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Okunade KS, Olowoselu FO, Oyedeji OA, Oshodi YA, Ugwu AO, Olumodeji AM, Adejimi AA, Adenekan MA, Ojo T, Ademuyiwa IY, Adaramoye V, Okoro AC, Olowe A, Adelabu H, Akinmola OO, Yusuf-Awesu S, Oluwole AA. Prevalence and determinants of moderate-to-severe anaemia in the third trimester of pregnancy: a multicenter cross-sectional study in Lagos, Nigeria. Sci Rep 2024; 14:11411. [PMID: 38762586 PMCID: PMC11102504 DOI: 10.1038/s41598-024-61487-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/06/2024] [Indexed: 05/20/2024] Open
Abstract
The high burden of anaemia during pregnancy underscores the urgent need to gain a comprehensive understanding of the factors contributing to its widespread occurrence. Our study assessed the prevalence and the trends of moderate-to-severe anaemia (MSA) in late pregnancy (28 to 36 weeks) and then investigated the key determinants driving this prevalence among women in Lagos, Nigeria. We conducted a secondary data analysis involving 1216 women enrolled in the Predict-PPH study between January and March 2023. We employed a multivariate binary logistic regression model with a backward stepwise selection approach to identify significant predictors of MSA. The study revealed a 14.5% prevalence of MSA during pregnancy. Independent predictors of MSA included having given birth to two or more children (adjusted odds ratio = 1.46, 95% confidence interval: 1.03-2.07), having a maternal body mass index (BMI) of 28 kg/m2 or higher (adjusted odds ratio = 1.84, 95% confidence interval: 1.29-2.61), having less than tertiary education (adjusted odds ratio = 1.51, 95% confidence interval: 1.08-2.11), and being unemployed (adjusted odds ratio = 1.97, 95% confidence interval: 1.19-3.26). It is crucial for pregnant women, particularly those with higher parities and elevated BMI, to be monitored regularly for anaemia and its consequences during their antenatal care. Additionally, addressing the link between low education, unemployment, and anaemia necessitates comprehensive strategies that empower women in terms of education and economic status to enhance the overall well-being of individuals and communities, ultimately reducing the prevalence of anaemia and associated health issues in pregnancy.
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Affiliation(s)
- Kehinde S Okunade
- Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, PMB 12003, Lagos, Nigeria.
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria.
- Center for Clinical Trials, Research and Implementation Science, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria.
| | - Festus O Olowoselu
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Olufemi A Oyedeji
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Yusuf A Oshodi
- Department of Obstetrics & Gynaecology, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Aloy O Ugwu
- Department of Obstetrics & Gynaecology, 68 Nigerian Army Reference Hospital, Yaba, Lagos, Nigeria
| | - Ayokunle M Olumodeji
- Department of Obstetrics & Gynaecology, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Adebola A Adejimi
- Department of Community Health & Primary Care, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Muisi A Adenekan
- Department of Obstetrics & Gynaecology, Lagos Island Maternity Hospital, Lagos Island, Lagos, Nigeria
| | - Temitope Ojo
- Department of Obstetrics & Gynaecology, Federal Medical Center, Ebute-Meta, Lagos, Nigeria
| | - Iyabo Y Ademuyiwa
- Department of Nursing Science, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Victoria Adaramoye
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Austin C Okoro
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Atinuke Olowe
- Department of Nursing Science, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Hameed Adelabu
- Center for Clinical Trials, Research and Implementation Science, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria
| | - Olukayode O Akinmola
- Department of Chemical Pathology, Lagos University Teaching Hospital, Surulere, Lagos, Nigeria
| | - Salimat Yusuf-Awesu
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ayodeji A Oluwole
- Department of Obstetrics & Gynaecology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, PMB 12003, Lagos, Nigeria
- Department of Obstetrics & Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
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Talin IA, Abid MH, Samad MA, Domínguez Azpíroz I, de la Torre Diez I, Ashraf I, Nahid AA. Exploring factors influencing the severity of pregnancy anemia in India: a study using proportional odds model. Sci Rep 2023; 13:22816. [PMID: 38129518 PMCID: PMC10739876 DOI: 10.1038/s41598-023-49872-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
Pregnancy-associated anemia is a significant health issue that poses negative consequences for both the mother and the developing fetus. This study explores the triggering factors of anemia among pregnant females in India, utilizing data from the Demographic and Health Survey 2019-21. Chi-squared and gamma tests were conducted to find out the relationship between anemia and various socioeconomic and sociodemographic elements. Furthermore, ordinal logistic regression and multinomial logistic regression were used to gain deeper insight into the factors that affect anemia among pregnant women in India. According to these findings, anemia affects about 50% of pregnant women in India. Anemia is significantly associated with various factors such as geographical location, level of education, and wealth index. The results of our study indicate that enhancing education and socioeconomic status may serve as viable approaches for mitigating the prevalence of anemia disease developed in pregnant females in India. Employing both Ordinal and Multinominal logistic regression provides a more comprehensive understanding of the risk factors associated with anemia, enabling the development of targeted interventions to prevent and manage this health condition. This paper aims to enhance the efficacy of anemia prevention and management strategies for pregnant women in India by offering an in-depth understanding of the causative factors of anemia.
