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Ebrahim M, Vadive PD, Dutton T, Anyasodor AE, Osuagwu UL, Bailey J. Retrospective audit compares screening and treatment of pregnancy-related anaemia in regional New South Wales with Australian guidelines. BMC Pregnancy Childbirth 2024; 24:457. [PMID: 38961376 PMCID: PMC11223411 DOI: 10.1186/s12884-024-06634-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 06/10/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Anaemia during pregnancy is common worldwide. In Australia, approximately 17% of non-pregnant women of reproductive age have anaemia, increasing to a rate of 25% in pregnant women. This study sought to determine the rate of screening for anaemia in pregnancy in regional New South Wales, and to determine whether screening and treatment protocols followed the recommended guidelines. METHODS This retrospective study reviewed antenatal and postnatal (48 h) data of women (n = 150) who had a live birth at Bathurst Hospital between 01/01/2020 and 30/04/2020. Demographic data, risk factors for anaemia in pregnancy, antenatal bloods, treatments provided in trimesters one (T1), two (T2) and three (T3), and postpartum complications were recorded. These were compared to the Australian Red Cross Guidelines (ARCG) using descriptive statistics. RESULTS Of the women with screening data available (n = 103), they were mostly aged 20-35yrs (79.6%), 23.3% were obese, 97.1% were iron deficient, 17% were anaemic and only a few (5.3%) completed the full pregnancy screening as recommended by the ARCG while a majority completed only partial screenings specifically Hb levels in T1 (56.7%), T2 (44.7%) and T3 (36.6%). Compliance to oral iron was largely undocumented, but constipation was a common side effect among the women. IV iron was administered in 14.0% of women, approximately 1.75x higher than the recommended rate. CONCLUSIONS This study provided useful information about compliance to screening and treatment guidelines for anaemia in pregnancy. We identified the need for improved documentation and communication between various health providers to ensure adequate antenatal care to prevent maternal complications during pregnancy. This will improve patient care and encourage further developments in maternal care, bridging the rural health gap.
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Affiliation(s)
- Mariam Ebrahim
- School of Medicine, Bathurst Rural Clinical School (BRCS), Western Sydney University, PO Box 9008, Bathurst, NSW, 2795, Australia
| | - Priya Dharshini Vadive
- School of Medicine, Bathurst Rural Clinical School (BRCS), Western Sydney University, PO Box 9008, Bathurst, NSW, 2795, Australia
| | - Tegan Dutton
- School of Medicine, Bathurst Rural Clinical School (BRCS), Western Sydney University, PO Box 9008, Bathurst, NSW, 2795, Australia
| | | | - Uchechukwu Levi Osuagwu
- School of Medicine, Bathurst Rural Clinical School (BRCS), Western Sydney University, PO Box 9008, Bathurst, NSW, 2795, Australia.
| | - Jannine Bailey
- School of Medicine, Bathurst Rural Clinical School (BRCS), Western Sydney University, PO Box 9008, Bathurst, NSW, 2795, Australia
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Jugha VT, Anchang JA, Sofeu-Feugaing DD, Taiwe GS, Kimbi HK, Anchang-Kimbi JK. Dietary micronutrients intake and its effect on haemoglobin levels of pregnant women for clinic visit in the Mount Cameroon health area: a cross-sectional study. Front Nutr 2024; 11:1341625. [PMID: 38774262 PMCID: PMC11106498 DOI: 10.3389/fnut.2024.1341625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/10/2024] [Indexed: 05/24/2024] Open
Abstract
Background Nutritional deficiencies and its consequences such as anaemia are frequent among pregnant women residing in under resource settings. Hence, this study sought to investigate specific dietary micronutrient inadequacy and its effect on maternal haemoglobin levels. Methods This institution based cross-sectional survey enrolled 1,014 consenting pregnant women consecutively. Data on socio-demographic, economic and antenatal characteristics were recorded using a structured questionnaire. Minimum dietary diversity for women (MDD-W) was assessed using the 24-h recall method and haemoglobin (Hb) concentration (g/dL) determined using a portable Hb metre. Significant levels between associations was set at p < 0.05. Results Among those enrolled, 40.9% were anaemic while 89.6% had inadequate dietary nutrient intake. In addition, uptake of blood supplements, haem iron, plant and animal-based foods rich in vitamin A were 71.5, 86.2, 35.5 and 12.6%, respectively. Moreover, anaemia prevalence was significantly (p < 0.05) lower in women who took iron-folic acid along with food groups rich in haem iron (38.5%) or both plant and animal vitamin A (29.0%). Besides, mean maternal Hb levels was significantly (p < 0.001) higher in women who consumed haem iron (11.08 ± 1.35) and vitamin A food groups (11.34 ± 1.30) when compared with their counterparts who did not consume haem iron (10.54 ± 1.19) and vitamin A food groups (10.74 ± 1.31). Conclusion Dietary uptake of foods rich in haem-iron and vitamin A significantly improves Hb levels in Cameroonian pregnant women. Our findings underscore the importance of improving maternal nutritional awareness and counselling during antenatal period to reduce the anaemia burden.
