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As shown elsewhere, women in low-income societies commonly suffer from nutritional deficiencies
before and after pregnancies (4). The study populations originated from the following geographical
areas: France (. Statistical significance of associations between anaemia prevalence and an individual
indicator of SES was analysed by chi-square test. Effectiveness is a function of efficacy as well as
of compliance. If all these had hookworm infestation it’s prevalence would still have been low, 3%.
This is a post-harvest period for rice and considered as the time when most of the households have
the best food and economic resources. The SES and associated cultural factors may modify the
perceptions of side effects as well as its influence on compliance. First of all I would like to express
my respect and sincere thanks to all the pregnant women in Mymensingh who participated in this
trial. The subset of women with low initial hemoglobin was also selected for this analysis. Dhaka:
Bangladesh Bureau of Statistics, Ministry of Planning, 2000. 104. BBS. Poverty incidence in
Bangladesh 99: regional and national estimates. It appears that the most likely explanation for lack of
difference in haemoglobin concentration is that the tablet intake distribution of the daily and weekly
regimens approached each other and by 6 weeks post partum tablet intake was similar in both groups,
but not optimal to produce the maximum effect. Am J Clin Nutr 1996;63:610-614. 83. Porter A.
Drug defaulting in a general practice. New York: Raven Press, 1992. 50. Stephenson L. Impact of
helminth infections on human nutrition. Serum ferritin (sFt) has frequently been used to estimate the
stored body iron. A guide to health administrators and programme managers. While these trials may
appear similar in design they were conceptually different and answered different research questions
making comparisons difficult. For school attendance, a woman who did not complete at least 1 year
in a formal school was categorized as having no schooling. The measurements including height,
weight, fundal height and haemoglobin concentration were standardised and both inter- and intra-
interviewer variations were assessed during the training. A sensitivity analysis found that the overall
results (i.e. no significant association) were not robust; removal of one study made the outcomes
significant. A stronger association between Fe and fatigue should, therefore, be expected in the RCT
than in the cross-sectional studies. This article has been cited by the following publications. If your
body does not get enough iron, it will cause a low level of red blood cells. World Health Stat Q
1991;44:98-106. 111. INACG. Measurement of iron status. Dhaka: BRAC and ICDDR,B, 1994. 114.
BBS. Report of the poverty monitoring survey. For women who had at least one child, the average
time since the last pregnancy was 33 months. Geneva: Administrative Committee on Coordination:
Subcommittee on nutrition. Finally, twelve studies were included for further analyses. Blood
1990;75:1870-1876. 65. Hallberg L, Bengtsson C, Garby L, Lennartsson J, Rossander L, Tibblin E.
Over 4 months of supervised supplementation no difference was found between the daily and
weekly. Subjects and Methods Study area The study area is located in Mymensingh district in
northern Bangladesh.
Several factors might have contributed to this situation. Harun KM Yusuf of Dhaka University, for
continuous stimulation, making me understand how important I am and for reading and commenting
on the manuscript. Out of 179 women, there were only two cases of severe anaemia and both of
them were in the lowest SES group. This could not be explained by a lack of response to iron
supplementation in either groups since a dose-effect relationship was shown between categories of
tablet intake during pregnancy and haemoglobin concentration at 6 weeks post partum. Re-training
on all the measurements was conducted at the middle of the study. It is also possible that it could be
due to impaired utilisation of stored iron due to vitamin A deficiency (Mejia, 1992). Haemoglobin
concentration measure- ment was performed on the same day, using the cyanmethaemoglobin
method16. It is defined as a “fall of haemoglobin concentration below a statistically defined
threshold laying at two standard deviations below the median of a healthy population of the same
age, sex, and stages of pregnancy” (5). Hyderabad: National Institute of Nutrition,
1998(mimeograph). 26 Kumar R, Sharma AK, Barik S, Kumar V. Bethesda, MD: Federation of
American Societies for Experimental Biology, 1984:120 pp. 130. BNNC. State of nutrition in
Bangladesh 1995. Soluble sTfR was assessed by an enzyme-linked immunosorbent assay (Ramco
Laboratories, Houston, TX). Statistical significance of association between anaemia prevalence and
an individual indicator of SES was analysed 80 SM Ziauddin Hyder et al. Page 71. The results were
summarised as the effect sizes, standard errors and 95 % CI. Prog Food Nutr Sci 1988;12:339-369.
