Volume 81, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Iron deficiency anemia is highly prevalent among women living in rural Vietnam. However, the utility and cut-offs of indices for diagnosing iron deficiency anemia in the public health context is ill defined. We assessed the ability of iron indices to predict the hemoglobin response (HBR) to weekly iron-folic acid supplementation (WIFS) in anemic rural Vietnamese women. We compared hemoglobin, serum ferritin, and soluble transferrin receptor in a cohort of 221 non-pregnant women of reproductive age before and after 3 months of WIFS and deworming. At baseline, anemia (Hb < 120 g/L) was present in 81/221 (36.7%) of subjects. After 3 months, anemia prevalence fell to 58/221 (26.2%), and the mean hemoglobin change was +3.5 g/L (95% confidence interval, 0.9, 6.6). A hemoglobin response was observed in 50/75 (66.6%) of anemic women. A ferritin cut-off < 30 ng/mL was a more sensitive predictor of response than ferritin < 15 ng/mL.


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  1. World Health Organization, 2008. Worldwide prevalence of anaemia 1993–2005. Benoist BD, McLean E, Egli I, Cogswell M, eds. WHO Global Database on Anaemia. Geneva: World Health Organization, p. 8.
  2. World Health Organization, 2004. Focusing on Anaemia—Towards an Integrated Approach for Effective Anaemia Control. Geneva: World Health Organization, United Nations Children’s Fund.
  3. Haas JD, Brownlie TT, 2001. Iron deficiency and reduced work capacity: a critical review of the research to determine a causal relationship. J Nutr 131: 676S–688S. [Google Scholar]
  4. Margetts BM, 2007. Weekly Iron and Folic Acid Supplementation for Women of Reproductive Age: Effectiveness and Safety. A Desk Review. Global Consultation on Weekly Iron and Folic Acid Supplementation for Preventing Anaemia in Women of Reproductive Age. Manila: World Health Organization.
  5. DeMaeyer E, Adiels-Tegman M, 1985. The prevalence of anaemia in the world. World Health Stat Q 38: 302–316. [Google Scholar]
  6. Stoltzfus R, 2001. Defining iron-deficiency anemia in public health terms: a time for reflection. J Nutr 131: 565S–567S. [Google Scholar]
  7. World Health Organization, 2009. Weekly Iron–Folic Acid Supplementation (WIFS) in Women of Reproductive Age: Its Role in Promoting Optimal Maternal and Child Health. Position Statement. Geneva: World Health Organization.
  8. WHO/UNICEF/UNU, 2001. Iron Deficiency Anaemia: Assessment, Prevention, and Control. A Guide for Programme Managers. Geneva: World Health Organization.
  9. Thurlow R, Winichagoon P, Green T, Wasantwisut E, Pongcharoen T, Bailey KB, Gibson RS, 2005. Only a small proportion of anemia in northeast Thai schoolchildren is associated with iron deficiency. Am J Clin Nutr 82: 380–387. [Google Scholar]
  10. Beutler E, Hoffbrand AV, Cook JD, 2003. Iron deficiency and overload. Hematology (Am Soc Hematol Educ Program) 40: 61. [Google Scholar]
  11. Zanella A, Gridelli L, Berzuini A, Colotti MT, Mozzi F, Milani S, Sirchia G, 1989. Sensitivity and predictive value of serum ferritin and free erythrocyte protoporphyrin for iron deficiency. J Lab Clin Med 113: 73–78. [Google Scholar]
  12. Mast AE, Blinder MA, Gronowski AM, Chumley C, Scott MG, 1998. Clinical utility of the soluble transferrin receptor and comparison with serum ferritin in several populations. Clin Chem 44: 45–51. [Google Scholar]
  13. WHO/CDC, 2007. Assessing the iron status of populations: including literature reviews: report of a Joint World Health Organization/Centers for Disease Control and Prevention technical consultation on the assessment of iron status at the population level. Geneva: WHO/CDC, pp. 5–9.
