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Geneva, Switzerland, WHO, 1992. 100 p.The discussion of the prevalence of anemia in women focused on definitions of nutritional anemia, cause of nutritional anemia, and the sources of data and estimation methods. Tables are provided by country and region for hemoglobin levels (mean and percentage below the mean for lactating women, for pregnant women, for nonpregnant women, and all women) and for serum iron, serum folate, and serum vitamin B12 (mean and percentage below the norm). WHO's Maternal Health and Safe Motherhood Program is the repository for data. Nutritional anemia is caused by malnutrition such that the hemoglobin content of the blood is lower than normal as a result of deficiency in 1 or more essential nutrients. Iron is usually stored in the bone where it can be used to increase the rate of formation of hemoglobin to satisfy increased needs, such as during pregnancy. Causes of anemia are low nutrient intake, poor absorption or utilization, or increased nutrient losses or demands. Iron is absorbed more readily in the presence of animal foods or vitamin C and inhibited by meals of tea or high levels of bran. Other causes are malaria, sickle cell disease, bacterial infections, blood loss from obstetric causes, or intestinal parasites, such as hookworms. Underlying factors are poverty and hardships from poor nutrition, water shortages, food taboos, inadequacies in food production and storage and the absence of effect systems of social security. Anemia can be a direct cause of death or contribute to hemorrhage, which can lead to death, e.g., an anemic mother during childbirth cannot afford to lose less than 150 ml of blood, compared with a healthy mother's 1 liter blood loss. Anemic mothers have a lower resistance to infection, and surgery poses a risk. WHO anemia levels are determined as < 120 g/L of hemoglobin for nonpregnant adult women and < 110 g.L for pregnant adult women, < .50mg/L serum iron, < 3 ng/ml serum folate concentration, and < 100 pg/ml serum vitamin B12. 2,170 million persons were found to be anemic according to WHO definitions. The most affected groups were pregnant women, preschool age children, low birth weight infants, other women, the elderly, school age children, and adult men. In developing countries, prevalence rates are 40-60% among pregnant women. In developed countries, 18% if pregnant women and 12% of nonpregnant women are anemic. Over 33% of women in the world were anemic; the problem is particularly acute in Asia.
Nutritional anemia: its understanding and control with special reference to the work of the World Health Organization.
American Journal of Clinical Nutrition. 1979 Feb; 32(2):368-417.Since 1949, the World Health Organization, recognizing the public health importance of nutritional anemia, has sponsored efforts directed towards its understanding and control. During this period, often as a result of the work of the Organization, advances have been made in many areas. Basic understanding of iron, folate, and vitamin B12 nutrition, and the various factors which may influence the availability and requirements of these factors, has greatly increased. Surveys in a number of countries have highlighted the widespread prevalence of nutritional anemia, particularly in developing countries. The major factor responsible is a deficiency of iron, with folate deficiency also playing a role in some population groups, especially in pregnant women. There is increasing evidence that anemia adversely affects the health of individuals and may have profound socioeconomic consequences. Control of nutritonal anemia is possible by providing the deficient nutrient(s) either as therapeutic supplements or by fortification of commonly used foodstuffs. Some control programs are reviewed and suggestions for further action are outlined. The Organization still has an important role to play in this field, encouraging the development of control programs and providing advice and technical assistance to member countries. (author's)
In: Diczfalusy, E., ed. Regulation of human fertility. (Proceedings of the WHO Symposium on Advances in Fertility Regulation, Moscow, USSR, November 16-19, 1976) Copenhagen, Denmark, Scriptor, 1977. p. 253-282This review of combined oral contraceptive (OC) preparations presents formulations, pregnancy rates, biochemical parameter changes, morbidity, and OC indications in 15 tables. The OC preparations are based on 2 different estrogens and 14 progestagens. Though steroid content differs among products, all act primarily to inhibit ovulation by suppression of midcycle release of pituitary gonadotropins. Variable-dose products are associated with higher pregnancy rates than fixed-dose preparations. Side effects of OCs, while difficult to identify, fall into 2 categories: 1) common adverse associations similar to responses to inert placeboes; and 2) serious biochemical and physiological alterations. There is no evidence of any increase in morbidity due to OC use, whereas avoidance of risks associated with pregnancy is beneficial. No convincing evidence of carcinogenic hazard is presented. Some evidence of reduced systemic side effects by lower-dose products is presented, though gynecological side effects, such as irregular bleeding, may increase. Drug interaction with OCs is described; rifampicin causes the most serious of these. OCs induce wide-ranging metabolic changes in many organ systems. These may relate to undesirable side effects (psychological or neurological signs, skin disorders, and blood pressure changes).
Indian Journal of Medical Research. October 1978; 68(Suppl):80-87.Cross-sectional and longitudinal studies were made to assess vitamin nutritional status of women using oral contraceptives (OCs). In the cross-sectional study, data obtained on 20 women, who had used Ovulen 50 for 6-12 months, were compared with data obtained on matched controls who had never used OCs. In the longitudinal study, 23 women were examined initially (before OC use) and again at 1 or more points during the next 6 months of OC use. Changes were found in several parameters of nutrition tested. 1) OC use produced a highly significant rise in plasma vitamin A within 1 month of treatment. 2) Thiamine activity measurements showed a slight fall, but did not affect the TPP effect, suggesting that OCs did not seriously alter thiamine status. 3) Erythrocyte riboflavin concentration showed a fall, revealing a very high incidence (> 80%) of biochemical riboflavin deficiency in women before starting OCs which was further reduced after treatment. 4) There was a marked rise in urinary excretion of xanthuremic and kynurenic acids after a standard tryptophan load, indicating impaired tryptophan metabolism due to pyridoxine deficiency. 5) Erythrocyte folate levels showed a small but significant fall. These observations on Indian women belonging to low income groups show clearly that OC use does affect the vitamin economy of the body adversely. Biochemical evidence presented argues that OCs alter vitamin economy through rise in levels of some proteins which bind vitamins. Vitamin supplements are recommended not only for patient benefit but for program acceptability.
Washington, D.C., U.S. Government Printing Office, June 1976. (Syncrisis, The Dynamics of Health No. 18) 149 pThere is no sector of Pakistani life which more graphically reflects the great sacrifice it took to make Pakistan a viable state than the health sector. Malaria, tuberculosis, and cholera continue to constitute threats to health. Gastrointestinal, infectious, and other parasitic diseases continue to contribute substantially to morbidity and mortality. These diseases are exacerbated by extremely primitive water supplies and waste disposal, bad housing, nutritional problems, and an increasingly heavy population growth. Public health resources to cope with these conditions have not previously been available. Pakistan's poor helth environment appears to result from widespread infectious and communicable diseases, poverty, and sociocultural attitudes which inhibit improving the environment, and ineffective policies administered by limited numbers of inadequately trained health workers, affecting both the urban poor and the rural population. In the latest 5-year plan, the 5th, 1975-1980, there is increasing attention to health. Regarding family planning, it has been suggested that the government has finally begun to recognize that urgent and dramatic steps are necessary to reduce Pakistan's population growth rate. The government has adopted a policy of using conventional contraceptives as the most acceptable method of contraception in Pakistan. A program of distributing the oral contraceptive without medical or paramedical constraints had been instituted, and the government has undertaken to subsidize the distribution of th oral contraceptive and the condom through some 50,000 outlets at 2.5 cents per monthly supply.