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Affiliation(s)
- Iffat Ara Talin
- Electronics and Communication Engineering Discipline, Khulna University, Khulna, 9208, Bangladesh
| | - Mahmudul Hasan Abid
- Electronics and Communication Engineering Discipline, Khulna University, Khulna, 9208, Bangladesh
| | - Md Abdus Samad
- Department of Information and Communication Engineering, Yeungnam University, Gyeongsan-si, Gyeongsangbuk-do, 38541, South Korea.
| | - Irma Domínguez Azpíroz
- Universidad Europea del Atlántico, Isabel Torres 21, 39011, Santander, Spain
- Universidad Internacional Iberoamericana, 24560, Campeche, Mexico
- Universidade Internacional do Cuanza, Cuito, Bié, Angola
| | - Isabel de la Torre Diez
- Department of Signal Theory, Communications and Telematics Engineering, Unviersity of Valladolid, Paseo de Belén, 15, 47011, Valladolid, Spain
| | - Imran Ashraf
- Department of Information and Communication Engineering, Yeungnam University, Gyeongsan-si, Gyeongsangbuk-do, 38541, South Korea.
| | - Abdullah-Al Nahid
- Electronics and Communication Engineering Discipline, Khulna University, Khulna, 9208, Bangladesh.
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Zhang J, Li Q, Song Y, Fang L, Huang L, Sun Y. Nutritional factors for anemia in pregnancy: A systematic review with meta-analysis. Front Public Health 2022; 10:1041136. [PMID: 36311562 PMCID: PMC9615144 DOI: 10.3389/fpubh.2022.1041136] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 09/26/2022] [Indexed: 01/29/2023] Open
Abstract
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.
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Affiliation(s)
- Jing Zhang
- Department of Obstetrics, Kunming City Maternal and Child Health Hospital, Kunming, China,Kunming Municipal Service Center for Maternal and Child Health, Kunming, China
| | - Quanhong Li
- Kunming Children's Hospital, Kunming, China,Department of Pharmacy, Children's Hospital of Kunming Medical University, Kunming, China
| | - Ying Song
- Department of Obstetrics, Kunming City Maternal and Child Health Hospital, Kunming, China,Kunming Municipal Service Center for Maternal and Child Health, Kunming, China
| | - Liping Fang
- Department of Obstetrics, Kunming City Maternal and Child Health Hospital, Kunming, China,Kunming Municipal Service Center for Maternal and Child Health, Kunming, China
| | - Lei Huang
- Department of Obstetrics, Kunming City Maternal and Child Health Hospital, Kunming, China,Kunming Municipal Service Center for Maternal and Child Health, Kunming, China
| | - Yu Sun
- Department of Obstetrics, Kunming City Maternal and Child Health Hospital, Kunming, China,Kunming Municipal Service Center for Maternal and Child Health, Kunming, China,*Correspondence: Yu Sun
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Liang J, Yang C, Liu T, Tang P, Huang H, Wei H, Liao Q, Long J, Zeng X, Liu S, Huang D, Qiu X. Single and mixed effects of prenatal exposure to multiple bisphenols on hemoglobin levels and the risk of anemia in pregnant women. ENVIRONMENTAL RESEARCH 2022; 207:112625. [PMID: 34973942 DOI: 10.1016/j.envres.2021.112625] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Bisphenols have endocrine-disrupting effects, which may disrupt hemoglobin (Hb) homeostasis and lead to anemia. However, the effects of bisphenols on anemia remain unknown. Therefore, we assessed the effects of single- and multiple-exposure to bisphenols on Hb levels and anemia of pregnant women. METHODS The study involved 2035 pregnant women from Guangxi Zhuang Birth Cohort in China. Generalized linear regression, principal component analysis (PCA), quantile g-computation (Qgcomp), and Bayesian kernel machine regression (BKMR) were performed to examine the effects of serum bisphenols on Hb levels and the risk of anemia. RESULTS After adjustment, elevated bisphenol A (BPA) levels were correlated with decreased Hb concentrations (β = -0.51; 95%CI: -0.92, -0.10) in the first trimester, and these correlations were more sensitive in mothers of males. Compared with the low-exposure group, bisphenol B (BPB) levels in the high-exposure group led to a 1.52 g/L (95%CI: -3.01, -0.03) decrease in Hb levels in the second trimester; tetrabromobisphenol A (TBBPA) levels in the high-exposure group led to a higher the risk of anemia in the third trimester (OR = 1.46; 95%CI: 1.07, 1.99); bisphenol F (BPF) in the high-exposure group led to lower Hb levels (β = -2.42; 95%CI:-4.69, -0.14) in mothers of male fetuses in the third trimester. Qgcomp showed that elevated levels of bisphenol mixture was correlated with (β = -1.42; 95%CI: -2.61, -0.24) decrease in Hb levels in the second trimester. PCA revealed a negative association between PC2 and Hb levels in the first trimester (β = -0.89; 95%CI: -1.61, -0.17). Similarly, a negative relationship was observed between PC1 and Hb levels in the third trimester among mothers with male fetuses (β = -1.00; 95%CI: -1.94, -0.06). CONCLUSIONS Prenatal exposure to single and mixed bisphenols may decrease Hb levels and increase the risk of anemia during pregnancy, the associations may be greater in mothers with male fetuses than those with female fetuses.
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Affiliation(s)
- Jun Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Chunxiu Yang
- The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, China
| | - Tao Liu
- Huaihua Center for Disease Control and Prevention, Huaihua, 418000, Hunan, China
| | - Peng Tang
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Huishen Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Huanni Wei
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Qian Liao
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Jinghua Long
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Xiaoyun Zeng
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Shun Liu
- Department of Child and Adolescent Health & Maternal and Child Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Dongping Huang
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Xiaoqiang Qiu
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China.
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Anemia among Women Who Visit Bost Hospital for Delivery in Helmand Province, Afghanistan. Anemia 2021; 2021:9358464. [PMID: 33520311 PMCID: PMC7817225 DOI: 10.1155/2021/9358464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/15/2020] [Accepted: 12/24/2020] [Indexed: 12/16/2022] Open
Abstract
Background Anemia is a global public health problem that affects a large number of pregnant women worldwide. In developed and developing countries, the number of pregnant women who become anemic ranges between 18% and 56%, respectively. The aim of this study was to determine the prevalence of anemia and factors associated with anemia among pregnant women who visit Bost Hospital for delivery in Helmand province, Afghanistan. Methods This was a hospital-based cross-sectional study that included 787 pregnant women who visited Bost Hospital for delivery services from January to June 2019. Data was collected in a self-structured questionnaire, which included sociodemographic, obstetrics, and laboratory information. Data was analyzed using SPSS 21.00 Statistical software. The prevalence of anemia was presented as a percentage. Bivariate analysis and binary logistic regression were used to identify the predictors of anemia among pregnant women. Results The overall prevalence of anemia in this study was 51% (95% CI = 48.7%–54.7%). The mean hemoglobin concentration among the study participants was 10.8 (±1.8) g/dL. On bivariate analysis, age group 30 years and above, rural residency and unemployment/housewives, multiparity, and no previous use of contraceptive were found to be associated with anemia. Binary logistic regression showed that multiparity (AOR = 3.09, 95% CI = 1.81–5.29) and no contraceptive use (AOR = 1.53, 95% CI = 1.08–2.16) were the independent predictors of increased anemia among pregnant women. Conclusion Anemia was found to be a severe public health problem in the study area. Policymakers in Afghanistan must accelerate interventions to promote family planning. The need for prospective studies is also suggested to identify other factors associated with anemia among pregnant women.
