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BackgroundAnemia among married women of reproductive age (MWRA) is an emerging public health issue. With the growing prevalence in coastal slums, understanding of community perceptions, practices and attitudes towards consuming iron-rich food items is very crucial. An in-depth understanding of why community women are consuming gutka is also important in these slums. The aim of this paper is to present the findings of this qualitative study to better understand community perceptions and experiences regarding access to iron-rich food and use of gutka. MethodA simple exploratory design using focus group discussions with nonpregnant MWRA and community health workers as well as thorough interviews with different shopkeepers were performed at Rehri Goth, a coastal slum at Karachi, Pakistan. Further, observational visits were also conducted to perform a market survey and to explore the situation regarding the availability of iron-rich food items in the community. ResultsCommunity-level knowledge and understanding on consuming iron-rich food items was poor, and many participants shared concerns regarding accessibility in terms of purchasing power as well as poor availability of these food items in the community as the key issues. These issues are rooted in the sociocultural beliefs that lead to adopting behaviors that result in the use of monotonous diet. These findings were consistent with the fact that observational visits revealed that the community has very low availability of four iron-rich items. Meat shops are only available in 21.4% of the area, and beef availability was only 41.7% during observational visits. Additionally, gutka consumption is considered by locals as a solution to poor accessibility of food. ConclusionStudy findings suggest that strategies should be developed at the policy-forming and implementation level to increase awareness about consuming iron-rich food items as well as initiatives to improve the accessibility to these items.

BackgroundUnder-nutrition is a global public health threat, to which pregnant and lactating mothers are particularly susceptible. An estimated 468.4 million women (17%) of child bearing age have anemia, and this figure is as high as 50% of women of childbearing age in developing countries. Factors like substance abuse, nutritional habits, hygiene, reproductive health status and socio-cultural factors are associated with high prevalence of anemia among women. The aim of the study was to determine prevalence of anemia i.e. hemoglobin concentration of less than 12 gm/dl among non-pregnant married women of reproductive age (MWRA) and potential risk factors of anemia among these MWRA with a special focus on coastal slum.Methods A analytical cross sectional study conducted at a coastal slum of Karachi, Rehri Goth. We interviewed N-554 non pregnant MWRA and their blood samples were assessed for anemia. Cox proportional hazard algorithm was used for determining the association of potential covariates with anemia for the analysis purpose. ResultsThe prevalence of anemia among the non pregnant MWRA was 68.04% (95%CI: 64.15%, 71.92%). Prevalence ratio of anemia among gutka consumers was 1.37 times (95%CI: 1.12 - 1.68) higher than those who were not consuming it. Moreover, the prevalence ratio of anemia was 1.42 times higher in women who had not received formal education as compared to those who had received at least a primary education.(95% CI:1.13-1.81) Conclusion A high proportion of non pregnant MWRA of Rehri Goth were anemic. Women who were not literate were more likely to be anemic and were more likely to consume Gutka as a recreational substance.