Strategies to address anaemia among pregnant and lactating women in India: a formative research study

Prevalence and determinants of anaemia among women of reproductive age in Aspirational Districts of India: an analysis of NFHS 4 and NFHS 5 data

BACKGROUND

Over one-third of women worldwide suffer from anaemia. The prevalence of anaemia is particularly pronounced among women of reproductive age (WRA) in developing countries, such as India. No prior study has ever exclusively studied the prevalence of anaemia across the Aspirational Districts of India. Therefore, the purpose of this study was to examine the prevalence of anaemia across Aspirational Districts of India and to identify the determinants of anaemia among WRA in these districts.

METHODS

From the National Family Health Survey (NFHS)-4 (2015-16) and NFHS-5 (2019-21), data on 114,444 and 108,782 women aged 15-49 from Aspirational Districts were analyzed in our study, respectively. Bivariate statistics and multivariable binary logistic regression were used to identify the determinants of anaemia.

RESULTS

The national prevalence of anaemia among WRA has increased from 53% in NFHS-4 to 57% in NFHS-5 whereas anaemia among WRA in Aspirational Districts has increased from 58.7% in NFHS-4 to 61.1% in NFHS-5. Between 2015 and 2021, over 60% of Aspirational Districts experienced an increase in the prevalence of anaemia and one-fourth, specifically 29 out of 112, observed a rise by at least 10 percentage points (pp). Notably, there are significant variations in anaemia prevalence among districts, with Simdega and Udalgiri having the highest anaemia prevalence in NFHS-4 and NFHS-5 at 78.2% and 81.5%, respectively. During this period, Barpeta followed by Udalgiri of Assam have witnessed the maximum increase with 29.4% and 26.7% respectively. Moreover, pooled regression results show women with three to four children [AOR: 1.13, 95% CI: 1.08-1.17], women who breastfeed [AOR: 1.17, 95% CI: 1.13-1.20], Scheduled Tribe women [AOR: 1.39, 95% CI: 1.35-1.44], poorest women [AOR: 1.27, 95% CI: 1.22-1.33] and women those who consume fish occasionally [AOR: 1.14, 95% CI: 1.12-1.17] were more likely to be anaemic.

CONCLUSION

The significant increase in anaemia among WRA in Aspirational Districts of India is a matter of concern. Given the rise in anaemia among WRA, determinants-based and district-specific measures must be designed and implemented to reduce the prevalence of anaemia among Aspirational Districts of India.

Prevalence and factors associated with anaemia among pregnant women attending antenatal care in a district hospital and its feeder community healthcare centre of the Limpopo Province, South Africa

Background

Pregnancy anaemia is a significant public health concern in South Africa (SA), particularly in rural areas, but little is known about its prevalence and risk factors in rural areas. The objective of the study was to determine the prevalence and identify risk factors of pregnancy anaemia in the public health facilities of Limpopo Province (LP), SA.

Methods

A cross-sectional study was conducted among a consecutive sample of 211 pregnant women attending antenatal care at Seshego Hospital and its feeder health centre (May to June 2019). Anaemia was defined as haemoglobin (Hb) <11 g/dL and classified as mild (10-10.9 g/dL), moderate (7-9.9 g/dL) and severe anaemia (<7 g/dL). A multiple logistic regression analysis was used to identify predictors of anaemia.

Results

The mean age of the women was 28.4 ± 5.7 years (range from 18 to 41 years). Over half (52%) had secondary education, 65% were unmarried, 72% were unemployed, 34% were nulliparous, 15% were human immunodeficiency virus (HIV) infected and 67% were in the third trimester. The anaemia prevalence was 18.0% and was significantly associated with parity, HIV status and body mass index (BMI) in a multivariate logistic regression analysis.

Conclusion

This study found that less than one-third of pregnant women were affected by anaemia, associated with parity, HIV infected and BMI. It is essential to promote routine screening for anaemia, health education and prompt treatment of infections to reduce this burden. In addition, further studies on risk factors for anaemia during pregnancy in both urban and rural communities should be conducted to strengthen these findings.

