An outline of anemia among adolescent girls in Bangladesh: findings from a cross-sectional study

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Abstract

Background

Anemia is a significant wide spread public health threat especially among the adolescent girls who are more vulnerable towards low level of hemoglobin particularly of low and middle income countries (LMICs). We investigated the prevalence of anemia among the adolescent girls (10–19 years) in Bangladesh and its socio-demographics distribution.

Methods

We collected data digitally in ODK platform from a sub-sample of a nationwide cross-sectional survey of 1314 adolescent girls in 2015. Capillary blood hemoglobin level was estimated using HemoCue®; anthropometric measurements through standardized procedure and details socio-demographic information were captured and analyzed. Malnutrition was defined as BMI-for-age Z-score below -2SD (BAZ < −2SD), measured in WHO-AnthroPlus. Univariate analysis followed by multiple logistic regression were performed to examine the association between socio-demographic variables and anemia, while controlling the effect of potential confounding variables.

Results

Overall, 51.6% girls were suffering from any form of anemia (non-pregnant-Hb < 12 g/dl; pregnant-Hb < 11 g/dl) while 46% were mildly (non-pregnant-Hb: 10–11.9 g/dl; pregnant-Hb: 10–10.9 g/dl) and 5.4% were moderately (Hb: 7–9.9 g/dl) anemic while only 0.2% were severely anemic. After controlling for relevant covariates in multiple logistic regression model, malnutrition (AOR: 1.42, 95% CI = 1.0–2.10, p-value = 0.083), non-pregnancy (AOR: 6.10, 95% CI = 2.70–13.78, p-value < 0.001), and households with bottom wealth quintile (AOR: 1.54, 95% CI = 1.03–2.30, p-value = 0.037) were identified as significant risk factors of anemia among adolescent girls of Bangladesh.

Conclusions

Higher number of adolescent girls are still suffering from anemia in Bangladesh and non-pregnant adolescent girls contributed the most. Immediate, long term and sustainable public health intervention would require to combat the situation.

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Most cited references 39

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Impact of hookworm infection and deworming on anaemia in non-pregnant populations: a systematic review

Jennifer Smith, Simon J. Brooker (2010)

Objectives To summarise age- and intensity-stratified associations between human hookworm infection and anaemia and to quantify the impact of treatment with the benzimidazoles, albendazole and mebendazole, on haemoglobin and anaemia in non-pregnant populations. Methods Electronic databases (MEDLINE, EMBASE, PubMed) were searched for relevant studies published between 1980 and 2009, regardless of language, and researchers contacted about potential data. Haemoglobin concentration (Hb) was compared between uninfected individuals and individuals harbouring hookworm infections of different intensities, expressed as standardised mean differences (SMD) and 95% confidence intervals (CI). Meta-analysis of randomised control trials (RCTs) investigated the impact of treatment on Hb and anaemia. Results Twenty-three cross-sectional studies, six pre- and post-intervention studies and 14 trials were included. Among cross-sectional studies, moderate- and heavy-intensity hookworm infections were associated with lower Hb in school-aged children, while all levels of infection intensity were associated with lower Hb in adults. Among RCTs using albendazole, impact of treatment corresponded to a 1.89 g/l increase (95%CI: 0.13–3.63) in mean Hb while mebendazole had no impact. There was a positive impact of 2.37 g/l (95%CI: 1.33–3.50) on mean Hb when albendazole was co-administered with praziquantel, but no apparent additional benefit of treatment with benzimidazoles combined with iron supplementation. The mean impact of treatment with benzimidazoles alone on moderate anaemia was small (relative risk (RR) 0.87) with a larger effect when combined with praziquantel (RR 0.61). Conclusions Anaemia is most strongly associated with moderate and heavy hookworm infection. The impact of anthelmintic treatment is greatest when albendazole is co-administered with praziquantel.

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An update on anemia in less developed countries.

Karine Tolentino, Jennifer Friedman (2007)

The highest prevalence of anemia exists in the developing world where its causes are multi-factorial. Anemia is responsible for significant morbidity and mortality, particularly in less developed countries (LDCs). Understanding causes of anemia and potential mechanisms are crucial to our ability to intervene to reduce this burden. In the past decade, our understanding of the etiology and mechanisms of anemia in LDCs has advanced significantly. This review will focus on recent advances in our understanding of the burden of anemia in specific sub-groups, the causes and mechanisms of anemia, and consequences of anemia for the human host.

