Anemia and iron deficiency in pregnant Ghanaian women from urban areas

Hematological changes due to malaria - An update

Malaria, a parasitic infection caused by the genus Plasmodium, results to over 20 million reported cases annually worldwide. Most individuals exhibit various symptoms, and blood analysis plays a crucial role in determining the appropriate treatment approach. This study discusses various hematologic complications associated with different Plasmodium species. A review of scientific databases including PubMed, Science Direct, Web of Science, Scopus, EMBASE, Magiran, SID, IranMedex was conducted using standard keywords such as Plasmodium, malaria, anemia and blood disorders (hematologic disorder) between 2000 and 2024. The review focused on articles pertaining to clinical trials, prospective cohort, retrospective, cross-sectional and case-control studies. Articles evaluating the effects of malaria on blood cells and indices, with target groups including human and animals, were included. Articles not written in English or Farsi were excluded. Our review revealed that, apart from iron deficiency anemia and vascular dysfunction contributed in part by adhesion of infected RBC to endothelium, decreases in hematocrit and hemoglobin levels, as part of pancytopenia and thrombocytopenia, are characteristic of Plasmodium infection. Additionally, the occurrence of inflammation due to the release of inflammatory cytokines and complement activation can complicate the clinical features of malaria in individuals with hematologic conditions.

Exploring the perspective of young adults about anaemia prevention; the contributions of knowledge about at-risk groups and consequences of anaemia

BACKGROUND

Anaemia persistently remains a grave public health challenge in most sub-Saharan African countries. Understanding the perspectives of young adults concerning the multi-factorial nature of anaemia may be an important step towards meeting the 2025 global nutrition target of halving anaemia since these individuals might be in the process of reproductive decisions.

AIM

To explore the relationship between students' knowledge about individuals at risk of developing anaemia, and anaemia consequences, and anaemia prevention strategies in a tertiary student cohort.

METHODS

This sequential exploratory study adopted a mixed-methods approach to triangulate the data collection. A semi-structured questionnaire was used to gather baseline data regarding students' perspective on anaemia. Themes that emerged from the initial questionnaire data analyses guided a focus group discussion (FGD) to further explore students' perspectives on anaemia. FGD data was thematically analysed to unearth reasons behind questionnaire item selection. Structural equation modeling (SEM) was used to explore the relationship between constructs in the anaemia knowledge questionnaire.

RESULTS

Overall, 543 students participated in the initial questionnaire data acquisition compared to 16 in the FGD. Our latent variable structural model showed that knowing the causes of anaemia did not significantly (p > 0.05) associate with either knowledge about anaemia consequences (b = 0.113) or knowledge about anaemia prevention strategies (b = 0.042). However, knowledge about individuals at-risk of anaemia was significantly positively associated with both anaemia prevention strategies (b = 0.306, p < 0.05) and knowledge about consequences of anaemia (b = 0.543, 95%). Moreover, knowing the consequences of anaemia seemed to significantly positively mediate the association between knowledge about at-risk groups and preventive measures that could be adopted (b = 0.410, p < 0.05).

CONCLUSIONS

Systems thinking public health educational campaigns that highlight the consequences of anaemia and at-risk groups are more likely to inspire the adoption of preventive strategies among young adults.

Neonatal outcomes from a randomized controlled trial of maternal treatment of iron deficiency anemia with intravenous ferumoxytol vs oral ferrous sulfate

BACKGROUND

Anemia in pregnancy is common worldwide and has known maternal risks. The relationship between the types of treatment offered for maternal anemia and the effects on the fetus and newborn are largely uninvestigated.

OBJECTIVE

This study aimed to investigate whether maternal treatment with intravenous ferumoxytol compared to oral ferrous sulfate results in an increase in neonatal hematologic and iron indices. These analyses were planned secondary outcomes and post hoc analysis from the trial with a primary outcome of change in maternal hemoglobin.

STUDY DESIGN

A randomized controlled trial including 124 participants with anemia by World Health Organization criteria was performed in which participants were allocated in a 1:1 ratio to either 2 infusions of 510 mg of intravenous ferumoxytol or 325 mg oral ferrous sulfate twice daily. Fetal monitoring was performed during each intravenous iron infusion. Standard univariable statistical techniques were used to compare groups and to investigate associations between maternal and neonatal hemoglobin and iron indices.

RESULTS

Cord blood hematological parameters were equivalent between groups. Hemoglobin was 15.7 g/dL vs 15.4 g/dL (P=.6) and hematocrit was 50.5% and 49.2% (P=.4) in those randomized to intravenous ferumoxytol and oral ferrous sulfate, respectively. Iron studies revealed higher cord blood ferritin concentrations in infants of participants treated with intravenous ferumoxytol (294 vs 186, P=.005). There were equivalent iron (158 vs 146, P=.4), transferrin (186 vs 196, P=.4) and total iron binding capacity (246 vs 244, P=1) in neonates of participants receiving intravenous vs oral treatment. There were no effects of the infusions observed on cardiotocography. Gestational age at birth was equivalent between groups. We noted a larger birthweight in neonates of participants treated with intravenous ferumoxytol (3215 g vs 3033 g, P=.09), which was not statistically significant. Post hoc analyses revealed a statistically significant correlation between neonatal ferritin and maternal hemoglobin (P=.006) and neonatal ferritin and maternal ferritin (P=.017) at admission for delivery.

CONCLUSION

Neonates of participants who received intravenous ferumoxytol were born with higher ferritin concentrations in cord blood, at the same gestation with the same birthweight. Participants with higher hemoglobin and ferritin indices delivered infants with higher ferritin concentrations in cord blood.

