Anemia among Women Who Visit Bost Hospital for Delivery in Helmand Province, Afghanistan

Predictors of antenatal care services utilization by pregnant women in Afghanistan: Evidence from the Afghanistan Health Survey 2018

BACKGROUND

Poor utilization of maternal healthcare services remains a public health concern in most low and middle-income countries (LMICs), including Afghanistan. Late, inadequate, or no utilization of antenatal care (ANC) services pose a great concern.

OBJECTIVES

This study assessed the predictors of ANC service utilization among Afghan pregnant women, using secondary data from the Afghanistan Health Survey 2018 (AHS2018).

METHODS

In this study, we used data from 10,855 ever-married women, aged 13-49 years, who gave birth in the two years prior to the survey or those women who were currently pregnant. The outcome variable was defined as a binary variable on ANC utilization (≥1 ANC visit equals 1, and zero otherwise). We fitted a binary logistic regression model and examined the associations between ANC utilization and explanatory variables, providing findings based on univariate and multivariate analysis. STATA version 17 was employed for the data analysis.

RESULTS

Overall, 63.2%, 22.0%, and 3.1% of women had at least one ANC visit, ≥4 ANC visits, and ≥8 ANC visits during their last pregnancy, respectively. Higher odds of ANC utilization were observed in women who could read and write (AOR = 1.55, 95%CI: 1.36-1.77), whose husbands could read and write (AOR = 1.42, 95%CI: 1.29-1.56), who knew 1 sign (AOR = 1.93, 95%CI: 1.74-2.14), 2 signs (AOR = 2.43, 95%CI: 2.17-2.71) and ≥ 3 signs (AOR = 1.55, 95%CI: 1.36-1.77) of complicated pregnancy, and those with almost daily access to radio (AOR = 1.19, 95%CI: 1.08-1.327) and TV (AOR = 1.92, 95%CI: 1.73-2.13). We also found that women with one (AOR = 0.64, 95%CI: 0.49-0.84) and more than one (AOR = 0.60, 95%CI: 0.47-0.76) parity status, those for whom in-laws and others decided for their birthplace [(AOR = 0.85, 95%CI: 0.74-0.97) and (AOR = 0.63, 95%CI: 0.55-0.72), respectively], and those that resided in rural areas (AOR = 0.89, 95%CI: 0.79-1.00) had reduced odds of ANC utilization.

CONCLUSION

ANC service utilization is unacceptably low by pregnant women in Afghanistan. The predictors of ANC utilization identified by the study should be considered in the design of future interventions to enhance antenatal care utilization in Afghanistan.

Associations between nutritional deficiencies and food insecurity among adolescent girls: A cross-sectional study

There is a research gap in understanding the relationship between nutrient deficiency and food insecurity among adolescent girls in Afghanistan. The objective of this study was to investigate the associations between nutrient deficiencies and food insecurity among middle and high school-aged girls in Kabul. We conducted a cross-sectional study of 380 randomly selected 11-18-year-old girls attending public schools in grades 6-12. We assessed girls' food insecurity, food and nutrient intake, socioeconomic status, and physical activity. Nutrient consumption was calculated using Nutritionist IV software. Statistical analyses, including one-way analysis of variance, Chi-square tests, and t-tests, were used to assess the association between dietary intake and food insecurity. More than half (52.9%) of the participants were food insecure, with 35.8% experiencing hunger and 17.1% without hunger. Vitamin B3, C, selenium, and iron had the highest sensitivity, specificity, and accuracy and were the best indicators of food insecurity with and without hunger. The most prevalent nutrient deficiencies were vitamin B9 and E, calcium, magnesium, and zinc inadequacies. Food security was positively associated with fruit, vitamins E and K, dairy products (e.g., milk, yogurt, and cheese), meat products (e.g., chicken, meat, red meat, and egg), and nut intake. Our findings suggest that adolescent girls in Kabul may benefit from food programs that enrich nutrients such as B9 and E, calcium, magnesium, and zinc, which were found to be the most prevalent nutrient deficiencies. These findings highlight the importance of addressing food insecurity and nutrient deficiencies among adolescent girls in Afghanistan.

