The aetiology of anaemia in pregnancy in West Africa

Prevalence of Anemia and Its Associated Socio-Demographic Factors Among Pregnant Women Attending an Antenatal Care Clinic at Kisugu Health Center IV, Makindye Division, Kampala, Uganda

AIMS/OBJECTIVES

This study sought to determine the prevalence, morphological characterization and associated socio-demographic factors of anemia among pregnant women attending Kisugu Health Centre IV, Makindye Division, Kampala, in Uganda.

METHODS

This was a cross-sectional study that employed laboratory analysis of blood samples to determine hemoglobin concentration, and a structured questionnaire to obtain socio-demographic factors associated with anemia during pregnancy.

RESULTS

We enrolled 345 pregnant women aged 15 to 43 years. The median, interquartile range, and mean Hb levels were 8.1g/dL, 6.4 ± 2.1g/dL and 7.9g/dL, respectively. There were 89 participants whose Hb levels were indicative of anemia, giving anemia prevalence of 25.8% (95% confidence interval: 21.6-29.8). Of these, 25 (28.1%) had mild anemia, 46 (51.7%) had moderate anemia, while 18 (20.2%) had severe anemia. Thin blood film examination showed normocytic-hypochromic (75.3%), then microcytic-hypochromic (21.6%), and macrocytic-hypochromic red blood cells (3.4%). The socio-demographic factors of gestational age, parity, and mother's occupation were significantly associated with the risk of anemia (p< 0.05).

CONCLUSION

We report a high prevalence of anemia among pregnant women; with a majority of hypochromic-microcytic anemia. This may necessitate more anemia awareness and it requires institution of nutritional interventions to avert fetal-maternal complications.

Anaemia and thrombocytopenia among pregnant women attending Aminu Kano Teaching Hospital, Kano State, North Western Nigeria

BACKGROUND

Pregnancy induces a number of physiologic changes either directly or indirectly that affect the haematologic parameters. The most frequent haematologic complication associated with pregnancy is anaemia and thrombocytopenia.

OBJECTIVES

The aim of this case-control study was to investigate the prevalence of anaemia and thrombocytopenia among one hundred and twenty consecutively-recruited pregnant subjects and sixty age-matched non-pregnant controls.

METHOD

Socio-demographic and clinical data were obtained using a questionnaire. Three milliliters of blood were obtained from both the pregnant subjects and non-pregnant controls and distributed into EDTA and used for full blood count was determined using the fully automated Mythic 18 3-part differential haematology analyzer.

RESULT

The socio-demographic distribution among the subjects showed that the age group 25-29 years had the higher number of participants 41 (34.2%) followed by 30-34 years 39 (32.5%). Distribution based on socio-demography indicated that majority of the subjects were of Hausa ethnic group 47 (78.3), had no formal or Islamic education 53 (44.2%) and predominantly housewives 74 (61.7%). Distribution based on obstetric variables indicated that majority of the subjects were multiparous 86 (71.7%), had no problem in their previous pregnancies 99 (82.5%) and are not having problem in this current pregnancy 109 (90.8%). The HBG and HCT were significantly lower among the pregnant subjects compared to controls (p= 0.05 and 0.0308) respectively. The prevalence of anaemia and thrombocytopenia among the pregnant subjects was 75% and 6.7% respectively. The prevalence of anaemia (80%) and thrombocytopenia (8.0%) was higher among pregnant women in the second trimester compared to those in the first and third trimesters.

CONCLUSION

The values obtained from this research showed an increase in prevalence of anaemia and thrombocytopenia among pregnant women compared to the non-pregnant controls. It is vital to routinely monitor the indices of anaemia and thrombocytopenia among pregnant women to reduce the incidence of these diseases and of their complications.

