title: Aetiological factors and perception of anaemia in Tunisian women of reproductive age.
abstract: OBJECTIVE
  To identify aetiological factors in anaemia and to explore knowledge, perceptions and attitudes towards anaemia.
  
  
  METHODS
  Two cross-sectional surveys and sixteen focus group discussions.
  
  
  METHODS
  The two regions with the highest prevalence of anaemia in Tunisia, Greater Tunis (GT) and the South West (SW).
  
  
  METHODS
  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.
authors.affiliation: Study and Planning Department and Laboratory of Clinical Biology, National Nutrition Institute, 11 rue Jebel Lakhdar, Bab Sâdoun, 1007 Tunis, Tunisia. jalila.elati@rns.tn
authors.forename: Jalila
authors.initials: J
authors.lastname: El Ati
authors.forename: Pierre
authors.initials: P
authors.lastname: Lefèvre
authors.forename: Chiraz
authors.initials: C
authors.lastname: Béji
authors.forename: Chiheb
authors.initials: C
authors.lastname: Ben Rayana
authors.forename: Sadok
authors.initials: S
authors.lastname: Gaigi
authors.forename: Francis
authors.initials: F
authors.lastname: Delpeuch
mesh_terms: D000293:Adolescent; D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000209:etiology* / Q000517:prevention & control / Q000523:psychology*; D003430:Cross-Sectional Studies; D004032:Diet; D005260:Female; D017144:Focus Groups; D005511:Food Handling / Q000379:methods; D007722:Health Knowledge, Attitudes, Practice; D006454:Hemoglobins / Q000032:analysis / Q000378:metabolism; D006801:Humans; D006920:Hygiene; D019266:Iron, Dietary / Q000008:administration & dosage*; D008875:Middle Aged; D010465:Perception; D012307:Risk Factors; D013662:Tea / Q000009:adverse effects; D014416:Tunisia; D014930:Women / Q000193:education / Q000523:psychology*; D016387:Women's Health
chemical_list: D006454:Hemoglobins; D019266:Iron, Dietary; D013662:Tea