Magnitude of Anemia and Its Associated Factors among Pregnant Women Attending Antenatal Care at Najo General Hospital, Northwest Ethiopia

Infectious and obstetric determinants of anemia among pregnant women in Southwest Ethiopia

Background

Anaemia, characterized by low red blood cell or haemoglobin levels, impairs oxygen transport in the body and poses a major global public health issue, particularly affecting pregnant women and children. This study focuses on identifying the factors contributing to anaemia among pregnant women receiving antenatal care (ANC) at Mizan-Tepi University Teaching Hospital (MTUTH) in southwest Ethiopia.

Methods

A hospital-based unmatched case-control study was conducted from July 1 to August 30, 2022, involving 370 pregnant women (90 with anaemia and 280 without). Data collection included questionnaires, laboratory tests (Hgb and stool examination), and anthropometric measurements. SPSS version 21 was used for data analysis, with binary logistic regression identifying factors associated with anaemia. The significance level was set at a p-value <0.05.

Results

The study achieved a 100% response rate for both cases and controls. Factors identified as determinants of anaemia among pregnant women included malaria infection (AOR = 7.83, 95% CI: 3.89-15.8), hookworm infection (AOR = 2.73, 95% CI: 1.39-5.34), short birth interval (AOR = 7.11, 95% CI: 3.59-14.2), and history of unsafe abortion (AOR = 5.40, 95% CI: 2.46-11.8).

Conclusion

This study found that malaria infection, hookworm infection, birth interval <33 months, and a history of unsafe abortion are factors contributing to anaemia in pregnant women. Strategies such as distributing insecticide-treated bed nets (ITNs) to combat malaria, improving sanitation, anthelmintic drugs, promoting family planning to prevent unwanted pregnancies and unsafe abortions, and providing preconception care can help reduce the incidence of anaemia.

Magnitude of anemia and associated factors among pregnant women attending antenatal care in governmental health facilities of Shashemene Town, Oromia region, Ethiopia

Introduction

Anemia during pregnancy is a common issue that significantly affects the health of both the mother and her child. Globally, anemia is a major public health concern, affecting both developing and developed countries, with approximately 1.3 billion people affected. Pregnant women are among the most vulnerable to anemia.

Objective

To assess the magnitude and risk factors of anemia among pregnant women attending antenatal care in Shashemene Town, Oromia, Ethiopia.

Methods

A facility-based cross-sectional study was conducted among 391 pregnant women in Shashemene Town in April 2022. Data were collected using interviewer-administered questionnaires, along with laboratory examinations of blood and stool samples. The data were entered into EpiData 3.1 and analyzed using the Statistical Package for Social Sciences (SPSS) version 22. Bivariate logistic regression was performed, and variables with a p-value of <0.25 were included in the multivariate logistic regression analysis to identify factors associated with anemia. Adjusted odds ratio (AOR) with 95% CIs were calculated, and a p-value of < 0.05 was considered statistically significant. Finally, the results are presented using narration, descriptive statistics, such as tables, graphs, and charts.

Results

The prevalence of anemia was found to be 30.9% (95% CI: 26.4, 35.4%). Factors significantly associated with a reduced risk of anemia included high dietary diversity (AOR = 0.217, 95% CI: 0.105-0.451), no history of excessive menstrual bleeding (AOR = 0.162, 95% CI 0.076-0.345), age 25-34 years (AOR = 0.391, 95% CI 0.173-0.883), and age ≥ 35 years (AOR = 0.068, 95% CI 0.011-0.444). Conversely, a mild upper arm circumference (MUAC) of <23 cm (AOR = 4.939, 95% CI 2.330-10.469), no use of contraceptives (AOR = 4.935, 95% CI 2.207-11.032), and no iron supplementation use (AOR = 3.588, 95% CI 1.794-7.175) were significantly associated with an increased risk of anemia.

Conclusion

According to the WHO classification, anemia in this study was found to be a moderate public health issue. High dietary diversity, no previous excessive menstrual bleeding, and age were significantly associated with a reduced risk of anemia, whereas a MUAC of <23 cm, no contraceptive use, and no iron supplementation were significantly associated with an increased risk of anemia. Therefore, promoting diverse diets among pregnant women, providing counseling on the benefits of family planning and iron-folic acid supplements, and improving women's education and empowerment are essential.

Nutritional factors for anemia in pregnancy: A systematic review with meta-analysis

Background

Anemia in pregnancy is a serious threat to maternal and child health and is a major public health problem. However, the risk factors associated with its incidence are unclear and controversial.

Methods

PubMed, Ovid Embase, Web of Science, and Cochrane databases were systematically searched (inception to June 27, 2022). The screening of search results, extraction of relevant data, and evaluation of study quality were performed independently by two reviewers.