Nutraceutical and Functional Foods in Treatment of Anemia

WHO database mentions that the global anemia-affected population is 24.8%. To name a few conditions in which compromisation of the red blood corpuscles and hemoglobin occurs are iron deficiency anemia, gestational anemia, anemia due to malaria and parasitism, hemolytic anemia, sickle cell anemia. The line of treatment in case of anemia involves administration of iron supplements, plasmapheresis, steroids, blood transfusion at regular intervals, and lifestyle changes. The systematic approach applied for the pharmaceutical molecules should be equally inculcated in the case of nutraceuticals. The traditional system when woven carefully with the novel drug delivery system will give effective nutrient delivery. Functional foods have inherent nutritional value. Nutraceuticals and functional food cannot cure the anemic condition, but help the patient lead life almost like a normal individual.

Magnitude of Maternal Anaemia in Rural Burkina Faso: Contribution of Nutritional Factors and Infectious Diseases

Background. Maternal anaemia is a worldwide public health problem affecting particularly developing countries. In Burkina Faso, little data is available for rural areas. This study aimed to determine the prevalence of maternal anaemia and the risk factors associated with it in the rural health district of Hounde in Burkina Faso but also to define better control measures of maternal anaemia.Methods. This cross-sectional study conducted in 2010 had a sample of 3,140 pregnant women attending antenatal care in all the 18 primary health care facilities of the district. The women’s characteristics and their knowledge about contraceptives and sexually transmitted infections (STI) were collected. Also, physical and gynaecological examination, completed by vaginal, cervix, blood, and stool samplings, were collected.Results. A prevalence of 63.1% was recorded for maternal anaemia. Geophagy rate was 16.3% and vitamin A deficiency 69.3%. In addition, anaemia was independently associated with low education, low brachial perimeter, geophagy, and primigravida. But no statically significant relationship was found between maternal anaemia and infectious diseases or vitamin A deficiency.Conclusion. The magnitude of maternal anaemia was found to be higher in rural Hounde health district and should be addressed by adequate policy including education and the fight against malnutrition.

The effects of co-infection with human parvovirus B19 and Plasmodium falciparum on type and degree of anaemia in Ghanaian children

OBJECTIVE

To determin the extent to which parvovirus B19 (B19V) and co-infection of B19V and malaria contribute to risk of anaemia in children.

METHODS

B19V DNA and malaria parasites were screened for 234 children at the PML Children's Hospital in Accra. The role of B19V and co-infection with B19V and malaria in anaemia was evaluated by analysing full blood cell counts, malaria and B19V DNA results from these children.

RESULTS

The prevalence of B19V, malaria and co-infection with B19V and malaria was 4.7%, 41.9% and 2.6%, respectively. Malaria posed a greater risk in the development of mild anaemia compared to severe anaemia (OR=5.28 vrs 3.15) whereas B19V posed a higher risk in the development of severe anaemia compared to mild anaemia (OR=4.07 vrs 1.00) from a non-anaemic child. Persons with co-infection with B19V and malaria had 2.23 times the risk (95% CI=0.40-12.54) of developing severe anaemia should they already have a mild anaemia. The degree of anaemia was about three times affected by co-infection (Pillai's trace=0.551, P=0.001) as was affected by malaria alone (Pillai's trace=0.185, P=0.001). B19V alone did not significantly affect the development of anaemia in a non-anaemic child. Microcytic anaemia was associated with B19V and co-infection with B19V and malaria more than normocytic normochromic anaemia.

CONCLUSIONS

B19V was associated with malaria in cases of severe anaemia. The association posed a significant risk for exacerbation of anaemia in mild anaemic children. B19V and co-infection with B19V and malaria may be associated with microcytic anaemia rather than normocytic normochromic anaemia as seen in cases of B19V infection among persons with red cell abnormalities.

Protective effect of pregnancy in rural South Africa: questioning the concept of "indirect cause" of maternal death

Background

Measurement of the level and composition of maternal mortality depends on the definition used, with inconsistencies leading to inflated rates and invalid comparisons across settings. This study investigates the differences in risk of death for women in their reproductive years during and outside the maternal risk period (pregnancy, delivery, puerperium), focusing on specific causes of infectious, non-communicable and external causes of death after separating out direct obstetrical causes.