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Affiliation(s)
- Vanessa Tita Jugha
- Department of Animal Biology and Conservation, University of Buea, Buea, Cameroon
| | - Juliana Adjem Anchang
- International Centre for Agricultural Research in the Dry Areas, ICARDA, Cairo, Egypt
| | | | | | - Helen Kuokuo Kimbi
- Department of Animal Biology and Conservation, University of Buea, Buea, Cameroon
- Department of Biomedical Sciences, University of Bamenda, Bamenda, Cameroon
- Department of Microbiology and Immunology, College of Medicine, Drexel University, Philadelphia, PA, United States
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Alfalasi HA, Kausar S. Efficacy of Intravenous Iron Infusion in Gestational Iron Deficiency Anemia in Dubai, United Arab Emirates, During 2018-2019: A Retrospective Study. Cureus 2024; 16:e60185. [PMID: 38868236 PMCID: PMC11168021 DOI: 10.7759/cureus.60185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVE The objective is to investigate the effectiveness of intravenous (IV) iron infusion in increasing hemoglobin levels in gestational iron deficiency anemia (GIDA) patients in a tertiary-care hospital in Dubai emirate, United Arab Emirates (UAE). METHODS This is a retrospective cohort study of GIDA patients who were exposed to IV iron infusion supplementation. Study data of 40 cases aged 25-45 in a tertiary-care hospital in the UAE between 2018 and 2019 were analyzed. Variables accounted for were maternal age, age of gestation when IV iron was administered, and IV iron dose. RESULTS The average hemoglobin level before the intervention was 9 g/dL, and the average change after the intervention was 10.4 g/dL with a mean of 1.4 g/dL difference between before and after the intervention. CONCLUSION Supplementation of IV iron infusion in GIDA patients was seen to have increased the hemoglobin level after the intervention; however, the increase did not meet the recommended range of 12-16 g/dL.
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Affiliation(s)
| | - Shabana Kausar
- Obstetrics and Gynecology, Mediclinic City Hospital, Dubai, ARE
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4
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Yustus IM, Millanzi WC, Herman PZ. Prevalence, medication adherence, and determinants of type 2 diabetes mellitus during Coronavirus Disease 2019 pandemic among adults in Tanzania. SAGE Open Med 2024; 12:20503121241234222. [PMID: 38434796 PMCID: PMC10908235 DOI: 10.1177/20503121241234222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/16/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Excessive consumption of comfort foods, which are mostly high in carbs, and limitations on outdoor and gym-based physical activities, for instance, are associated with foods high in the glycemic index and raise the risk of obesity and type 2 diabetes. In pandemic and or epidemic situations, peoples' lifestyles may change significantly to lead them to non-communicable diseases. However, lifestyle changes and the occurrence of type 2 diabetes mellitus during the Coronavirus Disease 2019 pandemic among adults have not been well established in Tanzania. This study assessed the prevalence, medication adherence, and determinants of type 2 diabetes mellitus among adults in the country. Methods A community-based analytical cross-sectional study was conducted in Dodoma region, Tanzania between September and October 2020 of which 107 adults aged above 18 years were studied regardless of whether they were newly diagnosed with type 2 diabetes mellitus or not using a quantitative research approach. Interviewer-administered lifestyle habits and medication adherence structured questionnaires benchmarked from previous studies served as the main tools of data collection. The statistical package for social sciences computer program was used to analyze the data descriptively for frequencies and percentages and by regression analysis model to determine the association between variables with a 95% confidence interval and 5% significance level. Results With a mean age of 31 ± 2.527 years, 59.8% of the respondents were female. 60.7% and 11.7% of the respondents had unhealthy and moderate lifestyle choices respectively. The prevalence of type 2 diabetes mellitus accounted for 63.9% of the respondents of which 44.6% were diagnostically confirmed during the Coronavirus Disease 2019 pandemic against 19.3% of respondents who were diagnosed before the pandemic. Medication adherence among the type 2 diabetes mellitus respondents accounted for 77.9% of the study respondents. Type 2 diabetes mellitus was significantly associated with being in the 36-55 age group (AOR = 1.054; 95% CI: 0.292, 3.162; p < 0.05); being female (AOR = 1.398; 95% CI: 0.205, 3.048; p < 0.05); having a job (AOR = 2.597; 95% CI: 1.243, 4.402, p < 0.05); and having unhealthy lifestyle habits (AOR = 3.301; 95% CI: 1.199, 6.52; p < 0.05). Conclusion The majority of adults had type 2 diabetes mellitus of which most of them were confirmed to have the disease during the Coronavirus Disease 2019 pandemic. Few type 2 diabetes mellitus adults did not adhere to their medications as recommended. Their sociodemographic characteristics profiles and unhealthy lifestyles significantly led them to have the problem. The treatment of the disease above and health promotion activities may need to take unhealthy lifestyle choices and certain sociodemographic profiles of adults into consideration to assist in preventing the problem.
