Soofi Sajid, Khan Gul Nawaz, Sadiq Kamran, Ariff Shabina, Habib Atif, Kureishy Sumra, Hussain Imtiaz, Umer Muhammad, Suhag Zamir, Rizvi Arjumand, Bhutta Zulfiqar
Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
Global Child Health at the Hospital for Sick Children, Toronto, Canada.
BMJ Open. 2017 Dec 22;7(12):e018007. doi: 10.1136/bmjopen-2017-018007.
To determine the prevalence and possible factors associated with anaemia, and vitamin B and folate deficiencies in women of reproductive age (WRA) in Pakistan.
A secondary analysis was conducted on data collected through the large-scale National Nutrition Survey in Pakistan in 2011. Anaemia was defined as haemoglobin levels <12 g/dL, vitamin B deficiency as serum vitamin B levels of <203 pg/mL (150 pmol/L) and folate deficiency as serum folate levels <4 ng/mL (10 nmol/L).
A total of 11 751 blood samples were collected and analysed. The prevalence of anaemia, vitamin B deficiency and folate deficiency was 50.4%, 52.4% and 50.8%, respectively. After adjustment, the following factors were positively associated with anaemia: living in Sindh province (RR 1.07; 95% CI 1.04 to 1.09) P<0.00, food insecure with moderate hunger (RR 1.03; 95% CI 1.00 to 1.06) P=0.02, four or more pregnancies (RR 1.03; 95% CI 1.01 to 1.05) P<0.00, being underweight (RR 1.03; 95% CI 1.00 to 1.05) P=0.02, being overweight or obese (RR 0.95; 95% CI 0.93 to 0.97) P<0.00 and weekly intake of leafy green vegetables (RR 0.98; 95% CI 0.95 to 1.00) P=0.04. For vitamin B deficiency, a positive association was observed with rural population (RR 0.81; 95% CI 0.66 to 1.00) P=0.04, living in Khyber Pakhtunkhwa province (RR 1.25; 95% CI 1.11 to 1.43) P<0.00 and living in Azad Jammu and Kashmir (RR 1.50; 95% CI 1.08 to 2.08) P=0.01. Folate deficiency was negatively associated with daily and weekly intake of eggs (RR 0.89; 95% CI 0.81 to 0.98) P=0.02 and (RR 0.88; 95% CI 0.78 to 0.99) P=0.03.
In Pakistan, anaemia, and vitamin B and folate deficiencies are a severe public health concern among WRA. Our findings suggest that further research is needed on culturally appropriate short-term and long-term interventions within communities and health facilities to decrease anaemia, and vitamin B and folate deficiencies among Pakistani women.
确定巴基斯坦育龄妇女贫血、维生素B和叶酸缺乏症的患病率及其相关因素。
对2011年巴基斯坦大规模全国营养调查收集的数据进行二次分析。贫血定义为血红蛋白水平<12 g/dL，维生素B缺乏定义为血清维生素B水平<203 pg/mL（150 pmol/L），叶酸缺乏定义为血清叶酸水平<4 ng/mL（10 nmol/L）。
共采集并分析了11751份血样。贫血、维生素B缺乏和叶酸缺乏的患病率分别为50.4%、52.4%和50.8%。调整后，以下因素与贫血呈正相关：生活在信德省（相对风险1.07；95%置信区间1.04至1.09）P<0.00，粮食不安全且有中度饥饿（相对风险1.03；95%置信区间1.00至1.06）P=0.02，怀孕四次或更多次（相对风险1.03；95%置信区间1.01至1.05）P<0.00，体重过轻（相对风险1.03；95%置信区间1.00至1.05）P=0.02，超重或肥胖（相对风险0.95；95%置信区间0.93至0.97）P<0.00以及每周食用绿叶蔬菜（相对风险0.98；95%置信区间0.95至1.00）P=0.04。对于维生素B缺乏症，观察到与农村人口呈正相关（相对风险0.81；95%置信区间0.66至1.00）P=0.04，生活在开伯尔-普赫图赫瓦省（相对风险1.25；95%置信区间1.11至1.43）P<0.00以及生活在自由克什米尔地区（相对风险1.50；95%置信区间1.08至2.08）P=0.01。叶酸缺乏与每日和每周食用鸡蛋呈负相关（相对风险0.89；95%置信区间0.81至0.98）P=0.02和（相对风险0.88；95%置信区间0.78至0.99）P=0.03。
在巴基斯坦，贫血以及维生素B和叶酸缺乏是育龄妇女严重的公共卫生问题。我们的研究结果表明，需要进一步研究在社区和医疗机构内采用适合文化背景的短期和长期干预措施，以降低巴基斯坦女性贫血以及维生素B和叶酸缺乏的情况。