Intravenous infusions of ferumoxytol compared to oral ferrous sulfate for the treatment of anemia in pregnancy: a randomized controlled trial

BACKGROUND

Iron-deficiency anemia in pregnancy is highly prevalent and presents significant risk to patients. Initial treatment is often with oral medication. We hypothesized that intravenous ferumoxytol would result in superior treatment of anemia as compared to oral ferrous sulfate.

OBJECTIVE

This study aimed to investigate whether 2 infusions of intravenous ferumoxytol are superior to the use of twice-daily oral ferrous sulfate for the treatment of iron-deficiency anemia in pregnancy.

STUDY DESIGN

A randomized controlled trial was performed in which participants with anemic (hemoglobin <11 g/dL and hematocrit <33%) were allocated to receive either 2 infusions of 510 mg of intravenous ferumoxytol approximately 7 days apart, or 325 mg oral ferrous sulfate twice daily from enrollment to the end of their pregnancy. Participants were randomized in a 1:1 ratio to each treatment. Our primary outcome was the change in maternal hemoglobin. Secondary outcomes included maternal iron indices, maternal safety, and maternal tolerability.

RESULTS

There were 124 participants (N=62 per group). In the intravenous iron group, the mean change in hemoglobin was 1.86 g/dL (95% confidence interval, 1.57 g/dL-2.14 g/dL) and in the oral group was 0.79 g/dL (95% confidence interval, 0.42 g/dL-1.17 g/dL) (P<.0001). The median change in ferritin between groups was 64.5 (range, 31-364) vs 8 (range, -436 to +167) (P=.0001). The median change in iron between groups was also statistically significant with 47.5 ug/dL (range, -133 ug/dL to +664 ug/dL) in the intravenous group vs 8.5 ug/dL (range, -313 ug/dL to +437 ug/dL) in the oral iron group (P=.001).

CONCLUSION

Intravenous ferumoxytol was well tolerated, and it was associated with statistically significant increases in maternal hemoglobin, hematocrit, iron, and ferritin compared to oral ferrous sulfate.

Sociodemographic factors associated with anemia among reproductive age women in Mali; evidenced by Mali malaria indicator survey 2021: spatial and multilevel mixed effect model analysis

INTRODUCTION

Anemia is a severe global public health problem that threatens human health as well as social and economic development in both developing and developed nations. Anemia is a significant public health issue because; it affects people from all backgrounds. Anemia affected about one-third of non-pregnant women, 41.8% of pregnant women, and more than a quarter of the world's population. Any stage of a woman's life might result in anemia, due to physiological factors, infections, hormonal imbalances, pregnancy related complications, genetic factors, nutritional deficiency and environmental factors. Mali is a developing country with substantial anemia prevalence, particularly in the developing areas. In order to reduce anemia among women of reproductive age, the Mali government worked to enhance preventative and integrative interventions. One of the government's objectives is to reduce the prevalence of anemia in order to decrease maternal and infant mortality and morbidity.

METHODS

Secondary data analysis was conducted using data from Mali Malaria Indicator Survey 2021 datasets. The study comprised a total of 10,765 reproductive-age women. Spatial and multilevel mixed effect analysis, chi-square, bivariate and multivariate logistic regression were employed on determinant factors of anemia among reproductive age women in Mali. Finally, the percentage and odd ratio, its 95% confidence intervals, and the result of spatial analysis were reported.

RESULTS

This study includes a total weighted sample of 10,765 reproductive-age women from Mali Malaria Indicator Survey 2021. The prevalence of anemia was 38%. Of them, 1.4%, were severely anemic, while 23.5% and 13.1% were moderately and mildly anemic, respectively in Mali. In the spatial analysis, the spatial distribution of anemia showed that a higher proportion of anemia found in southern and south west region of Mali. The northern and north east region of Mali had a low of proportion of anemia. being youngest age [20-24] years [ AOR = 0.817; 95% CI = (0.638,1.047); P = 0.000], attending higher education [AOR = 0.401; 95% CI= (0.278,0.579); P = 0.000], being male headed household [AOR = 0.653; 95% CI= (0.536,0.794); P = 0.000] and being richest [AOR = 0.629; 95% CI= (0.524,0.754) P = 0.000] were protective factors for anemia among reproductive age women. In contrast to this, living in rural area [ AOR = 1.053; 95% CI = (0.880,1.260); P = 0.000], being animist religion follower [AOR = 3.10; 95% CI= (0.763,12.623) P = 0.04], using unimproved drinking water sources [AOR = 1.117; CI= (1.017,1.228); P = 0.021} and using unimproved toilet facility [AOR = 1.018; CI= (0.917,1.130); P = 0.041} were considered as the risk factors for anemia among reproductive age women.

CONCLUSION

In this study, anemia was linked to socio-demographic characteristics, and there were regional variations in the frequency of anemia among women of reproductive age. The most important measures to prevent anemia among women of reproductive age in Mali included empowering women to have higher levels of education, raising the wealth index, rise in awareness of improved drinking water sources and toilet facilities, spreading anemia education through religiously acceptable routes, and using an integrated approach to prevention and intervention in high-prevalent regions of the country.

Nutritional factors for anemia in pregnancy: A systematic review with meta-analysis

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.