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Affiliation(s)
- Isaack M Yustus
- Department of Clinical Nursing, Kilwa Road Police Hospital, Dar es Salaam, United Republic of Tanzania
| | - Walter C Millanzi
- Department of Nursing Management and Education, The University of Dodoma, Dodoma, United Republic of Tanzania
| | - Patricia Z Herman
- Department of Nursing Management and Education, The University of Dodoma, Dodoma, United Republic of Tanzania
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Dande A, Pajai S, Gupta A, Dande S, Sethi N. Unraveling the Role of Maternal Serum Ferritin Levels in Preterm Delivery: A Comprehensive Review. Cureus 2024; 16:e54515. [PMID: 38516441 PMCID: PMC10955505 DOI: 10.7759/cureus.54515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/11/2024] [Indexed: 03/23/2024] Open
Abstract
Preterm delivery remains a critical global health concern, with numerous adverse consequences for both neonate and healthcare systems. Understanding the relationship between maternal ferritin levels, as a marker of iron status, and the risk of preterm birth is the focal point of this comprehensive review. We provide insights into the multifaceted nature of this connection, highlighting factors that influence maternal ferritin levels, including dietary intake, genetic and physiological variations, comorbidities, and iron supplementation. While evidence suggests an association between low maternal ferritin levels and preterm birth, causality remains elusive, necessitating further research with robust study designs. The potential mechanisms linking maternal iron status to preterm birth, such as inflammation, infection, and oxidative stress, are explored, underscoring the need for in-depth investigations. This comprehensive review emphasizes the clinical importance of assessing and monitoring maternal ferritin levels in prenatal care and advocates for public health initiatives to raise awareness and provide targeted interventions, particularly in high-risk populations. As we strive to address these unanswered questions and embark on innovative research directions, the aim is to ultimately enhance our understanding of the complex relationship between maternal iron status and preterm birth, leading to improved maternal and child health outcomes.
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Affiliation(s)
- Anubha Dande
- Obstetrics and Genecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Sandhya Pajai
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Aishwarya Gupta
- Obstetrics and Genecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Seema Dande
- Obstetrics and Genecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Neha Sethi
- Obstetrics and Genecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Babah OA, Akinajo OR, Beňová L, Hanson C, Abioye AI, Adaramoye VO, Adeyemo TA, Balogun MR, Banke-Thomas A, Galadanci HS, Sam-Agudu NA, Afolabi BB, Larsson EC. Prevalence of and risk factors for iron deficiency among pregnant women with moderate or severe anaemia in Nigeria: a cross-sectional study. BMC Pregnancy Childbirth 2024; 24:39. [PMID: 38182997 PMCID: PMC10768359 DOI: 10.1186/s12884-023-06169-1] [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: 04/29/2023] [Accepted: 12/03/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Anaemia during pregnancy causes adverse outcomes to the woman and the foetus, including anaemic heart failure, prematurity, and intrauterine growth restriction. Iron deficiency anaemia (IDA) is the leading cause of anaemia and oral iron supplementation during pregnancy is widely recommended. However, little focus is directed to dietary intake. This study estimates the contribution of IDA among pregnant women and examines its risk factors (including dietary) in those with moderate or severe IDA in Lagos and Kano states, Nigeria. METHODS In this cross-sectional study, 11,582 women were screened for anaemia at 20-32 weeks gestation. The 872 who had moderate or severe anaemia (haemoglobin concentration < 10 g/dL) were included in this study. Iron deficiency was defined as serum ferritin level < 30 ng/mL. We described the sociodemographic and obstetric characteristics of the sample and their self-report of consumption of common food items. We conducted bivariate and multivariable logistic regression analysis to identify risk factors associated with IDA. RESULTS Iron deficiency was observed among 41% (95%CI: 38 - 45) of women with moderate or severe anaemia and the prevalence increased with gestational age. The odds for IDA reduces from aOR: 0.36 (95%CI: 0.13 - 0.98) among pregnant women who consume green leafy vegetables every 2-3 weeks, to 0.26 (95%CI: 0.09 - 0.73) among daily consumers, compared to those who do not eat it. Daily consumption of edible kaolin clay was associated with increased odds of having IDA compared to non-consumption, aOR 9.13 (95%CI: 3.27 - 25.48). Consumption of soybeans three to four times a week was associated with higher odds of IDA compared to non-consumption, aOR: 1.78 (95%CI: 1.12 - 2.82). CONCLUSION About 4 in 10 women with moderate or severe anaemia during pregnancy had IDA. Our study provides evidence for the protective effect of green leafy vegetables against IDA while self-reported consumption of edible kaolin clay and soybeans appeared to increase the odds of having IDA during pregnancy. Health education on diet during pregnancy needs to be strengthened since this could potentially increase awareness and change behaviours that could reduce IDA among pregnant women with moderate or severe anaemia in Nigeria and other countries.
