Trends in the prevalence of anaemia in Japanese adult women, 1989-2003

OBJECTIVE: There is an increasing concern of anaemia in Japanese women, but no national trend data has existed to date. We analysed long-term national trends of anaemia in adult women. DESIGN: Secondary analyses of 15 consecutive cross-sectional nationwide surveys conducted during the period 1989-2003. Analyses were based on 5-year intervals (1989-1993, 1994-1998, 1999-2003). SETTING: Japan. SUBJECTS: The subjects included the National Health and Nutrition Survey of Japan (NHNS-J) population. Analyses were based on 50 967 non-pregnant/non-lactating women aged 20 years and over, with complete data sets. We stratified subjects into six age groups (20-29 years, 30-39 years, 40-49 years, 50-59 years, 60-69 years and 70+ years), and three age groups (20-49 years, 50-69 years, 70+ years) for analyses on residential areas (metropolitan, cities and towns). RESULTS: Decreases in trends of mean haemoglobin values (intravenous) were significant in all age groups. Changes in the prevalence of anaemia were significant only in women aged 30-39 and 40-49 years. Anaemia (haemoglobin < 12.0 g dl-1) increased from 16.8% to 20.6% in women aged 30-39 years, and from 20.2% to 26.9% in women aged 40-49 years, respectively. Prevalence was highest in women aged 70 years and older in all times, but no significant change was observed. CONCLUSIONS: Haemoglobin values have declined significantly in all ages in the last 15 years. Anaemia was especially significant in women aged 30-39 years and 40-49 years. Our findings suggest that a large number of young women in Japan are at risk of anaemia, so continuous monitoring and controlling efforts of this trend are needed.     

Comparison of blood folate levels among pregnant Chinese women in areas with high and low prevalence of neural tube defects

OBJECTIVE: To characterise plasma and red-blood-cell (RBC) folate status among pregnant women in an area with an extremely high prevalence of neural tube defects, and to compare them with those of women from a low prevalence area. DESIGN: A cross-sectional survey conducted in 2003. SETTING: One county and one city from each of the high prevalence area and the low prevalence area in China. SUBJECTS: Five hundred and sixty-two women in their first trimester of pregnancy in the high prevalence area and 695 pregnant women in the low prevalence area. RESULTS: Women in the high prevalence area had less than half the plasma and RBC folate concentrations (12.2 and 440.0 nmol l- 1, respectively) of women in the low prevalence area (33.5 and 910.4 nmol l- 1, respectively). In the high prevalence area, 40% of rural women were deficient in RBC folate and 50% were deficient in plasma folate; 20% of urban women were deficient in RBC folate and 30% deficient in plasma folate. In contrast, only 4% (RBC folate) and 6% (plasma folate) of rural women, and 2% (RBC folate) and 1% (plasma folate) of urban women, were folate-deficient in the low prevalence area. Less than 10% of rural and about 26% of urban women in the high prevalence area took folic acid periconceptionally, compared with 70% and 60% of women in the low prevalence area. CONCLUSIONS: Blood folate deficiency is highly prevalent among pregnant women in an area of China with a very high prevalence of neural tube defects.     

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.     

Maize meal fortification is associated with improved vitamin A and iron status in adolescents and reduced childhood anaemia in a food aid-dependent refugee population

OBJECTIVE: To assess changes in the Fe and vitamin A status of the population of Nangweshi refugee camp associated with the introduction of maize meal fortification. DESIGN: Pre- and post-intervention study using a longitudinal cohort. SETTING: Nangweshi refugee camp, Zambia. SUBJECTS: Two hundred and twelve adolescents (10-19 years), 157 children (6-59 months) and 118 women (20-49 years) were selected at random by household survey in July 2003 and followed up after 12 months. RESULTS: Maize grain was milled and fortified in two custom-designed mills installed at a central location in the camp and a daily ration of 400 g per person was distributed twice monthly to households as part of the routine food aid ration. During the intervention period mean Hb increased in children (0.87 g/dl; P < 0.001) and adolescents (0.24 g/dl; P = 0.043) but did not increase in women. Anaemia decreased in children by 23.4% (P < 0.001) but there was no significant change in adolescents or women. Serum transferrin receptor (log10-transformed) decreased by -0.082 microg/ml (P = 0.036) indicating an improvement in the Fe status of adolescents but there was no significant decrease in the prevalence of deficiency (-8.5%; P = 0.079). In adolescents, serum retinol increased by 0.16 micromol/l (P < 0.001) and vitamin A deficiency decreased by 26.1% (P < 0.001). CONCLUSIONS: The introduction of fortified maize meal led to a decrease in anaemia in children and a decrease in vitamin A deficiency in adolescents. Centralised, camp-level milling and fortification of maize meal is a feasible and pertinent intervention in food aid operations.     

