12.1 INTRODUCT ION

1 1 A microcuvette is a small, transparent laboratory * 141 ANEMIA Kariyeva, A. Magtymova, and A. is a condition characterized by a decrease in the concentration of hemoglobin in theblood. Hemoglobin is necessary for transporting oxygen to tissues and organs in the body. Thereduction in oxygen available to organs and tissues when hemoglobin levels are low is responsiblefor many of the symptoms experienced by anemic people. The consequences of anemia includegeneral body weakness, frequent tiredness, and lowered resistance to disease.

2 Anemia can be aparticularly serious problem for pregnant women, leading to premature delivery and low birthweight. It is of concern in children since anemia is associated with impaired mental and physicaldevelopment. Overall, morbidity and mortality risks increase for individuals suffering from anemia(Sharmanov, 1998).Hemoglobin testing is the primary method of anemia diagnosis. The TDHS 2000 includeddirect measurement of hemoglobin levels in all women 15-49 and their children age 5 and under(born since January 1995). The HemoCue system was used in the TDHS 2000 for hemoglobintesting.

3 This system consists of a battery-operated photometer and a disposable microcuvette,1coated with a dried reagent that serves as the blood-collection device. After obtaining consent fromeach respondent (in the case of children, the consent of the child s mother), a drop of capillaryblood taken from a person s fingertip or heel was drawn into a microcuvette. The blood in themicrocuvette was analyzed using the photometer, which displayed the hemoglobin concentration(Sharmanov, 2000).Medically trained personnel, primarily doctors, assigned to each of the TDHS teamsconducted the testing.

4 The personnel responsible for the testing received extensive classroomtraining and field practice prior to the the fieldwork, each respondent was given the results of the test immediately. Incases in which the hemoglobin reading was below g/dl (grams per deciliter), the respondentwas referred to the local health care facilities for followup. With the permission of the respondent,the Ministry of Health and Medical Industry of Turkmenistan was also advised of the names of theindividuals with a reading below g/dl to help ensure that they would receive is classified as mild, moderate, or severe based on the concentrations of hemoglobinin the blood.

5 Mild anemia corresponds to a level of hemoglobin concentration of g/dlfor pregnant women and children under age 5 and g/dl for nonpregnant women. For allof the tested groups, moderate anemia corresponds to a level of g/dl, while severe anemiacorresponds to a level less than * AnemiaTable Anemia among womenPercentage of women age 15-49 classified as having anemia, by backgroundcharacteristics, Turkmenistan 2000_____ Percentage of women with anemia _____BackgroundSevereModerateMildNumberc haracteristicanemia1anemia2anemia3measur ed_____Age ,534 ,507 ,228 ,028 Residence ,528 ,186 Region Ashgabad ,130 ,606 Lebap ,601.

6 774 Education ,678 ,502 Ethnicity ,051 Total ,714_____1 Hemoglobin level less than 7g/dl2 Hemoglobin level g/dl3 Hemoglobin level g/dl ( g/dl for pregnant women) OF ANEMIA AMONG WOMEN AGE 15-49 Table shows anemia levels among the women 15-49 interviewed in the TDHS every second woman had some degree of anemia. The level of anemia was severe in about1 percent of the women, while 8 percent had a moderate level and 38 percent had mild anemia. Age was associated with anemia levels, with older women being somewhat more likely tobe moderately or severely anemic than younger women.

7 The rate of moderate-to-severe anemia(moderate and severe anemia combined) among women age 35-49 is almost three times as highas among women age * 143 Table Anemia among women by nutritional status, reproductive history,and IUD usePercentage of women age 15-49 years classified as having anemia bynutritional status, reproductive history, and IUD use, Turkmenistan 2000_____ Iron- deficiency anemia _____SevereModerateMildNumberCharacteris ticanemia1anemia2anemia3measured_____Nut ritional status BMI < BMI > history No pregnancies Number of births <2 Number of births >2 Average birth interval <24 months Average birth interval >24 months Use of IUD Currently using Currently not , , , ,036 , , , , ,694_____1 Hemoglobin level less than 7g/dl2 Hemoglobin level g/dl3 Hemoglobin level g/dl ( g/dl for pregnant women)

8 High rates of moderate and severe anemia were found among women living in the Balkanand Dashoguz regions (15 percent and 12 percent, respectively), while only 6 percent of womenin Ashgabad City were diagnosed as having moderate or severe with a higher education are less frequently anemic than women with a primary orsecondary-special education. The rates of moderate and severe anemia are higher among ethnicTurkmen and Uzbek women (10 percent each) than among women of other ethnic groups(7 percent).There are differentials in the anemia rates by nutritional and reproductive healthcharacteristics.

9 Table shows that the prevalence of moderate-to-severe anemia is higher amongwomen with a body mass index (BMI) less than (11 percent) than among women with a higherBMI (9 percent). The prevalence of moderate-to-severe anemia among women with two or morebirths (12 percent) is twice as high as that among women with fewer than two births or nopregnancies (6 and 5 percent, respectively). There is a relatively small association between the birthintervals and the rate of also suggest that IUD use can lead to iron depletion and iron- deficiency also shows that among women who are using intrauterine devices as a method ofcontraception, the prevalence of moderate-to-severe anemia (12 percent) is higher than amongwomen who are not using the IUD (9 percent).

10 According to the TDHS 2000 data, 25 percent ofwomen age 15-49 in Turkmenistan were using an IUD at the time of the survey, , when theywere tested for * AnemiaTable Iron supplementationPercentage of women who were given or bought iron tabletsduring current or last pregnancy and average number of dayswomen took iron tablets during the last pregnancy bybackground characteristics, Turkmenistan 2000_____Iron supplementation for current pregnancy or last birth_____PercentageWeightedwhoAveragenu mberBackgroundtook ironnumberofcharacteristicpillsof dayswomen_____Age 15-19( )( )42 46-49( )( )26 Residence ,052 ,417 Region Ashgabad Education ,715 Ethnicity ,992 Total ,470_____Note: Figures in parentheses are based on 25-49 SUPPLEMENTATION DURINGPREGNANCYS upplementation of iron duringpregnancy is one of the main componentsof the Anemia Control and PreventionStrategy of the UNICEF Area Office forCentral Asian Republics.