Reduction in antenatal anaemia over a 10-year period in Montserrat

Anemia during pregnancy is associated with adverse outcomes including maternal and perinatal mortality. However, health education and other public health strategies seeking to reduce its prevalence have usually met with only limited success. The study reported here surveyed anemia of pregnancy on the island of Montserrat in 1980, 1985, and 1990. This involved examination of clinic and hospital records for over 90 percent of all women giving birth in 1990. This examination showed a dramatic reduction in the prevalence of anemia at the time of the first prenatal visit (a drop from 82 percent of the study women in 1980 to 23 percent in 1985 and 19 percent in 1990) and also a marked drop at three days postpartum (from 91 percent in 1980 to 41 percent in 1985 and 39 percent in 1990). Logistic regression analyses indicated that after controlling for three possible confounding factors (maternal age, parity, and weeks of gestation at first prenatal visit) the difference between the risk of developing anemia during pregnancy in 1980 as compared to 1985 or 1990 was still highly significant. The reasons for the observed drop in anemia's prevalence during the survey period are not entirely clear, partly because of the retrospective nature of study. However, better nutrition resulting from improvement in the standard of living on Montserrat during the survey period could have been important, as could changes in health education and food supplementation activities (AU)

Micronutrient deficiencies in the English-speaking Caribbean and methods for their control - abstract

Multiple micronutrient deficiencies is not a public health problem in the Caribbean. The most widespread micronutrient deficiency is iron. In some countries as many as 75 per cent of pregnant women had low haemoglobin levels. In one country 80 per cent of children 6 months to 2 years of age had no iron reserves as measured by ferritin levels. There is also a high prevalence of dental caries in some countries. Flouride has been added to salt in Jamaica. This paper reviews some of the data on micronutrient deficiencies and concentrates on the approaches for the control of iron deficiency in the region. These approaches are supplementation, nutrition education, parasitic control and fortification. The problems and successes of each approach are discussed and how they are helping to control anaemia in the English-speaking Caribbean (AU)

A comparison of transferred receptor with other iron assessment measures in an upper-income post partum Jamaican sample.

Iron (Fe) deficiency is the most prevalent nutritional deficiency in the world. During their reproductive years, women are especially vulnerable. However, methods of assessing Fe deficiency in countries where both Fe deficiency and infection frequently coexist, are not optimal. Frequently used methods do not differentiate between anemia due to Fe deficiency or that due to inflammation. This study compared several Fe assessment methods (Plasma ferritin, serum transferrin receptor (s-TfR), and erythrocyte protoporphyrin) in a six week, post-partum, upper income sample. A variety of socio-economic, hematological, and dietary information was collected from 73 Jamaican women. S-TfR values were compared with the other Fe assessment indices using sensitivity/specificity/predictive value analysis. Results indicated that anemia (Hb < 12.0 g/dl) was present in 37.5% of the sample and that Fe deficient erythropoiesis existed in between 7 and 13% depending upon assessment method. S-TfR was highly specific, but had a low sensitivity and positive predictive value. Use of s-TfR and the high percent of anemia are discussed.

Control of iron and other micronutrient deficiencies in the English-speaking Caribbean

Most micronutrient deficiencies affect relatively few people in the Caribbean; however, many Caribbean residents are affecfted by anemia that appears due primarily to a lack of dietary iron. While generally substantial, the prevalences of such anemia have differed a good deal from place to place and study to study, observed rates ranging from 27 percent to 75 percent in pregnant women, 19 percent to 55 percent in lactating women, and 15 percent to 80 percent in young children. Severe anemia, defined by a blood hemoglobin concentration below 8 g/dl, has been found in approximatelty 6 percent of the pregnant women and 11 percent of the preschool children in some Caribbean countries. The principal ways of controlling iron deficiency anemia are through food fortification, control of intestinal parasites, direct oral supplementation, and dietary modification. Progress has been made in iron fortification of wheat flour and wheat products (the principal foodstuffs consumed by the general public in most of the English-speaking Caribbean). Data on control of relevant parasites in the Caribbean (primarily hookworm and to a lesser extent whipworm) are limited. Health services throughout the English-speaking Caribbean have been providing direct iron supplementation for pregnant women, but high levels of anemia during pregnancy still exist because of coverage, monitoring, and compliance problems. All the Caribbean countries also have education programs, which mainly advise pregnant women about iron-rich foods and iron absorption inhibitors and enhancers (AU)

Evaluation of a gastric delivery system for iron supplementation in pregnancy

The present investigation was undertaken to assess the efficacy of oral iron supplementation during pregnancy by using a gastric delivery system (GDS). Three hundred seventy-six pregnant women between 16 and 35 years of age and 14 and 22 weeks gestation were selected if mild anemia was present (hemoglobin concentration 80-110 g/l). The participants were randomly assigned to one of three study groups given no iron, two FeSO4 tablets (100 mg FE) daily, or one GDS capsule (50 mg Fe) daily. Blood was obtained initially and after 6 and 12 weeks for measurement of red blood cell and iron indexes, including serum transferrin receptor. There was a significant and comparable improvement in hematologic and iron-status measurements in the two group of women given iron whereas iron deficiency evolved in women given no iron supplement. We conclude that by elimating gastrointestinal side effects and reducing the administration frequency of an iron supplement to once daily, a GDS offers significant advantages for iron supplementation of pregnant women. (AU)

