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 Med. J. Cairo Univ., Vol. 78, No. 2, March: 109-118, 2010

www.medicaljornalo!caironiver"i#$.com

Effect of Nutritional Interventions on Anemic Pregnant Women’sHealth Using Health Promotion Model

MARIAM AMER AL-TELL, D.N.Sc.*1; FATEN KHAYRAT EL-GUINDI, D.N.Sc.*

2;

 NAWAL MAHMOUD SOLIMAN, D.N.Sc.*3

and HISHAM EL-NANA, M.D.**

4%he &e'ar#men#" o

1 ! Co

4mmni#$ (eal#h Nr"in)* and +"#e#ric" and

$n2e ,3

colo)$** , acl#$ o! Nr"in), /n-Najah Univer"i#$,

 Na'l", ale"#in*  , ** and acl#$ o! Nr"in), /in ham" Univer"i#$* .

A!stract

Iron de!c!enc" ane#!a !$ one o %&e #a!n &ea'%& (ro)'e#$!n a'e$%!ne, !% aec%$ a)o+% a +ar%er o (renan% o#en &oa%%ended %&e M!n!$%r" o Hea'%& ac!'!%!e$ !n %&e We$% /an0.I% !$ (re1en%a)'e &!'e !%$ con$e+ence$ can2% )e (re1en%edor %rea%ed ea$!'". Hea'%& /e'!e1e Mode' 3H/M4 !$ !de'" +$ed!n !n%er1en%!on (rora#$ %&a% a!#!n %o c&an!n  )e&a1!or$.

 /im o! #he #d$: Wa$ %o e1a'+a%e %&e eec% o n+%r!%!ona'!n%er1en%!on$ +$!n &ea'%& (ro#o%!on #ode' %&ro+& c&an!n!n %&e!r (erce(%!on reard %&e r!$0 o an!#a.

jec#" and Me#hod": 5+a$!-e6(er!#en%a' de$!n, +$!ncon%ro' ro+(.

am'le: I% a$ a con1en!en% $a#('e !nc'+ded 789 (renan% ro# an%ena%a' care 3AN:4 o MOH !n Na)'+$

c!%"a'e$%!ne.

 e"earch %ool: To %oo'$ ere +$ed or da%a co''ec%!on;%&e !n%er1!e!n +e$%!onna!re %&a% con$!$% o < (ar%$; %&e$oc!o-de#ora(&!c and #a%erna' (ro!'e o (renan% o#en,%&e!r (erce(%!on a)o+% r!$0 and $+$ce(%!)!'!%" %o !ron ane#!aand %&e!r d!e%ar" &a)!%$(rac%!ce. T&e $econd %oo' a$ %&e!n1e$%!a%!on 'a)ora%or" %oo' %&a% a$$e$$ed %&e &e#o'o)!n'e1e' o (renan% o#en. A'' (renan% o#en !n%er1!eed,and re$+'%$ o )'ood $a#('e$ or &e#o'o)!n 'e1e' o)%a!nedro# %&e MOH 'a)ora%or!e$. Da%a ere ana'"=ed +$!n SSS$o% are.

 e"l#": T&e $%+d" re$+'% $&oed o1era'' $!n!!can%re'a%!on$&!( )e%een  (erce!1!n r!$0 o ane#!a and ea%!n (rac%!ce$, and )e%een c&an!n ea%!n (rac%!ce$ and !#(ro1e-

#en% !n &e#o'o)!n 'e1e' o  (renan% o#en. Ac%!on$ a%#o%&er c&!'d &ea'%& cen%er$ reard!n #anae#en% o ane#!aa#on (renan% o#en +$!n (r!nc!('e$ o Hea'%& ro#o%!onMode'Hea'%& /e'!e Mode' !n d!eren% !n%er1en%!on (rora#$$&o+'d )e re+e$% or.

 Key Words:  re)nanc$ 3 4ron de!icienc$ anemia 3 (eal#helie! model 3  erceivin) ri"5 3 6a#in)  'rac-#ice" 3 (emo)loin level.

Correspondence to: Dr. Mar!a# A#er A'-Te'', T&e De(ar%#en%o :o##+n!%" Hea'%& N+r$!n, Fac+'%" o N+r$!n, An-Na>a&Un!1er$!%", Na('+$, a'e$%!n.

Introduction

ANEMIA" a$ de!ned )" S0!0ne #1$ !$ a de!c!enc"!n red )'ood ce''$ 3R/:$4 or a decrea$e !n &e#o-'o)!n and !% !$ a $"#(%o# %&a% can re$+'% ro##an" +nder'"!n  (a%&o'o!e$.

