Prevalence of Anemia Among Women of Reproductive Age in Rural Haryana, India

Abstract

Objectives Anemia is a public health problem in women of reproductive age in many low- and medium-income countries including India. Maternal anemia can cause low birth weight, impaired fetal growth, and preterm birth. We assessed the baseline prevalence of anemia, iron deficiency (ID), iron deficiency anemia (IDA), and inflammation using c-reactive protein (CRP) among non-pregnant, non-lactating women of reproductive age living in the Ambala District, Haryana, India prior to the start of a wheat flour fortification program. Methods We conducted a multistage cluster probability household and biomarker survey and analyzed venous blood samples from non-pregnant, non-lactating women aged 18–49 years residing in rural areas of two subdistricts in the Ambala District. Factors of interest were: anemia, hemoglobin < 12.0 g/dL; ID, serum ferritin < 15μg/L; IDA, presence of both anemia and iron deficiency; inflammation, CRP > 5 mg/L. We used the BRINDA regression adjustment for ferritin to account for inflammation. Prevalence and 95% confidence intervals (CI) for anemia, ID, IDA, and CRP were estimated. Results Among 775 non-pregnant, non-lactating women of reproductive age, 54.3% (95% CI; 50.7, 58.0) had anemia, 86.9% (95% CI; 84.3, 89.2) were iron deficient, and 15.1% (95% CI; 12.5, 18.1) had inflammation. Among those with anemia, 58.2% (95 CI; 54.3, 62.0) had iron deficiency anemia. Conclusions Anemia, iron deficiency, and iron deficiency anemia among non-pregnant, non-lactating women of reproductive age in Haryana are significant public health concerns. The findings from the survey helped quantify the burden of inadequate iron intake and informed the Haryana government's prevention strategy aimed at reducing micronutrient deficiencies through a wheat flour fortification program. Funding Sources Centers for Disease Control and Prevention.

Women in Selected Communities of Punjab, India Have a High Prevalence of Iron, Zinc, Vitamin B12, and Folate Deficiencies: Implications for a Multiply-Fortified Salt Intervention

“…2 Number of women who had ever given birth and were eligible to answer, n = 89. 3 A household was defined as a group of people who are primarily dependent on an individual person, currently eat from the same pot, and live under the same roof or in the same compound. 4 The number of children whose anthropometric indices were calculated, n = 34.…”

“…2 EARs were taken from the 2020 Indian Nutrient Reference Values (41). 3 EAR is based on an estimated bioavailability of 8% in Indian diets (41). 4 The EAR cut-point method was used to estimate inadequate intake after log transforming iron intake and EAR.…”

“…National-level surveys and other smaller studies directly corroborate the estimates of micronutrient deficiency and insufficiency from biochemical assessments reported in the current study. The National Family Health Surveys and the CNNS have reported a high burden of anemia (57%), iron (87%) and zinc (31%) deficiencies and folate (79%), and vitamin B12 (58%) insufficiencies in India [2][3][4]20]. A recent systematic review and meta-analysis of the micronutrient deficiency burden in India showed that 54% of the population had iron deficiency, 37% had folate deficiency, and 53% had a vitamin B12 deficiency [51].…”

“…2 The bioavailability of zinc in Indian diets was estimated to be 23% across all age and gender groups of the Indian population. 3,4 The EAR and RDA refer to folate.…”

“…However, these national averages mask striking geographical and socioeconomic disparities. A survey in Haryana showed that, among WRA, the prevalence of iron deficiency (87%), vitamin B12 deficiency (58%), and folate insufficiency (79%) was much higher than the national average [2,3]. In addition, India's 2016-2018 Comprehensive 2 of 14 National Nutrition Survey (CNNS) found that while 31% of adolescents were deficient in zinc nationwide; in Punjab, this prevalence was 52% [4].…”