60. Kaufer M, Casanueva E. This study was nested into an iron supplementation trial in pregnant
women in Bangladesh, where the response in haemoglobin concentration was compared between
daily and weekly iron supplementation and in this process differentiating between biologically and
behaviourally induced differences such as compliance (3). I am grateful that they shared their limited
time with the interviewers and agreed to answer a large number of questions and I would like to
dedicate my thesis to them. This has been done partly because the assessment of haemoglobin
concentration is relatively cheaper, requires less technical skill and is easier to administer in the
community (5). Dewasa pasien anemia kekurangan zat besi dapat mengakibatkan degradasi pekerjaan
fisik, penurunan daya tahan tubuh, lesu dan menurunnya produktivitas. The SPSS WIN 8.0 software
package was used for data analysis. Unless compliance is carefully monitored, it is difficult to
separate the two explanations. To detect difference between two independent groups, student’s t-test
was used. It can be treated in a variety of ways: Iron Enriched Diet Iron Supplements Iron
Replacement Medicine Surgery Iron Injections Transfusion If you do not want to have any of those
symptoms, then the best thing to do is to not get it at all. P values less than 0.05 were considered as
statistically significant. Each centre covers about 1000 population and is managed by a female
Community Health Worker. To increase the program effectiveness, an intermittent dose frequency of
iron supplementation was suggested (9), resulting in a number of field trials to test the efficacy and
effectiveness of weekly regimens. All members of the field research team at Mymensingh,
particularly to Mizan Bhai, Farid Bhai, Sandhya, Rahima, Rehana, Amina, Sultana, Etu,
Samsunnahar, Dolena and Badrul for their hard work, on many occasions beyond the official hours
in carrying out the very complex field work, for taking the pain of travelling across more than 50
villages over and over again, visiting women in the evenings of Ramadan, for being highly caring
and supportive. Am J Clin Nutr 2002;In press. 15. Grover V, Usha R, Kalra S, Sachdeva S. However,
there was no difference in attained hemoglobin concentration after 12 weeks of supplementation.
The complete terms and conditions of your reuse license can be found in the license agreement that
will be made available to you during the online order process. In HemoCue system, a disposable
cuvette was filled with blood by capillary forces, which was relatively simple to use.
All questionnaires were checked for correctness at two stages. If multiple measures were reported in
a single study, a simple average of effect sizes was calculated as a representative value. Among
these, haemoglobin is involved in the delivery of oxygen from the lungs to the tissues and transfer of
carbon dioxide from the tissues to the lungs. Lars-Ake, my studies in Sweden would not have been
possible without you making the necessary funds available. Circulatory shock Cardiogenic Shock
Hypovolemic Shock Sepsis, Septic Shock an. Video Say more by seamlessly including video within
your publication. They were divided into six groups, each responsible for two villages.
