Prevalence of Iron Deficiency Anemia among ... - ResearchGate

Barooti E, et al. JRITable 1. Detailed characteristics of 19 articles included in the systematic review on the prevalence of anemia during pregnancyin IranPlace of study(source)Time ofstudyPlace ofsamplingSamplesizeHb cut-offpoint (gr/dl)prevalenceof anemiaFerritincut-off pointfor IDA (ng/dl)Prevalence ofiron deficiencyMean serumferritinOrumie (27) ∗ 1998 Urban 400 11 4.3 -- 13.8 --Eslam-shahr(28) ∗ 2004 Urban 266 11 -- -- -- --Isfahan (29) ∗ 1999 Urban 799 11 14.2 15 50.9 19.9Babol (30) ∗ 2000 -- 214 10.5 ∗∗ 9.4 -- -- --Babol (31) 2004 -- 871 10.5 6.4 -- -- --Bandar-abbas(5) ∗ 2001 Both 401 11 17.5 10 37.3 --Tehran (32) 1995 -- 417 -- -- -- 34.8 --Tehran (7) 2002 Urban 970 12 14.9 -- -- --Tehran (8) 2003 Urban 302 -- 8.6 -- -- --Tehran (33) 2004 Urban 308 -- -- -- -- --Zahedan (6) 2003 Urban 287 10.5 12.9 12 42.2 --Semnan (34) 1999 Urban 691 -- 16.9 -- -- --Shiraz (35) ∗ 1999 Urban 263 11 16.7 -- 28.5 24.9Shiraz (36) 2002 Urban 2000 10.5 9 -- -- --Fars province(37) ∗ 1996 Both 3371 11 4.1 -- -- --Kermanshah(38) ∗ 1999 Urban 326 11 17.2 12 25.8 --Downloaded from http://www.jri.irVaramin (39) ∗ 1993 -- 251 11 26.1 -- -- --Hamedan (40) ∗ 2000 Urban 378 11 4.8 -- -- --Several regionsof Iran (4) ∗ 2001 Both 4368 11 21.5 12 11.2 41.7- If the date of a study had not been mentioned, it was calculated by reducing the average difference between the date of the performed researchand the date of publication.∗ included studies into meta-analysis∗∗ The prevalence of Hb < 11 gr/dl is calculated by means of mean hemoglobin concentration and its standard deviation.DiscussionIn this study, we tried to estimate the overallprevalence of iron deficiency anemia in Iranianpregnant women by reviewing the findings ofavailable studies. The overall prevalence ofanemia in Iranian pregnant women was 12.4%,which has a substantial difference with thereported estimation published by WHO based on areport with a small sample size (79 individuals) in1994 – 1995 (3). Therefore, one should regard theWHO estimate with caution.Although the findings of the included studieswere heterogeneous, they could relatively coverall geographical areas of Iran. In this study, theestimated prevalence of anemia in urban pregnantwomen (10.8%) was less than that of the mixedurban and rural populations (14.7%).Despite the fact that the above difference wasJ Reprod Infertil, Vol 11, No 1, Apr/Jun 201021

JRI Iron Deficiency Anemia during Pregnancy in Irannot statistically significant, we may conclude thatlifestyle modifications and health care interventionsin rural area have been of good results.Similarly, the overall prevalence of anemia inpregnant women was 58% with no significantdifferences between rural and urban populationsin a study carried out in China (19).In WHO categorization, the prevalence ofanemia in ranges between 5% and 19.9% isconsidered as a minor health problem (3).In our research, the highest research qualitybelonged to the study by Safavi et al. who hadassessed the prevalence of anemia and irondeficiency in 11 different geographical areas ofIran in 2001. They had reported the prevalence ofanemia and iron deficiency in Iran to be 21.5%and 42.7%, respectively. Based on that study, thehighest (44%) prevalence rates had been seen insouthern Kerman, southern Khorasan, and Sistan-Baluchestan, the three eastern provinces of Iran;and the lowest (9%) prevalence had been reportedto be in Isfahan, Yazd, Kohkilooye-and-Boyerahmad, and northern Kerman, mostly centralprovinces of Iran (4). However, in the presentreview, we found some academic thesis andcongress abstracts which estimated the prevalenceof anemia as high as 40% (20), but they wereexcluded from