Iron Supplementation Programs Research Articles

Prevalence of anemia and its determinants in urban school-going children of Mumbai

Context: WHO estimates that around two billion people are anemic with approximately 50% of all anemia attributable to iron deficiency. Weekly Iron and Folic Acid Supplementation Program is implemented in school, in various countries to reduce prevalence of anemia in adolescents. Aims: To find out baseline prevalence of anemia and its determinants in urban school-going children of Mumbai. Settings and Design: The cross-sectional study was carried out from August to October 2012 on sample size of 385 school children, selected by systematic random sampling of class VI to X of government-aided school. Materials and Methods: After a written-informed consent, students were interviewed by pre-tested, semi-structured questionnaire and then weight and height were recorded. Hemoglobin was estimated by cyan-methemoglobin method using a colorimeter. Data was analyzed by SPSS version 16. Statistical Analysis Used: Proportion, Chi-square test, Co-relation Co-efficient and Unpaired t test. Results: Mean age was 12.9 years with SD of 1.5 years. Overall prevalence of anemia was 53.2% with prevalence in females and males 56.5% and 50%, respectively. Proportion of mild, moderate and severe anemia was 21.6%, 30.9% and 0.8%, respectively. Age was significantly associated and negatively co-related with mean hemoglobin values with highest prevalence in age group of 15 to 19 years. Anemia was significantly associated with attainment of menarche. Practice of eating green leafy vegetables, groundnuts and egg was significantly higher in males as compared to females. Tiredness and palpitation were significantly higher in females as compared to males. Very few students (2.9%) were aware about anemia. Only 75% of the students were willing to consume weekly iron and folic acid supplementation for a year. Conclusions: Both males and females are susceptible to anemia with highest prevalence in age group of 15 to 19 years. Awareness of anemia was very poor in school-going children.

Maternal Nutritional Deficiencies and Interventions

Maternal Nutritional Deficiencies and Interventions

KEPATUHAN KONSUMSI TABLET BESI FOLAT PADA IBU HAMIL DAN FAKTOR YANG MEMPENGARUHI

Backgrounds : Anemia in pregnant women can effect maternal death, increased fetal morbidity and mortality. Iron supplementation programs should have a high success rate because the iron folate tablets are easily available and free of charge. But in reality. the compliance rate of iron folate tablets is still lowPurpose: analyze compliance rate of iron folate tablets in pregnant women at Puskesmas Halmahera and the factors influenced.Method: An analytic observational research with cross-sectional design. The subjects in this study is 56 pregnant women who went on Puskesmas Halmahera. Subject was taken by consecutive sampling technique with the criteria pregnant women trimester 2 and 3. Compliance data, knowledge, education, family support and health care obtained through interviews with a questionnaire. Normality of data was tested using Kolmogorov-Smirnov. Bivariate analyzes performed using Rank Spearman testResult: there is a association between knowledge scores with compliance (r = 0.370, p = 0.005), there is no significant association between education level and compliance (r = 0.032, p = 0.817 there is no significant association between family support and compliance (r = 0.216, p = 0.115) and there is no significant association between health service and compliance (r = 0.217, p = 0.108)Conclusion: more than a half of respondents (58,9%) did not comply consume iron folate tablets. Based on the data can be seen that the knowledge is the most influental factor.

Using Program Impact Pathways to Improve Anemia Reduction Programs

Recent evidence of the benefits of iron supplementation during pregnancy to reduce low birth weight and maternal mortality highlights the need for iron supplementation in pregnancy, an intervention known to be efficacious. Despite implementation of anemia reduction programs in many developing countries, the worldwide prevalence of maternal anemia in pregnancy remains over 40%. This suggests limitations in program delivery.To improve the delivery of a large‐scale anemia reduction program delivered through a mobile clinic program in rural Haiti, we designed a “Program Impact Pathway” (PIP) to delineate the mechanisms by which program activities resulted in desired outcomes. Survey data (n=663) from program beneficiaries were used to asses each essential component of the PIP, including consistent distribution of iron folic acid (IFA) at monthly clinics, women's understanding of how and why to IFA and barriers to adherence. Although knowledge about IFA benefits was high, irregular clinic attendance and inconsistent delivery of IFA resulted in a low median number of times women received IFA during pregnancy.Iron supplementation programs will be successful only if all essential elements linking program efforts to desired outcomes are identified and understood. The PIP provides such a method, and the lessons from its use in Haiti can be applied to other such programs.Research support: USAID, NIH/NIDDK