Results

A total of 51 studies of high quality (NOS score ≥ 7) were included, including 42 cross-sectional studies, six case-control studies, and three cohort studies. Meta-analysis showed that infected parasite, history of malarial attack, tea/coffee after meals, meal frequency ≤ 2 times per day, frequency of eating meat ≤ 1 time per week, frequency of eating vegetables ≤ 3 times per week, multiple pregnancies, multiparous, low household income, no antenatal care, rural residence, diet diversity score ≤ 3, have more than 3 children, history of menorrhagia, underweight, family size ≥ 5, middle upper arm circumference < 23, second trimester, third trimester, birth interval ≤ 2 year were all risk factors for anemia in pregnancy.

Conclusions

Prevention of anemia in pregnancy is essential to promote maternal and child health. Sufficient attention should be paid to the above risk factors from the social level and pregnant women's own aspects to reduce the occurrence of anemia in pregnancy.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier: CRD42022344937.

Predicting the level of anemia among Ethiopian pregnant women using homogeneous ensemble machine learning algorithm

BACKGROUND

More than 115,000 maternal deaths and 591,000 prenatal deaths occurred in the world per year with anemia, the reduction of red blood cells or hemoglobin in the blood. The world health organization divides anemia in pregnancy into mild anemia (Hb 10-10.9 g/dl), moderate anemia (Hb 7.0-9.9 g/dl), and severe anemia (Hb < 7 g/dl). This study aims to predict the level of anemia among pregnant women in the case of Ethiopia using homogeneous ensemble machine learning algorithms.

METHODS

This study was conducted following a design science approach. The data were gathered from the Ethiopian demographic health survey and preprocessed to get quality data that are suitable for the machine learning algorithm to develop a model that predicts the levels of anemia among pregnant. Decision tree, random forest, cat boost, and extreme gradient boosting with class decomposition (one versus one and one versus rest) and without class decomposition were employed to build the predictive model. For constructing the proposed model, twelve experiments were conducted with a total of 29,104 instances with 23 features, and a training and testing dataset split ratio of 80/20.

RESULTS

The overall accuracy of random forest, extreme gradient boosting, and cat boost without class decompositions is 91.34%, 94.26%, and 97.08.90%, respectively. The overall accuracy of random forest, extreme gradient boosting, and cat boost with one versus one is 94.4%, 95.21%, and 97.44%, respectively. The overall accuracy of random forest, extreme gradient boosting, and cat boost with one versus the rest are 94.4%, 94.54%, and 97.6%, respectively.

CONCLUSION

Finally, the researcher decided to use cat boost algorithms with one versus the rest for further use in the development of artifacts, model deployment, risk factor analysis, and generating rules because it has registered better performance with 97.6% accuracy. The most determinant risk factors of anemia among pregnant women were identified using feature importance. Some of them are the duration of the current pregnancy, age, source of drinking water, respondent's (pregnant women) occupation, number of household members, wealth index, husband/partner's education level, and birth history.

Determinants of anemia status among pregnant women in ethiopia: using 2016 ethiopian demographic and health survey data; application of ordinal logistic regression models

Background

Anemia is a serious public health problem that occurs when the blood contains fewer red blood cells than normal. In Ethiopia, the prevalence of anemia in pregnancy increased between 2005 and 2016. The aim of this study was to determine what factors influence the anemia status of pregnant women in Ethiopia.

Methods

Anemia status in a sample of 1053 pregnant women was studied using data from Ethiopia's Demographic and Health Survey 2016. Percentages and graphs were used to show the prevalence of anemia. The marginal probability effect was used to determine the contribution of each explanatory variable category to a single response category of anemia level. Ordinal logistic regression models were constructed, and the best-fitting model was selected to reveal significant anemia status variables.

Results

The prevalence of anemia in pregnant women was found to be 37.51% (3.04% severe, 17.28% moderate, and 17.1% mild anemic). The fitted partial proportional odds model revealed that anemia status of pregnant women was significantly associated with region afar (OR = 0.45; CI: 0.21–0.96), antenatal care visits above 4 (OR = 1.58; CI: 1.03–2.43), parity between 1–2 (OR = 0.47;CI: 0.26–0.85), iron taking (OR = 3.68;CI: 2.41–5.64), and higher education (OR = 4.75;CI: 2.29–9.85).

Conclusions

Anemia among pregnant women has been identified as a moderate public health issue in Ethiopia. The study revealed that the prevalence of anemia varied among regions which the highest (65.9%) and the lowest (9%) being from Somali and Addis Ababa, respectively. As a result, it is argued that treatments target iron consumption, maternal education, antenatal visits, and mothers' access to health care.

