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1..-on
deficiency
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Total
population
INTRODUCTION
Health and nutrition are the two things that go hand in hand. Good nutrition is
essential for good health. Imbalance of proper nutrients in food causes
deterioration in health. Imbalance can be both over intake of nutrients i.e. over
nutrition and under intake of nutrients i.e. under nutrition. Over nutrition and obesity
is a major concern in developed countries as it increases the risk for diseases like
diabetes mellitus, cardiovascular disease, hypertension, stroke and various
cancers. 1
On the other hand under nutrition is a major health issue in developing countries.
The World Health Organization (WHO) long back in 1972 considered under
nutrition as the gravest single threat to the world's public health and declared
anemia as one of the top ten serious health problems in the world. 2 In a recent
report (2005) WHO reconfirmed anemia as the most serious global public health
problem 3 and reported that globally 41.8% pregnant females and 30.2 % of
nonpregnant females are anemic. 4
Anemia is a clinical condition characterized by reduction in the number of RBCs or
their Hemoglobin content below the accepted normal range depending upon age
and sex. Hemoglobin cut off levels for determining anemia as per WHO guidelines
are for adolescent girls and women in reproductive age group < 12 gm% and for
pregnant women< 11 gm%. 5
anemia. The factors responsible for nutritional anemia vary in each class. Even in
literate class proper awareness is lacking regarding dietary rich sources of iron and
anemia. In housewives typical Indian culture matters. In most of the Indian families
women are last to eat and least bothered about the quantity and quality of food
they eat. Labourers spend more energy due to their strenuous work and do not
usually take
professionals are mentally and physically strained, give less attention to food due
to time constraints and like adolescents consume more junk foods which can
supply calories but not micronutrients. Bioavailability of iron in pure vegetarian food
is less than non vegetarian food. 13
Generally female child gets second priority in all aspects of nutrition including
balanced diet. Gender bias is highly prevalent in all the castes and all socioeconomical classes across the country. 14 In lower socio-economic class economic
constraints also play an important role. Paradoxically in higher socio-economic
class adolescent girls are very conscious about their body figure, hence do forced
dieting and suffer from nutritional anemia. 15 Earlier mainly cooking was in iron
utensils, while at present the cooking is in microwave, non-stick, stainless steel
and aluminium. Cooking in iron utensil can supply 5-10 mg iron/day. 16
In India prevalence of anemia in different studies is varying from 35.1% to 90.1% in
adolescent girls 171819 and 57.8% to 96.0% in pregnant women. 131920 21 Bentley
ME et al 22 reported that prevalence of anemia was high among all women. Even in
high socio economic class the prevalence of anemia was > 40% and there was not
much difference between rich or poor, fat or thin and urban or rural. While there
are regional differences prevalence rates across the states are remarkably
similar. 23 24
Adolescent girls with nutritional anemia are prone to many health hazards. It
affects growth, concentration, 25 school performance and capacity to perform
physical work. There is decreased immunity and inadequate preparation for
motherhood. Adult females with nutritional anemia suffer from weakness, easy
fatiguability,
reduced
work
capacity, 26
impaired
cognitive
performance,
gives rise to diseases e.g. coronary heart disease, type 2 diabetes and
hypertension in their later life. 38 India was one of the first few countries to start
National Nutritional Anemia prophylaxis program as early as in 1970, yet the
current scenario is not satisfactory. 39 From the prevalence rate of anemia in
pregnant and non pregnant female WHO has put India into category of severe
public health problem group4 (Fig.1, Fig.2). Considering all these facts the present
study was undertaken to assess the health related hazards of nutritional anemia in
Indian females from adolescence to menopause in present times with following
aims and objectives.
Specific objectives :
(1)
(2)
(3)
(4)