Hepcidin is the major predictor of erythrocyte iron incorporation in anemic African children

AbstractIron supplementation strategies in the developing world remain controversial because of fears of exacerbating prevalent infectious diseases. Understanding the conditions in which iron will be absorbed and incorporated into erythrocytes is therefore important. We studied Gambian children with either postmalarial or nonmalarial anemia, who were given oral iron supplements daily for 30 days. Supplements administered on days 1 and 15 contained the stable iron isotopes 57Fe and 58Fe, respectively, and erythrocyte incorporation was measured in blood samples drawn 14 days later. We investigated how the iron-regulatory hormone hepcidin and other inflammatory/iron-related indices, all measured on the day of isotope administration, correlated with erythrocyte iron incorporation. In univariate analyses, hepcidin, ferritin, C-reactive protein, and soluble transferrin receptor (sTfR) strongly predicted incorporation of 57Fe given on day 1, while hepcidin, ferritin, and sTfR/log ferritin correlated with 58Fe incorporation. In a final multivariate model, the most consistent predictor of erythrocyte isotope incorporation was hepcidin. We conclude that under conditions of competing signals (anemia, iron deficiency, and infection), hepcidin powerfully controls use of dietary iron. We suggest that low-cost point-of-care hepcidin assays would aid iron supplementation programs in the developing world.

Iron Deficiency and Severe Plasmodium falciparum Malaria

Iron Deficiency and Severe Plasmodium falciparum Malaria

Strategies to prevent iron deficiency and improve reproductive health

Anemia and iron deficiency affect billions of people worldwide, especially women of reproductive age, pregnant women, and young children. Many countries have iron and folic acid supplementation programs for pregnant women. However, the impact of these programs is uncertain. Multiple-micronutrient supplementation during pregnancy has been advocated; however, it is unclear whether this has additional advantages. Overall, programs have shown only modest impact on increasing birth weight. This review discusses the present state of knowledge on interventions to improve iron status during pregnancy and reproductive health, and investigates other possibilities such as supplementation prior to conception to improve maternal and child health.

Implantação e impacto do Programa Nacional de Suplementação de Ferro no município de Viçosa - MG

The scope of this work was to evaluate the implementation of the National Iron Supplementation Program (NISP) in Viçosa in the State of Minas Gerais and its impact on 6- to 18-month-old non-anemic infants assisted by the Family Health Teams. Interviews were conducted with the professionals and with the children's mothers/guardians. The non-anemic children who didn't receive the earlier supplementation (n=133) were given ferrous sulphate syrup for six months. Hemoglobin dosage, anthropometric evaluation and a socioeconomic survey were conducted before and after the six-month period. Children who ingested 75% or more of the prescribed dosage were classified as high adhesion, while the others were classified as low adhesion, according to the mothers' testimonials. With respect to the implementation in the city, the distribution system was not always available to the priority group and there was a lack of training and motivation on the part of most Community Health Agents. The lack of promotion of NISP among the priority group was detected, apart from a mothers' awareness drive. Regarding diet supplementation, children showed low adhesion and the dosage wasn't effective in preventing anemia. Therefore, important operational barriers to implementation were observed.

Prevalence of anemia among non-pregnant and pregnant women of reproductive age in Nepal

