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Abioye AI, Hughes MD, Sudfeld CR, Premji Z, Aboud S, Hamer DH, Roberts DJ, Duggan CP, Fawzi WW. The effect of iron supplementation on maternal iron deficiency anemia does not differ by baseline anemia type among Tanzanian pregnant women without severe iron deficiency anemia. Eur J Nutr 2023; 62:987-1001. [PMID: 36344770 PMCID: PMC9987582 DOI: 10.1007/s00394-022-03029-0] [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: 01/09/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE Whether anemia type modifies the risk of pregnancy and newborn outcomes and the effectiveness of iron supplementation is unclear. We examined the association of iron deficiency anemia (IDA) and non-iron deficiency anemia (NIDA) on the risks of these outcomes and the extent to which anemia type modifies the impact of prenatal iron supplementation. METHODS This was a secondary analysis of a placebo-controlled trial of iron supplementation among 1450 HIV-negative women in Tanzania. Eligibility criteria included gestational age < 27 weeks, hemoglobin > 85 g/L, and ferritin > 12 µg/L. Individuals were categorized as non-anemia, IDA or NIDA using hemoglobin, ferritin and CRP. Analyses were conducted using regression models and likelihood ratio tests. RESULTS Compared to the non-anemia group, delivery hemoglobin was lower by 15 g/L (95% CI 10.9, 19.3) in the baseline IDA group, and 7.3 g/L (95% CI 3.1, 11.5) in the baseline NIDA group. The RRs of anemia severity, iron deficiency, placental malaria, stillbirths, perinatal mortality, birthweight, and preterm birth were not different among women in the baseline NIDA group (vs. non-anemia) compared to the baseline IDA group (vs. non-anemia). The difference in the mean delivery hemoglobin for iron supplementation and placebo arms was 8 g/L (95% CI 6, 11) in the non-anemia group, 7 g/L (95% CI 2, 13) in the NIDA group, and 16 g/L (95% CI 10, 22) in the IDA group. CONCLUSION Iron supplementation is effective even among pregnant women with NIDA. TRIAL REGISTRATION NCT01119612 (May 7, 2010).
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Affiliation(s)
- Ajibola Ibraheem Abioye
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard T.H. School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
| | - Michael D Hughes
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christopher R Sudfeld
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard T.H. School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Davidson H Hamer
- Department of Global Health, School of Public Health, Boston University, Boston, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher P Duggan
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard T.H. School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Wafaie W Fawzi
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard T.H. School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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2
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Karami M, Chaleshgar M, Salari N, Akbari H, Mohammadi M. Global Prevalence of Anemia in Pregnant Women: A Comprehensive Systematic Review and Meta-Analysis. Matern Child Health J 2022; 26:1473-1487. [PMID: 35608810 DOI: 10.1007/s10995-022-03450-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 01/05/2023]
Abstract
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.
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Affiliation(s)
- Mohammadmahdi Karami
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Chaleshgar
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hakimeh Akbari
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran.
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Diress G, Endalifer ML. Effect of alcohol consumption on haemoglobin level among non-pregnant reproductive age women in Ethiopia: a cross-sectional secondary data analysis of the 2016 Ethiopian Demographic Health Survey. BMJ Open 2022; 12:e046458. [PMID: 35190404 PMCID: PMC8860042 DOI: 10.1136/bmjopen-2020-046458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the effect of alcohol consumption on haemoglobin levels among non-pregnant reproductive age women using national representative data. METHOD A secondary data analysis was conducted using data from the 2016 Ethiopia Demographic and Health Survey. The main outcome of interest was anaemia defined as a haemoglobin value <12 g/which was measured using HemoCue, and adjusted for both altitude and smoking status. The main exposure variable was alcohol consumption. Both multivariable logistic regression and generalised linear model were employed to assess the association between alcohol consumption and anaemia and to compare the mean of haemoglobin between the non-drinkers and three alcohol consumption frequency categories, respectively, after adjusting for the potential confounders. RESULT In the current analysis, a total of 13 436 non-pregnant women were included. The overall prevalence of anaemia among non-pregnant women was 23.2% of which 17.9% were mildly anaemic, 4.6% were moderately anaemic and 0.7% were severely anaemic. There was a significant negative association between anaemia and respondents' history and frequency of alcohol consumption in the pooled sample. Among non-pregnant women, the odds of having anaemia were decreased with a history of alcohol drinking (adjusted OR (AOR)=0.32 (95% CI: 0.214 to 0.394)). Women who drunk alcohol less than once a week ((AOR=0.54 (95% CI: 0.31 to 0.94), those who drunk alcohol at least once a week (AOR=0.50 (95% CI: 0.28 to 0.88)) and who drunk alcohol almost every day in the last 12 months (AOR=0.42 (95% CI: 0.21 to 0.81)) had significantly lower odds of having anaemia than women who had not ever taken a drink that contain alcohol. CONCLUSION This study showed that nearly a quarter of non-pregnant women in Ethiopia were found to be anaemic. Alcohol consumption increases haemoglobin concentration. Further cohort or experimental studies are therefore needed to further assess the relationship between alcohol consumption and haemoglobin level among Ethiopian populations.
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Debella A, Eyeberu A, Getachew T, Atnafe G, Geda B, Dheresa M. OUP accepted manuscript. Int Health 2022; 15:274-280. [PMID: 35474135 PMCID: PMC10153563 DOI: 10.1093/inthealth/ihac021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/11/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Anemia is a worldwide problem with serious effects for mothers and their babies. Although efforts have been made to lessen the burden of anemia, it has remained a problem. Moreover, there is a paucity of information regarding the perinatal outcomes of anemia in the study area. Thus this study aimed to assess the perinatal outcomes in anemic pregnant women in eastern Ethiopia. METHODS A facility-based cross-sectional study was conducted among 407 systematically selected pregnant women. Data were collected by interview and entered into EpiData version 3.1 and then exported into SPSS for Windows version 20 for analysis. Bivariate and multivariate analyses were employed to determine the association between independent variables and the outcome variable. RESULTS Among pregnant women, 61.9% had an adverse perinatal outcome. The most common reported adverse perinatal outcomes were preterm birth, congenital anomalies and stillbirths. Furthermore, variables such as educational status (adjusted odds ratio [AOR] 2.11 [95% confidence interval {CI} 1.245 to 3.58]), antenatal care follow-up (AOR 2.75 [95% CI 1.47 to 5.18]) and hemoglobin level (AOR 4.1 [95% CI 2.609 to 6.405]) were significantly associated with perinatal outcomes. CONCLUSIONS Nearly three-fourths of anemic pregnant women experienced adverse perinatal outcomes. In general, this study identified that educational status, antenatal follow-up and hemoglobin level were associated with perinatal outcomes among anemic pregnant women. To prevent adverse perinatal outcomes, efforts must be made to ensure that all pregnant women receive antenatal care and have adequate maternal nutritional status.
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Affiliation(s)
- Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | | | - Tamirat Getachew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Genanaw Atnafe
- Department of Pediatrics, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Biftu Geda
- School of Nursing, College of Medicine and Health Sciences, Madda Walabu University, Bale-Robe, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Vanié SC, Edjème-Aké A, Kouassi KN, Gbogouri GA, Djaman AJ. Nutritional and Obstetric Determinant of Iron Deficiency Anemia among Pregnant Women Attending Antenatal Care Services in Public Health Hospitals in Abidjan (Côte d'Ivoire): A Cross-Sectional Study. Ecol Food Nutr 2021; 61:250-270. [PMID: 34672848 DOI: 10.1080/03670244.2021.1987229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Poorly diversified and micronutrient-deficient dietary intakes during pregnancy remain one of the major causes of nutritional anemia in developing countries. However, data on diet and its relation to anemia in pregnant women in Côte d'Ivoire are scarce. The objective of this study was to determine prevalence and iron deficiency anemia associated factors in pregnant women in Abidjan. A cross-sectional study was conducted among 389 pregnant women attending antenatal care services at public health hospitals in Abidjan. Sociodemographic, obstetrical, and dietary data were collected. Blood samples taken by venipuncture were analyzed for hemoglobin and iron biomarkers. Data were subjected to descriptive statistics and multivariate logistic regression. 47.8% of the pregnant women tested were anemic, 25.8% and 30.4% had iron deficiency and iron deficiency anemia, respectively. Based on AORs, the second and third trimesters of pregnancy (6.04 v 4.18, respectively), multiparity (13.18), skipping meals (3.05), inadequate energy (5.369), protein (2.74), and vitamin C (2.43) intakes and low dietary diversity (8.35) are the independent and significant determinants of iron deficiency anemia. The high prevalence of anemia among pregnant women in Abidjan reveals a real public health problem. Iron deficiency anemia is due to multiparity, gestational age, inadequate intake, low dietary diversity, and skipping meals.
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Affiliation(s)
- Stéphane Claver Vanié
- Training and Research Unit of Sciences and Food Technology, Laboratory of Nutrition and Food Safety, Nangui Abrogoua University, Abidjan, Côte d'Ivoire.,Department of Clinical and Fundamental Biochemistry, Pasteur Institute of Côte d'Ivoire (IPCI), Côte d'Ivoire
| | - Angèle Edjème-Aké
- Department of Clinical and Fundamental Biochemistry, Pasteur Institute of Côte d'Ivoire (IPCI), Côte d'Ivoire.,Training and Research Unit of Pharmaceutical and Biological Sciences, Félix Houphouët-Boigny University, Abidjan, Côte d'Ivoire
| | - Kouakou Nestor Kouassi
- Training and Research Unit of Sciences and Food Technology, Laboratory of Food Biochemistry and Tropical Products Technology, Nangui Abrogoua University, Abidjan, Côte d'Ivoire
| | - Grodji Albarin Gbogouri
- Training and Research Unit of Sciences and Food Technology, Laboratory of Nutrition and Food Safety, Nangui Abrogoua University, Abidjan, Côte d'Ivoire
| | - Allico Joseph Djaman
- Department of Clinical and Fundamental Biochemistry, Pasteur Institute of Côte d'Ivoire (IPCI), Côte d'Ivoire.,Training and Research Unit of Biosciences, Laboratory of Pharmacodynamics and Biochemistry, Félix Houphouët-Boigny University, Abidjan, Côte d'Ivoire
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Alamneh YM, Akalu TY, Shiferaw AA, Atnaf A. Magnitude of anemia and associated factors among children aged 6-59 months at Debre Markos referral hospital, Northwest Ethiopia: a hospital-based cross-sectional study. Ital J Pediatr 2021; 47:172. [PMID: 34389033 PMCID: PMC8362241 DOI: 10.1186/s13052-021-01123-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background Anemia, the most common micro-nutrient deficiency disorder, is the world’s second leading cause of morbidity and morbidity, affecting 24.8% of the population, of which 47.4% are under-five children. The prevalence of anemia ranges from 44 to 56% in Ethiopia. Although its magnitude has shown decreases across regions; it continues to be a significant public health problem, particularly in developing countries including Ethiopia. Despite this evidence, the magnitude and associated factors of anemia was not systematically explored and there is a limited information or limited evidences in the study area. Hence, the aim of this study was to assess the magnitude and associated factors of anemia among children aged 6–59 months attending at Debre Markos Referral Hospital, Northwest Ethiopia. Methods A hospital-based cross-sectional study was conducted at Debre Markos referral hospital Northwest Ethiopia from September 30 to December 30, 2019. Data on socio-demographic and socio-economic factors, health and nutritional features of children and their mothers were obtained using pre-tested structured questionnaires in a face-to-face interview with child care providers. Blood samples and stool examination for intestinal parasites were performed. Hemoglobin level was analyzed using the HemoCue device (HemoCueHb 301). The collected data were coded, cleared and entered into Epi-Data version 3.1, and analyzed using Stata version 14 software. To identify candidates and predictor variables, bivariate and multivariate logistic regressions were applied respectively. The significance level was determined at a confidence interval of 95% at p-value < 0.05. Results Of the total of 341 participants planned to be participated, about 310 mother-child pairs participated in the study, giving a response rate of 91%; and data were collected from children as well as their parents or guardians. In this study, the magnitude of anemia was 11.9% (95% CI, 8.5, 16.2%). Poor dietary diversity (AOR = 2.3; 95% CI: 1.12, 5.14), food-insecure households (AOR = 3.24; 95% CI: 1.85, 4.52), complementary feeding initiation time (AOR = 3.20; 95% CI:1.23, 6.61), intestinal parasites infection (AOR = 3.20; 95% CI:1.23, 6.61) and family income (AOR = 2.87; 95% CI:1.57, 5.0) were found to be factors significantly associated with anemia. Conclusion Overall, anemia is considered a public health problem among children aged 6–59 months attending at Debre Markos referral hospital, based on the cut-off point of the World Health Organization. Poor dietary diversity, complementary feeding initiation time, household food insecurity, intestinal parasite infection and family income were significantly associated with childhood anemia. Thus, it needs for proven interventions in public health such as food diversification, anti-helmintic drug provision and household food security. In addition, educating women about nutrition and diet diversification, as well as involving them in alternative sources of income-generating activity, can be vital in the study area.