Global Prevalence of Anemia in Pregnant Women: A Comprehensive Systematic Review and Meta-Analysis

BACKGROUND

Anemia is one of the most critical health conditions affecting people worldwide. The disease is silent, with a slow progression and a few physical symptoms. Anemia during pregnancy carries the risk of premature birth, low birth weight, and fetus malformations and can impose additional costs on society and families. Therefore, the aim of this study is to conduct a systematic review and meta-analysis on the prevalence of anemia in pregnant women worldwide.

METHODS

In this work, we have conducted a systematic review and meta-analysis of the studies that have examined the prevalence of anemia in pregnant women globally. The Google Scholar, Cochrane, ScienceDirect, Medline (PubMed), and Web of Science (WoS) databases were searched for articles published between 1991 and 2021. The search keywords were anemia, pregnancy, prevalence, and meta-analysis. In order to analyze the eligible studies, the stochastic effects model was used, and the heterogeneity of the studies was examined using the I² index. Data analysis was performed within the Comprehensive Meta-Analysis software (Version 2).

RESULTS

The search resulted in 338 deduplicated studies, of which 52 studies with a total sample size of 1,244,747 people were included in this review. According to the results of the meta-analysis, the overall prevalence of anemia in pregnant women is 36.8% (95% confidence interval: 31.5-42.4%). The highest prevalence of anemia is mild at 70.8 (95% CI 58.1-81) and highest in the third trimester of pregnancy with the prevalence of 48.8 (95% CI 38.7-58.9), while the highest prevalence of anemia in pregnant women was in Africa with the prevalence of 41.7 (95% CI 32.3-49.4).

CONCLUSION

The results of this study show a high prevalence of anemia among pregnant women worldwide, and the highest of this prevalence is mild anemia. The prevalence of anemia in the third trimester was higher than in the first and second trimesters. Anemia in pregnant women in developing countries is significantly higher than in developed countries due to pregnancy's economic, sociological, and health factors.

Predictors of Anaemia Prevalence Among Ghanaian Pregnant Women: A Cross-Sectional Study

Anaemia during pregnancy is a major public health concern. Despite its wide scope and adverse effects including increased maternal and perinatal morbidity and mortality, and long-term adverse effects on the newborn, appropriate interventions using upstream approaches to public health have largely not been implemented. This study investigated the prevalence and associated factors of anaemia among pregnant women in four health facilities in the Kwabre East Municipality. A cross-sectional survey with a two-stage sampling technique was conducted on 220 pregnant women who attended antenatal care at the selected health facilities. Interview-based structured questionnaires were used. Bivariate and multivariate logistic regression were used to identify predictors. The prevalence of anaemia was 11.4%. Few women (25) were anaemic and morphologically, 14 (56%) had normocytic normochromic anaemia and 9 (36%) had microcytic hypochromic anaemia. Iron deficiency was reported in 19 (8.6%) pregnant women. Independent predictors of anaemia were iron sulphate intake (AOR [95% CI] = 3.16 [1.15, 7.37], ANC follow-up during pregnancy (AOR [95% CI] = 3.07 [1.59, 7.99], household size of ≥5 (AOR [95% CI] = 3.58 [1.75, 9.52], folic acid intake (AOR [95% CI] = 5.29 [2.65, 12.39] and the period in pregnancy AOR [95% CI] = ≥36 weeks 3.2 (1.3-4.5). Though anaemia prevalence has been low in urban areas as previously reported, collaborated healthcare measures that aim at eradicating the menace are encouraged. Maternal healthcare interventions including the administration of folic acid, regular iron sulphate intake and intensive education on early ANC are recommended.

Factors associated with iron deficiency anaemia among pregnant teenagers in Ashanti Region, Ghana: A hospital-based prospective cohort study

BACKGROUND

Iron Deficiency Anaemia (IDA) is reportedly high in pregnant adults and the causes well studied. However, among pregnant teenagers, the levels and associated factors of IDA are not fully understood.

METHODS

In a prospective cohort study among Ghanaian pregnant teenagers, aged 13-19 years, IDA prevalence and associated factors were investigated. Sociodemographic data, household hunger scale (HHS), lived poverty index (LPI), FAO's women's dietary diversity score (WDDS) and interventions received during antenatal care (ANC) were obtained from 416 pregnant teenagers in Ashanti Region, Ghana. Micronutrient intakes using a repeated 24-hour dietary recall, and mid-upper arm circumference (MUAC) were determined and blood samples analysed for haemoglobin (Hb), serum levels of ferritin, prealbumin, vitamin A, total antioxidant capacity (TAC), C-reactive protein (CRP), and zinc protoporphyrin (ZPP).

RESULTS

Anaemia (Hb cutoff <11.0 g/dL) was 57.1%; deficient systemic supply of iron stores (31.4%), depleted body stores of iron (4.4%), inadequate dietary iron intake (94.5%), and inadequate multiple micronutrient intakes (49.5%), were all notable among study participants. Between-subject effects using Generalized Linear Modelling indicated malaria tablet given at ANC (p = 0.035), MUAC (p = 0.043), ZPP (p<0.001), ZPP/Hb ratio (p<0.001) and depleted body iron stores (DBIS) (p<0.001) to significantly affect Hb levels. Pregnant teenagers with a high ZPP/Hb ratio (OR = 9.7, p<0.001, 95%CI = 6.0-15.8) had increased odds of being anaemic compared to those with normal ZPP/Hb ratio. Participants who were wasted (OR = 1.2, p = 0.543, 95%CI = 0.6-2.3), and those with depleted iron stores (OR = 3.0, p = 0.167, 95%CI = 0.6-14.6) had increased odds of being anaemic. Participants who experienced hunger were close to 3 times more likely (OR = 2.9, p = 0.040, 95%CI = 1.1-7.8) for depleted iron stores, compared to those who did not experience hunger. Also, participants with inadequate multiple micronutrients intakes (OR = 2.6, p = 0.102, 95%CI = 0.8-8.4), and those with low serum levels of ferritin (OR = 3.3, p = 0.291, 95%CI = 0.4-29.2) had increased odds of depleted body iron stores.

