Epidemiological Analysis of O.P.D. and In Door Anaemic Patients in a Medical College Hospital

 

Azad K. L1., Shukla P.2 and Bansal A.K.3

1Dept. of Pathology, 2Ophthalmology, 3Community Medicine,

Govt. Medical College, Jagdalpur, Bastar 494001.

ABSTRACT:

Research Question: What is the magnitude of problem of anaemia. Objective: To know the problem of anaemia amongst the patients attending in Medical College, Hospital. Study Design: Cross-sectional. Participants: 250 anaemic patients, whose Hb < 12.5gm./dl. Study variables: Hb level, Anaemia, Age and Sex. Statistical Analysis: Test of proportion. Findings: 40 cases (16%) were of paediatric age group. Maximum 20.8% cases were seen in 15 - 24 yrs. age group with females being twice the number of males in this group. Above 45 yrs. males were 50%, more commonly affected than females.

 

KEYWORDS: Pregnant women, Adolescent girls.

 

 

INTRODUCTION:

Anemia a disorder with a patient suffer from tissue hypoxia, as a consequence of low oxygen carrying capacity of the blood. Anemia is functionally best characertized by haemoglobin concentration below normal and polycythaemia by hematocrit above normal. The use of two different erythroid parameters in the characterization of anemia and polycythaemia is based on clinical consideration. The vital processes of delivering oxygen to the tissue consist of three components; the Hb. in RBC, respiration, and circulation. Each of the three can compensate to some degree for deficiency in the other components. Over all prevalence of anaemia is estimated to be about 40 %of the human population .Globally prevalence is 35 % of non pregnant females and 51 % of pregnant females and tend to be higher in non industrialized countries than industrialized nations. In the United States of America in all races, age, socio economic groups, an overall drop from 7.8% in 1975 to 2.9 5in 1985 has been noted. While in developing countries like India the prevalence of anaemia is extremely high.

 

The relative prevalence of mild, moderate and severe anaemia was 13, 57, and 12% respectively in India. Regional variation are seen in anaemia state of Kerala has only 23% incidence in comparison to 62% in many non eastern countries.

 

In view of the above, and as very few reports of clinical study available and in 1957 a study group of World Health Organization (W.H.O.) has expressed the view that in order to get a comprehensive picture of disease more and more studies have to be carried out, Garg Narendra K.(1). This prompted the authors to undertake this study to find out the magnitude of anaemia in various section of the society.

 

MATERIAL AND METHODS:

The term anemia refers to a reduction below normal in the concentration of Hb or red cell in the blood. Any of three measures of concentration (Hb haematocrit or number of red cells) may be used to establish the presence of anemia, but the Hb concentration often preferred. WHO cut of points for diagnosis of anemia (2)

Age and Sex                                                   Venous                                                                         blood/gm./dl.

Adult male                                          -              13

Adult female                                       -              12

Children (6th month to 6th years)         -              11

Child (6th years to 14th years)              -              12

 

This is a prospective study conducted from Jan 2003- Oct. 2004 in Netaji Subhash Chandra Bose Medical College and associated hospital, Jabalpur. A total of 250 cases from both O.P.D. and inpatients, all with Hb < 12.5gm% were selected.

 

Initially all patients coming to haematology laboratory, “Central Lab”, N.S.C.B. Medical College, for CBC by automated cell counter were screened.

 

Those with Hb < 12.5 were selected. A possible patho-physiologic entity was assigned. Now the peripheral smear was screened and a specific etiology (category or cases) was assigned. These were done as follows:

 

Degrees of Anaemia: The degree of anaemia is decided by arbitrary limits. The one suggested by Dutta (3) are:

 

Mild Anaemia

Hb Conce. is 9 – 12 gm/dl

Moderate Anaemia

6 – 9 gm/dl

Severe Anaemia

Hb below 6 gm/dl

However the Indian Council of Medical Research (ICMR) uses four categories of severity of anaemia depending upon the Hb level (4). This is memmorizedc as follows:

 

S. No.

Severity

Hb level (gm. /dl.)

1

Mild

10-10.9

2

Moderate

6-10

3

Severe

< 7

4

Very severe (De-compensated)

< 4

 

A W.H.O. expert proposed that W.H.O. (1968) TRS No. 405 anaemia or deficiency should be considered to exist when haemoglobin is below the following levels: -

Cut of points for the diagnosis of anaemia:

 

Age and Sex                                       Venous Blood                                                                  gm./dl.

Adult Males                                        -              13

Adult Females (Non Pregnant)           -              12

Adult Females (Pregnant)                   -              11

Children 6 months to 6 years              -              11

Children 6 years to 14 years                              -              12

 

A haemoglobin level of 10 to 11 gm./ dl. Has been defined as early anaemia; a level below 10gm./dl on marked anaemia.

 

Based on these, appropriate diagnostic tests mentioned above were advised. Those patients for which these test results are available were assigned specific diagnosis. Now the data obtained from cell counter for these cases with a specific etiologic diagnosis were studied.

 

 

FINDINGS:

In this study 250 cases were studied with 128 female patients and 122 male patients. 40 cases (16%) were of paediatric age group. Maximum 20.8% cases were seen in 15 - 24 yrs. Age group with females being twice the number of males in this group. Above 45 yrs. males were 50%, more commonly affected than females (Table - I).

Table – II Shows that stratification of age and sex group with degree of anaemia showed severe anaemia to be slightly more common in femals. Mild anaemia was also more common in females. In moderate anaemia in both sexes and in all age group were included. Geriatric patient were few and females were poorly represented as seen above.

