Prevalence and Risk Factors of Iron Deficiency Anemia Amongst High Risk Health Care Workers in Udonthani Hospital, Thailand
Authors: Pongudom Saranya , Tantiworawit Adisak 
Published: October 2019

Abstract
Iron deficiency anemia (IDA) is a common problem which causes anemia in patients worldwide. A number of health care workers (HCW) have anemia from annual check up.
Objective: To find the prevalence and risk factors of IDA amongst the HCW with microcytic anemia in Udonthani hospital.
Materials and methods : One hundred and thirty five (135) high risk female HCWs had repeated CBC, Hb typing and ferritin and answered the questionnaire. High risk HCW is defined as HCW who has Hb <12 g/dl and MCV <80 fl. IDA is defined as serum ferritin< 45 μg/dl. Thalassemia is diagnosed by Hb typing. Thalassemia syndrome are B thal trait, B thal/HbE, homozygous Hb E and heterozygous Hb E. Cost of ferritin test and FBC are 310 baht per test and 0.5 baht per tablet, respectively. We performed a descriptive cross-sectional study. We calculated the sample size from formula: n = ( Z α/2)2 p (1-p)/d2 with p= 0.45 (from literature review1) 95% confidential level and 20% of an acceptable error, the result was 118. This study followed international standard ICH CGP and was approved by the ethics commitee of Udonthani hospital. Data were analyzed by STATA12. Risk factors and menstruation score were calculated by binary and multiple logistic regressions.
Results The total of 2,519 HCWs underwent annual check-up. Three hundred and ninty eight (398) HCWs were found to have anemia (Hb<12g/dl). Three hundred and seven (307) HCWs were at high risk. Of these high risk HCWs, three hundred (300, 97.2%) were female. Prevalence of IDA amongst high risk HCW was high (82/135= 60.74%) compared to WHO report. Heavy menstruation was a significant risk factor for IDA. The scoring of heavy menstruation was calculated (N=103) by using ≥ 5 total pads per day and pads were used with fully soaked (yes=1, no=0 point), the person with 2 and 1 point obtain OR 21.37; 95%CI, 4.89 to 93.37, p <0.0001 and OR 3.23; 95%CI, 0.98 to 10.66, p=0.05 respectively. Empirical iron supplement to high risk HCWs (N=135) for a 1-3 months without conducting ferritin tests can save nearly 40,000 baht with NNT=2. The prevalence of IDA in HCW with 2 points of menstruation score is really high (90.48%.) If high risk HCW dose not response to iron supplement or have any question, they can visit doctors at any time. The result can apply to other hospitals in North-East part of Thailand where a ferritin test is not established. In addition, the study also found IDA in thalassemia syndrome patients 46.34% (38/82).
Conclusion Theprevalence of IDA in high risk HCW was high (60.74%). Heavy menstruation is a statistical significant factor. Empirical iron supplement without conducting a ferritin test can save a number of money especially when menstruation score is equal to 2.
1= Control of iron deficiency anemia in low- and middle-income countries. Blood. 2013 Apr 4;121(14):2607-17 Table 1.Adjusted odd ratio between iron deficiency anemia and factorsCharacters (N=98)Adjusted OR95% CIP ValueMenstruation score1 mark3.23(0.98, 10.66)0.052 mark21.37(4.89, 93.37)<0.0001Dietary habitless than 3 meals/day2.34(0.81, 6.75)0.11not preferring meat4.19(0.79, 22.33)0.09eating entrails2.26(0.66, 7.53)0.19Menstruation mark = ≥ 5 total pad used/day (no =0, yes =1) + pads fully soaked (no = 0, yes =1)

Disclosures
No relevant conflicts of interest to declare.