MEDICINE Prevalence of Anemia Among Adults at Capital Governorate in Kuwait Salma M. AlDallal 1 & Maryam Al-Hilal 2 Accepted: 3 December 2019 /Published online: 17 December 2019 # Springer Nature Switzerland AG 2019 Abstract Anemia, defined by low hemoglobin level, is recognized as a major public health problem that has a significant impact on lifelong health. In 2014, the Kuwait Nutrition Surveillance System stated that the prevalence of anemia was 9.7% in adult males and 32.7% in adult females. This study aimed to establish the prevalence and classification of anemia among adult patients attending the Capital Governorate hospital of Kuwait. It is a retrospective record-based study. The study included patients (aged 18– 60 years) attending Amiri Hospital OPD and primary care centers affiliated from January 2014 to December 2018. Hemoglobin levels were taken from the Laboratory Information System (LIS) and were classified as mild, moderate, and severe based on WHO classification. This study showed that anemia was more prevalent among the Kuwaiti population than non-Kuwaitis. The maximum percentage of anemic people belonged to the moderate and mild range of anemia; a very low percentage was found in the severe range. The incidence of anemia was significantly higher among females compared to males (16–17% of females and 4–5% of males in the moderate range; 16–18% of females and 10–11% of males in the mild range; 2–3.3% of females and 0.8– 1.1% of males in the severe range). Age-wise comparison of data showed that anemia was more common among the older age groups. Prevalence of anemia is quite high in Kuwait; therefore, more studies and interventions are needed for certain vulnerable groups—specifically for women and people from older age groups—to reduce the risk of anemia. Keywords Anemia . Kuwait . Adults . Hemoglobin . Retrospective Introduction Anemia is a condition in which the number of red blood cells (RBCs) is insufficient to meet the body’ s physiologic needs. Specific physiological needs differ with a person’ s age, gen- der, residential elevation above sea level, smoking, and differ- ent phases of pregnancy. Globally, iron-deficiency anemia (IDA) is thought to be the most common cause of anemia, but other nutritional deficiencies, including vitamin B 12 and folate deficiency, acute and chronic inflammation, inherited or acquired disorders and parasitic infections that affect hemo- globin synthesis, RBC production or survival, can cause ane- mia [1]. Anemia is a public health problem that is commonly prev- alent worldwide. The World Health Organization’ s (WHO) definition of anemia is a Hb concentration < 130 g/L in men and < 120 g/L in women [1]. Anemia is worse in developing countries mainly because of infectious diseases, parasitic in- fections, and malnutrition [2, 3]. Iron-deficiency anemia (IDA), which is considered to be the primary cause of anemia, is not only highly widespread in less-developed countries but also remains an obvious dilemma in developed countries too, where another form of malnutrition has already been virtually eliminated [4]. Anemia has a major negative consequence on an individ- uals’ health and in the socioeconomic expansion of societies [2, 5]. The prevalence of anemia is a sign of both poor nutri- tion and poor health of population. WHO estimated that around 25% of the earths’ population is anemic [2]. In 2014, This article is part of the Topical Collection on Medicine Electronic supplementary material The online version of this article (https://doi.org/10.1007/s42399-019-00205-y) contains supplementary material, which is available to authorized users. * Salma M. AlDallal [email protected]1 Director of Hematology Training Program, Amiri Hospital, Kuwait Ministry of Health, Kuwait City, Kuwait 2 Medical Research Department, Yarmouk Primary Health Center, Kuwait Ministry of Health, Kuwait City, Kuwait SN Comprehensive Clinical Medicine (2020) 2:164–172 https://doi.org/10.1007/s42399-019-00205-y
Transcript
MEDICINE
Prevalence of Anemia Among Adults at CapitalGovernorate in Kuwait
Salma M. AlDallal1 & Maryam Al-Hilal2
Accepted: 3 December 2019 /Published online: 17 December 2019# Springer Nature Switzerland AG 2019
AbstractAnemia, defined by low hemoglobin level, is recognized as a major public health problem that has a significant impact on lifelonghealth. In 2014, the Kuwait Nutrition Surveillance System stated that the prevalence of anemia was 9.7% in adult males and32.7% in adult females. This study aimed to establish the prevalence and classification of anemia among adult patients attendingthe Capital Governorate hospital of Kuwait. It is a retrospective record-based study. The study included patients (aged 18–60 years) attending Amiri Hospital OPD and primary care centers affiliated from January 2014 to December 2018. Hemoglobinlevels were taken from the Laboratory Information System (LIS) and were classified as mild, moderate, and severe based onWHO classification. This study showed that anemia was more prevalent among the Kuwaiti population than non-Kuwaitis. Themaximum percentage of anemic people belonged to the moderate and mild range of anemia; a very low percentage was found inthe severe range. The incidence of anemia was significantly higher among females compared to males (16–17% of females and4–5% of males in the moderate range; 16–18% of females and 10–11% of males in the mild range; 2–3.3% of females and 0.8–1.1% of males in the severe range). Age-wise comparison of data showed that anemia was more common among the older agegroups. Prevalence of anemia is quite high in Kuwait; therefore, more studies and interventions are needed for certain vulnerablegroups—specifically for women and people from older age groups—to reduce the risk of anemia.