 

TABLE –I: AGE AND SEX WISE DISTRIBUTION OF THE STUDIED CASES

Age group

(in years)

Sex

Total

M

F

0 - 14

27 (22.13)

13 (10.16)

40 (16.0)

15 - 24

17 (13.93)

35 (27.34)

52 (20.8)

25 - 34

13 (10.66)

25 (19.53)

38 (15.2)

35 - 44

21 (17.21)

27 (21.09)

48 (19.2)

45 - 54

22 (18.03)

07 (05.46)

29 (11.6)

55 - 65

09 (07.37)

13 (10.16)

22 (08.8)

> 65

13 (10.66)

08 (06.25)

21 (08.4)

Total

122 (100.0)

128 (100.0)

250 (100.0)

TABLE –II: STUDY OF DEGREE OF ANAEMIA ACCORDING TO AGE AND SEX

Age group

(in years)

Hb (gm%)

Total

< 6

6 - 9

9 - 12

> 12

M

F

M

F

M

F

M

F

M

F

0 - 14

7

5

14

3

4

5

2

0

27

13

15 - 24

4

8

6

12

7

13

0

2

17

35

25 - 34

2

3

6

5

5

16

0

1

13

25

35 - 44

7

7

4

7

9

13

1

0

21

27

45 - 54

2

0

7

5

13

2

0

0

22

7

55 - 65

1

7

7

2

1

4

0

0

9

13

> 65

2

0

3

1

6

7

2

0

13

8

Total

25

30

47

35

45

60

5

3

122

128

 

 

 

Nutritional Deficiency Anaemia

 

INTERPRETATIONS:

In India the highest prevalence of nutritional anaemia (a condition in which the haemoglobin content of blood is lower than normal as a result of deficiency of one or more essential nutrients, regardless of the cause of such deficiency) in women and children. The prevalence of anaemia is highest among women and young children varying 60 to 70 %. About one half of non pregnant women and young children are estimated to suffer from anaemia. 60 to 80 % of pregnant are anaemic. 20 to 40 % of maternal deaths are attributed to anaemia. By far the most frequent cause of anaemia is iron deficiency and less frequently folate and vitamin B12 deficiency Park, K. (5). Swami, H.M. et. al. (6) in their study in rural area of Chandigarh found that over all prevalence of anaemia was 19.7 % .He further noted that the prevalence is very high (30.2 %)in females in comparision to their counterparts males (8.6 %).Prevalence of anaemia was directly related to literacy status of the individuals . About two third of cases with anaemia were below the age of 30 years.

 

With the latest National Family Health Survey (7) finding the prevalence of anaemia to be 80% in children, 70% in pregnant women and 24% in adult men. Anaemia among children (6-59 months) is highest in Bihar (78%), Madhya Pradesh (74.1%), Uttar Pradesh (73.9%), Haryana (72.3%) Chhattisgarh (71.2%) and Jharkhand (70.3%). pp – 60, Mysore IA 2000. Sahu T. et. al. (16) Stated that 90% of children between 1-2 years of age group found anaemic, of them 57.5%, 27.5% and 5.0% were suffering from mild, moderate and severe anaemia. Prevalence was comparatively low in exclusively breast fed children and those who were weaned properly. He suggested that appropriate weaning with iron rich foods, early recognition of anaemia by MPW (Female) by Hb estimation during booster D.P.T. & O.P.V., regular prophylaxis with Iron Folic Acid with a liquid base and early treatment of infections in children.

 

The fact that the prevalence of anaemia remained practically unchanged in the region for several years suggest that there is a need for the prevention and control of this problem. The present practice of blanket coverage to all pregnant women and children may not be appropriate .In view of seriousness and urgency of the problem, a suitable strategy would be screen the population and identify the groups which are below the cut off level of Hb so that they can be targeted and given special care and attention under the programme. The target population has to be appropriately counseled about the benefits of iron supplementation. Since worm infection is high in the region, deworming should be linked with the IDA prophylaxis programme. Further, instead of building stores of iron only after the women become pregnant, it would be desirable that action for improvement is initiated right at the adolescent girls of iron even before they are married and become pregnant. In the existing situation in the Region, the focus has to be on adolescent girls who constitute the key segment of the population. Inadequate attention is currently being paid to raise the awareness of this group regarding the available health and nutrition services and the need for their utilization. This has to be addressed and suitable means of communication selected for reaching out adolescent girls.

 

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2.       WHO (1968) Tech. Rep. Ser. No. 405.

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4.       ICMR (1990) Recommended Dietary Intakes for Indians, New Delhi.

5.       Park K.: Park’s Text Book of Preventive and Social Medicine; 19th edition M/s Banarsidas Bhanot, 1167, Prem Nagar, Jabalpur, 482001 (India); Nutrition and Health; 482 – 533.

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14.     Bansal A.K. and Chandorkar R.K. (1997) Immunization status of Tribal and Non Tribal Children of Raipur district, Madhya Pradesh; Tribal Health Bulletin (ICMR) Vol. – 3, No.-2; 12-14.

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17.     Bansal A.K. Vijay Kumar K., Tiwari P. et. al.; A study of the epidemiological pattern of sickle cell diseases in Bastar; MCI Platinum Jubilee CME on Sickle Cell Disease 28th September, 2008, GMCJ; pp 14-19.

 

Received on 26.04.2011

Accepted on 17.05.2011     

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Research J. Pharmacology and Pharmacodynamics. 3(3): May –June, 2011, 108-111