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Introduction:
Anemia is a known
serious health issue among Indians. Survey suggests it is very common
among childhood, adolescent females and pregnant, lactating females in India.
Efforts are taken to exterminate anemia but nothing much has changed in the
numbers from 1993 to 2016. Male population is prejudiously considered to be
devoid of this condition but it is not so.
Aim: The present study was aimed to investigate
the incidence of anemia among 700 apparently healthy looking male industry
workers in 18 and 59years age group.
Results:
Among 700
apparently healthy looking male industry workers 18.71% were mildly anemic,
22.29% were moderately anemic and 7.86% were severely anemic. Incidence of
anemia was about 60% in low and moderate income group. Amid 462 tea/coffee
consumer and habit of chewing or smoking of tobacco 21.55% were severely
anemic, 17.93% were moderately anemic. In a group of 154 alcohol consumers 13%
were severely anemic, 6% displayed moderate anemia.
Conclusion:
Apparently
healthy looking males are equally prone to anemia. Certain occupational
restrains, adapted food practices and succumbed habits make them prone.
Keywords: Anemia, Males, Industrial workers,
Alcoholism, Tobacco consumer, Healthy male
INTRODUCTION
Lethargy, lazy feeling, early fatigue, frequent
fevers, recurring infections, loss of mood to do the task are some of the
factors which affect productive life of an individual. In turn these contribute
to loss of productive man power and a cause to slowdown the economic growth of
a nation as whole. There are multiple factors which may develop such symptoms
in an individual, but when looked in to the root cause of such behavioral
changes, individual’s nutrition can be one of the factors. Iron, a
micronutrient required in milligram quantity, is an important element for the
synthesis of hemoglobin. Hemoglobin is required for the transport of oxygen
which help in oxidation of nutrients and there by the production of energy in
the body. Thus iron can have great impact on efficiency and health of an individual.
When hemoglobin content of blood decreases
than normal it is called Anemia. It may be due to lack of one or more essential
nutrients [1,2]. Anemia is a known serious health issue among Indians. A report
from 2016 survey indicates an average prevalence of 51.0% among females and
57.3% among less than 5 year age children of India [3,4]. ICMR study conducted
in eleven different states of India reveals 84.9% women are anemic during
pregnancy, among them 9.9% have severe anemia [5]. A study conducted by
Nutrition Foundation of India in seven different states of India during
2002-2003 reported 86.0% prevalence among which 9.3% were severely anemic [6].
Two decade study conducted on 9 to 36 month babies in urban slum area by Kapur
et al. [7] presented 64% prevalence with 7.8% severely anemic.
Thus survey suggests anemia is very common in
childhood, adolescent females and adult females in India [8]. Lot of effort are
taken by government organisations (GO) and Non-Government Organisations (NGO)
to bring down the percentage incidence of anemia in female population of India. Even
after extensive nutritional programmes
MATERIALS AND
METHODS
The present study was performed on apparently
healthy looking male industry workers from industrial area around Dharwad
(North West Karnataka) to assess incidence and cause of anemia. Study design
was cross sectional, non-interventional, observational and descriptive type.
The sample size was calculated using formula [11]:
n=[Z2Npq/(N-1)d2
+Z2pq]
where, z=1.96, p=50%, q=(100-50)=50, d=0.05.
Minimum number of sample required for
population study derived by formula was 684. We have included total 700
apparently healthy looking male individuals in our study. The study was
approved by institutional ethics committee. The purpose of study was explained
to each participant and written consent was obtained from each participant who
volunteered for the study. A set of questionnaire having yes/no response type
was distributed among participants. The response was collected within two days
and subjected for Statistical analysis using SPSS ver.2.1. Independent t test
was used for comparison of group values.
Apparently healthy looking male industrial
worker of any cadre in the age group of 18 to 59 years from various factories were
included in the study. Workers were asked to exclude themselves if their age is
less than 18 years and above 60 years, if they have any known blood disorders,
severe organ insufficiency, terminal illness or cases of malaria, dengue,
filariasis or under treatment of medication which can affect hemoglobin level
in blood. Female of all age and obviously males who did not volunteered were
excluded.
Required demographic information was
collected from the questionnaire and some other required relevant information
was collected or verified from HR department of respective factories.
To estimate hemoglobin level 20microlit of
blood was collected on Whatman filter paper by finger prick method as explained
in Dacie and Lewis [12]. Hemoglobin levels were estimated on colorimeter using
cyanmethemoglobinin method. In view of National consultation on control of
nutritional anemia in India, study population was categorised in to following
four groups:
1. Normal
(hemoglobin above 12.0 g/dl)
2. Mild
anemic (hemoglobin level 10.1 to 12.0 g/dl)
3. Moderately
anemic (hemoglobin level 8.0 to 10.0 g/dl)
4. Severely
anemic (hemoglobin less than 8.0 g/dl) [13,14]
RESULTS
In the present study, individual’s age ranged
between 18 and 59 years having mean age 40.8 ± 13.6 years. Average body weight
of participants was 51.7 ± 9.3 kg. Among 700 individuals 65 (9.29%) were bulky
and obese whereas 37 (5.29%) were slim and underweight for their age-group.