Anemia is a condition in which the number of red blood cells(RBCs) is insufficient to meet the body’s physiologic needs.Specific physiological needs differ with a person’s age, gen-der, residential elevation above sea level, smoking, and differ-ent phases of pregnancy. Globally, iron-deficiency anemia(IDA) is thought to be the most common cause of anemia,
but other nutritional deficiencies, including vitamin B12 andfolate deficiency, acute and chronic inflammation, inherited oracquired disorders and parasitic infections that affect hemo-globin synthesis, RBC production or survival, can cause ane-mia [1].
Anemia is a public health problem that is commonly prev-alent worldwide. The World Health Organization’s (WHO)definition of anemia is a Hb concentration < 130 g/L in menand < 120 g/L in women [1]. Anemia is worse in developingcountries mainly because of infectious diseases, parasitic in-fections, and malnutrition [2, 3]. Iron-deficiency anemia(IDA), which is considered to be the primary cause of anemia,is not only highly widespread in less-developed countries butalso remains an obvious dilemma in developed countries too,where another form of malnutrition has already been virtuallyeliminated [4].
Anemia has a major negative consequence on an individ-uals’ health and in the socioeconomic expansion of societies[2, 5]. The prevalence of anemia is a sign of both poor nutri-tion and poor health of population. WHO estimated thataround 25% of the earths’ population is anemic [2]. In 2014,
This article is part of the Topical Collection on Medicine
Electronic supplementary material The online version of this article(https://doi.org/10.1007/s42399-019-00205-y) contains supplementarymaterial, which is available to authorized users.
Kassebaum and colleagues [5] reported that the prevalence ofanemia globally was 32.9% in 2010. In addition, the WHOhas classified anemia into three major categories: mild, mod-erate, and severe (Table 1) [6].
Kuwait is a small wealthy country divided into 5 regions,called governorates. Since the discovery of oil in the 1940s,the lifestyle of Kuwaiti people has changed dramatically. As aresult, decreased physical activities and increased food intakehave been noticed [7].
There has been little data from Capital Governorate ofKuwait on anemia prevalence and classification, most studieshave focus on the genetic causes of anemia [8, 9]. In 2014,Kuwait Nutrition Surveillance System (KNSS) stated that theprevalence of anemia was 9.7% in adult males and 32.7% inadult females, with highest occurrence (38%) among adultfemales at 30 < 40 years of age [10]. Therefore, we decidedto investigate the prevalence and classification of anemia inadult patients aged between 18 and 60 years attending outpa-tient department (OPD) of Capital Governorate hospital andprimary care centers affiliated between the years 2014–2018.
Materials and Methods
Data Collection and Ethical Issues
This was a retrospective analysis of the medical documents ofpatients attending OPD of Amiri Hospital and primary carecenters associated over a period of 5 years (January 2014 toDecember 2018). Data were collected from LaboratoryInformation System (LIS) and ethical approval of this studywas granted by the Ethics Committee of Kuwait Ministry ofHealth.
Subjects and Data Collection
The study includes adult patients of both genders, aged be-tween 18 to 60 years, who visited the OPD of Amiri hospitaland affiliated primary care clinics. We attempted to extract allavailable data regarding the demographic characteristics suchas age, gender, and Hb levels. The cut-off value for the
determination of anemia according to WHO was defined asblood Hb < 130 g/L in males and < 120 g/L in females.
The severity of anemia was classified into three stages:
& Mild: 110–129 g/L in males and 110–119 g/L in females& Moderate: 80–109 g/L in males and females& Severe:< 8 g/L in males and females
Exclusion Criteria
We excluded all patients aged < 18 and > 60 years andinpatients.
Statistical Analysis
The statistical analysis was done using GraphPad prism. Weperformed two-way ANOVA and t test to determine the sig-nificance level (p value) among various parameters.
Results
Throughout the study, on average, the prevalence of anemiawas significantly higher in the female groups. Besides, mostof the people in this study—irrespective of gender–fell intothe moderate and mild range of anemia; rare cases were foundin the severe range of anemia.
Among Kuwaiti and non-Kuwaiti groups, we found ahigher percentage of anemia among Kuwaiti residents.Moreover, Kuwaiti females were the most prevalent anemicgroup in this study. Age-wise comparison of data showed thatthe 36–45 age group of females and 46–60 age group of maleshad the highest percentage of anemic people than other agegroups. However, the overall year-wise classification of datawas almost similar; we observed very little variation in thetotal percentage of anemia from 2014 to 2018 (Table 2).
