Iron deficiency anaemia among 6-to-36-month children from northern Angola

Prevalence and Determinants of Stunting-Anemia and Wasting-Anemia Comorbidities and Micronutrient Deficiencies in Children Under 5 in the Least-Developed Countries: A Systematic Review and Meta-analysis

CONTEXT

Despite shifting from addressing isolated forms of malnutrition to recognizing its multifaceted nature, evidence on the prevalence and determinants of micronutrient deficiencies, and their coexistence with undernutrition in children under 5, remains insufficient, unsystematic, and incohesive.

OBJECTIVE

The aim of this systematic review and meta-analysis was to assess the prevalence and determinants of stunting-anemia and wasting-anemia comorbidities and micronutrient deficiencies in children under 5 in the least-developed countries (LDCs).

DATA SOURCES

Electronic searches took place from January 15, 2023, to February 14, 2024, across multiple databases, including PubMed, Embase, Web of Science, SCOPUS, African Index Medicus (AIM), World Health Organization's Institutional Repository for Information Sharing (IRIS), and African Journals Online. The search spanned the years 2000 to 2024, yet it yielded eligible full-text English research articles from only 2005 to 2021 conducted in LDCs. Studies lacking quantitative data on malnutrition types and their determinants were excluded.

DATA EXTRACTION

Two independent authors assessed articles for bias and quality using Hoy et al's 10-item scale and Newcastle-Ottawa Scale (NOS) criteria. Prevalence and other details were extracted using a Joanna Briggs Institute Excel template. Authors extracted adjusted odds ratios (aORs) for determinant factors such as sex and vitamin A and iron supplementation.

DATA ANALYSIS

The search yielded 6248 articles from 46 LDCs. Sixty-nine articles, with a total sample size of 181 605, met inclusion criteria for the final meta-analysis. Vitamin A deficiency affected 16.32% of children, and iodine deficiency affected 43.41% of children. The pooled prevalence of wasting-anemia and stunting-anemia comorbidity was 5.44% and 19.47%, respectively. Stunting was associated with vitamin A deficiency (aOR: 1.54; 95% CI: 1.01-2.37), and not taking vitamin A supplementation was associated with iron-deficiency anemia (aOR: 1.37; 95% CI: 1.21-1.55).

CONCLUSION

A significant proportion of children under 5 in LDCs experienced stunting-anemia and wasting-anemia comorbidities and micronutrient deficiencies. This study underscores the urgent need to address factors driving these burdens.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023409483.

Relationship Between Iron Deficiency Anemia and Stunting in Pediatric Populations in Developing Countries: A Systematic Review and Meta-Analysis

BACKGROUND/OBJECTIVES

Iron deficiency anemia (IDA) and stunting are prevalent global health issues, particularly in developing countries, where previous studies have suggested a potential relationship between them. This systematic review aims to analyze the relationship between iron deficiency anemia and stunting in pediatric populations in developing countries.

METHODS

Literature searches were conducted on PubMed, EMBASE, Cochrane Library, and EBSCO Host. The primary outcome was the association between IDA and stunting. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies and the Effective Public Health Practice Project (EPHPP) for other observational studies. Meta-analysis was performed with a random-effects model and heterogeneity assessment. A Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessment was performed to determine the certainty and importance of the study.

RESULTS

Out of 19,095 articles, 15 studies were included in the systematic review, and 4 studies were included in the meta-analysis, encompassing 21,936 subjects aged 0 to 12 years. IDA prevalence ranged from 3.6 to 58.8%, while stunting prevalence varied from 6.6 to 44.5%. Nine articles supported a significant relationship between IDA and stunting, revealing that stunted children had a 1.31-6.785 times higher risk of developing IDA. The odds ratio of children with IDA to be stunted was 2.27 (95% CI = 1.30-3.95). All studies exhibited a moderate risk of bias. GRADE assessment suggested that the evidence's certainty is low but important.

CONCLUSIONS

The high IDA prevalence in developing countries, including Indonesia, is associated with stunting in children, suggesting a synergistic relationship.

