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Redalyc.Anemia in Mexican Women: a Public Health Problem Salud Pública de México ISSN: 0036-3634 [email protected] Instituto Nacional de Salud Pública México Shamah, Teresa; Villalpando, Salvador; Rivera, Juan A.; Mejía, Fabiola; Camacho, Martha; Monterrubio, Eric A. Anemia in Mexican women: A public health problem Salud Pública de México, vol. 45, núm. Su4, 2003, pp. S499-S507 Instituto Nacional de Salud Pública Cuernavaca, México Available in: http://www.redalyc.org/articulo.oa?id=10609806 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative Anemia in Mexican women ORIGINAL ARTICLE Anemia in Mexican women: A public health problem Teresa Shamah-Levy, MSc,(1) Salvador Villalpando, MD, Sc. Dr,(1) Juan A. Rivera, MS, PhD,(1) Fabiola Mejía-Rodríguez, BSc,(1) Martha Camacho-Cisneros, BSc,(1) Eric A Monterrubio, BSc.(1) Shamah-Levy T, Villalpando S, Rivera JA, Shamah-Levy T, Villalpando S, Rivera JA, Mejía-Rodríguez F, Camacho-Cisneros M, Monterrubio EA. Mejía-Rodríguez F, Camacho-Cisneros M, Monterrubio EA. Anemia in Mexican women: A public health problem. Anemia en mujeres mexicanas: un problema de salud pública. Salud Publica Mex 2003;45 suppl 4:S499-S507. Salud Publica Mex 2003;45 supl 4:S499-S507. The English version of this paper is available too at: El texto completo en inglés de este artículo también http://www.insp.mx/salud/index.html está disponible en: http://www.insp.mx/salud/index.html Abstract Resumen Objective. The purpose of this study is to quantify the prev- Objetivo. Cuantificar la prevalencia y distribución de ane- alence and distribution of anemia among women of child- mia de las mujeres en edad fértil (12 a 49 años de edad) bearing age (12 to 49 years) participating in the 1999 captadas en la Encuesta Nacional de Nutrición 1999 (ENN- National Nutrition Survey (NNS-1999). Material and 99). La Encuesta tuvo un diseño probabilístico y es repre- Methods. The survey had a probabilistic design and was sentativa del ámbito nacional mexicano, de zonas urbanas y representative at the national level, of urban and rural areas rurales y de cuatro regiones: norte, centro, Ciudad de México and four regions: North, South, Center, and Mexico City. y sur. Material y métodos: La concentración de hemoglo- Hemoglobin concentration was determined in capillary bina se determinó en sangre capilar mediante un fotómetro blood samples using a portable photometer (HemoCue), in portátil (HemoCue) en 17 194 mujeres, de las cuales 697 17 194 women, 697 of whom were pregnant. Results. The estaban embarazadas. Resultados. La prevalencia de ane- overall prevalence of anemia was 27.8% in pregnant women mia en el ámbito nacional fue de 27.8% para mujeres emba- and 20.8% in non-pregnant women. Higher prevalences were razadas y 20.8% para no embarazadas. Se encontró una observed in rural as compared to urban areas, both in preg- mayor prevalencia en zonas rurales que en urbanas, tanto nant (28.0% vs 27.7%) and non-pregnant (22.6% vs 20.0%) en mujeres embarazadas (28.0% vs 27.7%) como en no em- women, but the differences were not statistically significant barazadas (22.6% vs 20.0%) pero las diferencias no fueron (p >0.05). Women in the South had the greatest prevalence estadísticamente significativas (p>0.05). La región sur presen- (23.2%), followed by those in the North (20.9%), Center tó la mayor prevalencia de anemia ( 23.2%), seguida de la (20.6%), and Mexico City (16.4%). Non-pregnant indigenous región norte (20.9%), la centro (20.6%) y la Ciudad de México women had a prevalence of 24.8%, while in non-indige- (16.4%). Las mujeres no embarazadas indígenas presenta- nous women the prevalence was 20.4%. Conclusions. Ane- ron una prevalencia de anemia de 24.8%, mientras que en mia in women of childbearing age is a growing public health las no indígenas fue de 20.4%, no siendo esta diferencia es- problem that justifies the implementation of interventions tadísticamente significativa. Conclusiones. La anemia en for its prevention and control. The English version of this mujeres en edad fértil es un problema de salud pública que paper is available too at: http://www.insp.mx/salud/index.html justifica la implantación de programas de prevención y con- trol. El texto completo en inglés de este artículo también está disponible en: http://www.insp.mx/salud/index.html Key words: nutrition surveys; nemia; pregnant women; Palabras clave: encuestas nutricionales; anemia; mujeres hemocue; hemoglobin; Mexico embarazadas; hemocue; hemoglobina; México (1) Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México. Received on: August 20, 2002 • Accepted on: October 14, 2003 Address reprint requests to: Mtra. Teresa Shamah Levy, Departamento de Vigilancia de la Nutrición, Instituto Nacional de Salud Pública, Avenida Universidad 655, colonia Santa María Ahuacatitlán 62508 Cuernavaca, Morelos, México. E-mail: [email protected] salud pública de méxico / vol.45, suplemento 4 de 2003 S499 ORIGINAL ARTICLE Shamah-Levy T et al nemia is the most frequent nutritiona-related dis- Center, Mexico City, and South).