Why do adult women in Vietnam take iron tablets?

BACKGROUND: Conducting iron supplementation programs has been a major strategy to reduce iron deficiency anemia in pregnancy. However, only a few countries have reported improvements in the anemia rate at a national level. The strategies used for control of nutrition problems need regular review to maintain and improve their effectiveness. The objective of this study was to analyze the factors in compliance with taking iron tablets, where daily doses of iron (60 mg) and folic acid (400 μg) were distributed in rural Vietnamese communes. METHODS: A cross sectional survey was conducted in Nghe An province, Vietnam in January, 2003. The study population was adult women aged less than 35 years who delivered babies between August 1(st )2001 and December 1(st )2002 (n = 205), of which 159 took part in the study. Data for the study were collected from a series of workshops with community leaders, focus group discussions with community members and a questionnaire survey. RESULTS: Improvements in the rate of anemia was not given a high priority as one of the commune's needs, but the participants still made efforts to continue taking iron tablets. Two major factors motivated the participants to continue taking iron tablets; their experience of fewer spells of dizziness (50%), and their concern for the health of their newborn baby (54%). When examining the reasons for taking iron tablets for at least 5–9 months, the most important factor was identified as 'a frequent supply of iron tablets' (OR = 11.93, 95% CI: 4.33–32.85). CONCLUSION: The study found that multiple poor environmental risk factors discouraged women from taking iron tablets continuously. The availability (frequent supply) of iron tablets was the most effective way to help adult women to continue taking iron tablets

Reliable Detection of Paternal SNPs within Deletion Breakpoints for Non-Invasive Prenatal Exclusion of Homozygous α0-Thalassemia in Maternal Plasma

Reliable detection of large deletions from cell-free fetal DNA (cffDNA) in maternal plasma is challenging, especially when both parents have the same deletion owing to a lack of specific markers for fetal genotyping. In order to evaluate the efficacy of a non-invasive prenatal diagnosis (NIPD) test to exclude α-thalassemia major that uses SNPs linked to the normal paternal α-globin allele, we established a novel protocol to reliably detect paternal SNPs within the (−−SEA) breakpoints and performed evaluation of the diagnostic potential of the protocol in a total of 67 pregnancies, in whom plasma samples were collected prior to invasive obstetrics procedures in southern China. A group of nine SNPs identified within the deletion breakpoints were scanned to select the informative SNPs in each of the 67 couples DNA by multiplex PCR based mini-sequencing technique. The paternally inherited SNP allele from cffDNA was detected by allele specific real-time PCR. A protocol for reliable detection of paternal SNPs within the (−−SEA) breakpoints was established and evaluation of the diagnostic potential of the protocol was performed in a total of 67 pregnancies. In 97% of the couples one or more different SNPs within the deletion breakpoint occurred between paternal and maternal alleles. Homozygosity for the (−−SEA) deletion was accurately excluded in 33 out of 67 (49.3%, 95% CI, 25.4–78.6%) pregnancies through the implementation of the protocol. Protocol was completely concordant with the traditional reference methods, except for two cases that exhibited uncertain results due to sample hemolysis. This method could be used as a routine NIPD test to exclude gross fetal deletions in α-thalassemia major, and could further be employed to test for other diseases due to gene deletion

Adjusting plasma ferritin concentrations to remove the effects of subclinical inflammation in the assessment of iron deficiency: a meta-analysis

