IDA is highly common among women of reproductive age in Pakistan, and is considered a public health issue in the country. It is also linked to adverse reproductive outcomes.
However, current information on the prevalence and predictors of IDA among Pakistani women of reproductive age is scarce.
As such, researchers at Pakistan's Aga Khan University and the University of Sydney conducted a study to determine the extent of IDA in Pakistani women.
'A moderate burden'
Using data from the country's National Nutrition Survey 2011 — 2012, they assessed a total of 7,491 non-pregnant women between the ages of 15 and 49, and found that the prevalence of IDA was 18.1%.
Though this statistic was considerably lower than previous figures — which ranged from 30% to 60% — taken from smaller, non-representative samples in Pakistan, as well as lower than that reported in the previous National Nutrition Survey conducted in 2001 (25.5%), it was also higher than the global average of 17%.
The researchers wrote that "Pakistan still remains a country of moderate IDA burden according to WHO standards, which are based on the prevalence of anaemia defined by haemoglobin alone".
A multifarious problem
Multivariate regression analysis revealed that factors such as a lack of folic acid supplementation during a woman's last pregnancy, a history of four or more pregnancies, a birth interval of under 24 months, household food insecurity, and the presence of clinical anaemia contributed to the risk and prevalence of IDA.
An expectant mother's serum ferritin and iron stores are reduced by the growing demands of the developing foetus and placenta, especially in the later stages of the pregnancy.
Diet alone typically does not provide the required iron level; the problem is particularly serious in Pakistan due to the population's overall insufficient intake of iron.
Additionally, frequent pregnancies with short intervals in between — thanks to low contraception use — do not provide enough time for women to recover their iron stores, which are further depleted by lactation.
To further compound the issue, Pakistan has a great food insecurity burden, with access to food and nutrition across the country often restricted, thereby contributing to IDA prevalence.
A multifaceted solution
The researchers emphasised the need for a "multifaceted approach that incorporates iron supplementation, food fortification, improved family planning services, and efforts to reduce food insecurity" to lower IDA prevalence.
They also suggested a national programme to provide contraceptive services (such as IUDs and implants) to women immediately after they've given birth and before they are discharged from the hospital.
They added: "Recognising that Pakistan is a male-dominated society in which the majority of the decisions, including family planning, are taken by men, any successful family planning strategy will require the involvement of men.
"A recent large scale study of engaging men in family planning resulted in improvement in attitudes and behaviours, a decrease in the fertility rate, and an increase in the contraceptive prevalence rate."
They concluded that tackling IDA would necessitate iron supplementation for both women and adolescent girls, as well as solutions for the general population, such as the fortification of flour.
"Other programmes that can improve food security through food supplements and agricultural support that can have a greater impact with fewer side effects are also required."
Source: Asia Pacific Journal of Clinical Nutrition
https://doi.org/10.6133/apjcn.042017.14
"Prevalence and determinants of iron deficiency anaemia among non-pregnant women of reproductive age in Pakistan"
Authors: Muhammad Atif Habib, et al.