In $(!%e o %&e ac% %&a% #o$% M!n!$%r!e$ o Hea'%& !n de1e'o(!n co+n%r!e$ &a1e (o'!c!e$ %o%ac0'e %&!$ #a!n &ea'%& (ro)'e#, !.e. (ro1!de

 (renan% o#en !%& !ron !n $+(('e#en%,#a%erna' ane#!a  (re1a- 'ence &a$ no% dec'!ned,and a$ e$%!#a%ed )" WHO, %&e  (re1a'ence ra%e o !ron de!c!enc" ane#!a a#on (renan% o#en

or'd!'d !$ 3??.@4 #2$ co#(ared %o ?@ !nde1e'o(!n co+n%r!e$ o  (re- nan% o#en !nde1e'o(!n co+n%r!e$ are ane#!c. Ane#!a aec%$a)o+% 37@4 o#en d+r!n  (re- nanc" !nde1e'o(ed co+n%r!e$ #3"$ , #o$% o %&e# erea'read" ane#!c a% %&e %!#e o conce(%!on.

Iron de!c!enc" ane#!a !$ %&e one o #o$% co#-#on &e#a%o'o!c co#('!ca%!on d+r!n  (renanc",$e1ere ane#!a !ncrea$e$ %&e r!$0 o #a%erna' ande%a' #or)!d!%" and #or%a'!%", and %&e r!$0 o (re-#a%+re de'!1er" and 'o )!r%& e!&% or %&e !nan%,

and !% !$ a$$oc!a%ed !%& 'oer !nan% A(ar $core$#%&'$ . In add!%!on, !nan%$, &o$e #o%&er$ ere !ronde!c!enc" ane#!c, are a% !ncrea$ed r!$0 o de1e'-o(!n !ron de!c!enc" ane#!a ear'!er, )eca+$e %&e!r !ron $%ore$ #a" )e 'o a% )!r%& #($ .

Hea'%& /e'!e1e Mode' !$ !de'" +$ed !n !n%er-1en%!on (rora#$ %&a% a!#!n %o c&an!n  )e&a1-!or$, e$(ec!a''" %&o$e re'a%ed %o !nec%!o+$ d!$ea$e,d!e%ar" (rac%!ce$, and con%race(%!1e +$e, &!& )'ood

 (re$$+re $creen!n, $#o0!n ce$$a%!on, e6erc!$e,n+%r!%!on, )rea$% $e'-e6a#!na%!on and $e6+a' r!$0 

 )e&a1!or$ #)$ .

78B

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778  6!!ec# o! N#ri#ional 4n#erven#ion" on /nemic re)nan# 7omen Mariam /mer /l-%ell, e# al. 778

:&ane$ !n )e&a1!or accord!n %o %&!$ #ode' )a$ed on !1e co#(onen%$C erce!1ed $+$ce(%!)!'!%"CT&e )e'!e %&a% one !$ $+$ce(%!)'e %o %&e (ro)'e#,

 (erce!1ed $e1er!%"C T&e )e'!e %&a% a &ea'%& (ro)'e#!$ $er!o+$, (erce!1ed )ene!%$C T&e )e'!e %&a% c&an-

!n one$  )e&a1!or !'' red+ce %&e %&rea%, and (erce!1ed )arr!er$C A (erce(%!on o %&e o)$%ac'e$%o c&an!n one$  )e&a1!or. T&e$e co#(onen%$e6('a!n %&e !nd!1!d+a'2$ read!ne$$ %o ac% c+e$ %oac%!onC W&!c& $%!#+'a%e )e&a1!or, and $e'-e!cac",&!c& !$ one2$ con!dence !n %&e a)!'!%" %o $+cce$$-+''" (eror# an ac%!on and c&ane )e&a1!or #)&12$ . So %&e (o$!%!1e %&o+&%$, ra%&er %&an nea%!1eonce &e'( (er$on %o #a0e %&e c&ane. A$ con!%!1e!$ aec%ed )" a%%!%+de and ee'!n, %&ereore a%%!-%+de$ !n'+ence (eo('e2$ dec!$!on and ac%!on #13$ .eo('e do ea% or d!eren% rea$on$, !n add!%!on %o