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Affiliation(s)
- Ochuwa Adiketu Babah
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Opeyemi Rebecca Akinajo
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ajibola Ibraheem Abioye
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Victoria Olawunmi Adaramoye
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Titilope A Adeyemo
- Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Department of Haematology and Blood Transfusion, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Mobolanle Rasheedat Balogun
- Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Department of Community Health, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Aduragbemi Banke-Thomas
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Global Maternal and Newborn Health Hub, Institute of Lifecourse Development, University of Greenwich, London, UK
| | - Hadiza S Galadanci
- African Center of Excellence for Population Health and Policy, Bayero University, Kano, Nigeria
- Department of Obstetrics and Gynaecology, College of Health Sciences Bayero University Kano/ Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Bosede Bukola Afolabi
- Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Elin C Larsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Sharma S, Smitha M, Balakrishnan D. Telephonic intervention to combat non-adherence to oral iron-folic acid supplementation in pregnancy: A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol X 2023; 20:100235. [PMID: 37736306 PMCID: PMC10509657 DOI: 10.1016/j.eurox.2023.100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/16/2023] [Accepted: 09/02/2023] [Indexed: 09/23/2023] Open
Abstract
Introduction Iron deficiency anemia is a public health problem globally attributing to high incidences of maternal and infant mortality and morbidity. Iron and folic acid supplementation (IFAS) is essential and provided free of cost by the public health sectors, however, a systematic review shows that the national-level adherence to oral Iron-Folic Acid Supplementation (IFAS) is less than half in pregnant women, and the significant obstacles to non-adherence are fear of side effects and forgetfulness. This trial was designed to mitigate the side effects and tackle forgetfulness with telephonic intervention. The objectives were to investigate the effectiveness of the telephonic intervention on oral IFAS adherence and hemoglobin and the reasons for non-adherence to oral IFAS, to find out the proportion of anemia in the study population, and to assess the effectiveness of the intervention on maternal and neonatal outcomes. Methods Hospital-based open-label multi-centric parallel-group randomized controlled trial, used block randomization and allocated treatment in a 1:1 ratio recruited 286 anemic pregnant women between 14 and 24 weeks of gestation with hemoglobin level < 11 g/dl having smartphones at a secondary hospital and a tertiary hospital in Eastern India. The experimental group received telephonic intervention for one month via structured text reminders, WhatsApp audio messages, and phone calls. The standard course of treatment was given to the control group. Results 286 women (n1 =143, n2 =143) were randomized, 36 had attrition leaving 250 for analysis (n1 =123, n2 =127), the experimental group experienced a 44.9 % and the control group 13.8 % increase in adherence (P < 0.001). The leading reasons for non-adherence were forgetfulness (24 %), nausea and vomiting (23.2 %), and constipation (18.8 %). Hemoglobin level increased by 0.8 g/dl (P < 0.001) in the experimental group and 0.2 g/dl (P < 0.807) in the control group. Conclusion In addition to improving adherence to oral IFAS, telephonic intervention mitigates side effects and enhances hemoglobin in anemic pregnant women. The increase in adherence was threefold in the experimental group compared to a marginal rise in the control group. This study recommends the implementation of a telephonic intervention to promote adherence to oral IFAS among anemic pregnant women.
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Affiliation(s)
- Sakshi Sharma
- College of Nursing, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019, India
- All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh 273008, India
| | - M.V. Smitha
- College of Nursing, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019, India
| | - Deepthy Balakrishnan
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019, India
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Effectiveness of Dietary Interventions in Prevention and Treatment of Iron-Deficiency Anemia in Pregnant Women: A Systematic Review of Randomized Controlled Trials. Nutrients 2022; 14:nu14153023. [PMID: 35893877 PMCID: PMC9332092 DOI: 10.3390/nu14153023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 02/01/2023] Open
Abstract
Pregnant women are among the population groups most vulnerable to the development of anemia, as the overall iron requirement during pregnancy is significantly higher than in non-pregnant women. The aim of the systematic review was to assess the effectiveness of dietary interventions in the prevention and treatment of iron-deficiency anemia in pregnant women based on randomized-controlled trials. The systematic review was based on the PRISMA guidelines and is registered in the PROSPERO database (CRD42021261235). The search was conducted within PubMed and Web of Science databases for the period until June 2021. The included randomized controlled trials presented effectiveness of dietary interventions in prevention and treatment of iron-deficiency anemia in pregnant women. From the total number of 7825 screened records, the final number of seven studies were included in the systematic review. The procedure of screening, inclusion, reporting, and assessment of the risk of bias while using the revised Cochrane risk of bias tool for randomized trials was conducted by two independent researchers. The studies included in the systematic review were conducted in populations of anemic pregnant women, or mixed populations of anemic and non-anemic pregnant women. The interventions described within the studies were associated with including fortified products, regular products, or dietary counselling. They were based on providing an increased amount of iron, providing an increased amount of multiple nutrients, or general counselling only, while effectiveness was compared with effectiveness of the placebo, supplementation, or control group. The study duration was diversified from a few weeks to half a year or longer. The major biochemical measure assessed within the included studies was hemoglobin. All applied dietary interventions, based on providing increased amount of iron, providing increased amount of multiple nutrients, or general counselling only, were effective. The majority of included studies were assessed as ones of a medium risk of bias. For some studies a high risk of bias was indicated, which resulted from a risk of bias arising from the randomization process, due to deviations from the intended interventions, and in selection of the reported result. Considering this fact, more randomized controlled trials should be planned and conducted in a rigorous manner to confirm the formulated observations of effectiveness of the studied interventions based on providing an increased amount of iron, providing an increased amount of multiple nutrients, or general counselling only.
