An Analysis of Societal Determinant of Anemia among Adolescent Girls in Azad Jammu and Kashmir, Pakistan

Uncovering the hidden health burden: a systematic review and meta-analysis of iron deficiency anemia among adolescents, and pregnant women in Pakistan

INTRODUCTION

Iron deficiency anemia (IDA) is the most prevalent diet-related disorder and mainly affects women and children. To determine the trend of anemia incidence in Pakistan, a current review was carried out. This review aimed to estimate the prevalence of anemia among pregnant women and adult/adolescent nonpregnant women in Pakistan and to provide a 15-year trend analysis.

MATERIALS AND METHODS

Studies were identified by searching PubMed, Google Scholar, Scopus, and Science Direct, complementing this digital exploration, and a manual review of reference lists from previously published prevalence studies was performed to enhance the scope of relevant articles. A total of twenty-seven population-based anemia studies on adolescent/adult females and pregnant women published in Pakistan from January 1st-2007 until December 2021 were included. Systematic data extraction was facilitated through the implementation of a standardized and rigorously pretested data extraction checklist. For the subsequent analysis, the sophisticated capabilities of R statistical software were harnessed. The I2 test was used to assess heterogeneity among studies, and the pooled prevalence of anemia was calculated.

RESULTS

The final analysis included 27 research articles as well as two extensive National Nutrition survey reports, NNS 2011 and NNS 2018. The forest plot of sixteen studies on pregnant women revealed that the overall pooled prevalence of anemia among pregnant females in Pakistan was 70.4% (95% CI: 0.619, 0.789), and the forest plot of eleven studies on non-pregnant adolescent and adult females reported the pooled prevalence was 54.6% (95% CI: 0.422, 0.669). Subgroup analysis among pregnant women based on region, trimester and socioeconomic status revealed that the highest anemia incidence was observed in Punjab (77.4%). Similarly, females in the second trimester reported a higher prevalence of anemia 78% (95% CI, 0.556 1.015), and the status-wise group with a mixed background reported a higher prevalence 72.8% (95% CI, 0.620 0.835). According to the subgroup analysis, eleven studies of adult nonpregnant groups of mixed socioeconomic status reported a higher prevalence of 56.9% (95% CI, 0.292 0.845).

CONCLUSION

In Pakistan, anemia, is widespread among pregnant women and nonpregnant adolescent/adult females. A deeper understanding of anemia in Pakistani women is necessary for targeted interventions and policy decisions to predict demographic shifts.

Exploring the perspective of young adults about anaemia prevention; the contributions of knowledge about at-risk groups and consequences of anaemia

BACKGROUND

Anaemia persistently remains a grave public health challenge in most sub-Saharan African countries. Understanding the perspectives of young adults concerning the multi-factorial nature of anaemia may be an important step towards meeting the 2025 global nutrition target of halving anaemia since these individuals might be in the process of reproductive decisions.

AIM

To explore the relationship between students' knowledge about individuals at risk of developing anaemia, and anaemia consequences, and anaemia prevention strategies in a tertiary student cohort.

METHODS

This sequential exploratory study adopted a mixed-methods approach to triangulate the data collection. A semi-structured questionnaire was used to gather baseline data regarding students' perspective on anaemia. Themes that emerged from the initial questionnaire data analyses guided a focus group discussion (FGD) to further explore students' perspectives on anaemia. FGD data was thematically analysed to unearth reasons behind questionnaire item selection. Structural equation modeling (SEM) was used to explore the relationship between constructs in the anaemia knowledge questionnaire.

RESULTS

Overall, 543 students participated in the initial questionnaire data acquisition compared to 16 in the FGD. Our latent variable structural model showed that knowing the causes of anaemia did not significantly (p > 0.05) associate with either knowledge about anaemia consequences (b = 0.113) or knowledge about anaemia prevention strategies (b = 0.042). However, knowledge about individuals at-risk of anaemia was significantly positively associated with both anaemia prevention strategies (b = 0.306, p < 0.05) and knowledge about consequences of anaemia (b = 0.543, 95%). Moreover, knowing the consequences of anaemia seemed to significantly positively mediate the association between knowledge about at-risk groups and preventive measures that could be adopted (b = 0.410, p < 0.05).

CONCLUSIONS

Systems thinking public health educational campaigns that highlight the consequences of anaemia and at-risk groups are more likely to inspire the adoption of preventive strategies among young adults.