CONCLUSIONS

IDA is common among pregnant teenagers and the related factors include malaria tablets given at ANC, maternal hunger, maternal MUAC, a deficient systemic supply of iron, depleted body iron stores, ZPP, and ZPP/Hb ratio. Appropriate interventions are urgently needed to address the causes of IDA among pregnant teenagers.

Risks of aflatoxin exposure among adolescents in boarding schools in Kilimanjaro region, Tanzania

School feeding in low-income countries is dominated by cereals and legumes, which are susceptible to aflatoxin contamination but are usually not assessed for aflatoxins. A cross sectional study was conducted to assess aflatoxin exposure among adolescents through consumption of school meals in Kilimanjaro region. Food frequency questionnaires and 24 h dietary recalls were used to collect information on food consumption. At least four samples of common food used in school meals were collected. A deterministic approach was used to estimate the dietary aflatoxin exposure. High Performance Liquid chromatography (HPLC) was used to analyse presence of aflatoxin contamination. Results showed that, maize based food and beans were consumed on daily basis. The intake of maize flour and dehulled maize ranged from 17.5 to 738.2 g and 28.2 to 272 g per person per day respectively. Furthermore, consumption of beans and rice were in the range of 121.1 to 595.2 g and 15.7 to 42.2 g per person per day respectively. Total aflatoxins ranged 0.20-438.53 μg/kg (median 2.30 μg/kg). The highest contamination range (0.59-438.53 μg/kg) was in maize while the lowest (0.20-3.41 μg/kg) was found in rice. Similarly, the highest aflatoxin B1 (AFB1) concentration (35.88 μg/kg) was in dehulled maize while the lowest (0.44 μg/kg) was in rice. The highest dietary exposure to total aflatoxins and AFB1 due to consumption of maize ranged from 0.70 to 973.45 ng/kg/bodyweight (bw)/day, and from 0.05-81.06 ng/kg/bw/day, respectively. This pronounced risk of exposure to aflatoxins might have been contributed by a monotonous maize based diet in boarding schools. These findings call for institutions immediate interventions, such as the use of appropriate storage technologies, sorting, cleaning and winnowing in order to remove damaged grains, thereby reducing the risk of dietary exposure to aflatoxins. Likewise, the relevant ministries should consider food diversification and routine risk assessments of the susceptible crops throughout the value chain as a long-term intervention plan at policy level.

Perceptions and beliefs about anaemia: A qualitative study in three agroecological regions of Ghana

Little evidence exists concerning perceptions of anaemia in Ghanaian communities, which limits understanding of how to potentially improve health in settings with high anaemia prevalence. We explored lay perceptions of anaemia to understand local knowledge and beliefs and to provide an opportunity to inform interventions. A cross-sectional, qualitative study was conducted in selected communities in three regions of Ghana with high prevalence of anaemia. Forty-eight focus group discussions (FGDs) were conducted with adolescent girls, adult women of reproductive age and adult men (16 FGDs for each demographic group). Participants across the three demographic groups generally described anaemia as inadequate blood in the body and reported that poor diet, heat, alcohol intake, physiological factors and diseases such as malaria were the main causes of anaemia. Consequences of anaemia mentioned in the FGDs included dizziness, weight loss, loss of appetite and weakness. Prevention of anaemia was perceived to result from improved diet, avoidance of exposure to heat and improved sanitation to avoid diseases. The findings suggest that despite areas of convergence between lay and biomedical knowledge on the causes, consequences and prevention of anaemia, the burden of anaemia remains high in the study regions. This highlights a disconnect between local knowledge of anaemia and the health and nutrition behaviours needed to reduce its incidence. Effective interventions can be developed with and for communities that build upon existing knowledge while filling remaining knowledge gaps or misconceptions.

The prevalence of anemia and iron deficiency among pregnant Ghanaian women, a longitudinal study

Background

Gestational iron deficiency (ID) can be deleterious to mother and fetus. However, iron status is not routinely measured during pregnancy in Ghana. Therefore, the scope of ID in this population is unknown.

Objective

To determine the prevalence of anemia and ID across pregnancy in the Central Region of Ghana.

Methods

Women were recruited during their 1^st trimester of pregnancy (< 13 weeks; n = 116) and followed through to their 2^nd (n = 71) and 3^rd (n = 71) trimesters. Data on socio-demographic variables, weekly intake of iron-rich foods and vitamin C-rich fruits were collected. Blood samples were drawn and the concentrations of hemoglobin (Hb), ferritin (Ft), serum iron (sFe), total iron binding capacity (TIBC), were measured; transferrin saturation (TSAT) was calculated. Repeated measures ANOVA was used to determine change in anemia and iron variables over time with groups categorized by 1^st trimester iron status.

Results

Participants were 27.1 ± 5.2 years, on average. Prevalence of anemia (Hb <11.0 g/dL) was 37%, 63%, 58%; ID (Ft <15 μg/L) was 16%, 20%, 38%; and iron deficiency anemia (IDA; based on low Ft and Hb) was 6%, 12%, 25% in 1^st, 2^nd and 3^rd trimesters, respectively. Significant changes in Hb, Ft and TIBC occurred across time. Iron status at 1^st trimester had a significant effect on 2^nd but not 3^rd trimester iron status.