* Families were select- A ease worldwide, affecting half of children and ed according to a sampling frame developed by INE- pregnant women and between 20 and 25% of non-preg- GI (acronym from its Spanish name: Mexican National nant women in developing countries.1 Both nutrition- Institute of Statistics, Geography and Information). al and non-nutritional factors may cause anemia. The Sampling procedure for NNS-1999 followed a most common nutritional cause is iron deficiency. Oth- multistage, stratified, cluster design. The survey in- er nutritional causes are deficiencies of vitamin B12, folic cluded diverse data collection strategies for different acid, and vitamin A.2-4 Among the non-nutritional caus- age groups. In each household, data were collected es of anemia are intestinal parasitic infections such as from all children <5 years of age and school-age chil- uncinariasis and trichinosis.5-8 Other causes include dren (5-11 years), but only from one woman aged 12- hemodilution during pregnancy, concurrent acute and 49 years. chronic infections, and menstrual bleeding.9,10 Iron Only one woman between the ages of 12 and 49 deficiency also has deleterious effects on the immune was selected from those living in a given household. response, exercise endurance, cognitive ability, and Data obtained from 18 312 women aged between 12 psychosocial development.11,12 and 49 years were retrieved for this analysis, includ- The extent to which anemia affects the health of ing those subjects having information available on mothers and of their newborns is not completely es- hemoglobin concentrations, physiological status (preg- tablished, but some studies suggest that anemia dur- nant, lactating, non-pregnant non-lactating), ethnic ing pregnancy has adverse effects on both the mother background, socioeconomic status (SES), maternal par- and the fetus.13,14 Moreover, severe anemia greatly in- ity, education, employment, and maternal literacy. For creases the risk of maternal death.10,14 Insufficient ma- this analysis, indigenous background of a family was ternal iron stores are reflected in low iron stores in the operationally defined as at least one woman 12-49 newborn, leading to increased risk of iron deficiency years of age who spoke a native language. The socio- in the first months of life. Iron deficiency may also have economic level was graded using principal components long-term consequences on the health of both mother analysis. Selected variables were flooring material, and child. For example, iron deficiency anemia is as- availability of running water, ownership of household sociated with birth weight and pre-term birth. electrical appliances (washing machine, refrigerator, The most recent information on the extent and television, radio, and stove). This index explained distribution of anemia in Mexico was reported in the 51.6% of the generalized variance of the set of vari- 1988 National Nutrition Survey.15 The present study ables included. The distribution of this index was di- was designed to quantify the prevalence and describe vided into tertiles to classify SES into high, medium, the distribution of anemia in women aged 12 to 49 and low strata. Parity was stratified into three catego- years, at the national level, by urban and rural areas ries: women with less than three children, three to five and by region, and to assess the trend in anemia prev- children, and more than five children. Maternal edu- alence comparing the findings from this study to those cation was stratified into five categories: no education, of the 1988 National Nutrition Survey. primary, secondary, high school or equivalent, and completed college education. Employment status was Material and Methods stratified into three categories: paid job, student, and housewife. Maternal literacy was divided into two cat- Sample design and procedures Data for this analysis were obtained from the 1999 16 * North (Baja California, Baja California Sur, Coahuila, Chihuahua, National Nutrition Survey (NNS-1999). A general Durango, Nuevo León, Sonora and Tamaulipas), Center (Aguas- description of the NNS-1999 methods is included else- calientes, Colima, Guanajuato, Jalisco, México (excludes urban- where in this issue. In summary, the NNS-1999 assem- ised counties and localities adjacent
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