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Query: UMLS:C0002871 (anemia)
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Between 1975 and 1983 health care expenditures in Ghana dropped to a low point as a consequence of the structural readjustment program instituted by the World Bank. During 1975-76 only 15% of available funds were spent on primary health care (PHC), which was officially introduced in the late 1970s. PHC made up 20-25% of the health care expenditures by 1991 with about 25% of health personnel engaged in PHC. 2/3 of health care delivery covered urban areas when 60% of the population lived in the countryside. The district of Ejisu-Juaben in the Ashanti region had high morbidity. Tetanus, polio, whooping-cough, and diphtheria had been brought under control, but measles, diarrhea, and malnutrition were still widespread among children under 5 years old. Malaria, bilharzia, intestinal parasites, respiratory infections, hepatitis, anemia, hypertension, and vitamin A deficiency were also grave problems. AIDS was on the rise. Child mortality amounted to 130/1000 live births and maternal mortality to 1400/100,000 cases. The medical structure of the district comprises 10 health posts (6 governmental and 4 mission). Only 72 villages and 120,000 people are cared for. Each post has a mobile team. In 1993 a new community-based health care program began funded by Save the Children Netherlands. In 60 villages a village health committee existed but they were substandard. They were either reactivated or new committees were set up. Training activities were also started in prenatal care, delivery, care of malnutrition and diarrhea, hygiene, and sanitation. Two years later safe motherhood indicators had improved; postnatal care increased from 16% to 49%; medical deliveries increased from 27% to 37%; the share of families with contraceptive acceptance increased from 7% to 21%; and tetanus vaccination among mothers was estimated to have increased from 27% to 86%.
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PMID:[Primary health care in Ghana: no pay no cure?]. 750 Oct 68

This study was performed to assess the pregnant women's knowledge and attitudes towards anaemia, its causes, prophylaxis, and treatment and to describe existing problems with interventions for anaemia in antenatal clinics. A total of 310 women were interviewed from three MCH-clinics in suburban Dar-es-Salaam. Anaemia was considered a major problem by 88% and 75%, respectively in the two peripheral MCH clinics, but by only 44% of attenders in the hospital MCH clinic. Over 85% of interviewees were aware of the causes of and ways of preventing anaemia. The most frequently mentioned cause of anaemia were related to nutrition while intestinal parasites was mentioned by a few women. Only 5% believed that anaemia might not be dangerous for the mother. In all three clinics more than 90% were aware of the advantages of early booking for antenatal care. None of the mothers had received any ferrous supplements during the current pregnancy, and only a minority (38%) in the previous pregnancy though 40% of them said they were informed they had anaemia in the previous pregnancy. Side effects were not reported as a reason for non-compliance. Thus, mothers were aware that anaemia is a health problem in pregnancy. They would accept effective intervention if they were offered them. The irregular and inadequate supply of haematinics to antenatal clinics is a far more important obstacle to the implementation of the anaemia prevention programme than the knowledge and attitudes of the mothers.
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PMID:Anaemia in pregnancy: perceptions of patients in Dar-es-Salaam. 758 43

Most micronutrient deficiencies affect relatively few people in the Caribbean; however, many Caribbean residents are affected by anemia that appears due primarily to a lack of dietary iron. While generally substantial, the prevalences of such anemia have differed a good deal from place to place and study to study, observed rates ranging from 27% to 75% in pregnant women, 19% to 55% in lactating women, and 15% to 80% in young children. Severe anemia, defined by a blood hemoglobin concentration below 8 g/dl, has been found in approximately 6% of the pregnant women and 11% of the preschool children in some Caribbean countries. The principal ways of controlling iron deficiency anemia are through food fortification, control of intestinal parasites, direct oral supplementation, and dietary modification. Progress has been made in iron fortification of wheat flour and wheat products (the principal foodstuffs consumed by the general public in most of the English-speaking Caribbean). Data on control of relevant parasites in the Caribbean (primarily hookworm and to a lesser extent whipworm) are limited. Health services throughout the English-speaking Caribbean have been providing direct iron supplementation for pregnant women, but high levels of anemia during pregnancy still exist because of coverage, monitoring, and compliance problems. All the Caribbean countries also have education programs, which mainly advise pregnant women about iron-rich foods and iron absorption inhibitors and enhancers.
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PMID:Control of iron and other micronutrient deficiencies in the English-speaking Caribbean. 785 44