Tackling Anemia in Pregnant Women in India: Reviewing the Obstacles and Charting a Path Forward

This study examined the obstacles and factors influencing the prevention and treatment of anemia among pregnant women in India. Maintaining antenatal care is essential, leading to favorable birth outcomes and healthier offspring. However, inadequate consumption of essential nutrients is widespread among pregnant women, particularly in lower and middle-income economies such as India, contributing to high maternal and infant mortality rates. The factors influencing anemia prevention and treatment are categorized into individual, socioeconomic, interpersonal, and organizational levels. This study discussed the prevalence of anemia among pregnant women in different states of India. It highlights the interventions and initiatives the government and World Health Organization (WHO) have implemented to address the issue while also emphasizing the need for comprehensive approaches that effectively address the multiple levels of influence needed to prevent and treat anemia. It calls for increased awareness, improved education, and better healthcare services to ensure proper nutrition and iron supplementation. Strengthening healthcare systems and involving family members and healthcare providers in supporting pregnant women are crucial for successful anemia prevention and treatment programs.

Assessing food-based strategies to address anaemia in pregnancy in rural plains Nepal: a mixed methods study

Anaemia in pregnancy is a persistent health problem in Nepal and could be reduced through nutrition counselling and strengthened iron folic acid supplementation programmes. We analysed 24-hour diet recall data from 846 pregnant women in rural plains Nepal, using linear programming to identify the potential for optimised food-based strategies to increase iron adequacy. We then conducted qualitative research to analyse how anaemia was defined and recognised, how families used food-based strategies to address anaemia, and the acceptability of optimised food-based strategies. We did 16 interviews of recently pregnant mothers, three focus group discussions with fathers, three focus group discussions with mothers-in-law and four interviews with key informants. Dietary analyses showed optimised diets did not achieve 100 % of recommended iron intakes, but iron intakes could be doubled by increasing intakes of green leaves, egg and meat. Families sought to address anaemia through food-based strategies but were often unable to because of the perceived expense of providing an 'energy-giving' diet. Some foods were avoided because of religious or cultural taboos, or because they were low status and could evoke social consequences if eaten. There is a need for counselling to offer affordable ways for families to optimise iron adequacy. The participation of communities in tailoring advice to ensure cultural relevance and alignment with local norms is necessary to enable its effectiveness.

An unacceptably high burden of anaemia and it's predictors among young women (15-24 years) in low and middle income countries; set back to SDG progress

BACKGROUND

Anaemia is a major global public health problem, considerably affects young women in resource limited countries. The available researches on anaemia focused on children, pregnant women, or all women of reproductive age. However, women's biology and life experiences vary dramatically across 15 to 49 years, putting young women bear the higher burden of anaemia, mainly in low and middle income countries (LMICs). Therefore, this study assessed the burden of anaemia among young women (15-24 years) in 24 LMICs which conducted Demographic and Health Surveys (DHS) between 2016 and 2021.

METHOD

Data analysis was carried out with STATA version 14. The forest plot was used to explore the pooled prevalence of anaemia. Multilevel binary logistic regression was fitted to accommodate the hierarchical nature of the DHS data. Accordingly, a model with lowest deviance (model III) was the best-fitted model. All variables with a p-value ≤ 0.2 in the bi-variable analysis were fitted in the multi-level multivariable model. Adjusted odds ratio with 95% CI and p < 0.05 were presented to declare statistical significance.

RESULT

The pooled prevalence of anaemia among young (15-24 years) women in 24 LMICs was 41.58% (95%CI: 34.51, 48.65). Country wise, Mali (62.95%) and Rwanda (14.13%) constitute the highest and lowest prevalence of anaemia. In this study, young women who lived in the poorest wealth status, had no education, were underweight, perceived distance to the health facility a big problem, larger family size, and women who had ever terminated pregnancy were associated with increased odds of anaemia. Whereas, young women who were overweight and not breast feeding had decreased odds of anaemia.

CONCLUSION

The unacceptably high burden of anaemia among young women setbacks the SDG target; to end all forms of malnutrition by 2030. Therefore, it is highly recommended to take relevant interventions to reduce the burden of anaemia targeted the young women who are uneducated, have low socio-economic status, limited access to health facilities, and lived in larger family size.

