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Anemia, Iron Deficiency, Meat Consumption, and Hookworm Infection in Women of Reproductive Age in Northwest Vietnam

Iron deficiency anemia poses an important public health problem for women of reproductive age living in developing countries. We assessed the prevalence of iron deficiency and anemia and associated risk factors in a community-based sample of women living in a rural province of northwest Vietnam. A cross-sectional survey, comprised of written questionnaires and laboratory analysis of hemoglobin (Hb), ferritin, transferrin receptor, and stool hookworm egg count, was undertaken, and the soluble transferrin receptor/log ferritin index was calculated. Of 349 non-pregnant women, 37.53% were anemic (Hb < 12 g/dL), and 23.10% were iron deficient (ferritin < 15 ng/L). Hookworm infection was present in 78.15% of women, although heavy infection was uncommon (6.29%). Iron deficiency was more prevalent in anemic than non-anemic women (38.21% versus 14.08%, P < 0.001). Consumption of meat at least three times a week was more common in non-anemic women (51.15% versus 66.67%, P = 0.042). Mean ferritin was lower in anemic women (18.99 versus 35.66 ng/mL, P < 0.001). There was no evidence of a difference in prevalence (15.20% versus 17.23%, P = 0.629) or intensity (171.07 versus 129.93 eggs/g, P = 0.412) of hookworm infection between anemic and non-anemic women. Although intensity of hookworm infection and meat consumption were associated with indices of iron deficiency in a multiple regression model, their relationship with hemoglobin was not significant. Anemia, iron deficiency, and hookworm infection were prevalent in this population. Intake of meat was more clearly associated with hemoglobin and iron indices than hookworm. An approach to addressing iron deficiency in this population should emphasize both iron supplementation and deworming.

Received August 19, 2007. Accepted for publication November 25, 2007.

Acknowledgments: The authors thank Luong Ba Phu and his staff at the Malaria Control Program office, Yen Bai, for invaluable assistance with all the provincial aspects of the survey. In addition, we thank the Yen Bai People’s Committee for their ongoing support, the District Preventive Medicine staff, Commune and Village health workers, and the women who participated in the survey. The authors thank Keith Westbury and scientists at SEALS for their efficient processing of samples and Christalla Hajisava for assistance with formatting the manuscript.

^* Address correspondence to Beverley-Ann Biggs, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia. E-mail: babiggs{at}unimelb.edu.au

Authors’ addresses: Sant-Rayn Pasricha, Department of Haematology, The Alfred Hospital, Commercial Road, Prahran Victoria 3181, Australia, Telephone: 61-3-9276-2000, Fax: 61-3-9076-2222, E-mail: santapasricha{at}hotmail.com. Sant-Rayn Pasricha, Sonia R. Caruana, Gerard J. Casey, and Beverley-Ann Biggs, Department of Medicine (RMH/WH), The University of Melbourne, 4th Floor, Clinical Sciences Building, The Royal Melbourne Hospital, Parkville, Victoria 3050, Australia, and Centre of Clinical Research Excellence in Infectious Diseases (CCREID), The Royal Melbourne Hospital, Parkville Victoria 3050, Australia, Telephone: 61-3-8344-6252, Fax: 61-3-9347-1863, E-mail: sonia2rose{at}yahoo.com.au, gcasey{at}unimelb.edu.au, and babiggs{at}unimelb.edu.au. Tran Q. Phuc and Nong T. Tien, National Institute of Malariology, Parasitology and Entomology (NIMPE), 245 Luong The Vinh Street, Hanoi, Vietnam, Telephone: 84-4-8543035, Fax: 84-4-8543015, E-mail: tquangphuc{at}yahoo.com and nongthitien{at}yahoo.com. Damien Jolley and Sally Kingsland, Monash Institute of Health Services Research, Monash University, Clayton Campus, Wellington Road, Clayton, Victoria 3800, Australia, Telephone: 61-3-9905-4000, Fax: 61-39905-4007, E-mail: damien{at}jolley.com.au and sally.kingsland{at}gmail.com. Lachlan MacGregor, Clinical Epidemiology and Health Service Evaluation Unit, The Royal Melbourne Hospital, Royal Park Campus, Park House, Building 22, 34-54 Poplar Road, Parkville, Victoria 3052, Australia, Telephone: 61-3-9342-3040, Fax: 61-3-9342-7060, E-mail: Lachlan.Macgregor{at}mh.org.au. Antonio Montresor, World Health Organization, 63 Tran Hung Dao, Hanoi, Vietnam, Telephone: 84-4-943-3734, Fax: 84-4-943-3740, E-mail: montresora{at}vtn.wpro.who.int.

Reprint requests: Beverley-Ann Biggs, Department of Medicine (RMH/WH), The University of Melbourne, 4th Floor, Clinical Sciences Building, The Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.