Methods

Data on all deaths of women aged 15–49 years that occurred in the Agincourt sub-district between 1992 and 2010 were obtained from the Agincourt health and socio-demographic surveillance system (HDSS) located in rural South Africa. Causes of death were assessed using a validated verbal autopsy instrument. Analysis included 2170 deaths, of which 137 occurred during the maternal risk period.

Findings

Overall, women had significantly lower mortality during the maternal risk period than outside it (age-standardized RR = 0.75; 95% CI = 0.63–0.89). This was true in most age groups with the exception of adolescents aged 15–19 years where the risk of death was higher. Mortality from most causes, other than obstetric causes, was lower during the maternal risk period except for malaria, cardiovascular diseases and violence where there were no differences. Lower mortality was significant for HIV/AIDS (RR = 0.29, P<0.0001), cancers (RR = 0.10, P<0.023), and accidents (RR = 0, P<0.0001).

Interpretation

In this rural setting typical of much of Southern Africa, pregnancy was largely protective against the risk of death, most likely because of a strong selection effect amongst those women who conceived successfully. The concept of indirect cause of maternal death needs to be re-examined.

Maternal nutrition among women from Sub-Saharan Africa, with a focus on Nigeria, and potential implications for pregnancy outcomes among immigrant populations in developed countries

Pregnant women in countries of Sub-Saharan Africa (SSA) are at risk of poor nutritional status and adverse outcomes as a result of poverty, food insecurity, sub-optimal healthcare facilities, frequent infections and frequent pregnancies. Studies from Nigeria, for example, have revealed a high prevalence of both under- and over-nutrition, as well as nutrient deficiencies, including iron, folate, vitamin D and vitamin A. Subsequently, obstetric complications, including hypertension, anaemia, neural tube defects, night-blindness, low birth weight and maternal and perinatal mortality, are common. Migration patterns from SSA to the Western world are on the rise in recent years, with Nigerians now representing the most prevalent immigrant African population in many developed countries. However, the effect of immigration, if any, on the nutritional status and pregnancy outcomes of these women in their host countries has not yet been studied. Consequently, it is unknown to what extent the nutritional deficiencies and pregnancy complications occurring in Nigeria, and other countries of SSA, present in these women post-emigration. This may result in missed opportunities for appropriate antenatal care of a potential high-risk group in pregnancy. The present review discusses the literature regarding nutrition in pregnancy among SSA women, using Nigeria as an example, the common nutrition-related complications that arise and the subsequent obstetric outcomes. The concept of dietary acculturation among immigrant groups is also discussed and deficiencies in the literature regarding studies on the diets of pregnant immigrant women are highlighted.

Estimating obstetric mortality from pregnancy-related deaths recorded in demographic censuses and surveys

Demographic surveys and censuses often record pregnancy-related deaths, defined as those occurring during the maternal risk period (pregnancy, delivery, and six weeks postpartum), but do not include cause of death. This study presents a method for estimating obstetric mortality from pregnancy-related deaths data. Calculations are based on multiple-decrement life tables, and data needed are simply age-specific fertility and mortality rates that are commonly available in Demographic and Health Survey (DHS) or census data, and an estimate of the relative risk of death from nonobstetric causes during the maternal risk period. The method is tested on 59 DHS surveys from Africa. Results show that, on average, less than half of the pregnancy-related deaths are attributable to obstetric causes. This proportion varies with the level of mortality and fertility, and in particular with the prevalence of HIV in the population.

Impact of a Positive Deviance Approach to Improve the Effectiveness of an Iron-Supplementation Program to Control Nutritional Anemia among Rural Senegalese Pregnant Women

Background

Iron supplementation through prenatal care remains the most widespread strategy to control anemia during pregnancy, but its effectiveness is only partial, showing the need to address other approaches.

Objective

This study was conducted to measure the impact of a positive deviance approach to improve an iron-supplementation program among pregnant women in a rural Senegalese area.

