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.     

Risk factors for iron-deficiency anaemia among pregnant women living in rural Vietnam

OBJECTIVE: To assess the prevalence of anaemia in rural Vietnam and to determine its risk factors. DESIGN: A cross-sectional survey. SETTING: Vietnam, Nghe An Province. STUDY POPULATION: The total number of participants was 439. Of these participants, one was excluded from the study due to a mental disorder. Forty-seven did not participate in the test for parasites and 68 did not complete at least one of the questions. RESULTS: The prevalence of anaemia (haemoglobin (Hb) <11.0 g dl(-1)) was 43.2% and of severe anaemia (Hb <8.0 g dl(-1)) was 0.5%. Taking iron tablets, the consumption of eggs and the preference for Western medicine significantly and positively correlated with Hb concentration in the pregnant women in a multiple regression analysis. Pregnancy duration and hookworm infestation significantly and negatively correlated with Hb concentration in the pregnant women. CONCLUSION: The prevalence of anaemia in rural Vietnam has remained as high as that found in the national anaemia survey in 2000. The results of the present study could aid in the development of an iron-deficiency anaemia programme among pregnant women in rural Vietnam that emphasises iron supplementation, parasite control and improved diet, including the consumption of eggs. The programme's focus should be on women who prefer traditional medicine to Western medicine.     

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.     

Anthropometry of women of childbearing age in Morocco: body composition and prevalence of overweight and obesity

OBJECTIVE: To determine the prevalence of obesity and body fat distribution of Moroccan women of childbearing age, using a panel of anthropometric measurements. DESIGN AND SETTING: A cross-sectional survey conducted in 1995 in an agricultural community, El Jadida province of Morocco. Weight, height, waist and hip circumferences and triceps, biceps, subscapular and supra-iliac skinfold thicknesses were measured. Body mass index (BMI), waist/hip ratio (WHR), sum of all and sum of trunk skinfold thicknesses were determined. SUBJECTS: In total, 1269 women aged 15-49 years from urban and rural areas were surveyed. RESULTS: The means of all anthropometric measurements including body fat were higher in urban than in rural women and increased with age. Trunk fat contributed 50% of total fat. Globally, 4.7% of women were underweight (BMI<18.5 kg m(-2)), 35.2% were overweight or obese (BMI> or =25 kg m(-2)), 10.1% were obese (BMI> or =30 kg m(-2)) and 16.8% had central obesity (WHR>0.85). The prevalence of overweight and obesity was higher in the urban than in the rural area. Underweight prevalence decreased with age, whereas that of overweight and obesity increased. All anthropometric parameters adjusted for age increased with the increase of BMI and WHR. CONCLUSIONS: Although undernutrition is still prevalent, there is an alarming prevalence of overweight and obesity in Moroccan women of childbearing age. The results indicate a shift in this country from the problem of dietary deficiency to the problem of dietary excess, and alert one to the necessity of establishing an intervention to prevent obesity-related diseases. It is necessary to address which of the anthropometric variables studied here is the best predictor of obesity-related diseases in this population.