Aetiological factors and perception of anaemia in Tunisian women of reproductive age.

OBJECTIVES To identify aetiological factors in anaemia and to explore knowledge, perceptions and attitudes towards anaemia. DESIGN Two cross-sectional surveys and sixteen focus group discussions. SETTING The two regions with the highest prevalence of anaemia in Tunisia, Greater Tunis (GT) and the South West (SW). SUBJECTS Two representative samples of 687 (GT) and 729 (SW) women of reproductive age; 108 women were included in focus group discussions. RESULTS Among anaemic women, 63.4% in the GT region and 80.2% in the SW displayed iron deficiency (ID). Genetic haemoglobinopathies accounted for 10.0% and 3.6% of the cases of anaemia in the two regions, respectively. After adjustment for confounders, the major factors for iron-deficiency anaemia were low dietary Fe intake (OR = 5.0, 95% CI 3.0, 8.4), drinking tea after eating (OR = 3.4, 95% CI 2.0, 5.7) and pica (OR = 2.1, 95% CI 1.1, 3.9). Most of the women related anaemia to the following causes: malnutrition, lack of hygiene, and their heavy workload and responsibilities in the household. Many women connected anaemia with hypotension. Few established a relationship between ID and anaemia. They had confidence in their doctor for treatment, but many complained they were not given sufficient information. Low dietary Fe intake, inappropriate food practices and inadequate perceptions contribute to the aetiology of anaemia in women. CONCLUSIONS These results point out to the need for a strategy combining food fortification, Fe supplementation for pregnant women, nutritional education for the general public and at-risk specific target groups, and training of health professionals.