The prevalence of anemia among clients of family planning clinics in Egypt.

A hospital-based study of the prevalence of anemia among clients of family planning clinics in Egypt was carried out in collaboration with a number of university hospitals. The study aimed to estimate the prevalence of anemia among the clients of family planning clinics and to determine the underlying risk factors for developing anemia in this population, with special emphasis on the role played by different contraceptive methods. The study was designed as a cross-sectional study and was carried out in seven family planning clinics of Alexandria, Mansoura, Cairo, Al-Azhar, Ein Shams, El Minia, and Assiut University Hospitals during August 1993 to March 1994. A total of 1039 clients of family planning services who fulfilled the selection criteria were recruited in the study. A standardized interview questionnaire was used to record pertinent information on study subjects. As well, laboratory investigations were made to determine the hemoglobin level and the presence of bilharzial infection. The prevalence of anemia in the studied population reached 49.6%, with variations among centers. Anemia was more prevalent among urban compared to rural residents (55.7% and 42.0%, respectively). Anemia was more common in Lower Egypt, followed by urban governorates and Upper Egypt. Other independent determinants associated with high prevalence of anemia included: young age (20-39 years), lack of obesity, heavy menstrual periods, low parity, use of the intrauterine device (IUD), low intake of iron-rich foods, and bilharzial infection. Use of IUD were significantly associated with the highest prevalence of anemia among all contraceptive users (64.9%), and IUD users had the lowest level of hemoglobin compared to nonusers or users of other methods. Given the increasing prevalence of IUD use in Egypt, a major recommendation of this study would be to introduce the prescription of iron supplementation tablets as part of IUD services provided in family planning clinics, both to new users and to current users. Other recommendations include early treatment of menstrual disturbances and parasitic infections (including schistosomiasis), as well as improvement of the nutritional status of women at high risk for developing anemia, through mass media campaigns addressing dietary patterns and the health benefits of intake of iron-rich, inexpensive food items.

The effect of 1-year use of the CuT 380A and oral contraceptive pills on hemoglobin and ferritin levels.

This is a longitudinal study of the effect of 1 year of use of Cu-T 380A intrauterine device (IUD) and oral hormonal contraceptives (OC) on the hemoglobin (Hb) content, serum ferritin, and percent iron saturation (serum iron/total iron binding capacity) of women with initial Hb level of 9-12 g/dL. It was carried out by the Egyptian Fertility Care Society in collaboration with seven University and Ministry of Health Teaching Hospitals. Women were followed-up at fixed intervals when laboratory tests conducted at admission were repeated. The use of Cu-T380A IUD produced a statistically significant drop in the Hb content and percent iron saturation levels after 12 months of use, as compared to the use of OC for the same period. The drop was greater with longer IUD use, initial high Hb levels, and among urban and semiurban residents. It is recommended that iron supplementation be part of the IUD services provided in family planning units in view of the high prevalence of anemia among women in the childbearing age in Egypt.

PIP: This longitudinal study examined the effect of 1 year of use of the Cu-T 380A IUD and of oral contraceptives (OCs) on the hemoglobin (Hb) content, serum ferritin, and percent iron concentration of women with an initial Hb level of 9-12 g/dl. A total of 256 IUD initiators and 202 contraceptive pill initiators in seven participating centers in Egypt comprised the study population. Hb content was measured after 3, 6, 9, and 12 months, and the serum ferritin, serum iron, and total iron binding capacity after 6 and 12 months of contraceptive use. Findings revealed that the use of Cu-T 380A IUD produced a statistically significant drop in the Hb content and percent iron saturation levels after 12 months of use, as compared with the use of OCs for the same period. The drop was greater with longer IUD use, initial high Hb levels, and among urban and semiurban residents. It is recommended that iron supplementation be part of the IUD services provided in family planning units in view of the high prevalence of anemia among women of childbearing age in Egypt. Moreover, mass media campaigns should be carried out to improve the nutritional status of women, especially in the poorer population.