Determinants of Anemia in Pregnancy: Findings from the Ethiopian Health and Demographic Survey

Associations of Plasmodium and Intestinal Helminth Infections with Maternal Anemia and Adverse Pregnancy Outcomes in Northwest Ethiopia

Malaria and intestinal helminth infections are significant public health challenges in Ethiopia. However, little is known about the relationship of Plasmodium and intestinal helminth infections in pregnancy with maternal anemia and adverse pregnancy outcomes. A health-facility-based cross-sectional study was conducted among 526 parturients in northwest Ethiopia to investigate the associations of these parasitic infections with anemia and adverse pregnancy outcomes. Maternal and newborn profiles were collected using questionnaires and checklists. Maternal hematocrit was determined using the micro-hematocrit method. Malaria was diagnosed by microscopy, rapid diagnostic tests, and quantitative polymerase chain reaction, whereas intestinal parasites were detected microscopically using stool wet mount and Kato-Katz preparations. Among the women, 38.6% were anemic, and 36.5% had adverse pregnancy outcomes. Single infections of hookworm (adjusted odds ratio [aOR] = 3.11, 95% CI: 1.64-5.87) in pregnancy were associated with anemia at parturiency, whereas malaria single infections were associated with anemia (aOR = 4.28, 95% CI: 2.17-8.23) and adverse pregnancy outcomes (aOR = 2.94, 95% CI: 1.47-5.91). Moreover, intestinal helminth coinfections in pregnancy were associated with anemia (aOR = 13.3, 95% CI: 4.8-36.8), whereas malaria-helminth coinfections were associated with anemia (aOR = 7.47, 95% CI: 3.71-15.04) and adverse pregnancies (aOR = 4.75, 95% CI: 2.36-9.57). Overall, the study showed that Plasmodium and intestinal helminth infections in pregnancy are associated with anemia and adverse pregnancy outcomes. Thus, strengthening malaria and intestinal parasite infection prevention and control practices in pregnancy is warranted to alleviate the burden of anemia and adverse pregnancy outcomes.

Hotspot analysis of anaemia among pregnant women in Ethiopia: hotspot analysis of national demographic and health survey data

BACKGROUND

Anaemia is a significant global health problem, especially, in developing nations like Ethiopia. Despite increasing rates over the past two decades, there is limited research on the specific prevalence of anaemia among pregnant women in the country.

OBJECTIVE

To identify hotspot areas of anaemia-associated factors among pregnant women in Ethiopia.

STUDY DESIGN

Cross-sectional.

SETTING

Ethiopian demographic study from 2005 to 2016.

PARTICIPANTS

This study analysed 3350 pregnant women.

PRIMARY AND SECONDARY OUTCOME MEASURES

Hotspot area of anaemia among pregnant women, trend of anaemia and associated factors.

RESULTS

The prevalence of anaemia among pregnant women has shown significant fluctuations over the years. Between 2005 and 2011, there was a notable decrease from 30.9% to 21.5% while the prevalence increased from 21.5% in 2011 to 29.58% in 2016. The identified determinants of anaemia among pregnant women were female-headed household, belonging to the highest wealth quintile, being in the second or third trimester of pregnancy, being a working woman and residing in the Somalia region. Hotspot areas, where the prevalence of anaemia was particularly high, were identified in Somalia, Dire Dawa, Afar and Harari regions.

CONCLUSION

Anaemia during pregnancy is a major public health concern in Ethiopia, with a concerning increase between 2011 and 2016. Hotspot areas like Somali, Dire Dawa, Afar and Harari are particularly affected. Shockingly, nearly one in three pregnant women in Ethiopia suffer from anaemia. To address this issue effectively, targeted interventions prioritising economically disadvantaged households and pregnant women in their second and third trimesters are crucial. Monitoring spatial patterns and contributing factors is vital to develop tailored interventions and improve maternal health outcomes in these high-risk areas. By strategically targeting hotspot areas nationwide, significant progress can be made in reducing anaemia among pregnant women.

