Beyond hemoglobin: uncovering iron deficiency and iron deficiency anemia using serum ferritin concentration among pregnant women in eastern Ethiopia: a community-based study

Non-adherence to antenatal iron supplementation and its determinants among pregnant women in 35 sub-saharan African countries: a generalized linear mixed-effects modeling with robust Poisson regression analysis

BACKGROUND

Despite the integration of iron supplementation into routine antenatal care programs as a nutritional intervention to prevent anemia in pregnant women, the use of this supplement for the recommended duration remains low in sub-Saharan Africa (SSA). Evidence on maternal compliance with iron supplementation at the SSA level is lacking and most of the previous studies have been limited to specific geographic areas. Therefore, the current study used large population survey data from 35 SSA countries to estimate the pooled prevalence of non-adherence and its determinants.

METHODS

A secondary analysis was conducted using data from the demographic and health surveys across 35 SSA countries. After excluding women with missing data on the outcome variable, a weighted sample of 158,941 women who received iron supplementation during their recent pregnancy was included in the analysis. Forest plot was used to present the pooled and country-level rates of non-adherence to antenatal iron supplementation. A multilevel mixed-effects Poisson regression with robust variance was done to identify determinants of non-adherence.

RESULTS

The pooled prevalence of non-compliance to iron supplementation in SSA was 65.1% [95% CI: 64.9 - 65.3%], with the lowest level in Zambia (18%) and the highest in Burundi (97%). The analysis revealed that living in rural areas (aPR: 1.16, 95% CI: 1.13-1.19), lack of access to mass media (aPR: 1.10, 95% CI: 1.09-1.12), low household wealth (aPR: 1.11, 95% CI: 1.09-1.14), late (aPR: 1.19, 95% CI: 1.17-1.20) and frequent ANC visit (aPR: 1.28, 95% CI: 1.26, 1.29), women's employment status (aPR: 1.05, 95% CI: 1.03-1.06), husband illiteracy (aPR: 1.12, 95% CI: 1.10-1.13), and distance to a health facilities (aPR: 1.03, 95% CI: 1.01-1.05) were associated higher prevalence of non-adherence. Conversely, older maternal age was associated lower prevalence of non-compliance (aPR: 0.96, 95% CI: 0.94-0.97).

CONCLUSION

More than six out of ten pregnant women in SSA do not take iron supplements for the recommended period, with substantial variations across the countries. The level of non-adherence was significantly varied by women's sociodemographic and reproductive characteristics. This urges the need for strengthening community health interventions and other existing programs to reach women in rural and economically disadvantaged settings. Furthermore, promoting antenatal care services through mass media and community-based health education strategies is key for scaling up the utilization of the supplement. Our results also suggest the importance of establishing the community-based distribution of iron supplements to address women with limited access to the healthcare system.

Current research and evidence gaps on placental development in iron deficiency anemia

Studying the effects of maternal iron deficiency anemia (IDA) is complex owing to its diverse causes, each independently impacting the placenta and fetus. Simple treatment with iron supplements does not always resolve the anemia. Therefore, delving into how IDA alters placental development at a molecular level is crucial to further optimize treatment. This review addresses the effects of IDA on placental structures and functions, including changes in oxygen levels, blood vessels, and the immune system. Profound understanding of physiological characteristics and regulatory mechanisms of placental development is key to explain the mechanisms of abnormal placental development in pregnancy-associated disorders. In turn, future strategies for the prevention and treatment of pregnancy complications involving the placenta can be devised. These studies are significant for improving human reproductive health, enhancing sociodemographic qualities, and even lifelong wellbeing, a focal point in future placental research.

Awareness and practices in preventing maternal iron deficiency among pregnant women living in urban slum areas in Makassar City, Indonesia

BACKGROUND

During pregnancy, the body requires more complex nutritional intake. Therefore, problems with fulfilling nutrition during pregnancy occur often. One of the most common nutritional problems in pregnancy is iron deficiency anemia, the most widespread micronutrient problem and the most difficult to overcome worldwide. This study aimed to determine awareness and prevention behavior associated with the incidence of iron deficiency in pregnant women living in urban slum areas.

MATERIALS AND METHODS

This was a cross-sectional study. The data collection used KoboToolbox, an Android-based tool. Iron status was examined by serum ferritin level assay using ELISA at the Microbiology Laboratory Unit of Hasanuddin University Hospital.