Folate deficiency is associated with nutritional anaemia in Lebanese women of childbearing age

OBJECTIVE: The objective of this study was to identify the determinants of anaemia in Lebanese women of childbearing age attending health centres in Lebanon. DESIGN: Cross-sectional study carried out between May and December 2003. Anthropometric measurements as well as sociodemographic, health and dietary intake data were collected using a questionnaire. Haemoglobin (Hb), plasma ferritin, plasma folate and vitamin B12 were assessed using standard laboratory methods. SETTING: Governmental health centres in Lebanon. SUBJECTS: Four hundred and seventy non-pregnant Lebanese women aged 15-45 years. RESULTS: Anaemia (Hb <12 g dl(-1)) and iron deficiency (ferritin <15 microg l(-1)) were prevalent in 16.0 and 27.2% of the study sample, respectively. Of the total sample, 7.7% had iron-deficiency anaemia. The percentage of women with either Hb or ferritin deficiency or both was 35.6%. Plasma folate and vitamin B12 deficiency was reported in 25.1 and 39.4%, respectively, and 12.6% of the women had both folate and vitamin B12 deficiencies. Of the anaemic group, 48.0% of the women had iron deficiency. The intake of iron was lower in iron-deficient than in non-deficient women and a positive relationship was shown between folate intake and its corresponding serum levels. Regression analysis showed that ferritin, plasma folate and family history of anaemia were significant determinants of the anaemia in the sample of women. CONCLUSIONS: Anaemia not related to iron deficiency was partly explained by plasma folate deficiency. Measures to control folate and iron deficiency should be considered.     

Risk factors and prevalence of declined work ability among dairy farmers

Farm work, particularly with livestock, exposes farmers to injuries, occupational diseases, and disabling health conditions, which in many cases result in early retirement and loss of quality of life. The objectives of this study were to evaluate the prevalence of and risk factors for declined work ability among full-time dairy farmers. We conducted a postal survey using the standard Work Ability Index (WAI) questionnaire augmented with a form containing questions about working conditions and lifestyle factors that potentially affect work ability. We received 399 usable responses (245 female and 154 male; 41.5% response rate). The prevalence of declined work ability (poor or moderate WAI score) was 39% overall, 44% among females, and 32% among males. Older age, small herd size, lack of mental breaks from work, inadequate leisure, and non-use of alcohol were significantly associated with declined work ability. The odds ratios for these risk factors ranged from 2.04 to 4.67. Current injuries and diseases are part of the WAI questionnaire contributing to declined work ability. This study indicates that interventions are needed, particularly among older farmers and farmers with injuries or diseases, to restore their work ability. Life-long measures to maintain work ability are also important, preventing the steep decline in work ability currently occurring among older farmers. Based on this study, we recommend guidance addressing the identified risk factors, particularly the importance of organizing both farm and domestic work with adequate rest, leisure time, and mental breaks as counterbalance to the daily workload among livestock farmers.     