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Xu S, Zheng H, Tang Z, Gu Z, Wang M, Tang C, Xie Y, Kong M, Jing J, Su Y, Zhu Y. Antenatal Iron-Rich Food Intervention Prevents Iron-Deficiency Anemia but Does Not Affect Serum Hepcidin in Pregnant Women. J Nutr 2022; 152:1450-1458. [PMID: 35285912 DOI: 10.1093/jn/nxac065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/29/2021] [Accepted: 03/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Limited evidence supports the efficacy of iron-rich foods (IRFs) in improving iron status during pregnancy. OBJECTIVES The study aims to evaluate the effect of IRFs on iron status and biomarkers of iron metabolism in the third trimester of pregnancy. METHODS A total of 240 pregnant women at 11-13 wk of gestation without iron-deficiency anemia (IDA) in South China were recruited to this single-blind clinical trial [non-IDA referred to both hemoglobin (Hb) ≥110g/L and serum ferritin (SF) ≥15ng/mL], randomly assigned to 1) control, 2) IRFs containing 20 mg iron/d (IRF-20), or 3) IRFs containing 40 mg iron/d (IRF-40). The IRFs were consumed 3 days a week, including pork liver, chicken/duck blood, soybean, and agaric. The IRFs started at recruitment and ended in the predelivery room. Primary outcome included anemia (Hb <110 g/L), iron deficiency (ID, definition 1: SF <15 ng/mL; definition 2: SF <12 ng/mL), and IDA (ID and Hb <110 g/L). Secondary outcome was plasma Hb and iron indices, including SF, serum hepcidin, and iron. RESULTS All participants who completed the trial with full data (n = 170) were included in the analysis. At the endline, both intervention groups showed lower ID and IDA rates than control. Specifically, IRF-40 showed a lower ID (SF <12 ng/mL) rate than control (9.0% compared with 22.8%, P = 0.022). For IDA by definition 1, the incidence in IRF-40 was lower than that in control (1.9% compared with 8.9%, P = 0.045). For IDA by definition 2, the incidence in IRF-20 was lower than that in control (3.9% compared with 17.9%, P = 0.049). Moreover, IRF-20 showed higher SF concentrations than control (P = 0.039). No effects of IRFs on anemia (P = 0.856), plasma Hb (P = 0.697), serum hepcidin (P = 0.311), and iron (P = 0.253) concentrations were observed. The assessed iron intakes were 22.2 mg/d in IRF-20 and 25.0 mg/d in IRF-40, respectively. CONCLUSIONS Antenatal IRFs reduce the risk of ID and IDA in late pregnancy, although the present results are inadequate to confirm an ideal dosage (No. ChiCTR1800017574).
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Affiliation(s)
- Suhua Xu
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Hao Zheng
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhaoxie Tang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhuohe Gu
- Maoming Maternal and Child Health Care Hospital, Maoming, China
| | - Min Wang
- Maoming Maternal and Child Health Care Hospital, Maoming, China
| | - Cuilan Tang
- Maoming Maternal and Child Health Care Hospital, Maoming, China
| | - Yanqi Xie
- Maoming Maternal and Child Health Care Hospital, Maoming, China
| | - Minli Kong
- Maoming Maternal and Child Health Care Hospital, Maoming, China
| | - Jiajia Jing
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yanbin Su
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yanna Zhu
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Department of Maternal and Child Health, and Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Ajong AB, Kenfack B, Ali IM, Yakum MN, Onydinma UP, Mangala FN, Aljerf L, Telefo PB. Ionised and total hypocalcaemia in pregnancy: An analysis of prevalence and risk factors in a resource-limited setting, Cameroon. PLoS One 2022; 17:e0268643. [PMID: 35584129 PMCID: PMC9116680 DOI: 10.1371/journal.pone.0268643] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 05/04/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Hypocalcaemia remains a prevalent laboratory finding in pregnancy, capable of inducing adverse maternofoetal outcomes. This study compares the prevalence of hypocalcaemia in apparently healthy pregnant women from the ionised, and total calcaemia viewpoints and further identifies factors associated with total crude and ionised hypocalcaemia in pregnancy. Methods A hospital-based cross-sectional study was conducted between November 2020 and September 2021, targeting apparently healthy pregnant women received in late pregnancy in four maternities in the Nkongsamba Health District, Cameroon. Blood samples were collected and analysed for serum ionised calcium concentrations and pH (by ion-selective electrode potentiometry), and for total calcium and albumin concentration (by atomic absorption spectrophotometry). Sociodemographic, obstetric and nutritional data were collected using an interviewer-administered questionnaire. Results The average age of the 1074 participants included in the study was 28.20±6.08 years. The prevalence of total crude and total albumin-corrected hypocalcaemia in this study was 61.64 [58.69–64.50]% and 56.70 [53.72–59.64]%, respectively (p-value = 0.000). The prevalence of ionised hypocalcaemia was very low (2.89 [2.04–4.07]%) compared with the prevalence of total hypocalcaemia (p-value = 0.000). Monthly income below 100.000FCFA (179 USD) (AOR = 0.73, p-value = 0.024), taking more than 2 meals daily (AOR = 0.68, p-value = 0.006) and taking desserts (AOR = 0.73, p-value = 