Prevalance and determinants of anemia and iron deficiency: Among jordanian women 15-49 years of age: A National study

Anaemia affects over 2 billion people worldwide, causing tiredness, poor quality of life and low productivity. Over half the pregnant women in the world are vulnerable to these consequences because they are anemic. The consequences of anemia can be devastating in pregnant women. It can result in maternal mortality and stillbirth if Hemoglobin level is less than 7 gm/lOml. Moderate anemia (7-11 gm/l00ml) can lead to stillbirth and low birth weight and maternal death if the pregnant woman suffered another maternal complication.

The Great majority (99%) of maternal deaths occur in developing countries. In response to the enormity of the problem, the Safe Motherhood initiative (SMI), an interagency effort to reduce maternal mortality and morbidity, was launched in 1987 in Nairobi. Its target is to reduce levels of maternal deaths by at least half by the year 2000 and to achieve substantial reduction in maternal morbidity.

A number of hospital-based and community-based studies that were carried out in developing countries have shown that anemia contributed from a low (4-5%) of maternal deaths in Senegal and Bangladesh to a high of 16% in Ambala, North India. Many other countries reported figures somewhere in the middle (about 9%).

Anemia sequelae
In pregnancy, severe anemia can lead to cardiac failure. Moderate anemia is associated with decreased maternal well -being and contribute to maternal deaths from hemorrhage or infections. The sequelae of anemia are not limited to maternal complications but also contribute to perinatal morbidity and mortality by increasing the likelihood of intrauterine growth retardation and pre-term delivery.
The effects of anemia on maternal and perinatal mortality are largely preventable with appropriate treatment. However, in developing countries, there are as yet few MCI I programs that successfully implemented comprehensive control strategies. This meager intervention comes as a surprise when it is known that the epidemiology of anemia, the knowledge and technical means of preventation treatment are distributed worldwide.

 

The most common causes of anemia are iron and folate deficiency, malaria and hookworm infestation. It has been found that these common causes of anemia can be managed in a cost effective manner through the primary health care system.

This national study of 1801 Jordanian women in the child bearing age is the first and only study of the prevalence and determinants of anemia and iron deficiency among Jordanian women. In November of 1995, UNICEF in cooperation with the Ministry of Health, launched this study that aimed at examining the prevalence and determinants of anemia among Jordanian women in the child bearing age. UNICEF Jordan country program and the Ministry of Health were the first among five other countries in the ME-NA region to respond positively to a call by UNICEF regional office to participate in a multi-center study. Based on a randomly selected sample, prepared in cooperation with the Department of Statistics, women were interviewed in their homes to obtain a comprehensive data on their reproductive experiences, nutritional status, and demographic information that would help explain their hematological status. Blood samples were also drawn for all study subjects. Hemoglobin level and complete blood picture were determined for all study participants. Serum ferritin levels were analyzed for all women who were found to be anemic and an equivalent controls of non-anemic women.

The study results have shown that, on average, study women were 28 years old, married (68%), married at the age of 19 years, have been pregnant (5.6 times), and delivered (4.9 babies), have on average (4.6) living children, and pregnant in the sixth month. On average, a study woman has a mean hemoglobin of 12.4 gm/100 ml (+ 1.45) with a minimum level of 5.7 gm/100 and a maximum of 16.7 gm/lOOml. Serum ferritin values had a mean of 18.8 (+21) with a minimum value of 0.1 and a maximum of 165 ng/ul. A WHO recommended values were used as cust off points to estimate the proportion of women who were anemic and/or iron deficient. Among the study participants there were 28.6% anemic women and 55.3 % iron deficient women. In comparison to prevalence figures published by the WHO Maternal Health and Safe Motherhood Program (.), Jordanian figures are better than the world average of 37% anemic women. The prevalence of anemia in Jordan is also far better than developing countries in Africa (44%), Asia (45%), Latin America (31%).

Mean hemoglobin, serum ferritin, proportion of anemic, and iron deficient wonwi were further analyzed by examining the contribution of socioeconomic wellbeing, reproductive health practices and indicators of nutritional status into current hematological status of study women. Out of the studies determinant factors, reproductive health indicators were very closely related to mean hemoglobin level, prevalence of anemia and iron deficiency. We were unable to demonstrate a definitive and consistent relationship between women hematological status and the studied indicators of socioeconomic and nutrition indicators.

The report also concludes by a set of recommendations that feed into programming efforts of UNICEF and Ministry of Health with regards to strengthening of existing maternal health services.