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Affiliation(s)
- Yoseph Merkeb Alamneh
- Department of Biomedical Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia.
| | - Tadesse Yirga Akalu
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos Ethiopia, P.O. Box 269, Debre Markos, Ethiopia
| | - Abtie Abebaw Shiferaw
- Department of Medical Laboratory Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Aytenew Atnaf
- Department of Medical Laboratory Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
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Debella A, Dheresa M, Geda B, Tiruye G, Fage SG. A Third of Pregnant Women are Affected by Anemia in Eastern Ethiopia: A Facility-Based Study. J Blood Med 2021; 12:299-306. [PMID: 34040474 PMCID: PMC8140923 DOI: 10.2147/jbm.s305567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/13/2021] [Indexed: 01/17/2023] Open
Abstract
Background Although it is a public health problem of pregnant women in low, middle and high-income countries, the highest prevalence rate of anemia is found among pregnant women of low-income countries, particularly in Africa. Therefore, this study has aimed to determine the magnitude of the anemia and its associated factors among pregnant women admitted to labor wards of public hospitals in eastern Ethiopia. Methods and Materials A health facility-based cross-sectional study was conducted among 405 pregnant women admitted to labor wards in four public hospitals of Harar town and Dire Dawa City Administration. A systematic random sampling technique was used to select the study participants. Data were collected through an interview using a structured questionnaire. The hemoglobin level was measured for each study participant. Binary and multivariable logistic regression models were fitted and statistical significance was declared at P<0.05. Results The magnitude of anemia was 33.1% (95% CI: 28.4%, 37.8%). Being from rural areas (AOR: 3.8; 95% CI: 1.81, 7.94), no antenatal care (ANC) follow-up (AOR: 3.4; 95% CI: 1.34, 8.79), a habit of drinking milk with tea after meals (AOR: 2.8; 95% CI: 1.48, 5.61), taking a meal only 1–2 times per day (AOR: 3.9; 95% CI: 1.69, 8.97), experiencing no blood loss in the current pregnancy (AOR: 0.25; 95% CI: 0.06, 0.96) and a habit of eating leafy vegetables (AOR: 0.12; 95% CI: 0.06, 0.24) were significantly associated with anemia. Conclusion About one in three pregnant women were anemic and anemia was a moderate public health problem in the study settings. Interventions targeting reducing or preventing anemia should focus on pregnant women in rural areas, promoting the benefits of ANC follow-up, reducing the habit of drinking milk with tea after meals, enhancing the consumption of leafy vegetables and increasing meal frequency per day to minimize or prevent anemia and its consequences during pregnancy.
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Affiliation(s)
- Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Biftu Geda
- Department of Nursing, College of Health and Medical Sciences, Meda Welabu University, Bale-Robe, Ethiopia
| | - Getahun Tiruye
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Sagni Girma Fage
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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8
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The prevalence of anemia and iron deficiency among pregnant Ghanaian women, a longitudinal study. PLoS One 2021; 16:e0248754. [PMID: 33760869 PMCID: PMC7990185 DOI: 10.1371/journal.pone.0248754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/05/2021] [Indexed: 11/25/2022] Open
Abstract
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 1st trimester of pregnancy (< 13 weeks; n = 116) and followed through to their 2nd (n = 71) and 3rd (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 1st 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 1st, 2nd and 3rd trimesters, respectively. Significant changes in Hb, Ft and TIBC occurred across time. Iron status at 1st trimester had a significant effect on 2nd but not 3rd trimester iron status. Conclusions ID is prevalent in pregnant Ghanaian women, especially during the 3rd trimester. Anemia is a major public health problem during pregnancy in Ghana with a significant proportion due to factors other than ID.
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Hull JC, Bloch EM, Ingram C, Crookes R, Vaughan J, Courtney L, Jauregui A, Hilton JF, Murphy EL. Slower response to treatment of iron-deficiency anaemia in pregnant women infected with HIV: a prospective cohort study. BJOG 2021; 128:1674-1681. [PMID: 33587784 DOI: 10.1111/1471-0528.16671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Antenatal anaemia is associated with increased peripartum transfusion requirement in South Africa. We studied whether HIV was associated with the response to treatment of iron-deficiency anaemia. DESIGN Prospective cohort study. SETTING Hospital-based antenatal anaemia clinic in South Africa. SAMPLE Equal-sized cohorts of pregnant women testing positive for HIV (HIV+) and testing negative for HIV (HIV-) with iron-deficiency anaemia. METHODS Haemoglobin trajectories of women with confirmed iron-deficiency anaemia (ferritin < 50 ng/ml) were estimated from the initiation of iron supplementation using mixed-effects modelling, adjusted for baseline HIV status, ferritin level, maternal and gestational ages and time-varying iron supplementation. MAIN OUTCOME MEASURES Haemoglobin trajectories. RESULTS Of 469 women enrolled, 51% were HIV+, 90% of whom were on antiretroviral therapy (with a mean CD4+ lymphocyte count of 403 cells/mm3 ). Anaemia diagnoses did not differ by HIV status. A total of 400 women with iron-deficiency anaemia were followed during treatment with oral or intravenous (6%) iron therapy. In multivariable analysis, haemoglobin recovery was 0.10 g/dl per week slower on average in women who were HIV+ versus women who were HIV- (P = 0.001), 0.01 g/dl per week slower in women with higher baseline ferritin (P < 0.001) and 0.06 g/dl per week faster in women who were compliant with oral iron therapy (P = 0.002). CONCLUSIONS Compared with women who were HIV-, women who were HIV+ with iron-deficiency anaemia had slower but successful haemoglobin recovery with iron therapy. Earlier effective management of iron deficiency could reduce the incidence of peripartum blood transfusion. TWEETABLE ABSTRACT Among pregnant women with iron-deficiency anaemia in South Africa, HIV slows haemoglobin recovery in response to oral iron therapy.
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Affiliation(s)
- J C Hull
- Chris Hani Baragwanath Academic Hospital, Soweto, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | - E M Bloch
- Johns Hopkins University School of Medicine, Baltimore, MA, USA
| | - C Ingram
- National Bone Marrow Registry, Cape Town, South Africa
| | - R Crookes
- Cryo-Save Inc., Johannesburg, South Africa
| | - J Vaughan
- National Health Laboratory Services, CH Baragwanath Hospital, Soweto, South Africa.,Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa
| | | | - A Jauregui
- Stanford University School of Medicine, Stanford, CA, USA
| | - J F Hilton
- University of California San Francisco (UCSF), San Francisco, CA, USA
| | - E L Murphy
- University of California San Francisco (UCSF), San Francisco, CA, USA.,Vitalant Research Institute (VRI), San Francisco, CA, USA
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Dutta M, Bhise M, Prashad L, Chaurasia H, Debnath P. Prevalence and risk factors of anemia among children 6–59 months in India: A multilevel analysis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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11
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Abioye AI, Aboud S, Premji Z, Etheredge AJ, Gunaratna NS, Sudfeld CR, Noor RA, Hertzmark E, Spiegelman D, Duggan C, Fawzi W. Hemoglobin and hepcidin have good validity and utility for diagnosing iron deficiency anemia among pregnant women. Eur J Clin Nutr 2020; 74:708-719. [PMID: 31624364 PMCID: PMC7162716 DOI: 10.1038/s41430-019-0512-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND/OBJECTIVES Screening and diagnosis of iron deficiency anemia (IDA) is cumbersome as it may require testing for hemoglobin, ferritin, and an inflammatory biomarker. The aim of this study was to compare the diagnostic capacity of hematologic biomarkers to detect IDA among pregnant women in Tanzania. SUBJECTS/METHODS We pooled data from an iron supplementation trial of 1500 iron-replete pregnant woman and a prospective cohort of 600 iron-deficient pregnant women. Receiver operating characteristic curves (ROC) for hematologic biomarkers were used to assess the sensitivity, specificity, and area under the curve (AUC) for iron deficiency (ID) and iron deficiency anemia (IDA), crude, or corrected for inflammation. Regression models assessed the relationship of baseline biomarker categories (gestational age <27 weeks) and IDA at delivery. RESULTS Hemoglobin had the largest AUC for crude ID (0.96), while hepcidin had the largest AUC for corrected ID (0.80). The optimal hepcidin cutoff for the diagnosis of corrected IDA based on maximal sensitivity and specificity was ≤1.6 µg/L. An hepcidin cutoff of <4.3 µg/L had a sensitivity of 95% for regression-corrected ID. Among iron-replete women who did not receive iron, the association of baseline hemoglobin >110 g/L with IDA at delivery (RR = 0.73; 95% CI: 0.47, 1.13) was attenuated. Baseline hepcidin >1.6 µg/L was associated with reduced risk of anemia at delivery by 49% (95% CI: 27%, 45%). CONCLUSIONS Ascertaining hemoglobin and hepcidin levels may improve the targeting of iron supplementation programs in resource-limited countries, though hepcidin's high costs may limit its use.
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Affiliation(s)
- Ajibola I Abioye
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Zulfiqarali Premji
- Department of Parasitology/Medical Entomology, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Analee J Etheredge
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ramadhani A Noor
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ellen Hertzmark
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Donna Spiegelman
- Center on Methods for Implementation and Prevention Science, Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Christopher Duggan
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Wafaie Fawzi
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Mahamoud NK, Mwambi B, Oyet C, Segujja F, Webbo F, Okiria JC, Taremwa IM. Prevalence of Anemia and Its Associated Socio-Demographic Factors Among Pregnant Women Attending an Antenatal Care Clinic at Kisugu Health Center IV, Makindye Division, Kampala, Uganda. J Blood Med 2020; 11:13-18. [PMID: 32021527 PMCID: PMC6980843 DOI: 10.2147/jbm.s231262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/07/2020] [Indexed: 12/05/2022] Open
Abstract
AIMS/OBJECTIVES This study sought to determine the prevalence, morphological characterization and associated socio-demographic factors of anemia among pregnant women attending Kisugu Health Centre IV, Makindye Division, Kampala, in Uganda. METHODS This was a cross-sectional study that employed laboratory analysis of blood samples to determine hemoglobin concentration, and a structured questionnaire to obtain socio-demographic factors associated with anemia during pregnancy. RESULTS We enrolled 345 pregnant women aged 15 to 43 years. The median, interquartile range, and mean Hb levels were 8.1g/dL, 6.4 ± 2.1g/dL and 7.9g/dL, respectively. There were 89 participants whose Hb levels were indicative of anemia, giving anemia prevalence of 25.8% (95% confidence interval: 21.6-29.8). Of these, 25 (28.1%) had mild anemia, 46 (51.7%) had moderate anemia, while 18 (20.2%) had severe anemia. Thin blood film examination showed normocytic-hypochromic (75.3%), then microcytic-hypochromic (21.6%), and macrocytic-hypochromic red blood cells (3.4%). The socio-demographic factors of gestational age, parity, and mother's occupation were significantly associated with the risk of anemia (p< 0.05). CONCLUSION We report a high prevalence of anemia among pregnant women; with a majority of hypochromic-microcytic anemia. This may necessitate more anemia awareness and it requires institution of nutritional interventions to avert fetal-maternal complications.
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Affiliation(s)
- Naimo Khalif Mahamoud
- Institute of Allied Health Sciences, Clarke International University, Kampala, Uganda
| | - Bashir Mwambi
- Institute of Allied Health Sciences, Clarke International University, Kampala, Uganda
| | - Caesar Oyet
- Institute of Allied Health Sciences, Clarke International University, Kampala, Uganda
| | - Farouk Segujja
- Institute of Allied Health Sciences, Clarke International University, Kampala, Uganda
| | - Fred Webbo
- Institute of Allied Health Sciences, Clarke International University, Kampala, Uganda
- Lancet Laboratories, Kampala, Uganda
| | - John Charles Okiria
- Institute of Allied Health Sciences, Clarke International University, Kampala, Uganda
| | - Ivan Mugisha Taremwa
- Institute of Allied Health Sciences, Clarke International University, Kampala, Uganda
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Abusharib AB. Morphological patterns of anaemia among pregnant women from Sudan. Afr J Lab Med 2019; 8:743. [PMID: 31745454 PMCID: PMC6852600 DOI: 10.4102/ajlm.v8i1.743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/11/2019] [Indexed: 11/19/2022] Open
Abstract
Background Morphological patterns of anaemia in pregnancy are considered essential for classification, diagnosis and management of patients, especially in regions with high maternal mortality like Sudan. Objectives This study evaluated morphological patterns of anaemia among pregnant women in Sudan and morphological differences across characteristics of participants. Methods This cross-sectional study was conducted from September 2016 to February 2017. A total of 200 women were selected according to specific criteria. Laboratory tests were performed for complete blood count, blood smears were performed for morphology and vitamin B12, folate and iron levels were measured. Participants were classified as: normochromic normocytic, microcytic hypochromic, macrocytic or dimorphic. Further classification based on haemoglobin levels was also performed. Results A total of 116 participants (58%) had a dimorphic pattern, followed by 50 participants (25%) with a microcytic hypochromic pattern, 20 participants (10%) with a macrocytic pattern and 14 participants (7%) with a normochromic normocytic pattern. Participants with the dimorphic pattern also had low levels of iron and folate. The majority of dimorphic participants presented with mild anaemia, whereas the majority of participants with the microcytic hypochromic pattern presented with moderate or severe anaemia. A high percentage of participants in late pregnancy had the dimorphic pattern, and there were significant differences in the degree of anaemia by parity, gestational age and regular intake of haematinic supplements. Conclusion The most frequent morphological pattern of anaemia in this study was dimorphic, followed by microcytic hypochromic, macrocytic and normochromic patterns. Morphological patterns appeared to predict types of vitamin and mineral deficiency and the degree of anaemia.