0.046) reduced the odds of total crude hypocalcaemia, while having banana/plantain and tubers as the content of their most consumed meal significantly increased the odds of total crude hypocalcaemia (AOR = 1.37, p-value = 0.012). Single women (AOR = 2.54, p-value = 0.021), with a higher education (AOR = 3.27, p-value = 0.017), who initiated antenatal care before 4 months (AOR = 2.47, p-value = 0.029), had their odds of ionised hypocalcaemia significantly increased. On the other hand, women below 30 years (AOR = 0.44, p-value = 0.039), with occupations other than housewife (AOR = 0.34, p-value = 0.027), and women who took desserts between meals (AOR = 0.45, p-value = 0.034) had their odds of ionised hypocalcaemia significantly reduced. Taking calcium supplements simultaneously with other supplements also significantly reduced the odds of total hypocalcaemia in pregnancy (OR = 0.69, p-value = 0.027). Conclusion Ionised hypocalcaemia in pregnancy is a rare finding. Only 2.89% of all apparently healthy pregnant women have ionised hypocalcaemia in late pregnancy, while 56.70% have total hypocalcaemia. Factors like the daily number of meals, taking of desserts, the content of the most consumed meal and monthly revenue significantly affect the prevalence of total hypocalcaemia in pregnancy. On the other hand, factors like age above 30 years, having a higher education, being single, having initiated antenatal care before 4 months of pregnancy, being a housewife and not taking desserts between meals have a significantly positive association with ionised hypocalcaemia.
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Affiliation(s)
- Atem Bethel Ajong
- Kekem District Hospital, Kekem, West Region, Cameroon
- Department of Biochemistry, University of Dschang, Dschang, West Region, Cameroon
- * E-mail: (ABA); (PBT)
| | - Bruno Kenfack
- Department of Obstetrics / Gynaecology and Maternal Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, West Region, Cameroon
| | - Innocent Mbulli Ali
- Department of Biochemistry, University of Dschang, Dschang, West Region, Cameroon
| | - Martin Ndinakie Yakum
- Department of Epidemiology and Biostatistics, School of Medical and Health Sciences, Kesmonds International University, Bamenda, Cameroon
| | | | - Fulbert Nkwele Mangala
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Maternity Unit, Nkongsamba Regional Hospital, Nkongsamba, Littoral Region, Cameroon
| | - Loai Aljerf
- Department of Basic Sciences, Faculty of Dentistry, Damascus University, Damascus, The Syrian Arab Republic
- Key Laboratory of Organic Industries, Department of Chemistry, Faculty of Sciences, Damascus University, Damascus, The Syrian Arab Republic
| | - Phelix Bruno Telefo
- Department of Biochemistry, University of Dschang, Dschang, West Region, Cameroon
- * E-mail: (ABA); (PBT)
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Ameyaw EK, Njue C, Amoah RM, Appiah F, Baatiema L, Ahinkorah BO, Seidu AA, Ganle JK, Yaya S. Is improvement in indicators of women's empowerment associated with uptake of WHO recommended IPTp-SP levels in sub-Saharan Africa? A multilevel approach. BMJ Open 2021; 11:e047606. [PMID: 34716158 PMCID: PMC8559097 DOI: 10.1136/bmjopen-2020-047606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The global burden of malaria has reduced considerably; however, malaria in pregnancy remains a major public health problem in sub-Saharan Africa (SSA), where about 32 million pregnant women are at risk of acquiring malaria. The WHO has recommended that pregnant women in high malaria transmission locations, including SSA, have intermittent preventive treatment of malaria during pregnancy with at least three doses of sulphadoxine-pyrimethamine (IPTp-SP). Therefore, we investigated the prevalence of IPTp-SP uptake and associated individual-level, community-level and country-level predictors in SSA. DESIGN A cross-sectional survey was conducted using recent Demographic and Health Surveys datasets of 20 SSA countries. A total of 96 765 women were included. Optimum uptake of IPTp-SP at most recent pregnancy was the outcome variable. We fitted three-level multilevel models: individual, community and country parameters at 95% credible interval. RESULTS In all, 29.2% of the women had optimal IPTp-SP uptake ranging from 55.1% (in Zambia) to 6.9% (in Gambia). The study revealed a high likelihood of optimum IPTp-SP uptake among women with high knowledge (aOR=1.298, Crl 1.206 to 1.398) relative to women with low knowledge. Women in upper-middle-income countries were more than three times likely to have at least three IPTp-SP doses compared with those in low-income countries (aOR=3.268, Crl 2.392 to 4.098). We found that community (σ2=1.999, Crl 1.088 to 2.231) and country (σ2=1.853, Crl 1.213 to 2.831) level variations exist in optimal uptake of IPTp-SP. According to the intracluster correlation, 53.9% and 25.9% of the variation in optimum IPTp-SP uptake are correspondingly attributable to community-level and country-level factors. CONCLUSIONS The outcome of our study suggests that low-income SSA countries should increase budgetary allocation to maternal health, particularly for IPTp-SP interventions. IPTp-SP advocacy behavioural change communication strategies must focus on women with low knowledge, rural dwellers, married women and those who do not meet the minimum of eight antenatal care visits.
