Asian Journal of Medical Sciences 1 (2010) 12-13
ASIAN JOURNAL OF MEDICAL SCIENCES
Awareness of Iron Deficiency Anemia among women of Reproductive age in Hubei Province, China
Tabish Hussainab* and Li Yu Shua
aDepartment of Cardiology and Public Health, Union Hospital, Tongji Medical College, Huazhong University of Sciences and Tech-
nology, Wuhan, China
bDepartment of Internal Medicine Rawalpindi Medical College, Rawalpindi, Pakistan.
Objective: To assess the level of awareness about causes, prevention and treatment of iron deficiency anemia among women of reproductive age in Hubei
province, a south eastern province of China.
Method: Cross sectional study was conducted by using a self designed standardized pretested questionnaire in peripheral areas of Wuhan city, the capital of
Hubei province from January 2009 to December 2009.Women aged 18-45 years without any previous history of medical or gynecological problems were
Results: A total 385 women were surveyed for Iron Deficiency Anemia (IDA).77.9% women (n=300) were aware of the term IDA, with the highest proportion
of 88.1% falling in age group 25-35 years. Most of the women were aware of the fact that their diet contains iron and its importance in health. Women who had
children and of working class had greater knowledge about the iron deficiency anemia.
Conclusion: Awareness regarding IDA is directly linked with the educational and social status of a community and is found to be increasing with the passage
of time with exploration and accessibility to media and health care facilities. Women of younger ages are more concern about their own health and much careful
about their expected babies in terms of nutritional facts as compared to the elder ladies.
Keywords: Iron deficiency anemia; Reproductive age
Dr. Tabish hussain, Cardiology department, room 403, International doc-
tors building, Tongji Medical College, Wuhan, 430030,China; Ph No.
+86-15072474344;+86-27-83691233, E-mail: firstname.lastname@example.org
Iron deficiency anemia (IDA) occurs when iron deficiency is sufficiently
severe to diminish erythropoiesis and causes the development of anemia.
Iron deficiency is the most prevalent single deficiency state in the world.
“IDA is currently estimated to affect more than 500 million people” around
The main cause of high prevalence of iron deficiency is nutritional
inadequacy owing to low socioeconomic conditions. Women bear the main
burden of iron deficiency as it is more common among premenopausal
women. According to a survey done in Lahore, Pakistan “66% of the pregnant
women were anemic. Anemia was more common in women with lesser
education, low socioeconomic group and increasing parity. Iron deficiency
anemia was found in 72.7% of anemic women”.2
Iron deficiency caused solely by diet is uncommon in adults in countries
where meat is an important part of the diet. This occurs despite consumption
of a diet that contains an equivalent amount of total dietary iron because heme
iron is absorbed better from the diet than nonheme iron. Freshness of food
plays a major role too. “The inconsistency in concentration of metal ions at
various rotting stages, perhaps, is due to different rotten products, with varied
absorbency at different states of decay”.3 In certain geographic areas,
intestinal parasites, particularly hookworm, worsen the iron deficiency
because of blood loss from the gastrointestinal tract.4,5
It is important economically, because IDA diminishes the capability of
individuals in peripheral countryside living areas of rapidly developing
countries like China, India and Pakistan to perform physical labor as their
source of income, and it diminishes both growth and learning in children.
The aim of this study was to asses the level of knowledge about awareness,
causation, prevention and to some extent the treatment of IDA among women
of reproductive ages so as to make a formulation about the success of various
healthcare awareness programs started by the government in the provincial
capital of Hubei, Wuhan and its adjacent countryside areas with combined
population of over 100 million on average.
2. Materials and Methods
A cross sectional study was conducted in the peripheral areas of Wuhan for a
period of 1 year from January 2009 till December2009. Seven villages were
surveyed in collaboration with the medical-paramedical staff of primary and
secondary Health care centers. A total of 385 Ladies were selected randomly.
Target group was women of reproductive age, physically healthier and aged
18 to 45 years without considering marital status. Women with any previous
record of medical, surgical or gynecological problems were excluded from the
study. The survey was done with a face to face interview by going door
to door in the village. The questions were appropriately translated in Chinese.
Informed verbal consent was taken from the women. All the information was
kept confidential. Survey instrument was a self designed pretested
open-ended questionnaire, created according to relevant literature on Iron
Deficiency Anemia and modified with a total of 24 questions. The first
section of questions included information on age, marital status, and number
of children. The second section was regarding general knowledge about iron.
The women were asked if they knew what Iron is, if they were aware of the
fact that their diet contained iron and if they had an idea about Iron
Deficiency Anemia. All these questions had yes or no options. The third
section had questions concerned about their personal habits and if they were
aware of which foods had high iron content. The last section consisted of
questions regarding iron supplements, asking if women had ever used them.
The data entry was considered valid if the error rate was less then 0.3 percent.
