ABSTRACT
Objectives:
To determine the prevalence of anemia in female patients and its association with age, nutritional status, body mass index, number of children, intra-oral and extra-oral clinical finding
Materials and Methods:
A total of 1000 participants in various age groups were taken as sample, and a pro forma was used to collect data. Hemoglobin was recorded using Sahli’s method and categorized according to WHO. Statistical relation between anemia and age, nutritional status, BMI, marital status, intra-oral signs, and extra-oral signs was recorded.
Results:
A total of 485 out of 1000 patients in total had hemoglobin less than 12 gm%, 247 patients in the age group of 14–30 years, 188 patients in age group of 31–50 years, and 50 patients above 51 years had hemoglobin below 12 gm%; 188 vegetarian patients and 300 in the mixed category had hemoglobin below 12 gm%; 285 patients with BMI less than 18 were anemic; 270 patients without any intra-oral signs, 70 patients with bald tongue, 69 patients with cheilitis, 76 with both bald tongue and cheilitis were anemic; and 140 patients without any extra oral signs and 345 with pallor were anemic
Conclusion:
The study concluded that these could be a risk factor for anemia in women, and there is a need to develop strategies for health education.
KEYWORDS: Anemia, females, hemoglobin, hospital based, prevalence, study
INTRODUCTION
Anemia is a state of decrease in total number of red blood cells to meet one’s physiologic needs. These physiologic needs vary with age, gender, high altitudes, smoking, behavior, and different stages of pregnancy.[1] One-third of the world’s population suffers from anemia, mostly due to iron deficiency as per the estimation of WHO.[2] The prevalence of anemia is higher in India in comparison to other developing countries.
Therefore, the following study was carried out with the aim to investigate the prevalence of anemia in female patients reporting to the Department of Oral and Maxillofacial Surgery at Army College of Dental Sciences and compare it with various parameters like age, BMI, nutrition, intra-oral and extra-oral findings.
MATERIALS AND METHODS
Sample size
The study included 1000 female patients who visited the Department of Oral and Maxillofacial Surgery at Army College Of Dental Sciences, Secunderabad, from May 2018 to Sept 2018.
Inclusion criteria
Females of age 14 years and above were included in the study. Lactating mothers were also included.
Exclusion criteria
Females of age is below 14 years. Pregnant females were not included in the study. Male patients were not included.
Ethical clearance was obtained from the Institutional Ethical Clearance Committee of Army College of Dental Sciences, Secunderabad.
Methodology
It is an epidemiological cross-sectional study carried out in female patients, above the age of 14 years. The population was selected using simple random sampling technique. All subjects were fully ambulatory. All the participants were explained about the study, and an informed written consent was obtained for the same.
A standardized medical questionnaire was filled after the patient was seated in the dental chair. The self-reported age of the women was categorized into the following age groups: 14–30 yrs/31–50 yrs/Above 50 yrs. Individual’s weight and height were recorded using digital weighing machine and height measuring scale. BMI was calculated using the formula (weight (kg)/[height (m)]2). Patient’s diet history was asked and categorized as: Vegetarian/Mixed. Intra-oral signs were categorized into: no sign/bald tongue/cheilitis/both. Extra-oral signs were categorized into: no sign/pallor present.
After filling the questionnaire and before performing the extraction, blood samples for Hb test were collected through venipuncture and hemoglobin percentage was recorded using Sahli’s method.
WHO guidelines[1] were used for interpretation of anemia. We categorized our patients into two categories, i.e. females with hemoglobin values below and above 12 gm/dl.
Hemoglobin was assessed for the following variables:
Age
Diet
BMI
Intra-oral signs
Extra-oral signs
Data analysis
Results were analyzed using SPSSS 19 software of windows. Chi-square test (χ2) was used to assess the frequency distribution and the relationship between independent variables and anemia status. A variable with a P value < 0.05 in the multivariate analysis was considered statistically significant.
RESULTS
The present study was conducted in 1000 female patients in the age group of 14 years and above. Out of 1000 females, the hemoglobin value obtained was less than 12 gm% in 485 patients and more than 12 gm% in 515 patients [Table 1].
Table 1.
Haemoglobin percentage frequency in study sample
| Variable | Categories | Frequency | Percentage |
|---|---|---|---|
| Hb% | <10 | 485 | 48.5 |
| >10 | 515 | 51.5 |
The study population was divided in three groups according to the age. Among 14–30 years were 544 patients, in 31–50 years were 338 patients, and above 51 years were 118 patients. Correlation of age and Hb was carried out which revealed that in 247 patients in first group, 188 patients in the second group, and 118 in the third group, the value of Hb was obtained below 12 gm% [Table 2].
Table 2.
Association of Haemoglobin percentage with various age groups
| Variable | Categories | Frequency | Percentage |
|---|---|---|---|
| Age groups | 14–30 | 544 | 54.4 |
| 30–50 | 338 | 33.8 | |
| 51 and above | 118 | 11.8 |
Correlation with nutrition showed that in the study group comprising 434 were vegetarians, Hb was less than 12 gm% in 185 patients. In mixed category, 300 patients had Hb less than 12 gm%.