Gender-Wise Distribution of Anemic Population
In the moderate range, the females were nearly 3–4 timesmore anemic than males (nearly 16–17% of female and 4–5% of male), and this difference (13.24%) was highest in2016 (Fig. 1a, c). In the mild range, female groups were nearly1.6 times more anemic than their male counterparts (16–18%in female and 10–11% in male), and the year 2014 showed thehighest significant difference (7.31%) for this data. Comparedto the mild and moderate ranges, we found very less percent-age of people from both genders (2–3.3% among females and0.8–1.1% among males) in the severe range of anemia. In theyears of 2014, 2016, and 2018, the females were significantlymore anemic than males; however, the years 2015 and 2018
Table 1 Degree of anemia based on WHO classification system [6]
Hb concentration (g/L) Group
≥ 130 (men) or≥ 120 (women)
No anemia
110–129 (men) or110–119 (women)
Mild anemia
80–109 Moderate anemia
< 80 Severe anemia
SN Compr. Clin. Med. (2020) 2:164–172 165
showed no significant difference in the percentage of anemicmales and females in the severe range (Table 3).
Nationality-Wise Distribution of Anemic Population
Irrespective of gender, Kuwaitis were significantly moreanemic than non-Kuwaitis (Table 4). In the moderaterange, Kuwaiti females were 1.2–1.4 times more anemicthan non-Kuwaiti females, and Kuwaiti males were 1.6–2.2 times more anemic than non-Kuwaiti males. In themoderate range, the year 2016 showed the highest
difference in the percentage (6.07%) of anemic people be-tween Kuwaiti females and non-Kuwaiti females while theyear 2017 showed the highest difference (3.88%) betweenKuwaiti males and non-Kuwaiti males. The mild range ofdata showed no significant difference between Kuwaiti andnon-Kuwaiti females, but the Kuwaiti males were 1.2–1.4times more anemic than the non-Kuwaiti males. The year2015 had the highest significant difference betweenKuwaiti and non-Kuwaiti males in the mild range of ane-mia. The data for severe range of anemia showed no sig-nificant difference between Kuwaiti and non-Kuwaiti
Table 2 Mean and standard deviation of percentage of anemic (mild, moderate, and severe) population over 5 years at different conditions andstatistical analysis by using two-way ANOVA
Moderate anemia Mild anemia Severe anemia
Mean ofpercentage
SD Mean ofpercentage
SD Mean ofpercentage
SD
Female 17.03 0.73 17.21 0.77 2.92 0.3
Male 4.86 0.34 10.4 0.33 0.9 0.14
Kuwaiti female 19.09 1.009 17.89 1.21 2.83 0.42
Non-Kuwaiti female 13.99 0.55 16.32 0.4 3.04 0.39
Kuwaiti male 6.9 0.37 12.27 0.7 1.1 0.25
Non-Kuwaiti male 3.4 0.35 9.16 0.48 0.77 0.13
18–25 Female 19.47 3.8 15.2 1.5 2.02 0.2
26–35 Female 16.26 1.33 17.3 0.68 2.21 0.27
36–45 Female 17.79 1.23 18.26 0.81 4.7 0.94
46–60 Female 15.65 1 17.4 0.54 2.67 0.5
18–25 Male 5.36 1.21 7.56 1.08 0.97 0.74
26–35 Male 4.89 0.5 7.04 0.88 0.63 0.22
36–45 Male 2.71 0.28 7.69 0.45 0.66 0.09
46–60 Male 5.98 0.37 15.06 0.25 1.22 0.1
Conditions Df MS F P P value summary % of totalvariation
Female and male (moderate anemia) 1 370.1 926.1 < 0.0001 *** 99.3
Female and male (mild anemia) 1 115.9 739 < 0.0001 *** 97.59
Female and male (severe anemia) 1 10.16 148 0.0003 *** 95.72
Female Kuwaiti and female non-Kuwaiti (moderateanemia)
1 65.01 91.66 0.0007 *** 92.45
Female Kuwaiti and female non-Kuwaiti (mildanemia)
1 6.166 15.79 0.016 * 48.48
Female Kuwaiti and female non-Kuwaiti (severeanemia)
1 0.116 0.63 0.4716 ns 7.93
Male Kuwaiti and male non-Kuwaiti (moderateanemia)