Persistence of a high prevalence of anemia in rural areas among pregnant women in Burkina Faso. A cross-sectional study

Despite WHO recommendations to reduce the global prevalence of anemia among women of reproductive age by 2025, anemia remains a truly global public health problem, especially among pregnant women. The objective of our study was to examine the relationship between anemia and the place of residence in pregnant women. This cross-sectional study was conducted in six health facilities between December 2018 and March 2019. Anemia was diagnosed using HemoCue HB 301 and a hemoglobin concentration <11 g/dl was classified as anemic. Adjusted logistic regression analysis was performed to examine relation between anemia and the place of residence in pregnant women. A total of 1027 pregnant women were included in the study. The average age of females was 25.79±6.02 years. The prevalence of anemia was 57.2% (585/1023). In logistic regression analysis adjusted for age, wealth, education and parity, women living in rural areas were more likely to be anemic compared to women living in urban areas (ORa=1.33; 95% CI [1.01-1,74]. Rural women are more likely to be anemic. Strategies to prevent anemia among pregnant women need to be strengthened in rural areas.

Anemia among pregnant women in Cambodia: A descriptive analysis of temporal and geospatial trends and logistic regression-based examination of factors associated with anemia in pregnant women

Anemia is a major public health problem for thirty-two million pregnant women worldwide. Anemia during pregnancy is a leading cause of child low birth weight, preterm birth, and perinatal/neonatal mortality. Pregnant women are at higher risk of anemia due to micronutrient deficiencies, hemoglobinopathies, infections, socio-demographic and behavioral factors. This study aimed to: 1) assess temporal and geospatial trends of anemia in Cambodia and 2) identify factors associated with anemia among pregnant women aged 15-49 years old in Cambodia. We analyzed data from the Cambodia Demographic and Health Survey (CDHS) for 2005, 2010, and 2014. Data were pooled across the three survey years for all pregnant women aged 15-49 years. Survey weights were applied to account for the complex survey design of the CDHS. Descriptive statistics were estimated for key sociodemographic characteristics of the study population. We used logistic regressions to assess factors associated with anemia among pregnant women aged 15-49 years old. Anemia in pregnant women aged 15-49 in Cambodia decreased from 56% in 2005 to 53% in 2014. With the highest in Preah Vihear and Stung Treng provinces (74.3%), in Kratie province (73%), and in Prey Veng (65.4%) in 2005, 2010, and 2014 respectively. Compared to pregnant women from the wealthiest households, women from poorest households were more likely to have anemia (AOR = 2.8; 95% CI: 1.6-4.9). Pregnant women from coastal regions were almost twice as likely of having anemia (AOR = 1.9; 95% CI: 1.2-3.0). Pregnant women were more likely anemic if they were in their 2nd trimester (AOR = 2.6; 95% CI: 1.9-3.6) or 3rd trimester (AOR = 1.6 95% CI: 1.1-2.3). Anemia remains highly prevalent among pregnant women in Cambodia. Public health interventions and policies to alleviate anemia should be prioritized and shaped to address these factors.

The Effect of Fresh Moringa Leaf Consumption During Pregnancy on Maternal Hemoglobin Level in Southern Ethiopia: Multilevel Analysis of a Comparative Cross-Sectional Study

Purpose

Anemia, especially iron-deficiency anemia during pregnancy, significantly impacts maternal health, fetal growth, and development. Moringa leaf is an iron-rich food that can overcome anemia, but there is a lack of evidence on the association between fresh moringa leaf consumption and maternal hemoglobin level during pregnancy. The aim of this study is to test the effect of fresh moringa leaf consumption during pregnancy on maternal hemoglobin levels in southern Ethiopia.

Methods

A community-based comparative cross-sectional study was conducted from May to June 2022 among 230 fresh moringa leaf consumers and 230 non-consumers pregnant women. Data were collected using an interviewer-administered structured questionnaire and hemoglobin level was determined by HemoCue Hb 301. Multivariate multilevel linear regression models were fitted using Statistical Software for Data Science (STATA) version 14.

Results

The overall mean hemoglobin level among pregnant women was 11.76 g/dl ± 1.47 [12.06 g/dl ± 1.22 among fresh moringa leaf consumers and 11.45 g/dl ± 1.64 among non-consumers] with a significant coefficient of association (β) of 0.90 g/dl [β = 0.90 g/dl, 95% CI: 0.54, 1.27]. A number of under-five children, bleeding during the current pregnancy, male-headed household, and current antenatal care visit were the individual-level factors. Distance from the nearest health facility and urban dweller was identified as the community-level factor associated with maternal hemoglobin level during pregnancy.

Conclusion

This study showed that the consumption of fresh moringa leaf during pregnancy increases the level of hemoglobin. So policymakers and maternal and child health program managers need to target moringa tree scale-up and encourage fresh moringa leaf consumption during pregnancy, but its use needs additional rigorous clinical trials. In addition to this, mark the above factors in their efforts to increase maternal hemoglobin levels during pregnancy.