When BMI was considered <18 was found in 559 patients, of which 285 patients Hb was less than 12 gm%, 333 patients had BMI in between 18 and 24 of which 161 had Hb less than 12 gm% and in the remaining patients 39 had Hb less than 12 gm%.
When intra-oral clinical features were evaluated, 743 patients had no intra-oral signs of which in 270 patients Hb was below 12 gm%, 90 patients had bald tongue in which 70 patients’ Hb was obtained below 12 gm%. In 80 patients, cheilitis was present of which 69 of them had Hb less than 12 gm%.
Lastly, on evaluation of extra-oral clinical features, 528 patients presented with no signs, of which 140 of them, Hb was less than 12 gm%, and 472 patients presented with pallor in whom Hb was found to be less than 12 gm% in 345 patients.
DISCUSSION
Anemia is a condition characterized by a decrease in the concentration of hemoglobin in the blood. Despite the growth in the economy and the preventive measures available, anemia remains prevalent in India and is the largest cause of countrywide disorder. The etiology of anemia in India is multifactorial and population-specific.
Although iron deficiency anemia can occur at all stages of the life, it is more predominant in younger children and adolescents due to overall increase in the iron requirement related to rapid growth spurt during this age.[3] It is common in adolescent females due to physiological losses. In our study, significant association was found between the age and anemia. Female patients were most affected from 14 years to 30 years, and the reason being menstrual bleeding and nutritional deficiency. This is in contrast to the studies done by Gerardo Alvarez-Uria et al.[4] and Marcel. E. Salive et al.[5] where anemia was present in 10% of women and 11% of men over the age of 65 yrs.
Obesity increases the risk of type 2 diabetes, hypertension, heart disease, stroke, dyslipidemia, osteoarthritis, gynecological problems, sleep apnea, and respiratory problems. Studies conducted by CL Eckhardt et al.[6] showed positive relation of anemia with BMI, whereas study done by Shatha Al-Sharbatti et al.[7] showed no relation with BMI. In addition to the above studies, our observation also coincided with the study done by Shantha et al., although it was not found statistically significant.
Iron is essential for normal functioning of oral epithelial cells. Anemic patients may have burning sensation and numbness of oral mucosa, angular cheilitis, dry mouth, and dysfunction of taste (bald tongue) in comparison to healthy population. In our study, two of these signs, angular cheilitis and atrophic glossitis, were taken into consideration. Zaidan DTF et al.[8] concluded from their study that majority of the population who had angular cheilitis had low levels of hemoglobin. AW Ranasinghe et al.[9] also concluded the same. Our study is in agreement with the above studies showed a strong association between bald tongue and anemia.
CONCLUSION
Increase in the prevalence of anemia among women in India hampers the economic development and productivity of the country. An efficient way of evaluation and detection of anemia relies on a detailed history and physical examination and systematic approach for performing various tests for diagnosis purpose. There is a need to develop better strategies for health education for improvement in the same.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.WHO. Vitamin and Mineral Nutrition Information System. Geneva: World Health Organization; 2011. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. WHO/NMH/NHD/MNM/11.1. [Google Scholar]
- 2.Bentley ME, Griffiths PL. The burden of anemia among women in India. Eur J Clin Nutr. 2003;57:52–60. doi: 10.1038/sj.ejcn.1601504. [DOI] [PubMed] [Google Scholar]
- 3.Mengistu G, Azage M, Gutema H. Iron deficiency anemia among in-school adolescent girls in rural area of Bahir Dar city administration, North West Ethiopia. Anemia 2019. 2019:1097547. doi: 10.1155/2019/1097547. doi: 10.1155/2019/1097547. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Alvarez-Uria G, Naik PK, Midde M, Yalla PS, Pakam R. Prevalence and severity of anaemia stratified by age and gender in rural India. Anemia 2014. 2014:176182. doi: 10.1155/2014/176182. doi: 10.1155/2014/176182. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Salive ME, Cornoni-Huntley J, Guralnik JM, Phillips CL, Wallace RB, Ostfeld AM, et al. Anemia and hemoglobin levels in older persons: Relationship with age, gender, and health status. J Am Geriatr Soc. 1992;40:489–96. doi: 10.1111/j.1532-5415.1992.tb02017.x. [DOI] [PubMed] [Google Scholar]
- 6.Eckhardt CL, Torheim LE, Monterrubio E, Barquera S, Ruel MT. The overlap of overweight and anaemia among women in three countries undergoing the nutrition transition. Eur J Clin Nutr. 2008;62:238–46. doi: 10.1038/sj.ejcn.1602727. [DOI] [PubMed] [Google Scholar]
- 7.Al-Sharbatti SS, Al-Ward NJ, Al-Timimi DJ. Anemia among adolescents. Saudi Med J. 2003;24:189–94. [PubMed] [Google Scholar]
- 8.Zaidan TF. Angular cheilitis and iron deficiency anemia. Mustansiriya Dent J. 2008;5:37–41. [Google Scholar]
- 9.Ranasinghe AW, Warnakulasuriya KA, Tennekoon GE, Seneviratna B. Oral mucosal changes in iron deficiency anemia in a Sri Lankan female population. Oral Surg Oral Med Oral Pathol. 1983;55:29–32. doi: 10.1016/0030-4220(83)90302-x. [DOI] [PubMed] [Google Scholar]