Introduction: The prevalence of anaemia among pregnant women in developing countries is high. Iron deficiency is one of the major causes of nutritional anemia worldwide. In order to address the problem of anemia in Nepal, government of Nepal introduced the Iron Supplementation and Intensification Programs. The 2006 Nepal Demographic and Health Survey evaluated these programs and revealed the reduction in the prevalence of anemia among women of reproductive age. However, reduction on prevalence of anemia among the non-pregnant and pregnant women has not been studied separately so far. Thus, this study aims to explore the 2006 Nepal Demographic and Health Survey (NDHS) data to study the change in the prevalence of anemia among non-pregnant and pregnant women of reproductive age.
 Methods: The data is taken from the 2006 Nepal Demographic and Health Survey (NDHS) which is a nationally representative survey of 10647 women of reproductive age or 15-49 years. Out of them 604 were pregnant at the time of the survey. Hemoglobin level is adjusted for the altitude and daily cigarettes smoking is used in this study. Using the adjusted hemoglobin level, anemia is classified into four categories i.e. severe, moderate, mild and any anemia.
 Results: The prevalence of anemia among the non-pregnant reproductive age women is found to be 35.8%. The highest prevalence is observed for Far-Western terai (67.1%) followed by Mid-Western terai (59.4%), Central terai (55.5%) and Western terai (47.15%). Mean hemoglobin (Hb) level is found to be less than 12 g/dl at these regions. The prevalence of severe anemia among non-pregnant women of reproductive age at national and eco-development regions is less than 2%, moderate anemia is 5.6% and mild anemia is 29.8%. The overall prevalence of anemia among the pregnant reproductive age women is found to be 42.7%. The highest prevalence is again observed for Far-Western terai (69.2%) followed by Central terai (55.2%) and Western terai (52.1%). The mean h level is less than 11 g/dl at Central, Western, Mid-Western and Far-Western terai regions. Prevalence of severe anemia among pregnant women of Western terai and Mid-western terai is found to be more than 2%. Furthermore, Mid-western hill and Central terai also has equal or more than 1.5% prevalence of severe anemia among pregnant women of reproductive age.
 Conclusion: There are some eco-development regions where anemia prevalence was found to be less in the pregnant women than the non-pregnant women and vice-versa. This warrants an immediate intervention policies and programs from the governmental and non-governmental agencies. Even though Nepal has reduced the prevalence of anemia among non-pregnant and pregnant women of reproductive age, it is required needs to further decrease the anemia prevalence in order to reduce the maternal mortality in the country and meet the target 5a of MDG Goal 5 on maternal health.

Prevalence of anemia among non-pregnant and pregnant women of reproductive age in Nepal

Introduction: The prevalence of anaemia among pregnant women in developing countries is high. Iron deficiency is one of the major causes of nutritional anemia worldwide. In order to address the problem of anemia in Nepal, government of Nepal introduced the Iron Supplementation and Intensification Programs. The 2006 Nepal Demographic and Health Survey evaluated these programs and revealed the reduction in the prevalence of anemia among women of reproductive age. However, reduction on prevalence of anemia among the non-pregnant and pregnant women has not been studied separately so far. Thus, this study aims to explore the 2006 Nepal Demographic and Health Survey (NDHS) data to study the change in the prevalence of anemia among non-pregnant and pregnant women of reproductive age.
 Methods: The data is taken from the 2006 Nepal Demographic and Health Survey (NDHS) which is a nationally representative survey of 10647 women of reproductive age or 15-49 years. Out of them 604 were pregnant at the time of the survey. Hemoglobin level is adjusted for the altitude and daily cigarettes smoking is used in this study. Using the adjusted hemoglobin level, anemia is classified into four categories i.e. severe, moderate, mild and any anemia.
 Results: The prevalence of anemia among the non-pregnant reproductive age women is found to be 35.8%. The highest prevalence is observed for Far-Western terai (67.1%) followed by Mid-Western terai (59.4%), Central terai (55.5%) and Western terai (47.15%). Mean hemoglobin (Hb) level is found to be less than 12 g/dl at these regions. The prevalence of severe anemia among non-pregnant women of reproductive age at national and eco-development regions is less than 2%, moderate anemia is 5.6% and mild anemia is 29.8%. The overall prevalence of anemia among the pregnant reproductive age women is found to be 42.7%. The highest prevalence is again observed for Far-Western terai (69.2%) followed by Central terai (55.2%) and Western terai (52.1%). The mean h level is less than 11 g/dl at Central, Western, Mid-Western and Far-Western terai regions. Prevalence of severe anemia among pregnant women of Western terai and Mid-western terai is found to be more than 2%. Furthermore, Mid-western hill and Central terai also has equal or more than 1.5% prevalence of severe anemia among pregnant women of reproductive age.
 Conclusion: There are some eco-development regions where anemia prevalence was found to be less in the pregnant women than the non-pregnant women and vice-versa. This warrants an immediate intervention policies and programs from the governmental and non-governmental agencies. Even though Nepal has reduced the prevalence of anemia among non-pregnant and pregnant women of reproductive age, it is required needs to further decrease the anemia prevalence in order to reduce the maternal mortality in the country and meet the target 5a of MDG Goal 5 on maternal health.