Geostatistical analysis for spatial distribution of anemia (Hb level) among women of reproductive age and determinant factors

The study was designed to assess the geostatistical spatial distribution of anemia and determinant factors among the women of reproductive age group (RAG) in Gilgit district, Pakistan. The Hb levels for 15-25 RAG, 26-35 RAG, and 36-45 group showed 10.22 g/dL, 10.41 g/dL, and 9.90 g/dL levels, respectively, while the Hb level showed a nugget/sill ratio of 0.21 inferring strong for the 15-25 group, weak for the 26-36, and moderate for 36-45 spatial dependence. Furthermore, 15-25 RAG showed 8% severe and 33.34% sufficient cases and 26-35 showed 12% severe and 29.33% sufficient results in their Hb level, whereas 36-45 had 9.34% severe and 29.33% sufficient.

Prevalence of Anemia among Children and Adolescents of Bangladesh: A Systematic Review and Meta-Analysis

The prevalence of anemia is high among children and adolescents in low- and middle-income countries because of undernutrition resulting from their poor socioeconomic status and lack of knowledge on proper nutrition. We conducted a systematic review and meta-analysis to determine the prevalence of anemia among children and adolescents aged between 6 months and 19 years in Bangladesh. Databases such as PubMed, Scopus, and Google Scholar were searched to identify the studies that reported the prevalence of anemia among children and adolescents. A total of 24 studies, including the data of 14,062 cases, were included in the systematic review and meta-analysis of the time period between 1997 and 2019. The random-effects model was used to calculate the summary estimates. The protocol was registered with PROSPERO (CRD42021246960). The pooled prevalence of anemia, iron deficiency anemia (IDA), and non-severe and severe anemia were 46.8% [95% CI: 36.0-57.6], 13.6% [95% CI: 8.0-19.2], 56.4% [95% CI: 39.6-73.1] and 0.7% [95% CI: 0.1-1.4], respectively. Prevalence of anemia exhibited the highest among the children aged ≤2 years. Briefly, 91.67% of the studies were of high quality. No significant publication bias was found; however, two outlier studies were detected. The prevalence of anemia among children and adolescents was estimated as high in Bangladesh.

Fundamental Aspects of the Development of a Model of an Integrated Health Care System for the Prevention of Iron Deficiency Anemia among Adolescent Girls: A Qualitative Study

Iron deficiency anemia (IDA) in adolescent girls is a problem that has not been resolved. This study aimed to explore the critical aspects of an integrated health care system model for preventing IDA in adolescent girls in a rural area of Indonesia. This qualitative research employed a grounded theory approach in order to build a substantive theory. This study used in-depth interviews with adolescents, parents, teachers, health workers, and persons in charge of adolescent programs at the health office, education office, and ministry of religion. Purposive sampling was performed until data saturation was achieved. Codes, categories, and themes were generated through thematic data analysis to develop a substantive theory. Data analysis was performed using MAXQDA 2022 software. A total of 41 people participated in this study. This investigation generated twenty-two categories and seven themes. These themes relate to policymaker commitments, stakeholder governance, quality, adolescents' lifestyles, adolescents' self-factors, adolescents' access to health services, and social support. The themes identified become fundamental aspects of the integrated health care system model for preventing IDA in adolescent girls. The model of the integrated health care system consists of several essential points, which include awareness and efforts from policymakers and adolescent girls, supported by parents, teachers, and the community.

Iron Deficiency Anemia and Associated Factors Among Adolescent Girls and Women in a Rural Area of Jatinangor, Indonesia

Background

Iron deficiency anemia is a common problem among adolescent girls and women, with significant consequences on personal health. One of the causes of iron deficiency anemia is inadequate nutritional intake. This study explores iron-deficiency anemia and associated factors among adolescent girls and women in a rural area of Jatinangor, Indonesia.

Methods

A cross-sectional study was conducted with 95 adolescent girls and 85 women between April and November 2018. Cluster random sampling was used to select the participants from seven villages in the Jatinangor district. After obtaining informed consent, we collected sociodemographic data, menstrual histories, and related data, including nutritional intake using 24-hour dietary recall. Anthropometrics were gathered to determine the body mass Index (BMI), and venous blood samples were analyzed for complete blood count and hemoglobin levels. Descriptive statistics followed by bivariate and multivariable logistic regression were used to identify anemia-associated factors.

Results

The prevalence of iron deficiency anemia among the girls was 21.1% and 9.4% among women, with an average hemoglobin level in adolescents of 10.75 g/dL (± 0.79) and in adults 11.20 g/dL (± 0.61), whereas MCV was 74.49±8.22 fL in adolescents and 7.61±8.62 fL in adults. The majority of our samples were not stunted in growth and were also within a normal weight range. Multivariate logistic regression analysis showed that protein intake (OR=0.25; 95% CI 0.11–0.58) was a positively associated factor with anemia.