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Prevalence, Severity, and Correlates of Anaemia in Pregnancy among Antenatal Attendees in Warri, South-Southern Nigeria: A Cross-Sectional and Hospital-Based Study. Anemia 2020; 2020:1915231. [PMID: 32455008 PMCID: PMC7232721 DOI: 10.1155/2020/1915231] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 04/27/2020] [Indexed: 02/08/2023] Open
Abstract
Introduction Anaemia in pregnancy affects about half of all pregnant women globally and constitutes an important reproductive health issue. The World Health Organization estimates that the prevalence of anaemia in pregnancy varies from 53.8% to 90.2% in developing countries and 8.3% to 23% in developed countries. Anaemia in pregnancy is common in developing countries and prevalence statistics required for its effective management and control is not adequately available in Nigeria. Thus, this study seeks to provide prevalence statistics of anaemia in pregnancy for the study region and its severity and highlight some possible correlates. Methods A total of 218 pregnant women were recruited from the antenatal clinic of Central Hospital Warri using simple random technique after approval from the institutional review board and consent from the participants. Data on sociodemographics, economic status, and clinical history were collected using a pretested structured interviewer's questionnaire. Participant's haematocrit levels were estimated using standard laboratory techniques and anaemia was diagnosed using WHO-recommended cutoff. Results The overall prevalence of anaemia was 37.6%. This prevalence dropped to 10.6% when a cutoff of less than 30% haematocrit was used. There was a direct relationship between haematocrit values and the participants' age while mild anaemia accounted for the bulk (72%) of the anaemic cases. Participants younger than 20 years of age gave the highest age-based prevalence while parity-based prevalence was even among subgroups. Participants without formal education and those who were unemployed accounted for the highest prevalence in their different categories. Conclusion Based on the findings from our study, anaemia in pregnancy is still of primary public health concern if WHO cutoff is used for the diagnosis. However, the reduction observed when less than 30% haematocrit was used tags our study zone to be of moderate severity. Although all variables lacked statistical significance, younger age, no formal education, and unemployment were highlighted to be predisposing factors.
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Randall DA, Patterson JA, Gallimore F, Morris JM, Simpson JM, McGee TM, Ford JB. Haemoglobin trajectories during pregnancy and associated outcomes using pooled maternity and hospitalization data from two tertiary hospitals. Vox Sang 2019; 114:842-852. [DOI: 10.1111/vox.12839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/26/2019] [Accepted: 07/29/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Deborah A. Randall
- The University of Sydney Northern Clinical School Clinical and Population Perinatal Health Research St Leonards NSW Australia
- Northern Sydney Local Health District Kolling Institute St Leonards NSW Australia
| | - Jillian A. Patterson
- The University of Sydney Northern Clinical School Clinical and Population Perinatal Health Research St Leonards NSW Australia
- Northern Sydney Local Health District Kolling Institute St Leonards NSW Australia
| | - Felicity Gallimore
- Health Informatics, Kolling Institute, Northern Clinical School Sydney Medical School St Leonards NSW Australia
| | - Jonathan M. Morris
- The University of Sydney Northern Clinical School Clinical and Population Perinatal Health Research St Leonards NSW Australia
- Northern Sydney Local Health District Kolling Institute St Leonards NSW Australia
| | - Judy M. Simpson
- Sydney School of Public Health The University of Sydney Sydney NSW Australia
| | - Therese M. McGee
- Women's and Newborn Health Westmead Hospital Westmead NSW Australia
- The University of Sydney Sydney NSW Australia
| | - Jane B. Ford
- The University of Sydney Northern Clinical School Clinical and Population Perinatal Health Research St Leonards NSW Australia
- Northern Sydney Local Health District Kolling Institute St Leonards NSW Australia
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Selvaraj R, Ramakrishnan J, Sahu SK, Kar SS, Laksham KB, Premarajan KC, Roy G. High prevalence of anemia among postnatal mothers in Urban Puducherry: A community-based study. J Family Med Prim Care 2019; 8:2703-2707. [PMID: 31548960 PMCID: PMC6753800 DOI: 10.4103/jfmpc.jfmpc_386_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 05/13/2019] [Accepted: 06/17/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Anemia is a common problem across all life stages and ages with a higher burden among women. The postnatal period is an often-neglected period for the provision of effective care to the mothers. Anemia burden is also high during this period, which leads to many morbidities and poor quality of life. METHODS A community-based cross-sectional study was done in the field practice area of two Urban Primary Health Centres (PHCs) in Puducherry between March 2015 and February 2016. A total of 227 postnatal mothers were selected by simple random sampling from the list of mothers delivered from the field practice area. House visit was done within 4 weeks of completion of their postnatal period. Socio-demographic details and third-trimester hemoglobin levels were collected using a pretested questionnaire. Hemoglobin level during post-partum was measured using Sahli's Hemoglobinometer. Paired t-test is done to assess the difference in hemoglobin antepartum and post-partum. Multiple Logistic Regression is done to identify factors associated with postpartum anemia. RESULTS The mean (SD) hemoglobin during postpartum was 10.95 (1.1) gm% ranging from 7.4 gm% to 13.8 gm%. The prevalence of anemia among postnatal mothers is 76.2% (n = 173, 95% CI: 70.4%-81.4%). Around 26% (59) had mild anemia, 49.8% (113) had moderate anemia and 0.4% (1) had severe anemia. One-fourth of the mothers who had a normal hemoglobin level in their third trimester had developed anemia in the postnatal period. There was a significant difference in mean hemoglobin during postpartum and that of third trimester (10.95 vs 10.69 gm%, t = 3.4, df 226, P = 0.001). Birth order of two or more is significantly associated with postpartum anemia (aOR 2.2, 95% CI: 1.07-4.39). CONCLUSIONS The prevalence of anemia among postnatal mothers is high. Routine hemoglobin estimation, advice on consumption of iron-rich foods and Iron and Folic Acid (IFA) supplementation have to be provided to postnatal mothers to improve this situation.