Host-mediated regulation of superinfection in malaria

In regions of high rates of malaria transmission, mosquitoes repeatedly transmit liver-tropic Plasmodium sporozoites to individuals who already have blood-stage parasitemia. This manifests itself in semi-immune children (who have been exposed since birth to Plasmodium infection and as such show low levels of peripheral parasitemia but can still be infected) older than 5 years of age by concurrent carriage of different parasite genotypes at low asymptomatic parasitemias. Superinfection presents an increased risk of hyperparasitemia and death in less immune individuals but counterintuitively is not frequently observed in the young. Here we show in a mouse model that ongoing blood-stage infections, above a minimum threshold, impair the growth of subsequently inoculated sporozoites such that they become growth arrested in liver hepatocytes and fail to develop into blood-stage parasites. Inhibition of the liver-stage infection is mediated by the host iron regulatory hormone hepcidin, whose synthesis we found to be stimulated by blood-stage parasites in a density-dependent manner. We mathematically modeled this phenomenon and show how density-dependent protection against liver-stage malaria can shape the epidemiological patterns of age-related risk and the complexity of malaria infections seen in young children. The interaction between these two Plasmodium stages and host iron metabolism has relevance for the global efforts to reduce malaria transmission and for evaluation of iron supplementation programs in malaria-endemic regions.

Reduced risk for placental malaria in iron deficient women

BackgroundNutritional iron deficiency may limit iron availability to the malaria parasite reducing infection risk, and/or impair host immunity thereby increasing this risk. In pregnant women, there is evidence of an adverse effect with iron supplementation, but the few reported studies are strongly confounded.MethodsA case control study in pregnant Malawian women was undertaken in Chikhwawa southern Malawi in order to describe iron status in relation to placental malaria controlling for several confounding factors. Pregnancy characteristics were obtained and a blood sample at delivery. A full blood count was performed and serum ferritin and transferrin receptor quantified by enzyme-linked immunoassay. DNA analysis was used to identify genetic polymorphisms for ABO phenotype, hemoglobin HbS, and glucose -6 phosphate dehydrogenase deficiency. Placental tissue was obtained and malaria histology classified as active, past or no malaria infection.Results112 cases with placental malaria were identified and 110 women with no evidence of placental infection. Iron deficiency was less frequent in women with placental Plasmodium falciparum infection. In those with acute, chronic or past placental infections the odds ratio for iron deficiency was 0.4, 95% CI 0.2-0.8, p = 0.01; for acute and chronic infections 0.4, 0.2-0.8, p = 0.006; for acute infection 0.3, 0.1-0.7, p = 0.001. The association was greater in multigravidae.ConclusionWomen with either acute, or acute and chronic placental malaria were less likely to have iron deficiency than women without placental malaria infection There is a priority to establish if reversing iron deficiency through iron supplementation programs either prior to or during pregnancy enhances malaria risk.

Iron health

Iron health

Anemia Among Pregnant Women in the Sidi Bel Abbes Region (West Alegria) : An Epidemiologic Study

Background and Objectives: Anaemia in pregnancy is a major public health problem in developing countries. It is associated with an increased risk of maternal and perinatal morbidity and mortality. The aim of this present work is to study of prevalence and effect of some socio-biological factors on anemia of pregnancy in a mother-and-child health center (MCH) in area of Sidi Bel Abbes. Subjects and Methods: Across sectional study was conducted during three months (march to may 2010), on a representative sample of 242 pregnant women attending MCH center in sidi bel abbes region, west of Algeria for the assessment of their hemoglobine level. Most of the women did not have a follow-up at the MHC and they had not taken iron or vitamin supplement during pregnancy. Maternal venous fasting blood samples were collected with EDTA and haemoglobin concentration (Hb); Hematocrit (Htc), Mean cell haemoglobin concentration (MCHC), Mean cell volume (MCV) were determined by an electronic counter. Results: The overall prevalence of anemia (H<11g/dl) was found to be 40.08 %. Classified in each trimester, the prevalence was 17.3%, 23.8% and 50.0% in the first, second and third trimester, respectively. According to severity of anemia 36.08% having mild 49.48% moderate and 14.43% severe anemia. The study shows that 46.39% of the subject had MCV values less than standard value of 75fl suggesting microcytic anemia. No correlations were found between the hemoglobin and the maternal obstetric characteristics, in particular not between hemoglobine concentration and parity (p=0.40), betwwen Hb and number of abortion (r=0.005, p=0.30). Our study shows that age and parity were not a risk factor for anemia. Conclusions: Iron deficiency is quite frequent during third trimester of pregnancy in our study population. A comprehensive research in our country is needed on how to improve existing iron supplementation programs and the overall health care and nutritional status of women before they enter their reproductive years.