Often anaemia and other haematological changes are unrelated to primary diseases of the erythron but are secondary to gastrointestinal alterations, such as occult or overt blood loss or defective absorption of essential haemopoietic factors. This overview emphasizes, through the description of different pathological conditions, the fundamental role of the gastrointestinal tract in maintaining a normal haematological balance. This role is jeopardized in diseases related to the liver and to the various sections of the alimentary tract from the oesophagus to the rectum. Of primary importance in inducing haematological changes which may be modified by curing the primary condition are essentially the diseases of the small intestine, following malabsorption of iron, folic acid and vitamin B12, such as conditions associated with small intestine bacterial overgrowth, tropical sprue, gluten sensitive enteropathy whipple's disease and various infections with intestinal parasites. Moreover, the Authors briefly survey the other pathological conditions of the alimentary tract often associated with chronic bleeding. In this context of particular relevance are the screening procedures which may reveal the presence of occult bleeding caused by neoplastic diseases. It is important that the clinician be aware of this possibility and of the underlying physiopathological mechanism of the diseases of the alimentary tract, so that appropriate and timely therapeutic measures may be undertaken.
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PMID:Anaemias and other haematological changes due to disease of the alimentary tract. 821 Jun 28

A total of 14,740 schoolchildren in seven provinces of Shoa Administrative Region in Central Ethiopia were surveyed for the prevalence of goitre, xerophthalmia and anaemia. Haemoglobin and packed cell volume were assessed in 966 children in one province while an in-depth study was conducted on 344 children in the same province and two others. Goitre, xerophthalmia (Bitot's spots) and clinical anaemia were observed in 34.2, 0.91 and 18.6% respectively of the children. Most biochemical variables were within the normal range while those of haemoglobin (Hb), mean corpuscular Hb concentration (MCHC) and urinary I excretion were lower, and mean corpuscular volume, mean corpuscular Hb (MCH), and immunoglobulins G and M were higher. Hb was strongly correlated with retinol, ferritin, MCHC, MCH, packed cell volume and erythrocyte count while retinol formed a triad with transthyretin (TTR) and retinol-binding protein (RBP) which were all correlated with one another. Total and free thyroxin and total and free triiodothyronine were positively correlated as were the concentrations of the total and free hormones. Thyrotropin (TSH) was negatively correlated with total and free thyroxin and positively correlated with free triiodothyronine. Thyroxin and triiodothyronine in both free and combined forms were all correlated with thyroxin-binding globulin which in turn was negatively correlated with the triad retinol, RBP and TTR. The triad was also negatively correlated with C-reactive protein. Urinary I excretion was positively associated with total thyroxin and negatively associated with TSH. The anaemia found was not nutritional in origin but due to the effect of infestation with intestinal parasites and malaria.
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PMID:Interrelationship between vitamin A, iodine and iron status in schoolchildren in Shoa Region, central Ethiopia. 826 Apr 84

The health profile of two groups of Ethiopian immigrants in Israel was evaluated. Trichophytosis and active trachoma were observed in 5%-8.7% of prepubertal children. Among adults 13% had corneal opacities and 10.4% had cataracts. Goiter, spastic bronchitis, valvular heart disease, leprosy and onchocerciasis were prevalent. Malnutrition was common, with average body weights ranging from 72.4% to 85.2% of normal. Anemia was observed in 6.3% of young children and 70% of all immigrants. Fifty percent of children over 12 years and 98% of adults over 40 years of age had been exposed to hepatitis B virus; 9.8%-11.8% were HBsAg carriers. Tuberculin tests were positive in 9.8%-13%; and intestinal parasites were identified in 86%-98%. Hospitalization was required for 15.7% of immigrants arriving during the period 1978-90, and for 3.7% of those arriving in mid-1991 (Operation Solomon).
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PMID:Health profile of Ethiopian immigrants in Israel: an overview. 834 45

Anaemia is a very common condition during pregnancy. This is particularly so in developing countries where the level of intake of iron rich foods is low; malaria and other intestinal parasites are common. This study was conducted to determine the prevalence of anaemia and the type of anaemia existing in pregnant women in Morogoro municipality. The effect of anaemia on infant birth weight was also examined. Twenty randomly selected pregnant women in their last trimester of pregnancy were studied. The subjects were recruited from the three maternal and child health clinics in the municipality. The subjects were not taking iron, folate or vitamin B12 supplements at the time of the study. Blood samples were collected from subjects during their routine visit to maternal and child health clinics. A series of determinations was conducted to determine haemoglobin concentration (Hb); packed cell volume (PCV); red blood cells count (RBC); serum iron (SI); and total iron binding capacity (TIBC). The effect of anaemia on the weight of new born babies was examined by calculating the correlation coefficient of birth weight and haematological indexes. The mean values (SD) of haematological indexes were as follows: Hb 8.7 +/- 1.5 g/dl; PCV 30.4 +/- 5.1%; RBC 2.5 +/- 0.6 x 10(2)/l; mean corpuscular haemoglobin concentration (MCHC) 28.9 +/- 4 g/dl; mean corpuscular volume (MCV) 151.5 +/- 120 fl and mean corpuscular haemoglobin (MCH) 35.2 +/- 7.9 pg. The results have shown that 95% of the subjects were anaemic at the time of the study. All subjects were suffering from iron, folate and vitamin B 12 deficiencies. This suggests that all subjects had a combination of microcytic and megaloblastic anaemia. The results have also shown that there was a positive correlation (r = 0.76; P = 0.01) between Hb concentration and weight of the infants at birth. Subjects who had Hb concentration of below 7.4 g/dl delivered infants that were weighing below 2500 g (mean birth weight of 2160 +/- 228 g). For those who had an Hb concentration of above 9.5 g/dl delivered infants weighing more than 3000 g (mean 3142 +/- 329 g). The mean birth weight of the infants born to anaemic subjects (Hb < 7.9 g/dl) was significantly lower compared to that of infants born to non-anaemic subjects. This observation suggests that anaemia had a significant influence on the birth weight of the infant. This could also be an indication of poor food security in general. Major causes of anaemia were identified as being poor dietary intake of iron rich foods and probably poor utilisation due to diseases such as malaria. All women had basic knowledge on anaemia. Most of the information was obtained from maternal and child health clinics (76%), schools (15%) and radio programmes (4%). However, despite their awareness on anaemia, the women were still anaemic. The main reason was lack of economic access to appropriate foods.
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PMID:Prevalence of anaemia in pregnant women during the last trimester. 934 44

