Prevalence of Anemia and Correlated Factors in the

Reproductive Age Women in Rural Areas of Tabas

Majid Sadeghian; M.D., Ali Fatourechi; M.D.,
Mohammad Lesanpezeshki; M.D., Elham Ahmadnezhad; Ph.D.

Department of Disaster Public Health, Tehran University of Medical Sciences, Tehran, Iran

Received: December 2012; revised and accepted January 2013

Abstract
Objective: To find out the prevalence and relationship of anemia in reproductive age women in rural area
of Tabas, center of Iran. Iron deficiency anemia is the most common nutritional problem, affecting about
41.8% of pregnant and 30.2% of non-pregnant women worldwide.
Materials and methods: A cross-sectional study was conducted on the random sample of 382
reproductive age women in rural areas of Tabas in March 2010. Independent sample t-test, one way
analysis of variance (ANOVA) and logistic regression were applied for the data analysis.
Results: The obtained data revealed a total response rate of 13.8% for prevalence of anemia, while
14.5% and 5.9% belonged to non-pregnant and pregnant participants, respectively. Low socioeconomic
status (odds ratio 3.35) and high parity index (odds ratio 2.31) were associated with higher prevalence
of anemia.
Conclusion: Although this study was conducted in a rural area of Tabas, where their average incomes
were lower than average income of major cities in Iran, the prevalence of anemia was lower than the
rate reported in previous studies carried out in other locations of Iran, even in high risk (pregnant
women) groups.

Keywords: Anemia, Reproductive Age Women, Iran

Introduction1 preschool age children, young women and old people,

Nutritional anemia is the most common type of but it can occur at all ages and in any region. A high
anemia worldwide, this mainly includes iron, folate demand for iron during pregnancy, lactation, menstrual
and vitamin B12 deficiencies. The most common blood loss and nutritional deficiencies are the most
cause of anemia is the Iron deficiency that in most common causes of iron deficiency in reproductive age
time it is not clear signs and symptoms. With women. Although the diagnosis of IDA is relatively
consider that the most common cause of anemia, simple, it may go undiagnosed for a long time because
measuring the Iron deficiency anemia often counted of its nonspecific clinical signs (4, 5).
as the prevalence of all type of anemia (1-3). According to World Health Organization (WHO),
IDA is a common disorder among infants, the global prevalence of anemia is 24.8%, which
means about 1.62 billion people worldwide. It is
noted that the highest prevalence is in preschool age
Correspondence:
Ali Fatourechi, Department of Disaster Public Health, Tehran
children (47.4%), while the lowest prevalence is in
University of Medical Sciences, Tehran, Iran. men (12.7%). The prevalence rates for pregnant
Email: Ali_ fatourechi@yahoo.com women and non- pregnant women are 41.8% and

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 Sadeghian et al.

