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Bambo GM, Kebede SS, Sitotaw C, Shiferaw E, Melku M. Postpartum anemia and its determinant factors among postnatal women in two selected health institutes in Gondar, Northwest Ethiopia: A facility-based, cross-sectional study. Front Med (Lausanne) 2023; 10:1105307. [PMID: 37153091 PMCID: PMC10157165 DOI: 10.3389/fmed.2023.1105307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/15/2023] [Indexed: 05/09/2023] Open
Abstract
Background Anemia is highly prevalent globally and disproportionately affects postnatal women. It is a significant cause of maternal mortality and morbidity globally. Objective The main aim of this study was to determine the extent of postpartum anemia and associated factors among postnatal women in two selected health facilities in Gondar, Northwest Ethiopia. Methods A facility-based, cross-sectional study was conducted among 282 postnatal women from March to May 2021. A systematic sampling technique was used to recruit study participants from each institute. Sociodemographic, obstetric, and clinical data were collected through a semi-structured questionnaire. A venous blood sample was collected to determine the red blood cell parameters. A thin blood smear preparation was performed to examine blood morphology. In addition, direct wet mount and formalin-ether sedimentation techniques were used for stool examination to identify intestinal parasites. Data were entered into EpiData and exported to Stata 14 for statistical analysis. Descriptive statistics were presented in text, tables, and figures. A binary logistic regression model was used to identify factors associated with postpartum anemia. A p-value <0.05 was considered statistically significant. Results The proportion of postpartum anemia was 47.16%; 95% CI; 41.30-53.03 with moderate, mild, and severe anemia accounting for 45.11, 42.86, and 12.03%, respectively. The majority of the anemia (94%) was of the normocytic normochromic type. It was associated with postpartum hemorrhage (AOR = 2.23; 95% CI: 1.24-4.01), cesarean section (AOR = 4.10; 95% CI: 2.11-7.78), lack of iron and folate supplementation during pregnancy (AOR = 2.12; 95% CI: 1.17-4.02), and low diet diversity level (AOR = 1.83; 95% CI: 1.05-3.18). Conclusion The prevalence of anemia was found to be a major public health concern. Iron and folate supplementation during pregnancy, improved management of PPH, an effective cesarean section with post-operative care, and taking a diversified diet will reduce the burden. Therefore, identified factors should be considered to prevent and control postpartum anemia.
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Affiliation(s)
- Getachew Mesfin Bambo
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
- Department of Medical Laboratory Science, College of Health Sciences, Mizan-Tepi University, Mizan, Ethiopia
- *Correspondence: Getachew Mesfin Bambo,;
| | - Samuel Sahile Kebede
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
- Department of Medical Laboratory Science, College of Health Sciences, Mizan-Tepi University, Mizan, Ethiopia
| | - Chomaw Sitotaw
- University of Gondar Comprehensive Specialized Hospital Laboratory, Gondar, Ethiopia
| | - Elias Shiferaw
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Melku
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Fujita M, Wander K, Tran T, Brindle E. Characterizing the extent human milk folate is buffered against maternal malnutrition and infection in drought‐stricken northern Kenya. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022; 179:171-183. [PMCID: PMC9805107 DOI: 10.1002/ajpa.24603] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/09/2022] [Accepted: 07/20/2022] [Indexed: 09/29/2023]
Abstract
Objectives Folate is an essential nutrient fundamental to human growth and development. Human milk maintains high folate content across the maternal folate status range, suggesting buffering of milk folate with prioritized delivery to milk at the expense of maternal depletion. We investigated whether and how the extent of this buffering may diminish under prolonged nutritional and/or disease stress, while taking into consideration infants' varying vulnerability to malnutrition‐related morbidity/mortality. Methods A cross‐sectional study analyzed milk specimens from northern Kenyan mothers (n = 203), surveyed during a historic drought and ensuing food shortage. Multiple regression models for folate receptor‐α (FOLR1) in milk were constructed. Predictors included maternal underweight (BMI < 18.5), iron‐deficiency anemia (hemoglobin <12 g/dl and dried‐blood‐spot transferrin receptor >5 mg/L), folate deficiency (hyperhomocysteinemia, homocysteine >12 or 14 μmol/L), inflammation (serum C‐reactive protein >5 mg/L), infant age and sex, and mother‐infant interactions. Results In adjusted models, milk FOLR1 was unassociated with maternal underweight, iron‐deficiency anemia and inflammation. FOLR1 was positively associated with maternal folate deficiency, and inversely associated with infant age. There was interaction between infant age and maternal underweight, and between infant sex and maternal folate deficiency, predicting complex changes in FOLR1. Conclusions Our results suggest that mothers buffer milk folate against their own nutritional stress even during a prolonged drought; however, the extent of this buffering may vary with infant age, and, among folate‐deficient mothers, with infant sex. Future research is needed to better understand this variability in maternal buffering of milk folate and how it relates to folate status in nursing infants. Human mothers might have the capacity to buffer milk nutrient content against undue fluctuations under nutritional or disease stress. In the case of the micronutrient folate, this buffering is most apparent for younger infants.
