Thalassemia carrier status and groundwater iron: Implication for iron supplementation program for children in Bangladesh.

Background: Thalassemia, a congenital disorder of hemoglobin synthesis is characterized by low hemoglobin and high iron status, is prevalent in Bangladesh. Iron, consumed through drinking groundwater also increases the population iron status in Bangladesh. The study examined the effect of iron containing micronutrient powder (MNP) on the hemoglobin and ferritin status in Bangladeshi children with thalassemia and their non-thalassemia peers exposed to a high concentration of iron from drinking groundwater. Design and methods: Three hundred twenty-seven children aged 2-5 years were recruited for an MNP efficacy trial. A sub sample (n = 222) were screened for thalassemia. Hemoglobin and ferritin levels were measured in children with and without thalassemia. Intake of iron from the key sources-diet, groundwater and MNP was measured. Mann Whitney and t-test were employed to compare the groups. Results: Hemoglobin concentration of the children with thalassemia at the endpoint remained unchanged relative to the baseline; 11.56 ± 0.59 g/dL (Endpoint) versus 11.6 ± 0.54 g/dL (Baseline), p = 0.83. In children without thalassemia hemoglobin tended to increase; 12.54 ± 0.72 g/dL (Endpoint) versus 12.41 ± 0.72 g/dL (baseline), p = 0.06. Baseline reserve of body iron was significantly (p = 0.03) higher in thalassemia carriers (594 gm) compared to their non-carrier peers (558 gm). The increase of the infection-adjusted ferritin from baseline to the endpoint was 7.37% (p = 0.7) and 10.17% (p = 0.009) in the carrier and non-carrier groups respectively. Conclusions: In Bangladesh, the coexistence of thalassemia and the exposure to a high concentration of iron from drinking groundwater renders anemia prevention program with a low iron MNP potentially lesser hazardous to the thalassemia carriers.

Prevalence and Risk Factors of Vitamin B12 Deficiency among Pregnant Women in Rural Bangladesh.

Vitamin B12 deficiency is associated with an increased risk of pregnancy complications and adverse birth outcomes. However, data on vitamin B12 deficiency in pregnant Bangladeshi women are limited. This study examines vitamin B12 deficiency and marginal deficiency in rural Bangladeshi women during early and late pregnancies. Some 522 women whose gestational age was <20 weeks were recruited. Serum vitamin B12 concentrations were measured at baseline and after 14 weeks of iron-folate supplementation. Logistic regression analysis examined the association of various socio-demographic, dietary, and pregnancy-related factors with vitamin B12 deficiency and marginal deficiency. Overall, 19% of the women during early pregnancy had vitamin B12 deficiency (serum vitamin B12 concentration < 203 pg/mL) and nearly 40% had marginal deficiency (serum vitamin B12 concentration 203 to <300 pg/mL). Vitamin B12 deficiency doubled to 38% during late pregnancy, while marginal deficiency slightly increased to 41.7%. The pregnant women with a gestational age of ≥27 weeks had a higher risk of developing vitamin B12 deficiency (OR = 2.61; 95% CI = 1.096−6.214) than those of a gestational age of <27 weeks. Vitamin B12 deficiency was significantly higher in pregnant women in rented accommodation (OR = 13.32; 95% CI = 1.55−114.25) than in those living in their own house. Vitamin B12 deficiency was significantly higher among women who consumed red or organ meat <3 times a week than in those who consumed it more often (OR = 2.327, 95% CI = 1.194−4.536). None of these factors were significantly associated with marginal vitamin B12 deficiency. In conclusion, vitamin B12 deficiency and marginal deficiency among pregnant rural Bangladeshi women increased as their pregnancies progressed. Increasing gestational age, living in a rented house, and the consumption of red or organ meat <3 times a week were identified as the independent risk factors of vitamin B12 deficiency in this population. Further research with more in-depth assessments of dietary vitamin B12 intakes is needed to develop an intervention program preventing vitamin B12 deficiency in this population.

Prevalence and Predictors of Vitamin D Deficiency and Insufficiency among Pregnant Rural Women in Bangladesh.

