Erhabor Osaro (Ph.D.)

1. Comparative study of serum ferritin levels between pre and post menopausal women attending UDUTH , Nigeria Erhabor Osaro (Ph.D.) Faculty of Medical Laboratory Science, Department of Haematology, Usmanu Danfodiyo University, Sokoto, Nigeria

2. Introduction • Plasma ferritin is an indirect marker of the total iron stores and is used as a diagnostic test for IDA • Iron deficiency is one of the most prevalent nutrient disorders • Women's lives are marked by a continuum from intrauterine life to the elderly years: infancy, childhood and adolescence, menarche, reproductive life, the menopausal transition and postmenopausal • Menopause is a natural aging process during which a woman passes from the reproductive to the non-reproductive years • Premenopausal women are among those at greatest risk for iron deficiency anaemia due to low ferritin level

3. Statement of the Problem • Estrogen deficiency is the main causative factor in menopausal symptoms and diseases. • Levels of serum ferritin are increased by two- to threefold from before menopause to after menopause. • Increased iron as a result of menopause could be a risk factor affecting the health of postmenopausal women. • Concurrent but inverse changes occur between iron and estrogen levels in healthy women during menopausal transition. • Iron Deficiency Anaemia in young women is a relevant health issue. It affects It affects 20% of non-pregnant women (16 and 49 years) in industrialized countries and >40% of women in developing countries

4. Aim • The aim of this study is to determine the differences in ferritin level between pre and postmenopausal women attending Usmanu Danfodiyo University Teaching Hospital Sokoto.

5. Specific Objectives • To compare the serum ferritin between pre and postmenopausal women attending UDUTH Sokoto. • To determine the prevalence of anaemia due to low serum ferritin level among pre and post-menopausal women attending UDUTH Sokoto. • To determine the effect of ethnicity on the ferritin level in pre and postmenopausal women attending UDUTH Sokoto. • To determine the effect of age on the ferritin level in pre and post -menopausal women attending UDUTH Sokoto. • To determine the effect of level of education on the ferritin level in pre and post -menopausal women attending UDUTH Sokoto.

6. Study Design and Study Site • Study Design This study is a comparative case-control study of serum ferritin level among pre and postmenopausal women attending Usmanu Danfodiyo University Teaching Hospital Sokoto. • Site of the Study • UDUTH Sokotois located in Sokoto State. Sokoto is located at the extreme Northwest of Nigeria. • The State shares border with the Republic of Niger to the North, Kebbi State to the West and Southeast and Zamfara State to the East. The state covers land area of about 60.33km₂. • SokotoState had a population of 3.6 million (Sokoto Diary, 2008). • The indigenous inhabitants of the area are the Hausa and Fulani. Other ethnic group resident in the area includes Igbo,Yoruba, Ebira, and Igala.

7. Materials and Methods Subjects • One hundred and fifty women constituted the participants for this study • 75 Pre-menopausal women • 75 Post-menopausal women attending Usmanu Danfodiyo University Teaching Hospital Sokoto • Inclusion Criteria • Inclusion criteria included age ≥ 18 years, non-pregnant and willingness to offer a written informed consent and being either pre or post menopausal. • Exclusion Criteria • Non-consenting, non -pre and postmenopausal women, pregnant women and girls below the age of 18 years will be excluded for this study.

8. Informed Consent and Ethical Approval • Informed Consent Written informed consent was obtained from the patients prior to the commencement of the study. • Ethical Clearance The approval for the entire study was obtained from the ethical committee in Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.

9. Sample Collection and Methods • Blood samples were collected by clean venipuncture and was delivered into plain plastic tube container. It was allowed to clot and the serum was obtained. • Serum was tested for serum ferritin using the ACCU Diag™ ELISA Ferritin kit (Cortez Diagnostics, U.S.A.). • The test is an a solid phase ELISA-based assay.

10. Statistical Analysis • Data collected was analyzed using SPSS version 20 computer statistical software package. • The results were expressed as mean ± SD. • Comparisons between populations were made using the Student's t-test for parametric data and the Chi-Square test for non-parametric. • A value of < 0.05 denoted a statistically significant difference.

11. Result • Mean age 43.99±19.22. The age range for premenopausal and postmenopausal women was 18-49 and 50-87 years respectively. • The serum ferritin was significantly higher among postmenopausal women 47.38 ± 43.00 compared to premenopausal women 21.96 ± 20.15 (p=0.01). • The prevalence of anaemia based on serum ferritin level was higher among premenopausal women (8.7%) compared to postmenopausal women (2.7%). • Low ferritin level <3.5ng/ml was higher among Hausa /Fulani (6.02%) compared to other ethnic groups (p=0.91). • Ferritin level <3.5ng/ml was higher among subjects with no formal education (p=0.69). • This study has shown that anaemia based on serum ferritin level of <3.5ng/ml was significantly higher among premenopausal compared to postmenopausal women.

12. Results

13. Table 2: Comparison of mean serum ferritin level between pre and post menopausal women

14. Table 3: Prevalence of anaemia due to low serum ferritin level in pre and postmenopausal women

15. Table 4: The effect of ethnicity on serum ferritin level between pre and postmenopausal women

16. Table 5: Effect of level of education on serum ferritin in pre and postmenopausal women

17. DISCUSSION • Finding from this study indicates that premenopausal women had lower serum ferritin compared to postmenopausal women. This finding is consistent with previous report (Milmanet al., 1992) . • Finding from this study is consistent with a previous report which indicated that young premenopausal women are among those at greatest risk for iron deficiency anaemia due to low ferritin level (Dandekar and Ujjwala, 2009).

18. Conclusion and Recommendations • Pre-menopausal women had low ferritin compared to post menopausal women (menstruation and pregnancy) (Zimmermann and Hurrell, 2007;Haarveyet al., 2005). • Common reason for low ferritin and high prevalence of IDA among post menopausal women include; use of hormone replacement therapy, blood donation, aspirin use, intake of heme iron, body mass index, and alcohol intake and occult bleeding (from a gastrointestinal ulcer) (Liu et al., 2003). • Iron deficiency anaemia was higher among premenopausal women compared to postmenopausal women. This finding is consistent with that of (Milmanet al., 1993).

19. Discussion (Cont.) • Finding from this study indicated a higher incidence of low ferritin level among pre and postmenopausal women with no formal education. This finding was consistent with that reported by (Fatemehet al., 2013). • Observation from this study indicated that low ferritin level <3.5ng/ml was higher among Hausa /Fulani ethnic group. Our finding is consistent with report from the UK which indicated that females of Indian ethnic origin had lower levels of serum ferritin than Whites, Blacks and Orientals (Burt et al., 1993). • High incidence of under nutrition, poor diet, and concurrent micronutrient deficiencies may be responsible the high incidence of anaemia and low ferritin levels among pre and post-menopausal women of Hausa /Fulani ethnic groups.

20. Conclusion and Recommendations • Serum ferritin and anaemia is significantly higher among pre compared to postmenopausal women. • Ferritin level <3.5ng/ml varies based on ethnicity and level of educational attainment. • We recommend that that the serum ferritin should be used for the diagnosis and monitoring of IDA in pre and postmenopausal women. • Serum ferritin level of <3.5ng/ml should be used as cutoff for the diagnosis of depleted iron store.

21. Acknowledgement • Isah N • Ibrahim K • Abdulrahaman Y • Zama I • Buhari H • Onuigwe UF • Ibrahim BA • Ahmed M • Okwesili A • Imoru M • Udomah FA • Hassan M • Ian-Gobo M • Echonwere B • Egenti, BN • Fredrick C

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