Prevalence and severity of anaemia stratified by age and gender in rural India

Correlation of red blood cell parameters and platelet count among adult anemic patients attending Madda Walabu University Goba Referral Hospital, Goba, Southeast Ethiopia: A comparative cross-sectional study

Anemia is a worldwide public health problem and is associated with platelet disorders. The relationship between anemia and platelets is complex, with the association being either normal platelet count or thrombocytosis. Platelets are significantly decreased in patients with anemia, and thrombocytopenia has been documented in patients with severe anemia. There are few reports in the literature on the correlation between platelet count and red blood cell parameters in anemic patients. Therefore, this study aimed to compare the correlation between red blood cell parameters and platelet count in adult anemic patients attending Madda Walabu University Goba Referral Hospital (MWUGRH): Goba, Southeast Ethiopia, from May 30 to July 30, 2022. A cross-sectional comparative study was conducted among 352 subjects (176 anemic and 176 controls) who attended the hospital during the study period and were recruited using a convenient sampling technique. Sociodemographic and other relevant variables were collected using a structured questionnaire. Four milliliters of venous blood were collected and placed in a K2EDTA tube for analysis of hematologic parameters using the Sysmex XN-550 (Sysmex Corp., Japan) automated hematology analyzer; the hemoglobin value was used to determine anemia status. Data were entered into Epidata Manager, version 4.6.0.2, and analyzed using SPSS Statistical Software, version 25. The independent-sample t-test was used to compare parameters between groups, and correlation statistics was used to correlate parameters between groups. Chi-square was used at a 95% confidence interval, considering P < .05 statistically significant for association among categorical variables. Correlation analysis showed that platelet count was significantly, positively correlated with RBC, and negatively correlated with MCV, MCH, and MCHC (r (P) = 0.168 (.026) and -0.252 (.000), -0.275 (.001), -0.218 (.004), respectively). It was also negatively correlated with HGB and HCT levels in the healthy control (r (P) = -0.266 (.000) and -0.149 (.049) respectively). Morphologically, 44.32% were microcytic hypochromic anemia, 53.98% were normocytic normochromic anemia and 1.70% were macrocytic anemia. The findings showed that platelet count variation correlates well with red cell indices and morphologic types of anemia in adult anemic patients. Such correlation will enable physicians to make diagnoses and administer treatments.

Sex-dependent differences in hematopoietic stem cell aging and leukemogenic potential

Sex influences many biological outcomes, but how sex affects hematopoietic stem cell (HSC) aging and hematological disorders is poorly understood. The widespread use of young animal models to study age-related diseases further complicates these matters. Using aged and long-lived BALB/c mouse models, we discovered that aging mice exhibit sex-dependent disparities, mirroring aging humans, in developing myeloid skewing, anemia, and leukemia. These disparities are underlined by sex-differentiated HSC aging characteristics across the population, single-cell, and molecular levels. The HSC population expanded significantly with aging and longevity in males, but this occurred to a much lesser degree in aging females that instead expanded committed progenitors. Aging male HSCs are more susceptible to BCR-ABL1 transformation with faster development of chronic myeloid leukemia (CML) than female HSCs. Additionally, the loss of the aging regulator Sirt1 inhibited CML development in aging male but not female mice. Our results showed for the first time that sex-differentiated HSC aging impacts hematopoiesis, leukemogenesis, and certain gene functions. This discovery provides insights into understanding age-dependent hematological diseases and sex-targeted strategies for the treatment and prevention of certain blood disorders and cancer.

Prevalence and demographic distribution of anaemia among those visiting a teaching hospital located in tribal predominant block of Jharkhand: Retrospective record based analysis

Background

Anaemia is a major public health concern in developing countries, with cases increasing rapidly among women, young girls, and children under age 5.

Aims

This study aimed to estimate the prevalence of anaemia and to identify the age and gender distribution of anaemia among those attending IPD/OPD of a teaching hospital located in the tribal block.

Methodology

The study was conducted at a multispecialty tertiary care hospital in tribal predominant area, Jharkhand, India. A retrospective, chart-based study design was adopted to achieve the objectives. All inpatient case records available from the Department of Laboratory Medicine and the electronic hospital information system of the institute were reviewed between January 1, 2021, and January 31, 2024.

Result

A total of 15004 reports were screened for detecting anaemia, of them 7095 (47.3%) were males and 7909 (52.7%) were females. The overall prevalence of any grade of anaemia was found in 6579 (43.8%; 95% CI: 43.1-44.6). Univariate logistic regression analysis to predict status of anaemia among study participants showed the odds of being anaemic was 1.5 times (95% CI: 1.2-2.1) higher among those with age >60 years compared to those who were in the age group of 1-4 years. Females had 2.3 times (95% CI: 2.2-2.5) higher odds of having anaemia than males.

Conclusion

This study shows that half of the patients attending hospital are anaemic and the burden increases as the age increases and highest among elderly >60 years. The results of our secondary data analysis should contribute to better screening and identifying the cases among people attending the hospital and also could aid planning services at the primary care level.

Frequency of Anemia/IDA and Associated Risk Factors Among Working Women of a Medical Center in Tehran, Iran: A Cross-Sectional Study

Introduction

The study aimed to examine anemia prevalence and risk factors in employed women at a medical center compared to unemployed women from a charity center, with anemia defined as hemoglobin <120 g/L and iron deficiency as serum ferritin <30 ng/mL or serum iron <10 mcg/dL.

Material and Methods

This cross-sectional study included 651 employed, non-pregnant randomly selected women aged 20-67 years. Participants completed questionnaires on sociodemographic, nutritional, and obstetrical characteristics. Blood indicators such as hemoglobin, serum ferritin, iron, and TIBC were measured.

Results

Out of 651 participants, 395 (60.7%) had anemia/IDA (Hb <120 g/L, ferritin <30 ng/mL, or iron <10mcg/dL), comprising 308 (47.3%) having IDA and 215 (33%) having anemia. Younger age (<40 years) and menorrhagia were individually associated with 1.84- and 2.79- times increased risk of developing anemia in the studied population, respectively. A higher number of shifts and lack of vegetable consumption were found to be significantly prevalent in the anemic group. The prevalence of anemia/IDA among hospital staff and referred women was 60.7% and 43.1%, respectively.

Conclusions

The study emphasized the influence of employment on the prevalence of anemia/IDA among hospital staff compared to unemployed women.

Prevalence of anemia and associated factors in a Moroccan population from the Northwestern region of Morocco (M'diq-Fnideq-Martil Prefecture)

Introduction

anemia remains a major public health challenge worldwide, frequently having multifactorial causes and wide-ranging, largely underestimated repercussions. The purpose of this paper is to assess the prevalence of anemia and identify associated factors in a group of children, adults, and pregnant women.

Methods

our sample consisted of a total of 1360 volunteers (group I: 410 school-aged children aged 5-11 years; group II: 533 adults aged 16 to 65 years; group III: 417 pregnant women aged 17 to 45 years) randomly selected from different towns of the M'diq-Fnideq prefecture, Morocco from March 2018 to September 2018. Data on socio-demographic, anthropometric, and dietary status were collected from a questionnaire survey. A complete blood count was performed using a hematology analyzer, Sysmex KX21N® (Sysmex Corporation, Kobe, Japan), in the hematology laboratory of the Mohamed VI Hospital of M'diq.

Results

anemia was found in 31% of children, 52.4% of adults, and 22.5% of pregnant women. Microcytic hypochromic anemia was the most dominant type of anemia in children, adults, and pregnant women with percentages of 40.6%, 48.7%, and 43.5%, respectively. Mild anemia was much more common than moderate and severe anemia in all groups. Furthermore, anemia was associated with low socioeconomic and educational levels in adults (22.8% versus 27.9%) and pregnant women (18.1% versus 16.8%). Schoolchildren with illiterate parents and low socioeconomic levels are the most affected by anemia, with a prevalence of 75% and 69.44%, respectively. Also, children with insufficient stature are at a high risk for anemia compared to children of normal stature (p<0.001). As for weight for age, the odds ratio (OR) was 4.32. A significant difference between underweight and anemia was revealed (p<0.001). A frequency of meat product, vegetables, and fruit consumption lower than 1.5 times per week increases the risk of anemia in schoolchildren.

Conclusion

these findings showed a significant prevalence of anemia in all study groups associated with socioeconomic, anthropometric, and nutritional factors. However, further studies are needed to focus on interventions and etiologies in order to limit potential complications, especially in schoolchildren and pregnant women.

Plateletpheresis donor deferral patterns at a tertiary care hospital in North India: A need for rethink of haemoglobin cutoff

INTRODUCTION

The donor deferral criteria for blood or apheresis donations are established for two main reasons: (i) to ensure the safety of the blood donor (non-maleficence); (ii) to obtain safe blood of standard quality that has therapeutic benefit for the patient (beneficence). This study was planned to assess the various causes and patterns of plateletpheresis donor deferral in our hospital and to subsequently assess whether any evidence based changes can be done in the current plateletpheresis donor deferral criteria in India to maximize the platelet donor pool without compromising donor safety.