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Affiliation(s)
- Abuobieda B Abusharib
- Department of Pathology, College of Medicine, Najran University, Najran, Saudi Arabia
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14
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Anaemia and iron deficiency in pregnancy and adverse perinatal outcomes in Southern India. Eur J Clin Nutr 2019; 74:112-125. [PMID: 31296936 PMCID: PMC10122513 DOI: 10.1038/s41430-019-0464-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVES We examined the prevalence of anaemia, iron deficiency, and inflammation during pregnancy and their associations with adverse pregnancy and infant outcomes in India. SUBJECTS/METHODS Three hundred and sixty-six women participating in a randomised trial of vitamin B12 supplementation were monitored to assess haemoglobin (Hb), serum ferritin (SF), hepcidin, C-reactive protein (CRP), and alpha-1-acid glycoprotein (AGP) during pregnancy. Women received vitamin B12 supplementation (50 µg per day) or placebo daily; all women received daily prenatal iron-folic acid supplementation. Binomial and linear regression models were used to examine the associations of maternal iron biomarkers with pregnancy and infant outcomes. RESULTS Thirty percent of women were anaemic (Hb < 11.0 g/dl), 48% were iron deficient (SF < 15.0 µg/l), and 23% had iron deficiency anaemia at their first prenatal visit. The prevalence of inflammation (CRP > 5.0 mg/l: 17%; AGP > 1.0 g/l: 11%) and anaemia of inflammation (Hb < 11.0 g/dl, SF > 15.0 µg/l, plus CRP > 5.0 mg/l or AGP > 1.0 g/l: 2%) were low. Infants born to anaemic women had a twofold higher risk of low birth weight (<2500 g; risk ratio [RR]: 2.15, 95%CI: 1.20-3.84, p = 0.01), preterm delivery (RR: 2.67 (1.43-5.00); p = 0.002), underweight (WAZ < -2; RR: 2.20, 95%CI: 1.16-4.15, p = 0.02), and lower MUAC (β(SE): -0.94 (0.45)cm, p = 0.03). Similarly, maternal Hb concentrations predicted higher infant birth weight (p = 0.02) and greater gestational age at delivery (β(SE): 0.28 (0.08) weeks, p = 0.001), lower risk of preterm delivery (<37 weeks; RR: 0.76, 95%CI: 0.66-86, p < 0.0001); and higher infant MUAC (β(SE): 0.36 (0.13) cm, p = 0.006). Maternal SF concentrations were associated with greater birth length (β(SE): 0.44 (0.20) cm, p < 0.03). Findings were similar after adjusting SF concentrations for inflammation. IDA was associated with higher risk of low birth weight (RR: 1.99 (1.08-3.68); p = 0.03) and preterm birth (RR: 3.46 (1.81-6.61); p = 0.0002); and lower birth weight (p = 0.02), gestational age at birth (p = 0.0002), and infant WAZ scores (p = 0.02). CONCLUSIONS The prevalence of anaemia and iron deficiency was high early in pregnancy and associated with increased risk of adverse pregnancy and infant outcomes. A comprehensive approach to prevent anaemia is needed in women of reproductive age, to enhance haematological status and improve maternal and child health outcomes.
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Iwueke IP, Erhabor O, Digban K. Some haematological parameters among pregnant women of African descent attending antenatal clinic in Sokoto North Western Nigeria. Hum Antibodies 2019; 27:247-255. [PMID: 31045515 DOI: 10.3233/hab-190379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pregnancy is the fertilization and development of one or more offspring, known as an embryo or foetus in a woman's uterus. Pregnancy is a critical stage of development during which maternal nutrition can strongly influence obstetric and neonatal outcomes. The aim of this study was to determine the effect of pregnancy on the full blood count parameters of pregnant women of African descent residing in Sokoto, North Western Nigeria. This case-control study investigated 74 pregnant subjects and 22 non-pregnant controls. The mean age and income of the subjects were 28.00 ± 8.295 and 2760.42 ± 7975.178 respectively. Haematological parameters were determined using a fully automated 5-part differential haematology analyzer (Model Mythic 22-CT, Orpheee, Switzerland). Results obtained of pregnant subjects were compared with that of non-pregnant controls. The prevalence of anaemia (Hb < 11 g/dl) and thrombocytopenia (Platelet count < 140 × 109/L) was 58.11% and 6.75% respectively among the pregnant subjects. The mean haemoglobin, PCV, platelet and red cell count were significantly lower among the pregnant subjects (10.7 ± 0.13 g/dl and 31.4 ± 0.38%, 252.7 ± 14.35 × 109/L and 3.7 ± 0.04) compared to the non-pregnant controls (12.2 ± 0.44 g/dl, 36.2 ± 1.17 %, 362.7 ± 36.51 × 109/L and 4.3 ± 0.11) (p= 0.004, 0.001, 0.009 and 0.000) respectively. There were no significant differences in the total white blood cell count between the pregnant subjects (5.3 ± 0.22) and non-pregnant controls (4.6 ± 0.59) (p= 0.267). The Neutrophils count was significantly higher among the pregnant subjects (42.6 ± 3.06) compared to the non-pregnant controls (20.0 ± 2.33) (p= 0.000). This study has shown that pregnancy has a significant effect on some haematological parameters of women of African descent. The results of this research work indicates the need to routinely monitor the full blood count, anaemia and thrombocytopenia among pregnant women of African descent.
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Affiliation(s)
| | - Osaro Erhabor
- Department of Haematology, School of Medical Laboratory, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Kester Digban
- Department of Medical Laboratory Science, Igbinedion University, Okada, Nigeria
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16
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Dabour N, Dyab N, Kheadr E. Iron fortification of reduced‐fat bioyoghurt containing either short‐ or long‐chain inulin. INT J DAIRY TECHNOL 2019. [DOI: 10.1111/1471-0307.12575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Nassra Dabour
- Functional Foods and Nutraceuticals Laboratory (FFNL) Department of Dairy Science and Technology Faculty of Agriculture University of Alexandria Alexandria 21545 Egypt
| | - Noha Dyab
- Functional Foods and Nutraceuticals Laboratory (FFNL) Department of Dairy Science and Technology Faculty of Agriculture University of Alexandria Alexandria 21545 Egypt
| | - Ehab Kheadr
- Functional Foods and Nutraceuticals Laboratory (FFNL) Department of Dairy Science and Technology Faculty of Agriculture University of Alexandria Alexandria 21545 Egypt
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17
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Seitz J, Morales-Prieto DM, Favaro RR, Schneider H, Markert UR. Molecular Principles of Intrauterine Growth Restriction in Plasmodium Falciparum Infection. Front Endocrinol (Lausanne) 2019; 10:98. [PMID: 30930847 PMCID: PMC6405475 DOI: 10.3389/fendo.2019.00098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 02/01/2019] [Indexed: 12/21/2022] Open
Abstract
Malaria in pregnancy still constitutes a particular medical challenge in tropical and subtropical regions. Of the five Plasmodium species that are pathogenic to humans, infection with Plasmodium falciparum leads to fulminant progression of the disease with massive impact on pregnancy. Severe anemia of the mother, miscarriage, stillbirth, preterm delivery and intrauterine growth restriction (IUGR) with reduced birth weight are frequent complications that lead to more than 10,000 maternal and 200,000 perinatal deaths annually in sub-Saharan Africa alone. P. falciparum can adhere to the placenta via the expression of the surface antigen VAR2CSA, which leads to sequestration of infected erythrocytes in the intervillous space. This process induces a placental inflammation with involvement of immune cells and humoral factors. Especially, monocytes get activated and change the release of soluble mediators, including a variety of cytokines. This proinflammatory environment contributes to disorders of angiogenesis, blood flow, autophagy, and nutrient transport in the placenta and erythropoiesis. Collectively, they impair placental functions and, consequently, fetal growth. The discovery that women in endemic regions develop a certain immunity against VAR2CSA-expressing parasites with increasing number of pregnancies has redefined the understanding of malaria in pregnancy and offers strategies for the development of vaccines. The following review gives an overview of molecular processes in P. falciparum infection in pregnancy which may be involved in the development of IUGR.
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Affiliation(s)
- Johanna Seitz
- Placenta Lab, Department of Obstetrics, Jena University Hospital, Jena, Germany
| | | | - Rodolfo R. Favaro
- Placenta Lab, Department of Obstetrics, Jena University Hospital, Jena, Germany
| | - Henning Schneider
- Institute of Biochemistry and Molecular Medicine, University of Bern, Bern, Switzerland
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Udo Rudolf Markert
- Placenta Lab, Department of Obstetrics, Jena University Hospital, Jena, Germany
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18
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Martínez-Bustos F, Cruz Sánchez A, Ortega-Martínez ADC, Aguilar-Palazuelos E. Study of the functionality of nixtamalized maize flours and tortillas added with microcapsules of ferrous fumarate and folic acid. Cereal Chem 2018. [DOI: 10.1002/cche.10084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Fernando Martínez-Bustos
- Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional Unidad Querétaro; Querétaro México
| | - Alejandro Cruz Sánchez
- Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional Unidad Querétaro; Querétaro México
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Glosz CM, Schaffner AA, Reaves SK, Manary MJ, Papathakis PC. Effect of Nutritional Interventions on Micronutrient Status in Pregnant Malawian Women with Moderate Malnutrition: A Randomized, Controlled Trial. Nutrients 2018; 10:nu10070879. [PMID: 29986492 PMCID: PMC6073606 DOI: 10.3390/nu10070879] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/02/2018] [Accepted: 07/05/2018] [Indexed: 01/12/2023] Open
Abstract
Micronutrient deficiencies during pregnancy are common in Africa and can cause adverse outcomes. The objective was to measure micronutrient status and change in moderately malnourished pregnant Malawian women randomized to one of three nutritional interventions. Serum vitamin B12, 25-hydroxyvitamin D, folate, retinol, ferritin, zinc, albumin and C-reactive protein were measured in pregnant women with MUAC ≥20.6 cm and ≤23.0 cm at enrollment (n = 343) and after 10 weeks (n = 229) of receiving: (1) ready-to-use supplementary food (RUSF); (2) fortified corn-soy blend (CSB+) with multiple-micronutrient supplement (CSB+UNIMMAP); or (3) CSB+ with iron and folic acid (CSB+IFA). Each provided 100⁻300% Recommended Dietary Allowance of most micronutrients and 900 kcal/day. Birth length was measured in 272 infants. Enrollment measurements indicated deficiencies in vitamin B12 (20.9%) and zinc (22.3%), low values of ferritin (25.1%) and albumin (33.7%), and elevated CRP (46.0%). Vitamin B12 is known to decrease in the third trimester; the RUSF group had the smallest decrease from enrollment to week 10 (3%), compared to 20% decrease in the CSB+IFA group and 8% decrease in the CSB+UNIMMAP group (p = 0.001). Mean serum 25-hydroxyvitamin D increased most in the RUSF group (+6.4 ng/mL), compared to CSB+IFA (+1.7 ng/mL) and CSB+UNIMMAP (+2.7 ng/mL) (p < 0.001). Micronutrient deficiencies and inflammation are common among moderately malnourished pregnant women and had little improvement despite supplementation above the RDA, with the exception of vitamins B12 and D.
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Affiliation(s)
- Cambria M Glosz
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA 93407, USA.
| | - Andrew A Schaffner
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA 93407, USA.
| | - Scott K Reaves
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA 93407, USA.
| | - Mark J Manary
- Washington University School of Medicine, Washington University, St. Louis, MO 63110, USA.
| | - Peggy C Papathakis
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA 93407, USA.
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20
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Birhanu M, Gedefaw L, Asres Y. Anemia among School-Age Children: Magnitude, Severity and Associated Factors in Pawe Town, Benishangul-Gumuz Region, Northwest Ethiopia. Ethiop J Health Sci 2018; 28:259-266. [PMID: 29983525 PMCID: PMC6016356 DOI: 10.4314/ejhs.v28i3.3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 11/17/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Anemia is a global public health problem associated with increased mortality and morbidity. The cause of anemia in school-age children is multifactorial and has been associated with delayed psychomotor development, poor cognitive performance, impaired immunity and decrease working capacity. The aim of this study was to determine the magnitude, severity and determinant factors of anemia among school-age children (5-15 years) in Pawe Town, Northwest Ethiopia. METHODS A community based cross-sectional study was conducted from March 20 to June 19, 2015 in Pawe Town. A total of 422 school-age children were included in this study. Sociodemographic and related data were collected using structured questionnaire. Anthropometric data were collected from each study participant. Hemoglobin concentration was measured using HemoCue® Hb 201+ System (HemoCue, Angelholm, Sweden). Blood film for malaria diagnoses and stool examination for intestinal parasites were also performed. Data were analyzed using SPSS version 20.0. RESULTS The overall prevalence of anemia among school-age children was 33.9%. Mothers' illiteracy (AOR=7.5, 95% CI: 2.6-16.3), being from a family with low income (AOR=4.8, 95% CI: 1.3-10.9), being stunted (AOR=7.1, 95% CI: 2.9-11.9), being underweight (AOR=5.3, 95% CI: 2.1-13.3), infection with intestinal parasites (AOR=5.2, 95% CI: 2.1-12.6), and malaria infection (AOR=8.2, 95% CI: 1.8-14.5) were identified as associated factors of anemia. CONCLUSION In this study, anemia is a moderate public health problem among school-age children. School health strategies and interventions targeting nutritional deficiencies and parasitic infections might be very important.