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Affiliation(s)
- Edward Kwabena Ameyaw
- Faculty of Health, The Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Carolyne Njue
- Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | | | - Francis Appiah
- Department of Social Sciences, Berekum College of Education, Berekum, Ghana
| | - Linus Baatiema
- Department of Population and Health, Faculty of Social Sciences, University of Cape Coast, Cape Coast, Central, Ghana
| | - Bright Opoku Ahinkorah
- Faculty of Health, The Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, Faculty of Social Sciences, University of Cape Coast, Cape Coast, Central, Ghana
| | - John Kuumuori Ganle
- Department of Population, Family and Reproductive Health, University of Ghana, Legon, Ghana
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Apte A, Kapoor M, Naik S, Lubree H, Khamkar P, Singh D, Agarwal D, Roy S, Kawade A, Juvekar S, Banerjee R, Bavdekar A. Efficacy of transdermal delivery of liposomal micronutrients through body oil massage on neurodevelopmental and micronutrient deficiency status in infants: results of a randomized placebo-controlled clinical trial. BMC Nutr 2021; 7:48. [PMID: 34493339 PMCID: PMC8524365 DOI: 10.1186/s40795-021-00458-8] [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: 04/05/2021] [Accepted: 07/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Micronutrient deficiency is a known cause of adverse neurodevelopment and growth. Poor adherence to oral regimes of micronutrient supplements is a known challenge during the implementation of supplementation programs. The present study evaluates the benefits of liposomal encapsulated micronutrient fortified body oils (LMF oil) that can be used for infant body massage in terms of neurodevelopment and prevention of deficiency. STUDY DESIGN Double-blind randomized clinical trial. METHODS A total of 444 healthy infants aged 4-7 weeks were randomized to receive either LMF oil (containing iron, vitamin D, folate, and vitamin B12) or placebo oil for gentle body massage till 12 months of age. Blood samples were collected at 6 and 12 months for transferrin saturation (TSAT), hemoglobin, and 25-hydroxy vitamin (25-OH-D) levels. Mental and motor development was assessed at 12 months using developmental assessment for Indian Infants (DASII). RESULTS A total of 391 infants completed the study. There was no significant improvement in the hemoglobin in the intervention group at 12 months of age as compared to the placebo group [- 0.50 vs.-0.54 g%]. There was a marginally significant improvement in 25-OH-D at 12 months in the LMF oil group [+ 1.46vs.-0.18 ng/ml, p = 0.049]. In the subgroup of infants with moderate anemia, the intervention prevented the decline in hemoglobin at 12 months of age [adjusted mean change + 0.11vs.-0.51 g%, p = 0.043]. The mental or motor developmental quotients in the intervention group were not significantly different from those in the placebo group. CONCLUSION Use of LMF oil for prevention of nutritional deficiency did not offer significant protection against nutritional anemia but prevented vitamin D deficiency to some extent with improvement in 25-OH-D at 12 months. In the subgroup of infants with moderate anemia, the intervention prevented the decline in hemoglobin at 12 months of age. The intervention did not result in significant improvement in mental or motor development. Further evaluation with increased doses needs to be undertaken. TRIAL REGISTRATION CTRI no: CTRI/2017/11/010710 ; dated 30/11/2017.
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Affiliation(s)
- Aditi Apte
- Department of Biosciences and Bioengineering, Nanomedicine Laboratory, Indian Institute of Technology Bombay, Powai, Mumbai, India. .,PRERNA Young Scientist, KEM Hospital Research Centre, Pune, India.