MATERIAL AND METHODS

The present study was conducted from May 2021 till June 2022 in the department of transfusion medicine of a tertiary care hospital in North India. The first part of the study was conducted from May 2021 till March 2022 to assess the various causes of donor deferral by analysing the plateletpheresis donor deferral data during the corresponding period. The second part of the study was conducted from April 2022 till June 2022, to assess: (i) average decrease in haemoglobin after plateletpheresis procedure; (ii) red blood cell loss during plateletpheresis procedure; (iii) to determine whether any correlation exists between donor haemoglobin and platelet yield.

RESULTS

During the study period, a total of 260 donors were screened for plateletpheresis, out of which 221 (85%) donors were accepted and 39 (15%) donors were deferred for various reasons. Out of the 39 deferred donors, 33 (84.6%) were temporary deferrals, while 6 (15.4%) were permanent deferrals. Low haemoglobin (Hb < 12.5 g/dl) was a cause of deferral in 12.8% (n = 5) of the deferred donors. 192 (73.9%) out of the 260 donors were replacement donors. The calculated mean decrease in haemoglobin as a result of plateletpheresis procedure was 0.4 g/dl. No correlation was seen between donor pre-donation haemoglobin and platelet yield (p = 0.86, r = 0.06, R² = 0.003). The calculated mean red cell loss as a result of plateletpheresis procedure was 28 ml.

CONCLUSION

Low haemoglobin (<12.5 g/dl) is a significant cause of temporary plateletpheresis donor deferral in India. In view of the advancement in plateletpheresis technology, which has resulted in minimal red cell loss with the current generation apheresis devices, haemoglobin cutoff of 12.5 g/dl needs to be reconsidered. Perhaps, after performing a multi-centric trial, a consenscus can be reached for revision of haemoglobin cutoff for plateletpheresis donations.

Prevalence of Splenomegaly and Splenic Complications in Adults with Sickle Cell Disease and Its Relation to Fetal Hemoglobin

Background: Spleen has been found to be the earliest organ involved in sickle cell disease (SCD) patients with variable manifestations in different geographical regions. It usually undergoes autosplenectomy by adolescence but in countries like India, the course of the disease and splenic manifestations are different. And here we aim to study these differences and the relationship between spleen size and fetal hemoglobin (HbF) and various splenic complications in our patients with sickle cell disease. Materials and Methods: This is an observational study of 62 adult patients with sickle cell disease admitted in our prestigious institute in the northwestern part of India, mostly hailing from the tribal population. The clinical and ultrasonographic methods have been used to identify splenomegaly and spleen size and prevalence have been calculated. The correlation coefficient has been calculated between fetal hemoglobin, sickle hemoglobin, and spleen size. Results: The analysis done revealed that 77.4% of patients had abnormal spleen with high average HbF(14.9±5.0) values compared to those who had normal spleen(12.12±4.1). Only 2 patients were found to have no spleen and 3.3% had splenic infarct. All patients with splenomegaly had anemia, 51.6% of patients were in sickle cell crisis and 22.5% were having infections. We also found a weak but positive correlation between spleen size and HbF. Conclusion: This study revealed the persistence of the spleen, the high prevalence of splenomegaly in the Indian adult population with sickle cell disease, and higher levels of fetal hemoglobin, the exact reason for which is still a subject of speculation that needs research. But this paper provides clear evidence of different natural courses of SCD in India.

Exploration of the relationship between anemia and iron and zinc deficiencies in children under 5 years of age living in the malaria endemic area of South Kivu/Democratic Republic of Congo

The aim of this study was to explore the relationship of iron and zinc deficiencies and anemia in children aged under 5 years living in malaria endemic area of South Kivu/DRC. We conducted a cross-sectional study in the health zone of Miti Murhesa in South Kivu/DRC. A total of 1088 children in good general health were included in this study. Almost 40% of children were anemic. The prevalence of iron deficiency (ID) was found in 34.9% and 49.1% children based on ferritin or free erythrocyte protoporphyrin (FEP), respectively. If anemia is present, we found iron deficiency anemia (IDA) according to the WHO-criteria (ferritin) in 31%, and according to FEP in 66% of children. The overall prevalence of zinc deficiency was 17.6%. If anemia is present, zinc deficiency was found in 24.4% of children. Inflammation/infection, based upon CRP, was present in 39.7% children. The independent factors associated with anemia were recent illness, middle upper arm circumference, weight-for-height, ID according to FEP, zinc deficiency, and submicroscopic Plasmodium infection. A high prevalence of ID was observed in children in South Kivu according to FEP. Ferritin as acute phase protein was less suited in this population due to a high frequency of infection/inflammation. Iron and zinc deficiencies were found to be significantly associated with anemia in this population.

Mini Female Health Program for detection of non-communicable diseases in Women – In a urban teaching hospital in India

Background:

Prevalence of non-communicable diseases (NCDs) is increasing with women affected at an early age. The Mini Female Health Program (MFHP) is a simple screening package to detect NCDs in women.

Objective:

Determine the prevalence of selected NCDs in a hospital-based outpatient setting using MFHP.

Methods:

A cross-sectional observational study was conducted in an urban teaching hospital in India. MFHP included medical history, physical examination and investigations. NCDS of interest included anaemia, thyroid disorders, hypertension, diabetes, and obesity. Analysis was performed on groups stratified by age groups (18–30, 31–40 and > 41 years). Between group comparison and association of hypertension with other variables was undertaken.

Results:

Final analysis included 468 women, of whom 49.8%, 29.9%, and 20.3% were between 18–30, 31–40, and >41 years, respectively. Central obesity was most common NCD (waist to height ratio (WHR) > 0.5 (72.7%), waist circumference (WC) > 80 cm (62.7%)) followed by generalized obesity (body mass index (BMI) > 25 kg/m2 (52.4%)), anaemia (52.6%), thyroid disorders (27.4%), hypertension (14.1%) and diabetes (5.1%). Half of the women between 18 and 30 years were either overweight (BMI: 23–25 kg/m2) or obese. Increasing age was associated with a significant increase in the prevalence of hypertension, diabetes, thyroid disorders and obesity, but not anaemia. Only 9.8% of women were without an NCD with 17.3% having one NCD and 72.8% reporting multiple NCDs. Hypertension was strongly associated with age and WHR in multivariate regression analysis.

Conclusion:

The MFHP has highlighted the high prevalence of NCDs in women, particularly in young women demonstrating the value of simple screening programme in routine clinical care.

Gender difference in the relationship between anemia and vitamin D in Korean adults: the fifth Korea National Health and Nutrition Examination Survey

This study was conducted to assess the relationship between vitamin D deficiency and anemia, by gender, in Korean adults. The data of 16,060 adults were analyzed (men, 6,840; premenopausal women, 4,916; postmenopausal women, 4,340) from the fifth Korean National Health and Nutrition Examination Survey (KNHANES V) (2010–2012). There were several key findings. First, after adjusting for related variables, the odds ratio (OR) of anemia [hemoglobin (Hb) <13 g/dl in men or Hb <12 g/dl in women] using the vitamin D normal group {25-hydroxyvitamin [25(OH)D] ≥15.0 ng/ml} as reference, was significant for the vitamin D deficient group [25(OH)D <15.0 ng/ml] in the overall population [OR, 1.310; 95% confidence interval (CI), 1.168–1.470]. Second, the OR of anemia, using the vitamin D normal group as reference, was significant for the vitamin D deficient group in premenopausal women (OR, 1.293; 95% CI, 1.105–1.513). However, vitamin D deficiency in the vitamin D normal group in men (OR, 1.093; 95% CI, 0.806–1.484) and postmenopausal women (OR, 1.130; 95% CI, 0.906–1.409) was not significant. In conclusion, Vitamin D deficiency is positively associated with anemia in premenopausal women, but not in men and postmenopausal women.

Factors associated with childhood anaemia in Afro-descendant communities in Alagoas, Brazil

OBJECTIVE

To investigate factors associated with anaemia in preschool children.

DESIGN

A home survey was conducted in 2018. Anaemia in children (capillary blood Hb level < 110 g/l) was the outcome, and socio-economic, demographic and health factors of the mother and child were the independent variables. The measure of association was the prevalence ratio, and its 95 % CI was calculated using Poisson's regression with robust variance and hierarchical selection of independent variables.

SETTING

Afro-descendants communities living in the state of Alagoas, northeast Brazil.

PARTICIPANTS

Children aged 6-59 months and their mothers (n 428 pairs).

RESULTS

The prevalence of child anaemia was 38·1 % (95 % CI 33·5, 42·7). The associated factors with child anaemia were male sex, age < 24 months, larger number of residents at home (> 4), relatively taller mothers (highest tertile) and higher z-score of BMI for age, after further adjustment for wealth index, vitamin A supplementation in the past 6 months and clinical visit in the last 30 d.

CONCLUSIONS

The high prevalence of anaemia observed reveals a relevant public health problem amongst children under five from the quilombola communities of Alagoas. Considering the damage caused to health and multiplicity of risk factors associated with anaemia, the adoption of intersectoral strategies that act on modifiable risk factors and increase vigilance concerning those that are not modifiable becomes urgent.