Storytelling for persuasion: Insights from community health workers on how they engage family members to improve adoption of recommended maternal nutrition and breastfeeding behaviours in rural Bangladesh

Community health workers (CHWs) increasingly provide interpersonal counselling to childbearing women and their families to improve adoption of recommended maternal and child nutrition behaviours. Little is known about CHWs' first‐hand experiences garnering family support for improving maternal nutrition and breastfeeding practices in low‐resource settings. Using focused ethnography, we drew insights from the strategies that CHWs used to persuade influential family members to support recommendations on maternal diet, rest and breastfeeding in a behaviour change communication trial in rural Bangladesh. We interviewed 35 CHWs providing at‐home interpersonal counselling to pregnant women and their families in seven ‘Alive & Thrive’ intervention sites. In‐depth probing focused on how CHWs addressed lack of family support. Thematic coding based on Fisher's narrative paradigm revealed strategic use of three rhetorical principles by CHWs: ethos (credibility), pathos (emotion) and logos (logic). CHWs reported selectively targeting pregnant women, husbands and mothers‐in‐law based on their influence on behavioural adoption. Key motivators to support recommended behaviours were improved foetal growth and child intelligence. Improved maternal health was the least motivating outcome, even among mothers. Logically coherent messaging resonated well with husbands, while empathetic counselling was additionally required for mothers. Mothers‐in‐law were most intransigent, but were persuaded via emotional appeals. Persuasion on maternal rest was most effort‐intensive, resulting in contextually appealing but scientifically inaccurate messaging. Our study demonstrates that CHWs can offer important insights on context‐relevant, feasible strategies to improve family support and uptake of nutrition recommendations. It also identifies the need for focused CHW training and monitoring to address scientifically flawed counselling narratives.

Analysis of narratives of nutrition‐promoting, rural Bangladeshi community health workers (CHWs) suggest that behavior change communication (BCC) strategies to persuade husbands require logical and credible information (logos and ethos) to establish their support, while childbearing women may additionally require emotional appeals (pathos) to adopt promoted behaviors. Mothers‐in‐law, who traditionally influence multiple nutrition behaviors, can be persuaded via strategic use of ethos and pathos.

CHW communication strategies are useful in developing persuasive narratives that capture influential family members’ value beliefs and outcome expectancies and promote behavior change. However, additional programmatic efforts are needed to discourage use of unscientific narratives by CHWs.

Impact of Anemia in Pregnant Women on the Neonatal Conditions

Background. One of the most prevalent illnesses in the world is anemia. Anemia in pregnant women has been a pressing obstetric issue for many years and is one of the most common complications of pregnancy in the world, particularly in developing countries. Aim. To study the condition of neonates born to women with anemia during pregnancy. Methods. A retrospective analysis of 230 patients' medical records in maternity and pregnancy pathology departments. The patients were divided into 2 groups: Group 1 consisted of patients suffering from iron deficiency anemia, Group 2 comprised patients without iron deficiency anemia. Results. The height-to-weight ratio in the group of neonates born to mothers with anemia statistically was significantly lower compared to the control group. The proportion of neonates with hypotrophy in the group born to mothers with anemia statistically was significantly higher. Body length and birth condition indices assessed according to the APGAR scale were virtually identical across the groups. Conclusions. Anemia during pregnancy affects the trophism of a fetus, which is largely reflected in the health of neonates. Treating maternal anemia is important to prevent or decrease the incidence of underweight in infants at birth.

Sources of nutrition information for Indonesian women during pregnancy: how is information sought and provided?

OBJECTIVE

Adequate and appropriate nutrition education is expected to contribute towards preventing risk of child stunting and maternal overweight/obesity. Understanding women's information-seeking behaviours is an important key step for health professionals and departments of health in order to improve the development of optimal and targeted nutrition education during pregnancy. This study investigated the experience of Indonesian women in seeking and receiving nutritional information during pregnancy and its relationship to women's socio-demographic and pregnancy characteristics.

DESIGN

An online cross-sectional study.

SETTING

Malang City, Indonesia.

PARTICIPANTS

Women who had given birth within the past 2 years (n 335).

RESULTS

All women in this study sought or received food and nutrition information from multiple sources, including social and health professional contacts and media sources. The women frequently discussed nutrition issues with their family, particularly their husband (98·2 %) and mother or mother-in-law (91·6 %). This study identified four groups of sources based on women's search habits. Women from high socio-economic strata were more likely to discuss food and nutrition issues or received nutrition information from obstetricians, their family or online sources (adjusted R2 = 26·3 %). Women from low socio-economic strata were more likely to receive nutrition information from midwives, health volunteers or Maternal and Child Health books (adjusted R2 = 14·5 %).

CONCLUSIONS

A variety of nutrition information sources needs to be provided for women from different socio-economic strata. Involvement of family members in antenatal nutrition education may improve the communication and effectiveness of young mothers' dietary and nutrition education.