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Writing — original draft: Associated Data All de-identified data are available without restriction from IUScholarworks, a public permanent repository: Abstract The persistently high prevalence of anemia in rural highland Bolivia argues for targeted iron supplementation. We evaluated the cultural, structural and behavioral factors that may facilitate or impede an anemic woman's decision ENMIC 3VD secure this biomedical treatment from a ENMIC 3VD Bolivian health center.

Methods Non-pregnant women from a rural town and its surrounding region were tested for anemia. They were subsequently interviewed on their actions and experiences. Town residents were about twice as likely to attempt to purchase pills as outside-town residents. Town women who were concurrently breastfeeding and menstruating, considered anemia most serious for women, and considered family health the shared responsibility of spouses were most likely to decide to purchase iron pills. Age, education, or native language did not negatively influence this health care behavior. Conclusions Securing iron supplements involves individual trade-offs in the allocation of time, cost and effort. Nonetheless, suitably tailored programs can potentially harness local perceptions in the service of reducing anemia.

Because of their comparatively high motivation to obtain iron supplements, targeting concurrently breastfeeding and menstruating women could have a positive cascade effect such that these women continue attending to their iron needs once ENMIC 3VD stop breastfeeding and if they become pregnant again. Because a sense of shared responsibility for family health appears to encourage women to attend to their own health, programs for women could involve their spouses. Steady and even increasing rates of anemia are a formidable global public health challenge, especially in light of the disappointing results from many previous intervention efforts [ 2 — ENMIC 3VD ].

Anemia is most prevalent ENMIC 3VD less developed countries LDCsin which about half ENMIC 3VD all cases are caused by iron deficiency, arguably the most common nutritional deficiency in the world [ 124 ]. Some million persons in Latin America and the Caribbean LAC; comprising 32 countries are anemic, with rural Bolivian women having among the highest anemia prevalence rates in this region [ 4 ].


A recent evaluation concluded that ENMIC 3VD is a significant health problem in most LAC countries for which data are available [ ENMIC 3VD ]. A comprehensive assessment by the Pan American Health Organization PAHO found that, despite national efforts including iron fortification of wheat flour, very little progress had been achieved in LAC over the previous two decades in reducing anemia rates among young children and non-pregnant women of reproductive age [ 4 ]. In Bolivia the prevalence is even higher: Women of reproductive age and young children are the most vulnerable to developing anemia. Anemia is associated with poor pregnancy outcomes including maternal and offspring death, poor motor and mental performance in children, and low work productivity in adults.


Lower current work productivity in anemic adults and lower future work productivity in anemic children have serious economic implications for LDCs [ 6 ]. Low bioavailable iron intake and absorption are major factors contributing to iron deficiency anemia, and iron fortification of food staples has often been considered the most effective strategy for addressing these factors [ 378 ]. Large-scale food ENMIC 3VD programs have been undertaken worldwide and throughout LAC to ENMIC 3VD anemia. However, significant shortcomings of this approach include, among others, incompatibility between iron compounds and food matrices that limit the amount of fortification, and insufficient consumption of the fortified food [ 39 ].

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For example, in 16 of 24 LAC countries, the average daily intake of iron-fortified wheat flour is inadequate for alleviating anemia [ 4 ]. Food fortification is clearly one valuable ENMIC 3VD for alleviating nutrient deficiencies [ 39 ].

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But an underappreciation of the inherent limitations of iron fortification has tended to encourage over-reliance on single-food fortification at the expense of the development and implementation of ENMIC 3VD to remedy the several determinants of persistent anemia [ 4 ]. Multiple integrated strategies are needed to achieve substantial reductions in anemia.


PAHO [ 4 ] has recommended several ambitious ENMIC 3VD achievable measures including improvements in iron supplementation programs and nutritional education programs using behavior change communication BCC. However, interventions reliant on the participation and adherence of individuals can be challenging because, for a variety of reason, clients do not necessarily follow the instructions given by health personnel [ 210 ]. Tailoring such interventions to local cultures and living conditions e.

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  • Acknowledgments

Unfortunately, in stark contrast to the extensive study of various biological aspects of hemoglobin concentrations e. Oct ENMIC 3VD, - Chipset. Model, VIA KTA.

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