Factors Affecting Anemia in Pregnancy Women in Ibeju-Lekki, Lagos State, Nigeria

Anemia progresses due to low red blood cells counts or hemoglobin. The World Health Organization (WHO) has suggested the condition to be a serious global public health problem that affects pregnant women worldwide. Anemic pregnant women may suffer post-partum hemorrhage, pre-term delivery, seizures, and severe cases of anemia that potentially lead to cardiac failure or death. However, it is pertinent for pregnant women and health service providers to have the adequate knowledge about the factors associated with anemia in pregnancy. Thus, this study assessed the factors associated with anemia in pregnancy women attending primary healthcare (PHC) centers in Ibeju-Lekki Local government area, Lagos state. This study employed descriptive cross-sectional design using multi-stage sampling method to recruit 295 pregnant women into the study. Data were collected using a semi-structured, self-administered questionnaire. The recruited participants (56.6%) were majorly in their third trimester, of which their mean age was 28.7 ± 5.9 years. About 80.7% of the participants were married, having a mean knowledge score of 6.6 ± 3.2. More than half of respondents (56.3%) were anemic and had a poor knowledge (50.5%) of anemia in pregnancy. The mean hemoglobin concentration within the population was 11.06 ± 0.73 g/dl with a range of 8.3 to 12.0. There was no significant association between the respondents' knowledge of anemia in pregnancy and anemic status (X² = 0.549; P = .45). However, this study observed a significant association between dietary diversity score and anemic status (X² = 8.66; P = .01) and the trimester status of respondents' first antenatal visit (X² = 9.603; P = .008). The study concluded that anemia in pregnancy was associated with maternal factors such as their first antenatal visit and the dietary diversity score. Due to this, proper education of pregnant women on anemia by health workers during antenatal clinics or visits should be prioritize to improve their anemia status.

Spatial distribution and trends of anemia among pregnant women in Ethiopia: EDHS 2005-2016

Background

Anemia is a public health problem affecting both developed and developing nations worldwide with a significant consequence on health and economic growth. The problem is more severe in pregnant women. Hence, the main purpose of this study was to determine the factors of anemia levels among pregnant women in zones in Ethiopia.

Methods

We utilized data from 2005, 2011, and 2016 Ethiopian demographic and health survey (EDHSs), a population-based cross-sectional study. The study includes 8,421 pregnant women. An ordinal logistic regression model with spatial analysis was used to explore factors of anemia levels among pregnant women.

Result

About 224 (2.7%), 1,442 (17.2%), and 1,327 (15.8%) pregnant women were mild, moderate, and severely anemic, respectively. The spatial autocorrelation of anemia among the administrative zones of Ethiopia for the three consecutive was not significant. The middle wealth index of 15.9% (OR = 0.841, CI: 0.72-0.983) and richest wealth index of 51% (OR = 0.49, CI: 0.409-0.586) were less likely anemic compared to the poorest wealth index, age group of mother 30-39 was 42.9% (OR = 0.571, CI: 0.359-0.908) times less likely to be moderate and above anemic compared to <20 years, several household members 4-6 were 51% (OR = 1.51, CI: 1.175-1.94 more likely moderate and above anemic compared to 1-3.

Conclusion

Over one-third of the pregnant women (34.5%) were anemic in Ethiopia. Wealth index, age group, religion, region, number of household members, source of drinking water, and EDHS were significant factors in anemia levels. The prevalence of anemia among pregnant women varied among Ethiopian administrative zones. North West Tigray, Waghimra, Oromia special woreda, West shewa, and East shewa were a high prevalence of anemia.

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

Background

Anemia in pregnancy is a serious threat to maternal and child health and is a major public health problem. However, the risk factors associated with its incidence are unclear and controversial.

Methods

PubMed, Ovid Embase, Web of Science, and Cochrane databases were systematically searched (inception to June 27, 2022). The screening of search results, extraction of relevant data, and evaluation of study quality were performed independently by two reviewers.

Results

A total of 51 studies of high quality (NOS score ≥ 7) were included, including 42 cross-sectional studies, six case-control studies, and three cohort studies. Meta-analysis showed that infected parasite, history of malarial attack, tea/coffee after meals, meal frequency ≤ 2 times per day, frequency of eating meat ≤ 1 time per week, frequency of eating vegetables ≤ 3 times per week, multiple pregnancies, multiparous, low household income, no antenatal care, rural residence, diet diversity score ≤ 3, have more than 3 children, history of menorrhagia, underweight, family size ≥ 5, middle upper arm circumference < 23, second trimester, third trimester, birth interval ≤ 2 year were all risk factors for anemia in pregnancy.