30.2%, respectively; however, among different cell counter (system K-1000, TOA medical
population groups, the greatest number of individuals Electronics Co Ltd, Kobe, Japan). Data analysis was
affected by anemia belongs to non-pregnant women, done using the SPSS version 17 (Inc, Chicago, IL,
468.4 million (1, 2). USA). Frequencies, percentage, mean and standard
According to the WHO studies, the prevalence of deviation were applied for the descriptive analysis.
anemia in Iran was 40.5% in pregnant women and Independent sample t-test and one way analysis of
33% in non-pregnant women, considered as a severe variance (ANOVA) was also carried out to compare
health problem for pregnant women, as well as a obtained levels of mean hemoglobin across different
moderate health problem for non-pregnant women categories of the independent variables. The p value
(1). A study by Sheikholeslam et al. (2001) (6) has of 0.05 was taken as the level of significance. The
showed prevalence rates of anemia and IDA are 33% Level of Hb in different categories of anemia was
and 16/6%, respectively, for reproductive age defined as follows: (i) severe anemia < 7 g/dl, (ii)
women in urban and rural areas of Iran; in addition, moderate anemia 7-9.9 g/dl, (ii) mild anemia in
another study by Safavi et al(7) in 2001 has revealed pregnant women 10-10.9 g/dl, and (iv) mild anemia
a prevalence of 21/5% for IDA among Iranian in non-pregnant women 10-11.9 g/dl (1).
pregnant women.
Some previous studies showed a moderate to Results
severe prevalence of anemia for the reproductive age A total of 382 individuals participated in the study,
women in Iran, also these studies have illustrated the out of which 369 were included in the final analysis.
action of the Iranian government about screening and
Socio-demographic information
supportive programs for reproductive age women,
specially pregnant women in order to decrease the The mean age of participants was 32.65 ±8.97 years.
prevalence of anemia. Therefore, the present study About 4.5% of them were illiterate. The mean
was conducted to determine the prevalence of anemia monthly family income was 284.4 ±163.22 US
in reproductive age women in rural area of Tabas, Dollars (US$), while 12.6% of them had less than
center of Iran; in addition, to identify different 100$ of monthly family income. The socio-
potential factors, like socio-cultural, economic, demographic information of participants is
demographic, nutritional, reproductive and other summarized in the Table 1.
correlates of anemia in this region in order to Reproductive information
investigate an appropriate attempt (8). The menarche status of participants was 9.7%
pregnant, 10.8% breastfeeding and 79.5% no-
Materials and methods
pregnant/no-breastfeeding. The mean age of marriage
This was a prevalence study, completed in March was 17.63 ±3.63 years, while 18.8% of them were
2010 by a cross sectional method to evaluate the married under the age of 15. The mean age of first
anemia in reproductive women (18-49 years), living pregnancy was 19.28 ±3.59 years, (Either you may
in rural area of the city of Tabas, located in the center say: 19.28 year (±3.59) OR 19.28 ±3.59 years) while
zone of Iran in Yazd province. Two stage samples 6.4% of them had their first pregnancy under the age
were performed as follows: (i) we chose a village by of 15. The mean number of children was 2.56 ±2.07,
random and cluster sampling methods, then selected while 15% of them had more than five children.
individuals listed in health centers of villages as our Current use of contraception was 59.7% (41.3%
study subjects (ii) sample size was 382 individuals condom, 27.2% tubal ligation, 26.8% OCP and 4.7%
who were called and were informed about the study, IUD). The reproductive information is summarized in
followed by obtaining a verbal consent from all the Table 2.
participants. The study used modified DHS
Demographic Health Survey questionnaire to collect Anemia prevalence
information of participants about the different The prevalence of anemia among participants was
variables, like economic, socio-demographic, 13.8%. Their different levels of HB were as follows:
pregnancy history, breastfeeding history, family 11.5% with mild anemia, 2.3% with moderate, and no
history, contraception, residency, and literacy. Blood one with severe anemia. The prevalence of anemia
samples were also used to determine the hemoglobin among non-pregnant and pregnant participants were
and levels of Mean Corpuscular Volume (MCV) by 14.5% and 5.9%, respectively. The mean hemoglobin

140 Vol. 7, No. 3, September 2013 jfrh.tums.ac.ir Journal of Family and Reproductive Health 
 Anemia in the Reproductive Age Women