Iron and Vitamin A Status of Children Aged 0 to 36 Months in Thulamela Municipality, Vhembe District, South Africa

Objective: The present study assessed the iron and Vitamin A status of children aged 0 to 36 months in Thulamela municipality, Vhembe District. Methods: A cross-sectional study was conducted among 250 children aged 0 to 36 months attending well-baby clinic services with their mothers. Convenience sampling was used to select study participants, and simple random sampling was used to choose clinics. Data were gathered via a questionnaire administered by the researcher and field workers from August to September 2019. Standard techniques were used to measure body weight and height. In addition, serum retinol, haemoglobin, iron, ferritin, transferrin saturation, and transferrin levels were also assessed. Information on dietary diversity was gathered through a 24 h dietary recall. Results: The prevalence of underweight, wasting, and stunting was 3.6%, 2%, and 9.2%, respectively. Using serum retinol <10 µg/dL, 22% of children had vitamin A deficiency. The prevalence of anaemia was 53.6%, while 13.1% of children had iron deficiency anaemia when using serum ferritin of less than 12 μg/dL. Most children (90.8%) had an inadequate dietary diversity score, while 9.2% had sufficient dietary diversity. The most consumed food groups were grains, roots and tubers, vitamin A rich fruits and vegetable, and flesh foods. A higher percentage (44%) of children with low iron ferritin were underweight compared to those with normal iron ferritin (df = 1, p-value = 0.007). Conclusion: Iron, anaemia, and vitamin A deficiencies, accompanied by a high prevalence of stunting, were common among children in Thulamela Municipality. Thus, improving nutritional status in this area is a critical need.

Associated factors in pediatric patients admitted with severe iron-deficiency anemia in the last seven years - the experience of a single pediatric unit

OBJECTIVES

To study the causes of iron deficiency, laboratory findings and clinical manifestation of infants aged 6-12 months and children aged 1-3 years diagnosed with severe iron-deficiency anemia.

PATIENTS, MATERIALS AND METHODS

We conducted an observational, retrospective single tertiary center study between January 2015 and April 2022, which included 142 children. The control group (patients with no diagnosis of severe iron-deficiency anemia) included 71 patients and the study group (patients diagnosed with severe iron-deficiency anemia) included also 71 patients. Clinical data were retrospectively collected from hospital medical records. Statistical analysis was conducted using Statistical Package for the Social Sciences (SPSS) 25.0 software.

RESULTS

Seventy-one children had hemoglobin <7 g∕dL and low values of ferritin/serum iron (22 infants aged 6-12 months and 49 children aged 1-3 years). In both the study and control groups, the male gender was slightly more prevalent. Mother's age at birth and living standard is significantly lower in the study group. We note a higher frequency of premature births (14.08%) in children identified with anemia compared to control group (8.45%). We found a statistically significant distribution of cow's milk consumption among the two groups (p<0.001). Pearson's correlation test revealed a significant positive correlation, indicating that anemia is directly proportional to cow's milk consumption.

CONCLUSIONS

The most frequent cause of iron-deficiency anemia in infants and children 1-3 years old was the consumption of cow's milk following incorrect diversification and incomplete prophylaxis of iron-deficiency anemia.

Comparing delayed cord clamping and umbilical cord milking during elective cesarean section for the neonatal outcome

Objectives

to compare between immediate cord clamping, delayed cord clamping, and umbilical cord milking and their effects on hemoglobin and bilirubin level in term infants in cesarean section.

Study design

A randomized clinical trial was conducted from November 2021 to June 2022, including 162 full term pregnant women undergoing elective cesarean section at EL-Shatby Maternity University Hospital. They were randomly assigned (1:1:1 ratio) either to immediate cord clamping just after delivery (Group 1) or delayed cord clamping for 30 s (Group 2) or umbilical cord milking 10 times for 10-15 s (Group 3). The primary outcome measures included hemoglobin and hematocrit levels of the newborn at birth and the secondary outcome was bilirubin level measurement at 72 h of life.

Results

one hundred sixty- two newborns were randomized into 3 groups, fifty-four cases in each, and were investigated on hemoglobin and hematocrit levels; five were lost to follow-up and one hundred fifty-seven were tested for bilirubin. Participants among groups had no significant difference regarding demographic and clinical characteristics, regarding the hemoglobin at birth it was significant higher in the umbilical cord milking group (Group 3) through all groups (14.91 ± 0.91 g/dl vs15.38 ± 0.74 g/dl vs 16.56 ± 1.03 g/dl, p value <0.001), regarding hematocrit level at birth it was significant in the umbilical cord milking group (Group 3) through all groups (44.71 ± 2.94 vs 46.48 ± 2.61 vs 49.74 ± 3.26, p value <0.001). On the other hand, bilirubin level after 72 h had no significant different through the 3 groups (8.80(IQR 4.50-17.20), vs 9.70(IQR3.50-14.70), vs 8.50(IQR 3.20-19.50), respectively p value= 0.348).