1 29.19 241.1` 0.0001 *** 96.26
Male Kuwaiti and male-non Kuwaiti (mild anemia) 1 24.14 93.84 0.0006 *** 89.12
Male Kuwaiti and male non-Kuwaiti (severe anemia) 1 0.275 12.31 0.02 * 45.56
Age variation among female groups (moderateanemia)
3 14.63 2.84 0.082 ns 36.07
Age variation among female groups (mild anemia) 3 8.44 25.23 < 0.0001 *** 63.28
Age variation among female groups (severe anemia) 3 7.6 24.35 < 0.0001 *** 81.85
Age variation among male groups (moderate anemia) 3 10.12 26.38 < 0.0001 *** 79.59
Age variation among male groups (mild anemia) 3 73.1 124 < 0.0001 *** 96.1
Age variation among male groups (severe anemia) 3 0.39 2.84 0.08 ns 32.05
166 SN Compr. Clin. Med. (2020) 2:164–172
Fig. 1 a–c Percentage of anemia comparisons between male and female
Table 3 Comparisons of prevalence of anemia (moderate, mild, and severe range) between male and female in each year (2014–2018). Statisticalanalysis was done by two-way ANOVA on all data followed by t test between different groups
Years Total female (n) Anemic female (%) Total male (n) Anemic male (%) Difference in % 95% CI of diff. t P value Summary
Female vs male (moderate anemia)
2014 49,578 (8278) 16.7 50,023 (2375) 4.748 − 11.95 − 16.07 to − 7.833 13.37 P < 0.001 ***
2015 54,935 (8800) 16.02 56,595 (2826) 4.993 − 11.03 − 15.14 to − 6.909 12.33 P < 0.01 **
2016 58,305 (10257) 17.59 56,643 (2464) 4.35 − 13.24 − 17.36 to − 9.126 14.81 P < 0.001 ***
2017 57,913 (10345) 17.86 56,624 (2821) 4.982 − 12.88 − 17.00 to − 8.765 14.41 P < 0.001 ***
2018 53,818 (9153) 17.01 52,806 (2781) 5.266 − 11.74 − 15.86 to − 7.625 13.13 P < 0.001 ***
Female vs male (mild anemia)
2014 49,578 (8990) 18.13 50,023 (5413) 10.82 − 7.312 − 9.891 to − 4.733 13.05 P < 0.001 ***
2015 54,935 (9773) 17.79 56,595 (6041) 10.67 − 7.116 − 9.695 to − 4.537 12.7 P < 0.01 **
2016 58,305 (10077) 17.28 56,643 (5716) 10.09 − 7.192 − 9.771 to − 4.613 12.84 P < 0.01 **
2017 57,913 (9533) 16.46 56,624 (5713) 10.09 − 6.372 − 8.950 to − 3.793 11.38 P < 0.01 **
2018 53,818 (8825) 16.4 52,806 (5462) 10.34 − 6.054 − 8.633 to − 3.476 10.81 P < 0.01 **
Female vs male (severe anemia)
2014 49,578 (1559) 3.14 50,023 (402) 0.80 − 2.34 − 4.046 to − 0.6338 6.314 P < 0.05 *
2015 54,935 (1563) 2.84 56,595 (647) 1.14 − 1.7 − 3.406 to 0.006180 4.587 P > 0.05 ns
2016 58,305 (1722) 2.95 56,643 (538) 0.94 − 2.01 − 3.716 to − 0.3038 5.424 P < 0.05 *
2017 57,913 (1876) 3.23 56,624 (454) 0.80 − 2.43 − 4.136 to − 0.7238 6.557 P < 0.05 *
2018 53,818 (1322) 2.45 52,806 (453) 0.85 − 1.6 − 3.306 to 0.1062 4.318 P > 0.05 ns
SN Compr. Clin. Med. (2020) 2:164–172 167
Table4
Prevalence
ofanem
iabetweenKuw
aitiandnon-Kuw
aiti(m
aleandfemale)
Kuw
aitifemalevs
non-Kuw
aitifemale(m
oderateanem
ia)
Years
TotalK
uwaitifemale
Moderateanem
icKuw
aitifemale
Totaln
on-K
uwaitifemale
Moderateanem
icnon-Kuw
aitifemale
Difference
95%
CIof
diff.
tPvalue
Summary
2014
26,102
(4813)
18.44
23,476
(3465)
14.76
−3.679
−9.163to
1.804
3.089
P>0.05
ns2015
29,507
(5263)
17.84
25,428
(3536)
13.91
−3.931
−9.414to
1.553
3.3
P>0.05
ns2016
34,095
(6858)
20.11
24,210
(3399)
14.04
−6.075
−11.56to
−0.5911
5.1
P<0.05
*2017
36,489
(7334)
20.1
21,424
(3011)
14.05
−6.045
−11.53to
−0.5612
5.075
P<0.05
*2018
35,523
(6738)
18.97
18,295
(2415)
13.2
−5.768
−11.25to
−0.2840
4.843
P<0.05
*Kuw
aitifemalevs
non-Kuw
aitimale(m
oderateanem
ia)
Years
TotalK
uwaitimale(n)
Moderateanem
icKuw
aitimale(%
)To
taln
on-K
uwaitimale(n)
Moderateanem
icnon-Kuw
aitimale(%
)Difference
95%
CIof
diff.