PREVALENCE OF PARASITIC INFECTIONS IN CHILDREN OF BOKE, GUINEA

Helminthic and intestinal protozoan infections and malaria infections are common in children less than 15 yr old in sub-Saharan Africa, but little is known about these infections in Guinea. The aim of this study was to determine the prevalence of parasitic infections in children aged less than 15 yr and the relationship of these infections with anemia. The cross-sectional study was done in Dabbis sub-prefecture in the Boke region of Guinea from 18 to 26 March 2017. A simple random sampling at the household level was performed, and 1 child under the age of 15 was included per eligible household. A total of 392 children were included in the analysis. Clinical and parasitological information were assessed, including anthropometric measures (weight and height), disease symptoms, hemoglobin level, and malaria parasitemia. Helminthic and protozoan intestinal infections were present in 59.7% of the children surveyed. Malaria infection prevalence was 45.5% when assessed by microscopy and 43.6% when assessed by a rapid diagnostic test. Plasmodium falciparum, accounting for 84.2% of malaria infections, was the main malaria species infection. Gastrointestinal parasites were present in 19.1% of children. The main gastrointestinal parasites present included Entamoeba coli (5.4%) and Giardia intestinalis (5.1%). There was no association between the presence of anemia and the parasitic status of the children. Parasitic screening and mass treatment in this age group, as well as household awareness raising, would reduce cases of parasitic infections in rural Guinea.

Socio-economic inequality in anaemia among men in India: a study based on cross-sectional data

BACKGROUND

Undernutrition is a serious matter of public health concern in India. Existing studies, policies and programs focus on women and children thereby ignoring men in policymaking. This study examines the socio-economic inequality in anaemia levels among men in India and tries to decompose the factors behind it.

METHODS

The fourth round of National Family Health Survey is used to fulfill the study objectives. The outcome variable of the study is men having anaemia or not. The study uses bivariate and multivariate techniques to identify the factors associated with the outcome variable. Further, concentration index and concentration curve are calculated to measure the socio-economic inequality in anaemia among men in India.

RESULTS

The results indicate that majority of the socio-economic related inequality is explained by wealth quintile followed by geographical regions of India, body mass index and educational attainment. The results also emphasize that older men belong to the high-risk groups. Moreover, the likelihood of anaemia is 40% more likely among men who belonged to East region and 25%, 13% and 7 % less likely among those who belonged to Northeast, West and South region compared to those who belonged in the North region of the country.

CONCLUSION

Existing policies on anaemia should include men to achieve an anaemia free India. Individual education and awareness should be encouraged to improve nutritional status.

Moringa oleifera Teabags Increase Hemoglobin in Adolescent Females

AIM: The study aims to determine the effect of Moringa oleifera teabags on increased Hemoglobin (Hb) in adolescent girls. METHODS: The research method used in this research was a pre-post-test one group design, a research design to determine the cause and effect or effect of an intervention. The treatment was carried out by giving M. oleifera teabags 2 times. Specifically, one sachet (3 g) in the morning and one sachet (3 g) in the afternoon, dipped in 250 ml hot water, and added two teaspoons granulated sugar. The treatment was given for 30 days. RESULTS: An increase in the average of Hb (mean) before the intervention was 10.71 g/dl. After 15 days of the intervention, it was 11.03 g/dl. Subsequently, after 30 days of intervention, the average Hb value (mean) was 11.63 g/dl, then the p-value ≤ α, which was 0.000 (p < 0.05), and these results indicated a significant difference between Hb before and after the intervention. CONCLUSION: There was a significant difference between Hb before and after the intervention, meaning that there was an effect of Moringa leaf teabags on the increase in Hb in adolescent females.

Prevalence of anemia in pediatric patients of traumatic brain injury and problems associated with management in a developing country: Unfolding of an underrated comorbidity

Background

Pediatric anemia has a high prevalence in developing countries such as Pakistan. It is common knowledge among hospital specialties but little is done to manage this condition by hospitalists. The issue is compounded with a poor primary care infrastructure nationally. The aim of this study is to bring to light the high prevalence of anemic children in neurosurgery and to describe the difficulties in managing their anemia in a tertiary hospital setting. A literature review is presented highlighting the socioeconomic difficulties that contribute to this widespread comorbidity and the difficulty in managing it from a hospital specialty point of view.

Methods

A prospective descriptive case series was carried out between March 2020 and September 2020. All patients under the age of 13 who presented to our department for traumatic brain injury (TBI) meeting our inclusion and exclusion criteria were enrolled and assessed for the presence and severity of anemia. Demographic data were collected. Following discharge, patients were referred to our hospital's pediatrics' anemia clinic which was before their first neurosurgery follow-up 2 weeks following discharge and attendance to follow up was documented.

Results

The prevalence of anemia was 78.9%. Over 95% of patients attended their neurosurgery follow-up but only 28% of patients attended their referral to the anemia clinic.

Conclusion

Anemia is highly prevalent in children presenting to neurosurgery for TBI and its longitudinal management has difficulties with lost to follow up in a tertiary hospital setting. There is a need for national initiatives to reduce the prevalence of anemia but concurrently better strategies need to be devised to manage anemic children in a hospital setting.

Incidence of Non-Traumatic Subconjunctival Hemorrhage in an Indian Rural Population

Purpose

To determine the incidence of non-traumatic subconjunctival hemorrhage (NTSH) in Indian rural population and analyze the associated risk factors.

Methods

The study included patients diagnosed having subconjunctival hemorrhage (SCH) who attended the out-patient department (OPD) of ophthalmology. Demographic characteristics of subjects included age, gender, medical and ocular history, and location of hemorrhage.

Results

The incidence rate of NTSH in this study was 3.07 per 1000 patients per year attending OPD. The men to women ratio for NTSH was 1.26 (95% CI). The commonest site of presentation was nasal side (n=36, 51.4%). Right eye (n= 37, 54.3%) was affected more than the left eye (n=28, 40%). The analysis showed 24 patients (34.3%) did not have any etiological factor attributable to SCH. Conjunctivochalasis (CCH) was associated in 15 patients (21.4%). An antiplatelet agent was associated with SCH in 7 patients (10%). Other factors associated with SCH were hypertension, leukemia, and anemia (n=6, 8.6%).

Conclusion

This study indicates that NTSH occurs in 3 out of 1000 individuals per year in the rural population presenting to the OPD. Nasal conjunctiva was commonly involved. CCH was associated with 15 patients. Use of antiplatelet agents, hypertension and blood disorders are associated with the risk of NTSH. Patients presenting for the first time with NTSH should be screened for systemic etiological factors.

Prevalence of Anemia and Its Association with Frailty, Physical Function and Cognition in Community-Dwelling Older Adults: Findings from the HOPE Study

OBJECTIVES

The prevalence of anemia and its impact on frailty and physical function amongst the multiethnic older populations in the Southeast Asian (SEA) countries are often not well studied. Singapore, a nation comprised of multiethnic communities, is one of the most rapidly aging population globally. We aim to evaluate the prevalence of anemia and its impact on frailty, and physical function in Healthy Older People Everyday (HOPE)- an epidemiologic population-based study on community-dwelling older adults in Singapore.

DESIGN

Cross-sectional study.

SETTING

Community.

PARTICIPANTS

480 adults ≥ 65 years old.

MEASUREMENTS

Data were collected from interviewers-administered questionnaires on socio-demographics, FRAIL scale, Mini-Mental State Examination, EQ-5D, Barthel Index, and Lawton index. Hemoglobin concentration and physical assessments, including anthropometry, grip strength, timed up-and-go (TUG) were measured.

RESULTS

The overall prevalence of anemia was 15.2% (73 out of 480). The Indian ethnic group had the highest prevalence of anemia (32%, OR=3.02; 95%CI= 1.23-7.41) with the lowest hemoglobin concentration compared to the overall population (13.0±1.3g/L and 13.5±1.4g/L, p=0.02). Hemoglobin levels and anemia were significantly associated with frailty (OR=2.28; 95% CI=1.02-5.10), low grip strength (OR=1.79; 95% CI=1.01-3.03), ≥ one IADL impairment (OR=2.35; 95% CI=1.39-3.97). Each 1 g/dL increase in hemoglobin was associated with a 6% decrease in frailty odds after adjusting for potential covariates (OR = 0.94, 95% CI: 0.90-0.99). There was a significant difference in the mean TUG between the non-anemic (11.0±3.4 seconds) and anemic (12.3±6.0 seconds, p=0.01) counterparts, but no difference in the number of falls.

CONCLUSION

In our multiethnic Asian population, anemia was adversely associated with frailty, decreased muscle strength, and IADL impairment. Health policies on anemia screening should be employed to avoid or potentially delay or reverse these adverse outcomes associated with anemia. Recognition, evaluation, and treatment of anemia amongst this vulnerable population is warranted.

Assessment of protective relationship of G6PD and other lifestyle factors with Malaria: A case-control study of medical professionals from a teaching medical institute, Gujarat

Background

There remains equivocal evidence in terms of glucose-6-phosphate dehydrogenase (G6PD) and malaria occurrence. A case-control study was performed to assess protective relationship of G6PD and other lifestyle factors with malaria.