Contents of antenatal care services in Afghanistan: findings from the national health survey 2018

BACKGROUND

Maternal and newborn mortality is a public health concern in low- and middle-income countries (LMICs), including Afghanistan, where the evolving socio-political circumstances have added new complexities to healthcare service delivery. Birth outcomes for both pregnant women and their newborns are improved if women receive benefits of quality antenatal care (ANC).

OBJECTIVES

This study aimed to assess the contents of ANC services and identify predictors of utilization of services by pregnant women during ANC visits to health facilities in Afghanistan.

METHODS

In this cross-sectional study, we used data from the Afghanistan Health Survey 2018 (AHS2018). We included a total of 6,627 ever-married women, aged 14-49 years, who had given birth in the past 2 years or were pregnant at the time of survey and had consulted a health worker for ANC services in a health facility. The outcome was defined as 1-4 services and 5-8 services that a pregnant woman received during an ANC visit. The services were (i) taking a pregnant woman's blood pressure, (ii) weighing her, (iii) testing her blood, (iv) testing her urine, (v) providing advice on nutrition, (vi) advising about complicated pregnancy, (vii) advising about the availability of health services, and (viii) giving her at least one dose of Tetanus Toxoid (TT) vaccine. The binary outcome (1-4 services versus 5-8 services) was used in a multivariable logistic regression model.

RESULTS

Of all 6,627 women, 31.4% (2,083) received 5-8 services during ANC visits. Only 1.3% (86) received all 8 services, with 98.7% (6,541) receiving between 1 and 7 services, and 71.6% (4,745) women had their blood pressure measured during ANC visits. The likelihood (adOR = Adjusted Odds Ratio) of receiving 5-8 services was higher in women who could read and write (adOR = 1.33: 1.15-1.54), in women whose husbands could read and write (adOR = 1.14: 1.00-1.28), in primipara women (adOR = 1.42: 1.02-1.98), in women who knew one danger sign (adOR = 5.38: 4.50-6.45), those who knew 2 danger signs (adOR = 8.51: 7.12-10.19) and those who knew ≥ 3 danger signs (adOR = 13.19: 10.67-16.29) of complicated pregnancy, and in women who had almost daily access to TV (adOR = 1.16: 1.01-1.33). However, the likelihood of receiving 5-8 services was lower in women who used private clinics (adOR = 0.64: 0.55-0.74) and who received services from nurses (adOR = 0.27 (0.08-0.88).

CONCLUSION

Our findings have the potential to influence the design and implementation of ANC services of health interventions to improve the delivery of services to pregnant women during ANC visits.

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.

High rates of COVID-19 vaccine refusal among Afghan pregnant women: a cross sectional study

Severe Acute Respiratory Syndrome Corona Virus Type-2 (SARS-COV-2) was first detected in China and created a global pandemic rapidly. Subsequently after serious efforts different types of vaccines produced against the virus and recommended for all people including pregnant women. The aim of this study was to realize the willingness of pregnant women to accept the COVID-19 vaccine in Kabul Afghanistan. For this purpose, a cross-sectional study was conducted in gynecology wards of several hospitals in Kabul, Afghanistan from 10th of July to 20th of August 2021 through direct interview with the pregnant women who had come for prenatal care to the healthcare centers. The collected data were analyzed through Statistical Package for Social Studies (SPSS) version 25. Simple descriptive analysis computed for demographic characteristics and bi-variable (Chi-square) analysis was carried out to find out the associations of taking vaccine with demographic variables. A p-value of < 0.05 was considered significant at 95% confidence interval. A total of 491 who were completed the inclusion criteria included in the analysis. A small portion of pregnant women (8.6%) illustrated the intent to get the COVID-19 vaccine if it is recommended by the health authorities in Afghanistan. Our study found a high rate of COVID-19 vaccine refusal among pregnant women in Kabul, Afghanistan. They showed the concern on adverse effects of the vaccine as the main reason for refusal, emphasizing the need to reduce the misconception on vaccine efficacy and campaigns to enhance awareness on the vaccine safety and benefits for mothers and babies.

