Iron deficiency anemia among rural population attending tertiary care teaching hospital

Background: Nutritional anemia is a major public health problem in India and is primarily due to iron deficiency which is more common among rural population. The present study aimed at evaluating iron deficiency anemia among rural population attending our tertiary care teaching hospital. Materials and Methods: Patients having hemoglobin level below 11g/dl with Serum Iron level <30 ug/dl and/or serum TIBC>400 ug/dl were enrolled in the study. A total of 259 patients were included in the study. Hemoglobin estimation and other investigations were performed as per standard protocol in pathology laboratory. Results: Majority of patients were females (58.69%) and preponderance of iron deficiency anemia was seen in the age group of 21-30 (28.96%) followed by 31-40 (25.09%). Majority of male patients had mild anemia (55.14%) whereas majority of females had moderate anemia (57.24%). Conclusion: Iron deficiency anemia is significantly high among women of reproductive age group. Among females moderate anemia was predominant. Mild anemia was commonly observed in males.


Introduction
Anemia is an abnormal physiological and hematological condition concerned with reduction in oxygen carrying capability of the blood due to decline in Red Blood Cell (RBC) count, Packed Cell Volume (PCV) and Hemoglobin (Hb) concentrations than normal ranges [1]. Anemia is a major global health problem, especially 30% or nearly one third of world's population is suffering from anemia due to various causes [2]. The most common being deficiency of essential elements for the synthesis of hemoglobin (Iron, Vitamin B12 and Folic Acid), blood loss, repeated pregnancies in females of reproductive age, worm infestation, hemolysis due to known or unknown causes and bone marrow conditions causing suppression of red cell synthesis. Chronic diseases such as chronic renal failure, rheumatoid arthritis and tuberculosis are also known causes [3].
Iron deficiency anemia is a major nutritional problem in It is of note that anemia is particularly prevalent among three population groups, i.e., preschool-age children, pregnant females, and women of reproductive age [4].
Consequences among pregnant women include, abortions, premature births, post-partum hemorrhage and low birth weight were especially associated with low hemoglobin.
Anemia among pre school children and school going age group is predominantly due to parasitic diseases such as maiaria and worm infestations.
Iron deficiency anemia may impair the activity of host defense mechanisms and make host more prone to infections. Further it causes decrease in working capability of the individual [4].
Hence, we aimed at evaluating anemia among various age groups and proportion of iron deficiency anemia in mild, moderate and severe anemic patients.

Materials and Methods
This is a prospective, observational study conducted in The level of Hb in different categories of anemia was defined as follows: (i) severe anemia < 7 g/dl, (ii) moderate anemia 7-9.9 g/dl, (ii) mild anemia in pregnant women 10-10.9 g/dl, and (iv) mild anemia in non-pregnant women 10-11.9 g/dl. [5].
Statistical analysis: Analysis of results was performed by simple percentage method.

Research Article
Tropical Journal of Pathology & Microbiology Available online at: www.pathologyreview.in 3 | P a g e

Results
A total of 259 patients were included in the study. Out of them 107(41.31%) were males and 152(58.69%) were females.
The lowest hemoglobin recorded in our study was 3.5gms. In males, the prevalence of iron deficiency was 4.25% in ages 1 to 10 years, 5.02% in 11 to 20 years.
Majority of male patients were belonged to the age group of 31-40 and accounted for 10.42%. In females, the prevalence of iron deficiency was highest in the age group of 21-30 and accounted for (28.96%). (Table.1)

Discussion
Anemia can be of various types, but most common in developing countries is nutritional anemia. Globally anemia due to iron deficiency is perhaps the most widespread clinical nutritional deficiency disease especially among rural population. In our study, the age group of 21-40 years had highest prevalence of anemia.
This is in agreement with the studies conducted previously [6,7].
However, another study from South India reported 40-45 years age group as predominant [8]. Another study conducted by Lamsal, showed highest prevalence in 40-49 years age group [9].
In the present study anemia were in elderly 9.65%, in contrast another community based study conducted by

This is in accordance with the study conducted by
Reena kouli et al [11], who reported 39.92% males and 60.08% females. However, other studies showed no statistical difference between both genders [12,13]. This is in contrast with the study conducted by Chul won choi et al [14].
To explain the variations in prevalence rates of anemia, few researchers argued that estrogens act as inhibitors of erythropoiesis and make women more vulnerable to the development of anemia.
However, while postmenopausal estrogen levels decrease, there is an increase in red cell mass to levels that are similar to those in males, which makes it unreasonable to use different criteria for anemia in each gender [15]. The presumed mechanism for this effect is the reduced oxygen transport associated with anemia; tissue iron deficiency may also play a role through reduced cellular oxidative capacity. Iron plays an essential role in oxidative energy production [22].
Higher rate of parasitic infestations were observed in our study. Stool examination was performed for the detection of intestinal parasites in 95 patients, but not in all which remained as one of the limitations of the study.
In 27 stool specimens ova of hook worm was seen.
Cysts of Entamoeba histolytica were seen in 8 stool specimens and two stool specimens with Giardia lamblia trophozoites were seen. Least number of malaria cases has been reported from this region. In our study, two cases of Plasmodium vivax were seen in peripheral smear. Few studies associated urinary tract infections with anemia and an elevated s-CRP [24].
Various studies reported anemia as a common complication of pulmonary tuberculosis [25]. A number of studies in India, Indonesia, South Korea, Nigeria have documented anemia in patients with TB, however, all the studies involved only small numbers of patients and the results were not uniform [26].

Conclusion
Iron deficiency anemia is significantly high among women of reproductive age group. Preponderance of moderate anemia was seen in females and mild anemia was commonly observed in males.
Effective public health education, school based deworming and promoting cost effective iron rich diet among rural population would help in reducing the incidence of iron deficiency anemia.
Funding: Nil, Conflict of interest: None initiated,