Prevalence and predictors of anemia among pregnant women in Ethiopia: Systematic review and meta-analysis

Background

In Ethiopia limited information is available regarding the prevalence and predictors of anemia in pregnancy. This systematic review and meta-analysis estimated the pooled prevalence of anemia among pregnant women in Ethiopia and also identified its predictors.

Materials and methods

The published primary studies were searched in the following electronic databases; PubMed/Medline, Google scholars, AJOL, and EMBASE. All primary studies published from 01/01/2010 to 30/05/2020 and written in English language were included without restriction on study setting and design. Critical appraisal of all available articles was done and extracted data was analyzed using STATA software version 14. The pooled prevalence of anemia was presented using a forest plot. The I2 statistical test for heterogeneity, and the Egger’s and Begg’s tests for publication bias were used. The relative risk was used to assess the association of predictor variables with anemia.

Result

After screening 274 articles, sixty studies were included in the analysis. The pooled prevalence of anemia among pregnant women was 26.4(95% CI: 23.1, 29.6). Sub-group analysis showed higher pooled prevalence from community-based studies than institutional-based studies. Factors that were protective against maternal anemia included urban residence, formal education and smaller family size. Short birth interval and not having antenatal care (ANC) are associated with a higher risk of maternal anemia. Women with low dietary diversity [RR: 2.61(95% CI, 1.85, 3.68)], mid-upper arm circumference (MUAC) less than 23 cm [RR: 2.35(95% CI, 1.53, 3.68)] and those not taking iron-folic acid [RR: 1.53(95% CI: 1.30, 1.81)] also had a higher risk of anemia.

Conclusion

Almost one in four pregnant women in Ethiopia had anemia. Being literate, living in urban areas with small family size and adequate birth spacing, as well as good dietary diversity are associated with a lower risk of anemia in pregnancy.

Registration number

(ID: CRD42020211054).

Critical factors associated with postpartum maternal death in Ethiopia

BACKGROUND

Globally most maternal deaths occur during the postpartum period; however, the burden is disproportionately higher in some Sub-Saharan African countries including Ethiopia. According to Ethiopian Ministry of Health's annual report, in 2019 alone, nearly 70% of maternal deaths happen during the postpartum period. Although several studies have been conducted on postpartum maternal deaths in Ethiopia, most of the studies were focused either on individual-level or district-level determinants with limited emphasis on the timing of death and in relatively small and localized areas. Therefore, this study aimed at identifying the determinants of postpartum death both at an individual and districts level, which could shed light on designing pragmatic policies to reduce postpartum maternal death.

METHODS

The study utilized secondary data obtained from the Ethiopian maternal death surveillance system. A total of 4316 reviewed maternal death from 645 districts of Ethiopia were included in the analysis. A multilevel multinomial logistic regression model was applied to examine factors significantly associated with postpartum maternal death in Ethiopia.

RESULT

The findings revealed that 65.1% of maternal deaths occurred during the postpartum period. The factors associated with postpartum death included previous medical history (history of ANC follow up and party), medical causes (obstetrics haemorrhage, hypertensive disorder of pregnancy, pregnancy-related infection, and non-obstetrics complication), personal factors (poor knowledge of obstetrics complication), and facility-level barriers (shortage of life-saving maternal commodities and delay in receiving treatment).

CONCLUSION

Almost seven in ten maternal deaths happen during the postpartum period. The rate was even higher for some women based on their previous medical history, level of awareness about obstetrics complication, medical conditions, as well as the readiness of the health facility at which the women was served. Since the postpartum period is identified as a critical time for reducing maternal death, policies and actions must be directed towards improving health education, ANC service utilization, and facility-level readiness.

Magnitude of Anemia and Its Associated Factors Among Pregnant Women Attending Antenatal Care in Hiwot Fana Specialized University Hospital in Eastern Ethiopia

Background

Anemia is a significant public health issue, accounting for 20–40% of maternal deaths. Despite the government's commitment and the interventions of various stakeholders, the magnitude and major risk factors of anemia remain unabated. Though there are few documented studies on anemia among pregnant women in eastern Ethiopia in general, in the study area in particular, some of the variables such as helminthics and history of caesarian section in relation to anemia need to be studied. As a result, the purpose of this study was to determine the magnitude of anemia and associated factors among pregnant women attending antenatal care in University Hospital in eastern Ethiopia.

Methods

A facility-based cross-sectional study was conducted on a sample of 456 clients who were attending antenatal care in Hiwot Fana specialized university hospital from 01 to 30 June 2021. Systematic sampling was used to select the study participants. A pretested and structured interviewer-administered questionnaire and sample collection were used to collect the data. The data were coded, double-entered to Epi data version 3.1, cleaned, and exported to SPSS version 20 for analysis. Descriptive statistics were used to present frequency distributions. Variables with p-value < 0.25 during bivariate analysis were entered into the multivariate logistic regression models to control for all possible confounders to identify the factors associated with a magnitude of anemia. Odds ratio along with 95% CI were estimated to measure the strength of the association. The level of statistical significance was declared at a p-value of < 0.05.