Methods

One-hundred twenty six medical professionals were randomly selected from a tertiary care clinical institute. Along with demographic and lifestyle details, subjects were interviewed about their history of occurrence of malaria at all in previous 10 years. Their hematological, biochemical, and metabolic profile was assessed clinically as well as by investigations. The analysis was carried out with two groups: (1) those who were subjected with malaria at least once in past 10 years (Malaria Ever Group); (2) those who never encountered malaria (Malaria Never Group).

Results

Out of 126, 65 subjects were in Malaria Ever Group and 61were in Malaria Never Group. There was no difference in lifestyle measures, hematological, and biochemical parameters. Mean G6PD levels were found similar in both the groups. Of 61 subjects in "malaria-never" group, 1 had deficient (1.1 unit/gm of Hb), 9 had low normal (between 2.5 and 10 units/gm of Hb), 48 had normal (10.1-20.5 units/gm of Hb), and 3 had higher than normal (>20.5 units/gm of Hb) G6PD levels. In comparison, 65 participants from "malaria ever" group, none was deficient, 6 had low normal, 58 had normal, and none had higher than normal G6PD levels. HPLC-based hemoglobin analysis showed significant higher number of participants in "malaria-never" group having altered hemoglobin. 12 participants had increased hemoglobin A2 levels, of which 10 were in "Malaria Occurrence Never" group; of them 6 could be diagnosed having hemoglobinopathy of specified variety. 3 of these 10 participants of "malaria-never" group had low G6PD levels also.

Conclusion

Malaria Protection Hypothesis was not found to be true as per our findings, but there were subtle hints that G6PD protection with or without change in hemoglobin alteration maybe operable.

Measuring the Drudgery and Time-Poverty of Rural Women - A Pilot Study from Rural Rajasthan

CONTEXT

Women's hard-work toward family responsibility is rarely examined from a health perspective. Excessive physical work translates into musculoskeletal disorders (MSDs). It is essential to understand certain parameters of this burden.

SUBJECTS AND METHODS

This was a cross-sectional study of 565 rural women. The participants were selected using a stratified random sampling method. A pre-tested questionnaire was used, focusing mainly on physical activities, durations, and health complaints.

RESULTS

The self-reported mean durations of various physical were quite high. On average, a woman spent around 11 h per day in domestic work-related physical activities. Older women (more than 50 years) spent similar durations for most of the physical activities compared to younger women (50 years or less). In the sample, 53.4% (n = 302) participants reported at least one Chronic MSD, and 16.99% (n = 96) took medication for the same in the last one year. Point prevalence of low back pain (LBP) was 29.2% (CI 25.5 to 33.1). Women worked even with MSDs as there was no significant difference in the mean durations among women with and without MSDs for most of the activity categories except for 'work in bending position' and 'work in farm'. General caste women spent higher time in domestic work.

CONCLUSIONS

Higher self-reported MSDs were likely to be contributed by continuous and repeated strenuous domestic work. Women had to continue working even with MSDs or higher age. Women got very less time for rest. Provision of basic amenities like electricity, water, cooking fuel, etc. at doorstep can help. Below poverty line women seem to have higher burden of MSDs.

Sex differences in child health and healthcare: A reappraisal for India

India has an unenviable reputation as one of the world's most gender disparate countries. Previous studies of sex bias in childhood have shown large differences between Indian boys and girls in immunization and curative healthcare, but little difference in health status as indicated by anaemia and stunting. India has changed rapidly in past decades, hence we reappraise the situation with the National Family Health Survey-4 (2015-16). We found no evidence of sex differentials in immunization coverage but a small degree of discrimination in favour of boys in medical treatment for common symptoms of infection. This discrimination was no greater in the North and Central regions of India, where severe excess mortality among female children persists. Sex differences in anaemia and stunting were small, with no regional pattern. We found no evidence that healthcare or health status of girls was influenced by the presence of other daughters in the family.

Effect on Crystallinity of Rice After Iron Fortification

Background:

Iron-deficiency anaemia (IDA) is the most common nutritional disorder observed in India particularly in under-five- year-old children, adolescent girls and pregnant women.

Objective:

The present study pioneered an investigation, into one of the varieties of paddy (IR-64) and their fortification with sodium iron EDTA salt, its physical properties, cooking characteristics, color, texture and characterization studies.

Methods:

Fortification was done at two concentrations 1.88g/kg and 3.39g/kg (250 & 450 mg/kg corresponding iron content), it was found that the iron content increased three to four-fold after fortification when compared to their corresponding controls.

Results:

The results revealed that, there was significant difference in the physical properties of rice in the control, fortified brown and milled rice. Cooking characteristics revealed, that water uptake and volume expansion were higher for fortified milled rice as compared to brown rice. The texture of fortified brown rice was hard as compared to fortified milled rice, although the taste was found satisfactory. The colour was significantly different in brown and milled rice.

Conclusion:

X-ray diffraction results revealed the polycrystalline nature of the fortified sample, was somewhat less crystalline as compared to control sample.

Prevalence of Anemia and its Associated Factors among Chinese 9-, 12-, and 14-Year-Old Children: Results from 2014 Chinese National Survey on Students Constitution and Health

Background: Anemia has been one of the main nutritional challenges around the world. Not enough attention has been paid to this issue in children and adolescents in China. In this study, we aimed to estimate the prevalence of anemia among 9-, 12-, and 14-year old Chinese children and investigate the associated factors of anemia. Methods: Data come from a cross-sectional survey conducted in 26 provinces and 4 municipalities in mainland China. A total of 48,537 children aged 9, 12, and 14 years old were included in data analyses. Anthropometric measurements were conducted to obtain information about height and weight. Capillary blood was collected from the fingertip, and hemoglobin concentration was tested by HemoCue201+. Information about sleep duration, daily consumption of eggs, milk, and breakfast were obtained from a self-administrated questionnaire. The mixed-effects logistic regression model was applied to estimate the association between selected variables and risk of anemia. Results: A total of 8.4% of participants were identified as being anemic; and the prevalence was higher in girls and rural children. Mixed-effects logistic regression analysis showed that children who were overweight, obese, and consumed eggs and milk every day had a lower risk of anemia. Spermarche, overweight/obesity, and having milk every day were associated with lower risk of anemia in boys, while menarche was found to be a risk factor and eating eggs every day to be a protective factor of anemia in girls. Conclusions: Anemia among 9-, 12-, and 14-year-old children is still high. Intervention programs of adding egg and milk into school daily diet might contribute to reducing anemia in Chinese school aged children, especially for those living in rural areas or girls with menarche.

New Biological Insights on X and Y Chromosome-Bearing Spermatozoa

A spermatozoon is a male germ cell capable of fertilizing an oocyte and carries genetic information for determining the sex of the offspring. It comprises autosomes and an X (X spermatozoa) or a Y chromosome (Y spermatozoa). The origin and maturation of both X and Y spermatozoa are the same, however, certain differences may exist. Previous studies proposed a substantial difference between X and Y spermatozoa, however, recent studies suggest negligible or no differences between these spermatozoa with respect to ratio, shape and size, motility and swimming pattern, strength, electric charge, pH, stress response, and aneuploidy. The only difference between X and Y spermatozoa lies in their DNA content. Moreover, recent proteomic and genomic studies have identified a set of proteins and genes that are differentially expressed between X and Y spermatozoa. Therefore, the difference in DNA content might be responsible for the differential expression of certain genes and proteins between these cells. In this review, we have compiled our present knowledge to compare X and Y spermatozoa with respect to their structural, functional, and molecular features. In addition, we have highlighted several areas that could be explored in future studies in this field.

Iron in Health and Disease: An Update

Iron is an essential micronutrient for oxygen transport, cellular energy metabolism, and many enzymatic reactions. Complex physiological processes have evolved for iron acquisition to meet metabolic needs while avoiding toxicity from iron-generated free radicals. Systemic iron homeostasis is centered around the regulation of iron absorption from duodenum and iron release from stores by hepcidin. Intracellular iron is maintained under tight control by iron regulatory proteins acting at post-transcriptional level. Despite these elaborate mechanisms, iron status is frequently altered by environmental or genetic influences. Iron deficiency anemia is the most common nutritional disorder affecting a quarter of the world population. Iron deficiency is associated with impaired cognitive development and reduced capacity for physical work, making it a high priority for public health initiatives. Chronic inflammation from infections or other causes limits iron availability and contributes to anemia of chronic disease. At the opposite end are conditions where iron overload leads to serious complications from organ damage. Mutations in HFE gene are the most frequent cause of hereditary hemochromatosis in European population, but rare elsewhere in the world. Iron overload develops in dyserythropoietic anemias from increased intestinal absorption. Transfusional iron overload, most often observed in thalassemia, is increasing among cancer survivors due to the use of protocols requiring intensive transfusion support. Tissue-specific brain iron overload is observed in some degenerative neurological diseases without an increase in systemic iron. New insights into iron metabolism are guiding the development of novel therapies for iron deficiency and iron overload.