tPvalue
Summary
2014
17,422
(1121)
6.434
32,601
(1254)
3.847
−2.588
−4.853to
−0.3223
5.259
P<0.05
*2015
19,863
(1458)
7.34
36,732
(1368)
3.724
−3.616
−5.882to
−1.350
7.348
P<0.01
**2016
21,788
(1425)
6.54
34,855
(1039)
2.981
−3.559
−5.825to
−1.294
7.233
P<0.01
**2017
24,849
(1780)
7.163
31,775
(1041)
3.276
−3.887
−6.153to
−1.622
7.899
P<0.01
**2018
25,358
(1788)
7.051
27,448
(993)3.618
−3.433
−5.699to
−1.168
6.977
P<0.05
*Kuw
aitifemalevs
non-Kuw
aitifemale(m
ildanem
ia)
Years
TotalK
uwaitifemale
Mild
anem
icKuw
aitifemale(%
)To
taln
on-K
uwaitifemale
Mild
anem
icnon-Kuw
aitifemale(%
)Difference
95%
CIof
diff.
tPvalue
Summary
2014
26,102
(5022)
19.24
23,476
(3968)
16.9
−2.338
−6.407to
1.732
2.645
P>0.05
ns2015
29,507
(5569)
18.87
25,428
(4204)
16.53
−2.341
−6.410to
1.729
2.648
P>0.05
ns2016
34,095
(6160)
18.07
24,210
(3916)
16.18
−1.892
−5.961to
2.177
2.141
P>0.05
ns2017
36,489
(6061)
16.61
21,424
(3472)
16.21
−0.4044
−4.474to
3.665
0.4575
P>0.05
ns2018
35,523
(5931)
16.7
18,295
(2894)
15.82
−0.8777
−4.947to
3.191
0.9931
P>0.05
nsKuw
aitifemalevs
non-Kuw
aitimale(m
ildanem
ia)
Years
TotalK
uwaitimale(n)
Mild
anem
icKuw
aitimale(%
)To
taln
on-K
uwaitimale(n)
Mild
non-Kuw
aitianem
icmale(%
)Difference
95%
CIof
diff.
tPvalue
Summary
2014
17,422
(2165)
12.43
32,601
(3248)
9.963
−2.464
−5.766to
0.8385
3.435
P>0.05
ns2015
19,863
(2657)
13.38
36,732
(3384)
9.213
−4.164
−7.466to
−0.8616
5.805
P<0.05
*2016
21,788
(2603)
11.95
34,855
(3113)
8.931
−3.016
−6.318to
0.2867
4.204
P>0.05
ns2017
24,849
(2851)
11.47
31,775
(2863)
9.01
−2.463
−5.765to
0.8393
3.434
P>0.05
ns2018
25,358
(3075)
12.13
27,448
(2387)
8.696
−3.43
−6.732to
−0.1275
4.782
P<0.05
*Kuw
aitifemalevs
non-Kuw
aitifemale(severeanem
ia)
Years
TotalK
uwaitifemale
Severe
anem
icKuw
aitifemale(%
)To
taln
on-K
uwaitifemale
Severe
anem
icnon-Kuw
aitifemale(%
)Difference
95%
CIof
diff.
tPvalue
Summary
2014
26,102
(742)2.84
23,476
817(3.48)
0.64
−2.160to
3.440
1.052
P>0.05
ns2015
29,507
(730)2.47
25,428
876(3.44)
0.97
−1.830to
3.770
1.595
P>0.05
ns2016
34,095
(1052)
3.08
24,210
670(2.76)
−0.32
−3.120to
2.480
0.5261
P>0.05
ns2017
36,489
(1242)
3.40
21,424
634(2.95)
−0.45
−3.250to
2.350
0.7399
P>0.05
ns2018
35,523
(844)2.37
18,295
478(2.61)
0.24
−2.560to
3.040
0.3946
P>0.05
nsKuw
aitifemalevs
non-Kuw
aitimale(severeanem
ia)
Years
TotalK
uwaitimale(n)
Severe
anem
icKuw
aitimale(%
)To
taln
on-K
uwaitimale(n)
Severe
non-Kuw
aitianem
icmale(%
)Difference
95%
CIof
diff.