Dietary and non-dietary determinants of central adiposity among Tehrani women

OBJECTIVE: To determine the correlates of central adiposity. DESIGN: Population-based cross-sectional study. SUBJECTS: A total of 926 women (aged 40-60 years) from all districts of Tehran. METHODS: Demographic data were collected and anthropometric indices were measured according to standard protocols. Dietary intakes were assessed by means of a semi-quantitative food-frequency questionnaire. The suggested cut-off point for waist-to-hip ratio (WHR>or=0.84) for Tehrani people, adjusted for their age group, was used to determine central adiposity. Logistic regression analysis was used to determine the correlates of WHR, which were adjusted for age, taking medications and body mass index (BMI). The components of dietary intake were determined by factor analysis. Pearson correlation was used to determine the association between the dietary components and WHR. Analysis of covariance was employed to compare the mean values of WHR in different lifestyle groups, with adjustment for BMI and age. RESULTS: Mean WHR was 0.82 +/- 0.06. The possibility of being centrally obese was higher in women with light physical activity (odds ratio: 2.11; 95% confidence interval: 1.40-2.53), depressed women (1.36; 1.02-1.93), smokers (1.21; 1.02-1.56) and unemployed women (1.41; 1.13-1.72). Marriage (1.31; 1.10-1.82), menopause (1.22; 1.02-1.61), low vitamin C intake (2.31; 1.25-4.25) and low calcium intake (1.30; 1.07-3.78) were associated with central fat accumulation. Dairy consumption was inversely correlated with central fat accumulation (r = -0.2, P < 0.05). CONCLUSION: Central adiposity is associated with poor lifestyle factors including low physical activity, depression, smoking, low intake of vitamin C, low intake of calcium and dairy products and high fat consumption. Thus lifestyle modifications should be encouraged to achieve a healthier body shape.     

Safety and animal handling practices among women dairy operators

This article presents suggestions toward safer animal handling utilizing the results of a qualitative study of women dairy farmers in Finland. A major proportion of injuries (43%) occur in livestock-related work in Finnish agriculture. An even greater proportion of women's farm injuries (77%) is related to animals. We investigated the working conditions often women dairy farmers. Data were collected by observing farm work and performing semi-structured interviews. The study farms represented different milk production technologies with an average farm size of 106 ha (262 acres) of cultivated land, 51 ha (126 acres) of forest, and 45 dairy cows. Farm-related injuries were frequent; eight respondents out often had suffered one or several injuries during the previous two years. The women considered farm animals as the greatest hazard, and unexpected animal behavior was viewed as the most significant work-related injury risk. Dangerous situations often resulted from stress in cows caused by unpleasant circumstances or making animals fearful of people. Experiences from some farms suggested that dairy farm work can be relatively safe and that improving the trust between the cows and their handlers plays a key role in safety. We synthesized our findings into four animal handling strategies that can potentially reduce the risk of injury among stockpersons. We developed practical guidelines on how to gradually build a good cow-handler relationship based on our findings and the literature on cattle handling strategies and animal welfare science.     

Diagnosed skin diseases among migrant farmworkers in North Carolina: prevalence and risk factors

Skin diseases are common among farmworkers, yet little research documents their prevalence and risk factors. This analysis documents the prevalence of skin diseases among farmworkers in North Carolina, examines variation in the prevalence across the agricultural season, and delineates factors associated with skin disease. Data are from a longitudinal surveillance study with assessments at approximately three-week intervals from May through October 2005. The sample included 304 farmworkers from 45 camps with 1048 data points. Data collection included a structured interview and a standard set often digital photographs. A board-certified dermatologist reviewed the photographs and made specific diagnoses in five categories: inflammatory disease, infection, pigmentary disorder, tumor, and trauma. The prevalences of the five skin disease categories and specific diagnoses are described with counts and frequencies for the entire season and for six time periods. The inflammatory disease and infectious disease categories are modeled with an extension of logistic regression that accounts for repeated measures and clustering of farmworkers within camps. Farmworkers experience high levels of inflammatory skin disease (57.2%) including acne, folliculitis, and contact dermatitis; infectious skin disease (73.8%) including tinea pedis, onychomycosis, and warts; pigmentary disorders (19.1%); and trauma (34.5%). The odds of inflammatory skin disease decreased with age, while those for infectious skin disease increased with age. The odds of inflammatory skin disease increased with pesticide exposure and decreasing housing quality. Skin diseases are highly prevalent among farmworkers. Research is needed to delineate specific factors causing high levels of infection and inflammation in this population.     