Conclusions

Prevention of anemia in pregnancy is essential to promote maternal and child health. Sufficient attention should be paid to the above risk factors from the social level and pregnant women's own aspects to reduce the occurrence of anemia in pregnancy.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier: CRD42022344937.

Determinants of anemia status among pregnant women in ethiopia: using 2016 ethiopian demographic and health survey data; application of ordinal logistic regression models

Background

Anemia is a serious public health problem that occurs when the blood contains fewer red blood cells than normal. In Ethiopia, the prevalence of anemia in pregnancy increased between 2005 and 2016. The aim of this study was to determine what factors influence the anemia status of pregnant women in Ethiopia.

Methods

Anemia status in a sample of 1053 pregnant women was studied using data from Ethiopia's Demographic and Health Survey 2016. Percentages and graphs were used to show the prevalence of anemia. The marginal probability effect was used to determine the contribution of each explanatory variable category to a single response category of anemia level. Ordinal logistic regression models were constructed, and the best-fitting model was selected to reveal significant anemia status variables.

Results

The prevalence of anemia in pregnant women was found to be 37.51% (3.04% severe, 17.28% moderate, and 17.1% mild anemic). The fitted partial proportional odds model revealed that anemia status of pregnant women was significantly associated with region afar (OR = 0.45; CI: 0.21–0.96), antenatal care visits above 4 (OR = 1.58; CI: 1.03–2.43), parity between 1–2 (OR = 0.47;CI: 0.26–0.85), iron taking (OR = 3.68;CI: 2.41–5.64), and higher education (OR = 4.75;CI: 2.29–9.85).

Conclusions

Anemia among pregnant women has been identified as a moderate public health issue in Ethiopia. The study revealed that the prevalence of anemia varied among regions which the highest (65.9%) and the lowest (9%) being from Somali and Addis Ababa, respectively. As a result, it is argued that treatments target iron consumption, maternal education, antenatal visits, and mothers' access to health care.

Prevalence and predictors of anemia among pregnant women in Ethiopia: Systematic review and meta-analysis

Background

In Ethiopia limited information is available regarding the prevalence and predictors of anemia in pregnancy. This systematic review and meta-analysis estimated the pooled prevalence of anemia among pregnant women in Ethiopia and also identified its predictors.

Materials and methods

The published primary studies were searched in the following electronic databases; PubMed/Medline, Google scholars, AJOL, and EMBASE. All primary studies published from 01/01/2010 to 30/05/2020 and written in English language were included without restriction on study setting and design. Critical appraisal of all available articles was done and extracted data was analyzed using STATA software version 14. The pooled prevalence of anemia was presented using a forest plot. The I2 statistical test for heterogeneity, and the Egger’s and Begg’s tests for publication bias were used. The relative risk was used to assess the association of predictor variables with anemia.

Result

After screening 274 articles, sixty studies were included in the analysis. The pooled prevalence of anemia among pregnant women was 26.4(95% CI: 23.1, 29.6). Sub-group analysis showed higher pooled prevalence from community-based studies than institutional-based studies. Factors that were protective against maternal anemia included urban residence, formal education and smaller family size. Short birth interval and not having antenatal care (ANC) are associated with a higher risk of maternal anemia. Women with low dietary diversity [RR: 2.61(95% CI, 1.85, 3.68)], mid-upper arm circumference (MUAC) less than 23 cm [RR: 2.35(95% CI, 1.53, 3.68)] and those not taking iron-folic acid [RR: 1.53(95% CI: 1.30, 1.81)] also had a higher risk of anemia.

Conclusion

Almost one in four pregnant women in Ethiopia had anemia. Being literate, living in urban areas with small family size and adequate birth spacing, as well as good dietary diversity are associated with a lower risk of anemia in pregnancy.

Registration number

(ID: CRD42020211054).

Prevalence and associated risk factors for anaemia amongst pregnant women attending three antenatal clinics in Eswatini

BACKGROUND

 Anaemia is a global health problem affecting about a third of the world's population. In pregnancy, it is a public health concern with consequences for mothers and infants, including maternal death and infant mortality. In low-income countries (LICs), 25% indirect maternal mortality and 30% neonatal deaths are due to anaemia in pregnancy.

AIM

 This study aimed to determine the prevalence and risks associated with anaemia amongst pregnant women attending antenatal clinic (ANC) in three health facilities in Eswatini.