tPvalue
Summary
2014
17,422
(136)0.78
32,601
(265)0.81
0.03
−0.9442
to1.004
0.1418
P>0.05
ns2015
19,863
(292)1.47
36,732
(355)0.96
−0.51
−1.484to
0.4642
2.41
P>0.05
ns2016
21,788
(260)1.19
34,855
(278)0.79
−0.4
−1.374to
0.5742
1.89
P>0.05
ns2017
24,849
(247)0.99
31,775
(207)0.65
−0.34
−1.314to
0.6342
1.607
P>0.05
ns2018
25,358
(275)1.08
27,448
(178)0.64
−0.44
−1.414to
0.5342
2.08
P>0.05
ns
168 SN Compr. Clin. Med. (2020) 2:164–172
population (for both male and female groups). A very lowpercentage of Kuwaiti females (2–4%) and Kuwaiti males(0.5–2%) fell into the severe range of the anemia group.Year-wise comparison of data showed that the year 2017had the highest percentage (3.4%) of anemic people amongKuwaiti females and the year 2015 had the highest percent-age (1.4%) of anemic people among Kuwaiti males. Mostof the Kuwaiti population fell into the moderate and mildrange of anemia (Fig. 2a, f).
Age-Wise Distribution of Anemic Population
In the moderate range, among females, the 36–45 age grouphad predominantly higher percentage of anemic people thanother age groups for three consecutive years, i.e., 2014–2016(Table 5), while in 2017 and 2018, the youngest female adultgroup (18–25 years) had higher percentage of anemic peoplethan other age groups. In the mild range, among differentfemale groups, both 36–45 and 46–60 age groups were sig-nificantly more anemic than other age groups (SupplementaryTable 1). Also, in the severe range of anemia, the 36–45 agegroup had the highest percentage of the anemic populationthan other female groups, and this result was consistent for5 years (Supplementary Table 2). In 2017, the highest percent-age (6%) of females from the 36–45 age group fell into thesevere range of anemic group (Fig. 3a-3f).
Among various male groups, the oldest adult male group(46–60 years old) of this study showed consistently higher
anemia in both moderate and mild ranges over 5 years(2014–2018) (Supplementary Tables 3 and 4). Similar to thefemale groups, in the years 2017 and 2018, the youngest adult(18–25) group of males also showed an increase in the per-centage of anemic population at the moderate range(Supplementary Table 5). In the severe range of anemiaamong various male groups, the 46–60 age group had thehighest percentage of anemic people (SupplementaryTable 6).
Overall, in both male and female populations, the olderadult groups (36–45 and 46–60) had higher percentage ofanemic people than the younger adult groups; however, inthe years 2017 and 2018, the 18–25 age female group wasexceptional—significantly high percentage of anemia (25%and 21% respectively) was observed in the moderate rangein this age group for two consecutive years.
Discussion
The current 5-year study showed the prevalence of anemiawas significantly higher among females than males, which issimilar to the 2014 KNSS (Kuwait Nutrition SurveillanceSystem) data. Globally, on average, the prevalence of anemiais twice in females than in males [11]. The current studyshowed that females were nearly 3–4 times more anemic thanmales in the moderate range and nearly 1.6 times more anemicthan males in the mild range. Some studies showed that the
Fig. 2 a–f Percentage of anemia comparisons between Kuwaiti and non-Kuwaiti population
SN Compr. Clin. Med. (2020) 2:164–172 169
Table5
Anemicpopulatio
npercentage
ofdifferentage
grouppeople
Years
Age
group
Totalfem
ale(n)
Femalemoderateanem
ic(n)
Femalemoderateanem
ic(%
)Femalemild
anem
ic(n)
Femalemild
anem
ic(%
)Femalesevere
anem
ic(n)
Femalesevere
anem
ic(%
)2014
18–25
6297
1042
16.54756
1068
16.96046
141
2.239162
26–35
13,056
2008
15.3799
2362
18.0913