Anemia among pregnant women in internally displaced camps in Mogadishu, Somalia: a cross-sectional study on prevalence, severity and associated risk factors

BACKGROUND

Anemia in pregnancy is a serious global public health problem in most developing countries and a major cause of maternal morbidity and mortality. Somalia which already had very high maternal mortality ratio of 829 per 100,000 live births, pregnant women in internally displaced camps (IDPs) remain at most exposed. The aim of the study was to determine the prevalence, severity and associated risk factors of anemia among pregnant women in internally displaced camps in Mogadishu, Somalia.

METHODS

A community based cross-sectional study was conducted among 383 households in the most IDP settled districts in Mogadishu. Every pregnant mother in these sampled households who was voluntarily consented was targeted. A sample of blood was also taken by pricking the fingertip and inserted into hemoglobin meter. Those with Hb < 11 g/dl from hemoglobin meter had been taken another sample of 3 cc blood and put into EDTA tube for CBC analysis to identify the type of anemia. Data on risk factors were collected using structured pretested questionnaire via an interview. Collected data was coded and entered in SPSS- Version 22 for analysis. Descriptive analysis, bivariate chi-square and multivariate logistic regression were done.

RESULTS

The overall prevalence of anemia among study participants was 44.4% (95%CI: 39.5-49.3%), where severe and moderate anemia were 11.8 and 47.0% respectively. In addition all anaemic cases were microcytic hypochromic anemia. Young maternal age, low Family income, fewer/zero parity, being at third or second trimesters, lack of ANC attendance during pregnancy, lack of iron supplementation during pregnancy, taking tea immediately after meal during pregnancy, lower/zero frequency of daily meat and vegetables consumption during pregnancy were associated risk factors of anemia.

CONCLUSION

The anemia prevalence from this study was severe public health problem. Several factors were found to be associated with anemia during pregnancy. Measures has to be taken to curb the problem by including them mass iron supplementation and health education towards identified risk factors.

Factors Associated with Modern Contraceptive Use among Married Women Attending Comprehensive Health Centers (CHCs) in Kandahar, Afghanistan

Background

Modern contraceptives are highly effective and reliable methods of preventing unintended pregnancies and reducing maternal deaths. Only 22 percent of currently married women use modern methods of contraceptives in Afghanistan. This study assessed the factors associated with modern contraceptive use among married women attending comprehensive health centers (CHCs) in Kandahar Province.

Methods

This was an institution-based cross-sectional study that included 325 married women who attended randomly selected comprehensive health clinics in Kandahar between September and October 2019. The total sample size was allocated proportionally to selected health clinics based on the recent 3-month average patients load. We used a consecutive sampling method to select study participants. Data were collected in a structured questionnaire, which included information on respondents' demographic, socioeconomic, reproductive, and contraceptive experiences. Data was analyzed using SPSS 21.00 statistical software. We used descriptive statistics such as tables and proportions to present data. Binary and multiple logistic regression analyses were carried out to determine factors associated with modern contraceptive use.

Results

Out of 325 married women, 127 used modern contraceptives with a prevalence of 39.1% (95%CI = 33.7%–44.6%). The results indicated that the area of residence (AOR = 2.61, 95% CI 1.43-4.78) and ever use of contraceptives (AOR = 14.92, 95% CI 6.88-32.34) are associated with modern contraceptive use among married women attending comprehensive health centers in Kandahar.

Conclusion

This study found that modern contraceptive use was higher than reported on the national level. The most persistent factors associated with modern contraceptive use in this study were urban residence and ever use of contraceptives. As a policy measure, family planning programs should be prompted to the rural residency in Kandahar Province.