The final data was converted to SPSS (version 10.0) for analysis. Descriptive
analysis was conducted by calculating means and proportions for continuous
and discrete data entry. The ethical approval of the study was obtained from
the department of Community Health Sciences, at Tongji medical College,
We surveyed 385 participants for our study. The characteristics of study
sample are shown in Table-1.The largest proportions of the study population
were in the 25-35 years of age interval (41.3%, 159n). Regarding the aware-
ness of Iron Deficiency Anemia, 77.9% (300n) of the women were aware of
the term IDA, with the highest being in the age group 25-35 with an 88.1%
majority. The women that were employed, 100% were aware of IDA as
compared to the homemakers. Among homemakers 76.1% of which knew
about IDA (table-1).
Table 1: Awareness of Iron deficiency Anemia in different age groups
Among all the age groups, 53.8% women knew that their diet contains iron
(fig.-1) and 63.9% of women thought that women needed more iron than men.
Although Women with children stated that 100% of them had felt weakness
and fatigue during pregnancy, but only 59.9% of these married women were
aware of the fact that pregnant women needed an increased intake of iron, and
a similar percentage (59.9%) of married women knew breast-feeding required
greater iron intake.
Among women in the community taking iron tablets, 61.3% found them to be
beneficial; the remaining 38.7% did not feel that Iron supplementation
improved their health in any significant way. It was seen that of the women
taking regular iron supplements, 58.1% took the tablets with food. 98.2% of
them thought that iron tablets should be taken with milk or water (Table -2*)
and only 29.7% thought that the tablets should be taken with orange juice to
get best results.
52 (43.7%) 18-25
25-35 140 (88.1%) 19 (11.9%)
35-45 93 (86.9%) 14 (13.1%)
Married 205 (72.2%) 79 (27.8%)
Unmarried 95 (94.05%) 6 (5.95%)
Employed 29 (100%) 0 (0%)
Unemployed 271 (76.1%) 85 (23.9%)
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Figure 1: Showing frequency of awareness concerning iron content in
66.5% of the women with children had taken iron tablets at some point in
their lives and most of the population was willing to take iron supplements.
Women with knowledge about IDA, 50.9% knew that different foods contain
iron, 49.1% did not know food contained iron and 42.7% had some
knowledge that worm infestation can be a cause of iron deficiency.
Table 2: showing responses to what iron tablets should be taken with
We found that the only half of the women surveyed knew that their diet
contains iron. It was seen that majority of these women were employed or
young and unmarried.
Most of the sampling population was aware of the condition IDA. The
unmarried group had more knowledge about it and education plays the major
role. The unmarried young women were also the group that was employed.
Two thirds of the married women knew that pregnant women required a
greater amount of iron in their diet for the wellbeing of the mother and fetus
and also during the period of lactation. The women realize that breast feeding
increases the demand of nutrients for the mother and the nursing infant.
Almost half of the women interviewed were aware that worm infestation can
cause weakness and fatigue which are symptoms of iron deficiency anemia.
Many of the women may have experienced this, have been told about it or had
visits to antenatal clinics.
Our study clearly reflected that the women in the community of Wuhan,
China are aware of some of the effects caused by iron deficiency. They
seemed to have a good idea about the importance of iron for maintaining good
health and also in pregnancy. Since the predominant age group of our sample
was between 25-35 years, but this is not entirely accurate as many older
women refused to tell their age due to the conservative culture seen in the
The married women in the community are better informed regarding the
importance of iron and the need to take iron supplements during pregnancy.
The unmarried group is also informed but to a lesser degree. Married woman
are informed because of antenatal clinic visits and the Lady Health Visitors
counseling. Their personal experience of feeling tired and the difference felt
after the iron supplements has proved to them the importance of iron.
Unmarried women are aware of this as most of them are much younger and
many were employed. Employment has increased their awareness and
education plays a major role. Education seems to be critical in awareness
regarding IDA. Although the survey did not include the level of education
instead employment is a good indicator for the importance of education.2
The majority age groups (25-35), were the women who were employed and
had the highest knowledge about this condition, showing that education plays
a role in the awareness of iron deficiency anemia.5 Lady Health Visitors also
play a vital role in creating the awareness of the importance of foods rich in
“In 1993, the World Health Organization (WHO) instituted its Safe
Motherhood Initiative with a goal of reducing the number of maternal deaths
by half before the year 2000. A key component was to eradicate anemia in
pregnancy, focusing on the greater risk in younger women. In 1997, WHO
convened a regional consultation of experts to address malnutrition issues
among adolescent girls in South-East Asia. Among the recommendations for
action was a need for the development of assessment, advocacy, prevention,
and control initiatives, in most countries, to reduce anemia in adolescent girls.