Background: The World Health Organization recommends serum ferritin concentrations as the best indicator of iron deficiency (ID). Unfortunately, ferritin increases with infections; hence, the prevalence of ID is underestimated. Objective: The objective was to estimate the increase in ferritin in 32 studies of apparently healthy persons by using 2 acute-phase proteins (APPs). C-reactive protein (CRP) and alpha(1)-acid glycoprotein (AGP), individually and in combination, and to calculate factors to remove the influence of inflammation from ferritin concentrations. Design: We estimated the increase in ferritin associated with inflammation (ie, CRP >5 mg/L and/or AGP >1 g/L). The 32 studies comprised infants (5 studies), children (7 studies), men (4 studies), and women (16 studies) (n = 8796 subjects). In 2-group analyses (either CRP or AGP), we compared the ratios of log ferritin with or without inflammation in 30 studies. In addition, in 22 studies, the data allowed a comparison of ratios of log ferritin between 4 subgroups: reference (no elevated APP), incubation (elevated CRP only), early convalescence (both APP and CRP elevated), and late convalescence (elevated AGP only). Results: In the 2-group analysis, inflammation increased ferritin by 49.6% (CRP) or 38.2% (AGP; both P <0.001). Elevated AGP was more common than CRP in young persons than in adults. In the 4-group analysis, ferritin was 30%, 90%, and 36% (all P < 0.001) higher in the incubation, early convalescence, and late convalescence subgroups, respectively, with corresponding correction factors of 0.77, 0.53, and 0.75. Overall, inflammation increased ferritin by approximate to 30% and was associated with a 14% (CI: 7%, 21%) underestimation of ID. Conclusions: Measures of both APP and CRP are needed to estimate the full effect of inflammation and can be used to correct ferritin concentrations. Few differences were observed between age and sex subgroups. Am J Clin Nutr 2010;92:546-55

α-thalassaemia

Alpha-thalassaemia is inherited as an autosomal recessive disorder characterised by a microcytic hypochromic anaemia, and a clinical phenotype varying from almost asymptomatic to a lethal haemolytic anaemia

Micronutrient fortification of food and its impact on woman and child health: A systematic review

Background: Vitamins and minerals are essential for growth and metabolism. The World Health Organization estimates that more than 2 billion people are deficient in key vitamins and minerals. Groups most vulnerable to these micronutrient deficiencies are pregnant and lactating women and young children, given their increased demands. Food fortification is one of the strategies that has been used safely and effectively to prevent vitamin and mineral deficiencies.Methods: A comprehensive search was done to identify all available evidence for the impact of fortification interventions. Studies were included if food was fortified with a single, dual or multiple micronutrients and impact of fortification was analyzed on the health outcomes and relevant biochemical indicators of women and children. We performed a meta-analysis of outcomes using Review Manager Software version 5.1.Results: Our systematic review identified 201 studies that we reviewed for outcomes of relevance. Fortification for children showed significant impacts on increasing serum micronutrient concentrations. Hematologic markers also improved, including hemoglobin concentrations, which showed a significant rise when food was fortified with vitamin A, iron and multiple micronutrients. Fortification with zinc had no significant adverse impact on hemoglobin levels. Multiple micronutrient fortification showed non-significant impacts on height for age, weight for age and weight for height Z-scores, although they showed positive trends. The results for fortification in women showed that calcium and vitamin D fortification had significant impacts in the post-menopausal age group. Iron fortification led to a significant increase in serum ferritin and hemoglobin levels in women of reproductive age and pregnant women. Folate fortification significantly reduced the incidence of congenital abnormalities like neural tube defects without increasing the incidence of twinning. The number of studies pooled for zinc and multiple micronutrients for women were few, though the evidence suggested benefit. There was a dearth of evidence for the impact of fortification strategies on morbidity and mortality outcomes in women and children.Conclusion: Fortification is potentially an effective strategy but evidence from the developing world is scarce. Programs need to assess the direct impact of fortification on morbidity and mortality

Zinc Deficiency in Low and Middle Income Countries: Prevalence and Approaches for Mitigation

This review addresses the prevalence of zinc deficiency in Low and Middle Income Countries (LMICs) and assesses the available strategies for its alleviation. The paucity of national level data on the zinc deficiency in LMICs is partially due to the lack of a reliable biomarker. Zinc deficiency appears to be a public health problem in almost all the LMICs irrespective of the recommended indicators (plasma zinc concentration, dietary zinc adequacy and stunting prevalence) used. Based on plasma/serum zinc concentration (PZC), the most appropriate indicator at present, the prevalence of zinc deficiency in LMICs are of concern. Among the 25 countries for which national PZC data were available, 23 had a zinc deficiency prevalence of >20% for at least one physiological group. Zinc supplementation is largely restricted as an adjunct therapy for diarrhoea management in children, but the best platform and the most effective way of preventive zinc supplementation delivery needs to be determined. Impact assessment for current zinc fortification programmes in LMICs and the effectiveness of zinc supplementation as part of a multi-micronutrient powder is to be ascertained. Dietary diversification, though promising for LMICs, is in nascent stages of development at present. Inclusion of meat and animal products can be an important way to improve zinc status. Programmatic experience with the promotion of home processing techniques to increase absorbable zinc in the diet is lacking. Conventional biofortification techniques are gaining recognition in LMICs, however transgenic biofortification as a strategy remains controversial