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Affiliation(s)
- Ramya Selvaraj
- Department of Community Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Karaikal, Puducherry, India
| | - Jayalakshmy Ramakrishnan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Swaroop Kumar Sahu
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Karthik Balajee Laksham
- Department of Community Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Karaikal, Puducherry, India
| | - K. C. Premarajan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Gautam Roy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Vindhya J, Nath A, Murthy GVS, Metgud C, Sheeba B, Shubhashree V, Srinivas P. Prevalence and risk factors of anemia among pregnant women attending a public-sector hospital in Bangalore, South India. J Family Med Prim Care 2019; 8:37-43. [PMID: 30911478 PMCID: PMC6396586 DOI: 10.4103/jfmpc.jfmpc_265_18] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Anemia affects almost two-thirds of pregnant women in developing countries and contributes to maternal mortality and low birthweight. According to the National Family Health Survey-4 reports, maternal anemia continues to be a public health problem. Objective: To study the prevalence of anemia and its risk factors among pregnant women attending a public-sector hospital. Materials and Methods: This study was nested within an ongoing cohort study “ÇASCADE” which is exploring the effect of prenatal exposure to maternal cortisol and psychological distress on infant development in Bangalore. The respondents were enrolled from the antenatal clinic at Jayanagar General Hospital, which is a sub-district hospital. A total of 280 women who fulfilled the eligibility criteria were enrolled. Results: The prevalence of anemia was observed to be 33.9%; proportion of mild and moderate anemia was almost similar (48.4 and 49.5%). The mean hemoglobin level of all the participants was 11.33 ± 1.460 g/dl. The mean hemoglobin level concentration was high during early gestation with a slight decrease by 21–24 weeks. Prenatal depression but not anxiety appeared to be a strong predictor of anemia on bivariate as well as multivariate analysis. No association was observed with socio-demographic and obstetric variables. Conclusion: The burden of maternal anemia was considerably high in the study population. Although iron-folic acid supplementation is available under the national health program to address this issue, it is important to consider and address other risk factors when designing and implementing target interventions for anemia control in selected populations.
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Affiliation(s)
- J Vindhya
- Indian Institute of Public Health-Hyderabad Bengaluru Campus, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Anita Nath
- Indian Institute of Public Health-Hyderabad Bengaluru Campus, Public Health Foundation of India, Hyderabad, Telangana, India
| | - G V S Murthy
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Chandra Metgud
- Department of Community Medicine, JN Medical College, Belgavi, India
| | - B Sheeba
- Indian Institute of Public Health-Hyderabad Bengaluru Campus, Public Health Foundation of India, Hyderabad, Telangana, India
| | - V Shubhashree
- Indian Institute of Public Health-Hyderabad Bengaluru Campus, Public Health Foundation of India, Hyderabad, Telangana, India
| | - P Srinivas
- Indian Institute of Public Health-Hyderabad Bengaluru Campus, Public Health Foundation of India, Hyderabad, Telangana, India
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Ugwuja EI, Nnabu RC, Ezeonu PO, Uro-Chukwu H. The effect of parity on maternal body mass index, plasma mineral element status and new-born anthropometrics. Afr Health Sci 2015; 15:986-92. [PMID: 26957991 DOI: 10.4314/ahs.v15i3.37] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Adverse pregnancy outcome is an important public health problem that has been partly associated with increasing maternal parity. AIM To determine the effect of parity on maternal body mass index (BMI), mineral element status and newborn anthropometrics. METHODS Data for 349 pregnant women previously studied for the impacts of maternal plasma mineral element status on pregnancy and its outcomes was analysed. Obstetric and demographic data and 5mls of blood samples were obtained from each subject. Blood lead, plasma copper, iron and zinc were determined using atomic absorption spectrophotometer. RESULTS Maternal BMI increases with parity. Women with parity two had significantly higher plasma zinc but lower plasma copper with comparable levels of the elements in nulliparous and higher parity groups. Although plasma iron was comparable among the groups, blood lead was significantly higher in parity > three. Newborn birth length increases with parity with a positive correlation between parity and maternal BMI (r = 0.221; p = 0.001) and newborn birth length (r = 0.170; p = 0.002) while plasma copper was negatively correlated with newborn's head circumference (r = -0.115; p = 0.040). CONCLUSION It is plausible that parity affects maternal BMI and newborn anthropometrics through alterations in maternal plasma mineral element levels. While further studies are desired to confirm the present findings, there is need for pregnant and would-be pregnant women to diversify their diet to optimize their mineral element status.