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Affiliation(s)
- Masako Fujita
- Department of AnthropologyMichigan State UniversityEast LansingMichiganUSA
- Biomarker Laboratory for Anthropological ResearchMichigan State UniversityEast LansingMichiganUSA
| | - Katherine Wander
- Department of AnthropologyBinghamton University (SUNY)BinghamtonNew YorkUSA
- Laboratory for Anthropometry and BiomarkersBinghamton UniversityBinghamtonNew YorkUSA
| | - Tin Tran
- Biomarker Laboratory for Anthropological ResearchMichigan State UniversityEast LansingMichiganUSA
- College of PharmacyUniversity of IowaIowa CityIowaUSA
| | - Eleanor Brindle
- Maternal, Newborn and Child Health & NutritionPATHSeattleWashingtonUSA
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Clinton O, Micheal K, Namyalo Angella K, Mary M, Mike M, Muwanguzi E, Okongo B, Wagubi R. Anaemia, Morphological Classification and Its Associated Risk Factors Among Lactating Mothers at Mbarara City Council Health Centre IV, Southwestern Uganda. J Blood Med 2022; 13:473-481. [PMID: 36081646 PMCID: PMC9448346 DOI: 10.2147/jbm.s367453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The objectives of this study were to determine the prevalence of anaemia, morphological classification and its associated risk factors among the lactating mothers accessing postnatal care at Mbarara City Health Centre IV, Southwestern Uganda. Patients and Methods A cross-sectional study was conducted at Mbarara City Health Centre IV among 264 participants. A structured questionnaire was used to capture characteristics of study participants. 4 mL of venous blood was collected from each participant for complete blood count (CBC) and peripheral blood smear (PBS). CBC was done using hematology analyzer (BC-2800 Mindray Hematology Analyzer) while PBS were taken for participants with hemoglobin (Hb) <12.0g/dl and stained using Giemsa–Maygrunwald stain. Bivariate analysis and multivariate logistic regression were used to determine the associations between factors and anaemia. A p-value of <0.05 was considered significant. Results The overall prevalence of anaemia was 65 (24.6%), with mean hemoglobin (Hb) concentration of 12.5g/dL. Out of the anaemic participants (24.6%), morphological classifications of anaemia were as follows: normocytic normochromic 27 (41.5%), microcytic hypochromic 20 (30.8%), normocytic hypochromic 16 (24.1%) and macrocytic normochromic 2 (3.1%). According to the severity of anaemia, majority had mild anaemia 52 (80%), moderate anaemia was 11 (16.9%), and severe anaemia was 2 (3.1%). The following risk factors were significantly associated with anaemia: duration of lactation (between 5 to 8 months, p-value 0.017, 95% CI (0.12–0.82) and alcohol consumption (p-value 0.032, 95% CI (1.12–12.16). The rest of the variables had no association with anaemia. Conclusion The prevalence of anaemia among lactating mothers is high and it is a moderate public health problem as defined by WHO. Nutrition promotion, and health education, may be the ideal way to reduce the prevalence of anaemia in this region.