Recommended guidelines for the prevention, detection, and management of iron deficiency anemia
among U.S. children and women of childbearing age. J Nutr 1995;125:82-91. 33. Deleeuw N,
Lowenstein L, Hsieh Y. Geneva: United Nations Children’s Fund, 2002. - - 59 Page 69. Anaemia
among non-pregnant women in rural Bangladesh. If your body does not get enough iron, it will
cause a low level of red blood cells. Original values were used in case of haemoglobin concentration
and transformed values were used in case of sFt - - 6 Page 143. Further research is needed to
evaluate the amount of iron required during pregnancy as well as an effective strategy to deliver this
amount. Biomed Environ Sci 1996;9(2-3):341-7. 29. Ekstrom E-C, Kavishe F, Habicht J-P, Frongillo
Jr E, Rasmussen K, Hemed L. Do side effects differ between daily and weekly groups. Iron
deficiency anemia is one of the most common anemias that occurs when you do not have enough
iron in your body. Thus, women with less than 1 year of schooling, who were landless or who were
economically deficit showed higher prevalence of anaemia. Most of these studies compared final
haemoglobin concentration between the supplementation groups without considering the potential
differential level of compliance. Am J Clin Nutr 1995;61:111-115. 102. Liu X, Kang J, Zhao L, Viteri
F. Baseline haemoglobin concentration, BMI at start of study, age or parity did not influence
compliance week 5-11 (data not shown). The lack of response could be attributable to reasons
including limited compliance or presence of other factors that limit the response such as vitamin A
deficiency (3, 18). Lazoi Lifecare Private Limited Anemia: A case based approach: Part-1 Anemia: A
case based approach: Part-1 Anas Bahnassi. The sample was diluted in sodium chloride solution and
the presence of worms was evaluated by a semi-quantitative technique (Brooks et al, 1995). Statistics
Make data-driven decisions to drive reader engagement, subscriptions, and campaigns. Information
on socio-economic situation (SES) and reproductive history was collected on identified pregnant
women having a fundal height - - 5 Page 142. Therefore, it appears that there is a need to further
identify what the contributing factors of maternal anaemia are. Geneva: WorldHealth Organization,
1989. 3 Scholl T, Hediger M, Fischer R, Shearer J. A study of intestinal parasites in antenatal clinic
patients in Lagos. The response was predicted from the dose effect curve (Figure 6).
In the rural setting of Bangladesh, most women are present around their houses and the cultural
practice is for men to be responsible for most of the outside activities including food purchase.
Frequent reproductive cycling: does it lead to nutritional depletion of mothers. This may both be an
underestimation and overestimation of this type of iron deficiency. The prospectively collected data
make causal interpretations of side effects and subsequent compliance plausible. The high buffer
capacity, solubility, and basicity of CaC03 influence the incidence of Fe chlorosis in this and other
crop plants in the Southern Great Plains and Mid-Western U.S., where 90% of sorghum production
is grown in calcareous soils. Out of 179 women, there were only two cases of severe anaemia and
both of them were in the lowest SES group. It is important to identify the causes of anaemia so that
the problem can be addressed in the most effective way. Fig. 2 Anaemia prevalence in non-pregnant
women in a rural area ofBangladesh by socioeconomic score ?n ? 179?: Lowest SESscore ? 0 and
highest SES score ? 3 82 SM Ziauddin Hyder et al. Page 73. These patterns clearly indicated that
women took the tablets routinely, sometimes with lower and sometimes with higher level of
compliance. What proportion of anaemia is due to iron deficiency. Seminario biologia molecular-
Universidad Pontificia Bolivariana. Women with fundal height 14-22 cm, reportedly corresponding
to gestational age 18-24 week (109), were included in the study. A logical intervention for its
prevention and control has therefore been the provision of iron supplementation during pregnancy
(1). In a multivariate logistic regression analysis, age, parity and Ascaris infestations were not
significantly associated with anaemia prevalence. The weekly dose of 60 mg iron Friday morning
and evening that was used in this study resulted in a slightly elevated frequency of reported side
effects in comparison with a daily dose of 60 mg. Am J Clin Nutr 1996;64:386-374. 13. Brock C,
Curry H, Hanna C, Knipfer M, Taylor L. Anemia of iron deficiency represent the problem of serious
society health because affecting at physical growth and psychical, behavior and work. For the other
days, each event was considered as one tablet taken. Information of socio-economic status and
reproductive history were obtained through home-visits and blood samples were collected at health
centres. The training on measurement of fundal height was provided at the Obstetrics unit of the
hospital by an expert obstetrician followed by rigorous field practices. Ann Trop Med Parasitol
1993;87:319-334. 126. Islam M, Karim E, Mian M, Kristensen S, Chowdhury M, Vermund S. Is
