Half of women attending family planning clinics at major university hospitals in Egypt suffered from anemia, according to a recent study, with prevalence varying from 24% to 100%.1 Of those who were practicing contraception at the time of their visit, women using the IUD were most likely to be anemic (65%), and those relying on long-acting hormonal methods were least likely (34%); the prevalence of anemia among nonusers was 43%. Anemia was significantly more frequent among women living in urban areas, those who were not obese and those who had a parasitic infection.
To examine the effect of the use of contraceptive methods on the prevalence of anemia among Egyptian women and to identify underlying risk factors for the condition, a cross-sectional study was conducted among clients of family planning clinics in the obstetrics and gynecology departments of seven university hospitals from August 1995 to March 1996.
A total of 1,039 Egyptian women aged 18-40 years were recruited from the participating centers. Women were excluded if they were pregnant or had been pregnant within the previous six weeks. All participants completed a standard questionnaire designed to obtain demographic and socioeconomic data. They also provided information about their medical and reproductive history, as well as samples of blood, urine and stool to be tested for anemia and for parasitic infection. Women who wished to start a new contraceptive method made up 44% of the group, while 32% were making a routine follow-up visit, 19% had a method-related problem and 5% were making a visit for other reasons.
The prevalence of anemia in the entire sample was 50%, a proportion that varied from 24% at Assiut to 100% at Al Azhar. Overall, anemia was more frequently diagnosed in women living in urban areas than in those living in rural areas (56% vs. 42%). In addition, women with some formal education were more likely to be anemic than were those with none (53-57% vs. 47%), and women with a moderate income were less likely to be anemic than those with a relatively high or low income (47% vs. 57-58%).
Some reproductive characteristics also had significant effects. The prevalence of anemia was higher among nulliparous women and among women with 1-2 children than among those with more children (61-67% vs. 35-52%). The condition was also more common among women with menstrual periods lasting four or more days than among those with shorter periods (50-54% vs. 42%). Women with moderate-to-heavy menstrual flow were more likely to be anemic than were those with lighter flow (50-52% vs. 37%).
There was a statistically significant association between contraceptive use and anemia. The prevalence of anemia reached 65% among IUD users, compared with 34% among women who were relying on long-acting hormonal methods (injectables or the implant), 40% among those using the pill and 43% among those not currently practicing contraception. Women relying on an IUD not only had the highest prevalence of anemia, but were also most likely to have severe anemia (26%). Pill users were the group least likely to be severely anemic (3%).
The prevalence of anemia was significantly higher among women who ate red meat, green vegetables and molasses no more than once a week than it was among other women. In addition, women with a parasitic infection were significantly more likely than noninfected women to be anemic (79% vs. 49%).
Multivariate logistic regression analyses revealed that women living in urban areas were 1.8 times as likely as those in rural areas to be anemic, while those who were not obese were 1.5 times as likely to be anemic as were other women. The prevalence of anemia was 2.2 times as high among women relying on the IUD as it was among women using other contraceptives or no method. Finally, women infected with parasites were 2.9 times as likely to be anemic as were uninfected women.
The investigators note that the elevated prevalence of anemia among urban women probably reflects the low socio-economic status of the populations generally served by the study centers. The protective effect of obesity, they add, may indicate a higher intake of iron-rich foods. Given the increase in IUD use in Egypt and the high prevalence of anemia, they recommend the prescription of iron supplement tablets as part of the IUD services provided by family planning clinics, early treatment of parasitic infections and the mounting of mass media campaigns encouraging the intake of iron-rich foods. --D. J. Estrin
REFERENCE
1. Hassan EO, El-Hussinie M and El-Nahal N, The prevalence of anemia among clients of family planning clinics in Egypt, Contraception, 1999, 60(2):93-99.