Anemia, iron deficiency and iron deficiency anemia among female university students in Khon Kaen Province: relationship to menstruation

Abstract

Anemia is one of the major public health problems in in developing countries. It is believed that the main cause is iron deficiency due to the poor iron intake. Previous studies on the burden of anemia focus mainly in pregnant women and pre-school age children. For female university students who have regular blood loss via menstruation, information about the anemia burden and related factors is limited. In this study, we determined the prevalence of anemia, iron deficiency (ID) and iron deficiency anemia (IDA) among 307 female university students in Khon Kaen province. Related factors including social factors, frequency of meat consumption and amount of blood loss via menstruation were collected by using questionnaires. To diagnose anemia, ID and IDA, blood samples were taken to determine hemoglobin concentration and serum ferritin (SF) level. Genetic factors related to anemia (thalassemia) were determined using a combined test approach; i.e. the mean corpuscular volume (MCV) in combination with the DCIP test. Based on Hb < 12 g/dl, anemia prevalence was 36.8% (95% CI =31.4-42.5). Using SF < 15 ng/ml as cutoff value, 25.4% (95% CI =20.6-30.7) had ID. The prevalence of IDA was 14.7 % (95% CI =10.9-19.1).  Analyzing the risk factors for anemia revealed that factors associated with anemia significantly were ID and thalassemia screening (OR = 3.2, 95% CI = 1.9-5.5 and 6.1, 95% CI = 3.6-10.2). Meat consumption did not show any association to anemia, ID and IDA. However, the menstruation period was associated with ID and IDA significantly. Female students who had menstruation period longer than 5 days were 2 times likely to have ID and IDA (OR = 2.0, 95% CI =1.2-3.5 and 2.1, 95% CI =1.1-4.1), as compared to those who had menstruation within 3-5 days. These findings indicate that ID and IDA among female university students may result from blood loss via menstruation rather than a low intake of meat.