Conclusion

The prevalence of iron-deficiency anemia in this study represents a mild public health problem in the study sample. Based on the hemoglobin level, anemia, can be classified as moderate in adolescents and mild in adults. Low levels of MCH indicate iron-deficiency anemia. Sufficient protein intake did not prevent anemia due to macronutrient and micronutrient intake.

Spatial distributions and determinants of anaemia among adolescent girls in Ethiopia: a secondary analysis of EDHS 2016 - a cross-sectional study

OBJECTIVE

This study aimed to investigate the spatial distributions and determinants of anaemia among adolescent girls in Ethiopia. Exploring the spatial epidemiology of anaemia and identifying the risk factors would inform policymakers to come up with evidence-based prevention strategies for anaemia, especially in adolescent girls, who are the most affected segment of the population.

METHODS

Secondary analysis of the Ethiopian Demographic and Health Survey 2016 was conducted. A total of 3172 adolescents were included in the analysis. The Bernoulli model was fitted using SaTScan V.9.6 to identify hotspot areas and the geospatial pattern and prediction of anaemia were mapped using ArcGIS V.10.8. A multilevel logistic regression model was fitted to identify factors associated with anaemia among adolescent girls. Adjusted OR with 95% CI was calculated and variables having a p value less than 0.05 were statistically significant factors of anaemia.

RESULT

The overall prevalence of anaemia among adolescent girls in Ethiopia was 23.8 (22.4 to 25.3), with significant spatial variations across the country. The SaTScan analysis identified a primary cluster in the eastern, northeastern and southeastern parts of Ethiopia (loglikelihood ratio=39, p<0.001). High anaemia prevalence was observed in eastern parts of the country. In the multivariable multilevel logistic regression analysis, no formal education (adjusted OR (AOR)=1.49, 95% CI 1.05 to 2.12), Afar (AOR=3.36, 95% CI 1.87 to 6.05), Somali (AOR=4.63, 95% CI 2.61 to 8.23), Harari (AOR=1.90, 95% CI 1.32 to 4.10), Dire Dawa (AOR=2.32, 95% CI 1.32 to 4.10) and high cluster altitude (AOR=1.37, 95% CI 1.03 to 1.82) were significantly associated with anaemia.

CONCLUSION

The national distributions of anaemia varied substantially across Ethiopia. Educational status, region and cluster altitude were significantly associated with anaemia in the multivariable logistic regression model. Thus, targeted public health interventions for adolescent girls should be implemented in the hotspot areas.

Multilevel analysis of determinants of anemia among young women (15-24) in sub-Sahara Africa

Background

Anemia is a disorder by which the body’s red blood cells are inadequate to fulfill The physiological needs of the body. The World Health Organization (WHO) defines anemia as having a hemoglobin (Hb) level of less than 120 g/l for nonpregnant women and 110 g/l for pregnant women. It has serious implications for human health as well as negative social and economic consequences like decreased workforce, impaired learning, and stunted child development. As these women are highly vulnerable to different micro and macro-nutritive deficiency associated with rapid physical, mental and psychological development, particular attention should be given to a young woman (15–24). Therefore this study assesses the magnitude and determinants of anemia among young women in sub-Saharan Africa (SSA).

Methods

This was a secondary data analysis based on the Demographic and Health Surveys (DHS) data conducted in sub-Saharan Africa. We pooled the most recent DHS surveys done in 31 sub-Sahara Africa and a total weighted sample of 88, 832 young women (15–24 years) were included. At bivariable analysis, variables with a p-value of ≤0.2 were selected for multivariable analysis, and at the multivariable analysis variables with a p-value of ≤0.05 were considered as a significant factor associated with anemia among young women (15–24 years).