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Affiliation(s)
- Olong Clinton
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Kanyesigye Micheal
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Kimuli Namyalo Angella
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Muhawenimana Mary
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Mugume Mike
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Enoch Muwanguzi
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Benson Okongo
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara City, Uganda
- Correspondence: Benson Okongo, Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara City, Uganda, Tel +256 778557867/759 101508, Fax +256 485 20782, Email
| | - Robert Wagubi
- Department of Clinical Laboratories, Mbarara Regional Referral Hospital, Mbarara City, Uganda
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Fujita M, Wander K, Paredes Ruvalcaba N, Brindle E. Human milk sIgA antibody in relation to maternal nutrition and infant vulnerability in northern Kenya. EVOLUTION MEDICINE AND PUBLIC HEALTH 2019; 2019:201-211. [PMID: 32405414 PMCID: PMC7216193 DOI: 10.1093/emph/eoz030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 11/09/2019] [Indexed: 12/11/2022]
Abstract
Background The maternal buffering hypothesis posits that human lactation biology can buffer milk against the mild-to-moderate malnutrition that occurred routinely in evolutionary history through the mobilization of maternal body reserves. This perspective may provide insights for understanding human milk immune content variation, such as milk sIgA, which protects infants’ intestines from microbial colonization and prevents diarrheal disease. Objective To investigate how maternal delivery of sIgA to milk may vary in a way that can buffer milk against maternal malnutrition, while taking into consideration infants’ varying needs for immune protection across age or by sex. Methodology A cross-sectional study analyzed archived milk specimens from breastfeeding mothers in Ariaal communities of northern Kenya surveyed during the 2006 Horn-of-Africa drought. Multiple regression models for ln-transformed sIgA were constructed using maternal nutrition, infant age/sex and their interactions as predictors. Maternal nutrition variables included iron-deficiency anemia (IDA), vitamin A deficiency (VAD) and mid-upper arm circumference (MUAC). Infant vulnerability was considered high in young age and/or male sex. Results and implications Milk sIgA did not significantly differ by maternal IDA. Milk sIgA increased with infant age and maternal MUAC (n = 202). Significant interactions were observed between infant age and maternal VAD and between infant sex and maternal MUAC, such that milk sIgA content was low for younger infants particularly among VAD mothers, while among mothers with low MUAC, sIgA was lower for male infants. Results imply that mothers’ ability to deliver/buffer milk sIgA may be lowered when nutritional stress is combined with high infant vulnerability to infection. Lay Summary Human milk sIgA antibody content was low for younger infants among vitamin A deficient mothers. Among mothers with small arm-circumference, milk sIgA was lower for sons. Double burden of raising young or male infants with high needs for immune protection and being malnourished, might lower maternal sIgA delivery to milk.
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Affiliation(s)
- Masako Fujita
- Department of Anthropology, Michigan State University, East Lansing, MI 48824, USA.,Biomarker Laboratory for Anthropological Research, Michigan State University, East Lansing, MI 48824, USA
| | - Katherine Wander
- Department of Anthropology, Binghamton University (SUNY), Binghamton, NY, USA.,Laboratory for Anthropometry and Biomarkers, Binghamton University, Binghamton, NY, USA
| | - Nerli Paredes Ruvalcaba
- Department of Anthropology, Michigan State University, East Lansing, MI 48824, USA.,Biomarker Laboratory for Anthropological Research, Michigan State University, East Lansing, MI 48824, USA
| | - Eleanor Brindle
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA
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Corbitt M, Paredes Ruvalcaba N, Fujita M. Variation in breast milk macronutrient contents by maternal anemia and hemoglobin concentration in northern Kenya. Am J Hum Biol 2019; 31:e23238. [PMID: 30908793 DOI: 10.1002/ajhb.23238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 01/23/2019] [Accepted: 03/09/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES This study explored differing levels of macronutrients in breast milk in relation to maternal anemia and hemoglobin. METHODS Archived milk specimens and data from a cross-sectional sample of 208 breastfeeding mothers in northern Kenya, originally collected in 2006, were analyzed; data included milk fat, maternal hemoglobin concentration, and anemia status (anemia defined as hemoglobin <12 g/dL). Total protein and lactose were measured and energy was calculated. To explore the association between milk outcomes (fat, protein, lactose, and energy) and anemia, regression models were constructed with and without adjustment for maternal age, parity, and time (days) postpartum. The same models were constructed using hemoglobin as a continuous predictor in lieu of dichotomous anemia to explore the role of hemoglobin levels and anemia severity in predicting milk outcomes. RESULTS The group comparison indicated significantly higher milk protein and lower milk fat for anemic mothers relative to nonanemic counterparts. After adjustment for maternal age, parity, and time postpartum, maternal anemia was associated with significantly higher milk protein (P = 0.001) and significantly lower milk fat (P = 0.025). Hemoglobin had a significant inverse relationship with milk protein (P = 0.017) and a marginally significant positive relationship with milk fat (P = 0.060) after adjusting for the maternal variables. Neither anemia nor hemoglobin was significant in predicting lactose or milk energy. CONCLUSIONS Maternal anemia and hemoglobin concentration may be associated with complex changes in milk macronutrients. Future research should clarify the impact of maternal anemia on a range of breast milk components while accounting for other maternal characteristics.