 (&"$!o'o!ca' ac%or$; an6!e%", 'one'!ne$$, de(re$-

$!on, &a((!ne$$, ce'e)ra%!on. So 0no'ede o &a%%o ea% !$ e$$en%!a' %o !n'+ence &ea'%&+' oodc&o!ce, a'%&o+& %&e re'a%!on$&!( )e%een, ood andn+%r!en% and &a% %&e" ea% !$ 1er" ee0 a$re(or%ed )" Ho''!, e% a'. #13$ +n'e$$ (eo('e are!''!n and #o%!1a%ed %o c&ane. T&e #ode'a$$+#e$ %&a% a  (er$on2$ )e'!e$ a)o+% &ea'%& arede%er#!nan%$ o %&e (o$$!)!'!%" o an !nd!1!d+a'%o #a0e c&ane$ !n %&e '!e$%"'e )e&a1!or$#)"11"12"13$

. Hea'%& ed+ca- %!on !$ a 1er" cr+c!a'ac%or !n (re1en%!n !''ne$$, &!& (ro(or%!on o o#en 'ac0 !nor#a%!on reard- !n %&e!r &ea'%&and r!$0 ac%or$. *ro1!$!on o !nor#a%!on !''

&e'( %&e# !n %a0!n care o %&e#- $e'1e$ and %&e!r a#!'".

In a'e$%!ne, ane#!a !$ $%!'' con$!dered a (+)'!c&ea'%&  (ro)'e#, a$ !% aec%$ a)o+% a +ar%er o 

 (renan% o#en &o a%%ended %&e M!n!$%r" o Hea'%& ac!'!%!e$ !n %&e We$% /an0. Accord!n %o3HI:, 9884 #1$ %&e ra%e o ane#!c (renan%o#en &o a%%ended %&e MOH ac!'!%!e$, reac&ed%o 39?.@4; 37.@4 ere  (r!#!-ra1!da and37B.4 ere #+'%!-(aro+$ o#en. In UNRWA,%&e  (re1a'ence ra%e o ane#!a a#on  (renan%o#en a$ 3

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%ool" o! da#a collec#ion:

To %oo'$ ere +$ed or da%a co''ec%!on.

%he !ir"# #ool:

 4n#erviewin) e"#ionnaire: T&e +e$%!onna!rea$ de1e'o(ed )" re$earc&er !n Ara)!c 'an+ae,

 )a$ed on %&e re'a%ed '!%era%+re re1!e and $+(er1!-$or$ o(!n!on$, !% co#(r!$ed o %&e o''o!n %&ree

 (ar%$C

ar% oneC Soc!o-de#ora(&!c da%a and #a%erna'&!$%or" 3(re- a$$e$$#en% %oo'4 o (renan% o#en2$ae, occ+(a%!on, ed+ca%!ona' 'e1e', !nco#e 'e1e',n+#)er o (ar!%", n+#)er o a)or%!on, a#!'" ('an-n!n #e%&od$ +$ed, &!$%or" o (re$en%  (renanc",and %&e +$e o !ron $+(('e#en%, !n add!%!on %o#ed!ca' o)$%e%r!c &!$%or" (re$en% and  (a$%.

ar% %oC renan% o#en2$ (erce(%!on 3(re- (o$% %oo'4. I% con$!$%ed o 9 !%e#$; (erce!1ed r!$0 o !ron de!c!enc" ane#!a and (erce!1ed $+$ce(%!-

 )!'!%" %o !ron de!c!enc" ane#!a. T&e %o  (ar%$co#(o$ed o $%a%e#en% o '!0er% $ca'e #1'$ , %&a%+$ed or a$$e$$#en% o re$(onden% a%%!%+de$ and

 )e'!e$. T&e $ca'e &ad !1e re$(on$e a'%erna%!1e$3raned ro# $%ron'" aree %o $%ron'" d!$aree4,and !% )a$ed on &ea'%& )e'!e #ode' co#(onen%$,ado(%ed %&e de$!n o 3Ha=a1e&e!, e% a'., 988J4.

ar% %&reeC renan% o#en2$ (rac%!ce$ 3(re- (o$% %oo'4; !% co#(o$ed o %o e'e#en%$; %&e !r$%

one con$!$%ed o 3784 +e$%!on$ %&a% a$$e$$ed %&eo#en2$ ea%!n (rac%!ce$. T&e $econd one !nc'+ded3@4 +e$%!on$ %&a% a$$e$$ed %&e o#en coc0!n&a)!%$. T&e 7@ %& $%a%e#en%$ &ad < re$(on$e a'%erna-%!1e$, raned ro# ne1er %o a'a"$, and !% a$$cored a$ o''o!nC T&e < re$(on$e a'%erna%!1e$ere !1en %&e 1a'+e o

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'earn!n #a%er!a' a!#ed a% ac+!r!n (renan%o#en !nor#a%!on a)o+% ane#!a.