there any socio-economic difference in the prevalence. There was no difference in anaemia
prevalence in daily and weekly regimens neither after 12 weeks supplementation nor at 6 weeks post
partum (Table 5). In both the latter studies, the haemoglobin response was limited, suggesting that a
lack of difference between daily and weekly may in part be due to a lack of response to the iron
supplementation activity. The presence of ANCCs was an important prerequisite in organising the
field activities of the iron supplementation trial. The clinical measurement of serum transferrin
receptor. To differentiate between these two effects we have used the concepts dose frequency and
supplementation regimen. Most studies evaluating iron supplementation do not report the actual
prevalence of side effects and, therefore, their impact on compliance is not possible to assess. The
area is about 110 km north of the capital Dhaka, in the rural plain areas typical of Bangladesh. Most
of the womenhad mild (52%) or moderate (20%) anaemia, but a few of them suffered from
severeanaemia (1%). Daily iron supplementation is more effective than twice weekly iron
supplementation in pregnant women in Pakistan in a randomized double-blind clinical trial.
Br J Haematol 1993;85:787-798. 66. Stoltzfus RJ, Dreyfuss ML. At the lower end of the range,
haemoglobin concentration has been associated with an increased maternal and perinatal mortality,
pre-term delivery and low birth weight (10-16). Thus, women with less than 1 year of schooling,
who were landless or who were economically deficit showed higher prevalence of anaemia.
Conceptual framework A conceptual framework of the thesis was developed examining a number of
issues that are linked to the aetiology of anaemia and the effect of iron supplementation during
pregnancy and puerperium (Figure 1). Thus control for confounding in this type of analyses is
theoretically not necessary but was done nevertheless to increase plausibility (19). This may both be
an underestimation and overestimation of this type of iron deficiency. While it is possible that the
women might have opened the pill bottle and not consumed a tablet, it is not likely that it happened
to a large extent. It is my father who would be the happiest person to see me completing the thesis
work. However, supplement- ing newly wed women has also been discussed recently. This type of
analysis is often referred to as intent-to-treat analysis. Compliance during week 5 to 11 of the
supplementation was higher in the weekly regimen (mean 93%) than in the daily regimen (mean
61%, p - - 5 Page 128. Geneva: World Health Organization, 1968. 43. Velez H, Restrepo A, Vitale J,
Hellerstein E. Altered fetal growth: antenatal diagnosis by symphysis-fundal height in India in
comparison with western charts. Haemoglobin concentration measure- ment was performed on the
same day, using the cyanmethaemoglobin method16. A sensitivity analysis found that the overall
results (i.e. no significant association) were not robust; removal of one study made the outcomes
significant. There was no difference in anaemia prevalence in daily and weekly regimens neither after
12 weeks supplementation nor at 6 weeks post partum (Table 5). This could not be explained by a
lack of response to iron supplementation in either groups since a dose-effect relationship was shown
between categories of tablet intake during pregnancy and haemoglobin concentration at 6 weeks post
partum. A logical intervention for its prevention and control has therefore been the provision of iron
supplementation during pregnancy (1). J Nutr 2000;130:2697-2702. 12. Muslimatun S, Schmidt M,
Schultink W, et al. As indicated in the model, compliance is hypothesised to be affected by the dose
frequency of iron supplementation and also by the side effects that are experienced due to ingestion
of iron compounds. Analyses of the serum samples were performed at the end of the study at
Department of Nutrition, - - 20 Page 30. All analyses were tested for the confounding effects of
maternal age, fundal height, initial hemoglobin concentration, parity, and SES. The field supervisor
travelled across the field area every day to monitor the study related activities. Rome: Food and
Agriculture Organization of the United Nations, 2001. 106. UNICEF. The state of the world's
children 2000. Inclusion criteria were as follows: (1) cross-sectional studies on symptomatic fatigue
between subjects with normal Fe status and those with IDNA or (2) RCT of Fe therapy on
symptomatic fatigue in non-anaemic subjects including IDNA. Therefore, none of these studies could
answer the question if the finding of no difference in trial effectiveness between the supplementation
regimens was explained by differential compliance or poor efficacy or a combination of both. Am J
Clin Nutr 1988;47:280-297. 68. Chanarin I, Rothman D. In the context of this thesis, the term
compliance has been used to refer the extent to which women follow daily and weekly regimens of
iron supplementation, respectively. World Health Stat Q 1985;38:302-316. 35. ICMR. Evaluation of
the National Nutritional Anaemia Prohylaxis programme. The iron supplementation trial was
conducted on women attending 50 out of a total of 54 ANCCs.