Conclusion

this study showed that umbilical cord milking 10 times for 10-15 s is more effective than delayed cord clamping for 30 s in enhancing hemoglobin and hematocrit levels in newborn delivered by cesarean section with no significant difference on bilirubin level in the newborn.

Evaluation of factors associated the expression of anti-HBs in children in Hunan Province, China

BACKGROUND AND OBJECTIVES

Vaccine is the most essential avenue to prevent hepatitis B virus (HBV) infection in infants and preschool children in China, with the largest populations carrying HBV in the world. This study aimed to evaluate the factors associating the response level of anti-HBs in children, providing instructions for HBV prevention clinically.

METHODS

The children taking physical examinations in the Third Xiangya Hospital from January 2013 to April 2020 were recruited. Telephone follow-up were adopted to collect further information. Univariate logistic regression was used to analyse the relationship between age and anti-HBs expression. Grouping by age and anti-HBs expression, we used chi-square test and T test to compare qualitative and quantitative data between positive group and negative group in each age subgroup. The meaningful variables (P < 0.10) in chi-square test or T test were further assessed with collinearity and chosen for univariate and multivariate logistic regression analysis by the stepwise backward maximum likelihood method (α_in = 0.05, α_out = 0.10).

RESULTS

A total of 5838 samples (3362 males, 57.6%) were enrolled. In total, the incidence of negative anti-HBs increased with age[OR = 1.037(1.022-1.051)]. Multivariate logistic regression analysis illustrated that anemia[OR = 0.392(0.185-0.835)], age[OR = 2.542(1.961-3.295)] and Vit D[OR = 0.977(0.969-0.984)] in 0.5-2.99 years subgroup, Zinc deficiency[OR = 0.713(0.551-0.923] and age[OR = 1.151(1.028-1.289)] in 3-5.99 years subgroup, Vit D[OR = 0.983(0.971-0.995)] in 12-18 years subgroup had significant association with anti-HBs.

CONCLUSIONS

This retrospective study illustrated that age, anemia status, zinc deficiency and vitamin D were associated with anti-HBs expression in specific age groups of children, which could serve as a reference for the prevention of HBV.

Anaemia and associated factors among children aged 6-23 months in agrarian community of Bale zone: a cross-sectional study

Anaemia remains among the most prevalent nutritional problems among children in developing countries. In Ethiopia, more than half of children <5 years of age are anaemic. In the early stages of life, it leads to poor cognitive performance, delay psychomotor development and decreases working capacity in later life. The present study aimed to assess the prevalence and associated factors of anaemia among children aged 6-23 months in the Bale zone. A community-based cross-sectional study was conducted from 1 to 30 June 2021. Multistage stratified sampling and simple random sampling techniques were employed to select 770 samples. An interviewer-administered questionnaire was used to collect data on socio-demographic, child health and feeding practices. Haemoglobin levels were estimated using a portable Hemosmart machine. Children with haemoglobin values below 11 g/dl were considered anaemic. Binary logistic regression analysis was performed to identify factors associated with anaemia. Statistical significance was set at P < 0⋅05. The prevalence of anaemia was 47⋅9 % (95 % CI (44⋅4, 51⋅5)). The multivariate analysis showed that child age (6-11 months) (AOR 1⋅47; 95 % CI (1⋅06, 2⋅03)), household food insecurity (AOR 1⋅44; 95 % CI (1⋅01, 2⋅04)), having diarrhoea and cough in the past 2 weeks (AOR 1⋅70; 95 % CI (1⋅18, 2⋅44)) and (AOR 1⋅97; 95 % CI (1⋅28, 3⋅04), respectively), not consuming the recommended dietary diversity (AOR 2⋅72; 95 % CI (1⋅96, 3⋅77)) and stunting (AOR 1⋅88; 95 % CI (1⋅31, 2⋅70)) were significantly associated with anaemia. Anaemia in children aged 6-23 months was a severe public health problem in the study area. Integrated nutritional interventions combined with iron fortification and supplementation is recommended.

Bacterial Meningitis in Children With Sickle Cell Disease in Angola

Sickle cell disease (SCD) was found in 10% of children with bacterial meningitis (BM) in Luanda, 5-fold more than in the general population. BM children with SCD versus BM children without SCD had higher inflammatory markers, more often had pneumococcal meningitis (71% vs. 39%), and either died (39% vs. 22%) or had a longer hospital stay (15 vs. 11 days).