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Affiliation(s)
- Muluken Birhanu
- Departemnt of Medical Laboratory Science, College of Health Science, Assosa University, Assosa, Ethiopia
| | - Lealem Gedefaw
- School of Medical Laboratory Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Yaregal Asres
- School of Medical Laboratory Science, Institute of Health, Jimma University, Jimma, Ethiopia
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21
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Hampel D, Shahab‐Ferdows S, Gertz E, Flax VL, Adair LS, Bentley ME, Jamieson DJ, Tegha G, Chasela CS, Kamwendo D, van der Horst CM, Allen LH. The effects of a lipid-based nutrient supplement and antiretroviral therapy in a randomized controlled trial on iron, copper, and zinc in milk from HIV-infected Malawian mothers and associations with maternal and infant biomarkers. MATERNAL & CHILD NUTRITION 2018; 14:e12503. [PMID: 28851037 PMCID: PMC5832511 DOI: 10.1111/mcn.12503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/27/2017] [Accepted: 07/12/2017] [Indexed: 12/03/2022]
Abstract
We evaluated effects of antiretroviral (ARV) therapy and lipid-based nutrient supplements (LNSs) on iron, copper, and zinc in milk of exclusively breastfeeding HIV-infected Malawian mothers and their correlations with maternal and infant biomarkers. Human milk and blood at 2, 6, and 24 weeks post-partum and blood during pregnancy (≤30 weeks gestation) were collected from 535 mothers/infant-pairs in the Breastfeeding, Antiretrovirals, and Nutrition study. The participants received ARV, LNS, ARV and LNS, or no intervention from 0 to 28 weeks post-partum. ARVs negatively affected copper and zinc milk concentrations, but only at 2 weeks, whereas LNS had no effect. Among all treatment groups, approximately 80-90% of copper and zinc and <50% of iron concentrations met the current adequate intake for infants at 2 weeks and only 1-19% at 24 weeks. Pregnancy haemoglobin was negatively correlated with milk iron at 2 and 6 weeks (r = -.18, p < .02 for both). The associations of the milk minerals with each other were the strongest correlations observed (r = .11-.47, p < .05 for all); none were found with infant biomarkers. At 2 weeks, moderately anaemic women produced milk higher in iron when ferritin was higher or TfR lower. At 6 weeks, higher maternal α-1-acid glycoprotein and C-reactive protein were associated with higher milk minerals in mildly anaemic women. Infant TfR was lower when milk mineral concentrations were higher at 6 weeks and when mothers were moderately anaemic during pregnancy. ARV affects copper and zinc milk concentrations in early lactation, and maternal haemoglobin during pregnancy and lactation could influence the association between milk minerals and maternal and infant iron status and biomarkers of inflammation.
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Affiliation(s)
- Daniela Hampel
- USDA, ARS Western Human Nutrition Research CenterDavisCaliforniaUSA
- Department of NutritionUniversity of CaliforniaDavisCaliforniaUSA
| | | | - Erik Gertz
- USDA, ARS Western Human Nutrition Research CenterDavisCaliforniaUSA
| | - Valerie L. Flax
- Gillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Linda S. Adair
- Gillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Margaret E. Bentley
- Gillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | | | | | - Charles S. Chasela
- UNC ProjectLilongweMalawi
- School of Public HealthUniversity of WitwatersrandJohannesburgSouth Africa
| | | | | | - Lindsay H. Allen
- USDA, ARS Western Human Nutrition Research CenterDavisCaliforniaUSA
- Department of NutritionUniversity of CaliforniaDavisCaliforniaUSA
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Antony AC. Evidence for potential underestimation of clinical folate deficiency in resource-limited countries using blood tests. Nutr Rev 2018; 75:600-615. [PMID: 28969365 DOI: 10.1093/nutrit/nux032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Although a low serum folate concentration is a useful biomarker of pure folate deficiency, the presence of vitamin B12 deficiency or hemolysis or both in individuals with low folate status predictably raises serum folate levels. Therefore, in resource-limited settings where dietary folate deficiency can coexist with vitamin B12 deficiency or malaria or both, the serum folate concentration can range from normal to high, leading to serious underestimation of tissue folate status. This review traces the genesis of an inappropriate overreliance on the serum folate concentration to rule out folate deficiency in vulnerable populations of women and children. Of significance, without due consideration of a chronically inadequate dietary folate intake, authors of influential studies have likely wrongly judged these populations to have an adequate folate status. Through repetition, this error has led to a dangerous entry into the contemporary medical literature that folate deficiency is rare in women and children. As a consequence, many millions of under-resourced women and children with mild to moderate tissue folate deficiency may have been deprived of folate replacement. This review uses historical documents to challenge earlier conclusions and re-emphasizes the need for contextual integration of clinical information in resource-limited settings.
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Affiliation(s)
- Asok C Antony
- Division of Hematology-Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, USA
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23
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Abioye AI, Park S, Ripp K, McDonald EA, Kurtis JD, Wu H, Pond-Tor S, Sharma S, Ernerudh J, Baltazar P, Acosta LP, Olveda RM, Tallo V, Friedman JF. Anemia of Inflammation during Human Pregnancy Does Not Affect Newborn Iron Endowment. J Nutr 2018; 148:427-436. [PMID: 29546300 PMCID: PMC6454452 DOI: 10.1093/jn/nxx052] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/27/2017] [Indexed: 12/20/2022] Open
Abstract
Background To our knowledge, no studies have addressed whether maternal anemia of inflammation (AI) affects newborn iron status, and few have addressed risk factors for specific etiologies of maternal anemia. Objectives The study aims were to evaluate 1) the contribution of AI and iron deficiency anemia (IDA) to newborn iron endowment, 2) hepcidin as a biomarker to distinguish AI from IDA among pregnant women, and 3) risk factors for specific etiologies of maternal anemia. Methods We measured hematologic biomarkers in maternal blood at 12 and 32 wk of gestation and in cord blood from a randomized trial of praziquantel in 358 pregnant women with Schistosoma japonicum in The Philippines. IDA was defined as anemia with serum ferritin <30 ng/mL and non-IDA (NIDA), largely due to AI, as anemia with ferritin ≥30 ng/mL. We identified cutoffs for biomarkers to distinguish IDA from NIDA by using area under the curve (AUC) analyses and examined the impact of different causes of anemia on newborn iron status (primary outcome) by using multivariate regression modeling. Results Of the 358 mothers, 38% (n = 136) had IDA and 9% (n = 32) had NIDA at 32 wk of gestation. At 32 wk of gestation, serum hepcidin performed better than soluble transferrin receptor (sTfR) in identifying women with NIDA compared with the rest of the cohort (AUCs: 0.75 and 0.70, respectively) and in identifying women with NIDA among women with anemia (0.73 and 0.72, respectively). The cutoff that optimally distinguished women with NIDA from women with IDA in our cohort was 6.1 µg/L. Maternal IDA, but not NIDA, was associated with significantly lower newborn ferritin (114.4 ng/mL compared with 148.4 µg/L; P = 0.042). Conclusions Hepcidin performed better than sTfR in identifying pregnant women with NIDA, but its cost may limit its use. Maternal IDA, but not NIDA, is associated with decreased newborn iron stores, emphasizing the need to identify this cause and provide iron therapy. This trial was registered at www.clinicaltrials.gov as NCT00486863.
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Affiliation(s)
- Ajibola I Abioye
- The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI,Department of Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI
| | - Sangshin Park
- The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI,Department of Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI,Address correspondence to SP (e-mail: or )
| | - Kelsey Ripp
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Emily A McDonald
- The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI,Department of Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI
| | - Jonathan D Kurtis
- The Warren Alpert Medical School of Brown University, Providence, RI,Department of Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI,Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI
| | - Hannah Wu
- The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI,Department of Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI
| | - Sunthorn Pond-Tor
- Department of Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI
| | - Surendra Sharma
- The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Jan Ernerudh
- Departments of Clinical Immunology and Transfusion Medicine and Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden,Departments of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden
| | - Palmera Baltazar
- Research Institute for Tropical Medicine, Manila, Philippines,Remedios Trinidad Romualdez Hospital, Tacloban City, Leyte, Philippines
| | - Luz P Acosta
- Research Institute for Tropical Medicine, Manila, Philippines
| | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Jennifer F Friedman
- The Warren Alpert Medical School of Brown University, Providence, RI,Department of Pediatrics, Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI,Department of Center for International Health Research, and Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI
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24
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Feleke BE, Feleke TE. Pregnant mothers are more anemic than lactating mothers, a comparative cross-sectional study, Bahir Dar, Ethiopia. BMC HEMATOLOGY 2018; 18:2. [PMID: 29372060 PMCID: PMC5771125 DOI: 10.1186/s12878-018-0096-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 01/04/2018] [Indexed: 11/10/2022]
Abstract
Background Information on the hemoglobin status of pregnant and lactating mothers was scarce. The objectives of this study were to determine the burden and determinants of anemia in the pregnant and lactating mother. Methods A comparative cross-sectional study was conducted. Descriptive statistics were used to identify the prevalence of anemia. Binary logistic regression and multiple linear regressions were used to identify the predictors of anemia. Results The prevalence of anemia in lactating and pregnant women was 43.00% (95% CI {confidence interval}, 41% - 45%) and 84% of anemia was microcytic and hypocromic anemia. Anemia in lactating and pregnant women was positively associated with malaria infection [AOR{adjusted odds ratio} 3.61 (95% CI: 2.63–4.95)], abortion [AOR 6.63 (95% CI: 3.23–13.6)], hookworm infection [AOR 3.37 (95% CI: 2.33–4.88)], tea consumption [AOR 3.63 (95% CI: 2.56–5.14)], pregnancy [AOR 2.24 (95% CI: 1.57–3.12)], and Mid-upper arm circumference [B 0.36 (95% CI: 0.33, −0.4)]. Anemia in pregnant and lactating mother was negatively associated with urban residence [AOR 0.68, (95% CI: 0.5–0.94)], iron supplementation during pregnancy [AOR 0.03 (95% CI, 0.02–0.04)], parity [B -0.18 (95% CI: -0.23, −0.14)], age [B -0.03 (95% CI: -0.04, −0.03)]. Conclusion The burden of anemia was higher in pregnant women than lactating women.
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Affiliation(s)
- Berhanu Elfu Feleke
- 1Department of Epidemiology and Biostatistics, University of Bahir Dar, Bahir Dar, Ethiopia
| | - Teferi Elfu Feleke
- Departement of pediatrics, saint paulose hospital, Addis Ababa, Ethiopia
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25
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Engwa GA, Unaegbu M, Unachukwu MN, Njoku MGC, Agbafor KN, Mbacham WF, Okoh A. Low serum ferritin and G6PD deficiency as potential predictors of anaemia in pregnant women visiting Prime Care Hospital Enugu Nigeria. BMC Res Notes 2017; 10:721. [PMID: 29221497 PMCID: PMC5721478 DOI: 10.1186/s13104-017-3051-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 11/30/2017] [Indexed: 11/19/2022] Open
Abstract
Objectives Though iron deficiency is known to be a major risk factor of anaemia, the association of G6PD deficiency and malaria with anaemia still remains unclear. Hence, a cross-sectional study involving 95 pregnant women visiting Prime Care Hospital in Trans-Ekulu region of Enugu Nigeria was conducted to determine possible predictors of anaemia in pregnancy. Results The prevalence of anaemia, malaria and G6PD deficiency were 53.7, 12.6 and 60% respectively. Low serum ferritin (OR 5.500, CI 2.25–13.42, p < 0.05) and G6PD deficiency (OR 0.087, CI 0.03–0.23, p < 0.05) were associated with anaemia in pregnancy. On the other hand, malaria did not significantly associate (OR 1.184, CI 0.35–3.97, p = 0.964) with anaemia in pregnant women. These findings showed high prevalence of anaemia among pregnant women with low serum ferritin level and G6PD deficiency as high risk factors of anaemia.
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Affiliation(s)
- Godwill Azeh Engwa
- Biochemistry, Department of Chemical Sciences, Faculty of Natural and Applied Sciences, Godfrey Okoye University, P.M.B 01014, Thinkers Corner, Enugu, Nigeria.
| | - Marcellus Unaegbu
- Biochemistry, Department of Chemical Sciences, Faculty of Natural and Applied Sciences, Godfrey Okoye University, P.M.B 01014, Thinkers Corner, Enugu, Nigeria
| | - Marian N Unachukwu
- Department of Microbiology, Faculty of Natural and Applied Sciences, Godfrey Okoye University, P.M.B 01014, Thinkers Corner, Enugu, Nigeria
| | - Mary-Gloria C Njoku
- Department of Sociology/Psychology, Faculty of Social and Management Sciences, Godfrey Okoye University, P.M.B 01014, Thinkers Corner, Enugu, Nigeria
| | - Kingsley N Agbafor
- Department of Biochemistry, Ebonyi State University, P.M.B. 053, Abakaliki, Nigeria
| | - Wilfred Fon Mbacham
- Laboratory for Public Health Research Biotechnologies, The Biotechnology Centre, University of Yaounde I, BP 8094, Yaounde, Cameroon
| | - Anthony Okoh
- SAMRC Microbial Water Quality Monitoring Centre, Department of Biochemistry and Microbiology, University of Fort Hare, Alice, South Africa
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26
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Anchang-Kimbi JK, Nkweti VN, Ntonifor HN, Apinjoh TO, Chi HF, Tata RB, Achidi EA. Profile of red blood cell morphologies and causes of anaemia among pregnant women at first clinic visit in the mount Cameroon area: a prospective cross sectional study. BMC Res Notes 2017; 10:645. [PMID: 29187241 PMCID: PMC5707787 DOI: 10.1186/s13104-017-2961-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 11/21/2017] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Anaemia is a serious problem in pregnancy in malaria-endemic countries. This study investigated red cell morphologies and possible causes of anaemia among pregnant women at first clinic visit. Venous blood samples from consented women were used to determine haemoglobin (Hb) levels, mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH) using an automated haematology analyzer. Malaria parasitaemia was diagnosed by microscopy. Definitions were as follows: anaemia (Hb < 11.0 g/dl), microcytosis (MCV < 78 fl), macrocytosis (MCV > 101 fl), hypochromasia (MCH < 27 pg), microcytic hypochromia or normocytic hypochromia with anaemia [iron deficiency anaemia (IDA)], normocytic normochromia with anaemia in the absence of malaria parasitaemia (physiological anaemia of pregnancy). RESULTS Of the 279 pregnant women enrolled, 57% had anaemia. Malaria parasitaemia was associated with 23.3% of anaemic cases while 76.7% were non-malaria related. The distribution of red cell alterations was as follows: hypochromasia (32.6%), microcytosis (14.7%) and macrocytosis (1.1%). The co-occurrence of malaria parasitaemia, iron deficiency and anaemia was seen in 23.3% of the women, iron deficiency anaemia only occurred in 35.9% while physiological anaemia of pregnancy was 40.9%. Iron deficiency and physiological anaemia of pregnancy contribute to a greater proportion of anaemia in the study area.