Conclusions

ID is prevalent in pregnant Ghanaian women, especially during the 3^rd trimester. Anemia is a major public health problem during pregnancy in Ghana with a significant proportion due to factors other than ID.

Inverse Association between Iron Deficiency and Glycated Hemoglobin Levels in Ghanaian Adults-the RODAM Study

BACKGROUND

Glycated hemoglobin (HbA1c) is often used to diagnose type 2 diabetes (T2D), but studies show that iron deficiency (ID) is associated with elevated HbA1c in the absence of hyperglycemia. It is unknown whether ID prevalence varies between sub-Saharan African populations living in different locations and whether ID influences HbA1c levels in these populations.

OBJECTIVES

We assessed the prevalence of ID among Ghanaian migrants in Europe and nonmigrant Ghanaians, and the influence of ID on HbA1c categories among Ghanaians without T2D.

METHODS

We used the database from the cross-sectional RODAM (Research on Obesity and Diabetes among African Migrants) study. This contained data on 3377 Ghanaian men and women aged 25-70 y living in urban and rural Ghana and Ghanaian migrants living in Amsterdam, London, and Berlin. ID was defined as ferritin < 15 ng/mL or, if C-reactive protein was ≥5 mg/mL, as ferritin < 30 ng/mL according to the WHO. We used binary logistic regression to assess differences in ID between sites and its association with clinically defined HbA1c categories (<5.5%, ≥5.5% to <6.5%, ≥6.5%). Men and women were analyzed separately.

RESULTS

The prevalence of ID was higher in migrant [28.4%; adjusted OR (aOR): 3.08; 95% CI: 2.04, 4.65)] and urban (23.2%; aOR: 2.37; 95% CI: 1.56, 3.59) women than in rural women (11.9%). Among women, ID was associated with higher odds of HbA1c ≥ 5.5% to <6.5% in the absence of hyperglycemia (aOR: 1.43; 95% CI: 1.08, 1.87). This association was not found in men.

CONCLUSIONS

Further research is needed to identify factors underlying the high prevalence of ID among urban and migrant Ghanaian women, and the association of ID with HbA1c ≥ 5.5% to <6.5% in women. In addition, our study reinforces the need to consider iron concentrations if interpreting HbA1c among African populations.

Exploring associations between water, sanitation, and anemia through 47 nationally representative demographic and health surveys

Globally, no countries are on track to achieve the adopted global nutrition targets set for anemia in 2025. Given the linkages between water, sanitation, and hygiene (WASH) and nutrition, this secondary data analysis explores potential associations with anemia. Forty-seven demographic and health surveys were used to explore the association between unimproved water and sanitation and anemia in women and children with adjusted odds ratios (ORs) calculated by country and cumulatively. In over 60% of countries, children with off-premises water access had significantly increased odds of anemia. In over a quarter of countries, children exposed to surface water had higher odds of anemia. In Burundi, children were 1.65 times more likely to be anemic when reported to be living in households using surface water. However, in India, a protective effect was noted (adjusted OR: 0.70, P < 0.001) for surface water. In 60% and 65% of countries, women and children exposed to an open sanitation facility had higher odds of being anemic, respectively. There is evidence of an association between selected water and sanitation indicators and anemia. Promoting policies, practices and research that strengthen access to improved WASH should be considered for reducing anemia prevalence alongside standard nutrition interventions.

Descriptive epidemiology of anaemia among pregnant women initiating antenatal care in rural Northern Ghana

Background

Anaemia in pregnancy is associated with adverse obstetric outcomes. When detected early in pregnancy, it can be treated; however, information on its prevalence and associated factors is limited in rural Ghana.

Aim

The aim of this study was to determine the prevalence and maternal factors associated with anaemia in pregnancy at first antenatal care (ANC) visits.

Setting

The study was conducted in the Navrongo War Memorial Hospital, a secondary referral facility in the Kassena-Nankana district in rural northern Ghana.

Methods

A retrospective analysis of antenatal clinic records of pregnant women collected from January to December 2014. All pregnant women initiating antenatal clinic, who had initial haemoglobin (Hb) levels measured, were included in the study. Logistic regression analyses were carried out to determine factors associated with anaemia at the initiation of ANC.

Results

We analysed data from 506 women with median Hb of 11.1 g/dL (IQR 7.31–13.8). The median gestational age at booking was 14 weeks (5–36 weeks). The prevalence of anaemia was 42.7%, with 95% confidence interval (CI) [38.4–47.1], and was high among teenage mothers (52% [34.9–67.8]), mothers who booked in the third trimester (55% [33.6–74.7]) and grand multiparous women (58% [30.7–81.6]). Factors associated with anaemia included grand multiparity (odds ratio [OR] = 1.94 with 95% CI [1.58–2.46]), booking during the third trimester (OR = 2.06 [1.78–2.21]) and mother who were underweight compared to those with normal weight (OR = 3.17 [1.19–8.32]).

Conclusion

Burden of anaemia in pregnancy is still high in rural northern Ghana. We advocate further strengthening of the primary health care system to improve early access to ANC delivery.

Keywords

anaemia in pregnancy; booking visit; maternal and child health; Navrongo; rural; Ghana.