 4m'lemen#a#ion  'ha"e:

renan% o#en !n $%+d" ro+( ere oran!=ed

!n%o !1e ed+ca%!ona' ro+($ accord!n %o %&e!r e6(ec%ed da%e o de'!1er" 3EDD4. Eac& ro+( a$enco+n%ered %o 78 $e$$!on$.

 6vala#ion  'ha"e:

T&e $%+d" %oo' %&a% +$ed !n %&e a$$e$$#en% (&a$e a$ +$ed %o e1a'+a%e %&e eec% o %&e &ea'%& (ro- #o%!on (rora# on &ea'%& $%a%+$ o (renan%o#- en, and %&e!r  (erce(%!on, ea%!n

 (rac%!ce$. T&e e1a'+a%!on$ ere a%%a!ned %&ro+&co#(ar!n %&e $%+d" ro+( (re and (o$% %&e!#('e#en%a%!on o n+%r!%!ona' !n%er1en%!on

 (rora# and %&ro+& co#-  (ar!n %&e $%+d" and

%&e con%ro' ro+(. And !% a$ cond+c%ed %o %!#e$d+r!n %&e $%+d" and accord!n %o %&e E6(ec%edDa%e o De'!1er" 3EDD4 o (renan% o#enC T&e!r$% one a$ (eror#ed a% %&e $econd %r!#e$%er o 

 (renanc" 399-9? ee04 and &e#o'o- )!n 'e1e' o  (renan% o#en or )o%& $%+d" and con%ro'ro+($ ere rea$$e$$ed. T&e $econd e1a'- +a%!ona$ (eror#ed a% %&!rd (renanc" %r!#e$%er 3

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r!$0 and $+$ce(%!)!'!%" %o ane#!a and %&e!r ea%!n

 (rac%!ce$, Ta)'e 34C I''+$%ra%ed %&a%, (o$%-:NI, one

%&!rd o $%+d" ro+( &a1e &!& 'e1e' o (erce!1!n

r!$0daner %o ane#!a and ood ea%!n  (rac%!ce$'e1e', %&a% !nd!ca%ed a re'a%!on$&!( !n  (renan%o#en 'e1e' o ea%!n (rac%!ce and %&e!r (erce(%!on

reard r!$0 3 ' .1a'+e .87

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Ta)'e 34C D!$%r!)+%!on$ o $%+d" and con%ro' ro+($ reard$ %&e!r (erce(%!on 'e1e' a)o+% r!$0 %o IDA  (re-(o$%-:NI.

S%+d" No. 3? 74 :on%ro' No. 3?74 Te$%

I%e#re

o$%

# -%e$%

 ' .1a'+e

re

o$%

# -%e$%

 ' .1a'+e # -%e$%  ' .1a'+e

 erce'#ion level re)ard ri"5 o! anemia:

Under  9 9 -

Lo 9.J 79 ?.@J8 @.? .8 .< .

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Ta)'e 3J4C Re'a%!on$&!( )e%een d!e%ar" (rac%!ce$ and %&e!r   &e#o'o)!n  'e1e'  o   )o%&  ro+($  (o$%-:NI. 

Le1e' o (rac%!ce$

ar!a)'e S%+d" :on%ro' 

Good  oor r Good oor r 

.iscussion

F!nd!n o $%+d" 3Ta)'e 74 re1ea'ed %&a% #eanae o  (renan% o#en 99 .9 !%& d!eren%ed+ca%!on 'e1e', #ore %&an one %&!rd o $%+d" ro+(

and a)o+% one +ar%er o con%ro' ro+( &ad %&e!r +n!1er$!%" ed+ca%!on &!c& co#(a%!)'e !%& %&ere$+'%$ o :/S, #21$ %&a% !nd!ca%e$ '!%erac" ra%e,o e#a'e o ae ro+( 7?-9 and 9?-+!ce and $o+rce$ o 1!%a#!n : !%& !ron$+(('e#en% and ood, a$ !nd!ca%ed )" Sc&+#ann#2$ , Waer+ #2%$ , %&e a)$or(%!on ra%e$ o !ronco+'d r!$e $!n!- !can%'" ro# 'e$$ %&an 3?4 %o#ore %&an 37?4. In %&e o%&er &and ca'c!+#!n&!)!%$ and decrea$e a)$or(%!on o !ron and !% !$

reco##ended %o a1o!d %a0!n !ron %a)'e% or !ronr!c& ood !%& #!'0 #2*$ .