Result

A total of 456 participants were interviewed, with a response rate of 96.9%. The magnitude of anemia among pregnant women was 112 [(25.3%) 95%CI: (21.5–29.2%)], of which, 27 (6.10%), 36 (8.13%), and 49 (11.08%) had mild, moderate, and severe anemia, respectively. Birth interval < 2 years [AOR: 3.24, (95% CI: (1.88, 4.32)], number of children ≥2 [AOR: 2.54, (95% CI: (1.12, 4.64)], monthly income < 1,000 birr [AOR: 2.89, (95% CI: (1.31, 5.58)], third trimester pregnancy [AOR: 2.89, (95% CI: 4.86, 12.62)], and abnormal menstrual history [AOR: 2.28, (95% CI: (1.69, 5.24)] were the factors significantly associated with anemia.

Conclusion

Anemia among pregnant women was relatively high compared to previous studies. Birth intervals, number of children, history of menstrual disorder, monthly income, and trimester of pregnancy were all significantly associated with anemia in pregnant women.

Impact of helminthiasis on gestational anemia in low- and middle-income countries: a systematic review and meta-analysis of more than 19,000 women

Intestinal helminthiasis are a common public health problem in developed and developing countries. It is thought that they can influence pregnancy by causing gestational anemia. The aim of this study was to determine if there is a relationship between helminth infection and gestational anemia. A structured review of scientific literature was conducted through active search in the electronic databases MEDLINE^® and LILACS^® until December 2021, following 2020 PRISMA statement. The studies were reviewed independently by two authors, extracting the most relevant information from each study. Cross-sectional studies, case-control and ecological studies were included, with no date or language limit. Randomized clinical trials were excluded. A total of 38 studies were included in the systematic review. The study populations of all studies belonged to low- and middle-income countries: 28 studies from Africa, 6 from Asia, 3 from Latin America and 1 from Oceania. Overall, the average prevalence of gestational anemia among the included studies was 40% (95% CI 34-46%). Hookworm was the predominant species detected in most studies (19/38; 50%), followed by Ascaris lumbricoides (15/38; 39.5%). Gestational anemia was positively associated with A. lumbricoides (OR 1.86, 95% CI 1.12-3.08) and hookworms (OR 3.09, 95% CI 1.99-4.78). Prevalence of malaria was not associated with the magnitude of the effect of hookworm on anemia risk during meta-regression (p=0.5182). The results of this review indicate that there is a statistically significant association between helminthiasis and gestational anemia. Although hookworm is the main species associated with the outcome, prevalence of malaria was not associated with the magnitude of the effect of hookworm on anemia risk. The impact of other species needs to be defined given the expected bias that arises from polyparasitism when defining comparison groups.

Determinants of Anemia in The Third Trimester of Pregnancy in Mojokerto

Background: Anemia is a pregnancy complication that increases the morbidity and mortality of mother and baby during pregnancy and until puerperium. In 2015, the incidence of anemia in Indonesia was 23%. Purpose: The aim of this study was to determine factors that influence anemia in the third trimester of pregnancy. Methods: The study was conducted on pregnant women in Mojokerto. This study used a case-control design. The sample calculation results obtained 70 cases and 70 controls. The primary and secondary data were obtained from the MCH book and from interviews conducted according to questionnaire guidelines. Data were analyzed via chi-squared test and logistic regression test. Results: The factors that influence anemia in the third trimester of pregnancy were found to be age (p value = 0.04; OR 2.08; 95% CI = 1.04–4.16), occupation (p value = 0.02; OR = 2.27; 95% CI = 1.15–4.47), birth interval (p value = 0.03; OR = 2.25; 95% CI 1.08-4.69), nutritional status (p value = 0.02; OR = 2.33; 95% CI = 1.14- 4.82), knowledge [about anemia] (p value = 0.01; OR = 3.17; 95% CI = 1.41-7.09), income per month (p value = 0.03, OR = 2.25; 95% CI =1.08–4.69), smoking activity (p value = 0.04; OR = 2.00; 95% CI = 1.02–3.92), perception (p value = 0.02; OR = 2.20; 95% CI = 1.10–4.40) , and spousal support (p value = 0.01; OR = 2.63; 95% CI = 1.16 – 5.93) Conclusion: The most influential factors on anemia in the third trimester of pregnancy were birth interval, nutritional status, and knowledge.