Individual and community factors contributing to anemia among women in rural Baja California, Mexico

Introduction
Anemia is a public health concern among women in rural Baja California, Mexico. The purpose of this study was to identify the individual and community factors contributing to the disproportionately high prevalence of anemia among women in this region.
Methods
A cross-sectional study of 118 women (15–49 years) was performed in a rural colonia (small settlement) in Baja California, Mexico in 2012. Participants completed a survey comprised of demographic, socioeconomic, health, and dietary questions and provided a capillary blood sample. A portable HemoCue was used to measure hemoglobin and diagnose anemia. Anemic participants provided a venous blood sample for laboratory testing to elucidate the etiology of anemia. Anemic participants received vitamin supplements and nutritional counseling. Assessments of six local tiendas (community grocery stores) were performed to ascertain the types of food available for purchase within the community.
Results
Prevalence of anemia was 22% among women; laboratory tests revealed iron deficiency was the primary etiology in 80.8% of anemia cases. Other causes of anemia in women included vitamin B-12 deficiency (11.5%) and combined iron and vitamin B-12 deficiency (7.7%). Women from low SES households and women enrolled in the government assistance program Prospera were significantly more likely to be anemic (OR = 3.48, 95% CI 1.35–8.98 and OR = 2.49, 95% CI 1.02–6.09, respectively). Vitamin supplementation was significantly more common among non-anemic women (OR = 0.12, 95% CI 0.02–0.94). Dietary assessments showed limited consumption of iron absorption enhancing foods such as fruits and vegetables. Assessments of local tiendas revealed at least one type of meat and citrus fruit available for purchase at each store; however, leafy green vegetables were only available for purchase at one store.
Conclusion
All cases of anemia were due to nutritional deficiencies. While vitamin supplementation is a temporary solution, improved individual nutrition knowledge and community access to iron absorption enhancing foods, particularly produce, is needed. Promoting government assistance programs like Prospera and implementing additional programs designed to improve nutrition and health literacy, in conjunction with ensuring access to nutritious foods, might reduce the high prevalence nutritional anemia within the community.

引言
贫血是墨西哥下加利福尼亚州农村女性群体面临的一项公共卫生议题。本研究旨在明确该区域女性贫血患病率畸高的个体与社区层面影响因素。

研究方法
2012年，研究团队于墨西哥下加利福尼亚州某乡村殖民区（小型定居点）开展针对118名15至49岁女性的横断面研究。受试者完成涵盖人口统计学、社会经济地位（Socioeconomic Status, SES）、健康与饮食相关问题的问卷调查，并提供毛细血管血样。研究采用便携式HemoCue血红蛋白仪检测血红蛋白水平以诊断贫血。贫血受试者额外提供静脉血样用于实验室检测，以明确贫血病因。研究团队为贫血受试者提供维生素补充剂与营养咨询服务。此外，研究人员对社区内6家当地tiendas（社区杂货店）开展调研，以明确该社区可购食品的品类。

研究结果
该群体女性贫血患病率为22%；实验室检测显示，80.8%的贫血病例病因是铁缺乏，为首要病因。其余贫血病因包括维生素B12缺乏（11.5%）以及铁与维生素B12联合缺乏（7.7%）。来自低SES家庭的女性、以及参与政府援助计划Prospera的女性，贫血风险显著更高（比值比OR=3.48，95%置信区间CI：1.35~8.98；OR=2.49，95%CI：1.02~6.09）。非贫血女性服用维生素补充剂的比例显著更高（OR=0.12，95%CI：0.02~0.94）。膳食评估结果显示，受试者摄入铁吸收促进食物（如水果与蔬菜）的量不足。社区杂货店调研结果显示，每家门店均至少售卖一种肉类与柑橘类水果，但仅一家门店有售绿叶蔬菜。

研究结论
本研究中所有贫血病例均由营养缺乏导致。尽管维生素补充可作为临时解决方案，但仍需提升个体营养认知水平，并改善社区居民获取铁吸收促进食物（尤其是生鲜农产品）的途径。推广Prospera这类政府援助计划，同时实施旨在提升营养与健康素养的额外项目，并保障居民获取营养食品的渠道，或可降低该社区营养性贫血的高患病率。