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Affiliation(s)
| | - Vera Ngenwie Nkweti
- Department of Zoology and Animal Physiology, University of Buea, 63, Buea, Cameroon
| | - Helen Ngum Ntonifor
- Department of Biological Sciences, University of Bamenda, 39, Bamenda, Cameroon
| | - Tobias O. Apinjoh
- Department of Biochemistry and Molecular Biology, University of Buea, 63, Buea, Cameroon
| | - Hanesh Fru Chi
- Department of Molecular Parasitology, University of Buea, 63, Buea, Cameroon
| | - Rolland Bantar Tata
- Department of Molecular Parasitology, University of Buea, 63, Buea, Cameroon
| | - Eric Akum Achidi
- Department of Biochemistry and Molecular Biology, University of Buea, 63, Buea, Cameroon
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27
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Bahizire E, Tugirimana PL, Dramaix M, Zozo D, Bahati M, Mwale A, Meuris S, Donnen P. Malaria Is More Prevalent Than Iron Deficiency among Anemic Pregnant Women at the First Antenatal Visit in Rural South Kivu. Am J Trop Med Hyg 2017; 97:1551-1560. [PMID: 29016317 DOI: 10.4269/ajtmh.17-0267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Anemia is common during pregnancy and is associated with poor outcomes. Objectives were not only 1) to determine the prevalence of anemia and iron deficiency (ID) but also 2) to identify other factors associated with anemia in pregnant women from South Kivu province, in the eastern Democratic Republic of Congo. Between December 2013 and March 2014, 531 women attending the first antenatal visit in their second trimester of pregnancy were recruited. Sociodemographic, clinical, and biological data were collected. Hemoglobin (Hb) was determined by a portable photometer (Hemocue® Hb201+), and anemia was defined as altitude-adjusted Hb < 110 g/L. ID was defined as serum ferritin < 15 μg/L adjusted for inflammation status (C-reactive protein [CRP] > 5 mg/L and/or α-1-acid glycoprotein > 1 g/L) whereas hypoalbuminemia was defined as serum albumin < 35 g/L. A Giemsa-stained blood smear was used to diagnose malaria. The median age (interquartile range ) was 25.5 (21.1-31.3) years, with anemia in 17.6% and ID in 8%. Malaria was present in 7.5% and hypoalbuminemia among 44%. Soluble transferrin receptor concentration was higher in the presence of inflammation and/or malaria. In the final logistic regression model, factors independently associated with anemia were malaria (adjusted odds ratio [aOR]: 11.24 (4.98-25.37) P < 0.001), hypoalbuminemia [aOR: 2.14 (1.27-3.59); P = 0.004] and elevated CRP [aOR: 1.94 (1.10-3.45); P = 0.022]. ID was not highly prevalent and not associated with anemia in our population. Effective control of anemia during pregnancy in this region should consider fighting malaria and other infectious diseases in combination with measures to improve women's nutrition, both before and during pregnancy.
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Affiliation(s)
- Esto Bahizire
- Center of Research in Epidemiology, Biostatistics and Clinical Research, Université Libre de Bruxelles, Brussels, Belgium.,Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.,Centre de Recherche en Sciences Naturelles de Lwiro, Bukavu, DR Congo
| | - P Lundimu Tugirimana
- Faculty of Medicine, Université de Goma, Goma, DR Congo.,Department of Clinical Biology, National University of Rwanda, Kigali, Rwanda
| | - Michèle Dramaix
- Center of Research in Epidemiology, Biostatistics and Clinical Research, Université Libre de Bruxelles, Brussels, Belgium
| | - Déogratias Zozo
- Centre de Recherche en Sciences Naturelles de Lwiro, Bukavu, DR Congo
| | - Mugisho Bahati
- Division Provinciale de la Santé du Sud-Kivu, Bukavu, DR Congo
| | - Andrew Mwale
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Sylvain Meuris
- Laboratory of experimental hormonology, Université Libre de Bruxelles, Brussels, Belgium
| | - Philippe Donnen
- Center of Research in Health Policy and Systems-International Health, Université Libre de Bruxelles, Brussels, Belgium
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28
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Callaghan-Gillespie M, Schaffner AA, Garcia P, Fry J, Eckert R, Malek S, Trehan I, Thakwalakwa C, Maleta KM, Manary MJ, Papathakis PC. Trial of ready-to-use supplemental food and corn-soy blend in pregnant Malawian women with moderate malnutrition: a randomized controlled clinical trial. Am J Clin Nutr 2017; 106:1062-1069. [PMID: 28793991 PMCID: PMC6483045 DOI: 10.3945/ajcn.117.157198] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/14/2017] [Indexed: 01/16/2023] Open
Abstract
Background Malnutrition during pregnancy in sub-Saharan Africa is associated with poor birth outcomes. Objective This study compared maternal and offspring anthropometry for moderately malnourished pregnant women receiving ready-to-use supplemental food (RUSF), a fortified corn-soy blend (CSB+) with a daily multiple micronutrient antenatal supplement [United Nations International Multiple Micronutrient Preparation (UNIMMAP)], or standard of care comprising CSB+ and iron and folic acid (IFA). Design A single-blind randomized controlled clinical trial was conducted in southern Malawi among 1828 pregnant women with moderate malnutrition, defined as a midupper arm circumference (MUAC) ≥20.6 and ≤23.0 cm. Women received 1 of 3 dietary treatment regimens that provided ∼900 kcal/d and 33-36 g protein/d. Maternal and infant anthropometry were followed until the child was 3 mo old. Results Newborns had a mean length-for-age z score of -1.3 ± 1.2 and 22% were stunted at birth. Mothers receiving RUSF had the highest weight gain during supplementation (3.4 ± 2.6, 3.0 ± 2.2, and 3.2 ± 2.4 kg for the RUSF, CSB+ with UNIMMAP, and CSB+ with IFA groups, respectively; P = 0.03). Newborn birth weights and lengths were similar across intervention groups, but the incidence of newborns with a birth weight <2.4 kg (weight-for-age z score <-2) was higher in the CSB+ with UNIMMAP group than the other groups (17%, 18%, and 24% for the CSB+ with IFA, RUSF, and CSB+ with UNIMMAP groups, respectively; P = 0.02). At birth, HIV-exposed newborns had a similar length and weight as newborns without HIV exposure, but their head circumference was smaller (34.0 ± 1.5 and 34.3 ± 1.6 cm, respectively; P = 0.02). At 3 mo of age, HIV-exposed infants had smaller weights, lengths, and head and arm circumferences than infants without HIV exposure. Conclusions RUSF improved maternal weight gain compared with CSB+ with UNIMMAP. The large amount of food given and the modest effect on linear growth in newborns suggests that stunting in utero is unlikely to be reduced by supplemental food alone. This trial was registered at clinicaltrials.gov as NCT02120599.
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Affiliation(s)
| | - Andrew A Schaffner
- Department of Statistics, California Polytechnic State University, San Luis Obispo, CA
| | - Patsy Garcia
- Department of Statistics, California Polytechnic State University, San Luis Obispo, CA
| | - Jocelyn Fry
- Department of Nutrition and Food Science, California Polytechnic State University, San Luis Obispo, CA
| | - Rachael Eckert
- Department of Nutrition and Food Science, California Polytechnic State University, San Luis Obispo, CA
| | - Shirin Malek
- Department of Nutrition and Food Science, California Polytechnic State University, San Luis Obispo, CA
| | - Indi Trehan
- Department of Pediatrics, Washington University, St. Louis, MO
- School of Public Health and Family Medicine, College of Medicine, Blantyre, Malawi
| | - Chrissie Thakwalakwa
- School of Public Health and Family Medicine, College of Medicine, Blantyre, Malawi
| | - Kenneth M Maleta
- School of Public Health and Family Medicine, College of Medicine, Blantyre, Malawi
| | - Mark J Manary
- Department of Pediatrics, Washington University, St. Louis, MO
- School of Public Health and Family Medicine, College of Medicine, Blantyre, Malawi
| | - Peggy C Papathakis
- Department of Nutrition and Food Science, California Polytechnic State University, San Luis Obispo, CA
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29
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Mengist HM, Zewdie O, Belew A. Intestinal helminthic infection and anemia among pregnant women attending ante-natal care (ANC) in East Wollega, Oromia, Ethiopia. BMC Res Notes 2017; 10:440. [PMID: 28870241 PMCID: PMC5584021 DOI: 10.1186/s13104-017-2770-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 08/31/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Ethiopia is a developing country where intestinal helminthic infections are major public health problems. The burden of intestinal parasites, particularly the soil-transmitted helminths (STHs), is often very high in school children and pregnant women. Anemia, associated with STH, is a major factor in women's health, especially during pregnancy; it is an important contributor to maternal mortality. The aim of this study was to determine the prevalence of intestinal helminthic infection and anemia among pregnant women attending ANC in East Wollega Zone, Ethiopia. METHODS A cross-sectional study was conducted in five health centers of East Wollega Zone of Oromia Region, Ethiopia between November 2015 and January 2016. The health centers were selected randomly and study participants were enrolled consecutively with proportions from all the health centers. Stool and blood specimens were processed using standard operating procedures in accordance with structured questionnaires. Logistic regression models were applied to assess the association between predictors and outcome variables. P values less than 0.05 were taken as significant levels. Results were presented in tables and figures. RESULTS A total of 372 pregnant women were enrolled in this study with a median age of 25 years (range 17-40 years). The total prevalence of intestinal helminths was 24.7% (92/372) with the predominance of Hookworm (15.1%) followed by Ascaris lumbricoides (6.5%). Illiteracy [AOR, 95% CI 2.21 (1.3, 4.8), P = 0.042], absence of latrine [AOR, 95% CI 4.62 (1.7, 8.3), P = 0.013] and regular consumption of raw and/or unwashed fruit [AOR, 95% CI 3.30 (1.2, 6.3), P = 0.011] were significant predictors of intestinal helminthic infection. The overall prevalence of anemia was 17.5% (65/372) where mild anemia accounts for 80% of the total anemia. Anemia was significantly associated with the first trimester of gestation [AOR, 95% CI 2.82 (1.3, 6.2), P = 0.009], previous malaria infection [AOR, 95% CI 2.32 (1.3, 5.3), P = 0.003], failing to take iron supplements regularly [AOR, 95% CI 1.82 (1.1, 4.8), P = 0.022] and infection with intestinal helminths specifically with Hookworm (P = 0.001) and Ascaris lumbricoides (P = 0.022). CONCLUSION The prevalence of intestinal helminths and anemia was significantly high in this study. Different socio-demographic, lifestyle and obstetric factors were identified as significant contributors of intestinal helminthic infection and anemia among pregnant women. Therefore, public health measures and intensive antenatal care services are vital to promoting safe pregnancy.
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Affiliation(s)
- Hylemariam Mihiretie Mengist
- Department of Medical Laboratory Sciences, Faculty of Medical and Health Sciences, Wollega University, P.O.Box: 395, Nekemte, Ethiopia
| | - Olifan Zewdie
- Department of Medical Laboratory Sciences, Faculty of Medical and Health Sciences, Wollega University, P.O.Box: 395, Nekemte, Ethiopia
| | - Adugna Belew
- Department of Medical Laboratory Sciences, Faculty of Medical and Health Sciences, Wollega University, P.O.Box: 395, Nekemte, Ethiopia
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30
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Getahun W, Belachew T, Wolide AD. Burden and associated factors of anemia among pregnant women attending antenatal care in southern Ethiopia: cross sectional study. BMC Res Notes 2017; 10:276. [PMID: 28705235 PMCID: PMC5512984 DOI: 10.1186/s13104-017-2605-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 07/07/2017] [Indexed: 11/10/2022] Open
Abstract
Background Anemia is a condition in which the number of red blood cells or their oxygen-carrying capacity is insufficient to meet physiologic needs, which varies by age, sex, altitude, smoking, and pregnancy status. The study aim is to determine the prevalence and factors associated with anemia among pregnant women attending a hospital in southern Ethiopia using a structured interview administered questionnaire. Methods Facility-based cross-sectional study was conducted from March 01–April 30 2015 at Butajira General Hospital, Ethiopia. A total of 217 women responded to the questionnaire and provided blood and stool samples for analysis. Data were analyzed using Statistical packages for social sciences version 20 for windows. Result and conclusions The overall burden of anemia in this study was 27.6%. Residence, ANC follow up, history of excess menstrual bleeding and interpregnancy interval were statistically associated with anemia among the pregnant women. Therefore, working in the identified gaps could reduce the current burden of anemia among pregnant women in the study area.
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Affiliation(s)
- Weinshet Getahun
- Department of Biomedical Sciences, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Tefera Belachew
- Department of Reproductive and Population Health, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Amare Desalegn Wolide
- Department of Biomedical Sciences, College of Health Sciences, Jimma University, Jimma, Ethiopia.