Afebrile Plasmodium falciparum parasitemia decreases absorption of fortification iron but does not affect systemic iron utilization: a double stable-isotope study in young Beninese women

Iron deficiency anemia (IDA) affects many young women in sub-Saharan Africa. Its etiology is multifactorial, but the major cause is low dietary iron bioavailability exacerbated by parasitic infections such as malaria. We investigated whether asymptomatic Plasmodium falciparum parasitemia in Beninese women would impair absorption of dietary iron or utilization of circulating iron. Iron absorption and utilization from an iron-fortified sorghum-based meal were estimated by using oral and intravenous isotope labels in 23 afebrile women with a positive malaria smear (asexual P. falciparum parasitemia; > 500 parasites/μL blood). The women were studied while infected, treated, and then restudied 10 d after treatment. Iron status, hepcidin, and inflammation indexes were measured before and after treatment. Treatment reduced low-grade inflammation, as reflected by decreases in serum ferritin, C-reactive protein, interleukin-6, interleukin-8, and interleukin-10 (P < 0.05); this was accompanied by a reduction in median serum hepcidin of ≈ 50%, from 2.7 to 1.4 nmol/L (P < 0.005). Treatment decreased serum erythropoietin and growth differentiation factor 15 (P < 0.05). Clearance of parasitemia increased geometric mean dietary iron absorption (from 10.2% to 17.6%; P = 0.008) but did not affect systemic iron utilization (85.0% compared with 83.1%; NS). Dietary iron absorption is reduced by ≈ 40% in asymptomatic P. falciparum parasitemia, likely because of low-grade inflammation and its modulation of circulating hepcidin. Because asymptomatic parasitemia has a protracted course and is very common in malarial areas, this effect may contribute to IDA and blunt the efficacy of iron supplementation and fortification programs. This trial was registered at clinicaltrials.gov as NCT01108939.

Simple educational intervention will improve the efficacy of routine antenatal iron supplementation

Sri Lanka has a policy of free provision of iron supplements to pregnant women. However, iron deficiency anemia remains common in pregnancy. We tested the hypothesis that educating women regarding improving bioavailability could improve the efficacy of iron supplementation. The education focused on how best supplements could be taken and on how they should be stored. We carried out a study using a quasi-experimental design on a group of women attending for antenatal care at a suburban University Obstetric Unit in Sri Lanka. The control group had care free of charge including iron supplementation and antihelminthic therapy. In addition, the study group received an education in small groups regarding maximizing bioavailability of iron. Hemoglobin and iron status of the women were compared between the groups at recruitment and at 34 weeks of gestation. The two groups were equally matched in demographic data, and hemoglobin and iron status. There were significant differences between the two groups at 34 weeks in the hemoglobin levels, serum ferritin levels, anemia rates and the number with low ferritin (P < 0.0001 for all parameters), with a favorable outcome in the study group. The study group had used the iron tablets in ways that improved their bioavailability. A simple health education improved the efficacy of iron supplementation in this population. Such interventions should be an integral part of iron supplementation programs, especially in populations whose habits tend to reduce the bioavailability of iron.

Determinan keberhasilan program suplementasi zat besi pada siswi sekolah

Background: The iron supplementation program is implemented in many countries for improving the iron status. However, this program is not always successfully reducing the prevalence of anemia due to the various factors.Objective: To determine the success factors of iron supplementation program at the female school students. Method: The program of iron supplementation at the school was run by the Health Office of Bekasi City. The pre-post design study was applied among junior and senior high school female students. The variables collected were age, health status, menstrual pattern, hand washing habit, body mass index, capsule compliance, and food consumption. The hemoglobin (Hb) was measured by cyanmethemoglobin method. The logistic regression was applied to analyses the determinant factors.Results: The prevalence of anemia among female students was decreased by 3.4% after four month of supplementation. However, its result was different between the junior and senior high school students, in fact the prevalence of anemia at the junior students was increased. The number of students at the junior high school who decreased in hemoglobin and became anemia were more than the senior high school. The logistic regression analyses showed that the success determinant of iron supplementation program were students not anemic before supplementation (OR = 10.81; 90% CI: 7.04-16.50) and they used to hand washing (OR = 11.22; 90% CI: 1.90-64.60).Conclusion: After the iron supplementation program, the decrease prevalence of anemia was different between the junior and senior high school students. The determinants of success program were hand washing habits and the anemia status before supplementation.