T&e !nd!n o %&e $%+d" reard$ !ron $+(('e-#en%ar" +$ae, !n %er# o %!#e o +$e, '+!d$ +$ed!%& !ron $+(('e#en%, and %&e ad&erence o (re-nan% o#en %o %&e +$e o !ron $+(('e#en%, re'ec%%&e (oor (rac%!ce$ o (renan% o#en reard!n!ron $+(('e#en% +$e, %&a% aec% on %&e a#o+n% !ron )!oa1a!'a)!'!%" and %&e )ene!% o +$!n !%, !% a'$ore'ec% %&e!r 0no'ede a)o+% %&e !ron a)$or(%!on

 (ro#o%er$ and !n&!)!%or$.

Accord!n %o %&e (erce(%!on o (renan% o#enreard$ %&e r!$0 o IDA, !nd!n o $%+d" 3Ta)'e 4!''+$%ra%ed %&a%,  (re-:NI, a)o+% %o %&!rd o 

 (renan% o#en !n )o%& $%+d" and con%ro' ro+(&a$ 'o 'e1e' o (erce(%!on reard$ daner and r!$0 o IDA, !%& no $!n!!can% d!erence )e%een )o%&ro+($ 3 '.J8B4. W&!'e (o$%-NI re$+'%$ !nd!ca%ed%&a% %&ere a$ !#(ro1e#en% !n %&e!r 'e1e' o 

 (erce(%!on$ !%& $!n!!can% d!erence a#on$%+d" ro+(, and  )e%een $%+d" and con%ro'ro+(, 3  ' .1a'+e .8?4. T&e$e !nd!n$ ere !n '!ne!%& $%+d" )" :a#()e'' #12$ %&a% $%+d!ed %&e eec%o (erce(%!on o d!a)e%!c (a%!en% on %&e!r (re1en%!1e

 )e&a1!or$ and re(or%ed %&a% (oor co#('!ca%!on (re1en%!1e )e&a1!or a#on

 Ma#ernal (A level:

M!'d .J< 9.7 97.< .8<

Modera%e   @ 7@ .887 78.

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U$!n &ea'%& )e'!e #e%&od %o c&ane  (renan%o#en2$ d!e%ar" (rac%!ce$, o+r $%+d" re1ea'ed a$!n!!can% c&ane$ (re-(o$% n+%r!%!ona' !n%er1en%!on,!n %&e 'e1e' o (renan% o#en2$ (erce(%!on$reard r!$0 and $+$ce(%!)!'!%" %o ane#!a. I% a'$o

!nd!ca%ed  (o$!%!1e re'a%!on$&!( )e%een (renan%o#en2$  (erce(%!on 'e1e' reard ane#!a and%&e!r ea%!n (rac%!ce$ and $!n!!can% d!erenceco#(ar!n $%+d" !%& con%ro' ro+(. Reard %&ere'a%!on$&!(  )e%een c&an!n d!e%ar" (rac%!ce$'e1e' o  (re- nan% o#en and %&e!r &e#o'o)!n'e1e', %&e $%+d" !nd!ca%ed a $!n!!can% (o$!%!1ere'a%!on$&!( )e%een d!e%ar"  (rac%!ce$ and!#(ro1!n o &e#o'o)!n 'e1e' !n co#(are !%&con%ro' ro+(. A'$o %&ere a$ (o$!%!1ere'a%!on$&!( )e%een #a%erna' &e#o- 'o)!n 'e1e'a% %&!rd %r!#e$%er o $%+d" ro+(, and %&e!r a%!+e'e1e', !n co#(are !%& con%ro' ro+(.

 ecommenda#ion:

De$!n!n and !#('e#en%!n n+%r!%!ona'  (ro-ra# %&a% concern!n o#en2$ &ea'%& d+r!n (re-nanc" +$!n &ea'%& (ro#o%!on #ode'$.

-eferences

7- SKIKNE /.C Ane#!aC D!ano$!$ and %rea%#en% o(%!on or o#en. T&e o+rna' o Fa#!'" rac%!ce, 988J. Fro#&%%(C.>(on'!ne.co# .

9- YEKTA Q., AYATOLLAHI H., *OURALI R. andFARQIN A.C red!c%!n ac%or$ !n !ron $+(('e#en% !n%a0ea#on (renan% o#en !n +r)an care $e%%!n. o+rna' oRe$earc& Hea'%& Sc!ence, @ 374C ((. or %&eor!e$, Fa#!'" Hea'%& In%erna%!ona' 3FHI4, 9889. Re-%r!e1ed ro# &%%(C.&!.oren a!d$a!d$ca(a!d$(+)$

 )e&re$)cr%&eo.&%#'.

78- GLANQ K., LEWIS F.M. and RIMER /.K.C Hea'%&  )e-&a1!or and &ea'%& ed+ca%!onC T&eor", re$earc& and (rac%!ce39nd ed.4, San Franc!$coC oe" /a$$, 7BBJ.

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