Prevalence of Anemia in Saudi Women of Reproductive Age and its Association with a Family History of Anemia in Makkah, Saudi Arabia

INTRODUCTION

Anemia is defined as a reduced hemoglobin level (Hb) – below 13 g/dL for men and 12 g/dL for women – or a low hematocrit or red blood cell (RBC) count.^[1] It occurs when there is an inadequate number of red blood corpuscles to meet physiological needs.^[2] Anemia is a very common health problem that may affect people at any age in both developing and developed countries. Anemia is often associated with iron deficiency, the most common cause worldwide. Pregnant women, women of reproductive age (WRA), and children are at an increased risk of developing anemia.^[2,3] WRA are physiologically more susceptible to anemia due to chronic heavy menstrual blood loss (menorrhagia), repeated childbearing, and pregnancy demands.^[3] In 2016, the World Health Organization (WHO) estimated that anemia affected about 33% of WRA globally.^[4] Anemia impairs the capacity of the blood to transport oxygen to tissues.^[5] Complications of anemia range from mild to severe and can include headaches, fatigue, low productivity, and maternal mortality. In 2002, the WHO reported that anemia was considered one of the top 10 mortality risks.^[6,7] Anemia has three main mechanisms: (1) Excessive blood loss (e.g., acute bleeding or chronic low-volume loss), (2) extreme RBC destruction (hemolysis), and (3) deficient production of RBCs (ineffective hematopoiesis).^[8] The most common cause of anemia is poor nutrition, mostly due to a deficiency in iron, folic acid, or vitamin B12. Other causes of anemia include inherited anemia (e.g., sickle cell and thalassemia) or autoimmune (hemolytic anemia). Anemia can also be associated with family history, infection (malaria), demographic-related factors (age and gender), malabsorption (achlorhydria), environmental pollutants (lead exposure), socioeconomic factors (low maternal level of education or low household income), and chronic diseases (cancer).^[9] Moreover, anemia is often associated with chronic diseases, including hypothyroidism, hypertension, rheumatism, and heart failure.^[10,11]

Anemia occurs in people of any age; however, women of childbearing age and young children are especially susceptible.^[9] Anemia is associated with poor immunity, cognitive dysfunction, decreased ability to work, and reduced overall quality of life.^[12,13] During childhood, all bone marrow is hematopoietic, whereas hematopoietic marrow is restricted to the axial skeleton in adults. Therefore, Hb concentrations are higher in children than in adults.^[14] The WHO estimates that 24.8% of the world’s population suffers from anemia, which amounts to about 1.62 billion people.^[15] It has been reported that the highest prevalence of anemia was found in preschoolage children (47.4%), while the prevalence of anemia in men (12.7%) was the lowest.^[16] Approximately 32.4 million pregnant women around the world suffer from anemia. For all WRA, the prevalence of anemia is about 29% (528.7 million WRA).^[16] The WHO has reported that anemia was observed in 40% of Saudi WRA. Another study found that 32.3% of non-pregnant women of childbearing age in Saudi Arabia suffered from anemia.^[15,17] The female reproductive years are between menarche (the first menstrual cycle) and menopause (the cessation of menses for 12 consecutive months). According to the American community, the years between menarche and menopause fall roughly between age 12 and age 49.^[18] Previously, it was revealed that having a family history of iron deficiency anemia was associated with an increased risk of anemia.^[19] However, little data are available about the prevalence of anemia in women with a family history of anemia in the Saudi population.

Most research concerning anemia in Saudi Arabia has focused on preschool children under six and their nutritional status.^[20,21] Some hospital-based studies on the prevalence and risk factors for anemia have been conducted in Saudi Arabia;^[20-23] however, these studies are subjected to selection bias and cannot be generalized. Therefore, the present study aimed to estimate the prevalence of anemia in women with a family history of anemia in Makkah.

MATERIAL AND METHODS

RESULTS

Prevalence of anemia

The prevalence of anemia (low Hb level) and its severity are shown in Figure 1. The data show that 291 (63%) participants had mild anemia (10–12 g/dL), 141 (30%) had moderate anemia (8–10 g/dL), 15 (3%) had severe anemia (6.5–7.9 g/dL), and 14 (3%) had life-threatening (<6.5 g/dL) anemia. The prevalence of anemia in the entire sample was (57%). These findings highlight the significant burden of anemia in this population, with most participants experiencing mild to moderate levels of the condition. The data also imply the importance of addressing anemia as a public health concern, particularly in populations at risk for nutritional deficiencies or other health conditions that can contribute to low Hb levels [Figure 1].

Close

Figure 1:

The prevalence of anemia (low hemoglobin level) and its severity in participants (n = 807).

