An evaluation of common health and nutritional risk factors for anaemia in rural women between 25 and 49 years
| dc.contributor.advisor | Walsh, C. M. | |
| dc.contributor.advisor | Van Den Berg, V. L. | |
| dc.contributor.advisor | Van Rooyen, F. C. | |
| dc.contributor.author | Jordaan, Elizabeth Margaretha | |
| dc.date.accessioned | 2016-01-25T07:10:24Z | |
| dc.date.available | 2016-01-25T07:10:24Z | |
| dc.date.issued | 2015 | |
| dc.description.abstract | 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. | en_ZA |
| dc.description.abstract | Afrikaans: Anemie, ‘n wêreldwye openbare gesondheidsprobleem wat veral vroue beïnvloed, hou ‘n groot risiko vir menslike gesondheid in. Om hierdie rede is dit nodig om die faktore wat ‘n rol in die ontwikkeling van anemie speel te identifiseer. Die bepaling van faktore as oorsaak van anemie kan bydra tot die aanspreek van dié probleem deur middel van toepaslike intervensie. Die doel van hierdie studie was om die voorkoms van anemie, dieet diversiteit, antropometriese status, gerapporteerde gesondheidstatus, sosio-demografie en verbande tussen hierdie faktore onder vroue in landelike areas tussen 25-49 jaar te bepaal. 'n Dwarssnit, beskrywende studie-ontwerp is toegepas in 'n steekproef van 134 vroue wat in die landelike dorpe van Trompsburg, Springfontein en Philippolis in die Suid-Vrystaat, Suid-Afrika woon. Vroue wat swanger en/of HIV positief was tydens data-opname, was uit die huidige studie uitgesluit. Hierdie studie maak gebruik van data wat as deel van die “Assuring Health for All in the Free State” studie ingesamel is. Bloedmonsters is versamel en ontleed volgens standaard-tegnieke. Dit sluit in volbloedtelling, transferrien-versadiging, ferritien, homosisteïen en rooiselfolaat-vlakke. 'n 24-uur herroep is in 'n gestruktureerde onderhoud voltooi om dieet-diversiteit wat as laag (≤3 groepe), medium (4-5 groepe) en 'n hoog (≥6 groepe) geklassifiseer is te bepaal. ‘n Gerapporteerde gesondheidvraelys is vir elke vrou voltooi en het inligting oor tabak- en alkoholgebruikspatrone, mediese geskiedenis, medikasie sowel as menstruasiepatrone en die gebruik van voorbehoedmiddels ingesluit. 'n Sosio-demografiese vraelys is vir elke huishouding voltooi en het die basiese demografie van lede van die huishouding; struktuur van die huis; huishoudelike inkomste; geriewe; toegang tot water en sanitasie; indiensnemingstatus en kookgeriewe bepaal. Vrae met betrekking tot taal, ras, geslag, ouderdom, indiensnemingstatus en inkomste sowel as die tipe woning is ook ingesluit. Inligting met betrekking tot water, sanitasie, bron van energie en voedselberging-fasiliteite is verkry in terme van huishoudelike inligting. Inligting vir alle vraelyste is deur middel van gestruktureerde onderhoude verkry. Massa, lengte, middelomtrek, triseps, biseps, subskapulêre en suprailiaak velvoumates is volgens standaardtegnieke bepaal. Massa en lengte is gebruik om liggaamsmassa-indeks (LMI) te bepaal wat as ondermassa (<18.50kg /m2), normale massa (18.50-24.99kg /m2), oormassa (25.00-29.99kg /m2), vetsugklas I (30.00-34.99kg /m2), vetsugklas II (35.00-39.99kg /m2) en vetsugklas III (≥40.00kg /m2) geklassifiseer is. Middelomtrek was as normaal (<80cm), risiko (≥80cm) en 'n hoë risiko (≥88cm) geklassifiseer. Liggaamsvet-persentasie is bepaal deur middel van die som van die vier velvoue bereken en as té laag (≤8%), aanvaarbare onderste grens (9-23%), aanvaarbare boonste grens (24-31%) en té hoog (≥32 %) gekategoriseer. Die mediaan-ouderdom van die vroue in die studie was 41 jaar met die meeste van die vroue (79,9%) wat in die ouer ouderdomsgroep (35-49 jaar) val. Die voorkoms van anemie (4.6%), ystertekort-anemie (0,7%) en ystertekort (1.5%) onder die vroue was laag. Die voorkoms van anemie van meer as 4.9% binne ‘n spesifieke populasie word egter as ‘n matige publieke-gesondheidsprobleem deur die WGO beskou, wat baie naby aan die 4.6% van die vroue in die huidige studie is. Verhoogde homosisteïen-vlakke was teenwoordig in 7.5% van die steekproef met slegs 3.8% wat lae rooiselfolaat-vlakke getoon het. Dit is ‘n aanduiding van folaattekort. Meer as die helfte van die vroue (54.1%) het gerapporteer dat