One possible mechanism for this is that decreased VO 2 by tissues, especially muscles, in IDNA
creates cardiopulmonary stress, evoking a feeling of fatigue. Out of these, the cookies that are
categorized as necessary are stored on your browser as they are essential for the working of basic
functionalities of the website. Lancet 1993;342:1325-1327. 48. Rao B, Vijayasarathy C, Prabhavathi
T. Trop Doct 2000;30(2):84-8. 28. Liu XN, Liu PY. The effectiveness of weekly iron
supplementation regimen in improving the iron status of Chinese children and pregnant women.
Twelve villages were selected randomly from a complete list of all villages in the upazila. The
corresponding standard error was calculated as the square root of the weighted average of squared
standard errors using the degree of freedom (sample size minus 1) as weights. However, iron
supplementation as a public health measure (e.g., as part of antenatal care programmes) could not be
successful in reducing the problem (25). Altered fetal growth: antenatal diagnosis by symphysis-
fundal height in India in comparison with western charts. Geneva: World Health Organization, 1968.
43. Velez H, Restrepo A, Vitale J, Hellerstein E. Effectiveness has been defined as “the extent to
which a specific intervention, procedure, regimen or service when deployed in the field, does what it
is intended to do for a defined population” (31). At base-line there were no differences between
women in randomization groups regarding initial hemoglobin concentration, fundal height, age,
parity and SES. Disagreements were resolved by discussion between the reviewers. For a given
analysis potential confounders were identified as those variables with a P Results Participation
Among the 209 women enrolled in the study, 140 (67%) had complete information including
hemoglobin concentration after 12 weeks of supplementation and information on number of tablets
taken (Figure 1). Number of iron tablets actually consumed was, thus, not randomised and there was
a potential risk for confounding. Information on socio-economic situation (SES) and reproductive
history was collected on identified pregnant women having a fundal height - - 5 Page 142.
Therefore, efforts to improve these factors may be a better way to increase the effectiveness of iron
supplementation programmes. Seorang pasien wanita berusia 46 tahun mengeluh sakit dalam mulut
yang berulang terutama di lidahnya selama hampir 5 tahun. Alternatively, because IDNA is prevalent
in women, the use of an Fe preparation or improvement in Fe status through proper diet should be
considered for non-anaemic women with fatigue. Anthelmintic efficacy was markedly decreased in
iron-deficient mice; the deficiency was also associated with a decrease in body weight, altered
hematological parameters and a decreased net egg output; worm establishment in the deficient group
was not affected by the deficiency. GIT causes of IDA Coeliac disease IgA level and endomysial
and TTG antibodies H. Improving compliance by reducing side effects has not been found to be an
effective strategy. Therefore, prevention and control of post partum anaemia is an important issue
within the broader context of improving maternal and child health. Haemoglobin concentration in
non-pregnant women has been suggested to be one of the predictors of anaemia during pregnancy
(60). The aim of the efficacy analyses will, therefore, be to compare biologic differences in the
response to iron supplementation between daily and weekly groups. The field supervisor checked
and signed all finalised and error-free questionnaires. Running head: Impact of iron supplementation
in the post partum period. Studies done in Pakistan (25), Indonesia (26) and Malawi (27), all
evaluated trial effectiveness of supplementation regimen as there were no valid measures of
compliance. At 6 weeks post partum, there was no difference in haemoglobin concentration between
the daily and weekly regimens. Am J Clin Nutr 1996;63:610-614. 83. Porter A. Drug defaulting in a
general practice. Hemoglobin concentration was measured at baseline and after 4, 8, and 12 weeks of
supplementation.