Effort to Prevent Anaemia during Menstruation among Female Adolescent in Islamic Boarding School

Introduction: Female adolescents are generally prone to be infected by anaemiadue to the growing menstruation cycle which causes the loss of bloods insignificant amount every month and the needs of ferrum substance can bedoubled. The aimed of the research was to analyse factors related to the effort ofanaemia prevention during menstruation among female adolescents in Islamicboarding school.Methods: This research applied correlational descriptive design through theapproach of cross-sectional study. Total samples were 214 female students in 3Islamic boarding schools with criteria of female students aged 11-20 years oldand had experienced menstruation. Sample obtained by random sampling.Independent variables were knowledge, attitude, friends support, health facility,health efforts, and dependent variables was the efforts to prevention anaemia.Data obtained by questionnaire and analyzed by Spearman Rho with significancelevel α,0.005Results: The result showed significant correlation between knowledge (p=0.000;r=0.318). attitude (p=0.001; r=0.232). friends support (p=0.003; r=0.203). health facility (p=0.000; r=0.260). and health efforts (p=0.001; r=0.227) on prevention effort of anaemia on adolescents female menstruation in Islamic boarding school.Conclusion: Level of knowledge, posstive attitude, friends support, health facility,and health efforts can prevent anemia during menstruation. 

Prevalence of anaemia and associated factors among Oraon females of North 24 Parganas, West Bengal, India

Low haemoglobin level or anaemia is a health problem worldwide especially in developing countries like India. Anaemia is generally higher among indigenous groups compared to general population globally and females are specifically more prone to anaemia. However, studies are inadequate on indigenous groups of India. The aims of the study are to determine the prevalence of anaemia among the female Oraons of North 24 Parganas and to study the association between anaemia and concomitants like socio-demographic and food habit variables. Data have been collected on demographic, socio-economic and food habit variables using well-tested questionnaire from 309 Oraon females living in rural and urban areas of North 24 Parganas, West Bengal. Haemoglobin data were collected using standard instrument and technique. Descriptive statistics and binary logistic regression were used to analyze the data using SPSS version 16.0. Females of rural and urban areas were mostly married and non-literate, employed as labourers and had sedentary occupations. Majority of them consume fruits and vegetables but less animal protein and dairy product. Around 80% of the females were anaemic, irrespective of their habitat, socio-economic status and food habits. Anaemic status was associated with insufficient intake of animal protein, which is significantly associated with the anaemia status of the females in the present study.

Prevalence of anemia among adults at Hawassa University referral hospital, Southern Ethiopia

INTRODUCTION

Anemia is a public health problem in Ethiopia. In spite of the fact that anemia is a common health burden with much severe consequences, the prevalence of the different types of anemia and its severity have not yet been well documented in different parts of the country. The study aimed to assess the prevalence of different types of anemia, including severity and association with age and sex of study population.

MATERIALS AND METHODS

Four hundred anemic patients who are men and non-pregnant women above 15 years of age were selected from patients visiting the laboratory for Complete Blood Count (CBC) investigation. The type and severity of anemia were assessed based on red cell indices and haemoglobin levels respectively. Data was analyzed using SPSS version 19. Chi square was used at 95% confidence interval, considering P < 0.05 statistically significant for association among categorical variables.

RESULT

The overall prevalence of anemia in the study was 13%. Majority of cases had mild anemia 58.5%, while 19.0%, and 22.5% of the patients had moderate and severe anemia respectively. Overall, the prevalence of mild anemia increases with age, while the prevalence of moderate and severe anemia decreases as age increases. In the present study, the most common anemia was normocytic, which mostly occur in the elderly (61-85) years of age.

CONCLUSION

The CBC parameters help to diagnose and classify anemia in to major components, which might help for a better treatment practice in developing countries, where additional investigations are not available for a reliable diagnosis and classification of anemia. Despite resource limitations in developing countries, additional anaemia work up such as iron studies and markers of inflammation, will provide a more efficient diagnosis of anaemia.

Burden and Determinants of Anemia in a Rural Population in South India: A Cross-Sectional Study

Background/Objectives

To determine the prevalence and determinants of blood haemoglobin level and mild, moderate, and severe anemia in a sample of adults from rural Tamil Nadu, India.

Subjects/Methods

We recruited a sample of men and nonpregnant women aged 20 years and older. Clinical health measures included blood haemoglobin concentration and body mass index. We assessed associations between anemia outcomes and sociodemographic and dietary factors using linear and logistic regression modeling.

Results

A total of 753 individuals (412 women and 341 men) participated in this study. The prevalence of anemia was 57.2% among women and 39.3% among men (P<0.001). Prevalence of anemia increased with age among men (P<0.001) but not women (P>0.05). Iron intake was low; 11.7% women and 24.1% of men reported iron intakes above recommended dietary allowances (P<0.001). Factors (OR (95% CI)) associated with mild or moderate anemia among women included television ownership (0.27 (0.13, 0.58)), livestock ownership (0.46 (0.28, 0.75)), refined grain consumption (1.32 (1.02, 1.72)), meat consumption (0.84 (0.71, 0.99)), and commercial agriculture production (mild: 4.6 (1.1, 18.8); moderate: 6.8 (1.98, 23.1)). Factors associated with mild, moderate, or severe anemia among men included rurality (0.50 (0.25, 0.99)), sugar consumption (1.04 (1.01, 1.06)), egg consumption (0.80 (0.65, 0.99)), and high caste (7.3 (1.02, 52.3)).

Conclusion

Both women and men in this region may be particularly vulnerable to anemia, and future research must expand beyond dietary risk factors to examine the impacts of sociodemographic and environmental factors.

The co-occurrence of anaemia and stunting in young children

Anaemia and stunting are prevalent nutritional problems among children of low-income countries that have profound effects on development, morbidity, and mortality. Many use a single conceptual framework to identify the basic determinants of these and other forms of malnutrition. One would expect that problems with matching underlying determinants should co-occur in affected individuals to a greater degree than by chance. In 2 populations of children-ages 6-18 months in Bihar, India, (n = 5,664) and 6-36 months in Lambayeque, Peru (n = 688)-we measured the frequency of the co-occurrence of anaemia and stunting. We compared this value with the value expected by chance, the product of the prevalence of anaemia and stunting, using a chi-square test. We also built logistic regression models for each condition. The frequency of co-occurrence in the Indian population was 21.5%, and in the Peruvian population, it was 30.4%, which are similar to frequencies expected by chance, 21.3% (p = .97) and 31.5% (p = .85). In Peru, anaemia was associated with age and consumption of treated water. Stunting was associated with age, sex, dietary diversity, hand washing, language spoken, and wealth. In India, anaemia was associated with age, sex, caste, dietary diversity, and household hunger. Stunting was associated with age, sex, caste, wealth, and maternal illiteracy. Despite some basic shared factors, anaemia and stunting are more independent than commonly assumed. Interventions that target children based on 1 condition may miss children with the other form of malnutrition.

Investigation of Baseline Iron Levels in Australian Chickpea and Evaluation of a Transgenic Biofortification Approach

Iron deficiency currently affects over two billion people worldwide despite significant advances in technology and society aimed at mitigating this global health problem. Biofortification of food staples with iron (Fe) represents a sustainable approach for alleviating human Fe deficiency in developing countries, however, biofortification efforts have focused extensively on cereal staples while pulses have been largely overlooked. In this study we describe a genetic engineering (GE) approach to biofortify the pulse crop, chickpea (Cicer arietinum L.), with Fe using a combination of the chickpea nicotianamine synthase 2 (CaNAS2) and soybean (Glycine max) ferritin (GmFER) genes which function in Fe transport and storage, respectively. This study consists of three main components: (1) the establishment for baseline Fe concentration of existing germplam, (2) the isolation and study of expression pattern of the novel CaNAS2 gene, and (3) the generation of GE chickpea overexpressing the CaNAS2 and GmFER genes. Seed of six commercial chickpea cultivars was collected from four different field locations in Australia and assessed for seed Fe concentration. The results revealed little difference between the cultivars assessed, and that chickpea seed Fe was negatively affected where soil Fe bioavailability is low. The desi cultivar HatTrick was then selected for further study. From it, the CaNAS2 gene was cloned and its expression in different tissues examined. The gene was found to be expressed in multiple vegetative tissues under Fe-sufficient conditions, suggesting that it may play a housekeeping role in systemic translocation of Fe. Two GE chickpea events were then generated and the overexpression of the CaNAS2 and GmFER transgenes confirmed. Analysis of nicotianamine (NA) and Fe levels in the GE seeds revealed that NA was nearly doubled compared to the null control while Fe concentration was not changed. Increased NA content in chickpea seed is likely to translate into increased Fe bioavailability and may thus overcome the effect of the bioavailability inhibitors found in pulses; however, further study is required to confirm this. This is the first known example of GE Fe biofortified chickpea; information gleaned from this study can feed into future pulse biofortification work to help alleviate global Fe deficiency.

Prevalence of Anaemia among the Elderly in Malaysia and Its Associated Factors: Does Ethnicity Matter?

Introduction

Anaemia is common among the elderly, yet it remains an underresearched clinical condition. This study investigates ethnic differences in prevalence of anaemia and identifies potential factors associated with anaemia in the elderly.