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Affiliation(s)
- Emmanuel I Ugwuja
- Departments of Chemical Pathology, Faculty of Clinical Medicine, Ebonyi State University, P.M.B. 053, Abakalik i, Nigeria; Department of Biochemistry, Faculty of Biological Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - Richard C Nnabu
- Department of Community Medicine, Federal Teaching Hospital Abakaliki, Nigeria
| | - Paul O Ezeonu
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria
| | - Henry Uro-Chukwu
- Department of Social Mobilisation and Disease Control, National Obstetric Fistula Centre, Abakaliki, Nigeria
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Vosnacos E, Pinchon DJ. Survey of women's perceptions of information provided in the prevention or treatment of iron deficiency anaemia in an Australian tertiary obstetric hospital. Women Birth 2014; 28:166-72. [PMID: 25466172 DOI: 10.1016/j.wombi.2014.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 11/06/2014] [Accepted: 11/07/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND There is limited literature to understand the perceptions of Australian women regarding the information provided by healthcare professionals relating to the prevention and treatment of iron deficiency anaemia in pregnancy. AIM To establish an insight into the key themes and trends within a tertiary obstetric hospital related to the provision of dietary advice and use of iron supplements in pregnancy. METHODS A prospective patient survey of pregnant women and women up to 4 weeks postnatal attending hospital. FINDINGS Of the 110 women who participated, 73.6% were provided with information on iron rich foods and 67% made dietary changes. Eighty percent of women were advised to take oral iron and 65.5% of women were taking it at the time of the survey. In women who had independently ceased oral iron, 41.7% failed to inform their healthcare professional. In the women who did inform their healthcare professional 89.5% received advice to help overcome the reason that led to cessation. The main causes included forgetfulness and side effects. Women were less likely to require intravenous iron if oral iron was commenced early. CONCLUSIONS Compliance with recommended oral iron is variable within a population of pregnant women. Women are provided with information on a range of issues relating to the prevention and treatment of iron deficiency anaemia; yet there is a disparity between the information provided and the resulting action. Further research should focus on targeted measures to improve understanding and compliance with treatment from the both women's and health professionals perspective.
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Affiliation(s)
- Emma Vosnacos
- Infusion Unit, King Edward Memorial Hospital, Perth, WA, Australia
| | - Deborah J Pinchon
- Obstetric and Gynaecology Clinical Care Unit, King Edward Memorial Hospital, Perth, WA, Australia.