Each time the bottle was opened and closed, time and date were recorded. IV Is there any difference
in trial effectiveness between daily and weekly at 6 weeks postpartum. Over 4 months of supervised
supplementation no difference was found between the daily and weekly. For the generous
hospitality, support and help during my stay at Umea. Anthelmintic efficacy was markedly decreased
in iron-deficient mice; the deficiency was also associated with a decrease in body weight, altered
hematological parameters and a decreased net egg output; worm establishment in the deficient group
was not affected by the deficiency. Am J Clin Nutr 1996;63:610-614. 83. Porter A. Drug defaulting
in a general practice. There is also no established diagnostic method for IDNA in patients with
inflammatory diseases. Each time the bottle is opened and closed the time and date are recorded. Am
Clin Prod Rev 1987;6:22-25. 113. BRAC. Socio-economic development and health: a baseline
survey in Matlab, 1992. Multiple linear regression analysis was used to study the difference in
efficacy between the daily and weekly dose frequencies of iron supplementation. The next day, two
laboratory technicians visited the women at their houses and picked up the stool samples. Since most
of the improvement in haemoglobin concentration was found to occur early in treatment, the initial
supplementation dose in pregnancy should be set as high as possible, which may then be followed
by a lower (intermittent) dose. The concept of effectiveness in public health is often associated with
program effectiveness (19) that includes additional programmatic factors not dealt with in this
research trial. The area is about 110 km north of the capital Dhaka, in the rural plain areas typical of
Bangladesh. Anemia ini disebabkan kurangnya cadangan zat besi di dalam tubuh sehingga
menghambat proses pembentukan sel darah merah. In the comparison of efficacy between the daily
and weekly regimens, the main determinant tested was the amount of iron supplements consumed
(Paper III). The intake of tablets was monitored by pill-bottles equipped with electronic counting
devices. Apart from the direct measures, an alternative way to assess iron deficiency is to monitor
haemoglobin response to iron supplementation (65). The privacy of the participating women was
secured by interviewing them in seclusion. However, the theory has so far not been supported by
human studies. A higher fundal height among women with incomplete data occurred to a similar
extent in both daily and weekly group. I have enjoyed Abed Bhai’s long-term vision of the necessity
in BRAC’s research capacity development. From the plain land of Nepal, a prevalence of 73% with
7% being severely anaemic has been reported (Dreyfuss et al, 2000). Food and Nutr Bull
1995;16:139-146. 103. BBS. 1999 statistical year book of Bangladesh. Recommended guidelines for
the prevention, detection, and management of iron deficiency anemia among U.S. children and
women of childbearing age. The advantage of the daily regimen appears to be the shorter time
required for maximum effect. Supplementation with vitamin A and iron for nutritional anaemia in
pregnant women in West Java. The results of RCT on Fe and fatigue are controversial. At the lower
end of the range, haemoglobin concentration has been associated with an increased maternal and
perinatal mortality, pre-term delivery and low birth weight (10-16). Daily iron supplementation is
more effective than twice weekly iron supplementation in pregnant women in Pakistan in a
randomized double-blind clinical trial.