Browsing by Author "Ekstrom, Eva-Charlotte"

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Anaemia among non-pregnant women in rural Bangladesh
(Public Health Nutrition, 2000) Ekstrom, Eva-Charlotte; Hyder, SM Ziauddin; Persson, Lars-Ake; Chowdhury, A.M..R.
Anaemia among non-pregnant women in rural Bangladesh
(2001-02) Hyder, S.M. Ziauddin; Persson, Lars-Ake; Chowdhury, A.M.R.; Ekstrom, Eva-Charlotte
Anaemia and iron deficiency during pregnancy in rural Bangladesh
(Public Health Nutrition, 2004) Chowdhury, Mushtaque; Hyder, SM Ziauddin; Persson, Lars-Ake; Lonnerdal, Bo; Ekstrom, Eva-Charlotte
Anemia and iron deficiency during pregnancy in rural Bangladesh
(BRAC Research and Evaluation Division (RED), 2000) Hyder, S.M. Ziauddin; Persson, Lars-Ake; Chowdhury, AMR; Lonnerdal, B; Ekstrom, Eva-Charlotte
Objective: To assess the prevalence of anemia, iron deficiency and iron deficiency anemia (IDA) among pregnant women in rural Bangladesh Design: Baseline data on 215 pregnant women who were invited to participate in an iron supplementation trial were used. The women were in their second trimester and selected at registration from 50 antenatal care centers. Hemoglobin (Hb) concentration of venous blood samples was measured by HemoCue® system. Serum was collected for \ . assessment of ferritin by imrnuno-radiometric assay and transferrin receptors (sTtR) by immunoassay double sandwich method. , Anemia was defined as having Hb concentration <110 giL, iron deficiency as serum ferritin <12 f.Lg/L and/or sTtR >8.5 mg/L and IDA as the combination of anemia and iron deficiency. High sTfR/serum ferritin ration was >500. Setting: The central part of Bangladesh, in a rural area of Mymensingh district between May-November, 1997. Results: Mean (SD) of Hb was 110 giL (14 giL), while median serum ferritin, sTfR and sTfRJserum ferritin was 13.7 f.Lg/L, 6.2 mg!L and 458, respectively. The prevalence of anemia was 50%, iron deficiency 54% and high sTfR/serum ferritin 48%. None of the study women had severe anemia. The ·prevalence of IDA was 33%. Of the anemic women 66% had iron deficiency and 64% high sTfR/serum ferritin. Conclusion: Both anemia and iron deficiency were highly prevalent. About two-thirds of the anemia cases were associated with iron deficiency. Sponsorship: The study was financially supported by Sida/SAREC, Sweden and BRAC, Bangladesh. Descriptors: Anemia, iron deficiency, iron deficiency anemia, serum transferrin receptor, serum ferritin, pregnant women, Bangladesh
Arsenic exposure in pregnancy: a population-based study in Matlab, Bangladesh
(2006) Vahter, Marie E.; Li, Li; Nermell, Barbro; Rahman, Anisur; Arifeen, Shams El; Rahman, Mahfuzar; Persson, Lars Ake; Ekstrom, Eva-Charlotte
Do side-effects reduce compliance to iron supplementation: a study of daily- and weekly-dose regimens in pregnancy
(International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), 2002) Hyder, S.M. Ziauddin; Persson, Lars Ake; Ekstrom, Eva-Charlotte; Chowdhury, A.M..R.
Side-effects of iron supplementation lead to poor compliance. A weekly-dose schedule of iron supplementation rather than a daily-dose regimen has been suggested to produce fewer side-effects, thereby achieving a higher compliance. This study compared side-effects of iron supplementation and their impact on compliance among pregnant women in Bangladesh. These women were assigned to receive either weekly doses of 2x60 mg iron (one tablet each Friday morning and evening) or a daily dose of I x60 mg iron. Fifty antenatal care centres were randomly assigned to prescribe either a weekly- or a daily-supplementation regimen (86 women in each group). Side-effects were assessed by recall after one month of supplementation and used for predicting compliance in the second and third months of supplementation. Compliance was monitored using a pill bottle equipped with an electronic counting device that recorded date and time whenever the pill bottle was opened. Of five gastrointestinal side-effects (heartburn, nausea, vomiting, diarrhoea, or constipation) assessed, vomiting occurred more frequently in the weekly group (21 %) than in the daily group (11 %. p<0.05). Compliance (ratio between observed and recommended tablet intake) was significantly higher in the weekly supplementation regimen (93%) than in the daily-supplementation regimen (61 %, p<0.05). Overall, gastrointestinal side-effects were not significantly associated with compliance. However. the presence of nausea and/or vomiting reduced compliance in both regimens, but only among women from the lower socioeconomic group. In conclusion, weekly supplementation of iron in pregnancy had a higher compliance compared to daily supplementation of iron despite a higher frequency of sideeffects. The findings support the view that gastrointestinal side-effects generally have a limited influence on compliance, at least in the dose ranges studied. Efforts to further reduce side-effects of iron supplementation may not be a successful strategy for improving compliance and effectiveness of antenatal iron supplementation.