Buruli ulcer, caused by Mycobacterium ulcerans, is a chronic ulcerative skin disease, found predominantly in central and west Africa and Australia. A boy of 2.5 years of age from Angola was admitted to our hospital with severe kwashiokor and a large ulcer with undermined edges on the left side of the thorax. Further examination revealed anaemia, hypoproteinaemia, bacterial superinfection of the ulcer and intestinal parasites. Histological analysis showed acid-fast bacilli and histopathological changes typical of Buruli ulcer. M. ulcerans was detected by PCR and culture. The patient was treated by surgical excision of diseased skin, followed by split-skin grafting. He also received antibiotic therapy (ciprofloxacin, clarithromycin, rifabutin, and dapsone). After six months, the child was discharged from hospital in good condition. This is the first published case of Buruli ulcer from Angola.
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PMID:Mycobacterium ulcerans infection in a child from Angola: diagnosis by direct detection and culture. 959 57

Anaemia is considered a serious public health problem in Egypt, although updated population-based data are lacking. Similarly, data on prevalence and intensity of infection with intestinal parasites, which are considered one possible cause of anaemia, are available only from small, unrepresentative sample surveys. The present research was implemented on an entire Governorate representative sample. The aim of the study was to assess the prevalence of anaemia and intestinal parasites in the area and to evaluate the role of each parasite in the epidemiology of anaemia among school age children. At the end of the survey, results of faecal analyses from direct smear and the Kato-Katz examination techniques were available from 1844 and 1783 children respectively, as well as haemoglobin levels measured by spectrophotometer from 1238 children aged 6-12 years. The prevalence of anaemia in the area was high (90 per cent), but very few serve forms were detected (< 2 per cent). Prevalence of intestinal parasites was high only for protozoa (Giardia intestinalis 24.7 per cent Entamoeba histolytica 17.5 per cent) and Schistosoma mansoni (20.7 per cent). From analysis of the results, Fasciola infection appeared to be highly endemic, even among children (3 per cent), and emerged as the factor most strongly correlated with low levels of haemoglobin (p < 0.0001). The effect of Fasciola on haemoglobin levels was related to the intensity of infection with this parasite. The role of S. mansoni as a risk factor for anaemia was supported by the present study. Among the protozoa, G. intestinalis was significantly correlated with low haemoglobin levels (p < 0.05). The present results substantiated similar findings from smaller studies. In future research, the relationship between Fasciola infection and anaemia needs to be studied with a well-controlled longitudinal design.
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PMID:Anaemia and intestinal parasitic infections among school age children in Behera Governorate, Egypt. Behera Survey Team. 997 72

In 1996, the Honduran Ministry of Health conducted a national micronutrient survey of children 12-71 months old, which also included an assessment of the nutrition status of their mothers/caretakers. The 1,126 mothers/caretakers who participated in the survey tended to be short and plump. About 15% of them were at obstetric risk by virtue of their short stature and/or low body weight. About 9% had chronic energy deficiency (CED), but 27% were at least 20% overweight. CED was associated with socioeconomic indicators of poverty. Risk factors for being at least 20% overweight included being over 30 years old, not breast-feeding, having attended no higher than grade 4, 5, or 6 of primary school, coming from a wealthier household, and living in San Pedro Sula or medium-sized cities. Among the women surveyed, 26% of nonpregnant and 32% of pregnant mothers/caretakers were anemic. The likely principal cause of anemia was the low intake of bioavailable iron from food and, in some cases, excessive iron loss associated with intestinal parasites, especially hookworm. Only 50% of the mothers/caretakers participating in this study had received iron during their last pregnancy, and just 13% had received postpartum vitamin A. The results highlight the need to develop and implement an effective program to control iron deficiency anemia in women of reproductive age, including by fortifying such widely consumed foods as processed wheat and maize flour and by routinely administering iron supplements to high-risk groups. Postpartum vitamin A supplementation should be encouraged to protect both the mother and newborn infant against vitamin A deficiency.
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PMID:Nutrition of Honduran mothers/caretakers. 1035 14


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