CHAPTER I

INTRODUCTION

Background of the Study

Anemia is considered as a major public health problem in developing countries

as well as some economically developed countries albeit less common. Around one

third of the world’s population is said to be anemic and throughout its entirety the

prevalence of anemia is highest in South Asian countries. According to World Health

Organization (WHO), India has the highest prevalence of anemia among the South

Asian countries (Singh and Singh, 2017).

Medical students, in particular, may suffer from anemia because of the stress

brought about by a busy schedule including late-night and overnight studying, clinical

postings, and extracurricular activities (Pandey and Singh, 2013). Another factor that

could contribute to anemia amongst the Indian medical students is their lifestyle which

include their diet and frequency of exercising. According to a study by Bassi et.al. 2015,

people who have BMIs that lean toward underweight values would have a higher risk of

anemia and Indians, in particular, usually have a diet which consists of food that

generally has lesser iron content which also contributes to anemia. However, the latter

was difficult to assess in the study since food intake is not constant and varies all

throughout. Considering that medical students are also at risk for anemia and Indians

even more so, this study would assess the prevalence and severity of anemia amongst

the Indian medical students in Davao Medical School Foundation.

Review of Related Literature

Prevalence of Anemia worldwide

According to the World Health Organization, the global prevalence of anemia for

the general population is 24.8% and it is estimated that 1620 million people are affected

by anemia. The highest prevalence is in Africa (67.6%) and South-East Asia (65.5%). The

highest prevalence is in preschool-age children (47.4%, 95% CI: 45.7–49.1), and the

lowest prevalence is in men (12.7%, 95% CI: 8.6–16.9%). However, the population group

with the greatest number of individuals affected is non-pregnant women (468.4 million,

95% CI: 446.2–490.6).

The WHO regions of Africa and South-East Asia have the highest risk, where about

two thirds of preschool-age children and half of all women are affected. In numbers, the

main burden is concentrated in South-East Asia, where about 40% of anemic preschool-

age children and non-pregnant women, and about 30% of pregnant women reside.

Prevalence of Anemia in India

One of the major health problem in India is anemia. In a household survey NFHS

III (National Family Health Survey) conducted last 2005-2006, the prevalence of anemia

was 70% in children aged 6-59 months, 55% in females aged 15-49 years and 24% in

males aged 15-49 years (Arnold et al., 2009). According to the NFHS-III, India has the
highest number of cases of anemia in the world. The possible reasons that results to

anemia ranges from poor food quality, expensive healthcare facilities and low status of

women (Kaur, 2014). Another study conducted in India using retrospective observation

among patient who attended outpatient clinic indicate that anemia was present in children

less than 10 years of age, older adults and women after the onset of puberty (Uria et al.,

2014).

Risk of Anemia and Management

There are many factors that can put an individual at increased risk of Anemia. One is

a diet lacking in certain vitamins, having a diet that is consistently low in iron, Vitamin B12

and folate. Also, having an intestinal disorder that affects the absorption of nutrients in

your small intestine such as Crohn’s disease and Celiac disease (Kaitha et al, 2015). In

general, women who haven’t experience menopause have a greater risk of Iron deficiency

anemia than do men and postmenopausal women, that is because menstruation causes

the loss of red blood cells. Another major risk factor is when a woman is pregnant and

aren’t taking a multivitamin with folic acid. For chronic conditions, if an individual has

cancer, kidney failure or another chronic condition could happen and could also lead to

shortage of red blood cells. Family history and age might be also a risk factor that could

lead to Anemia (Kassebaum et al, 2014) .

Management depends on the type of Anemia the patient have. For Iron deficiency

anemia, it usually suggests iron supplements and change in diet. Vitamin deficiency
anemias, dietary supplements and increasing nutrients in diet for folic and vitamin B12

deficiency. In anemia of chronic disease, there is no specific treatment for this type of

anemia, doctors focus on treating the underlying disease, if symptoms become severe,

blood transfusion or injections of synthetic erythropoietin that may help the stimulation of

red blood cell production and ease fatigue (Thakur et al, 2014).

For anemias with bone marrow disease, treatment includes medication,

chemotherapy or bone marrow transplantation. A so-called Plasmapheresis is a

necessary management for Hemolytic anemias, depending on its severity (Parkin et al,

2016).

Importance of Hemoglobin and Peripheral Blood Smear for Anemia Diagnosis

According to NCBI, the fewer number of hemoglobin present in the blood results

to hypoxia because oxygen binds to the hemoglobin for its delivery to tissues. There can

be several causes of this. One example is carbon monoxide poisoning, where carbon

monoxide has greater affinity to hemoglobin than oxygen. Second example is a

decreased in hematocrit or true anemia. It occurs when the hemoglobin concentration

inside the RBCs decreases resulting to a reduce capacity of blood to carry oxygen.

Peripheral blood smear is a laboratory work up that involves cytology of peripheral

blood cells smeared on a slide. Despite advances in haematology automation and

application of molecular techniques, the PBF has remained a very important diagnostic

test to the haematologist.

 This study aims to identify the type of anemia the international medical students

suffer from and to know how severe it is affecting these students.

Moreover, this study aims to identify the cause or etiology of the anemia and

recommend a diet plan to treat the anemia.

Hypotheses
Theoretical Framework

In the study of Pandey and Singh (2013), anemia is mostly prevalent among

medical students who are females. The study of Saxena et al., 2010 reported that female

medical students were anemic, having a hemoglobin level of <12 gm %. However, none

of the male medical students had a hemoglobin level less than 12 gm % (Saxena et al.,

2010). This may be so because as suggested by Thomsen et al., 1986 that in males, the

achievement of adult testosterone concentration is associated with an increase in

erythropoiesis and hemglobin concentration.

Concerning the location in the prevalence and severity of anemia among Indian

medical students, it can be proposed that their immigration in the Philippines has effects

in their hemoglobin levels due to diet and lifestyle. According to Little et al., 2018, Indian

diet is low in micronutrients such as vitamin A, iodine, and iron. Better nutrition may

provide better hemoglobin results to students who has adapted an improved diet and

lifestyle to the the country they’ve migrated over the years.

.Hemoglobin levels will determine anemia and its severity based on the cut-off

values provided by WHO.

Conceptual Framework

Independent Variables Dependent Variables

Significance of the Study

The results and findings of this study will provide details regarding the prevalence

and severity of anemia on Indian medical students living in the Philippines. Additionally,

this will benefit the following sectors:

The Respondents. Those who helped provide data for this study may also benefit

by giving them information regarding their anemia and showing how many people share

the same fates as them.

Society. People with anemia reading this study will see what certain factors affect

the severity and prevalence on anemia that can lead to changes that they can do to avoid

bad outcomes. Moreover, Indian people living in the Philippines will now have a better

grasp of their knowledge regarding anemia and how their stay in the Philippines may

affect their lifestyles which can enable them to do adjustments that will favor good

outcomes.

Future Researchers. Fellow researchers reading this study may take the

recommendations provided by this study and further improve it. The study may expand

to other nationalities and may even include comparisons of severity and prevalence.

Additionally the data in this study may also serve as additional literature to support future

researches.