Maternal anaemia during postpartum: Preliminary findings from a cross-sectional study in Dodoma City, Tanzania

A rapid landscape review of postpartum anaemia measurement: challenges and opportunities

BACKGROUND

Anaemia is a reduction in haemoglobin concentration below a threshold, resulting from various factors including severe blood loss during and after childbirth. Symptoms of anaemia include fatigue and weakness, among others, affecting health and quality of life. Anaemic pregnant women have an increased risk of premature delivery, a low-birthweight infant, and postpartum depression. They are also more likely to have anaemia in the postpartum period which can lead to an ongoing condition and affect subsequent pregnancies. In 2019 nearly 37% of pregnant women globally had anaemia, and estimates suggest that 50-80% of postpartum women in low- and middle-income countries have anaemia, but currently there is no standard measurement or classification for postpartum anaemia.

METHODS

A rapid landscape review was conducted to identify and characterize postpartum anaemia measurement searching references within three published systematic reviews of anaemia, including studies published between 2012 and 2021. We then conducted a new search for relevant literature from February 2021 to April 2022 in EMBASE and MEDLINE using a similar search strategy as used in the published reviews.

RESULTS

In total, we identified 53 relevant studies. The timing of haemoglobin measurement ranged from within the immediate postpartum period to over 6 weeks. The thresholds used to diagnose anaemia in postpartum women varied considerably, with < 120, < 110, < 100 and < 80 g/L the most frequently reported. Other laboratory results frequently reported included ferritin and transferrin receptor. Clinical outcomes reported in 32 out of 53 studies included postpartum depression, quality of life, and fatigue. Haemoglobin measurements were performed in a laboratory, although it is unclear from the studies if venous samples and automatic analysers were used in all cases.

CONCLUSIONS

This review demonstrates the need for improving postpartum anaemia measurement given the variability observed in published measures. With the high prevalence of anaemia, the relatively simple treatment for non-severe cases of iron deficiency anaemia, and its importance to public health with multi-generational effects, it is crucial to develop common measures for women in the postpartum period and promote rapid uptake and reporting.

Risk factors of anaemia among postpartum women in Bolgatanga Municipality, Ghana

INTRODUCTION

Anaemia is a major public health problem affecting women of reproductive age globally. This study was conducted to assess the prevalence and determinants of anaemia among postpartum women in Bolgatanga Municipality, Ghana.

METHODS

The study employed an analytical cross-sectional study design to recruit 405 women who delivered in the last 6 weeks from 9 health facilities in the Municipality. Data were collected on socio-demographic characteristics, obstetric characteristics, dietary diversity, knowledge on iron-folic acid (IFA), iron and anaemia, and haemoglobin level of the women. Postpartum anaemia (PPA) was defined as hemoglobin < 12 g/dl. Chi-square and logistic regression analysis were used to identify the determinants of PPA.

RESULTS

The mean age of the participants was 27.4 ± 5.3 years and 46.70% of them had PPA. The risk factors of PPA were not meeting dietary diversity [Adjusted Odds Ratio (AOR) = 2.96; 95% Confidence Interval (CI): 1.67-5.25], low knowledge on IFA, iron and anaemia (AOR = 3.03; 95% CI: 1.67-5.25), and first trimester pregnancy anaemia (AOR = 10.39; 95% CI: 1.32-6.95). Kusasi ethnicity was protective of PPA (AOR = 0.35; CI: 0.16-0.75).

CONCLUSION

Anaemia is prevalent in postpartum women in Bolgatanga Municipality and its risk factors are dietary diversity, knowledge on IFA, iron and anaemia, pregnancy anaemia and ethnicity. Nutrition counselling and intervention in pregnancy and after delivery are warranted to reduce the burden of anaemia in this population.

Prevalence of post-partum anemia and associated factors among women attending public primary health care facilities: An institutional based cross-sectional study

Background

Severe post-partum anemia is an important cause of maternal deaths and severe morbidity in sub-Saharan Africa. In Tanzania, little information is available to guide health care professionals in ensuring good health of women after delivery. The objective of our study was to determine the prevalence of post-partum anemia and associated factors among women attending public primary health care facilities.

Materials and methods

An institutional based cross sectional study was carried out. Women in post-partum period (the period from child birth to six weeks after delivery) attending the public primary health care facilities from October to December 2019 for children vaccination were recruited. The prick method was used to obtain blood for haemoglobin estimation. Post-partum anemia was defined as a haemoglobin level of less than 11g/dl. Participants found anaemic were asked to undertake malaria and helminths parasites tests from blood and stool samples respectively. The samples were examined by an experienced laboratory scientist on study sites according to the Tanzania national standard for medical laboratories protocols.

Results

A total of 424 women were enrolled with mean age of 27.8 years (SD 5.93). Most of the participants 234(55.2%) had primary education and nearly half 198(46.7%) of them were house wives. The overall prevalence of post-partum anemia was 145(34.2%). Among the anaemic participants, 34(23.5%) had positive blood slide for malaria parasite while 15(10.3%) had positive test for stool helminths infection. Delivery by vaginal route and low parity were protective against post-partum anemia (p<0.001).Other factors that were associated with post-partum anemia included absence of a marital partner (p<0.001) and inter pregnancy interval of less than two years (p<0.001). The risk of post-partum anemia in women with less than two years interval between their last two pregnancies was about 18 times more as compared to women with more than two years interval between their last two pregnancies, (COR = 18; 95% CI 8.617–38.617).Women without marital partners were 10 times more likely to get anemia as compared to married women, (COR = 10; 01.910–54.935).

Conclusions

The prevalence of anaemia among post-partum women found in this study points to a situation of public health problem according to WHO cut-off values for the public health significance of anaemia. Inter pregnancy interval of less than two years and absence of a marital partner were associated with post-partum anemia while delivery by vaginal route and low parity were protective against post-partum anemia. Strategies should therefore be put in place to encourage thorough health education and promotion programs among both pregnant and post-partum women.

Maternal anaemia during postpartum: Preliminary findings from a cross-sectional study in Dodoma City, Tanzania

AIM

The aim of this study was to determine the prevalence and correlates of anaemia among postnatal women.

DESIGN

A cross-sectional survey was conducted from April-July, 2020, at a healthcare facility in Dodoma City.

METHODS

Haemoglobin concentration was measured by using HemoCue Hb 201+ analyser machine. Anaemia was defined as haemoglobin concentration of <11 g/dl. Chi-square test and logistic regression analysis were conducted to identify the correlates of anaemia.

RESULTS

The overall prevalence of postpartum anaemia was found to be 21.6% (83). Correlates of anaemia were found to be multiple birth (AOR = 4.97), consumption of pulses (AOR = 2.07), normal BMI (AOR = 2.28) and perception of insufficient milk supply (AOR = 3.05).

CONCLUSION

The prevalence of postpartum anaemia found in this study is high. Iron and folic acid supplementation, promotion of dietary diversification practices and screening women higher risk for anaemia may be feasible interventions.