Abstract
BackgroundThe negative impact of anemia on work capacity has been studied extensively in male and female workers; however, the simultaneous contributions of confounding variables such as physical activity, as well as other behavioral and sociodemographic characteristics have not been considered. The purpose of this study was to examine cross-sectionally the multivariable correlates of work capacity in non-pregnant women (n = 330) living in rural India.MethodsThe Reduction in Anemia through Normative Innovations (RANI) Project is a norms-based, clustered randomized controlled trial to reduce anemia among women (15–49 years) living in Odisha, India between 2018 and 2021. For the larger trial, 89 clusters of villages were randomized into treatment and control groups on a 1:1 basis. Women (2055/group) living in 15 selected clusters (40–41 villages) were then randomly selected for data collection. The sampling design also randomly-generated a subset (n = 375) of non-pregnant participants who performed a modified Queen’s College Step Test (QCST) and who wore an activity monitor for 3 days. Predicted work capacity (VO2max) was determined using the QCST. Levels (h/day) of daily reclining, sitting, standing, walking (steps/day), and energy expenditure (MET∙h/day) were determined using an ActivPAL accelerometer. Hemoglobin concentrations (g/dL) were determined using a HemoCue photometer. Predetermined hierarchical (non-multilevel) regression models tested the independent associations between the primary study variables of interest (physical activity, hemoglobin concentrations) and predicted VO2max, while adjusting for age, body mass index (BMI: kg/m2), education, parity, and dietary diversity score.ResultsApproximately 61% of the participants had anemia (Hb < 12 g/dL). Age2 (β = − 0.01; 95% CI: − 0.01, 0.00), BMI (β = − 0.19; 95% CI:-0.28, − 0.09), educational attainment (β = − 1.35; 95% CI: − 2.34, − 0.36), and MET∙h/day (β = 0.19; 95% CI: 0.00, 0.38) were significant and independent determinants of work capacity. Hemoglobin concentration was marginally associated with work capacity in the presence of the other covariables (β = 0.22; 95% CI:-0.02, 0.47).ConclusionsOur data indicate that factors other than anemia are important correlates of work capacity and should be considered when promoting the health and economic capacity of rural Indian women.Trial registrationClinical Trial Registry- India (CTRI) http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=26285&EncHid=&userName=CTRI/2018/10/016186 on 29 October 2018.
Highlights
The negative impact of anemia on work capacity has been studied extensively in male and female workers; the simultaneous contributions of confounding variables such as physical activity, as well as other behavioral and sociodemographic characteristics have not been considered
Anemia is defined by a low (< 12 g/dL) concentration of hemoglobin (Hb) in the blood [5], which contributes to a diminished work capacity due to the reduction in the oxygen-transport ability of blood in response to prolonged and heavy exercise
The effects of a diet lacking in sufficient caloric intake, micronutrient, and macronutrient content on anemia and consequent work capacity are wellknown [6,7,8,9], and recent qualitative research conducted in Odisha, India, indicates that women tend not to prioritize their own health, relative to the health of their husbands or children [10]
Summary
The negative impact of anemia on work capacity has been studied extensively in male and female workers; the simultaneous contributions of confounding variables such as physical activity, as well as other behavioral and sociodemographic characteristics have not been considered. The effects of a diet lacking in sufficient caloric intake, micronutrient, and macronutrient content on anemia and consequent work capacity are wellknown [6,7,8,9], and recent qualitative research conducted in Odisha, India, indicates that women tend not to prioritize their own health, relative to the health of their husbands or children [10]. They tend to eat only after everyone else in the family has eaten and are often left with inadequate and poor quality food. Anemia is exacerbated in these women, as they tend not to seek medical care for their own health and physical weakness is understood to be part of their identity as women [11]
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