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Estimation of health impacts of nutritional deficiencies (iron and folic acid) and the preventive measures development

Author: Ciobanu Angela
Degree:doctor of medicine
Speciality: 14.00.07 - Hygiene
Scientific adviser: Ion Bahnarel
doctor habilitat, professor
Scientific council:


The thesis was presented on the 8 September, 2010
Approved by NCAA on the 4 November, 2010


Adobe PDF document2.66 Mb / in romanian


iron deficiency, folic acid, anemia, pregnant women, women of childbearing age, food supplements


Thesis structure: introduction, five chapters, conclusions, practical recommendations, bibliography with 207 references, 7 annexes, 117 pages of basic text, 30 tables, 28 figures, 4 boxes. The results were published in 9 scientific journals and collections.

The work is focused on the study of iron and folate deficiencies impacts on human health and the effectiveness of implemented prevention measures of these deficiencies in pregnant women, as well as on the development of preventive measures at the national level. The research’s objectives include: determination of anemia prevalence in different population groups and associated risk factors; assessment of birth defects caused by folic acid deficiency; assessment of knowledge on the application of iron and folic acid supplements by pregnant women and family doctors; evaluation of economic consequences caused by iron deficiency anemia, and justification of National Program to control iron and folic acid deficiencies.

Three studies have been carried out. The first study, based on laboratory analyses, included pregnant women before delivery (total – 286 persons) whose level of hemoglobin and serum iron in the blood was determined; additionally, the information on newborns was collected. In the second research a hemoglobin level was determined in women of childbearing age (7.099 persons). In both studies, the epidemiological data and data about KAP on folic acid and iron, were collected. The third study was designed to investigate, using a specially developed questionnaire, the knowledge of family doctors in prescribing iron and folic acid supplements for women during a pregnancy. Research results showed the high levels of anemia among pregnant women (43%) and women of childbearing age (27,3%). The statistical analysis demonstrated that the content of serum iron determines up to 70% of Hb level in the blood of pregnant women; in turn, a Hb low level result in the birth of premature and low birth-weight children. As risk factors for anemia there were identified: the consumption of meat <1 time per week (OR = 1,8), low education level (OR = 1,6), the presence of three and more children in the family (OR = 1,8), and < 60 days use of iron supplement (OR = 2,2) during pregnancy. The low level of knowledge and bad practice in using these supplements during pregnancy was established. Evaluated economic loss due to iron deficiency amount about an annual loss of 62,4 lei per capita, equivalent to 0,61 % of GDP.

Results of the study have served as a basis to draft the National Program to control iron and folic acid deficiencies.