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31
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Namaste SML, Rohner F, Huang J, Bhushan NL, Flores-Ayala R, Kupka R, Mei Z, Rawat R, Williams AM, Raiten DJ, Northrop-Clewes CA, Suchdev PS. Adjusting ferritin concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am J Clin Nutr 2017; 106:359S-371S. [PMID: 28615259 PMCID: PMC5490647 DOI: 10.3945/ajcn.116.141762] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: The accurate estimation of iron deficiency is important in planning and implementing interventions. Ferritin is recommended as the primary measure of iron status, but interpretability is challenging in settings with infection and inflammation.Objective: We assessed the relation between ferritin concentrations and inflammation and malaria in preschool children (PSC) (age range: 6-59 mo) and women of reproductive age (WRA) (age range: 15-49 y) and investigated adjustment algorithms to account for these effects.Design: Cross-sectional data from 15 surveys for PSC (n = 27,865) and 8 surveys for WRA (24,844), from the Biomarkers Reflecting the Inflammation and Nutritional Determinants of Anemia (BRINDA) project were analyzed individually and combined with the use of a meta-analysis. Several approaches were explored to estimate depleted iron stores (ferritin concentration <12 μg/L in PSC and <15 μg/L in WRA) in inflammation and malaria settings as follows: 1) increase ferritin-concentration cutoff to <30 μg/L; 2) exclude individuals with C-reactive protein (CRP) concentrations >5 mg/L or α-1-acid glycoprotein (AGP) concentrations >1 g/L; 3) apply arithmetic correction factors; and 4) use a regression correction approach.Results: Depleted iron-store estimates incrementally increased as CRP and AGP deciles decreased (4% compared with 30%, and 6% compared with 29% from highest compared with lowest CRP deciles for pooled PSC and WRA, respectively, with similar results for AGP). Depending on the approach used to adjust for inflammation (CRP plus AGP), the estimated prevalence of depleted iron stores increased by 7-25 and 2-8 absolute median percentage points for PSC and WRA, respectively, compared with unadjusted values. Adjustment for malaria in addition to CRP and AGP did not substantially change the estimated prevalence of depleted iron stores.Conclusions: Our results lend support for the use of internal regression correction to estimate the prevalence of depleted iron stores in regions with inflammation. This approach appears to mathematically reflect the linear relation of ferritin concentrations with acute-phase proteins. More research is warranted to validate the proposed approaches, but this study contributes to the evidence base to guide decisions about how and when to adjust ferritin for inflammation.
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Affiliation(s)
- Sorrel ML Namaste
- Strengthening Partnerships, Results, and Innovations in Nutrition Globally, Arlington, VA;,Helen Keller International, Washington, DC
| | | | - Jin Huang
- Department of Oncology, Johns Hopkins University, Baltimore, MD
| | - Nivedita L Bhushan
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC
| | | | | | | | - Rahul Rawat
- Poverty Health and Nutrition Division, International Food Policy Research Institute, Dakar, Senegal
| | | | - Daniel J Raiten
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD; and
| | | | - Parminder S Suchdev
- Nutrition Branch, CDC, Atlanta, GA;,Emory University, Department of Pediatrics, Atlanta, GA
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Titilayo A, Palamuleni ME, Omisakin O. Sociodemographic factors influencing adherence to antenatal iron supplementation recommendations among pregnant women in Malawi: Analysis of data from the 2010 Malawi Demographic and Health Survey. Malawi Med J 2017; 28:1-5. [PMID: 27217909 DOI: 10.4314/mmj.v28i1.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND AIM Maternal morbidity and mortality statistics remain unacceptably high in Malawi. Prominent among the risk factors in the country is anaemia in pregnancy, which generally results from nutritional inadequacy (particularly iron deficiency) and malaria, among other factors. This warrants concerted efforts to increase iron intake among reproductive-age women. This study, among women in Malawi, examined factors determining intake of supplemental iron for at least 90 days during pregnancy. METHODS A weighted sample of 10,750 women (46.7%), from the 23,020 respondents of the 2010 Malawi Demographic and Health Survey (MDHS), were utilized for the study. Univariate, bivariate, and regression techniques were employed. While univariate analysis revealed the percent distributions of all variables, bivariate analysis was used to examine the relationships between individual independent variables and adherence to iron supplementation. Chi-square tests of independence were conducted for categorical variables, with the significance level set at P < 0.05. Two binary logistic regression models were used to evaluate the net effect of independent variables on iron supplementation adherence. RESULTS Thirty-seven percent of the women adhered to the iron supplementation recommendations during pregnancy. Multivariate analysis indicated that younger age, urban residence, higher education, higher wealth status, and attending antenatal care during the first trimester were significantly associated with increased odds of taking iron supplementation for 90 days or more during pregnancy (P < 0.01). CONCLUSIONS The results indicate low adherence to the World Health Organization's iron supplementation recommendations among pregnant women in Malawi, and this contributes to negative health outcomes for both mothers and children. Focusing on education interventions that target populations with low rates of iron supplement intake, including campaigns to increase the number of women who attend antenatal care clinics in the first trimester, are recommended to increase adherence to iron supplementation recommendations.
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Affiliation(s)
- A Titilayo
- Population Training and Research Unit, North-West University, Mafikeng, South Africa; Department of Demography and Social Statistics, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - M E Palamuleni
- Population Training and Research Unit, North-West University, Mafikeng, South Africa
| | - O Omisakin
- Department of Demography and Social Statistics, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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Abstract
Folate is essential for DNA synthesis and the survival and growth of the malaria parasite. Folate sufficiency may be associated with an increased risk of malaria. Antifolate antimalarial drugs are of major importance in the prophylaxis and treatment of malaria. Folic acid reverses the inhibition by antifolate drugs of plasmodial growth or survival in vitro, and folic acid supplements given to children with malaria may increase the failure rate of treatment with antimalarials. There is no convincing evidence of a significant prevalence of folate deficiency in children in malarious areas, nor of a beneficial effect of folic acid supplementation on malarial anemia. In areas where Plasmodium falciparum malaria is holoendemic, universal supplementation of children with iron and folic acid may increase the incidence of severe morbidity and mortality. These regions should be excluded from the World Health Organization recommendation of universal folic acid supplementation of children in areas of high prevalence of anemia. This does not apply to supplementation of pregnant women with folic acid.
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Adanikin AI, Awoleke JO, Olofinbiyi BA, Adanikin PO, Ogundare OR. Routine Iron Supplementation and Anaemia by Third Trimester in a Nigerian Hospital. Ethiop J Health Sci 2016; 25:305-12. [PMID: 26949294 PMCID: PMC4762968 DOI: 10.4314/ejhs.v25i4.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Anaemia in pregnancy is associated with adverse maternal and fetal outcome. Unfortunately, in developing countries its prevalence has continued to rise. To improve the situation, iron supplement is routinely prescribed during pregnancy. We therefore examine the impact of the intervention as being currently practised in our clinical setting. Methods In total, 255 prenatal clinic attendees who had more than 8 weeks of prescribed iron supplements were sampled. Data was obtained on their socio-demographic features, haemoglobin concentration at booking, compliance with iron supplements and third trimester haemoglobin value. Results Observed iron supplementation compliance rate was 184(72.2%). There was a significant drop in mean haemoglobin (Hb) concentration between the two time points (booking Hb: 32.56±2.99; third trimester Hb: 31.67±3.01; mean diff: 0.89±3.04; t = 4.673; 95% CI= 0.52–1.27; p= <0.001). Anaemia increased from 132(51.8%) to 150(58.8%) by the third trimester. Increase in anaemia occurred in both iron-compliant and non-compliant groups. Non-compliance however had higher odds of predicting anaemia by the third trimester (OR: 1.83; 95% CI: 1.03–3.26; p: 0.04). Conclusion Although iron supplementation is still a good intervention in developing countries, it is not sufficient to reduce overall prevalence of anaemia by the third trimester. There is a need to look beyond the approach and reinforce the importance of better feeding practices, food fortification and reduced frequency of pregnancies.
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Affiliation(s)
- Abiodun I Adanikin
- Department of Obstetrics and Gynecology, Ekiti State University, Ado-Ekiti, Nigeria
| | - Jacob O Awoleke
- Department of Obstetrics and Gynecology, Ekiti State University, Ado-Ekiti, Nigeria
| | | | - Pipeloluwa O Adanikin
- Department of Family Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Omobolanle R Ogundare
- Nursing Unit, Prenatal Clinic, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
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Gordon SB. Patient outcome in adults with pneumococcal meningitis or bacteraemia admitted to QECH. Malawi Med J 2016; 15:38-42. [PMID: 27528954 DOI: 10.4314/mmj.v15i2.10774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pneumococcal infections are common in Malawian adults. We set out to determine which factors influence in-hospital mortality and long-term survival among these patients. Features of history and examination, inpatient mortality and long-term survival were described among consecutively admitted QECH patients with S. pneumoniae in blood or CSF. 217 patients with pneumococcal disease were studied over an 18-month period. Among these, 158 of 167 consenting to testing (95%) were HIV positive. Inpatient mortality was 65% for pneumococcal meningitis (n=64), 20% for pneumococcaemic pneumonia (n=92) and 26% for patients with pneumococcaemia without localising signs (n=43). Lowered conscious level (OR 5.8, p<0.001), hypotension(OR 4.8, p=0.04) and age exceeding 55 years (OR 3.8, p=0.001) at presentation were associated with inpatient death but not long-term outcome in survivors. Outpatient death was associated with multilobar chest signs (HR 2.1, p=0.01), oral candidiasis (HR 1.8, p=0.03) and severe anaemia (HR 3.9, p=0.005) as an inpatient. In conclusion, most patients with pneumococcal disease in Malawi have severe disease, HIV co-infection and a poor prognosis. At discharge patients with multilobar chest signs or anaemia are at particular risk.
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Affiliation(s)
- Stephen B Gordon
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre.
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Efficacy and safety of adjuvant recombinant human erythropoietin and ferrous sulfate as treatment for iron deficiency anemia during the third trimester of pregnancy. Eur J Obstet Gynecol Reprod Biol 2016; 205:32-6. [PMID: 27566219 DOI: 10.1016/j.ejogrb.2016.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 06/27/2016] [Accepted: 08/01/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE Gestational anemia increases the incidence of maternal and fetal complications. Adjuvant recombinant human erythropoietin (rHuEPO) has been used in patients who refuse blood transfusions, have a low response to treatment with iron sulfate, have limited time before birth, or have other illnesses that complicate the anemia. We demonstrated that the use of adjuvant rHuEPO with iron sulfate reduces the anemia time period and is innocuous to the fetus. METHOD An experimental longitudinal prospective study; 100 pregnant women in their third trimester were included. Group 1 (n=50) was set as control for prevalence of anemia and establish hematological maternal and fetal parameters at delivery for our population; 50 women diagnosed with iron deficiency anemia were randomly assigned to treatment groups. Group 2 (n=25) third trimester women with a hemoglobin of <11g/dL were treated with iron sulfate, 600mg administered orally daily for 4 weeks, evaluating the hematologic response for the mother weekly and for both mother and fetus at birth; Group 3 (n=25) women similar to group 2, treated in addition with adjuvant rHuEPO, 4000 units subcutaneously, three times a week, for 4 weeks evaluating the same parameters. RESULTS Group 2 and 3 showed a corrected anemia before delivery (mean 11.1 vs 11.4g/dL), but Group 3 showed a statistically broader and more rapid increase in hemoglobin (1.22 vs 1.92g/dL, p value 0.013) with an rHuEPO dose of 4000 units, three times a week for 1 month. No clinical or hematologic difference or changes in growth were observed in the fetus. CONCLUSIONS Erythropoietin is safe and effective for both mother and fetus, although an ideal pregnancy dose has not yet been established.