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Affiliation(s)
- Mary Corbitt
- Department of Anthropology, Michigan State University, East Lansing, Michigan.,Biomarker Laboratory for Anthropological Research, Michigan State University, East Lansing, Michigan
| | - Nerli Paredes Ruvalcaba
- Department of Anthropology, Michigan State University, East Lansing, Michigan.,Biomarker Laboratory for Anthropological Research, Michigan State University, East Lansing, Michigan
| | - Masako Fujita
- Department of Anthropology, Michigan State University, East Lansing, Michigan.,Biomarker Laboratory for Anthropological Research, Michigan State University, East Lansing, Michigan
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Fujita M, Ruvalcaba NP, Wander K, Corbitt M, Brindle E. Buffered or impaired: Maternal anemia, inflammation and breast milk macronutrients in northern Kenya. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2019; 168:329-339. [PMID: 30575959 PMCID: PMC6352968 DOI: 10.1002/ajpa.23752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 09/25/2018] [Accepted: 10/25/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Maternal anemia has adverse consequences for the mother-infant dyad. To evaluate whether and how milk nutrient content may change in ways that could "buffer" infants against the conditions underlying maternal anemia, this study assessed associations between milk macronutrients and maternal iron-deficiency anemia (IDA), non-iron-deficiency anemia (NIDA), and inflammation. METHODS A secondary analysis of cross-sectional data and milk from northern Kenya was conducted (n = 204). The combination of hemoglobin and transferrin receptor defined IDA/NIDA. Elevated serum C-reactive protein defined acute inflammation. The effects of IDA, NIDA, and inflammation on milk macronutrients were evaluated in regression models. RESULTS IDA (β = 0.077, p = .022) and NIDA (β = 0.083, p = .100) predicted higher total protein (ln). IDA (β = -0.293, p = .002), NIDA (β = -0.313, p = .047), and inflammation (β = -0.269, p = .007) each predicted lower fat (ln); however, anemia accompanying inflammation predicted higher fat (β = 0.655, p = .007 for IDA and β = 0.468, p = .092 for NIDA). NIDA predicted higher lactose (β = 1.020, p = .003). CONCLUSIONS Milk macronutrient content both increases and decreases in the presence of maternal anemia and inflammation, suggesting a more complicated and dynamic change than simple impairment of nutrient delivery during maternal stress. Maternal fat delivery to milk may be impaired under anemia. Mothers may buffer infant nutrition against adverse conditions or poor maternal health by elevating milk protein (mothers with IDA/NIDA), lactose (mothers with NIDA), or fat (mothers with anemia and inflammation). This study demonstrates the foundational importance of maternal micronutrient health and inflammation or infection for advancing the ecological understanding of human milk nutrient variation.
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Affiliation(s)
- Masako Fujita
- Department of Anthropology, Michigan State University
- Biomarker Laboratory for Anthropological Research, Michigan State University
| | - Nerli Paredes Ruvalcaba
- Department of Anthropology, Michigan State University
- Biomarker Laboratory for Anthropological Research, Michigan State University
| | - Katherine Wander
- Department of Anthropology, Binghamton University (SUNY)
- Laboratory for Anthropometry and Biomarkers, Binghamton University (SUNY)
| | - Mary Corbitt
- Department of Anthropology, Michigan State University
- Biomarker Laboratory for Anthropological Research, Michigan State University
| | - Eleanor Brindle
- Center for Studies in Demography and Ecology, University of Washington
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