Haemoglobin levels in West Indian antenatals

Studies conducted in the English-speaking Caribbean have shown that anaemia is a public health problem in pregnancy. However, these studies have been questioned because the World Health Organization (WHO) haemoglobin criteria, which are based on studies of North American and European women, may not apply to Caribbean women. Antenatal clinic records were studied at the University of the West Indies (UHWI), Kingston, Jamaica. Over half of the antenatal women were between the ages of 21 and 27 years. Modal parity was 1 (41 percent) followed by a parity of 2 (31 percent). Median value for gestation was 13 weeks. The mean haemoglobin level was 12.4+1.5 gm/dl (median - 12.6). Twenty-one antenatal women (3.9 percent) had haemoglobin levels below 11 gm/dl and only 4 (0.6 percent) had haemoglobin levels below 10 gm/dl. The mean haemoglobin at the UHWI was 1.9 gm/dl higher than that of 159 patients from Antigua. However, the Antiguans were an average of 6 weeks further advanced in pregnancy. In Montserrat, the mean of 138 antenatal haemoglobin levels was 2.4 gm/dl lower than the UHWI mean; these patients were also about 6 weeks further advanced in pregnancy. This study suggests that, given the right environment, the antenatal women in Montserrat and Antigua, who are roughly the same ethnic origin as those from Jamaica, could achieve the same haemoglobin levels as those of pregnant women attending antenatal clinic at the UHWI, Kingston, Jamaica (AU)

Anaemia in antenatals in the Turks & Caicos Islands

Anaemia in the Turks & Caicos Islands was studied by examining all antenatal records for a four-year period from 1981 to 1984. If the World Health Organization (WHO) standards were used, 60-70 per cent of the antenatals were classified as anaemic over the four-year period. The per cent of antenatals with haemoglobin levels below 9.0 gm/dl varied from 7 to 9 percent. There was a statistical difference between the four years of data from the Turks & Caicos Islands and the haemoglobin levels of the University Hospital of the West Indies antenatals (AU)

A survey of the iron anaemia status in the Grenadian population - abstract

Community studies, over the past 15 years, have demonstrated that anaemia is a public health problem in Grenada. In November 1984, an all-island survey was conducted in Grenada to study the prevalence, types and causes of anaemia in that island. Anaemia existed in all age and sex groups. A high prevalence was found in ante-natal and post-natal women and in pre-school age children. In these groups, 63 percent, 47 percent and 43.7 percent, respectively, were found to have haemoglobin levels less than those recommended by WHO. Eighty per cent of pre-school age children, 12-23 months of age, had haemoglobin levels of less than 11 g/dl. Plasma ferritin levels were found to be low in all age and sex groups, the highest prevalence being in post-natals where 62 percent had plasma ferritin levels below 12 æg/l; 60 percent of pre-school age children had ferritin levels less than 12 æg/l. It was also found that 72.2 percent of pre-school children who were anaemic, according to WHO haemoglobin standards, had plasma ferritin levels below 12 æg/l. The percentage of other age and sex groups who were both anaemic and had a plasma ferritin level below 12 æg/l ranged from 23 percent to 67 percent. The results of the study indicated that iron deficiency and anaemia are still public health problems in Grenada (AU)

Haemoglobin levels in West Indian antenatals - abstract

Studies conducted in the English-speaking Caribbean have shown that anaemia is a public health problem in pregnancy. However, these studies have been questioned because the WHO haemoglobin criteria, which are based on studies of North American and European women, may not apply to Caribbean women. Antinatal clinic records were studied at the University of the West Indies (UWI), Kingston, Jamaica. Over half of the antenatal women were between the ages of 21 and 27 years. Modal parity was 1 (41 percent) followed by a parity of 2 (31 percent). Median value for gestation was 13 weeks. The mean haemoglobin level was 12.4 ñ 1.5 gm/dl (median - 12.6) Twenty-one antenatal women (3.9 percent) had haemoglobin levels 11 gm/dl and only 4 (0.6 percent) had haemoglobin levels below 10 g/dl. The mean haemoglobin at the University Hospital of the West Indies (UHWI) was 1.9 gm/dl higher that of 159 patients from Antigua. However, the Antiguans were an average of 6 wk further advanced in pregnancy. In Montserrat, the mean of 138 antenatal haemoglobin levels was 2.4 gm/dl lower than the UWI mean; these patients were also about 6 weeks further advanced in pregnancy. This study suggests that, given the right environment, the antenatal women in Monsterrat and Antigua, who are of roughly the same ethnic origin as those from Jamaica, could achieve the same haemoglobin levels as those of pregnant women attending the antenatal clinic at the UHWI, Kingston, Jamaica (AU)

Nutritional Anaemia in ante-natals in the English-speaking Caribbean

Information on the prevalence and causes of anaemia in ante-natals in the English-speaking Caribbean was obtained from the study of information from ante-natal clinics and surveys conducted in the Caribbean from 1972-1982. There are an estimated 76,086.5, 65,796.0 and 6,422.5 ante-natals with haemoglobin levels below 11.0, 10.0 and 8.0 g/dl respectively, from an estimated population in the English-speaking Caribbean of 5,670,000. This anaemia is probably caused from a deficiency of iron, folate and vitamin B12. Parasitic infestations could be a causative factor in some of the anaemias. Sickle cell disease has also been noted

Nutritional anaemia in ante-natals in the English-speaking Caribbean

Information on the prevalence and causes of anaemia in ante-natals in the English-speaking Caribbean was obtained from the study of information from ante-natal clinics and surveys conducted in the Caribbean from 1972-1982. There are an estimated 76,086.5, 65,796.0 and 6,422.5 ante-natals with haemoglobin levels below 11.0, 10.0 and 8.0 g/dl respectively, from an estimated population in the English-speaking Caribbean of 5,670,000. This anaemia is probably caused from a deficiency of iron, folate and vitamin B12. Parasitic infestations could be a causative factor in some of the anaemias. Sickle cell disease has also been noted