Masters Degrees (Nutrition and Dietetics)
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Browsing Masters Degrees (Nutrition and Dietetics) by Subject "Anemia -- Nutritional aspects"
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Item Open Access An evaluation of common health and nutritional risk factors for anaemia in rural women between 25 and 49 years(University of the Free State, 2015) Jordaan, Elizabeth Margaretha; Walsh, C. M.; Van Den Berg, V. L.; Van Rooyen, F. C.English: Anaemia, a global public health problem that particularly affects women, holds major consequences for human health. For this reason, the factors that play a role in the development of anaemia need to be identified. Determining the causal factors of anaemia can contribute to addressing the problem through appropriate interventions. The aim of this study was to determine the prevalence of anaemia, dietary diversity, anthropometric status, reported health status, socio-demography and associations between these factors among rural women aged 25–49 years. A cross-sectional descriptive study design was applied in a sample of 134 women living in the rural towns of Trompsburg, Springfontein and Philippolis in the Southern Free State, South Africa. Women who were pregnant at the time of data collection and who were HIV positive were excluded from the current study. This study made use of data collected as part of the Assuring Health for All in the Free State study. Blood samples were collected and analysed according to standard techniques. These included full blood counts, transferrin saturation, ferritin, homocysteine and red cell folate levels. A 24-hour recall was completed in a structured interview to determine dietary diversity, categorised as low (≤3 groups), medium (4–5 groups) and high (≥6 groups). A reported health questionnaire was completed for each woman and included information on tobacco and alcohol consumption patterns, medical history and medications as well as menstruation patterns and contraceptive use. A socio-demographic questionnaire was completed for each household which assessed basic demographics of household members; structure of the house; household income; amenities; access to water and sanitation; employment status and cooking facilities. Questions pertaining to language, race, gender, age, employment status and income as well as type of dwelling were also included. Information related to water, sanitation, source of energy and food storage facilities was obtained in terms of household information. Information for all questionnaires were obtained through structured interviews. Weight, height, waist circumference, triceps, biceps, subscapular, and suprailiac skinfold measurements were measured according to standard techniques. Weight and height were used to calculate body mass index (BMI) which was categorised as underweight (<18.50kg/m2), normal weight (18.50–24.99kg/m2), overweight (25.00–29.99kg/m2), obesity class I (30.00–34.99kg/m2), obesity class II (35.00–39.99kg/m2) and obesity class III (≥40.00kg/m2). Waist circumference was categorised as normal (<80cm), at risk (≥80cm) and high risk (≥88cm). Body fat percentage was determined by means of the sum of the four skinfolds and categorised as too low (≤8%), acceptable lower end (9–23%), acceptable upper end (24–31%) and too high (≥32%). The median age of the women in the study was 41 years with most of the women (79.9%) falling in the older age group (35–49 years). Occurrence of anaemia (4.6%), iron deficiency anaemia (0.7%) and iron deficiency (1.5%) among the women was low. However, the prevalence of anaemia of more than 4.9% within a specific population is considered a mild public health problem by the WHO (2008:Online) which is close to the 4.6% of the women in the current study. Elevated homocysteine levels were present in 7.5% of the sample with only 3.8% presenting with low red cell folate levels indicative of folate deficiency. More than half of the women (54.1%) reported that they menstruated regularly and 71.6% had currently or previously used injectable contraceptives. As expected, women who menstruated regularly had significantly lower median haemoglobin levels than those who did not. With regard to the women’s diets, almost half (44.7%) of the women in the sample had a low dietary diversity with flesh meats and fish (good sources of haem iron) consumed by 76.9% of the women. Only a quarter (25.4%) of the women ate dark green leafy vegetables (sources of non-haem iron and folate). All the women consumed starchy foods, some of which are sources of folate and iron due to their mandatory fortification. Significant associations between median MCV and MCH levels and dietary diversity score may indicate that the mandatory food fortification programme is having a positive impact on the micronutrient intake of these women. A predominant pattern of malnutrition, characterised by overweight and obesity (70.8%), high rates of abdominal obesity (79.2%) and unhealthy body fat percentages (86.2%) were prevalent. Significant associations between BMI, waist circumference and body fat percentage categories with MCV, MCH levels and transferrin saturation indicate that risk for iron deficiency is associated with obesity. In terms of the women’s reported health, median haemoglobin levels were significantly higher among those women who smoked compared to those who did not. A small percentage of the women (17.9%) had been hospitalised within the past 24 months with some women reporting breathlessness with usual activity (41.0%), loose stools/ diarrhoea for at least three days (17.3%), vomiting (18.0%), loss of appetite (41.0%), blood in their urine (7.5%) and involuntary weight loss of more than 3kg (42.5%) in the past six months. Unexpectedly, median haemoglobin levels were significantly higher among those women who experienced breathlessness with usual activity, but did not differ significantly between women who suffered from anaemia and those who did not, which could indicate that the breathlessness was due to other reasons not investigated in the current study. Poverty was prevalent in the sample with 37.7% of women being unemployed and only 21.6% having a husband or partner who was a full time wage earner. Even though most women had access to basic infrastructure, low levels of income and dependence on social grants as main source of income (52.7%) show that poverty was prevalent. In the poorest households (with no flush toilet), women were more likely to have a lower median haemoglobin. Results from the current study thus indicate that regular menstruation, poverty, smoking and obesity are factors that influenced the women’s risk for anaemia. Attention should be given to improving the nutritional status and lifestyles of these women in order to improve their overall health and to reduce their risk for chronic diseases and anaemia.