Quantification of fatty acid and mineral levels of selected seeds, nuts, and oils in Northern Ghana

The purpose of this study was to identify locally available foods that can be utilized by Northern Ghanaians to improve child growth status. An assortment of seeds, nuts and oils were collected from a local market, packaged in plastic containers, and shipped to the US for all analyses. Fatty acids (FAs) were extracted and derivatized to FA methyl esters prior to quantification by GC/MS. ANOVA were conducted on FA concentrations and Tukey's post hoc test was used to compare FA content. Food grade oils, particularly palm oil and shea butter, contained higher saturated and monounsaturated FAs than seeds or nuts. Soybean, was significantly higher in the essential omega-3 FA alpha-linolenic acid (2.98 mg/g), whereas neri seed (68.4 mg/g) and fermented dawadawa (seed; 56.3 mg/g) had significantly higher amounts of total polyunsaturated FAs than all other foods. Iron levels in soybean (353 mg/kg), neri (282 mg/kg) and fermented dawadawa (165 mg/kg) were also the highest of all foods. Together, these foods may be useful for future intervention to curb stunting and iron-deficiency anemia.

Early-Life Neuronal-Specific Iron Deficiency Alters the Adult Mouse Hippocampal Transcriptome

Background

Iron deficiency (ID) compromises the developing nervous system, including the hippocampus, resulting in later-life deficits despite iron repletion. The iron-dependent molecular changes driving these lasting deficits, and the effect of early iron repletion, are incompletely understood. Previous studies have utilized dietary models of maternal-fetal ID anemia (IDA) to address these questions; however, concurrent anemia prevents delineation of the specific role of iron.

Objective

The aim of the study was to isolate the effects of developmental ID on adult hippocampal gene expression and to determine if iron repletion reverses these effects in a mouse model of nonanemic hippocampal neuronal ID.

Methods

Nonanemic, hippocampus-specific neuronal ID was generated by using a Tet-OFF dominant negative transferrin receptor (DN-TFR1) mouse model that impairs cellular iron uptake. Hippocampal ID was reversed with doxycycline at postnatal day 21 (P21) in a subset of mice to create 2 experimental groups, chronically iron-deficient and formerly iron-deficient mice, which were compared with their respective doxycycline-treated and untreated iron-sufficient controls. RNA from adult male hippocampi was sequenced. Paired-end reads were analyzed for differential expression. Differentially expressed genes were analyzed in Ingenuity Pathway Analysis.

Results

A total of 346 genes were differentially expressed in adult, chronically iron-deficient hippocampi compared with controls. ID dysregulated genes in critical neurodevelopmental pathways, including axonal guidance, CDK5, Ephrin receptor, Rac, and Neurotrophin/Trk signaling. Iron repletion at P21 normalized adult hippocampal expression of 198 genes; however, genes involved in cAMP response element-binding protein (CREB) signaling, neurocognition, and neurologic disease remained dysregulated in adulthood.

Conclusions

Chronic ID during development, independent of anemia, alters the adult mouse hippocampal transcriptome. Restoring iron status during a known critical period of hippocampal neurodevelopment incompletely normalized these changes, suggesting a need for additional studies to identify the most effective timeline for iron therapy, and adjunctive treatments that can fully restore ID-induced molecular changes, particularly in human populations in whom chronic ID is endemic.

Fruit and vegetable consumption and anemia among adult non-pregnant women: Ghana Demographic and Health Survey

BACKGROUND

Anemia is the most widely prevalent form of micronutrient deficiency that affects over a quarter of the global population. Evidence suggests that the burden of anemia is higher in the developing countries with women of reproductive age and children being the most at-risk groups. The most common causes are believed to be malnutrition and low bioavailability of micronutrients, which usually result from poor dietary habits and inadequate intake of food rich in micronutrients such as fresh fruits and vegetables. Regular consumption of F&V was shown to have protective effect against NCDs; however, evidence on this protective effect against micronutrient deficiency diseases are limited.

OBJECTIVES

(1) To measure the prevalence of anemia among adult non-pregnant women in Ghana, and (2) to investigate if there is any cross-sectional relationship between F&V consumption and anemia.

METHODS

This is a cross-sectional study based on data extracted from the Ghana Demographic and Health Survey, 2008. Subjects were 4,290 non-pregnant women aged between 15 and 49 years. Hemoglobin levels were measured by HemoCue® hemoglobin-meter. Association between anemia and F&V consumption was assessed by multivariable regression methods.

RESULTS

Findings indicate that well over half (57.9%) of the women were suffering from anemia of some level. The percentage of women consuming at least five servings of fruits and vegetables a day were 5.4% and 2.5% respectively. Results of multivariable analysis indicated that among urban women, consumption of <5 servings fruits/day was associated with significantly higher odds of severe [AOR = 9.27; 95% CI [5.15-16.70]] and moderate anemia [AOR = 6.63; 95% CI [4.21-10.44]], and consumption of <5 servings of vegetables/day was associated with higher odds of moderate anemia [AOR = 2.39; 95% CI [1.14-5.02]] compared with those who consumed >5 servings/day.

CONCLUSION

The findings indicate that urban women who did not maintain WHO recommended level of F&V consumption bear a significantly higher likelihood of being moderate to severely anemic.