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Liu L, Han X, Huang Q, Zhu X, Yang J, Liu H. Increased neuronal seizure activity correlates with excessive systemic inflammation in a rat model of severe preeclampsia. Hypertens Res 2016; 39:701-708. [DOI: 10.1038/hr.2016.53] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 03/22/2016] [Accepted: 03/29/2016] [Indexed: 12/15/2022]
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McCauley ME, van den Broek N, Dou L, Othman M. Vitamin A supplementation during pregnancy for maternal and newborn outcomes. Cochrane Database Syst Rev 2015; 2015:CD008666. [PMID: 26503498 PMCID: PMC7173731 DOI: 10.1002/14651858.cd008666.pub3] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The World Health Organization recommends routine vitamin A supplementation during pregnancy or lactation in areas with endemic vitamin A deficiency (where night blindness occurs), based on the expectation that supplementation will improve maternal and newborn outcomes including mortality, morbidity and prevention of anaemia or infection. OBJECTIVES To review the effects of supplementation of vitamin A, or one of its derivatives, during pregnancy, alone or in combination with other vitamins and micronutrients, on maternal and newborn clinical outcomes. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 March 2015) and reference lists of retrieved studies. SELECTION CRITERIA All randomised or quasi-randomised trials, including cluster-randomised trials, evaluating the effect of vitamin A supplementation in pregnant women. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. MAIN RESULTS We reviewed 106 reports of 35 trials, published between 1931 and 2015. We included 19 trials including over 310,000 women, excluded 15 trials and one is ongoing. Overall, seven trials were judged to be of low risk of bias, three were high risk of bias and for nine it was unclear. 1) Vitamin A alone versus placebo or no treatmentOverall, when trial results are pooled, vitamin A supplementation does not affect the risk of maternal mortality (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.65 to 1.20; four trials Ghana, Nepal, Bangladesh, UK, high quality evidence), perinatal mortality (RR 1.01, 95% CI 0.95 to 1.07; one study, high quality evidence), neonatal mortality, stillbirth, neonatal anaemia, preterm birth (RR 0.98, 95% CI 0.94 to 1.01, five studies, high quality evidence), or the risk of having a low birthweight baby.Vitamin A supplementation reduces the risk of maternal night blindness (RR 0.79, 95% CI 0.64 to 0.98; two trials). There is evidence that vitamin A supplements may reduce maternal clinical infection (RR 0.45, 95% CI 0.20 to 0.99, five trials; South Africa, Nepal, Indonesia, Tanzania, UK, low quality evidence) and maternal anaemia (RR 0.64, 95% CI 0.43 to 0.94; three studies, moderate quality evidence). 2) Vitamin A alone versus micronutrient supplements without vitamin AVitamin A alone compared to micronutrient supplements without vitamin A does not decrease maternal clinical infection (RR 0.99, 95% CI 0.83 to 1.18, two trials, 591 women). No other primary or secondary outcomes were reported 3) Vitamin A with other micronutrients versus micronutrient supplements without vitamin AVitamin A supplementation (with other micronutrients) does not decrease perinatal mortality (RR 0.51, 95% CI 0.10 to 2.69; one study, low quality evidence), maternal anaemia (RR 0.86, 95% CI 0.68 to 1.09; three studies, low quality evidence), maternal clinical infection (RR 0.95, 95% CI 0.80 to 1.13; I² = 45%, two studies, low quality evidence) or preterm birth (RR 0.39, 95% CI 0.08 to 1.93; one study, low quality evidence).In HIV-positive women vitamin A supplementation given with other micronutrients was associated with fewer low birthweight babies (< 2.5 kg) in the supplemented group in one study (RR 0.67, 95% CI 0.47 to 0.96; one study, 594 women). AUTHORS' CONCLUSIONS The pooled results of three large trials in Nepal, Ghana and Bangladesh (with over 153,500 women) do not currently suggest a role for antenatal vitamin A supplementation to reduce maternal or perinatal mortality. However, the populations studied were probably different with regard to baseline vitamin A status and there were problems with follow-up of women. There is good evidence that antenatal vitamin A supplementation reduces maternal night blindness, maternal anaemia for women who live in areas where vitamin A deficiency is common or who are HIV-positive. In addition the available evidence suggests a reduction in maternal infection, but these data are not of a high quality.
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Affiliation(s)
- Mary E McCauley
- Liverpool School of Tropical MedicineCentre for Maternal and Newborn Health, Department of International Public HealthPembroke PlaceLiverpoolMerseysideUKL3 5QA
| | - Nynke van den Broek
- Liverpool School of Tropical MedicineCentre for Maternal and Newborn Health, Department of International Public HealthPembroke PlaceLiverpoolMerseysideUKL3 5QA
| | - Lixia Dou
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Mohammad Othman
- Faculty of Medicine, Albaha UniversityDepartment of Obstetrics and GynaecologyAlbahaSaudi Arabia
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Egbi G, Ayi I, Saalia FK, Zotor F, Adom T, Harrison E, Ahorlu CK, Steiner-Asiedu M. Impact of Cowpea-Based Food Containing Fish Meal Served With Vitamin C-Rich Drink on Iron Stores and Hemoglobin Concentrations in Ghanaian Schoolchildren in a Malaria Endemic Area. Food Nutr Bull 2015; 36:264-75. [PMID: 26385950 DOI: 10.1177/0379572115596253] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nutritional anemia is a public health problem among Ghanaian schoolchildren. There is need to employ dietary modification strategies to solve this problem through school and household feeding programs. OBJECTIVE To evaluate the effectiveness of cowpea-based food containing fish meal served with vitamin C-rich drink to improve iron stores and hemoglobin concentrations in Ghanaian schoolchildren. METHODS The study involved cross-sectional baseline and nutrition intervention phases. There were 150 participants of age 6 to 12 years. They were randomly assigned to 3 groups, fish meal -vitamin C (n = 50), vitamin C (n = 50), and control (n = 50), and given different cowpea-based diets for a 6-month period. Height and weight measurements were done according to the standard procedures, dietary data were obtained by 24-hour recall and food frequency questionnaire, hemoglobin concentrations were determined by Hemocue Hemoglobinometer, and serum ferritin and complement-reactive protein (CRP) were determined by enzyme-linked immunosorbent assay. Participants' blood samples were examined for malaria parasitemia and stools for helminthes using Giemsa stain and Kato-Katz techniques, respectively. RESULTS Mean ferritin concentration was not significantly different among groups. End line mean or change in hemoglobin concentrations between fish meal-vitamin C group (128.4 ± 7.2/8.3 ± 10.6 g/L) and control (123.1 ± 6.6/4.2 ± 10.4 g/L) were different, P < .05. Change in prevalence of anemia in fish meal-vitamin C group (19.5%) was different compared to those of vitamin C group (9.3%) and the control (12.2%). Levels of malaria parasitemia and high CRP among study participants at baseline and end line were 58% and 80% then 55% and 79%, respectively. Level of hookworm infestation was 13%. CONCLUSION Cowpea-based food containing 3% fish meal and served with vitamin C-rich drink improved hemoglobin concentration and minimized the prevalence of anemia among the study participants.
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Affiliation(s)
- Godfred Egbi
- Department of Nutrition, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Irene Ayi
- Department of Nutrition, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Firibu Kwesi Saalia
- Department of Nutrition, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | | | | | - Eric Harrison
- Department of Nutrition, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Collins K Ahorlu
- Department of Nutrition, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Matilda Steiner-Asiedu
- Department of Nutrition, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
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Ugwa EA. Vitamins A and E Deficiencies among Pregnant Women Attending Antenatal Care at General Hospital Dawakin Kudu, North-West Nigeria. Int J Prev Med 2015; 6:65. [PMID: 26288709 PMCID: PMC4521299 DOI: 10.4103/2008-7802.161078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/10/2015] [Indexed: 12/05/2022] Open
Abstract
Background: Vitamins A and E deficiency is prevalent in developing countries, and plasma levels are low in pregnancy. This study was undertaken to determine the serum Vitamins A and E status among pregnant women attending antenatal care at a General Hospital in Dawakin Kudu, Kano and to provide the necessary information needed to suggest the supplementation of Vitamins A and E during pregnancy. Methods: The study was done in General Hospital Dawakin Kudu Local Government Area. Dawakin Kudu, a rural community in Kano State is about 12 km from Kano metropolis which is the most populous city in Nigeria and commercial nerve center of Northern Nigeria. Most of the women are housewives, however, some engage in subsistent farming and petty trading. This was a prospective study of 200 pregnant women at various maternal ages, gestational ages, and parities. Informed consent was obtained from the participants. Research structured questionnaire was administered to 200 respondents which showed age and parity distributions. Determination of Serum Vitamins A and E was done using methods of Bessey, et al. and Tsen. Ethical approval for the research was obtained from General Hospital, Dawakin Kudu, Kano. Statistical Analysis Used: Data obtained were analyzed using SPSS version 17 statistical software (SPSS Inc., IL, Chicago, USA). Descriptive statistics was done. Mean serum Vitamins A and E concentration between trimesters were compared using two-way ANOVA and P < 0.05 was considered statistically significant. Results: Majority of the women were aged 20–39 years with mean of 23.67 ± 6.11. Most were in the 1–4 parity range. Mean birth weight was 2.42 ± 0.74 kg. Above 65% were deficient while 34.5% had normal levels of Vitamin A and 51% were deficient of serum Vitamin E. Serum Vitamins A and E levels showed a marked reduction from first through third trimester. The differences were statistically significant (P < 0.05). Conclusions: There is a significant reduction in the serum Vitamins A and E concentration throughout the period of pregnancy with the highest levels in the first trimester. Therefore, further studies should evaluate the value of Vitamins A and E supplementation during pregnancy especially for those whose fruit and vegetable consumption is inadequate.
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Adanikin AI, Awoleke JO. Sociodemographic factors associated with anaemia in pregnancy at booking for antenatal care. J OBSTET GYNAECOL 2015. [PMID: 26214716 DOI: 10.3109/01443615.2015.1025727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Late patronage of antenatal care by women in low-resource areas makes timely intervention at correcting anaemia difficult. This study aimed to identify modifiable sociodemographic factors that predict anaemia before commencing antenatal care and make appropriate recommendation. A survey of sociodemographic features and haemoglobin concentrations of 232 women booking for antenatal care was conducted. Anaemia was diagnosed in 119 (51.3%), of which 87 (37.5%) had mild anaemia and 32 (13.8%) were moderately anaemic. There was no severe anaemia. Anaemia was highest among respondents who were 35 years of age, Muslims, of Igbo ethnicity (64.3%), single (55.0%), student/unemployed (58.8%), nulliparous (57.3%) and those who registered at 21 weeks' gestation (54.2%). Only occupation of the woman showed association with anaemia before antenatal care (p 0.007). A personal source of income may reduce anaemia in pregnancy; and it is advisable to have a social welfare package for unemployed pregnant women.
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Affiliation(s)
- A I Adanikin
- Departments of Obstetrics and Gynaecology, Ekiti State University, Ado-Ekiti, Nigeria, Africa
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Duedu KO, Sagoe KWC, Ayeh-Kumi PF, Affrim RB, Adiku T. The effects of co-infection with human parvovirus B19 and Plasmodium falciparum on type and degree of anaemia in Ghanaian children. Asian Pac J Trop Biomed 2015; 3:129-39. [PMID: 23593592 DOI: 10.1016/s2221-1691(13)60037-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 12/12/2012] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To determin the extent to which parvovirus B19 (B19V) and co-infection of B19V and malaria contribute to risk of anaemia in children. METHODS B19V DNA and malaria parasites were screened for 234 children at the PML Children's Hospital in Accra. The role of B19V and co-infection with B19V and malaria in anaemia was evaluated by analysing full blood cell counts, malaria and B19V DNA results from these children. RESULTS The prevalence of B19V, malaria and co-infection with B19V and malaria was 4.7%, 41.9% and 2.6%, respectively. Malaria posed a greater risk in the development of mild anaemia compared to severe anaemia (OR=5.28 vrs 3.15) whereas B19V posed a higher risk in the development of severe anaemia compared to mild anaemia (OR=4.07 vrs 1.00) from a non-anaemic child. Persons with co-infection with B19V and malaria had 2.23 times the risk (95% CI=0.40-12.54) of developing severe anaemia should they already have a mild anaemia. The degree of anaemia was about three times affected by co-infection (Pillai's trace=0.551, P=0.001) as was affected by malaria alone (Pillai's trace=0.185, P=0.001). B19V alone did not significantly affect the development of anaemia in a non-anaemic child. Microcytic anaemia was associated with B19V and co-infection with B19V and malaria more than normocytic normochromic anaemia. CONCLUSIONS B19V was associated with malaria in cases of severe anaemia. The association posed a significant risk for exacerbation of anaemia in mild anaemic children. B19V and co-infection with B19V and malaria may be associated with microcytic anaemia rather than normocytic normochromic anaemia as seen in cases of B19V infection among persons with red cell abnormalities.
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Affiliation(s)
- Kwabena Obeng Duedu
- Department of Microbiology, University of Ghana Medical School, Korle-Bu, Accra, Ghana ; Institute of Cell Biology, School of Biological Sciences, University of Edinburgh, Scotland, UK
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Dim C, Ugwu E, Dim N, Anyaehie U. Hematocrit, anemia, and arm preference for blood sample collection: a cross-sectional study of pregnant women in enugu, South-eastern, Nigeria. Ann Med Health Sci Res 2015; 5:36-41. [PMID: 25745574 PMCID: PMC4350060 DOI: 10.4103/2141-9248.149783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Anemia in pregnancy is a common cause of maternal morbidity and mortality in developing countries. Regular review of hematocrit (HCT) and anemia patterns in pregnancy is necessary in our environment. AIM The aim was to determine the average HCT, prevalence, and pattern of anemia, as well the arm preferences for blood sample collection among pregnant women in Enugu, South East Nigeria. SUBJECTS AND METHODS HCT was determined using venous blood of 200 antenatal women at the University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria. Questionnaires were used to assess participants' arm preference for blood sample collection for clinical investigations. Data analysis was descriptive and inferential at 95% confidence level. RESULTS Participants' mean HCT was 33.3 (3.7%). The average HCT in second trimester 33.3% (3.76%) was significantly lower than that of third trimester (34.6 [3.4%], P = 0.01,). Prevalence of anemia was 28.0% (56/200), and a majority (94.6%, 53/56) of anemic women belong to the mild category. Only parity groups had a significant association with anemia in pregnancy (P = 0.04). None of the participants reported being asked about her arm preference during blood collection for routine antenatal investigations. One hundred and five (52.5%) women expressed preference for either left (34.5%, 69/200) or right arm (18.0%, 36/200) for blood sample collection. CONCLUSION The average HCT among pregnant women at the UNTH, Enugu Nigeria was within normal range and the prevalence of anemia was relatively low. The majority of women expressed a preference for either right or left arm for blood sample collection for clinical investigations and would wish their choices sought for and respected.