Results

The pooled prevalence of anemia among young women (15–24) in sub-Sahara Africa was 42.17% [95%CI: 41.85, 42.50]. Young women of aged 20–24 years [AOR = 0.92, 95%CI: 0.89–0.95], women from rich household [AOR = 0.83, 95%CI: 0.80–0.87], young women with primary [AOR = 0.7, 95%CI: 0.67–0.72], secondary [AOR = 0.72, 95%CI: 0.69–0.75] and higher educational status [AOR = 0.58, 95%CI: 0.53–0.64], married women [AOR = 1.12, 95%CI: 1.08–1.17], divorced/separated/widowed women [AOR = 1.16, 95%CI: 1.08–1.25], women who use modern contraceptive [AOR = 0.65, 95%CI: 0.62–0.67], young women who ever had terminated pregnancy [AOR = 1.22, 95%CI: 1.14–1.29], overweight young woman [AOR = 0.79, 95%CI: 0.76–0.82] and young women from female-headed household [AOR = 0.94, 95%CI: 0.91–0.97] were the individual-level factors that significantly associated with anemia of young women. Meanwhile, being a rural dweller [AOR = 0.82, 95%CI: 0.79–0.85] and high community educational level [AOR = 0.87, 95%CI: 0.70–0.97] were the community level determinant of anemia. Interclass correlation coefficient (ICC), Median Odds Ratio (MOR) and Percentage change in variance (PCV) were done for the assessment of the random effect model of the multilevel analysis. The ICC value in the null model was 0.05, which indicates that 5% of the variation in anemia among young women in sub-Saharan Africa was attributed to community-level factors.

Conclusion

The prevalence of anemia among young women in this study was higher compared with reports from the previous studies. Divorced/separated/widowed women, married women and women with ever terminated pregnancy, young women with primary, secondary and higher educational achievement, being rural dwellers, young women aged 20–24 years, being from rich households and women who used modern contraceptives were factors that significantly associated with anemia among young women. Therefore, particular attention should be given to those higher-risk women including, young women with a history of a terminated pregnancy, those from rural areas and young women aged 15–19 years to reduce the burden of anemia among these young women as the continuity of the future generation depends on the health of young women.

Anemia in Pregnant Women and Children Aged 6 to 59 Months Living in Mozambique and Portugal: An Overview of Systematic Reviews

INTRODUCTION

Globally, anemia is still a public health issue faced by people in low and high-income countries. This study gives an overview of published scientific articles related to the prevalence, nutritional indicators, and social determinants of anemia in pregnant women and children aged 6 to 59 months living in Mozambique and Portugal.

METHODS

We performed a review of scientific literature in April 2021, searching for published indexed articles in the last 15 years (2003-2018) in electronic databases. Subsequently, quality assessment, data extraction, and content analysis were performed.

RESULTS

We have identified 20 relevant publications. Unsurprisingly, anemia plays a relevant role in disability and life imbalances for these subgroups in Mozambique compared with Portugal. For both countries, data on anemia and iron deficiency in pregnant women and children aged 6 to 59 months old are either outdated or remain unclear. Similarly, studies on social determinants and anemia are also still scarce.

CONCLUSIONS

A gap of information on anemia, other nutritional indicators, and social determinants in pregnant women and children between 6 and 59 months of age living in Mozambique and Portugal is highly observed. More research is crucial to help achieve the goals established by the Sustainable Development Goals.

Prevalence of anaemia among school going adolescent girls attending Test, Treat and Talk (T-3) camp under Anaemia Mukt Bharat in Delhi

Background

Adolescent period is signalized by marked physical activity and rapid growth spurt; therefore, they need additional nutritional supplements and are at utmost risk of developing nutritional anaemia. Anaemia play a major role in affecting the adolescents especially girls. On September 2019, Ministry of Health and Family welfare, Govt. of India directed to all state and district health authority to conduct Test, Treat and Talk (T-3) anaemia camps for celebration of nutrition month (Poshan Maah) in all government schools and colleges. The present study aimed to assess prevalence of anaemia and factors associated with it among school going adolescent girls attending T-3 camp in Delhi.

Methods

A cross-sectional study was conducted among 203 adolescent girls in government girls' school in central district of Delhi. Hb estimation was done by HemoCue 201 and data regarding socio-demographic details, deworming, dietary preferences were collected. Clinical examination and anthropometric measurements were done by resident doctors. Data was analysed using STATA vs. 13.

Results

The prevalence of anaemia was found to be 59% with mean (±SD) Hb of 11.3 gm/dl (±1.55) among 203 participants. The majority (48%, n = 119) of anaemic girls had mild degree of anaemia. Among 203 girls, 65% participants were of age 14-15 years with mean (±SD) age of 14.6 years (±1.18). There was a significant relationship between anaemia and diet, deworming status, and BMI (P < 0.05).

Conclusion

The study revealed that anaemia was highly prevalent among adolescent girls. Among anaemic girls, majority had mild anaemia. Factors like vegetarian diet, underweight, deworming and presence of pallor were found to be associated with anaemia. There is need to conduct T-3 camps at regular interval in all schools to curb the problem of adolescent anaemia.