Methods

Data from the National Health & Morbidity Survey (NHMS) 2015 conducted by Ministry of Health was analyzed. Haemoglobin levels were measured using point-of-care testing, HemoCue® Hb 201+ System©, from consenting individuals. Demographic information and other clinical information were obtained through a structured questionnaire. Descriptive and multivariate analyses were conducted and significant results were presented as adjusted odds ratio.

Results

A total of 3794 participants aged 60 years and older responded to the anaemia module with a response rate of 93.7%. 64.0% of respondents were of Malay ethnicity, 21.6% were Chinese, 6.1% were Indians, and 8.3% were of other ethnicities. The overall prevalence of anaemia among older people was 35.3%. The highest prevalence of anaemia was found among respondents of Indian ethnicity (45.5%). The Indian (aOR: 1.72; 95% CI 1.26–2.34) and Malay (aOR: 1.25; 95% CI 1.04–1.49) ethnic groups were more likely to be anaemic in comparison to those of Chinese ethnicity. Anaemia in older people was also associated with increasing age, history of hospital admission, and the presence of diabetes mellitus.

Conclusion

Anaemia in the elderly is associated with Indian and Malay ethnicities, increasing age, hospitalization, and diabetes. Our study has identified important information on a common condition which will guide and assist future studies in reducing the burden of anaemia.

Iron Deficiency Anemia with Menorrhagia: Ferric Carboxymaltose a Safer Alternative to Blood Transfusion

Background:

Menstrual disorder accounts for 5%–10% of the women presenting with iron deficiency anemia (IDA) in the perimenopausal age group. Heavy menstrual bleeding in this age group leads to severe anemia and frequently requires blood transfusion which has its own adverse effects. We today have ferric carboxymaltose (FCM) as a safer alternative to blood transfusion.

Objective:

The objective of the study is to evaluate the safety and efficacy of FCM in treating anemia in patients of menorrhagia. Thus avoiding blood transfusion.

Materials and Methods:

It was an open, single arm observational study including 90 women of age more than 30 years with definitive diagnosis of menorrhagia with IDA and hemoglobin (Hb) levels between 4 gm% and 11 gm%. Intravenous FCM (500–1500 mg) was administered, and the improvement in blood indices was assessed after 3 weeks of total dose infusion. Menorrhagia was controlled by medical treatment till Hb improvement was achieved and definitive surgical intervention was done.

Result:

Most of the women were in the age group of 40–50 years. Blood indices measured pre-FCM and 3 weeks post-FCM showed a mean increase in Hb from 8.33 ± 1.10 to 10.89 ± 1.02 with a statistically significant P < 0.01. There was a statistically significant rise of packed cell volume, serum ferritin, and serum iron in the post-FCM blood levels after 3 weeks. No serious life-threatening adverse events were observed after FCM administration.

Conclusion:

Intravenous FCM is an effective and a safe treatment option for IDA with a single administration of high dose without serious adverse effects obviating the need for blood transfusion before surgery.

Linking iron-deficiency with allergy: role of molecular allergens and the microbiome

Atopic individuals tend to develop a Th2 dominant immune response, resulting in hyperresponsiveness to harmless antigens, termed allergens. In the last decade, epidemiological studies have emerged that connected allergy with a deficient iron-status. Immune activation under iron-deficient conditions results in the expansion of Th2-, but not Th1 cells, can induce class-switching in B-cells and hampers the proper activation of M2, but not M1 macrophages. Moreover, many allergens, in particular with the lipocalin and lipocalin-like folds, seem to be capable of binding iron indirectly via siderophores harboring catechol moieties. The resulting locally restricted iron-deficiency may then lead during immune activation to the generation of Th2-cells and thus prepare for allergic sensitization. Moreover, iron-chelators seem to also influence clinical reactivity: mast cells accumulate iron before degranulation and seem to respond differently depending on the type of the encountered siderophore. Whereas deferoxamine triggers degranulation of connective tissue-type mast cells, catechol-based siderophores reduce activation and degranulation and improve clinical symptoms. Considering the complex interplay of iron, siderophores and immune molecules, it remains to be determined whether iron-deficiencies are the cause or the result of allergy.

High Prevalence of Anemia but Low Level of Iron Deficiency in Preschool Children during a Low Transmission Period of Malaria in Rural Kivu, Democratic Republic of the Congo

Anemia is a worldwide public health concern especially in preschool children in developing countries and iron deficiency (ID) is generally assumed to cause at least 50% of the cases. However, data on this contribution are scarce. To close this gap, we determined in 2013 the contribution of ID in the etiology of anemia and measured others factors associated to noniron deficiency anemia (NIDA) in 900 preschool children randomly selected during a two-stage cluster nutritional survey in the Miti-Murhesa health zone, in eastern Democratic Republic of the Congo. In these children, we collected sociodemographic, clinical, and biological parameters and determined the nutritional status according to the World Health Organization 2006 standards. Anemia was defined as altitude-adjusted hemoglobin < 110 g/L and ID was defined as serum ferritin < 12 μg/L or < 30 μg/L in the absence or presence of inflammation, respectively. Median (interquartile range) age was 29.4 (12-45) months. The prevalence of anemia was 46.6% (391/838) among whom only 16.5% (62/377) had ID. Among children without signs of inflammation, only 4.4% (11/251) met the ferritin-based (unadjusted) definition of ID. Logistic regression analysis identified ID, history of fever during the last 2 weeks and mid-upper arm circumference < 125 mm as the only independent factors associated to anemia. In conclusion, anemia is a severe public health problem in the Miti-Murhesa health zone, but NIDA is mostly predominant and needs to be further studied. Control of infections and prevention of acute undernutrition (wasting) are some of appropriate interventions to reduce the burden anemia in this region.

Newborn Thyroid Screening: Influence of Pre-Analytic Variables on Dried Blood Spot Thyrotropin Measurement

BACKGROUND

Measuring thyrotropin (TSH) eluted from a dried blood spot (DBS) is used to screen an estimated 30 million newborns annually for congenital hypothyroidism (CH). Newborn thyroid screening has eliminated cretinism from the industrialized world and decreased the adverse effects of unrecognized CH on neurocognitive development. Hematocrit, a pre-analytic variable that affects the measurement of TSH from a DBS, contributes to the imprecision of DBS TSH measurement and could account for false-negative and false-positive DBS newborn screening test results. To assess whether variations in hematocrit found in newborns have a clinical effect in DBS-based newborn thyroid screening, the effects of hematocrit variability on the measurement of DBS TSH were studied.

METHODS

U.S. Centers for Disease Control and Prevention procedures for manufacturing DBS performance testing standards were used to generate DBSs from blood samples, with hematocrits of 35%, 40%, 45%, 50%, 55%, 60%, and 65% and serum TSH concentrations of 6.3 ± 0.4 and 26.6 ± 8.0 mIU/L. TSH was measured in the eluates of four replicate DBS 3 mm punches at each hematocrit using the Thailand Ministry of Public Health Newborn Screening Operation Center enzyme-linked immunosorbent assay. Data were analyzed using a linear mixed-effects model.

RESULTS

Based on the mixed-effects model, hematocrit significantly affected DBS TSH measurement (p < 0.001). A 1% increase in hematocrit resulted in a 0.06 mIU/L decrease in eluate TSH when TSH was 6.3 + 0.4 mIU/L, and a 0.21 mIU/L decrease in eluate TSH when TSH was 26.6 + 8.0 mIU/L.

CONCLUSIONS

DBS TSH is significantly affected by the blood sample hematocrit. The pre-analytic variability due to hematocrit is independent of TSH assay sensitivity, specificity, precision, repeatability, and reference intervals. The effect of hematocrit on DBS TSH measurement is clinically relevant, could account for geographic and ethnic variation in the incidence of CH, and may result in both false-positive and false-negative CH screening results. Individual newborn and population-specific hematocrit correction factors may improve the precision of DBS TSH measurement.

How Non Consumers Differ from Consumers: A Qualitative Approach to Synthesize the Attributes of Iron Folic Acid End Users

INTRODUCTION

Anaemia continues to be a major hurdle to achieve optimum health in Indian population context. Although government continues to promote Iron Folic Acid (IFA) supplementation as one of the key strategies to combat with burden of anaemia, the expected level of IFA consumption and subsequent anaemia reduction could not be achieved. This study tries to investigate those influences, concerns, experiences and behaviour from an end user perspective through a qualitative methodology which may affect the IFA consumption ambi-directionally.

AIM

To explore and understand the several aspects related with anaemia and IFA supplementation with special emphasis to reveal the contributory factors behind low level of IFA consumption at consumer end.

MATERIALS AND METHODS

A community based qualitative study was conducted in clusters identified through multileveled stratification from a state of central India. A conceptual construct was made in priory for this study. As the research question was related with policy, this study adapted a framework technique for making interview topic guides. Two consumers and two non consumers from each identified cluster were interviewed in depth. The data obtained through 160 in depth interviews (from 80 consumers and 80 non consumers) was utilized for thematic framework, linkage association and to typify the phenomenon.

RESULTS

Ignorance, difficult intake, meaninglessness, misconceptions and discontentment with the system were the major dimensions (sub themes) associated with discontinuation. All these sub themes were further converged into major theme of informational discontinuity. Investigators further typified the users/non users into persistent user, potential defaulters, impending defaulters and absolute non users.

