The etiology of iron deficiency anemia during pregnancy among rural mothers in Malaysia
Creators: name: Arshad, Fatimah
Publisher: name: University of British Columbia
Year: 2010

description: This thesis reports the findings of two aspects of an investigation on iron deficiency anemia among rural pregnant mothers in the district of Kuala Selangor, Malaysia. The primary aim of the first aspect of the study was to identify and confirm the prevalence of iron deficiency anemia among these mothers. The second aspect of the study was to investigate the etiology of iron deficiency anemia among these mothers. A total of 378 mothers attending the antenatal clincis were chosen for the study. Two parametric instruments were used. The first was analyses of blood and stool samples. The blood samples were analysed by hematological and biochemical methods. Hematological indices were hemoglobin (Hb), packed cell volume (PCV), mean cell volume (MCV), mean cell hemoglobin (MCH), mean cell hemoglobin concentration (MCHC), and morphology. The biochemical indices included serum folate and ferritin levels. Thick blood smears were done to detect malarial parasites. Stool samples were analyzed for ova and cysts. Interview technique was the second parametric instrument used. The purpose of the interview was to evaluate socioeconomic status, compliance characteristics with iron therapy, parity, sanitation conditions, parasite infestation and other health related factors. A 24-hour dietary recall, presence of food belief and food frequency listing were also obtained during the interview. The hematological and biochemical findings indicated that 55.1% of the mothers were anemic (Hb &lt; 11 g/dL) and 68% were iron deficient (ferritin &lt; 15 ng/mL). The prevalence of anemia was lower (28.6%) when the hemoglobin level of less than 10 g/dL was used. Among the anemic mothers, 37% were also folate deficient. Therefore, iron deficiency anemia was present together with some cases of folate deficiency. About 4.2% of the mothers were suspected of hemoglobinapathy as indicated by hematological and biochemical indices. The possible etiology of iron deficiency anemia included low socioeconomic status, poor nutritional status, presence of undesirable food beliefs, noncompliance with iron supplements and health related factors including parasite infestation and multiparity. Socioeconomic status of the mothers was measured by education level, occupation, ownership of property and amount of money spent on food. The findings indicated no significant differences (P ≤ 0.05) between anemic and nonanemic mothers in education level, ownership of property and cash economy. This could be due to the homogeneity of the population which was mainly of low socioeconomic background. However, there was a definite relationship between the occupational levels of their husbands and iron deficiency among these women. The wives of the teachers, who had relatively higher income and education were less anemic compared to the wives of the farmers and laborers. The Chinese mothers who spent more money on food, compared to the Malay farmers and Indian laborers were generally less anemic. The prevalence of anemia was lowest for the Chinese (19.6%) compared to the Malays (28.0%) and Indians (41.9%). The Malay mothers spent less money on food, but grew gardens around their houses. The Indian mothers, spent less on food and were not able to meet their nutritional requirements. The majority did not have gardens around their house. The general nutritional status of the study population was poor compared to the recommended daily dietary standard. Most of the anemic mothers who were mainly Indians, had subnormal levels of nutrient intake. The two major hemopoietic nutrients lacking were protein and iron. This could be attributed to the diets of these mothers. The Indians consumed vegetable proteins and less meats or fish while the Malays consumed less quantity of meats and the Chinese ate a varied diet and large amounts of meats, vegetables and other foods. Since the iron status of most of the mothers was low, the only way of getting adequate iron was by taking iron supplements. Only about one third of the mothers complied by taking iron supplements. No definite effect of compliance towards the improvement of hemoglobin levels was found. It was possible that these supplements had not been taken long enough by the mothers. Compliance with iron therapy was predicted by a number of variables including race, economic status, presence of health problems, frequency of clinic visits, attitude towards iron tablets, gestation stage, stool color and presence of food beliefs. There was no association between parasite infestation and anemia. The problem of worm and malarial parasite infestations in the population studied was minor since reasonably adequate control measures of these parasites were practised in the area. Deworming of children and spraying of insecticides to kill the mosquito larvae were examples of surveilance practices in this study area. The majority of the mothers (70%) were between their first, second or third pregnancies. The duration from the last to present pregnancies was highest for the Malays (3.3 years), followed by the Chinese (2.8 years) and Indians (2.1 years). The average duration between pregnancies was significantly longer for the Malay mothers (2.7 years) compared to the Chinese and Indian mothers (2.0 years). The anemic mothers had significantly shorter duration between pregnancies and shorter interval between previous and present pregnancy. This indicated that family planning was not practised by many of the anemic mothers. A hierachy of causal factors was ranked by the logistic regression analysis. Only two significant variables were detected. They were in order of magnitude, the average duration between pregnancies and dietary protein intake. The relative odds of these two variables were calculated. The relative odds for average duration between pregnancies is 0.6 showing that increasing the duration of pregnancy by one year decreases the risk of anemia approximately by half. The relative odds for dietary protein is 0.7 indicating that an increase of 20 g protein intake will decrease the risk of anemia by 0.7. The findings of this study have significant practical implications towards the improvement of the mother's health status. The existing nutritional and family planning services have to be evaluated and improved to overcome the problem of iron deficiency anemia.