| | - Mudra Kapoor
- Department of Biosciences and Bioengineering, Nanomedicine Laboratory, Indian Institute of Technology Bombay, Powai, Mumbai, India
| | | | - Himangi Lubree
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Pooja Khamkar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Diksha Singh
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Dhiraj Agarwal
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Sudipto Roy
- PRERNA Young Scientist, KEM Hospital Research Centre, Pune, India
| | - Anand Kawade
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Rinti Banerjee
- Department of Biosciences and Bioengineering, Nanomedicine Laboratory, Indian Institute of Technology Bombay, Powai, Mumbai, India
| | - Ashish Bavdekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
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Moshi FV, Millanzi WC, Mwampagatwa I. Factors Associated With Uptake of Iron Supplement During Pregnancy Among Women of Reproductive Age in Tanzania: an Analysis of Data From the 2015 to 2016 Tanzania Demographic and Health Survey and Malaria Indicators Survey. Front Public Health 2021; 9:604058. [PMID: 34336749 PMCID: PMC8316680 DOI: 10.3389/fpubh.2021.604058] [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: 09/08/2020] [Accepted: 05/25/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Pregnant women are vulnerable to iron deficiency due to the fact that more iron is needed primarily to supply the growing fetus and placenta and to increase the maternal red cell mass. Little is known on the factors associated with uptake of iron supplement during pregnancy. Methods: The study used data from the 2015 to 2016 Tanzania Demographic and Health Survey and Malaria Indicators Survey. A total of 6,924 women of active reproductive age from 15 to 49 were included in the analysis. Both univariate and multiple regression analyses were used to determine factors associated with uptake of iron supplement during pregnancy. Results: Majority of the interviewed women 5,648 (81.6%) always took iron supplement during pregnancy, while a total of 1,276 (18.4%) women never took iron supplement during pregnancy. After controlling for confounders, the predictors for uptake of iron supplement during pregnancy were early antenatal booking (adjusted odds ratio, AOR = 1.603 at 95% CI = 1.362–1.887, p < 0.001); rural residence (AOR = 0.711 at 95% CI = 0.159–0.526, p = 0.007); wealth index [rich (AOR = 1.188 at 95% CI = 0.986–1.432, p = 0.07)]—poor was the reference population; level of education [primary education (AOR = 1.187 at 95% CI = 1.013–1.391, p = 0.034)]—no formal education was the reference population; parity [para 2 to 4 (AOR = 0.807 at 95% CI = 0.668–0.974, p = 0.026), para 5 and above (AOR = 0.75 at 95% CI = 0.592–0.95, p = 0.017)], para 1 was the reference population; zones [mainland rural (AOR = 0.593 at 95% CI = 0.389–0.905, p = 0.015) and Unguja Island AOR = 0.63 at 95% CI = 0.431–0.92, p = 0.017]—mainland urban was the reference population; and current working status [working (AOR = 0.807 at 95% CI = 0.687–0.949, p = 0.009)]. Conclusion: The study revealed that, despite free access to iron supplement during pregnancy, there are women who fail to access the supplement at least once throughout the pregnancy. The likelihood to fail to access iron supplement during pregnancy was common among pregnant women who initiated antenatal visits late, were from poor families, had no formal education, reside in rural settings, had high parity, were from mainland rural, and were in working status. Interventional studies are recommended in order to come up with effective strategies to increase the uptake of iron supplement during pregnancy.
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Affiliation(s)
- Fabiola Vincent Moshi
- Department of Nursing Management and Education, School of Nursing and Public Health, University of Dodoma, Dodoma, Tanzania
| | - Walter C Millanzi
- Department of Nursing Management and Education, School of Nursing and Public Health, University of Dodoma, Dodoma, Tanzania
| | - Ipyana Mwampagatwa
- Department of Obstetric and Gynecology, School of Medicine and Dentistry, University of Dodoma, Dodoma, Tanzania
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Mishra A, Marwah S, Divedi P, Dewan R, Ahluwalia H. A Cross-Sectional Study of Barriers in Prevention of Anemia in Pregnancy. Cureus 2021; 13:e12802. [PMID: 33628671 PMCID: PMC7894214 DOI: 10.7759/cureus.12802] [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] [Indexed: 11/05/2022] Open
Abstract
Introduction Anemia in pregnancy is a significant health challenge in India and other developing countries. Various health programs aiming anemia prevention are existing in India for many decades. Despite that, anemia affects more than half of pregnant women. Our objective for performing this study was to evaluate the barriers in the prevention of anemia and to evaluate the perceptions and practices of anemic women towards their condition. Methods A cross-sectional questionnaire-based study, including 210 anemic women, was conducted in a tertiary care center in Delhi, India. In-depth interviews were conducted with 50 participants. Results Our important observations were that anemia was more prevalent in multigravida, and 43.80% of anemic patients were not taking iron supplements at the time of diagnosis. Chronic diseases were associated with 28.2% (n=59) of anemic women. Only 19% (n=40) of women sought antenatal care in the first and second trimester; the rest all booked themselves in the third trimester only. Twenty-two percent (n=48) of women reached our hospital after 36 weeks. Ignorance to anemia symptoms and the importance of consistent intake of the oral iron supplements was seen in 35.2% (n=74). One hundred and sixty-five (74.8%) women accepted that healthcare provider had informed them about iron-rich and high protein diet, but only 47.1% (n=98) actually made dietary modifications. Only 9.5% (n=20) of women were consistent in iron intake. Side effects of iron were reported by 30% (n=64) of women, and 15% (n=32) were intolerant to oral iron. Non-availability, change of residence, and forgetfulness were the main reasons behind non-compliance to oral iron. Conclusion We emphasize motivation for early registration, regular antenatal care, adequate iron supplement supply, and persistent counseling to ensure compliance to iron supplements by the antenatal care provider. Behavior-changing communication is needed at a societal level for antenatal mothers and their families aiming to prevent anemia in pregnancy instead of focussing on treatment.
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Affiliation(s)
- Archana Mishra
- Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Sheeba Marwah
- Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Pragati Divedi
- Department of Obstetrics and Gynecology, Rama Medical College and Hospital, Hapur, IND
| | - Rupali Dewan
- Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Himani Ahluwalia
- Department of Physiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
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