The mean hemoglobin level among 700
apparently healthy looking male industrial participants was 11.3 ± 4.8 g/dl.
Among these 700 individuals 342 (48.86%) participants were anemic and 358
(51.14%) were normal. Among anemic, 131 (18.71%) were mildly anemic, 156
(22.29%) were moderately anemic and 55 (7.86%) were severely anemic (Table 1).
Incidence of anemia among apparently healthy looking
males’ industrial workers on comparing with their monthly income
Severe anemia
was highest among low income group (11.06%) and least among middle income group
(5.35%). When compared between three income groups, low and moderate income
group expressed high incidences of anemia about 60% whereas, middle income
group shows low incidence of 35% (Table 2).
Incidence of anemia amid apparently healthy male’s
industrial participants consuming more than 5 cups of tea/coffee per day or
habituated to either chewing or smoking of tobacco
Out of 700
apparently healthy male participants 462 (66%) participants were having habit
of consuming more than 5 cups of tea/coffee per day or having habit of chewing
or smoking of tobacco frequently. Among these 462 subjects 21.55% were severely
anemic, 17.93% were moderately anemic, 15.05% were mildly anemic and only
11.47% were having normal hemoglobin levels (Table 3).
Incidence of anemia among apparently healthy
males who disclosed habit of alcohol consumption
Among 700 participants 154 (22%) apparently
healthy looking male industrial males disclosed the habit of alcohol
consumption. Frequency of alcohol consumption ranged between occasional to
regular drinkers. In the group of 154 alcohol consumers 13% were severely
anemic, 6% displayed moderate anemia, 1% had mild anemia whereas 2% were having
normal hemoglobin level (Table 4).
DISCUSSION
Anemia can be defined as a condition in which
the Hemoglobin (Hb) content of blood is lower than normal due to deficiency of
one or more essential nutrients irrespective of the cause of such deficiencies [1,15].
The problem of anemia is related to wider population than the traditionally
considered groups of the pregnant and lactating females, adolescent girls and growing
age children. Milder form of anemia remains “silent”, i.e., individual does not
exhibit any symptoms whereas moderate to severe form is
associated with symptoms like fatigue, weakness, dizziness and drowsiness. It
may further leads to loss of normal skin color (fair skin), pale lips, tongue
and nail if remains unattended. High incidence of anemia (48.86%) observed in
present study suspects poor dietary habit, consuming stale tiffin food of low
quality with frequent consumption of tea coffee or tobacco. In addition, poor
sanitary habits and low income precipitates the anemic condition.
Nutritional deficiency and parasitic
infestation are common causes of anemia. Among the most common nutritional
factors contributing to anemia is iron deficiency. Diet that is monotonous and
rich in phytates inhibits absorption of dietary iron by the body [16]. Even
overcooking of food which destroys heat labile vitamins, inadequate iron intake
due to lesser consumption of green vegetables and increased tendency to alcohol
addiction are some additional factors responsible for anemia [16]. Excessive
consumption of tannin rich tea, coffee [17] and alcohol decreases
bioavailability of dietary iron. Poor bioavailability of iron is the major
factor responsible for very high prevalence of anemia in the country [2,18].
Hookworm infestation and schistosomiasis also
contribute to anemia. A report from Madhya Pradesh states that approximately 44
million pregnant women have hookworm infestation and 20 million people are
severely infected with schistosomiasis [19,20]. Poor hygiene among industrial
workers may be responsible for observed high frequency of anemia observed in
present study.
A study conducted points out Gutkha, tobacco;
Niswar aggravates anemia and reports prevalence of 56% anemia among rural
Panjabi males [10].
When hemoglobin levels were compared between
smokers and non-smokers, a slight contradictory result reveals the higher
levels of hemoglobin in smokers which mask anemia this may be to increase in
red cell production against tobacco smoke and to compensate altered hemoglobin
[10,21]. Another study concludes smoking hinders iron absorption which may
contribute to iron deficiency anemia [22]. High incidence of anemia found in
low income group indicates poor dietary habits [23]. Frequent use of tobacco
products. Increased frequency of anemia among high income group may point
towards secondary causes like diabetes, cardiac or renal problems which need to
be evaluated [24].
CONCLUSION
Overall impression emerged from present study
specifies that apparently healthy looking males are equally prone to anemia.
Certain occupational restrains, adapted food practices, poor
hygiene and succumbed habits make them more prone. Under social constrains this
condition prolongs and leads to severe disease without making it obvious among
males.
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(2011) Hemoglobin concentrations for the diagnosis of anemia and assessment of
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S (1999) A database on iron deficiency anemia (IDA) in India: Prevalence,
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Rao BS (1978) Iron content, bioavailability and factors affecting iron status
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on iron absorption. Gut 16: 193-200.
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VG, Aggrawal MC, Yadav R, Das SK, Sahare LK (2003) Intestinal parasitic
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G, Desh D, Naveen G (2010) Study of relationship of tobacco smoking with
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Indian J Med Sci 23: 349-357.
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