CONCLUSION

Informational gap seems to be the fundamental factor behind sub optimum IFA consumption. On a policy perspective, all the attempts should be done to instigate arise felt need' among target groups for IFA consumption.

Gemcitabine-cisplatin versus gemcitabine-oxaliplatin doublet chemotherapy in advanced gallbladder cancers: a match pair analysis

BACKGROUND

Gemcitabine-cisplatin (GC) and gemcitabine-oxaliplatin (GO) are the most commonly used regimens in advanced gallbladder cancer (GBC).

METHODS

The data of patients with advanced GBC, treated between January 2013 and June 2015 were retrieved. A 1:1 matching without replacement was performed by using nearest neighbor matching method.

RESULTS

A total of 326 patients (163 GC and 163 GO), were matched 1:1 by age and gender. The response rates for GC and GO were 31.2% and 36.3% (P = 0.350). The overall median event free survival (EFS) was 4.34 months (95% CI 4.030-4.644 months). The median EFS was 4.67 months (95% CI 4.060-5.271 months) in GC cohort and 3.88 months (95% CI 3.369-4.385 months) in GO cohort (P = 0.023). The overall median OS was 8.016 months (95% CI 7.361-8.672 months). The median OS was 8.02 months (95% CI 7.257-8.776 months) in GC cohort and 7.79 months (95% CI 6.690-8.88 months) in GO cohort (P = 0.455). The incidence of Grade 2/3 peripheral neuropathy (9.2% vs. 3.1%; P = 0.445) and Grade 3/4 transamintis (14.7% vs. 6.1%) was higher with GO while the incidence of anemia (22.1% vs. 6.7%; P < 0.001), neutropenia (7.3% vs. 2.4%; P = 0.49) and thrombocytopenia (9.8% vs. 3.7%; P = 0.033) was higher with GC.

CONCLUSION

Gemcitabine-cisplatin or gemcitabine-oxaliplatin can be used as an initial regimen in advanced GBC. Higher EFS, potentially lower costs, lower incidence of peripheral neuropathy and hepatotoxicity favor the use of GC, whereas a lower incidence of hematological toxicities, and potential ease of administration in patients with borderline renal and cardiac functions favor GO.

Prevalence of anemia and related factors among women in Turkey

Objective:

To determine the prevalence of anemia and related factors among women in Turkey.

Methods:

This descriptive study was conducted at the outpatient clinics of the Department of Internal Medicine, Ege University Medical School. Randomly selected women were given questionnaires regarding their socio-demographic and obstetric characteristics. The data were coded and analyzed using SPSS version 17.0 software. Statistical analyses with 95% confidence intervals were considered to be significant if p<0.05.

Results:

The study results showed an anemia prevalence of 27.8% in the study sample. Among all anemia diagnoses among the participants, 56.0% were determined to have iron deficiency, 37.1% iron-deficiency anemia, and 6.9% severe anemia. It was observed that anemia was detected among women who were 15-49 years of age (p<0.05), menstruating (p<0.05), had a history of Cesarean section (p<0.05), and had not entered menopause (p<0.05). Based on forward-stepwise-logistic regression analysis, the most important parameter was concluded to be age group, which was followed by menopausal status.

Conclusions:

The study results suggest that the anemia prevalence rate is specifically higher among women of reproductive age. To prevent anemia at a low cost, it is recommended to provide women with relevant information and well-planned interactive educational programs.

Association between RDW and stent thrombosis in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

Stent thrombosis is a rare but potentially fatal complication of percutaneous coronary interventions (PCIs). In recent years, the predictive and prognostic value of the red cell distribution width (RDW) as an indicator of inflammation has been shown in many cardiovascular diseases. Aim of this study was to examine the predictive value of RDW for stent thrombosis in patients who underwent successful stent implantation for ST-elevation myocardial infarction (STEMI).In this retrospective study, 146 patients who underwent successful PCI to native coronary artery due to STEMI previously and presented with acute coronary syndrome with stent thrombosis were included (stent thrombosis group). A total of 175 patients who had similar procedural characteristics (type, diameter, and length of stent) and not had stent thrombosis were consisted control group.Patients were divided into tertiles according to the admission RDW values (12.9 ± 0.4, 14.2 ± 0.4, and 16.3 ± 1.5, respectively). Stent thrombosis developed in 47 (40.9%) patients in the lowest tertile, 39 (37.9%) patients in mid tertile, and 60 (58.3%) patients in the highest tertile (P = 0.006). Female gender ratio was statistically significantly higher in the 3rd tertile (13 [11.3%], 8 [7.8%], 24 [23.3%], P = 0.003, respectively). RDW (OR: 1.397 [95% CI 1.177-1.657], P < 0.001) and platelet count (OR: 1.008 [95% CI 1.004-1.012], P < 0.001) remained independent predictors of stent thrombosis after multivariate logistic regression analysis. ROC curve analysis demonstrated that, admission RDW values higher than 13.9 can predict the development of stent thrombosis with a sensitivity of 57% and a specificity of 52% (The area under the ROC curve: 0.59 [95% CI 0.53-0.65] P = 0.007).High RDW values found to be independently associated with the development of stent thrombosis in patients with STEMI.

Finger on the Pulse: Pumping Iron into Chickpea

Iron deficiency is a major problem in both developing and developed countries, and much of this can be attributed to insufficient dietary intake. Over the past decades several measures, such as supplementation and food fortification, have helped to alleviate this problem. However, their associated costs limit their accessibility and effectiveness, particularly amongst the financially constrained. A more affordable and sustainable option that can be implemented alongside existing measures is biofortification. To date, much work has been invested into staples like cereals and root crops-this has culminated in the successful generation of high iron-accumulating lines in rice and pearl millet. More recently, pulses have gained attention as targets for biofortification. Being secondary staples rich in protein, they are a nutritional complement to the traditional starchy staples. Despite the relative youth of this interest, considerable advances have already been made concerning the biofortification of pulses. Several studies have been conducted in bean, chickpea, lentil, and pea to assess existing germplasm for high iron-accumulating traits. However, little is known about the molecular workings behind these traits, particularly in a leguminous context, and biofortification via genetic modification (GM) remains to be attempted. This review examines the current state of the iron biofortification in pulses, particularly chickpea. The challenges concerning biofortification in pulses are also discussed. Specifically, the potential application of transgenic technology is explored, with focus on the genes that have been successfully used in biofortification efforts in rice.

Randomised control trial showed that delayed cord clamping and milking resulted in no significant differences in iron stores and physical growth parameters at one year of age

AIM

Placental redistribution has been shown to improve haematological outcomes in the immediate neonatal period and early infancy. This study compared the effects of delayed cord clamping (DCC) and umbilical cord milking (UCM) on haematological and growth parameters at 12 months of age.

METHODS

This was a follow-up study of a randomised control trial, conducted in a tertiary care paediatric centre from August 2013 to August 2014. We studied 200 apparently healthy Indian infants randomised at birth to receive DCC for 60-90 seconds or UCM. The outcome measures were iron status and physical growth parameters at 12 months.

RESULTS

Of the 200 babies, 161 completed the follow-up and baseline characteristics were comparable in both groups. The mean haemoglobin in the DCC group (102.2 (17.2) g/L and serum ferritin 16.44 (2.77) μg/L) showed no significant differences to the UCM group (98.6 (17.1) g/L and 18.2 (2.8) μg/L) at one year. In addition, there were no significant differences in weight, height and mid-upper arm circumference in the two groups.

CONCLUSION

Term-born Indian infants who had DCC at 60-90 seconds or UCM showed no significant differences in ferritin and haemoglobin levels and growth parameters at 12 months of age.

A Prospective Study on Prevalence and Causes of Anaemia in Patients with Acute Coronary Syndrome

INTRODUCTION

Anaemia is a contributor for adverse prognosis in Acute Coronary Syndrome (ACS), but the epidemiology and causes of anaemia in such patients is not defined.

AIM

To study the prevalence and aetiology of anaemia in hospitalized patients with ACS.

MATERIALS AND METHODS

All consecutive patients admitted with ACS from January to March, 2010 were included. Their clinical information was recorded.

RESULTS

Of 130 (87 males) consecutive admissions for ACS, 47.7% had unstable angina, 10% had Non ST-Elevation Myocardial Infarction (NSTEMI) and 42.3% had ST-Elevation Myocardial Infarction (STEMI). Overall prevalence of anaemia (haemoglobin <130 g/l in men and <120 g/l in women) was 51.5% (n=67) and was more prevalent in women (n=30, 69.8%) than men (n=37, 42.5%). Moderate to severe anaemia was more in women (34.9%) compared to men (20.8%). Anaemia was more common in unstable angina patients (58.2%) than in NSTEMI (11.9%) or STEMI (29.9%) patients (p=0.013). Aspirin (p<0.01) and/or clopidogrel intake (p<0.01) and raised serum creatinine (p<0.01) were more often in anaemic patients. Heart failure (p<0.01) and triple vessel disease (p<0.05) were associated with anaemia. Multivariate predictors of duration of hospital stay were haemoglobin (p<0.05) at admission and revascularisation procedure (p=0.01) during hospital stay. The most common cause of anaemia was iron deficiency (29.9%).