305
2.336091
36–45
12,086
2190
18.12014
2338
19.3447
491
4.062552
46–60
18,139
3038
16.74844
3222
17.76283
622
3.429075
Age
group
Totalm
ale(n)
Malemoderateanem
ic(n)
Malemoderateanem
ic(%
)Malemild
anem
ic(n)
Malemild
anem
ic(%
)Malesevere
anem
ic(n)
Malesevere
anem
ic(%
)18–25
4985
236
4.734203
330
6.61986
220.441324
26–35
11,940
499
4.179229
944
7.906198
490.410385
36–45
12,226
365
2.985441
967
7.909373
800.654343
46–60
20,872
1275
6.108662
3172
15.19739
251
1.202568
2015
Age
group
Totalfem
ale(n)
Femalemoderateanem
ic(n)
Femalemoderateanem
ic(%
)Femalemild
anem
ic(n)
Femalemild
anem
ic(%
)Femalesevere
anem
ic(n)
Femalesevere
anem
ic(%
)18–25
7540
1159
15.37135
1243
16.48541
168
2.228117
26–35
14,712
2122
14.4236
2641
17.95133
302
2.052746
36–45
13,136
2386
18.16382
2459
18.71955
541
4.118453
46–60
19,547
3132
16.02292
3428
17.53722
552
2.823963
Age
group
Totalm
ale(n)
Malemoderateanem
ic(n)
Malemoderateanem
ic(%
)Malemild
anem
ic(n)
Malemild
anem
ic(%
)Malesevere
anem
ic(n)
Malesevere
anem
ic(%
)18–25
6132
317
5.169602
453
7.387476
124
2.022179
26–35
13,796
652
4.726008
989
7.168745
118
0.85532
36–45
13,974
423
3.02705
1112
7.957636
106
0.758552
46–60
22,693
1434
6.319129
3487
15.36597
299
1.317587
2016
Age
group
Totalfem
ale(n)
Femalemoderateanem
ic(n)
Femalemoderateanem
ic(%
)Femalemild
anem
ic(n)
Femalemild
anem
ic(%
)Femalesevere
anem
ic(n)
Femalesevere
anem
ic(%
)18–25
9117
1736
19.04135
1374
15.07075
176
1.93046
26–35
15,583
2625
16.84528
2666
17.10839
390
2.502727
36–45
13,939
2701
19.37729
2513
18.02855
651
4.670349
45–60
19,666
3196
16.2514
3524
17.91925
505
2.567884
Age
group
Totalm
ale(n)
Malemoderateanem
ic(n)
Malemoderateanem
ic(%
)Malemild
anem
ic(n)
Malemild
anem
ic(%
)Malesevere
anem
ic(n)
Malesevere
anem
ic(%
)18–25
6865
261
3.801894
467
6.802622
104
1.514931
26–35
13,613
656
4.818923
758
5.568207
630.462793
36–45
13,896
339
2.439551
1136
8.175014
710.510938
45–60
22,269
1211
5.438053
3355
15.06579
300
1.347164
2017
Age
group
Totalfem
ale(n)
Femalemoderateanem
ic(n)
Femalemoderateanem
ic(%
)Femalemild
anem
ic(n)
Femalemild
anem
ic(%
)Femalesevere
anem
ic(n)
Femalesevere
anem
ic(%
)18–25
10,369
2600
25.07474
1404
13.54036
203
1.957759
26–35
15,776
2681
16.99417
2649
16.79133
369
2.338996
36–45
13,433
2324
17.30068
2309
17.18901
852
6.342589
45–60
18,335
2740
14.9441
3171
17.29479
452
2.46523
Age
group
Totalm
ale(n)
Malemoderateanem
ic(n)
Malemoderateanem
ic(%
)Malemild
anem
ic(n)
Malemild
anem
ic(%
)Malesevere
anem
ic(n)
Malesevere
anem
ic(%
)18–25
7509
476
6.33906
577
7.684112
370.492742
26–35
14,143
768
5.430248
1009
7.134271
770.544439
36–45
13,245
321
2.423556
936
7.066818
890.671952
45–60
21,727
1256
5.780826
3192
14.6914
251
1.155245
2018
Age
group
Totalfem
ale(n)
Femalemoderateanem
ic(n)
Femalemoderateanem
ic(%
)Femalemild
anem
ic(n)
Femalemild
anem
ic(%
)Femalesevere
anem
ic(n)
Femalesevere
anem
ic(%
)18–25
10,352
2211
21.35819
1447
13.97798
182
1.758114
26–35
15,197
2690
17.70086
2519
16.57564
277
1.822728
36–45
12,266
1966
16.02805
2214
18.04989
532
4.337192
45–60
16,003
2286
14.28482
2645
16.52815
331
2.068362
Age
group
Totalm
ale(n)
Malemoderateanem
ic(n)
Malemoderateanem
ic(%
)Malemild
anem
ic(n)
Malemild
anem
ic(%
)Malesevere
anem
ic(n)
Malesevere
anem
ic(%
)18–25
7918
538
6.794645
740
9.345794
330.416772
26–35
14,146
753
5.32306
1055
7.457939
126
0.890711
36–45
12,381
335
2.705759
913
7.374202
910.734997
45–60
18,361
1155
6.290507
2754
14.99918
203
1.105604
170 SN Compr. Clin. Med. (2020) 2:164–172
daily intake of iron, calcium, vitamin A, folate, and zinc wasbelow the recommended daily allowance (RDA) amongKuwaiti women [12, 13].