our systematic review because oftheir low research quality or study in some targetsubgroups.It seems that the differences in geographicalareas, life style, and diet in different parts of Iran,to be the main reason for the wide spectrum of thereported results in various studies.The prevalence of anemia in a region depends onnumerous factors such as socio-economic status,iron intake, and prevalence of parasitic andinfectious diseases (21-23). Moreover, the prevalenceof anemia is higher in women in fertileyears, due to menstrual bleeding and pregnancy.IDA is more challenging in developing countries,because of inadequate intake of iron and folic acidsupplements and unhealthier diets (10, 24).However, it must be kept in mind that thepopulations in the included studies had beenmostly the medical care seeking pregnant womenwho had attended health care centers, whichroutinely provide pregnant women with iron andfolic acid supplements and the coverage of thisprogram is very high in Iran. In addition, nationalnutritional programs for the fortification of flourwith iron and folic acid may also help reduce theprevalence of anemia.Based on our findings, it seems that Iranianpregnant women are in a better situationcompared to the prevalence of anemia in pregnantwomen in the Eastern Mediterranean Region(EMRO). The prevalence of anemia in pregnantwomen in some of these countries are reported asfollows: Bahrain 33%, Egypt 26%, Jordan 35%,and the United Arab Emirates 14% (25). Studiesin India and Pakistan have reported the prevalenceof anemia as high as 80% to 90% (10, 24). Lackof standard frameworks for evaluating anemia andpoor reporting characteristics in published studiesin this region seem to be another important issue.Therefore, use of a unified methodology andpublishing format for these types of studies arerecommended.There were a few studies employing standardmethods and criteria in Iran, but the absence of anational health care strategy for surveys on thesesubjects, create numerous challenges for planningand intervening in this field.Promoting national health standards andreducing the rate of diseases and their mortalityrates are some of the most important goals ofhealth systems. Improvement of health indices ina community need interventions that are based onaccurate analysis of risk factors and efficientmarkers (26).ConclusionMaternal anemia is an important public healthproblem, not only in the East MediterraneanRegion but also in many other countriesworldwide. The results of the present systematicreview suggest that prevalence of anemia duringpregnancy in Iran is less than what has beenreported by WHO; however, there seems to be theneed to implement programmes to reach an idealstate of the disease.Regarding the increasing rate of research ondifferent health issues and the varieties in theirmethods and results, it would be impossible toevaluate the present status or forecast the futureprospects of any disease if directed and definedefforts such as secondary studies, amongst themsystematic reviews, meta-analysis, and modelingstudies, are not carried out. However, like primaryDownloaded from http://www.jri.ir22J Reprod Infertil, Vol 11, No 1, Apr/Jun 2010