The inherited diseases of haemoglobin are an emerging global health burden

Thalasseamia is one of the common genetic disorders. A genetic defect causes reduction of the globin chains leading to chronic haemolytic anaemia from birth. The mainstay of treatment is blood transfusion to maintain adequate levels of the haemoglobin. Secondary iron overload in &beta;-thalassaemia patients is secondary to multiple blood transfusions and increased iron absorption. Excesses iron potentially catalyses free-radicals generation and impairment in cellular function and integrity. Extensive iron-induced injury develops in the heart, liver, pancreas and endocrine system. In regularly transfused patients, in the absence of iron-chelation therapy, death from iron-induced heart failure occurs by the mid-teenage years. Conventional treatment with the parenteral iron chelator desferrioxamine improves mortality but it is too expensive for middle and lowincome countries. Oral iron chelators, such as deferiprone (L1) and deferasirox, appear to be promising, however, they are still too expensive or need special monitoring. Serum ferritin has been used for many years as a guide for chelation therapy. However, recent studies demonstrated that using serum ferritin or liver iron measurements as a monitor of iron-chelation intensive therapy would have been discontinued long before the iron had cleared from the heart. There is evidence of the value of myocardial T2* measurements by MRI for the detection of early cardiac iron overload which cannot be predicted by liver iron or serum ferritin and for the monitoring of iron-chelation therapy. The major problem is the expensiveness of MRI measurement. In conclusion, the problem of iron chelation in low-income countries may be summarized as follows: i) drugs, are not available in every countries that need the medicine, ii) the cost of drugs is too high for most low income countries, iii) there is poor education of doctor, parents/ patients and local government about the benefit of iron chelation, iv) there is need for monitoring of its toxicity and adverse drug reaction. In the TIF conference in Dubai, in 2006, a group of experts had agreed to send a document to the D-G of the WHO with a strong request that all chelators (currently available and those that will be available in the future) be designated essential for the treatment of transfusion dependent anaemias.&nbsp;地中海贫血是一种常见的遗传病。 某种遗传缺陷会引起球蛋白链减少，使患者自出生时就引发慢性溶血性贫血。 主要治疗方法是通过输血将血红蛋白维持在适当水平。 &Beta;型地贫患者再次铁过载不如多次输血和增加铁吸收的效果好。 过量的铁对于自由基生成具有潜在的催化作用，并且对于细胞功能和完整性也有所伤害。 大量输入铁会对心脏、肝脏、胰腺、内分泌系统都造成伤害。 在定时接受输血的患者中，几岁的儿童会因缺乏铁螯合疗法，输入铁而引发的心力衰竭造成死亡。 注射铁螯合剂去铁胺这种常规疗法能降低死亡率，但是对于中低收入国家来说这种疗法价格非常昂贵。 口服螯合剂，例如去铁酮（L1）和口服除铁药等，看似不错，但价格仍然昂贵，有些服药还需特别监测。 一直以来，铁蛋白都用作螯合疗法的引导剂。 然而，近年的研究表明，在去除心脏中的铁之前，利用铁蛋白或肝脏含铁量测量来监控大量使用铁的螯合疗法就中断了。 有证据表明，为了发现无法以肝脏铁或铁蛋白来预测的早期心脏铁过载以及为了监控铁螯合疗法而使用核磁共振成像（MRI）来测定心肌衰竭T2*值。 主要问题是核磁共振成像（MRI）价格昂贵。 总而言之，在低收入国家使用铁螯合疗法可总结如下： 1）并非每个有需要用药的国家都能提供药；2）对大多数低收入国家来说，药的价格都过于昂贵；3）医生、患儿父母、患者、当地政府在铁螯合疗法的优点方面所受教育程度不足；4）需要监控其毒性以及药物不良反应。 在2006年迪拜举行的地中海贫血国际联盟（TIF）大会上，一批专家赞同将资料提交给世界卫生组织（WTO）D-G，并强烈要求所有的螯合剂（目前可找到的以及未来可使用的）都应指定给需依靠输血来维持生命的贫血性疾病的疗法</p