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Affiliation(s)
- Cc Dim
- Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Eo Ugwu
- Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Nr Dim
- Department of Radiation Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Ub Anyaehie
- Department of Physiology, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
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Micronutrients Deficiency, a Hidden Hunger in Nepal: Prevalence, Causes, Consequences, and Solutions. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2015; 2015:276469. [PMID: 27347513 PMCID: PMC4897390 DOI: 10.1155/2015/276469] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 12/22/2014] [Indexed: 01/13/2023]
Abstract
Micronutrient deficiency is a global challenge to health as in Nepal. In Nepal, the targeted beneficiaries are less aware about importance of micronutrients (MNs), which has resulted in low intake of foods rich in MNs. Micronutrient deficiencies (MNDs) have huge impact on health of vulnerable population like women and children and have jeopardized the national economy and prosperity of developing countries including Nepal. However, less attention has been paid towards MNDs, which can be prevented. Therefore, this study aims to draw attention of the concerned authorities and researchers to combat against MNDs in Nepal. This study showed that different types of MNDs with higher prevalence exist in Nepal. The major causes of MNDs were poor diet, diseases and infestations, and poor health caring practices. The results of MNDs were unwanted child and maternal mortality, impairments of lives, and reduction in productivity and intellectual capacity. School health and nutrition education and supplementation and fortification of essential MNs proved to be effective while dietary diversification and economic growth and poverty eradication seemed promising. Control and prevention of MNDs can help to achieve Millennium Development Goals as well, so studies in this sector should be emphasized.
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Dickinson N, Rankin J, Pollard M, Maleta K, Robertson C, Hursthouse A. Evaluating environmental and social influences on iron and zinc status of pregnant subsistence farmers in two geographically contrasting regions of Southern Malawi. THE SCIENCE OF THE TOTAL ENVIRONMENT 2014; 500-501:199-210. [PMID: 25217995 DOI: 10.1016/j.scitotenv.2014.08.087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/22/2014] [Accepted: 08/25/2014] [Indexed: 05/27/2023]
Abstract
Micronutrient deficiency affects over 4.5 billion people worldwide, the majority in developing countries. Deficiencies of iron (and associated anaemia) and zinc in pregnancy are associated with complications, maternal and neonatal mortality, and developmental disorders in the foetus and growing child. We report the results of pilot study which used an interdisciplinary approach to explore environmental and sociocultural factors influencing the micronutrient status in the soil-plant-human transfer for pregnant subsistence farmers in two geographically contrasting regions of Southern Malawi. It evaluated micronutrient status in soil and the staple crop and explored the context for their transfer to pregnant women. Scientific and social science methods were used to collect data, following full sensitisation of the communities. A total of 99 participants were recruited from Chiradzulu (plateau) and Chikwawa (floodplain). Soil, maize and blood samples were collected, along with food frequency and health behaviour questionnaires and anthropological observation. Statistical analysis revealed that soil iron was significantly higher in Chiradzulu than in Chikwawa; total iron concentration is not deemed to be deficient in either area. Soil zinc was not significantly different between areas. Maize concentrations of iron and zinc were not significantly different between areas, and were not deficient relative to improved cultivars. Blood iron deficiency and associated anaemia were problematic in both areas, but more so in Chikwawa than in Chiradzulu, and zinc deficiency was similar in both areas. The study has identified a significant difference in the blood iron status of the participants of the two communities, and has shown that this difference is not accounted for by the staple crop maize. Socio-geographical factors appear to play a significant role in the micronutrient health of the populations. The findings lend support to multifaceted community intervention studies which educate communities on strategies to tackle micronutrient deficiencies.
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Affiliation(s)
- N Dickinson
- Institute of Biomedical & Environmental Health Research, School of Science, University of the West of Scotland, Paisley PA1 2BE, UK; School of Health, Nursing & Midwifery, University of the West of Scotland, Paisley PA1 2BE, UK
| | - J Rankin
- School of Health, Nursing & Midwifery, University of the West of Scotland, Paisley PA1 2BE, UK
| | - M Pollard
- School of Health, Nursing & Midwifery, University of the West of Scotland, Paisley PA1 2BE, UK
| | - K Maleta
- University of Malawi, College of Medicine, Community Health, P/Bag 360 Chichiri, Blantyre 3, Malawi
| | - C Robertson
- Department of Mathematics and Statistics, University of Strathclyde, 26 Richmond Street, Glasgow G1 1XH, UK
| | - A Hursthouse
- Institute of Biomedical & Environmental Health Research, School of Science, University of the West of Scotland, Paisley PA1 2BE, UK.
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Kefiyalew F, Zemene E, Asres Y, Gedefaw L. Anemia among pregnant women in Southeast Ethiopia: prevalence, severity and associated risk factors. BMC Res Notes 2014; 7:771. [PMID: 25362931 PMCID: PMC4223834 DOI: 10.1186/1756-0500-7-771] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 10/24/2014] [Indexed: 11/29/2022] Open
Abstract
Background Anemia is a significant public health problem in developing countries, particularly in pregnant women. It may complicate pregnancy, sometimes resulting in tragic outcomes. There is a lack of information on the magnitude of anemia among pregnant women in Southeast Ethiopia. The aim of this study is, therefore, to determine the prevalence of anemia and assess associated factors among pregnant women attending antenatal care (ANC) at Bisidimo Hospital in Southeast Ethiopia. Methods A facility-based cross-sectional study, involving 258 pregnant women, was conducted from March to June 2013. Socio-demographic, medical and obstetric data of the study participants were collected using structured questionnaire. Hemoglobin was measured using a hematology analyzer and faecal specimens were examined to detect intestinal parasites. Anemia in pregnancy was defined as hemoglobin <11 g/dl. Results Overall, prevalence of anemia was 27.9%, of which 55% had mild anemia. Rural residence (AOR =3.3, 95% CI: 1.5-7.4), intestinal parasitic infection (IPI) (AOR = 2.5, 95% CI: 1.3-4.8) and history of heavy cycle (AOR =2.7, 95% CI: 1.3-1.7) were predictors of anemia. Conclusions This study showed moderate prevalence of anemia among the pregnant women, with a sizable proportion having severe anemia. Routine testing of pregnant women for IPIs and creating awareness on factors predisposing to anemia is recommended.
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Affiliation(s)
| | | | | | - Lealem Gedefaw
- Department of Medical Laboratory Science and Pathology, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia.
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The aetiology of anaemia during pregnancy: a study to evaluate the contribution of iron deficiency and common infections in pregnant Ugandan women. Public Health Nutr 2014; 18:1423-35. [DOI: 10.1017/s1368980014001888] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo describe the aetiology of anaemia in pregnant Ugandan women and explore Fe deficiency and common infections as contributors to anaemia in this population.DesignCross-sectional study in which Hb, ferritin, transferrin receptor (sTfR), C-reactive protein, α-1 acid glycoprotein, hepcidin, malaria, hookworm infestation, syphilis and Helicobacter pylori infection were assessed.SettingAntenatal care clinic at Kawempe Health Centre, Kampala, Uganda.SubjectsHIV-negative women (n 151) in their first or second pregnancy at 10–16 weeks’ gestation.ResultsThe prevalence of anaemia was 29·1 %. Fe deficiency was 40·4 % and 14·6 % based on ferritin <30 μg/l and on adjusted ferritin <12 μg/l respectively, and 6·6 % based on sTfR >8·3 μg/ml. The prevalence of Fe-deficiency anaemia was 9·3 % based on ferritin <30 μg/l, 6·6 % based on adjusted ferritin <12 μg/l and 4·3 % based on sTfR >8·3 μg/ml. Hepcidin concentration was positively correlated with ferritin concentration (n 151, r=0·578, P<0·00001). H. pylori infection was highly prevalent (70 %) while malaria, hookworm infestation and syphilis were not common. Of all women, 60·3 % had α-1 acid glycoprotein >1 g/l and/or C-reactive protein >5 mg/l. Malaria parasitaemia (OR=6·85; 95 % CI 1·25, 37·41, P=0·026) and Fe deficiency defined using sTfR (OR=5·58; 95 % CI 1·26, 24·80, P=0·024) were independently and positively associated with anaemia. Population-attributable risk factors for anaemia for raised C-reactive protein, Fe deficiency defined by sTfR >8·3 μg/ml and presence of malaria parasites were 41·6 (95 % CI 11·1, 72·2) %, 13·5 (95 % CI 2·0, 25·0) % and 12·0 (95 % CI 1·4, 22·6) %, respectively.ConclusionsInfections and inflammation are of greater significance than Fe deficiency in the aetiology of anaemia in pregnant Ugandan women during the first trimester.
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Ugwa E, Gwarzo M, Ashimi A. Oxidative stress and antioxidant status of pregnant rural women in north-west Nigeria: prospective cohort study. J Matern Fetal Neonatal Med 2014; 28:544-7. [PMID: 24824107 DOI: 10.3109/14767058.2014.924102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND/OBJECTIVE This research was undertaken to determine the oxidative stress and antioxidant status of pregnant northern Nigerian women. METHODS Prospective cohort study. The study was done at General Hospital, Dawakin Kudu LGA, Kano. Kano has a population of 9.2 million and predominantly Muslims. Two hundred consecutive women presenting for antenatal care and 100 apparently normal controls. Ethical approval was obtained. Socio-demographic and clinical information were obtained via interviewer-administered questionnaires from 200 consecutive pregnant women who presented for antenatal care. Serum levels of vitamins A, C, E and malondialdehyde were determined. Data was analyzed with SPSS version 16.0 statistical software. Descriptive statistics was used. Means were compared using analysis of variance (ANOVA). Associations between trimesters and oxidative stress/antioxidant status were tested using chi-square test and p < 0.05 was considered statistically significant. RESULT The mean serum vitamin A, E and C levels were 13.39 ± 9.44 µg/dl, 0.35 ± 0.51 mg/dl and 5.99 ± 3.95 µ/dl respectively (below normal limits). The prevalence of vitamins A, C and E deficiency were 65.5%, 79.5% and 51% respectively. The mean serum levels of malondialdehyde was 4.04 ± 0.91 nmol/l (pregnant) and 1.84 ± 0.40 nmol/l (non-pregnant) (p = 0.001). There was strong negative correlation between serum levels of malondialdehyde and vitamins A, C and E. CONCLUSION Vitamins A, C, E deficiency and oxidative stress is a problem among Northern Nigeria pregnant women, therefore the value of antioxidant vitamin supplementation should be explored.
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Affiliation(s)
- Emmanuel Ugwa
- Department of Obstetrics and Gynecology, Federal Medical Centre , Birnin Kudu, Jigawa State , Nigeria and
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Prevalence of anaemia among pregnant women at booking in the University of Uyo Teaching Hospital, Uyo, Nigeria. BIOMED RESEARCH INTERNATIONAL 2014; 2014:849080. [PMID: 24982910 PMCID: PMC4055238 DOI: 10.1155/2014/849080] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 04/13/2014] [Accepted: 05/05/2014] [Indexed: 11/18/2022]
Abstract
Background. Anaemia with an estimated prevalence of 35–75% among pregnant women is a major cause of maternal deaths in Nigeria. Objective. To determine the prevalence of anaemia, associated sociodemographic factors and red cell morphological pattern among pregnant women during booking at the University Teaching Hospital, Uyo. Material and Methods. A cross-sectional analytical study of 400 women at the booking clinic over a 16-week period. The packed cell volume and red cell morphology of each pregnant woman were determined. Their biodata, obstetric and medical histories, and results of other routine investigations were obtained with questionnaires and analyzed with SPSS Package version 17.0. Results. The mean packed cell volume was 31.8% ±3.2 and 54.5% of the women were anaemic. The commonest blood picture was microcytic hypochromia and normocytic hypochromia suggesting iron deficiency anaemia. Anaemia was significantly and independently related to a history of fever in the index pregnancy (OR = 0.4; P = 0.00; 95% CI = 0.3–0.7), HIV positive status (OR = 0.2; P = 0.01; 95% CI = 0.1–0.6), and low social class (OR = 0.3; P = 0.00; 95% CI = 0.2–0.7). Conclusion. Women need to be economically empowered and every pregnant woman should be encouraged to obtain antenatal care, where haematinics supplementation can be given and appropriate investigations and treatment of causes of fever and management of HIV can be instituted.
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Ugwu EO, Dim CC, Uzochukwu BS, Iloghalu EI, Ugwu AO. Malaria and anaemia in pregnancy: a cross-sectional study of pregnant women in rural communities of Southeastern Nigeria. Int Health 2014; 6:130-7. [PMID: 24664630 DOI: 10.1093/inthealth/ihu009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Several strategies are used in the care of pregnant women accessing antenatal care in primary health centres in Nigeria, with the aim of reducing the burden of malaria and anaemia. The objective of the study was to appraise the prevalence of malaria parasitaemia and anaemia in pregnant women attending antenatal clinics in rural communities of Southeastern Nigeria where malaria preventive strategies are in place. METHODS We undertook a cross-sectional study of 300 pregnant women receiving antenatal care in randomly selected primary health centres in the Nkanu West local government area (LGA), Enugu state, Nigeria from August to September 2010. RESULTS The prevalence of malaria parasitaemia was 92.0% (276/300) (mild in 86.7% [260/300] and moderate in 15.3% [16/300]). The prevalence of anaemia was 49.3% (148/300) (mild in 29.3% [88/300] and moderate in 20% [60/300]). There were no severe cases of malaria parasitaemia or anaemia. The educational status and occupation of participants were significantly associated with the occurrence of peripheral parasitaemia and anaemia respectively (p<0.05). CONCLUSION The prevalence of malaria and anaemia is very high in the Nkanu West LGA of Enugu State, Nigeria. Efforts to reduce the prevalence of malaria parasitaemia and anaemia in pregnancy should be intensified in rural settings of Enugu state and Nigeria as a whole.
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Affiliation(s)
- Emmanuel O Ugwu
- Department of Obstetrics/Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Cyril C Dim
- Department of Obstetrics/Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Benjamin S Uzochukwu
- Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Emeka I Iloghalu
- Department of Obstetrics/Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Angela O Ugwu
- Department of Haematology/Immunology, University of Nigeria Teaching Hospital, Enugu, Nigeria
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