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12
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Lover AA, Hartman M, Chia KS, Heymann DL. Demographic and spatial predictors of anemia in women of reproductive age in Timor-Leste: implications for health program prioritization. PLoS One 2014; 9:e91252. [PMID: 24632676 PMCID: PMC3954687 DOI: 10.1371/journal.pone.0091252] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 02/10/2014] [Indexed: 01/02/2023] Open
Abstract
Anemia is a significant risk factor for poor health outcomes for both the mother and neonate; however, the determinants of anemia in many epidemiological settings are poorly understood. Using a subset of a nationally representative cluster survey (2010 Demographic and Health Survey) in combination with other non-contemporaneous survey data, the epidemiology of anemia among women of reproductive age in Timor-Leste has been explored. Logistic regression was used to identify risk factors, population-level impacts were estimated as population attributable fractions and spatial analytics were used to identify regions of highest risk. The DHS survey found that ∼21% of adult women in Timor-Leste are anemic (49,053; 95% CI: 37,095 to 61,035), with hemoglobin <12.0 g/dL. In this population, the main risk factors (adjusted odds ratio; 95% CI) are: currently abstaining from sex for any reason (2.25; 1.50 to 3.38); illiteracy (2.04; 1.49 to 2.80); giving birth within the previous year (1.80; 1.29 to 2.51); consumption of fruits/vegetables low in vitamin A (1.57; 1.13 to 2.20); and the district-level confirmed malaria incidence (1.31; 1.15 to 1.49). A review of prior soil-transmitted helminth surveys in Timor-Leste indicates low-to-moderate prevalence with generally low egg counts, suggesting a limited impact on anemia in this setting, although comprehensive survey data are lacking. Examination of the population-level effects highlights the impacts of both recent births and malaria on anemia, with more limited impacts from diet; the evidence does not suggest a large contribution from geohelminths within Timor-Leste. These patterns are divergent from some other settings in the Asia-Pacific region and highlight the need for further focused research. Targeting high-burden districts and by increasing access to pre/postnatal care, raising literacy levels, increasing access to family planning, and improving malaria control should be prioritized to maximize inherently limited health budgets in reaching these populations.
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Affiliation(s)
- Andrew A. Lover
- Saw Swee Hock School of Public Health, The National University of Singapore, Singapore
- * E-mail:
| | - Mikael Hartman
- Saw Swee Hock School of Public Health, The National University of Singapore, Singapore
- Department of Surgery, The National University Hospital, Singapore
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, The National University of Singapore, Singapore
| | - David L. Heymann
- Public Health England, Department of Health, London, United Kingdom
- Department of Infectious Disease Epidemiology, The London School of Hygiene and Tropical Medicine, London, United Kingdom
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Sanneving L, Trygg N, Saxena D, Mavalankar D, Thomsen S. Inequity in India: the case of maternal and reproductive health. Glob Health Action 2013; 6:19145. [PMID: 23561028 PMCID: PMC3617912 DOI: 10.3402/gha.v6i0.19145] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 01/15/2013] [Accepted: 01/15/2013] [Indexed: 11/18/2022] Open
Abstract
Background Millennium Development Goal (MDG) 5 is focused on reducing maternal mortality and achieving universal access to reproductive health care. India has made extensive efforts to achieve MDG 5 and in some regions much progress has been achieved. Progress has been uneven and inequitable however, and many women still lack access to maternal and reproductive health care. Objective In this review, a framework developed by the Commission on Social Determinants of Health (CSDH) is used to categorize and explain determinants of inequity in maternal and reproductive health in India. Design A review of peer-reviewed, published literature was conducted using the electronic databases PubMed and Popline. The search was performed using a carefully developed list of search terms designed to capture published papers from India on: 1) maternal and reproductive health, and 2) equity, including disadvantaged populations. A matrix was developed to sort the relevant information, which was extracted and categorized based on the CSDH framework. In this way, the main sources of inequity in maternal and reproductive health in India and their inter-relationships were determined. Results Five main structural determinants emerged from the analysis as important in understanding equity in India: economic status, gender, education, social status (registered caste or tribe), and age (adolescents). These five determinants were found to be closely interrelated, a feature which was reflected in the literature. Conclusion In India, economic status, gender, and social status are all closely interrelated when influencing use of and access to maternal and reproductive health care. Appropriate attention should be given to how these social determinants interplay in generating and sustaining inequity when designing policies and programs to reach equitable progress toward improved maternal and reproductive health.
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Affiliation(s)
- Linda Sanneving
- Department of Public Health, Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
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Correlates of anaemia in pregnant urban South Indian women: a possible role of dietary intake of nutrients that inhibit iron absorption. Public Health Nutr 2012; 16:316-24. [PMID: 22575487 DOI: 10.1017/s136898001200119x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify correlates of anaemia during the first trimester of pregnancy among 366 urban South Indian pregnant women. DESIGN Cross-sectional study evaluating demographic, socio-economic, anthropometric and dietary intake data on haematological outcomes. SETTING A government maternity health-care centre catering predominantly to the needs of pregnant women from the lower socio-economic strata of urban Bangalore. SUBJECTS Pregnant women (n 366) aged ≥18 and ≤40 years, who registered for antenatal screening at ≤14 weeks of gestation. RESULTS Mean age was 22·6 (sd 3·4) years, mean BMI was 20·4 (sd 3·3) kg/m2 and 236 (64·5 %) of the pregnant women were primiparous. The prevalence of anaemia (Hb <11·0 g/dl) was 30·3 % and of microcytic anaemia (anaemia with mean corpuscular volume <80 fl) 20·2 %. Mean dietary intakes of energy, Ca, Fe and folate were well below the Indian RDA. In multivariable log-binomial regression analysis, anaemia was independently associated with high dietary intakes of Ca (relative risk; 95 % CI: 1·79; 1·16, 2·76) and P (1·96; 1·31, 2·96) and high intake of meat, fish and poultry (1·94; 1·29, 2·91). CONCLUSIONS Low dietary intake of multiple micronutrients, but higher intakes of nutrients that inhibit Fe absorption such as Ca and P, may help explain high rates of maternal anaemia in India.