Iron for Africa-Report of an Expert Workshop

Scientific experts from nine countries gathered to share their views and experience around iron interventions in Africa. Inappropriate eating habits, infections and parasitism are responsible for significant prevalence of iron deficiency, but reliable and country-comparable prevalence estimates are lacking: improvements in biomarkers and cut-offs values adapted to context of use are needed. Benefits of iron interventions on growth and development are indisputable and outweigh risks, which exist in populations with a high infectious burden. Indeed, pathogen growth may increase with enhanced available iron, calling for caution and preventive measures where malaria or other infections are prevalent. Most African countries programmatically fortify flour and supplement pregnant women, while iron deficiency in young children is rather addressed at individual level. Coverage and efficacy could improve through increased access for target populations, raised awareness and lower cost. More bioavailable iron forms, helping to decrease iron dose, or prebiotics, which both may lower risk of infections are attractive opportunities for Africa. Fortifying specific food products could be a relevant route, adapted to local context and needs of population groups while providing education and training. More globally, partnerships involving various stakeholders are encouraged, that could tackle all aspects of the issue.

Anaemia in pregnancy: a public health problem in Enugu, southeast Nigeria

The aim of the study was to determine the prevalence of anaemia in pregnancy at booking and to determine factors associated with its occurrence in order to proffer solutions. This was a 12-month cross-sectional study of pregnant women attending the antenatal clinic for the first time (booking visit) at ESUTTH, Enugu, Nigeria from 1 April 2009 to 31 March 2010. Sociodemographic characteristics of the mothers were extracted using an already prepared proforma. The blood haemoglobin concentration and HIV status of the women were determined and the results were analysed. The prevalence rate of anaemia in pregnancy was 64.1%. Based on severity, 94.6%, 4.3%, 1.1% of them had mild, moderate and severe anaemia. The mean age of the anaemic women was significantly lower than that of the non-anaemic women (p = 0.0001). Those that had no formal education and those that booked for antenatal care in the 3rd trimester had a significantly higher prevalence of anaemia. HIV-positive pregnant women had a significantly higher prevalence of anaemia than HIV-negative pregnant women (p = 0.0072, odds ratio 2.37). It was concluded that the prevalence of anaemia in pregnancy from the study is unacceptably high. To achieve Millennium Development Goals 4 and 5, efforts must be geared towards its prevention to ensure a healthy baby and mother.

The association between malaria and iron status or supplementation in pregnancy: a systematic review and meta-analysis

Introduction

Malaria prevention and iron supplementation are associated with improved maternal and infant outcomes. However, evidence from studies in children suggests iron may adversely modify the risk of malaria. We reviewed the evidence in pregnancy of the association between malaria and markers of iron status, iron supplementation or parenteral treatment.

Methods and Findings

We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Global Health Library, and the Malaria in Pregnancy library to identify studies that investigated the association between iron status, iron treatment or supplementation during pregnancy and malaria. Thirty one studies contributed to the analysis; 3 experimental and 28 observational studies. Iron supplementation was not associated with an increased risk of P. falciparum malaria during pregnancy or delivery in Africa (summary Relative Risk = 0.89, 95% Confidence Interval (CI) 0.66–1.20, I² = 78.8%, 5 studies). One study in Asia reported an increased risk of P. vivax within 30 days of iron supplementation (e.g. adjusted Hazard Ratio = 1.75, 95% CI 1.14–2.70 for 1–15 days), but not after 60 days. Iron deficiency (based on ferritin and C-reactive protein) was associated with lower odds for malaria infection (summary Odds Ratio = 0.35, 0.24–0.51, I² = 59.2%, 5 studies). With the exception of the acute phase protein ferritin, biomarkers of iron deficiency were generally not associated with malaria infection.

Conclusions

Iron supplementation was associated with a temporal increase in P vivax, but not with an increased risk of P. falciparum; however, data are insufficient to rule out the potential for an increased risk of P. falciparum. Iron deficiency was associated with a decreased malaria risk in pregnancy only when measured with ferritin. Until there is more evidence, it is prudent to provide iron in combination with malaria prevention during pregnancy.

Prevalence of peripheral blood parasitaemia, anaemia and low birthweight among pregnant women in a suburban area in coastal Ghana

Introduction

Malaria and anaemia have adverse effects in pregnant women and on the birth weight of infants in malaria endemic areas. P. falciparum malaria, the most virulent species continues to be a major health problem in sub-Saharan Africa. This study was carried out to establish the prevalence of pregnancy-associated malaria and its associated consequences including maternal anaemia and low birthweight (LBW) deliveries and placental malaria among pregnant women in a sub-urban area in coastal Ghana.

Methods

A facility-based investigation was carried out among 320 pregnant women seeking antenatal care in a hospital in suburban coastal Ghana. Information on the use of Insecticide Treated Nets (ITNs) and Intermittent Preventive Treatment in pregnancy (IPTp) were collected using a structured questionnaire at enrolment. Venous blood was collected for microscopy and screening for Glucose 6-phosphate dehydrogenase (G6PD) deficiency. Haemoglobin concentration was obtained from an automatic blood analyzer. Placental smears and birth weight measurements were taken at delivery.

Resuls

The prevalence of Plasmodium falciparum parasitaemia was 5%. The mean haemoglobin (Hb) level at registration was 11.44g/dL (95% CI 11.29 – 11.80). Placental blood parasitaemia and low birthweight were 2.5% and 3% respectively. ITN possession was 31.6% with 5.4% usage. The IPTp coverage was 55%.

Conclusion

The prevalence of malaria and anaemia among the pregnant women were low at enrolment. Placental blood parasitaemia and LBW at delivery were also low. These are clear indications of the high coverage of the IPTp. Increase in ITN use will further improve birthweight outcomes and reduce placental malaria.

Assessment of maternal near-miss and quality of care in a hospital-based study in Accra, Ghana

OBJECTIVE

To assess the baseline incidence of maternal near-miss, process indicators related to facility access, and quality of care at a tertiary care facility in urban Ghana.