Copula Geo-Additive Modeling of Anaemia and Malnutrition among Children under Five Years in Angola, Senegal, and Malawi

Notwithstanding the interventions implemented to address child mortality, anaemia and malnutrition remain a concern for the future of developing countries. Anaemia and malnutrition contribute a high proportion of the causes of childhood morbidity in Africa. The objective of this study is to jointly model anaemia and malnutrition using a copula geo-additive model. This study is a secondary data analysis where a Demographic and Health Survey of 2016 data from Angola, Malawi, and Senegal was used. The descriptive analysis was conducted in SPSS and the copula geo-additive model analysis was performed in R 3.63. The results showed that female children are notably associated with anaemia and a malnourished status (female estimate = 0.144, p-value = 0.027 for anaemia; female estimate = −0.105, p-value = 000 for malnutrition). The probability of each result decreased with an improvement in the mother’s level of schooling. This indicates an urgent requirement for interventions to be implemented by policymakers in order to manage children’s mortality rates. These interventions can include the introduction of educational programs for older adults, children’s dietary programs, and income generation initiatives (starting a small business, etc.). It is hoped that this paper can foster the utilization of copula methodology in this field of science with the use of cross-sectional data.

Wasting, Stunting, and Anemia in Angolan Children after Deworming with Albendazole or a Test-and-Treat Approach for Intestinal Parasites: Binary Longitudinal Models with Temporal Structure in a Four-Arm Randomized Trial

Undernutrition, anemia, and intestinal parasitic infections are public health problems in Angola, especially in pre-school children. We analyzed binary data from a longitudinal four-arm randomized parallel trial conducted in Bengo Province, northern Angola, over the course of two years, with seven follow-up assessments to explore the effects of four interventions (deworming and a test-and-treat approach for intestinal parasites, at both the individual and household levels) on wasting and stunting, and to understand their indirect benefits for anemia, malaria, diarrhea, and vomiting. A total of 121 children with intestinal parasitic infections received baseline treatment, and were allocated to the four arms (1:1:1:1). Using continuous outcome variables of height-for-age (HAZ) and weight-for-height (WHZ) statistical approaches did not reveal a clear benefit of any particular arm (Pathogens 2021, 10, 309). Next, HAZ and WHZ were transformed into binary variables of stunting and wasting, respectively, considering their mild-to-severe (Z-score < −1) and moderate-to-severe degrees (Z-score < −2). Original clinical data (on anemia, diarrhea, vomiting, and malaria) were also analyzed. From a binary longitudinal analysis with different dependence structures, using the R package bild, fitted models revealed the potential benefit of a test-and-treat approach at the individual level for wasting compared with annual albendazole at the individual level, especially considering mild-to-severe forms (ORadj = 0.27; p = 0.007). All arms showed similar effects on stunting, compared with annual albendazole, at a 5% significance level. Time and age at baseline presented favorable effects in the percentage of stunting using both severity degrees. Results showed a decreased chance of having anemia and diarrhea over time, although with no significant differences between arms. Data from longitudinal studies are essential to study the direct and indirect effects of interventions, such as deworming, and to explore additional approaches aiming at better understanding the temporal structure of nutrition and health outcomes in children.

Zinc Deficiency Interacts with Intestinal/Urogenital Parasites in the Pathway to Anemia in Preschool Children, Bengo–Angola

In host organisms with normal micronutrient status, nutritional immunity is a strongly regulated response aiming at decreasing the progression and severity of infections. Zinc deficiency may disturb this balance, impairing immune responses to infections, which may indirectly increase infection-related anemia. Since zinc deficiency may associate directly with anemia, the role of infections is often overlooked. Herein, we investigated the participation of infections (or inflammation) in the causal pathway between zinc deficiency and anemia. This transversal study, conducted in 2015 in Bengo-Angola, enrolled 852 under-3-year-old children. Logistic regression models were used to investigate interaction and mediation effects, and significance was confirmed by the Sobel test. In sum, 6.8% of children had zinc deficiency, 45.9% had anemia, and 15.6% had at least one intestinal/urogenital parasite. Furthermore, we found (1) no evidence that inflammation mediates or interacts with zinc deficiency to cause anemia, and (2) zinc deficiency interacts with infections, significantly increasing the odds of anemia (OR: 13.26, p = 0.022). This interaction was stronger among children with iron deficiency anemia (OR: 46.66, p = 0.003). Our results suggest that zinc deficiency may impair the immune response to infections and/or that intestinal parasites could have developed mechanisms to avoid zinc-limited environments. Further studies are needed to corroborate these suggestions.

