Community screening for iron deficiency in reproductive aged women: Lessons learnt from Australia.

Background and objectives: Reproductive-aged women are at an increased risk of developing iron deficiency (ID). We aimed to develop a non-invasive screening tool to identify ID in women and assess the acceptability of screening.

Study design and methods: We screened women (age 18-49 years) in the community of Western Australia.

Primary outcome: acceptability of screening, assessed by the feasibility of recruiting the required sample size (n = 323).

Secondary outcomes: Hand grip strength, finger prick haemoglobin concentration (Hb), prevalence of heavy menstrual bleeding (HMB), diet, pregnancy history, blood donation, symptoms of ID and history of ID or anaemia (Hb < 120 g/L). Those with Hb <130 g/L and no history of iron therapy in the past 2 years were given referrals for venous full blood count and ferritin sampling.

Results: Across 5 days, we recruited 640 eligible women. Of which, 178 (28%) had HMB and 79 (12%) were anaemic. Mean age was 33.5 ± 9.2 years, and mean Hb was 132.4 ± 11.9 g/L. In the past 2 years: 335 (52%) were diagnosed with ID or anaemia; 322 (50%) had taken oral iron; and 210 (33%) had an intravenous iron infusion. Vegetarian diets were followed by 89 (14%); 40 (6%) were regular blood donors; 290 (45%) had a previous pregnancy. HMB increased the risk of symptoms of ID and having prior ID/anaemia diagnosis (67% vs. 47%) or treatment (p < 0.022). Hand grip strength showed a positive relationship with both Hb (adjusted R² = 0.012, p = 0.004) and ferritin (adjusted R² = 0.135, p = 0.005).

Conclusion: ID screening was well accepted by women in the community, with high recruitment rates over a short period. Future screening tool development may consider incorporating hand grip strength and HMB assessment.