SETTING

 This study was conducted in three health facilities in Eswatini, namely Mankayane, Raleigh Fitkin Memorial (RFM) and Mbabane Hospital.

METHODS

 This cross-sectional study used non-probability sampling in three hospitals of Eswatini, to select 550 pregnant women, aged 15-49 years. Data were collected from January to March 2021, using face-to-face interviews with a structured questionnaire. Logistic regression was used for statistical analysis.

RESULTS

 A total of 550 pregnant women were included in the study. Anaemia prevalence amongst pregnant women was 43.1% with mild, moderate and severe cases of 21.3%; 21.1% and 0.7%, respectively. Prevalence was high amongst women aged 15-19 years (53.3%). Factors associated with anaemia included living in urban areas (odds ratio [OR]: 1.8; confidence interval [CI]: 1.19-2.72), having anaemia 6 months before pregnancy (OR: 4.64; CI: 1.15-18.71), and gestational age at first ANC: third trimester (OR = 10.42; CI: 4.27-25.4) and second trimester (OR: 1.62; CI: 1.02-2.60).

CONCLUSION

 Anaemia remains prevalent amongst pregnant women in Eswatini. A comprehensive anaemia prevention programme would be justified and could lower the country's burden of anaemia.

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

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.

Comparative Analysis of Beet Juice and Red Guava Juice against Erythrocyte and Hematocrit Levels in Post-partum Women

BACKGROUND: Post-partum physiological bleeding can cause post-partum mothers to experience anemia; often, post-partum mothers are limited by nutrient and fluid intake to keep the body strong and have ideal body weight. AIM: The aim of the study is to knowing the difference between beet juice and Guava juice on erythrocyte and hematocrit (HTC) levels in post-partum mothers at Darul Imarah Health Center, Darul Imarah District, Aceh Besar District. METHODS: This was a quasi-experimental study with a pre-post test design using a randomized controlled trial. The population of post-partum mothers in the Darul Imarah Health Center, Darul Imarah District, Aceh Besar District. The sample selection is purposive sampling with inclusion and exclusion criteria; the sample is 45 people. RESULTS: The results showed differences in erythrocyte and HTC levels between before and after giving guava and iron (Fe) juices with a p-value of 0.00 <0.05. Beet juice increases the average erythrocytes and HTC levels higher than guava juice. There were significant differences in erythrocyte levels in the guava + Fe, beet + Fe, and control (Fe) treatment groups with a p-value of 0.001 <0.05. the difference in the average difference in erythrocyte levels between the guava and beet treatment groups was 0.03. The treatment group Bit + Fe had a higher mean erythrocyte level different than the guava + the treatment group and the control group (Fe). There was a significant difference in HTC levels in the guava + Fe, beet + Fe, and control (Fe) treatment groups with a p-value of 0.001 <0.05. the difference in the average difference in erythrocyte levels between the guava and beet treatment groups was 0.03. The treatment group Bit + Fe had a higher mean difference in HTC levels than the guava + the treatment group and the control group (Fe). CONCLUSION: There is a significant difference in erythrocytes and HTC levels between before and after giving guava juice and beet juice to post-partum mothers with a p-value of 0.00 <0.05. Beet juice increases the average level of erythrocytes and HTC, which is higher than guava juice in post-partum mothers at the Darul Imarah Health Center.

Barriers to Health Workers in Iron Deficiency Anemia Prevention among Indonesian Pregnant Women

Background

Anemia is a global maternal health problem that commonly occurs in developing countries. During pregnancy, a woman will receive antenatal services to check her condition and prevent complications. This study aimed to explore barriers towards achieving eradication of iron deficiency anemia among pregnant women in Aceh Besar District, Indonesia.

Methods

This qualitative study was conducted on 18 health workers who were recruited through a purposive sampling method. Data were collected through in-depth interviews using open-ended questions to gain insight about participants' experiences in managing iron deficiency anemia among pregnant women. Data analysis was conducted by an inductive content analysis method to evaluate, encode, and analyze the interview's result.

Result

Three main themes emerged: (1) facilities, infrastructures, and supplement support; (2) sociocultural factors; and (3) health provider competency deficits and no developing guidelines.

Conclusion

Our findings provide understanding that there are many obstacles and barriers encountered by health workers in iron deficiency anemia prevention management. Thus, the management of anemia must be supported by a skilled health worker and quality facilities. Health workers and pregnant women must work together to achieve optimal management of anemia prevention.