RESULTS

The prevalence of pregnant women who experienced iron deficiency was 78%. The logistic regression analysis showed that poor awareness (AOR = 3.03, CI 95% 1.26-7.29, P = 0.013) and practices in taking iron enhancers (AOR = 2.85, CI 95% 1.18-6.92, P = 0.020) became the main factors associated with iron deficiency among pregnant women.

CONCLUSIONS

Poor awareness and practices regarding consuming iron enhancers increased the risk of iron deficiency among pregnant women living in urban slum areas. Iron deficiency is a major health concern for pregnant women, especially those living in slum settlements, which must be addressed. A more optimal healthcare system for pregnant women may reduce the incidence of iron anemia in pregnancy by improving health promotion and optimizing healthcare services.

Anemia in an ethnic minority group in lower northern Thailand: A community-based study investigating the prevalence in relation to inherited hemoglobin disorders and iron deficiency

BACKGROUND

Anemia is a globally well-known major public health problem. In Southeast Asia where there is ethnic diversity, both iron deficiency (ID) and inherited hemoglobin disorders (IHDs) are prevalent and are considered to be the major factors contributing to anemia. However, little is known about the anemia burden among the ethnic minorities. In this study, we determine the burden of anemia, in relation to ID and IHDs, among the Karen ethnic minorities living in the rural area of lower northern Thailand.

METHODS

A cross-sectional community-based study was conducted at Ban Rai district, Uthai Thani province. Study participants included 337 Karen people aged over 18 years. Socio-economic and health-related information were obtained through interviews and recorded by local health staff. Anemia, IHDs and ID were diagnosed according to standard laboratory methods. Multivariate logistic regression analysis was applied to identify risk factors of moderate-to-severe anemia.

RESULTS

The prevalence of overall anemia was 27.9% (95% CI = 23.2-33.0). Mild and moderate anemia were detected in 18.7% (95% CI = 14.7-23.3) and 8.9% (95% CI = 6.1-12.5) respectively. Severe anemia was found in one case (0.3%). Various forms of IHDs were identified in 166 participants, constituting 49.3% (95% CI = 43.8-54.7). The most common form of IHDs was α+-thalassemia (32.9%), followed by β-thalassemia (12.2%), α0-thalassemia (4.2%), hemoglobin E (3.9%), and hemoglobin Constant Spring (0.9%). Among 308 participants who were investigated for ID, the prevalence was discovered to be 6.8% (95% CI = 4.3-10.2). Analysis of risk factors of moderate-to-severe anemia revealed that individuals with ID, β-thalassemia and age > 65 years were at high risk with adjusted odds ratio of 17 (95% CI = 3.8-75.2), 6.2 (95% CI = 1.4-27.8) and 8.1 (95% CI = 1.6-40.4) respectively.

CONCLUSIONS

Anemia among the Karen is of public health significance; and IHDs are the major contributing factors. Because of the high risk of developing moderate-to-severe anemia, special attention should be paid to individuals affected with ID, β-thalassemia and the elderly. Public awareness of the health burden of severe thalassemia syndromes should also be campaigned.

Chrononutrition during Pregnancy and Its Association with Maternal and Offspring Outcomes: A Systematic Review and Meta-Analysis of Ramadan and Non-Ramadan Studies

Much evidence suggests that food intakes and eating patterns are major determinants of the phase of peripheral circadian clocks, and desynchronization between them is thought to contribute to the development of metabolic disorders. However, much remains to be understood about how different dimensions of chrononutrition during pregnancy affect pregnant women's and their offspring's health outcomes. Therefore, we systematically reviewed and integrated all emerging evidence on chrononutrition during pregnancy (including meal skipping, meal frequency, night eating, and (Ramadan) fasting) and their relationships with maternal and offspring outcomes. The results suggest that meal skipping and night eating during pregnancy were generally associated with adverse pregnancy and birth outcomes, whereas no strong conclusion could be reached for meal frequency. In our meta-analysis, Ramadan fasting did not seem to be related with birth weight or gestational age at birth, but evidence for other mother-offspring outcomes was inconsistent. To further elucidate the effect of chrononutrition factors on maternal and offspring health outcomes, larger and well-conducted prospective cohort and interventional studies are needed. In addition, information on covariates such as physical activity, sleep, diet quality and quantity, fasting days, fasting period per day, and trimester exposure should also be collected and considered during analysis.