Export to PPT

DISCUSSION

This is one of the first studies conducted in Makkah, KSA to measure the burden of anemia among women with a family history of anemia. Our study specifically focuses on WRA (12–49 years) because this population is at a significantly higher risk of anemia due to menstrual blood loss, pregnancy, and increased iron demands. The WHO recognizes anemia as a major public health concern among reproductiveage women, particularly in regions with high rates of iron deficiency and nutritional anemia.^[31] Several studies have documented that anemia prevalence is notably high among adolescents and young women, particularly in Middle Eastern populations, including Saudi Arabia.^[32,33] Factors such as dietary habits, menstrual blood loss, pregnancy, and family history play a crucial role in this group, making it a relevant and necessary focus of investigation. While anemia does increase with age, our study’s primary aim is to assess its prevalence in reproductive-age women and its association with family history. The findings provide critical insights into preventative and interventional strategies targeting this vulnerable age group, ultimately helping to reduce anemia-related complications in later life.

Global data (WHO) indicate that anemia is notably prevalent among younger populations, particularly children under five and WRA (15–49 years). According to the WHO, in 2019, 39.8% of children aged 6–59 months and 29.9% of women aged 15–49 years were affected by anemia.^[34] A comprehensive study analyzing data from 47 low- and middle-income countries between 2010 and 2018 found that 64.3% of children aged 6–35 months and 46.8% of those aged 36–59 months were anemic, highlighting a higher prevalence in younger children.^[35] Furthermore, a 2023 study published in The Lancet Haematology reported that in 2021, 46% of women globally were anemic, with the prevalence rising to 33.7% among women aged 15– 49 years.^[36] These statistics underscore that anemia is particularly prevalent among younger age groups, especially children under five and WRA, emphasizing the importance of focusing on these populations in anemia-related research and interventions. Another study reported that 49.5% of women aged 15–49 years were anemic, with factors such as education level, socioeconomic status, and dietary habits significantly influencing anemia prevalence.^[37] A study found that 54.3% of non-pregnant, non-lactating women aged 18–49 were anemic. Iron deficiency was prevalent in 86.9% of participants, underscoring the need for targeted interventions.^[38] A research study identified a 59.06% prevalence of anemia among women aged 15–49, with higher rates observed in pregnant women. Factors such as educational status, menstrual irregularities, and low body weight were significantly associated with anemia.^[39] Thus, anemia remains a significant public health concern among WRA (12–49 years), with global studies consistently reporting high prevalence rates in this population. The evidence highlights that nutritional deficiencies, menstrual blood loss, pregnancy, and socioeconomic factors are key contributors to anemia in younger women, often exceeding the rates seen in older populations. Addressing anemia in this age group is crucial for improving maternal and child health outcomes, reducing long-term complications, and preventing its persistence into older adulthood. The study found that anemia remains a public health issue, with a high prevalence of anemia (57%) of participants who were residing in Makkah. These results are consistent with those of previous studies that showed the prevalence of iron-deficiency anemia among female Saudi university students.^[15,17,40] Further research is needed to explore the underlying causes of anemia in this population as well as to develop targeted interventions to address this issue. Education and awareness campaigns may be necessary to increase knowledge about anemia and promote healthy lifestyle choices that can help prevent and manage the condition. Collaboration between healthcare providers, policymakers, and community leaders will be essential in addressing the burden of anemia among women in Makkah and improving overall health outcomes in the region.

The results of the current study showed statistically significant association between anemia and socioeconomic or educational factors, including marital status and income. These results are consistent with those of a previous study that found that demographic or socioeconomic factors^[41,42] and anthropometric status were not associated with any type of anemia.^[43] Efforts should be made to increase awareness about anemia and its potential impact on overall health. By working together, healthcare providers, policymakers, and community leaders can create a comprehensive approach to addressing anemia and improving the well-being of women in the region. The results of the current study showed a positive, statistically significant correlation between anemia and family history factors at the statistical level (a = 0.05). Previously, it was reported that genetic Hb disorders (e.g., sickle cell anemia and thalassemia) in family members played a role in the occurrence of anemia.^[44] Several previous Saudi Arabian studies reported that a family history of anemia created a significantly heightened risk of anemia in individuals. Another study suggested that a family history of anemia (iron deficiency) was significantly associated with an increased risk of anemia in adolescents, which might be similar to the other disorders.^[45]

A limitation of this study was that we could not compare the results of this study with similar studies conducted in other regions of Saudi Arabia, as few studies have focused on this topic. Data gathered through self-recall questionnaires may be subject to various biases that may affect the validity and reliability of the data collected. Future studies should aim to obtain objective levels of hemoglobin (HGB). Clearly, future approaches to prevent and control anemia should include detailed epidemiological studies to determine the causes of anemia in this population.

CONCLUSION

In the current study, 57% of our sample of Saudi WRA in Makkah had anemia. The findings indicated a statistically significant correlation between anemia and family history factors. However, no significant correlation was found between the presence of anemia and socioeconomic factors, such as marital status and income, or with chronic disease or medication use. Clearly, future approaches to prevent and control anemia should target the population with a family history of anemia. We recommend conducting more studies in Makkah with a large sample and conducting more studies in different regions of the Kingdom of Saudi Arabia and comparing the results with those of our research on anemia in the Makkah region.