Gender difference in prevalence of upper extremity musculoskeletal symptoms among Swedish pig farmers

There have been very few epidemiological studies dealing with pig farmers' musculoskeletal health. The aim of this study was to carry out a cross-section postal questionnaire survey dealing with musculoskeletal symptoms among female and male pig farmers in large-scale production. The participation rate overall was 70% (288/410). Over 10% of the questionnaires had missing gender data. Three different questionnaires were used: the general standardized Nordic questionnaire for the analysis of musculoskeletal symptoms; a questionnaire dealing with occurrence of numbness, reduced muscle strength, etc., in the wrists and hands; and occupational factors were screened by a special questionnaire. The results showed that musculoskeletal morbidity is high among pig farmers. The women had significantly more problems than the men with respect to the upper extremities. Symptoms in the wrists and hands such as numbness, reduced muscle strength, aching fingers and wrists, and tendency to drop things were significantly more common among the women than the men. Occupational factors dealing with, for example, the size of the pig farm, were not related to the occurrence of symptoms. Occupational factors of importance for the development of disorders, particularly among women pig farmers, should be given priority in ergonomic interventions.     

Prevalence and associated risk factors of undiagnosed diabetes among adult Moroccan Sahraoui women

OBJECTIVE: The goal of the present work was to examine the prevalence and associated risk factors of undiagnosed diabetes among urban Moroccan Sahraoui women. DESIGN AND SETTING: Randomised sample of adult women living in the city of Laayoune in south Morocco who visited public health centres during an immunisation campaign. Body weight, height, waist and hip circumferences, blood pressure, fasting plasma glucose (FPG), triglycerides, dietary intake and physical activity were collected. SUBJECTS: Data were obtained on 249 urban women aged 15 years and older, who were not pregnant. Only subjects identified as of Sahraoui origin were eligible for this investigation. RESULTS: The prevalence of impaired fasting glucose (IFG) was 5.5% and that of undiagnosed diabetes 6.4%. Diabetes and IFG were more common among older and obese women as well as among women with hypertension or a family history of diabetes. In addition, sucrose intakes were higher in women with diabetes than in those with normal FPG. Also, physical activity estimated as the time spent in walking was negatively associated with FPG. Regression analyses showed an independent association of age, obesity, family history of diabetes and triglycerides with diabetes. CONCLUSION: The high proportion of unknown diabetes suggests the need for increased diabetes awareness in this population. The data suggest also the involvement of obesity in diabetes and the potential importance of intervention strategies to reduce population adiposity for the prevention and management of cardiovascular risk factors.     

Breast-feeding and maternal mental well-being among Bangladeshi and Pakistani women in north-east England

OBJECTIVES: To explore the relationship between infant feeding and maternal mental well-being among women of Bangladeshi and Pakistani ethnicity; and to explore the sources of advice, information and support available to women before and after childbirth. DESIGN: A cross-sectional survey of infant feeding and maternal well-being via structured interviews conducted in the home. SETTING: Home visits within two inner-city wards of Newcastle upon Tyne. SUBJECTS: Eighty-six women of South Asian ethnicity. RESULTS: Enjoyment of everyday activities was higher among women who breast-fed only (P = 0.028); whereas feeling sad or crying during pregnancy was lower among breast-feeding women (P = 0.005), as was not sleeping well (P = 0.003) and feeling that everything was too much (P = 0.039), compared with women who used formula or mixed feeding. Women who breast-fed only had better mean mood scores than those who formula-fed or those who both breast-fed and formula-fed (P < 0.001). Mean mood responses were also significantly associated with the mother's level of understanding of English and number of years in education (P = 0.005 and P = 0.003, respectively). The association between method of feeding and maternal mood remained strong after controlling for the effects of English language and maternal education. CONCLUSIONS: The study suggests that breast-feeding may be an important mediator of maternal mental well-being after childbirth. Community-based programmes tailored to the needs of Bangladeshi and Pakistani women which support breast-feeding and encourage exclusive breast-feeding may be of benefit.