  14. Akesson A, Bjellerup P, Vahter M, 1999. Evaluation of kits for measurement of the soluble transferrin receptor. Scand J Clin Lab Invest 59: 77–81. [Google Scholar]
  15. Rees DC, Williams TN, Maitland K, Clegg JB, Weatherall DJ, 1998. Alpha thalassaemia is associated with increased soluble transferrin receptor levels. Br J Haematol 103: 365–369. [Google Scholar]
  16. Punnonen K, Irjala K, Rajamaki A, 1997. Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency. Blood 89: 1052–1057. [Google Scholar]
  17. Van Thuy P, Berger J, Nakanishi Y, Khan NC, Lynch S, Dixon P, 2005. The use of NaFeEDTA-fortified fish sauce is an effective tool for controlling iron deficiency in women of childbearing age in rural Vietnam. J Nutr 135: 2596–2601. [Google Scholar]
  18. Le Hung Q, de Vries PJ, Giao PT, Binh TQ, Nam NV, Kager PA, 2005. Anemia, malaria and hookworm infections in a Vietnamese ethnic minority. Southeast Asian J Trop Med Public Health 36: 816–821. [Google Scholar]
  19. World Health Organization, 2006. WHO Global Database on Anaemia – Viet Nam. Micronutrient Deficiency Information System. Geneva: World Health Organization.
  20. Pasricha SR, Caruana SR, Phuc TQ, Casey GJ, Jolley D, Kingsland S, Tien NT, Macgregor L, Montresor A, Biggs BA, 2008. Anemia, iron deficiency, meat consumption, and hookworm infection in women of reproductive age in northwest Vietnam. Am J Trop Med Hyg 78: 375–381. [Google Scholar]
  21. Bureau of Statistics, 2006. Statistics Handbook for Yen Bai Province 2005. Hanoi, Vietnam: Bureau of Statistics.
  22. Weiss G, Goodnough LT, 2005. Anemia of chronic disease. N Engl J Med 352: 1011–1023. [Google Scholar]
  23. Suominen P, Punnonen K, Rajamaki A, Irjala K, 1998. Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical iron deficits. Blood 92: 2934. [Google Scholar]
  24. Hallberg L, Bengtsson C, Lapidus L, Lindstedt G, Lundberg PA, Hulten L, 1993. Screening for iron deficiency: an analysis based on bone-marrow examinations and serum ferritin determinations in a population sample of women. Br J Haematol 85: 787–798. [Google Scholar]
  25. Andrews NC, 2008. Forging a field: the golden age of iron biology. Blood 112: 219–230. [Google Scholar]
  26. Le TH, Pissard S, Pham HV, Lacombe C, Truong DH, Goossens M, Truong DK, 2001. Molecular analysis of beta-thalassemia in South Vietnam. Hemoglobin 25: 305–309. [Google Scholar]
  27. Nguyen P, Boskovic R, Yazdani P, Kapur B, Vandenberghe H, Koren G, 2008. Comparing folic acid pharmacokinetics among women of childbearing age: single dose ingestion of 1.1 versus 5 MG folic acid. Can J Clin Pharmacol 15: e314–e322. [Google Scholar]
  28. Kirkwood BR, Sterne JA, 2003. Essential Medical Statistics. Oxford: Blackwell Science.
  29. Akobeng AK, 2007. Understanding diagnostic tests 3: receiver operating characteristic curves. Acta Paediatr 96: 644–647. [Google Scholar]
  30. Garby L, Irnell L, Werner I, 1969. Iron deficiency in women of fertile age in a swedish community. III: Estimate of prevalence based on response to iron supplementation. Acta Med Scand 185: 113–117. [Google Scholar]
  31. World Health Organization, 2006. WHO Global Database on Anaemia—Vietnam. Vitamin and Mineral Nutrition Information System. Geneva: World Health Organization.

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  • Received : 26 Mar 2009
  • Accepted : 27 Aug 2009

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