Previous reports showed that nearly 5.6% of the US popu-lation was under anemia category; moreover, on average,1.5% of the US population fell under the moderate-severeanemia in 2003–2012, which was quite low compared to cur-rent data of Kuwait, where nearly 16% female and 5% malewere in the moderate range of anemia [14]. The prevalence ofanemia in Canada and northern Europe is nearly similar to thatin the USA and is much lower than that in Kuwait [11]; how-ever, women from some of the underprivileged and develop-ing countries in Africa (nearly 47.5%) and Asia (35.7%) havea quite higher rate of anemia than Kuwaitis [15, 16]. It wasreported that the rates of anemia increased monotonically inmen; however, in female, bimodal increase was observed, i.e.,40–49 years and 80–85 years age groups had the highest riskof anemia than other groups [14]. In our study, we found thatthe 36–45 age group among females and 46–60 age groupamong males were the most prevalent anemic population,which was nearly similar to the previous reports. Globally,bimodal frequency distribution of acute anemia affects mainlytwo age groups, young adult group and people with the ageabove 50s [11]. Current study showed similar results in 2017and 2018, the youngest female adult group (18–25 years) hada higher percentage of anemic people than other age groups.The reasons for anemia in the young adult female group mightbe due to heavy menstrual and ectopic bleeding or severehemolysis during childbearing periods [11].
The current study showed the prevalence of anemia wasmore in the Kuwaiti population than the non-Kuwaiti popula-tion, and most of them belong to the moderate and mild rangeof anemia, which was similar to the World HealthOrganization classification of public health.
In this study, we found that the rate of anemia can vary withdifferent factors like age group, nationality, and gender.Therefore, taking these multiple factors into account, it is im-perative to design response systems carefully to reduce theanemic population in Kuwait. Though the per capita incomeof Kuwaiti people is quite higher than in many countries, theprevalence of anemia is alarming, specifically among femalesand older people. Therefore, more studies and public aware-ness programs are needed to reduce the anemia rate in Kuwait.
Compliance with Ethical Standards
Conflict of Interest The authors declare that they have no conflict ofinterest.
Ethical Approval Ethical approval of this study was granted by theEthics Committee of Kuwait Ministry of Health.
Informed Consent Not applicable.
References
1. WHO. Nutritional anemia: report of a WHO scientific group.Geneva: WHO, 1968.
Fig. 3 a–f Percentage of anemia comparison between different agegroups. “***” denotes most significant and its p value is < 0.0001, “**”denotes p value < 0.001, “*” denotes least significant which p value is <
0.05, and “ns” denotes not significant. The statistical analysis was doneusing GraphPad prism. We performed two-way ANOVA and t test todetermine the significance level (p value) among various parameters
SN Compr. Clin. Med. (2020) 2:164–172 171
2. McLean E, Cogswell M, Egli I. Worldwide prevalence of anemia,WHO vitamin and mineral nutrition information system. PublicHealth Nutr. 200;12:444–454.
3. Benoist BD, McLean E, Egli I. WHO global database on anemia.Geneva: World Health Organization, 2008.
4. Durrani A. Prevalence of anemia in adolescents: a challenge to theglobal health. ACTA Sci Nutr Health. 2018;2:24–7.
5. KassebaumN, Jasrasaria R, NaghaviM,Wulf SK, JohnsN, LozanoR, et al. A systemic analysis of global anemia burden from 1990 to2010. Blood. 2014;123:615–24.
6. WHO. Haemoglobin concentrations for the diagnosis of anaemiaand assessment of severity. Retrieved: July 15, 2019, from WorldHealth Organization.
7. Al-Qaoud NM, Al Shami E, Prakash P. Anemia and associatedfactors among Kuwaiti preschool children and their mothers.Alexandria J Med. 2015;51:161–6.
8. Diejomaoh FM, Haider MZ, Dalal H, Abdulaziz A, D'Souza TM,Adekile AD. Influence of alpha-thalassemia trait on the prevalenceand severity of anemia in pregnancy among women in Kuwait.Acta Haematol. 2000;104:92–4.
9. Adekile A, Haider M. Haptoglobin gene polymorphisms in sicklecell disease patients with different betaS-globin gene haplotype.Med Princ Pract. 2010;19:447–50.
10. Kuwait Nutrition Surveillance System 2014 Annual Report.Retrieved 07 18, 2019, from Kuwait Ministry of Health: https://
12. AlMousaa Z, Prakasha P, Jackson RT, AlRaquaa M. A comparisonof selected nutrient intakes in anemic and nonanemic adolescentgirls in Kuwait. Nutr Res. 2003;23:425–33.
13. Al Zenki S, AlomirahH, Al Hooti S, Al Hamad N, JacksonRT, RaoA, et al. Prevalence and determinants of anemia and iron deficiencyin Kuwait. Int J Environ Res Public Health. 2015;12:9036–45.
14. Le CH. The prevalence of anemia and moderate-severe anemia inthe US population (NHANES 2003-2012). PLoS One. 2016;11:e0166635.
15. Mahoney DH Jr. Anemia in at-risk populations—what should beour focus? Am J Clin Nutr. 2008;88:1457–8.
16. WHO C. Worldwide prevalence of anaemia 1993–2005. WHOglobal database on anaemia 2008. https://www.who.int/vmnis/database/anaemia/anaemia_status_summary/en/.
Publisher’s Note Springer Nature remains neutral with regard tojurisdictional claims in published maps and institutional affiliations.