As an outcome, WHO training programs for adolescent nutrition have been
initiated. In 1999, a special symposium entitled „Improving Adolescent Iron
Status before Childbearing‟ was convened in Washington DC. The
conclusions of this group were that many girls are already anemic by the time
they become pregnant (16–55%), and that pregnancy is too short a period of
time in which to reduce pre-existing anemia, especially when many women
do not seek prenatal care until the second or third trimester. Thus, they
concluded that emphasis needs to be placed on pre-pregnancy programs to
increase body iron stores”.6
Maternal health care centers and regular antenatal care visits really play a
major role in creating awareness regarding IDA and other women gender
problems. Media also have a key influence on the awareness regarding iron in
the diet and also in informing which foods are rich in iron.7
Majority of the women population are realizing the importance of iron
supplements in their diet, but still there are a number of women who do not
see any benefits of taking iron supplements which could be due to their high
cost, the lack of education and counseling given by elders in the community
and health practitioners. Another reason for this could be that these women
often expect to have immediate results after taking the iron supplements but
find that it takes months before any significant changes can be felt, so lack of
compliance can have lead to this finding in our survey. Also a large number
of the population is not willing to take iron supplements. This could be
attributed to many causes such as cultural beliefs, lack of trust in health care
practitioners and lack of counseling by the medical personnel
But, overall, the level of knowledge and healthy life style information is
gradually rising day by day, reflected by the fact that the women of modern
society realize that they need to have adequate intake of food and take more
care of their diet to ensure the growth of the baby8. There is increased
awareness due to the media as well.9
“The burden of iron deficiency can be reduced by taking a more holistic
approach that would include promotion of healthy weaning practices and use
of appropriate complementary foods, together with improving the nutritional
value of such foods. There is an increasing body of peer-reviewed literature to
support the contention that "micronutrient Sprinkles" is an effective strategy
to improve the nutritional value of home-prepared complementary foods and
thus to reduce the burden of iron deficiency among children”.10 “Decrease of
vitamin C level is related to the changes of initial stages of iron metabolism
and its further absorption”.11
Finally, Iron deficiency can be overcome by directing the financial resources
to the vulnerable segments of population and enhancing their access to
Mrs. Roshan Ara, Muhammad Ismail Anwar, Dr. Abbas Hayat, Engg.
Tajammul Hussain and Dr. Aamra Sartaj.
1. Cook JD, Skikne BS, Baynes RD. Iron deficiency: the global perspective.
Adv Exp Med Biol. 1994; 356:219-28. PMid:7887226
2. Rubina Sohail, Sadia Zainab, Farrukh Zaman. Prevalence of anemia in
obstetrical population. King Edward Med College 2004;10(2):146-8.
3. Shakila Zaman, Hameed A Tahir, Uzaira Rafiq. Changes in concentration
of iron and lead in food due to rotting. Rawal Med J 2006;31(1):6-9.
4. Chen LH, Luo HS. Effects of H. pylori therapy on erythrocytic and iron
parameters in iron deficiency anemia patients with H. pylori-positive
chronic gastritis; World J Gastroenterol 2007;13(40):5380-3.
5. Shun-xing Li, Nan-sheng Deng. Speciation analysis of iron in traditional
Chinese medicine by flame atomic absorption spectrometry. J of Pharm
and Biomed Analysis 2003;(32)1:51-57.
6. Paul R Meier, H. James Nickerson, Kurt A. Olson, Richard L. Berg, and
James A. Meyer. Prevention of Iron Deficiency Anemia in Adolescent
and Adult Pregnancies. Clin Med Res. 2003;1(1): 29–36. doi:10.3121/
7. Charlotte Adams, Alice Costello, Sarah Flynn. Iron Deficiency Anemia
In Ecuador: Does Education Matter? Cited 2009 Available from http://
8. Purushothaman V, Amirthaveni M, Tsou SCS, Shanmugasundaram S.
Supplementing iron bioavailability enhanced mung bean. Asia Pac J Clin
Nutr. 2008; 17 Suppl 1:99-102. PMid:18296312
9. Leenstra T, Coutinho HM, Acosta LP, Langdon GC, Su L, Olveda RM,
McGarvey ST, Kurtis JD, Friedman JF. Schistosoma japonicum reinfec-
tion after praziquantel treatment causes anemia associated with inflam-
mation. Infect Immun. 2006 Nov; 74(11):6398-407. Epub 2006.
doi:10.1128/IAI.00757-06 PMid:16923790 PMCid:1695508
10. Christofides AL, Hyder SM, Schauer CS, Tondeur MC, Sharieff W. Con-
trolling iron deficiency anemia through the use of home-fortified comple-
mentary foods Indian J Pediatr. 2004;71(11):1015-9. doi:10.1007/
11. Akhmeteli KT, Eradze TsSh, Tushurashvili PR, margvelani GP. Vitamins
C, B12 and folic acid in latent iron deficiency. Georgian Med News.
2005 ;( 128):109-11. PMid:16369081
12. Nayyar Yaqoob, Shahid Mumtaz Abbasi. Nutritional Iron Deficiency in
our population. J Coll Physicians Surg Pakl 2002; 12(7):395-7.
T. Hussain et al. / Asian Journal of Medical Sciences, 1 (2010) 12–13
Bread 42 (10.9%) 343 (89.1%)
Tea 185 (48.1%) 200 (51.9%)
Orange 122 (31.7%) 263 (68.3%)
Water 367* (95.3%) 18 (14.7%)
Yogurts 29 (7.5%) 356 (92.5%)
Rice 99 (25.7%) 286 (74.3%)
Milk 370* (96.1%) 15 (3.9%)