counts suggested that consumption was 70% (0.70 +/- 0.35). Using multiple regression, an earlier first prenatal visit and greater self-reported compliance were positively associated with Hb concentrations. Additionally, perceived health benefits from taking the supplements and higher health programme knowledge were positively associated with pill consumption, while experiencing side-effects and disliking the taste of the supplements were associated with lower pill consumption. A greater number of living children was negatively associated with the frequency of prenatal visits. The number of children was also directly negatively associated with Hb concentrations. CONCLUSIONS: Compliance was positively related to Hb concentrations. Several factors associated with greater compliance were identified, including marital status, number of children, health programme knowledge, side-effects, perceived health benefits, and dislike of taste. Some of these factors may serve as avenues for interventions to increase compliance, and ultimately Hb concentrations.     

Aetiological factors and perception of anaemia in Tunisian women of reproductive age

OBJECTIVES: To identify aetiological factors in anaemia and to explore knowledge, perceptions and attitudes towards anaemia. DESIGN: Two cross-sectional surveys and sixteen focus group discussions. SETTING: The two regions with the highest prevalence of anaemia in Tunisia, Greater Tunis (GT) and the South West (SW). SUBJECTS: Two representative samples of 687 (GT) and 729 (SW) women of reproductive age; 108 women were included in focus group discussions. RESULTS: Among anaemic women, 63.4% in the GT region and 80.2% in the SW displayed iron deficiency (ID). Genetic haemoglobinopathies accounted for 10.0% and 3.6% of the cases of anaemia in the two regions, respectively. After adjustment for confounders, the major factors for iron-deficiency anaemia were low dietary Fe intake (OR = 5.0, 95% CI 3.0, 8.4), drinking tea after eating (OR = 3.4, 95% CI 2.0, 5.7) and pica (OR = 2.1, 95% CI 1.1, 3.9). Most of the women related anaemia to the following causes: malnutrition, lack of hygiene, and their heavy workload and responsibilities in the household. Many women connected anaemia with hypotension. Few established a relationship between ID and anaemia. They had confidence in their doctor for treatment, but many complained they were not given sufficient information. Low dietary Fe intake, inappropriate food practices and inadequate perceptions contribute to the aetiology of anaemia in women. CONCLUSIONS: These results point out to the need for a strategy combining food fortification, Fe supplementation for pregnant women, nutritional education for the general public and at-risk specific target groups, and training of health professionals.     

The potential effect of iron defortification on iron-deficiency anaemia in the US population

OBJECTIVE: To quantify the potential effect of iron defortification in the USA on iron-deficiency anaemia (IDA). METHODS: Monte Carlo models were built to simulate iron nutrition in the US population. A hypothetical cohort of 15 000 persons from the general population was used in 15-year simulations to compare the prevalence of IDA with and without fortification. RESULTS: With iron fortification, the prevalence of IDA was 2.4% for children aged 3-5 years, 5.4% for women aged 20-49 years, and 0.14% for men aged 20-49 years. The corresponding IDA estimates under iron defortification were 4.5%, 8.2% and 0.46%, respectively. Defortification had little effect on the distribution of iron indicators at or above the 50th percentile within each of these three groups and little effect on the distributions of iron indicators among adult men. CONCLUSION: Iron defortification is likely to increase IDA among children and women of reproductive age, but is not likely to have meaningful effects on the iron status of men or the majority of women and children.     

Risk factors for occupational injuries among full-time farmers in Finland

The objectives of this study were to evaluate the frequency of and farm management-related risk factors for occupational injuries among full-time farmers. A computer-assisted telephone interview was conducted among randomly selected self-employed full-time farmers (n = 1182; 911 male and 271 female), The response rate was 86%. Two-thirds of the respondents raised dairy or beef cattle. Nearly 16% of the farmers had experienced one or more occupational injuries requiring medical consultation during the past 12 months; the total number of such injuries was 222. Injuries were more common among male (17 injuries/100 person-years) than female farmers (13 injuries/ 100 person-years). The injuries occurred most frequently in animal husbandry work (n = 97). Falling or slipping was the most common mechanism of injury. Poisson regression with a stepwise (forward) model selection procedure identified the following risk factors for occupational injuries: male gender, younger age, cooperation with other farmers, perceived high accident risk, and stress symptoms. The adjusted rate ratios for these risk factors ranged from 1.40 to 1.96. This study indicates that interventions are needed, particularly among male farmers in their early years of full-time farm operation. At this stage of life, heavy financial burden and stress while establishing and expanding production may contribute to injuries. To reduce stress and related injuries, we recommend guidance for farmers regarding the organization and management of farm work.     

Breast-feeding initiation and exclusive breast-feeding in rural Vietnam

OBJECTIVE: To investigate the initiation of breast-feeding and exclusive breast-feeding within the first week after delivery for women in rural Vietnam. DESIGN: An interviewer-administered survey was conducted on a sample of rural women who gave birth during August-October 2002. SETTING: Quang Xuong District, Thanh Hoa Province of Vietnam. SUBJECTS: Four hundred and sixty-three women participated in the study, of whom 181 delivered at the district hospital (39.1%), 229 at a commune health centre (49.5%) and 53 at home attended by a traditional birth attendant (11.4%). RESULTS: Although the initiation and exclusive breast-feeding rates were relatively high at 98.3% and 83.6% respectively, the premature introduction of complementary food was a great concern. Logistic regression analysis showed that, together with socio-cultural determinants such as feeding preferences of the husband and maternal grandmother, feeding practices of friends, factors relating to delivery methods, delivery locations and health problems could influence the initiation rate and breast-feeding patterns. CONCLUSIONS: To promote breast-feeding practices of rural mothers, health education on breast-feeding should take into account local socio-cultural features in addition to improving the counselling skills of health workers.     

Inadequate intakes of dietary zinc among pregnant women from subsistence households in Sidama, Southern Ethiopia

OBJECTIVE: To assess the prevalence of zinc inadequacy based on dietary intakes and plasma zinc concentrations and, simultaneously, the prevalence of inadequate intakes of energy, protein, calcium and iron. DESIGN: A cross-sectional study of a convenience sample of subsistence farming households in Sidama, Southern Ethiopia. SUBJECTS: Dietary intakes were calculated from 1-day weighed food records and 40 repeats from 99 pregnant women in the third trimester using analysed values of major staple foods for zinc, iron, calcium and phytate. The distribution of observed intakes was adjusted for usual intakes and the prevalence of inadequacy estimated using the estimated average requirement (EAR) cutpoint method. Prevalence of inadequacy for zinc, protein and iron intakes were compared with those based on biochemical measures. RESULTS: Prevalence of zinc inadequacy was very high: 99% for US FNB EAR and 100% for IZiNCG EAR compared to 72% based on low plasma zinc concentrations. Corresponding prevalence estimates for iron were much lower: 4% for inadequate intakes based on US FNB EAR vs. 8.7% for iron deficiency anaemia (haemoglobin < 110 g l-1; ferritin < 12 microg l-1) and 32.3% for low storage iron. Prevalence of inadequacy for protein was 100% for adjusted intakes and 91% for serum albumin < 32 g l-1. For calcium, 74% were at risk for inadequate intakes. CONCLUSION: The high prevalence of inadequate intakes of zinc and protein was reasonably consistent with those based on biochemical measures. Such dietary deficits could be overcome by regular consumption of cellular animal protein. In contrast, both dietary and biochemical measures of iron inadequacy were low.