Prevalence and determinants of anemia among young (15-24 years) women in Ethiopia: A multilevel analysis of the 2016 Ethiopian demographic and health survey data

BACKGROUND

Anemia is a major global public health problem that had tremendous impacts on human health, social and economic development. African countries contribute to the highest-burden of anemia among women, particularly in adolescent females and young women. Anemia among young women remains a public health problem in most parts of Africa, including Ethiopia. Therefore, this study aimed to investigate the prevalence and determinants of anemia among young women in Ethiopia.

METHODS

A secondary data analysis was conducted based on the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 5796 young women (15-24 years) was included in this study. We employed a multilevel analysis to assess factors associated with anemia since the EDHS has hierarchical nature. Deviance, Intraclass Correlation Coefficient (ICC) and Median Odds Ratio (MOR) were used for model comparison as well as for assessing model fitness. Variables with a p-value of less than 0.20 at bivariable multilevel analysis were considered for the multivariable multilevel analysis. In the multivariable multilevel analysis variables with p-value ≤ 0.05 were declared to be a significant factor associated with anemia, and the Adjusted Odds Ratio (AOR) with the 95% Confidence Interval (CI) were reported to assess the strength and direction of the association.

RESULTS

The overall prevalence of anemia among young women was 21.7% (95%CI = 20.7%, 22.8%). In the multivariable multilevel binary logistic regression analysis; being Muslim religion follower [adjusted odds ratio (AOR) = 1.31, 95%CI = 1.07, 1.70] and being protestant religion follower [AOR = 1.31; 95%CI = 1.01, 1.71], being rural dweller [AOR = 1.34; 95%CI = 1.02, 1.78], and being married [AOR = 1.46; 95%CI = 1.22, 1.74] were significantly associated with higher odds of anemia among young women. While, modern contraceptive use (AOR = 0.66; 95%CI = 0.53, 0.83) were significantly associated with lower odds of anemia among young women.

CONCLUSION

In this study, the prevalence of anemia among young women was high. Being a follower of Muslim and protestant religions, being married women, modern contraceptive use and being from the rural area were found to be significant determinants of anemia among young women. Therefore, giving special attention to these high-risk groups and distributing modern contraceptives for those in need of it could decrease this devastating public health problem in young women.

Prevalence of Anemia in View of Socio-demographic and Health Status of Adolescent Girls Enrolled in Government School at Border-belt of Indian Punjab

Poor socio-demographic and health status are considered key factors for prevalence of anemia in school-going adolescent girls in developing countries. A cross-sectional study was conducted (2019-2020) on 32 adolescent girls, randomly selected from 9^th, 10^th, 11^th, and 12^th standards at Government School, Harike Pattan to assess magnitude of anemia and its associated factors. Hemoglobin level of adolescent girls was assessed using cyanmethaemoglobin method. Subsequently, adolescent girls were interviewed about their hygiene and health status through a pre-structured interview schedule. Collected data were analyzed by applying One-way ANOVA (analysis of variance) with Tukey's post-hoc test and Chi-square test to investigate prevalence of anemia and its association (p < .05) with various independent variables, correspondingly. Research findings indicated a high (100%) overall prevalence of anemia among adolescent girls, with mild, moderate, and severe anemia in 28, 59, and 13% of total adolescent girls, respectively, reflect the burden of this nutritional turmoil at a great extent. Low mean hemoglobin level (9.9 g/dl) was significantly (p < .05) associated with low socio-economic status, schedule caste, long duration of menstruation, poor personal and food hygiene profile, and infections among adolescent girls. Awareness on factors enhancing iron bio-accessibility among adolescent girls is highly recommended.

Knowledge, Attitude, and Practice of Blood Donation Among Undergraduate Medical Students in Azad Kashmir

Objective

To evaluate the knowledge and attitude of undergraduate medical students of Poonch Medical College about blood donation.

Methods

This cross-sectional study was done using a 27-item, validated, interviewer-administered questionnaire involving undergraduate medical students from March to October 2018. Informed consent and ethical clearance were secured.

Results

A total of 318 undergraduate medical students (response rate of 63.6%) was included in this study. Most respondents knew the difference between whole blood and blood components (294; 92.5%) and they also believed that spreading knowledge of blood donation among the health workers is a necessity (306; 96.2%). There was a statistically significant correlation between knowledge and attitude (p .021). Overall knowledge was higher among the female students (p = .019).

Conclusion

The study revealed an overall good level of knowledge and attitude among medical students. However, there are still areas of improvement such as blood donation and vaccination-related knowledge. The study also identified important facilitators and barriers to blood donation.