Acute Copper Supplementation Does Not Inhibit Non-Heme Iron Bioavailability in Humans

To measure the effect of acute copper (Cu) administration, given as an aqueous solution, on the absorption of iron (Fe), 29 healthy adult women participated in two iron absorption studies. Subjects received 0.5 mg of Fe, as ferrous sulfate, alone or with Cu, as copper sulfate, at 0.5:1, 1:1, or 2:1 Cu/Fe molar ratios (study I) or at 4:1, 6:1, or 8:1 Cu/Fe molar ratios (study II) as an aqueous solution on days 1, 2, 14, and 15 of the study. Fe absorption was assessed by erythrocyte incorporation of iron radioisotopes (55)Fe and (59)Fe. Geometric mean (range +/- SD) absorption of Fe alone or at 0.5:1, 1:1, 2:1 Cu/Fe molar ratios were 34.4% (17.3-68.5%), 40.9% (24.9-67.2%), 48.3% (24.8-94.1%), and 50.2% (25.3-99.5%), respectively (ANOVA, p = 0.12). Geometric mean (range +/- SD) absorption of Fe alone or at 4:1, 6:1, 8:1 Cu/Fe molar ratios were 28.7% (12.1-67.9%), 21.5% (6.5-71.5%), 29.6% (10.3-85.4%), and 36.5% (18.3-73.1%), respectively (ANOVA, p = 0.16). In conclusion, combined Cu and Fe administration in an aqueous solution does not inhibit Fe bioavailability. This information could help in the design of rational guidelines for copper and iron supplementation programs. Our results support the hypothesis that divalent metal transporter 1 is not physiologically relevant for copper absorption in humans.

Impact of a Positive Deviance Approach to Improve the Effectiveness of an Iron-Supplementation Program to Control Nutritional Anemia among Rural Senegalese Pregnant Women

Iron supplementation through prenatal care remains the most widespread strategy to control anemia during pregnancy, but its effectiveness is only partial, showing the need to address other approaches. This study was conducted to measure the impact of a positive deviance approach to improve an iron-supplementation program among pregnant women in a rural Senegalese area. A positive deviance approach (PD Micah) was compared with an ongoing integrated nutrition and health program intervention (Micah) in a rural Senegalese area. A pre-post evaluation was conducted using independent cross-sectional samples with a total of 371 pregnant women. A sociodemographic questionnaire was administered, and biologic and anthropometric measurements were performed. After 9 months of activities, the mean hemoglobin level rose from 93.9 to 100.7 g/L in the PD Micah group. Distribution of iron supplements through community volunteers and implementation of healthy pregnancy promotion sessions on a monthly basis improved the accessibility to 23.3% in the PD Micah group. No significant change was observed in the Micah group. Logistic regression analysis showed a significantly reduced risk of anemia in the PD Micah area (adjusted odds ratio, 0.25; 95% confidence interval, 0.12 to 0.53). This intervention shows that a community-based strategy, such as the positive deviance approach, can contribute to improving the effectiveness of iron supplementation during pregnancy.

Periconceptional Iron and Folate Status Is Inadequate among Married, Nulliparous Women in Rural Bangladesh

Recent evidence suggests that poor fetal growth is associated with preconception anemia and first trimester iron deficiency. Periconceptional iron and folate supplementation may improve the effectiveness of iron supplementation programs during pregnancy by treating preexisting anemia, building iron stores, and reducing risk of neural tube defects. Our objective in this study was to describe the iron and folate status of married, nulliparous women in rural Bangladesh from March to May 2007. Of 272 women, 37% were anemic (hemoglobin <120 g/L), 13% were folate deficient (plasma folate <or=10 nmol/L), 15% were iron deficient (plasma ferritin <12 microg/L or tranferrin receptor >4.4 mg/L), 11% were iron deficient and anemic, and 81% were estimated to have <500 mg of iron stores. Risk of anemia was 4 times greater among nonstudents than students (95% CI: 1.23, 14.69), twice as likely among women with a previous miscarriage compared with those who had never been pregnant (95% CI: 1.04, 5.47), and 6 times greater among iron-deficient compared to iron-replete women (95% CI: 2.76, 11.81). Adolescents (<or=19 y) had lower mean plasma ferritin concentration (38.3 +/- SD vs. 49.1 +/- SD microg/L; P = 0.004) and body iron stores [3.4 +/- 5.2 mg/kg vs. 4.3 +/- 5.6 mg/kg (0.06 +/- 0.09 mmol/kg vs. 0.08 +/- 0.10 mmol/kg); P = 0.006] compared with adults. An unacceptably high percentage of nulliparous women in rural Bangladesh have inadequate iron and folate status. As they enter pregnancy, more than one-third will be anemic, >80% will have inadequate iron stores, and more than one-tenth will be folate deficient. Further research is needed on risk factors of poor nutritional status before the start of a woman's childbearing years.