الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
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Abstract
Iron deficiency aanemia remains the most commonly recognized nutritional deficiency. The aim of this work was to study the effect of copper-bearing IUD 380 A and combined low-dose oral contracptive methods ’On the haemoglobin concentration and iron stores in border-line anemic and anemic women through 12 months of continious use. The study was carried out in the family planning clinic of ElShatby University Hospital-Alexanderia. ~;> The studied sample comisted of 300 women, distributed into 3equal groups: group I (n=100, IUD users), group n (n=100,OCP users), group In (n= 100, controls). Recruitment started on Fibruary 1995, ended on June 1995, follow up was completed on July 1996, and data analysis and writing of the thesis ended on January 1997. The following techniques were used for the selection of participants, collection of data, laboratory tests and providing the contraceptive methods: 1 A structured interview was used for all participants to collect data about sociodemographic charactristics, reproductive variables, menstrual history, contraceptive methods, eating iron-rich food items and medical and drug history, Urine test, stool test and haematological tests (Hb, PCV, RBCs, MCV, MCH and MCHC) for all participants were done in EI Shatby Hospital laboratory . General and gynecological examination and providing the centraceptive methods (IUDs insertion and OCP supplied) were done in the family planning clinic of EI-Shatby Hospital. 4 Serum tests (serum ferritin, serum iron and TIBC) were done in the laboratory unit of the Gynecological and Obestetrices department of Faculty of Medicine Cairo University. 5 During follow up visits: Follow up interview questionnaire were completed, General and gynecological examination, if required, heamologicals and serological tests were done as on admission. The study showed the following main results: I. Admission: 1 Most of the sociodemograpghic charactristics showed no significant differences between the 3 groups. Most of the participants were of low and moderate social class with low percapita monthly income (less than 80 Egyptian pound/month) 2 There were no significant differences between the 3 groups regarding the reproductive variables. ~ ) There were no significant differences between the 3 groups regarding mean days of MBF. However, the distribution of 1 ~ studied women by quantity of MBF showed significant differences, as the control group had more women with scanty MBF than the other 2 groups. 4 The frequancy of eating iron-rich food items were better among controls than the other 2 groups. 5 There was no significant differences between body weight of the 3 groups, but significant differences existed between the 3 groups regarding mean body mass index. as the mean body mass index of OCP users was higher than the other 2 groups. 6. There were no significant differences between the 3 groups regarding systolic and diastolic blood pressure. 7 Most of the heamatological variables showed no significant differences between the 3 groups. 8 The IUD users showed more border line anemic women (Hb 1112 gldl) and less anemic women (Hb 9- < 11 g/dL) than the other 2 groups. 9 The IUD users had mean serum ferritin and serum iron better than the other 2 groups. The percentage of women with depleted iron stores (Ferritin level < 12 ugIL) were less among IUD users than the other 2 groups. 10- Significant differences existed between the 3 groups as regard means of serological variables (higher serum ferritin, higher serum iron and low TIBC among IUD users). 11- The multiple regression analysis showed that, there were significant association between serum ferritin (as an indicator of iron stores) and Hb concentration, gravidely and parity. 12- The stepwise multiple reression analysis showed that, there is strong association only between ferritin level and Hb concentration. <. ” 11 Follow up The 12 months follow up showed the following results: 1 The IUD users showed significant increase in the mean number of days of MBF throughout the study. Those with heavy MBL were increasing significantly throughout the follow up period. 2 The OCP users showed significant decrease in mean number of days of MBF mainly at the first 6 months of follow up. Those with scanty MBL were increaseng significantly throughout the follow up period. 3 The changes in mean number of days and quantity of MBL were mild among controls, compared to the other 2 groups. 4. There was significant decrease of Bb concentraation among IUD users for both subgroups (Bb < 11 g/dL and Bb > 11 g/dL) throughout the study. 5. There was significant increase of Hb concentration for only subgroup I (Bb < 11 g/dL) among OCP users, while the changes in Bb concentration among subgroup II (Bb > 11 g/dL) ofOCP users were slight non significant changes. 6 The changes of Hb concentration among controls were less than the changes among the other 2 groups. .( 7 The changes in the other heamotological variables were more or less similar to the changes in Bb concentration. There were significant decrease in means of serum ferritin and serum iron for both subgroups (Bb < 11 g/ dL and Bb > 11 g/ dL ) of IUD users throughout the follow up period. Those with depleted iron stores (ferritin < 12 ug/L) were increasing significantly among IUD users throughout the follow up period. The changes of TIBC among IUD users were less than that of serum ferritin and serum iron. Among OCP users, there were significant increase in means of serum ferritin and serum iron throughout the study only for subgroup I (Bb < 11 g/dL). For subgroup II, the increase in means of serum ferritin and serum iron were only during the first 6 months ofOCP use. Those with depleted iron stores (ferritin < 12 ug/L) were decreasing significantly among OCP users throughout the study. The changes in mean ofTIBC among OCP users was more on less like the changes in means of serum ferritin and serum iron. 10- The changes in the means of serological variables (Serum ferritin, serum iron and TIBC) of the control group were mild, compared to the other :2 groups. 11- The main reasons for dropout were: method’s side effects, changes to other methods and refusal of given blood samples. The following are the main recommendations: Short term recommendations: Client screening and counseling to make choice of the safe contraceptive method for her to use. t Abnormal uterine bleeding and iron deficiency anemia should be treated before IUDs insertion. Regular check up for menstrual changes and for iron deficiency aneamia among IUDs users by at least Hb & ferritin levels. 4 Iron supplement for IUD users whom are at risk of developing iron deficiency anemia. 5. OCP may be the method of choice for those at risk of developing iron deficiency anemia. Health education, emphasising on risk factors and complecations of iron deficiency anemia and ways of protection. Long term recommendations: Health programme for screening of iron deficiency anemIa among females in reproductive age. Researches are needed to introduce the progestin-releasing IUDs among the family planning methods. More researches are needed to modify the present use IUDs so that the MBL will be less.^leng