CONCLUSION

Anaemia was common in our patients admitted with ACS. Female gender, antiplatelet drug intake and raised creatinine were associated with anaemia, which in turn was associated with adverse in-hospital outcomes. The impact of correcting anaemia on outcomes in ACS needs long term prospective study.

Prevalence of iron-deficiency anaemia and risk factors in 1010 adolescent girls from rural Maharashtra, India: a cross-sectional survey

OBJECTIVE

Iron-deficiency anaemia (IDA) is the most common nutritional disorder observed in adolescent girls in India. Our aim was to investigate the prevalence and risk factors associated with IDA in rural Maharashtra, India, to address current evidence gaps.

STUDY DESIGN

Cross-sectional survey.

METHODS

The study recruited 13- to 17-year-old adolescent girls living in 34 villages of Osmanabad district. Data were collected on individual health, dietary, sociodemographic factors, and anthropometric measurements were taken. Haemoglobin (Hb) levels were measured using Sahli's haemometer. Logistic and linear regressions were used to identify risk factors associated with IDA and Hb levels, respectively.

RESULTS

Among 1010 adolescent girls (response rate 97.5%), the mean Hb was 10.1 g/dl (standard deviation = 1.3), and 87% had anaemia (Hb < 12 g/dl). The prevalence of mild (11.0-11.9 g/dl), moderate (8.0-10.9 g/dl) and severe (Hb ≤ 7.9 g/dl) anaemia was 17%, 65% and 5%, respectively. Anaemia likelihood increased significantly with age (odds ratio (OR): 1.41 per year, 95% confidence interval (CI): 1.17-1.70). Factors associated with decreased anaemia risk were mid-upper arm circumference (MUAC) ≥22 cm (OR: 0.51, 95% CI: 0.31-0.82), ≥3 days/week consumption of fruit (OR: 0.35, 95% CI: 0.23-0.54) or rice (OR: 0.39, 95% CI: 0.17-0.91), and incomplete schooling (OR: 0.47, 95% CI: 0.24-0.91). In the final model lower age, MUAC and fruit consumption were significantly associated with Hb level.

CONCLUSION

Anaemia prevalence was extremely high among adolescent girls in rural areas of Maharashtra. Whilst we identified risk factors that could be used for targeting interventions, there is urgent need of comprehensive preventative interventions for the whole adolescent girl population.

Cost-Effectiveness of Price Subsidies on Fortified Packaged Infant Cereals in Reducing Iron Deficiency Anemia in 6-23-Month-Old-Children in Urban India

INTRODUCTION

Iron deficiency anaemia (IDA) is a major public health problem in India and especially harmful in early childhood due to its impact on cognitive development and increased all-cause mortality. We estimate the cost-effectiveness of price subsidies on fortified packaged infant cereals (F-PICs) in reducing IDA in 6-23-monthold children in urban India.

MATERIALS AND METHODS

Cost-effectiveness is estimated by comparing the net social cost of price subsidies with the disability-adjusted life-years (DALYs) averted with price subsidies. The net social costs correspond to the cost of the subsidy minus the monetary costs saved by reducing IDA. The estimation proceeds in three steps: 1) the current lifetime costs of IDA are assessed with a health economic model combining the prevalence of anemia, derived from a large population survey, with information on the health consequences of IDA and their costs in terms of mortality, morbidity, and DALYs. 2) The effects of price subsidies on the demand for F-PICs are assessed with a market survey among 4801 households in 12 large Indian cities. 3) The cost-effectiveness is calculated by combining the findings of the first two steps with the results of a systematic review on the effectiveness of F-PICs in reducing IDA. We compare the cost-effectiveness of interventions that differ in the level of the subsidy and in the socio-economic strata (SES) eligible for the subsidy.

RESULTS

The lifetime social costs of IDA in 6-23-month-old children in large Indian cities amount to production losses of 3222 USD and to 726,000 DALYs. Poor households incur the highest costs, yet even wealthier households suffer substantial losses. The market survey reveals that few households currently buy F-PICs, with the share ranging from 14% to 36%. Wealthier households are generally more likely to buy FPICs. The costs of the subsidies per DALY averted range from 909 to 3649 USD. Interventions targeted at poorer households are most effective. Almost all interventions are cost saving from a societal perspective when taking into account the reduction of future production losses. Return per DALY averted ranges between gains of 1655 USD to a cost of 411 USD.

CONCLUSION

Price subsidies on F-PICs are a cost-effective way to reduce the social costs of IDA in 6-23-month-old children in large Indian cities. Interventions targeting poorer households are especially cost-effective.

Magnitude of Anemia and Hematological Predictors among Children under 12 Years in Odisha, India

Background. Anemia is a wide spread public health problem in India which affects children. The present study evaluates the prevalence of anemia and status of various hematological parameters among children of Khurda district, Odisha. Method. A total of 313 children aged 0-12 years were enrolled for the study which included preschool (0-5 years) and school aged (6-12 years) groups. Hematological indicators were measured by standard procedures, which include red blood cell (RBC) indicators, white blood cell (WBC) indicators, and plasma ferritin. Results. Mean hemoglobin (Hb) of the study population was 10.43 ± 3.33 g/dL and prevalence of anemia was 62%. In this population, boys had a lower mean Hb value than that of the girls. All grades of anemia were higher among school age children than preschool children. Mean plasma ferritin was found to be higher in school age boys than their counterpart girls. The mean level of WBC count was found to be higher among preschool age boys than among the school age boys (p = 0.025). Conclusion. The prevalence of anemia was higher with concomitant acute infection among study population, which is a matter of concern. Since the hematological parameters are interrelated with each other as well as with the age and gender, relevant intervention strategy and constant monitoring are needed while providing public health nutrition programs to eradicate anemia.

Predictors of outcome in patients admitted with acute exacerbation of chronic obstructive pulmonary disease in a rural Tertiary Care Center

Background:

Chronic obstructive pulmonary disease (COPD) is associated with a high degree of mortality and morbidity around the world with the burden of the disease being more in the developing countries. In the Indian context data is limited. This study was carried out to determine the predictors of outcome in patients admitted with acute exacerbation of COPD in a rural Tertiary Care Center in the state of Kerala.

Materials and Methods:

This was a prospective cohort study. Patients admitted with acute exacerbation of COPD in the Intensive Care Unit between August 2013 and July 2014 was included in the study. Sociodemographic data, clinical variables, and investigations were collected. Mortality with respect to relevant risk factors was compared using Kaplan–Meier method and Cox proportional hazard model.

Results:

Seventy patients were enrolled in the study of whom 58 (82.9%) were above the age of 60 years. Majority of the patients (87.1%) were males. Tobacco smoking was the main risk factor in them. All the females had a history of exposure to biomass fuel in the form of firewood; none of them were smokers. Majority of patients (80.0%) had a history of one or more co-existing illnesses. Anemia was found to be an independent risk factor for mortality (adjusted hazard ratio: 3.167, 95% confidence interval: 1.516–6.616). Risk factors for poor outcome in COPD patients reported from other centers in India were not found to be relevant in this study.

Conclusions:

Anemia could be an independent risk factor for mortality in COPD patients. India already has a high prevalence of iron deficiency anemia especially in the rural area and in the geriatric population. Henceforth, family practitioners and primary care physicians may remain vigilant regarding the development of anemia in their COPD patients and institute remedial measures without delay. Futhermore, the wide variation reported in the predictors of outcome of COPD along with the finding of this study calls for an urgent need for more studies.

Social Costs of Iron Deficiency Anemia in 6-59-Month-Old Children in India

INTRODUCTION

Inadequate nutrition has a severe impact on health in India. According to the WHO, iron deficiency is the single most important nutritional risk factor in India, accounting for more than 3% of all disability-adjusted life years (DALYs) lost. We estimate the social costs of iron deficiency anemia (IDA) in 6-59-month-old children in India in terms of intangible costs and production losses.

MATERIALS AND METHODS

We build a health economic model estimating the life-time costs of a birth cohort suffering from IDA between the ages of 6 and 59 months. The model is stratified by 2 age groups (6-23 and 24-59-months), 2 geographical areas (urban and rural), 10 socio-economic strata and 3 degrees of severity of IDA (mild, moderate and severe). Prevalence of anemia is calculated with the last available National Family Health Survey. Information on the health consequences of IDA is extracted from the literature.

RESULTS

IDA prevalence is 49.5% in 6-23-month-old and 39.9% in 24-58-month-old children. Children living in poor households in rural areas are particularly affected but prevalence is high even in wealthy urban households. The estimated yearly costs of IDA in 6-59-month-old children amount to intangible costs of 8.3 m DALYs and production losses of 24,001 m USD, equal to 1.3% of gross domestic product. Previous calculations have considerably underestimated the intangible costs of IDA as the improved WHO methodology leads to a threefold increase of DALYs due to IDA.

CONCLUSION

Despite years of iron supplementation programs and substantial economic growth, IDA remains a crucial public health issue in India and an obstacle to the economic advancement of the poor. Young children are especially vulnerable due to the irreversible effects of IDA on cognitive development. Our research may contribute to the design of new effective interventions aiming to reduce IDA in early childhood.