Although adequate vitamin D status during pregnancy is essential for maternal health and to prevent adverse pregnancy outcomes, limited data exist on vitamin D status and associated risk factors in pregnant rural Bangladeshi women. This study determined the prevalence of vitamin D deficiency and insufficiency, and identified associated risk factors, among these women. A total of 515 pregnant women from rural Bangladesh, gestational age ≤ 20 weeks, participated in this cross-sectional study. A separate logistic regression analysis was applied to determine the risk factors of vitamin D deficiency and insufficiency. Overall, 17.3% of the pregnant women had vitamin D deficiency [serum 25(OH)D concentration <30.0 nmol/L], and 47.2% had vitamin D insufficiency [serum 25(OH)D concentration between 30-<50 nmol/L]. The risk of vitamin D insufficiency was significantly higher among nulliparous pregnant women (OR: 2.72; 95% CI: 1.75-4.23), those in their first trimester (OR: 2.68; 95% CI: 1.39-5.19), anaemic women (OR: 1.53; 95% CI: 0.99-2.35; p = 0.056) and women whose husbands are farmers (OR: 2.06; 95% CI: 1.22-3.50). The risk of vitamin deficiency was significantly higher among younger pregnant women (<25 years; OR: 2.12; 95% CI: 1.06-4.21), nulliparous women (OR: 2.65; 95% CI: 1.34-5.25), women in their first trimester (OR: 2.55; 95% CI: 1.12-5.79) and those with sub-optimal vitamin A status (OR: 2.30; 95% CI: 1.28-4.11). In conclusion, hypovitaminosis D is highly prevalent among pregnant rural Bangladeshi women. Parity and gestational age are the common risk factors of vitamin D deficiency and insufficiency. A husband's occupation and anaemia status might be important predictors of vitamin D insufficiency, while younger age and sub-optimal vitamin A status are risk factors for vitamin D deficiency in this population.

Effect of routine iron-folic acid supplementation among rural pregnant women living in low- and high-groundwater-iron areas in Bangladesh.

OBJECTIVE: The present study investigated the risks and benefits of routine Fe-folic acid (IFA) supplementation in pregnant women living in low- and high-groundwater-Fe areas in Bangladesh. DESIGN: A case-controlled prospective longitudinal study design was used to compare the effect of daily Fe (60 mg) and folic acid (400 µg) supplementation for 3·5 months. SETTING: A rural community in Bangladesh. PARTICIPANTS: Pregnant women living in low-groundwater-Fe areas (n 260) and high-groundwater-Fe areas (n 262). RESULTS: Mean Hb and serum ferritin concentrations at baseline were significantly higher in pregnant women in the high-groundwater-Fe areas. After supplementation, the mean change in Hb concentration in the women in the low-groundwater-Fe areas (0·10 g/dl) was higher than that in the pregnant women in the high-groundwater-Fe areas (-0·08 g/dl; P = 0·052). No significant changes in the prevalence of anaemia or Fe deficiency (ID) in either group were observed after IFA supplementation; however, the prevalence of Fe-deficiency anaemia (IDA) decreased significantly in the women in the low-groundwater-Fe areas. The risk of anaemia, ID and IDA after supplementation did not differ significantly between the groups. None of the participants had Fe overload. However, a significant proportion of the women in the high- and low-groundwater-Fe areas remained anaemic and Fe-deficient after supplementation. CONCLUSION: IFA supplementation significantly increased the Hb concentration in pregnant women living in the low-groundwater-Fe areas. Routine supplementation with 60 mg Fe and 400 µg folic acid does not pose any significant risk of haemoconcentration or Fe overload. Further research to identify other nutritional and non-nutritional contributors to anaemia is warranted to prevent and treat anaemia.

Anemia and iron deficiency in rural Bangladeshi pregnant women living in areas of high and low iron in groundwater.