Barooti E, et al. JRIstudies, these kinds of studies also have inevitablelimits, biases, and misdirections. In order to getmore accurate and reliable figures, uniform andstandard methods and study designs are alsorecommended for primary studies at the nationallevel.AcknowledgementThis study was a part of an approved andfinancially supported project by Women’s AffairsOffice at Iran's Ministry of Health and MedicalEducation. The authors appreciate all the researcherswhose articles were included in the study. Inaddition, the authors appreciate Dr. AbtinHeidarzade for reviewing the present article andproviding great guidance.References1. Gautam CS, Saha L, Sekhri K, Saha PK. Iron deficiencyin pregnancy and the rationality of iron supplementsprescribed during pregnancy. Medscape JMed. 2008;10(12):283.2. Malee M. Anemia in Pregnancy. Obstet Gynecol.2008; 112(1):201-7.3. De Benoist B, McLean E, Egli I, Cogswell M.Worldwide prevalence of anaemia 1993–2005,WHO Global Database on Anemia. Geneva: WorldHealth Organization; 2008. p. 21.4. Safavi M, Sheykh Aleslam R, Naghavi M, AbdollahiZ, Sadeghian Sharif S, Sadegh zadeh E, et al.[Prevalence of Iron deficiency anemia amongIranian Pregnant woman, Spring 2001]. Iran JEpidemiol. 2006;1(4):1-10. Persian.5. Khademi Z, Shahi A, Farshid Far GhR, Zare Sh,Vaziri F. [Prevalence of iron deficiency anemia inpregnant women referred to Shariati hospital inBandar Abbas, Iran]. Hormozgan Med J. 2004;8(1):27-31. Persian.6. Navidian A, Ebrahimi Tabas E, Sarani H, Ghalge M,Yaghobinia F. [The prevalence of Iron-deficiencyanemia in the pregnant women referring to healthcenters in Zahedan]. J Reprod Infertil. 2006;7(2):132-8. Persian.7. Borna S, Borna H, Ghanbari Z, Khezrdoost S.Anemia and factors that affect it in pregnancy.Tehran Univ Med J. 2005;63(6):448-52.8. Davaritanha F, Kaveh M, Salehi B. [Incidence ofanemia in pregnancy and its relationship withmaternal characteristics and pregnancy outcome].Hayat. 2005;11(24,25):23-31. Persian.9. Haghdoost AA, Sadeghirad B, Hajarizadeh B,Mirzazadeh A. The Application of SystematicReview and Meta-analysis Concepts in Summarizingthe Findings of Observational Studies. Iran JPsychiatry. 2007;2(4):132-6.10. Baig-Ansari N, Badruddin SH, Karmaliani R,Harris H, Jehan I, Pasha O, et al. Anemia prevalenceand risk factors in pregnant women in anurban area of Pakistan. Food Nutr Bull. 2008;29(2):132-9.11. Khosla AH, Dahiya P, Dahiya K. Burden ofchronic severe anemia in obstetric patients in ruralnorth India. Indian J Med Sci. 2002;56(5):222-4.12. Stroup DF, Berlin JA, Morton SC, Olkin I,Williamson GD, Rennie D, et al. Meta-analysis ofobservational studies in epidemiology: a proposalfor reporting. JAMA. 2000;283(15):2008-12.13. Moher D, Tetzlaff J, Tricco AC, Sampson M,Altman DG. Epidemiology and reporting characteristicsof systematic reviews. PLoS Med. 2007;4(3):e78.14. Heidarnia MA, Entezari A, Moein M, Mehrabi Y,Pourpak Z. [Prevalence of asthma symptom inIran: a meta-analysis]. J Res Med Sci. 2007;31(3):217-25. Persian.15. Haghdoost AA, Rezazadeh-Kermani M, SadghiradB, Baradaran HR. Prevalence of type 2 diabetes inthe Islamic Republic of Iran: systematic review andmeta-analysis. East Mediterr Health J. 2009;15(3):591-9.16. Haghdoost AA, Sadeghirad B, RezazadehkermaniM. Epidemiology and heterogeneity of hypertensionin Iran: a systematic review. Arch Iran Med.2008;11(4):444-52. Review.17. Mirzazadeh A, Sadeghirad B, Haghdoost AA,Bahrein F, Rezazadeh Kermani M. The prevalenceof obesity in Iran in recent decade; a systematicreview and meta-analysis study. Iran J PublicHealth. 2009;38(3):1-11.18. Entezari A, Mehrabi Y, Varesvazirian M, PourpakZ, Moin M. A systematic review of recent asthmasymptom surveys in Iranian children. Chron RespirDis. 2009;6(2):109-14.19. Ma AG, Schouten E, Wang Y, Xu RX, Zheng MC,Li Y, et al. Anemia prevalence among pregnantwomen and birth weight in five areas in China.Med Princ Pract. 2009;18(5):368-72.20. Ebrahimi Tabarsi A. [Prevalence of iron deficiencyanemia in Zahedan pregnant women referred tohealth centers of Zahedan University of medicalscience] [Medical Doctor's thesis]. Kerman (Iran):Downloaded from http://www.jri.irJ Reprod Infertil, Vol 11, No 1, Apr/Jun 201023

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