Prevalence and significance of anaemia in childhood bacterial meningitis: a secondary analysis of prospectively collected data from clinical trials in Finland, Latin America and Angola

OBJECTIVES

To describe the prevalence and severity of anaemia and to examine its associations with outcome in children with bacterial meningitis (BM).

DESIGN

Secondary analysis of descriptive data from five randomised BM treatment trials.

SETTING

Hospitals in Finland, Latin America and Angola.

PARTICIPANTS

Consecutive children from 2 months to 15 years of age admitted with BM and who had haemoglobin (Hb) measured on admission.

OUTCOME MEASURES

Prevalence and degree of anaemia using the WHO criteria, and their associations with recovery with sequelae or death.

RESULTS

The median Hb was 11.8 g/dL in Finland (N=341), 9.2 g/dL in Latin America (N=597) and 7.6 g/dL in Angola (N=1085). Of the children, 79% had anaemia, which was severe in 29%, moderate in 58% and mild in 13% of cases. Besides study area, having anaemia was independently associated with age <1 year, treatment delay >3 days, weight-for-age z-score <-3 and other than meningococcal aetiology. Irrespective of the study area, anaemia correlated with the markers of disease severity. In children with severe to moderate anaemia (vs mild or no anaemia), the risk ratio for death was 3.38 and for death or severe sequelae was 3.07.

CONCLUSION

Anaemia, mostly moderate, was common in children with BM, especially in Angola, in underweight children, among those with treatment delay, and in pneumococcal meningitis. Poor outcome was associated with anaemia in all three continents.

TRIAL REGISTRATION NUMBER

The registration numbers of Angolan trials were ISRCTN62824827 and NCT01540838.

Feeding practices and micronutrient status of children aged 0-36 months in Thulamela Municipality, Limpopo province

BACKGROUND

Micronutrient deficiency continues to be a major public health problem affecting infants and young children under 5 years of age worldwide.

AIM

The study aims to investigate feeding practices and micronutrient status of children aged 0-36 months.

SETTING

The study was conducted at government clinics located in Thulamela Municipality, which is one of the local municipalities in Vhembe District, Limpopo province.

METHODS

A cross-sectional survey was conducted. A total of 250 mothers with children aged 0-36 months were enrolled. A structured questionnaire was used to interview the mothers. Biochemical measurements of children were assessed using standard procedures.

RESULTS

Only 7.6% of children were exclusively breastfed for 6 months. Majority (87.5%) of the children were introduced to complementary foods before 6 months and 98.8% of the children had a low dietary diversity score of less than four, while 9.2% had a dietary diversity score of more than four. The prevalence of vitamin A deficiency, anaemia and iron deficiency was 21.7%, 53.6% and 13.1%, respectively. For mothers who initiated breastfeeding immediately after delivery, the odds of children having low ferritin were 0.11 times, as compared to children who were initiated breastfeeding a day after delivery (odds ratio = 0.11; 95% confidence interval = 0.015-0.812).

CONCLUSION

Most of the children were introduced to complementary foods earlier than 6 months of age. Infant feeding practices were associated with micronutrients status.

CONTRIBUTION

The study contributes to the body of literature on feeding practices and the micronutrient status of children.

Risk factors of anaemia and iron deficiency in Somali children and women: Findings from the 2019 Somalia Micronutrient Survey

There are limited data on the prevalence of anaemia and iron deficiency (ID) in Somalia. To address this data gap, Somalia's 2019 micronutrient survey assessed the prevalence of anaemia and ID in children (6–59 months) and non‐pregnant women of reproductive age (15–49 years). The survey also collected data on vitamin A deficiency, inflammation, malaria and other potential risk factors for anaemia and ID. Multivariable Poisson regressions models were used to identify the risk factors for anaemia and ID in children and women. Among children, the prevalence of anaemia and ID were 43.4% and 47.2%, respectively. Approximately 36% and 6% of anaemia were attributable to iron and vitamin A deficiencies, respectively, whereas household possession of soap was associated with approximately 11% fewer cases of anaemia. ID in children was associated with vitamin A deficiency and stunting, whereas inflammation was associated with iron sufficiency. Among women, 40.3% were anaemic, and 49.7% were iron deficient. In women, ID and number of births were significantly associated with anaemia in multivariate models, and approximately 42% of anaemia in women was attributable to ID. Increased parity was associated with ID, and incubation and early convalescent inflammation was associated with ID, whereas late convalescent inflammation was associated with iron sufficiency. ID is the main risk factor of anaemia in both women and children and contributed to a substantial portion of the anaemia cases. To tackle both anaemia and ID in Somalia, food assistance and micronutrient‐specific programmes (e.g. micronutrient powders and iron supplements) should be enhanced.