Table 1: Socio-demographic information of the level of all participants was 13.07±1.35 g/dl. The
responders highest prevalence of anemia was 30.5% among the
Variables Frequency Percentage (%) age group of 40-44 years, while the lowest
Age in years prevalence, practically zero, was among the age
15-19 5 1.4
20-24 67 18.3 group of 15-19 years. It is interesting to know that
25-29 82 22.3 there was approximately a linear association between
30-34 67 12.5 increases in prevalence of anemia with individuals
35-39 46 12.5 aged from 15 to 44 years.
40-44 39 10.6
45-49 61 16.6 Anemia related factors
Type of residency
Temporary 9 2.5 In the economic status, the lowest mean hemoglobin
Permanent 348 97.5 level of 12.56±1.46 g/dl belonged to the lowest
Literacy economic group, and the highest mean hemoglobin
Illiterate 16 4.5 level of 13.26±1.44 g/dl belonged to the highest
Read and write 35 9.9 economic group. There was a significant correlation
Primary school 141 39.7
Guidance school 114 32.1 between anemia and family income status (p=0.05).
Diploma 41 11.5 Fig 1 shows the level of mean blood hemoglobin
Upper 8 2.3 across different family income categories.
Family Income In the age category, the highest level of mean
<100$ 46 12.6
101-200$ 74 20.3 hemoglobin of 13.29±1.36 g/d was for group of 20-
201-300$ 138 37.9 24 years old, and the lowest level of 12.73 g/dl
301-400$ 51 14 (± 1.55 g/dl) was for group of 40-44 years old. Fig 2
401-500$ 31 8.5 shows the level of mean blood hemoglobin across
>500$ 24 6.6
different age group categories.
The women with more than two pregnancies had
Table 2: Reproductive information of the responders
Variables Frequency Percentage (%)
higher rate of anemia with odds ratio of 2.31 (95%
Age of marriage CI: 1.21-4.41).
10-14 67 18.8 Type of residency, literacy, contraception and age
15-19 205 57.6 of first pregnancy did not reveal any association with
20-24 70 19.7 rate of anemia. Table 3 shows the correlates of
25-29 11 3.1
30-34 2 0.6 anemia.
34-40 1 0.3
Age of first pregnancy Discussion
10-14 20 6.4 The main finding of this study was the mild
15-19 154 49.4
20-24 112 35.9 prevalence of anemia (13.8%) among reproductive
25-29 23 7.4 age women in rural areas of Tabas, center of Iran.
30-34 1 0.3 According to WHO, cut off points for prevalence of
Number of pregnancies mild anemia is 5-19.9%, which considered as mild
0-2 175 47.4
2< 194 52.6 public health significance (1). In 2001, WHO and
Number of children another study by Sheikholeslam et al (6) have
0-2 202 54.7 reported the moderate prevalence of anemia (33%) in
2< 167 45.3 Iran. A study in rural areas of south India has
Current contraception
None 144 40.3
reported the prevalence of 34.83% in reproductive
OCP 51 16 age women (8). This study found the prevalence of
IUD 10 2.8 5.9% among pregnant women in comparison with
Condom 88 24.6 14.5% in non-pregnant women, despite the higher
Tubal ligation 58 16.2 risk of anemia in pregnancy. The pregnant women are
Menarche
No pregnant/No one of the vulnerable groups to the occurrence of
280 79.5 anemia (1). The study by Safavi et al (7) in 2001 has
breast feeding
Pregnant 34 9.7 showed a prevalence of 21.5% in pregnant women in
Breastfeeding 38 10.8 Iran. In the study by WHO, prevalence rates of

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 Sadeghian et al.

Figure 1: Level of mean blood hemoglobin with 95% CI across different family income categories

Figure 2: Level of mean blood hemoglobin level with 95% CI across different age group categories

142 Vol. 7, No. 3, September 2013 jfrh.tums.ac.ir Journal of Family and Reproductive Health 
 Anemia in the Reproductive Age Women

Table 3: Correlates of anemia in Tabas, 2012

Variables Non-anemic Anemic OR (95% CI)
Age in years
15-19 5 0 0
20-24 63 3 0.23 (0.06-0.92)
25-29 72 9 0.62 (0.23-1.69)
30-34 60 6 0.5 (0.16-1.50)
35-39 34 10 1.47 (0.53-4.01)
40-44 28 11 1.96 (0.72-5.33)
45-49 45 9 1
Type of residency
Temporary 7 1 1
Permanent 294 47 1.11 (0.13-9.30)
Literacy
Illiterate 14 2 1
Read and write 27 7 1.81 (0.33-9.92)
Primary school 119 20 1.17 (0.24-5.57)
Guidance school 98 14 1.0 (0.20-4.87)
Diploma 36 3 0.58 (0.08-3.87)
Upper 7 1 1.0 (0.07-13.01)
Family Income
<100$ 34 12 3.35 (0.67-16.58)
101-200$ 62 11 0.52 (0.34-8.28)
201-300$ 122 14 1.09 (0.22-5.18)
301-400$ 44 5 1.08 (0.19-6.06)
401-500$ 23 5 2.65 (0.35-11.87)
>500$ 19 2 1
Age of marriage
10-14 56 11 1
15-19 171 29 0.8 (0.4-1.84)
20-24 61 8 0.66 (0.25-1.77)
25-29 9 1 0.56 (0.06-4.92)
30-34 2 0 0
34-40 1 0 0
Number of pregnancies
0-2 155 15 1
2< 152 34 2.31(1.21-4.41)