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Barroso F, Allard S, Kahan BC, Connolly C, Smethurst H, Choo L, Khan K, Stanworth S. Prevalence of maternal anaemia and its predictors: a multi-centre study. Eur J Obstet Gynecol Reprod Biol 2011; 159:99-105. [DOI: 10.1016/j.ejogrb.2011.07.041] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 06/27/2011] [Accepted: 07/11/2011] [Indexed: 10/17/2022]
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Abstract
BACKGROUND Iron deficiency, the most common cause of anaemia in pregnancy worldwide, can be mild, moderate or severe. Severe anaemia can have very serious consequences for mothers and babies, but there is controversy about whether treating mild or moderate anaemia provides more benefit than harm. OBJECTIVES To assess the effects of different treatments for anaemia in pregnancy attributed to iron deficiency (defined as haemoglobin less than 11 g/dL or other equivalent parameters) on maternal and neonatal morbidity and mortality. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (7 June 2011), CENTRAL (2011, Issue 5), PubMed (1966 to June 2011), the International Clinical Trials Registry Platform (ICTRP) (2 May 2011), Health Technology Assessment Program (HTA) (2 May 2011) and LATINREC (Colombia) (2 May 2011). SELECTION CRITERIA Randomised controlled trials comparing treatments for anaemia in pregnancy attributed to iron deficiency. DATA COLLECTION AND ANALYSIS We identified 23 trials, involving 3.198 women. We assessed their risk of bias. Three further studies identified are awaiting classification. MAIN RESULTS Many of the trials were from low-income countries; they were generally small and frequently methodologically poor. They covered a very wide range of differing drugs, doses and routes of administration, making it difficult to pool data. Oral iron in pregnancy showed a reduction in the incidence of anaemia (risk ratio 0.38, 95% confidence interval 0.26 to 0.55, one trial, 125 women) and better haematological indices than placebo (two trials). It was not possible to assess the effects of treatment by severity of anaemia. A trend was found between dose and reported adverse effects. Most trials reported no clinically relevant outcomes nor adverse effects. Although the intramuscular and intravenous routes produced better haematological indices in women than the oral route, no clinical outcomes were assessed and there were insufficient data on adverse effects, for example, on venous thrombosis and severe allergic reactions. Daily low-dose iron supplements may be effective at treating anaemia in pregnancy with less gastrointestinal side effects compared with higher doses. AUTHORS' CONCLUSIONS Despite the high incidence and burden of disease associated with this condition, there is a paucity of good quality trials assessing clinical maternal and neonatal effects of iron administration in women with anaemia. Daily oral iron treatment improves haematological indices but causes frequent gastrointestinal adverse effects. Parenteral (intramuscular and intravenous) iron enhances haematological response, compared with oral iron, but there are concerns about possible important adverse effects (for intravenous treatment venous thrombosis and allergic reactions and for intramuscular treatment important pain, discolouration and allergic reactions). Large, good quality trials, assessing clinical outcomes (including adverse effects) as well as the effects of treatment by severity of anaemia are required.
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Affiliation(s)
- Ludovic Reveiz
- Research Promotion and Development Team, Health Systems Based on Primary Health Care (HSS), Pan American Health Organization, 525, 23rd St, NW, Washington DC, USA, 20037-2895
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Rohilla M, Raveendran A, Dhaliwal LK, Chopra S. Response to comments on: Rohilla M, Raveendran A, Dhaliwal LK, Chopra S. 2010. Severe anaemia in pregnancy: a tertiary hospital experience from northern India. Journal of Obstetrics and Gynaecology 30:694–696. J OBSTET GYNAECOL 2011. [DOI: 10.3109/01443615.2011.591951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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