METHODS

A prospective observational study of all women delivering at the facility, including those with pregnancy-related complications, was conducted between October 2010 and March 2011. Quality of maternal health care was assessed via a newly developed WHO instrument based on near-miss criteria and criterion-based clinical audit methodology.

RESULTS

Among 3438 women, 516 had potentially life-threatening conditions and 131 had severe maternal outcomes (94 near-miss cases and 37 maternal deaths). More than half (64.4%) of the women had been referred to the facility. The incidence of maternal near-miss was 28.6 cases per 1000 live births. Anemia contributed to most cases with a severe maternal outcome. More than half of all women with severe maternal outcomes developed organ dysfunction or died within the first 12 hours of hospital admission. Although preventive measures were prevalent, treatment-related indicators showed mixed results.

CONCLUSION

The WHO near-miss approach was found to represent a feasible strategy in low-resource countries. Improving referral systems, effective use of critical care, and evidence-based interventions can potentially reduce severe maternal outcomes.

Adolescent pregnancy and the risk of Plasmodium falciparum malaria and anaemia-a pilot study from Sekondi-Takoradi metropolis, Ghana

The problem of malaria in adolescence has been surpassed by the immense burden of malaria in children, most especially less than 5. A substantial amount of work done on malaria in pregnancy in endemic regions has not properly considered the adolescence. The present study therefore aimed at evaluating the prevalence of Plasmodium falciparum and anaemia infection in adolescent pregnant girls in the Sekondi-Takoradi metropolis, Ghana. The study was carried out at four hospitals in the Sekondi-Takoradi metropolis of the western region of Ghana from January 2010 to October 2010. Structured questionnaires were administered to the consenting pregnant women during their antenatal care visits. Information on education, age, gravidae, occupation and socio-demographic characteristics were recorded. Venous bloods were screened for malaria using RAPID response antibody kit and Geimsa staining while haemoglobin estimations were done by cyanmethemoglobin method. The results revealed that adolescent pregnant girls were more likely to have malaria infection than the adult pregnant women (34.6% verses 21.3%, adjusted OR 1.65, 95% CI, 1.03-2.65, P=0.039). In addition, adolescent pregnant girls had higher odds of anaemia than their adult pregnant women equivalent (43.9% versus 33.2%; adjusted OR 1.63, 95% CI, 1.01-2.62, P=0.046). Taken together, these data suggest that adolescent pregnant girls were more likely to have malaria and anaemia compared to their adult pregnant counterpart. Results from this study shows that proactive adolescent friendly policies and control programmes for malaria and anaemia are needed in this region in order to protect this vulnerable group of pregnant women.

Prenatal care associated with reduction of neonatal mortality in Sub-Saharan Africa: evidence from Demographic and Health Surveys

OBJECTIVE

To determine whether prenatal care by a skilled provider (physician, nurse or midwife) and specific prenatal interventions were associated with decreased neonatal mortality.

DESIGN

Mothers' reports in nationally representative surveys (conducted 2003-2009) about their most recent delivery were analyzed. Setting. Sub-Saharan Africa, 17 least developed countries (UN designation).

POPULATION

89 655 women aged 15-49 years with a singleton birth within 3 years prior to survey. Methods. Logistic regression models were used to measure the associations between having a skilled prenatal provider, as well as specific interventions, and neonatal mortality.

MAIN OUTCOME MEASURES

Neonatal mortality, defined as a live birth ending in death at less than one month of age.

RESULTS

Overall, 70.7% of women saw a skilled prenatal provider during their previous pregnancy. Prenatal care from a skilled provider was associated with a decreased neonatal mortality risk compared with no provider [adjusted odds ratio (AOR) 0.70, 95% confidence interval (CI) 0.62-0.80] and compared with an unskilled provider (AOR 0.81, 95% CI 0.68-0.96). The most effective prenatal interventions were weight (AOR 0.71, 95% CI 0.64-0.80) and blood pressure measurements (AOR 0.77, 95% CI 0.69-0.86), and two or more tetanus immunizations (AOR 0.78, 95% CI 0.70-0.86). Four or more prenatal visits compared with none were associated with decreased neonatal mortality risk (AOR 0.68, 95% CI 0.59-0.79).

CONCLUSIONS

Prenatal care provided by skilled providers, at least four prenatal visits, weight and blood pressure assessment, and two or more tetanus immunizations were associated with decreased neonatal mortality in Sub-Saharan African countries.

Association between anemia and aflatoxin B1 biomarker levels among pregnant women in Kumasi, Ghana

Aflatoxins are fungal metabolites that contaminate staple food crops in many developing countries. Up to 40% of women attending a prenatal clinic in Africa may be anemic. In a cross-sectional study of 755 pregnant women, Aflatoxin B(1)-lysine adducts (AF-ALB) levels were determined by high-performance liquid chromatography. Participants were divided into quartiles "low," "moderate," "high," and "very high." Anemia was defined as hemoglobin levels < 11 g/dL. Logistic regression was used to examine the association of anemia with AF-ALB. The mean AF-ALB level was 10.9 pg/mg (range = 0.44-268.73 pg/mg); 30.3% of participants were anemic. The odds of being anemic increased 21% (odds ratio [OR], 1.21, P = 0.01) with each quartile of AF-ALB reaching an 85% increased odds in the "very high" compared with the "low" category (OR, 1.85; confidence interval [CI], 1.16-2.95). This association was stronger among women with malaria and findings were robust when women with evidence of iron deficiency anemia were excluded. This study found a strong, consistent association between anemia in pregnancy and aflatoxins.