anemia for pregnant women are 57.1% in Africa, of the programs applied by Iran’s Ministry of Health,
24.1% in Americas and 44.2% in Eastern which has a long term planning and interventions to
Mediterranean, whereas the prevalence rates of reduce the prevalence of anemia among vulnerable
anemia for non-pregnant women are 47.5% in groups, especially pregnant women. In primary health
African, 17.8% in Americas and 32.4% in Eastern care services all supplements and care are free for all
Mediterranean (1). The prevalence rate of anemia in pregnant women.
our study is lower than the reports by WHO. In our study, being in the lower economic groups
We found a lower frequency and severity of was a predisposing factor to the anemia; also other
anemia among reproductive age women, especially in studies have reported the similar relation (9-11).
pregnant women, indicating that anemia issue is The parity had a clear effect on the prevalence of
changing from a moderate to a mild public health anemia, the women with more than two pregnancies
problem. This reduction might probably be the result had significantly higher rate of anemia. Furthermore,

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 Sadeghian et al.

other studies in Ethiopia (2) and Mexico (12) have anaemia in South Africa in 2000. S Afr Med J
found the same result, while a study in south India (8) 2007;97:741-6.
has reported higher rate of anemia for the parity index 4. Haas J, Brownlie T. Iron deficiency and reduced work
more than four. This might be due to the increase of capacity: a critical review of the research to determine a
women’s nutritional needs during pregnancy, and causal relationship. J Nutr 2001;131:676S-88S.
also shows the importance of contraception 5. Halterman J, Kaczorowski J, Aligne C, Auinger P,
educations, particularly in rural areas. Szilagyi P. Iron deficiency and cognitive achievement
The age group of 40-44 years had the highest among school-aged children and adolescents in the
prevalence of anemia, while the study in the Ethiopia United States. Pediatrics 2001;107:1381-6.
(2) has reported the age group of 25-39 years, as the 6. Sheikholeslam R, Jamshidbeygi E, Salehian P,
highest prevalence. A study in India (13) has assigned Malekafzali H. Prevalence of iron deficiency, anemia
the younger women (<30 years old), but another and iron deficiency anemia in reproductive age
study in south India (8) has considered the age group women(49-15 years) in urban and rural areas of Iran.
of 41-45 years for the highest prevalence. The Teb va Tazkiyeh 2001;47:37-44.
relation of anemia and age was different for various 7. Safavi M, Abdollahi Z, Naghavi M, SadeghianSharif S,
locations. Sadeghzadeh E, Mohammadian S. prevalence of Iron
Our study did not find any relation between Deficiency Anemia among Iranian Pregnant Women,
literacy and anemia; it might be the low ratio of Spring 2001. Iranian Journal of Epidemiology
illiterate women (4.5%) in Tabas. Although some 2006;4:1-10.
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Conclusion 9. Akramipour R, Rahimi Z, Rahimi Z. Prevalence of
Although this study was conducted in a rural area of iron deficiency anemia among adolescent schoolgirls
Tabas, where their average incomes were lower than from Kermanshah, Western Iran. Hematology
average income of major cities in Iran, the prevalence 2008;13:352-5.
of anemia was lower than the rate reported in 10. Massawe S, Urassa E, Nystrom L, Lindmark G.
previous studies carried out in other locations of Iran, Anaemia in women of reproductive age in Dar-es-
even in high risk (pregnant women) groups. Salaam, Tanzania. East Afr Med J 2002;79:461-6
11. Engmann C, Adanu R, Lu TS, Bose C, Lozoff B.
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