Effectiveness of the daily and weekly doses of iron supplementation in pregnancy and puerperium on Haemoglobin and iron status at 6 weeks postpartum
(BRAC Research and Evaluation Division (RED), 2000) Hyder, S.M. Ziauddin; Persson, Lars-Ake; Chowdhury, AMR; Lonnerdal, B; Ekstrom, Eva-Charlotte
Objective: Describe the effectiveness of continuous daily and weekly doses of iron supplementation during pregnancy and puerperium on haemoglobin and iron status at 6 weeks postpartum. Design: An iron supplementation trial conducted at antenatal care centre (ANCC) assigned randornly_·either to the daily (lx60-mg) or weekly (2x60-mg) doses of iron supplementation. Setting: Fifty community-based ANCCs in a rural area of Bangladesh. Subjects: In the trial, 209 pregnant women during second trimester were recruited. Fifty-one were lost to follow-up and the final sample size consisted of 158 women (daily n=72 and weekly n=86). Intervention: Each woman in the daily group received I tablet (60 mg Fe) per day and in the weekly group 2 tablets (120 mg Fe) per week. Intake of iron tablets was monitored by the MEMS~ during 11 weeks in ~pregnancy. Haemoglobin was assessed on venous blood by HemoCue~, serum concentrations of ferritin by radio immunoassay and serum transferrin receptors by immunoassay double sandwich method. Results: At 6 weeks postpartum, haemoglobin and iron status did not differ between the two supplementation groups. However, an overall improvement in haemoglobin and iron status was observed compared to the baseline status. Women who took 2:40 tablets in 11 weeks had higher haemoglobin (P=0 .05) and SFt (P=0.04) and lower sTfR (P=0.32) at 6 weeks postpartum. Conclusions: A lack of difference in response was observed between the daily and weekly doses of iron supplementation. Higher number of iron tablet intake during pregnancy and puerperium was associated with better haemoglobin and iron status at 6 weeks postpartum. Sponsorship: SIDA/SAREC, Sweden and BRAC, Bangladesh. Descriptors: Anaemia, iron deficiency, daily weekly supplementation. postpartum, Bangladesh
Efficacy and trial effectiveness of weekly and daily iron supplementation among pregnant women in rural Bangladesh: disentangling the issues
(2002) Ekstrom, Eva-Charlotte; Hyder, S.M. Ziauddin; Chowdhury, A. Mushtaque R.; Chowdhury, Sadia A.; Lonnerdal, Bo; Habicht, Jean-Pierre; Persson, Lars Ake
Efficacy and trial effectiveness of weekly and daily iron supplementation among pregnant women in rural Bangladesh: disentangling the issues
(The American Journal of Clinical Nutrition, 2002) Ekstrom, Eva-Charlotte; Hyder, S.M. Ziauddin; Chowdhury, AMR; Chowdhury, Sadia A.; Lonnerdal, Bo; Habicht, Jean-Pierre; Persson, Lars Ake
BACKGROUND: According to our current understanding, iron absorption with weekly iron supplements is not higher than that with daily supplements (ie, there is no mucosal block). However, community-based trials have repeatedly shown that a weekly regimen is as effective as a daily one. Furthermore, when differences in absorption are found, they are commonly smaller than would be expected on the basis of differences in the amount of iron provided. The possibility of differential compliance between the regimens needs to be evaluated to explain these findings. OBJECTIVE: Taking compliance into account, we compared the efficacy and trial effectiveness of weekly and daily iron supplementation during pregnancy. DESIGN: In Bangladesh, 50 antenatal centers were randomly assigned to prescribe either 2 doses of 60 mg Fe once weekly or 1 dose of 60 mg Fe/d. Compliance was monitored by using a pill bottle equipped with an electronic counting device. Hemoglobin concentrations were measured at baseline and after 4, 8, and 12 wk of supplementation. RESULTS: There was no differential effect per iron tablet between weekly and daily regimens. A 12-wk daily regimen (68% compliance) produced a small but significantly greater hemoglobin response than did the weekly regimen (104% compliance). The first 20 tablets consumed produced most of the effect; after 40 tablets, there was no further response. CONCLUSIONS: There was no evidence of a mucosal block in the daily regimen. Over 12 wk, 50% of the amount of iron in a daily regimen was sufficient for maximum hemoglobin effect. The weekly regimen provided a large part of this amount, explaining the limited difference in effect. It appears that the current international recommendation for iron supplementation in pregnancy is higher than necessary.
Impact of daily and weekly Iron supplementation to women and iron status six weeks postpartum
(Scandinavian Journal of Nutrition, 2002) Hyder, S. M. Ziauddin; Persson, Lars-Ake; Lonnerdal, Bo; Ekstrom, Eva-Charlotte
Impact of daily and weekly iron supplementation to women in pregnancy and puerperium on haemoglobin and iron status six weeks postpartum: results from a community-based study in Bangladesh
(2003) Hyder, S. M. Ziauddin; Persson, Lars-Ake; Chowdhury, A. M. R; Lonnerdal, Bo; Ekstrom, Eva-Charlotte
Supplementation for nutritional anemias [book chapter]
(2002) Ekstrom, Eva-Charlotte