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High prevalence of anemia with lack of iron deficiency among women in rural Bangladesh: a role for thalassemia and iron in groundwater.

Rebecca D Merrill, Abu Shamim, Hasmot Ali … (2012)

Iron deficiency was absent in a recent population assessment of rural Bangladeshi women exhibiting anemia (57%), suggesting other causes of low hemoglobin. We assessed the relative influence on anemia of thalassemia, groundwater arsenic and iron, and diet among women of reproductive age living in rural Bangladesh. Women (n=207) sampled from a previous antenatal nutrient intervention trial in rural Bangladesh were visited during two seasons in 2008. Collected data included 7-day dietary and 24-hour drinking water intake recalls, 7-day morbidity recall, anthropometry, and drinking water arsenic and iron concentrations. Capillary blood was analyzed for iron (plasma ferritin, soluble transferrin receptor), inflammation (C-reactive protein) and thalassemia (β thalassemia and Hb E) status. In stratified, adjusted analyses, only parity was associated with anemia (odds ratio, OR (95% CI): 11.34 (1.94, 66.15)) for those with thalassemia (28% prevalent). In contrast, groundwater iron intake (>30 mg/d, 0.48 (0.24, 0.96)) and wasting (2.32 (1.17, 4.62)) were associated with anemia among those without thalassemia. Elevated groundwater arsenic (>50 μg/L, 12% of tubewells) and a diverse diet were unrelated to anemia regardless of thalassemia diagnosis (p>0.70 and >0.47, respectively). Among women in this typical rural Bangladeshi area, the prevalence of thalassemia was high and, unlike iron deficiency which was absent most likely due to high iron intake from groundwater, contributed to the risk of anemia. In such settings, the influence of environmental sources of iron and the role of thalassemias in contributing to anemia at the population level may be underappreciated.

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Author and article information

Contributors

Sabuj Kanti Mistry: +88 02 9881265 , sabuj.km@brac.net

Fatema Tuz Jhohura: fatema.jhohura@brac.net

Fouzia Khanam: fouzia.khanam@brac.net

Fahmida Akter: fahmida.akter@brac.net

Safayet Khan: safayet.k@brac.net

Fakir Md Yunus: fakir.yunus@usask.ca

Md Belal Hossain: belal.h@brac.net

Kaosar Afsana: afsana.k@brac.net

Md Raisul Haque: raisul.h@brac.net

Mahfuzar Rahman: mahfuzar.rahman@brac.net

Journal

Journal ID (nlm-ta): BMC Hematol

Journal ID (iso-abbrev): BMC Hematol

Title: BMC Hematology

Publisher: BioMed Central (London )

ISSN (Electronic): 2052-1839

Publication date (Electronic): 22 August 2017

Publication date PMC-release: 22 August 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 13

Affiliations

[1 ]ISNI 0000 0001 0746 8691, GRID grid.52681.38, , Research and Evaluation Division, BRAC, BRAC Centre, ; 75 Mohakhali, Dhaka, 1212 Bangladesh

[2 ]ISNI 0000 0001 0746 8691, GRID grid.52681.38, , Health, Nutrition and Population Programme, BRAC, BRAC Centre, ; 75 Mohakhali, Dhaka, 1212 Bangladesh

[3 ]ISNI 0000 0001 2154 235X, GRID grid.25152.31, College of Pharmacy and Nutrition, , The University of Saskatchewan, ; 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada

Article

Publisher ID: 84

DOI: 10.1186/s12878-017-0084-x

PMC ID: 5568267

PubMed ID: 28116101

SO-VID: 455f43e8-f88c-41c4-9c33-395fa49ad149

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 16 January 2017

Date accepted : 9 August 2017

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Keywords: adolescent anemia,malnutrition,hemoglobin,socio-demographic factors

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Keywords: adolescent anemia, malnutrition, hemoglobin, socio-demographic factors

An outline of anemia among adolescent girls in Bangladesh: findings from a cross-sectional study

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Most cited references 39

Impact of hookworm infection and deworming on anaemia in non-pregnant populations: a systematic review

An update on anemia in less developed countries.

High prevalence of anemia with lack of iron deficiency among women in rural Bangladesh: a role for thalassemia and iron in groundwater.

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