Methods

A positive deviance approach (PD Micah) was compared with an ongoing integrated nutrition and health program intervention (Micah) in a rural Senegalese area. A pre-post evaluation was conducted using independent cross-sectional samples with a total of 371 pregnant women. A sociodemographic questionnaire was administered, and biologic and anthropometric measurements were performed.

Results

After 9 months of activities, the mean hemoglobin level rose from 93.9 to 100.7 g/L in the PD Micah group. Distribution of iron supplements through community volunteers and implementation of healthy pregnancy promotion sessions on a monthly basis improved the accessibility to 23.3% in the PD Micah group. No significant change was observed in the Micah group. Logistic regression analysis showed a significantly reduced risk of anemia in the PD Micah area (adjusted odds ratio, 0.25; 95% confidence interval, 0.12 to 0.53).

Conclusions

This intervention shows that a community-based strategy, such as the positive deviance approach, can contribute to improving the effectiveness of iron supplementation during pregnancy.

Anaemia in pregnancy: a survey of pregnant women in Abeokuta, Nigeria

BACKGROUND

Anaemia in pregnancy is a common problem in most developing countries and a major cause of morbidity and mortality especially in malaria endemic areas. In pregnancy, anaemia has a significant impact on the health of the foetus as well as that of the mother. 20% of maternal deaths in Africa have been attributed to anaemia.

OBJECTIVES AND METHODS

This study was therefore carried out to determine the prevalence of anaemia among pregnant women receiving antenatal care in two hospitals and a traditional birth home in order to obtain a broader prevalence data. Pregnant women were enrolled in the study at their first antenatal visit and were monitored through pregnancy for anaemia. Packed cell volume (PCV) was used to assess level of anaemia; Questionnaires were also administered to obtain demographic information.

RESULTS

Three hundred and sixty five (76.5%) of the women were anaemic at one trimester of pregnancy or another. Anaemia were more prevalent among primigravidae (80.6%) than the multigravidae(74.5%)(P>0.05). Two hundred and eleven women (57.8%) had moderate anaemia while 147 (40.3%) had mild anaemia and 7(1.9%) were severely anaemic (5 (71.4%) of which were primigravidae). All severely anaemic women were under 30 years old. Women attending TBH for antenatal care were found to be more anaemic (81.2%) (Even at various trimesters of pregnancy) than those attending the hospitals (72.5%) (P<0.05). However, in all the antenatal centers more women were anaemic in the 2(nd) trimester of pregnancy. Forty-seven (9.8%) of the enrolled women booked for antenatal care in the first trimester, while 303(63.5%) booked in the second trimester and 127(26.6%) in the 3(rd) trimester of their pregnancies. 62.5% of these women were already anaemic at the time of antenatal booking, with a higher prevalence among the primigravidae (69.7%)(P < 0.05). Absence of symptoms of ill health was the major reason for late antenatal booking. Anaemia was higher among unemployed women and those with sickle cell traits.

CONCLUSION

Educating women on early antenatal booking and including those in TBHs in health interventions is necessary to reduce the problem of anaemia in pregnancy in Nigeria.

Malaria in the pregnant woman

Women become more susceptible to Plasmodium falciparum malaria during pregnancy, and the risk of disease and death is high for both the mother and her fetus. In low transmission areas, women of all parities are at risk for severe syndromes like cerebral malaria, and maternal and fetal mortality are high. In high transmission areas, where women are most susceptible during their first pregnancies, severe syndromes like cerebral malaria are uncommon, but severe maternal anemia and low birth weight are frequent sequelae and account for an enormous loss of life. P. falciparum-infected red cells sequester in the intervillous space of the placenta, where they adhere to chondroitin sulfate A but not to receptors like CD36 that commonly support adhesion of parasites infecting nonpregnant hosts. Poor pregnancy outcomes due to malaria are related to the macrophage-rich infiltrates and pro-inflammatory cytokines such as tumor necrosis factor-alpha that accumulate in the intervillous space. Women who acquire antibodies against chrondroitin sulfate A (CSA)-binding parasites are less likely to have placental malaria, and are more likely to deliver healthy babies. In areas of stable transmission, women acquire antibodies against CSA-binding parasites over successive pregnancies, explaining the high susceptibility to malaria during first pregnancy, and suggesting that a vaccine to prevent pregnancy malaria should target placental parasites. Prevention and treatment of malaria are essential components of antenatal care in endemic areas, but require special considerations during pregnancy. Recrudescence after drug treatment is more common during pregnancy, and the spread of drug-resistant parasites has eroded the usefulness of the few drugs known to be safe for the woman and her fetus. Determining the safety and effectiveness of newer antimalarials in pregnant women is an urgent priority. A vaccine that prevents pregnancy malaria due to P. falciparum could be delivered before first pregnancy, and would have an enormous impact on mother-child health in tropical areas.

