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      Anemia in Mexican women: a public health problem Translated title: Anemia en mujeres mexicanas: un problema de salud pública

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          Abstract

          OBJECTIVE: The purpose of this study is to quantify the prevalence and distribution of anemia among women of childbearing age (12 to 49 years) participating in the 1999 National Nutrition Survey (NNS-1999). MATERIAL AND METHODS: The survey had a probabilistic design and was representative at the national level, of urban and rural areas and four regions: North, South, Center, and Mexico City. Hemoglobin concentration was determined in capillary blood samples using a portable photometer (HemoCue), in 17 194 women, 697 of whom were pregnant. RESULTS: The overall prevalence of anemia was 27.8% in pregnant women and 20.8% in non-pregnant women. Higher prevalences were observed in rural as compared to urban areas, both in pregnant (28.0% vs 27.7%) and non-pregnant (22.6% vs 20.0%) women, but the differences were not statistically significant (p >0.05). Women in the South had the greatest prevalence (23.2%), followed by those in the North (20.9%), Center (20.6%), and Mexico City (16.4%). Non-pregnant indigenous women had a prevalence of 24.8%, while in non-indigenous women the prevalence was 20.4%. CONCLUSIONS: Anemia in women of childbearing age is a growing public health problem that justifies the implementation of interventions for its prevention and control.

          Translated abstract

          OBJETIVO: Cuantificar la prevalencia y distribución de anemia de las mujeres en edad fértil (12 a 49 años de edad) captadas en la Encuesta Nacional de Nutrición 1999 (ENN-99). La Encuesta tuvo un diseño probabilístico y es representativa del ámbito nacional mexicano, de zonas urbanas y rurales y de cuatro regiones: norte, centro, Ciudad de México y sur. MATERIAL Y MÉTODOS: La concentración de hemoglobina se determinó en sangre capilar mediante un fotómetro portátil (HemoCue) en 17 194 mujeres, de las cuales 697 estaban embarazadas. RESULTADOS: La prevalencia de anemia en el ámbito nacional fue de 27.8% para mujeres embarazadas y 20.8% para no embarazadas. Se encontró una mayor prevalencia en zonas rurales que en urbanas, tanto en mujeres embarazadas (28.0% vs 27.7%) como en no embarazadas (22.6% vs 20.0%) pero las diferencias no fueron estadísticamente significativas (p>0.05). La región sur presentó la mayor prevalencia de anemia ( 23.2%), seguida de la región norte (20.9%), la centro (20.6%) y la Ciudad de México (16.4%). Las mujeres no embarazadas indígenas presentaron una prevalencia de anemia de 24.8%, mientras que en las no indígenas fue de 20.4%, no siendo esta diferencia estadísticamente significativa. CONCLUSIONES: La anemia en mujeres en edad fértil es un problema de salud pública que justifica la implantación de programas de prevención y control.

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          Most cited references 75

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          Epidemiological and nutritional transition in Mexico: rapid increase of non-communicable chronic diseases and obesity.

          The objective of this paper is to characterise the epidemiological and nutritional transition and their determinants in Mexico. Age-adjusted standardised mortality rates (SMRs) due to acute myocardial infarction (AMI), diabetes mellitus and hypertension were calculated for 1980-1998. Changes in the prevalences of overweight and obesity in women and children and of dietary intake from 1988 to 1999 were also used in the analysis. Quantities of food groups purchased by adult equivalent (AE) and food expenditures away from home between 1984 and 1989 were used to assess trends. All information was analysed at the national and regional levels, and by urban and rural areas. SMR for diabetes, AMI and hypertension increased dramatically parallel to obesity at the national and regional levels. Fat intake in women and the purchase of refined carbohydrates, including soda, also increased. The results suggest that obesity is playing a role in the increased SMRs of diabetes, AMI and hypertension in Mexico. Total energy dietary intake and food purchase data could not explain the rise in the prevalence of obesity. The increases in fat intake and the purchase of refined carbohydrates may be risk factors for increased mortality. Information on physical activity was not available. SMRs due to diabetes, hypertension and AMI have increased dramatically in parallel with the prevalence of obesity; therefore actions should be taken for the prevention of obesity. Reliable information about food consumption and physical activity is required to assess their specific roles in the aetiology of obesity.
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            An analysis of anemia and pregnancy-related maternal mortality.

            The relationship of anemia as a risk factor for maternal mortality was analyzed by using cross-sectional, longitudinal and case-control studies because randomized trials were not available for analysis. The following six methods of estimation of mortality risk were adopted: 1) the correlation of maternal mortality rates with maternal anemia prevalence derived from national statistics; 2) the proportion of maternal deaths attributable to anemia; 3) the proportion of anemic women who die; 4) population-attributable risk of maternal mortality due to anemia; 5) adolescence as a risk factor for anemia-related mortality; and 6) causes of anemia associated with maternal mortality. The average estimates for all-cause anemia attributable mortality (both direct and indirect) were 6.37, 7.26 and 3.0% for Africa, Asia and Latin America, respectively. Case fatality rates, mainly for hospital studies, varied from 50%. The relative risk of mortality associated with moderate anemia (hemoglobin 40-80 g/L) was 1.35 [95% confidence interval (CI): 0.92-2.00] and for severe anemia (<47 g/L) was 3.51 (95% CI: 2.05-6.00). Population-attributable risk estimates can be defended on the basis of the strong association between severe anemia and maternal mortality but not for mild or moderate anemia. In holoendemic malarious areas with a 5% severe anemia prevalence (hemoglobin <70 g/L), it was estimated that in primigravidae, there would be 9 severe-malaria anemia-related deaths and 41 nonmalarial anemia-related deaths (mostly nutritional) per 100,000 live births. The iron deficiency component of these is unknown.
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              Etiology of anemia in pregnancy in south Malawi.

              Anemia in pregnancy is a major public health problem in developing countries. In sub-Saharan Africa, such anemia is generally accepted as resulting from nutritional deficiencies, particularly iron deficiency. We comprehensively assessed the full spectrum of nutritional and nonnutritional factors associated with pregnancy anemia. Iron, folate, vitamin B-12, and vitamin A were measured in serum in a cross-sectional study of 150 pregnant women in Blantyre, Malawi. Bone marrow aspirates were evaluated, peripheral blood films were examined for malaria parasites, stool and urine samples were examined for helminthic infection, and tests were done for genetic disorders and for HIV infection. C-reactive protein (CRP) concentrations and erythrocyte sedimentation rates were measured as markers of inflammation. Of the 150 anemic women, 23% were iron deficient with no evidence of folate, vitamin B-12, or vitamin A deficiencies; 32% were deficient in iron and one or more of the other micronutrients; 26% were not iron deficient but had evidence of one of the other micronutrient deficiencies, most often vitamin A; and 19% were not deficient in any of the micronutrients studied. CRP concentrations were notably high in 54% of the anemic women with no nutritional deficiencies and in 73.5% of the anemic women who were iron replete by bone marrow assessment. The role of chronic inflammation as a possible contributing factor to anemia in pregnancy has important implications for the clinical evaluation and treatment of women.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                spm
                Salud Pública de México
                Salud pública Méx
                Instituto Nacional de Salud Pública (Cuernavaca, Morelos, Mexico )
                0036-3634
                2003
                : 45
                : suppl 4
                : 499-507
                Affiliations
                Cuernavaca Morelos orgnameInstituto Nacional de Salud Pública orgdiv1Centro de Investigación en Nutrición y Salud México
                S0036-36342003001000006
                10.1590/s0036-36342003001000006

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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                Product Information: SciELO Public Health
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