Iron deficiency anemia among children aged 2-5 years in southern Ethiopia: a community-based cross-sectional study

Background

Iron-deficiency anemia (IDA) is a common type of nutritional anemia in low-income countries, including Ethiopia. However, there is limited data on iron deficiency anemia prevalence and associated factors in Ethiopia, particularly for children aged 2 to 5 years.

Objectives

To establish the prevalence of iron deficiency anemia and associated risk factors, focusing on iron-rich food consumption among children aged 2 to 5 years in southern Ethiopia.

Methods

A community-based cross-sectional study was conducted in southern Ethiopia in 2017, involving 331 randomly selected children aged 2 to 5 years old. A structured questionnaire was used to collect information about the children and the households. Venous blood was collected from each child in a test tube to measure hemoglobin, ferritin, and C-reactive protein (CRP). Hemoglobin levels were determined using Hemocue^®301 and adjusted for altitude. Anemia was defined as hemoglobin levels <11 g/dl. Ferritin was adjusted for inflammation based on CRP concentration and low ferritin concentration defined as adjusted ferritin concentration <12 µg/L. IDA was considered when a child had both hemoglobin level <11g/dl and low ferritin concentration. Bi-variable and multivariable logistic regression models were performed to identify factors associated with IDA and iron-rich food consumption.

Results

The prevalence of iron deficiency anemia was 25%, and the total anemia prevalence was 32%. Only 15% of children consumed iron-rich foods in the preceding 24 h, and 30% of children consumed iron-rich foods at least once in the preceding week. IDA decreased as the height for age z-score increased (Adjusted Odds Ratio 0.7; 95% CI [0.5–0.9]). Mothers with increased educational level (AOR 1.1; 1.0–1.2) and households with increased dietary diversity (AOR 1.4; 1.2–1.6) consumed more iron-rich foods.

Conclusions

Iron deficiency anaemia was a moderate public health problem in southern Ethiopia, and the iron-rich food consumption was low. Interventions should focus on food supplementation and fortification, food diversification and nutritional education, and promoting women’s education.

A randomized controlled clinical trial on peripartum effects of delayed versus immediate umbilical cord clamping on term newborns

OBJECTIVES

To compare the hemoglobin and serum bilirubin concentration of term newborn following delayed and immediate umbilical cord clamping.

METHODS

A randomized controlled trial of eligible parturients with singleton pregnancy delivered between July 1, 2019 and September 30, 2020 were randomly assigned (1:1 ratio) to either delayed clamping of umbilical cord (60 s after delivery) or immediate clamping (0-15 s) was done. The primary outcome measures included hemoglobin and bilirubin levels of the newborn measured at birth and 48 h of life. Intention-to-treat principle was applied to analysis (www.pactr.org: PACTR201906668876480).

RESULTS

One hundred and two newborns were randomized into each group and none was lost to follow-up. Participants in both groups had similar socio-demographic and clinical characteristics. At 0 h of birth, cord blood hemoglobin concentration and total bilirubin values were not significantly different between the two groups (p > 0.05). At 48 h of birth, mean hemoglobin concentration was significantly higher in delayed clamping group than immediate clamping group (16.51 ± 1.71 g/dl vs 15.16 ± 2.27 g/dl; p < 0.001) but total mean bilirubin concentration was not significantly different (3.88 ± 1.54 mg/dl vs 3.71 ± 1.20 mg/dl; p = 0.380). There was no significant difference in postpartum hemorrhage (p = 0.653), neonatal jaundice (p = 0.856), and need for phototherapy (p = 0.561) while respiratory symptoms, polycythemia and anemia were not reported.

CONCLUSION

Delayed cord clamping at childbirth is more advantageous for term infants in terms of more hemoglobin concentration compared to traditional immediate cord clamping. The maternal and perinatal complications were either not significantly different or absent.