BACKGROUND: Recent studies found a low rate of iron deficiency in Bangladeshi non-pregnant and non-lactating women. This was attributed to high iron concentrations in drinking water. However, there are limited data on iron deficiency among pregnant women in Bangladesh. OBJECTIVES: Our aim was to investigate the prevalence of anemia, iron deficiency, and iron deficiency anemia (IDA) among rural pregnant women and explore the association of groundwater iron concentration with anemia and iron deficiency in this group. METHODS: This study used data from a baseline assessment of an intervention study on rural pregnant women (n = 522), gestational age ≤20 wk, living in areas of low and high iron in groundwater. RESULTS: Overall, 34.7% of the pregnant women had anemia, 27% had iron deficiency, and 13.4% had IDA. Prevalence of anemia, iron deficiency, and IDA among the pregnant women living in low-groundwater-iron areas was significantly higher than among the pregnant women from high-groundwater-iron areas. The odds of iron deficiency were significantly lower among pregnant women in the higher quartiles of daily iron intake from drinking water. CONCLUSIONS: This study found a differential prevalence of anemia and iron deficiency among pregnant women living in areas of high and low groundwater iron. Iron status was independently associated with daily iron intake from drinking water. However, a significant proportion of the anemia could not be attributed to iron deficiency. Further research to identify other nutritional and non-nutritional contributors to anemia in Bangladesh is needed to formulate effective prevention and control programs for anemia.

Efficacy of twice-weekly multiple micronutrient supplementation for improving the hemoglobin and micronutrient status of anemic adolescent schoolgirls in Bangladesh.

BACKGROUND: Although iron deficiency is a major cause of anemia, other micronutrient deficiencies may also play a role. OBJECTIVE: We examined whether multiple micronutrient supplementation is more efficacious than is supplementation with iron and folic acid alone for improving the hemoglobin and iron status of anemic adolescent girls in Bangladesh. DESIGN: Anemic (hemoglobin < 12.0 g/dL) girls (n = 197) aged 14-18 y from rural schools in Dhaka District were entered into a randomized double-blind trial and received twice-weekly supplements of iron and folic acid (IFA group) or multiple micronutrients (15 micronutrients, including iron and folic acid; MMN group) for 12 wk. RESULTS: At recruitment, the characteristics of the girls in the 2 groups were not significantly different, except for family size and body mass index. At the end of the study, although both groups benefited significantly from supplementation, mean changes in hemoglobin and serum ferritin concentrations were not significantly different between groups. Compared with the IFA group, girls in the MMN group had significantly greater increases in mean serum vitamin A, plasma vitamin C, red blood cell folic acid, and riboflavin concentrations (assessed as erythrocyte glutathione reductase activation coefficient). After 12 wk of supplementation, only the prevalence of vitamins A and C and riboflavin deficiencies decreased more significantly in the MMN group than in the IFA group. CONCLUSIONS: Twice-weekly MMN supplementation for 12 wk significantly improved the status of the micronutrients assessed but was not more efficacious than was supplementation with iron and folic acid alone in improving the hematologic status of anemic adolescent girls. More frequent doses may be needed to achieve full benefit.

Physical status, nutrient intake and dietary pattern of adolescent female factory workers in urban Bangladesh.

This cross-sectional study examined the physical status, nutrient intake and dietary pattern of adolescent female factory workers in urban Bangladesh. A total of 1211 postmenarchial girls aged 14-19 y from seventeen readymade garment industries spread over the Dhaka City participated in the study. Body weight, height and skin fold thickness were measured for all subjects. The nutrient intake was assessed by 24-h recall method and 7-day food frequency questionnaire was used to investigate their dietary pattern on a sub-sample of 509 girls. Sixty five percent of the girls were short (height-for-age, <3rd percentile of NCHS reference values). Pre-valence of short stature was higher in the older girls. Mean body weight was 38k g for the 14 year old girls, which gradually increased across the age groups to about 42 kg for the 18 and 19 year olds. About 17% of the girls were thin (BMI-for-age <5th percentile of NCHS reference values). Over all, about 23% were lean (TSFT-for-age <5th percentile of NCHS reference values). Food intake data revealed a deficit of 1.62 MJ/day in energy. Mean intake of protein, calcium, iron, vitamin A, thiamin, riboflavin, niacin and vitamin C were below the recommended dietary allowance. Most of the energy and nutrients came from cereal grains. Habitual pattern of food intake revealed poor intake of eggs, milk, meat, and green leafy vegetables. In conclusion, the data show a poor physical status of the adolescent female factory workers in Bangladesh. Simultaneous substantial deficits in energy and several nutrients in their diet stress the need for an appropriate intervention to improve their overall nutritional and physical status of these young females.