hulle gereeld menstrueer en 71.6% het tans of voorheen gebruik gemaak van inspuitbare voorbehoedmiddels. Soos verwag, het die vroue wat gereeld menstrueer, aansienlik laer mediaan-hemoglobienvlakke gehad as diegene wat nie gemenstrueer het nie. Met betrekking tot die vroue se dieet het byna die helfte (44.7%) van die vroue in die steekproef 'n lae dieet diversiteit gehad met 76.9% van die vroue wat vleis en vis (goeie bronne van heemyster) ingeneem het. Slegs 'n kwart (25.4%) van die vroue het donkergroen blaargroentes (bronne van nie-heem yster en folaat) geëet. Al die vroue neem styselrykevoedsel in, waarvan sommige bronne van folaat en yster as gevolg van hul verpligte verryking. Beduidende verbande is tussen mediaan MCV- en MCH-vlakke asook dieet-diversiteittelling gevind wat daarop kan dui dat die verpligte voedselverrykingprogram 'n positiewe impak op die mikrovoedingstofinname van hierdie vroue het. ‘n Oorheersende patroon van wanvoeding, wat gekenmerk word deur oormassa en vetsug (70.8%), 'n hoë voorkoms van abdominale vetsug (79,2%) en ongesonde liggaamsvetpersentasie (86,2%), was teenwoordig. Beduidende verbande tussen LMI, middelomtrek en liggaamsvetpersentasie-kategorieë met MCV, MCH en transferrienversadiging dui daarop dat die risiko vir ystertekort geassosieer word met vetsug. In terme van die vroue se gerapporteerde gesondheid, was die mediaan-hemoglobienvlakke aansienlik hoër onder vroue wat gerook het in vergelyking met diegene wat nie gerook het nie. 'n Klein persentasie van die vroue (17,9%) was die afgelope 24 maande in die hospitaal opgeneem en 'n paar vroue het benoudheid met gewone aktiwiteit (41.0%), los stoelgange / diarree vir ten minste drie dae (17,3%), braking (18.0 %), verlies van eetlus (41.0%), bloed in urine (7.5%) en onwillekeurige massaverlies van meer as 3 kg (42.5%), ervaar. Mediaan-hemoglobienvlakke was aansienlik hoër onder vroue wat benoudheid met gewone aktiwiteit ervaar het, maar geen beduidende verskil was tussen vroue wat aan anemie gely het of nie. Dit daarop kan dui dat die benoudheid as gevolg van ander redes, wat nie in die huidige studie ondersoek is nie, was. Armoede het oor die algemeen onder die vroue voorgekom met 37,7% van vroue wat werkloos was en slegs 21,6% met 'n man of lewensmaat wat 'n voltydse loon verdien. Selfs al het die meeste vroue toegang tot basiese infrastruktuur dui lae vlakke van inkomste en afhanklikheid van maatskaplike toelaes as hoofbron van inkomste (52,7%) dat armoede algemeen was. In die armste huishoudings (met geen spoeltoilet), was vroue meer geneig om 'n laer mediaan-hemoglobien te hê. Resultate van die huidige studie dui dus aan dat gereelde menstruasie, armoede, rook en vetsug faktore is wat die vroue se risiko vir anemie beïnvloed. Aandag moet aan die verbetering van die voedingstatus en lewenstyl van hierdie vroue gegee word, om so hul algehele gesondheid te verbeter en om hul risiko vir chroniese siektes en anemie te verminder. | af |
| dc.description.sponsorship | National Research Foundation (NRF) | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11660/2231 | |
| dc.language.iso | en | en_ZA |
| dc.publisher | University of the Free State | en_ZA |
| dc.rights.holder | University of the Free State | en_ZA |
| dc.subject | Anaemia | en_ZA |
| dc.subject | Haemoglobin | en_ZA |
| dc.subject | Iron | en_ZA |
| dc.subject | Iron Deficiency | en_ZA |
| dc.subject | Folate | en_ZA |
| dc.subject | Folate Deficiency | en_ZA |
| dc.subject | Dietary Diversity | en_ZA |
| dc.subject | Body Composition | en_ZA |
| dc.subject | Health | en_ZA |
| dc.subject | Socio-Demographics | en_ZA |
| dc.subject | Anemia -- Nutritional aspects | en_ZA |
| dc.subject | Women -- Health and hygiene | en_ZA |
| dc.subject | Women -- Nutrition | en_ZA |
| dc.subject | Health risk assessment | en_ZA |
| dc.subject | Nutrition | en_ZA |
| dc.subject | Rural health | en_ZA |
| dc.subject | Dissertation (M.Sc. Dietetics (Nutrition and Dietetics)--University of the Free State, 2015 | en_ZA |
| dc.title | An evaluation of common health and nutritional risk factors for anaemia in rural women between 25 and 49 years | en_ZA |
| dc.type | Dissertation | en_ZA |