Anaemia and micronutrient deficiencies

Anaemia in pregnancy is a common and worldwide problem that deserves more attention. For many developing countries, prevalence rates of up to 75% are reported. Anaemia is frequently severe in these situations and can be expected to contribute significantly to maternal mortality and morbidity. After a discussion of definitions, screening for anaemia and prevalence, the relationship between anaemia and maternal mortality and morbidity will be reviewed. Micronutrient deficiency and especially iron deficiency is believed to be the main underlying cause for anaemia. More recently the role of vitamin A deficiency as a contributing factor to anaemia has also been examined. The difficulties of assessment of micronutrient sufficiency or deficiency in pregnancy are described, as is the interaction between infection and micronutrient deficiency states.

Etiology of anemia in pregnancy in south Malawi

BACKGROUND

Anemia in pregnancy is a major public health problem in developing countries. In sub-Saharan Africa, such anemia is generally accepted as resulting from nutritional deficiencies, particularly iron deficiency.

OBJECTIVE

We comprehensively assessed the full spectrum of nutritional and nonnutritional factors associated with pregnancy anemia.

DESIGN

Iron, folate, vitamin B-12, and vitamin A were measured in serum in a cross-sectional study of 150 pregnant women in Blantyre, Malawi. Bone marrow aspirates were evaluated, peripheral blood films were examined for malaria parasites, stool and urine samples were examined for helminthic infection, and tests were done for genetic disorders and for HIV infection. C-reactive protein (CRP) concentrations and erythrocyte sedimentation rates were measured as markers of inflammation.

RESULTS

Of the 150 anemic women, 23% were iron deficient with no evidence of folate, vitamin B-12, or vitamin A deficiencies; 32% were deficient in iron and one or more of the other micronutrients; 26% were not iron deficient but had evidence of one of the other micronutrient deficiencies, most often vitamin A; and 19% were not deficient in any of the micronutrients studied. CRP concentrations were notably high in 54% of the anemic women with no nutritional deficiencies and in 73.5% of the anemic women who were iron replete by bone marrow assessment.

CONCLUSION

The role of chronic inflammation as a possible contributing factor to anemia in pregnancy has important implications for the clinical evaluation and treatment of women.

Iron status in pregnant women: which measurements are valid?

Anaemia in pregnancy in developing countries continues to be a public health problem of significant proportion. At least 50% of the anaemia has been blamed on iron deficiency. In populations where chronic inflammation and iron deficiency anaemia coexist, the criteria to accurately define iron status are not always clear. Similarly, in pregnancy, with marked physiological changes, cut-off points for biochemical parameters need to be re-examined. In this study we examined the diagnostic accuracy of iron parameters including mean cellular volume (MCV), serum iron, transferrin, total iron binding capacity (TIBC) and its saturation, zinc protoporphyrin (ZPP), ferritin and serum transferrin receptor (TfR) for the assessment of iron status in a population of anaemic pregnant women in Malawi. Stained bone marrow aspirates were used as the standard for comparison. Results show that for the purpose of screening, serum ferritin is the best single indicator of storage iron provided a cut-off point of 30 microg/l is used. A number of other commonly used parameters of iron status were shown to have limited diagnostic accuracy. Logistic regression was used to obtain mathematical models for the prediction of bone marrow iron status using a combination of available parameters.