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Bekele Y, Gallagher C, Vicendese D, Buultjens M, Batra M, Erbas B. The Effects of Maternal Iron and Folate Supplementation on Pregnancy and Infant Outcomes in Africa: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:856. [PMID: 39063433 PMCID: PMC11276896 DOI: 10.3390/ijerph21070856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/13/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Iron and folate deficiency are prevalent in pregnant women in Africa. However, limited research exists on the differential effect of oral iron-only, folate-only, or Iron Folic Acid (IFA) supplementation on adverse pregnancy and infant outcomes. This systematic review addresses this gap, focusing on studies conducted in Africa with limited healthcare access. Understanding these differential effects could lead to more targeted and potentially cost-effective interventions to improve maternal and child health in these settings. METHODS A systematic review was conducted following PRISMA guidelines. The primary exposures were oral iron-only, folate-only, or IFA oral supplementation during pregnancy, while the outcomes were adverse pregnancy and infant outcomes. A qualitative synthesis guided by methods without meta-analysis was performed. RESULTS Our qualitative synthesis analysed 10 articles reporting adverse pregnancy (adverse birth outcomes, stillbirths, and perinatal mortality) and infant outcomes (neonatal mortality). Consistently, iron-only supplementation demonstrated a reduction in perinatal death. However, evidence is insufficient to assess the relationship between iron-only and IFA supplementation with adverse birth outcomes, stillbirths, and neonatal mortality. CONCLUSION Findings suggested that iron-only supplementation during pregnancy may reduce perinatal mortality in African women. However, evidence remains limited regarding the effectiveness of both iron-only and IFA supplementation in reducing stillbirths, and neonatal mortality. Moreover, additional primary studies are necessary to comprehend the effects of iron-only, folate-only, and IFA supplementation on pregnancy outcomes and infant health in the African region, considering rurality and income level as effect modifiers.
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Affiliation(s)
- Yibeltal Bekele
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia; (M.B.); (M.B.); (B.E.)
- School of Public Health, Bahir Dar University, Bahir Dar 79, Ethiopia
| | - Claire Gallagher
- School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia; (C.G.); (D.V.)
| | - Don Vicendese
- School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia; (C.G.); (D.V.)
- School of Computing, Engineering and Mathematical Sciences, La Trobe University, Melbourne, VIC 3086, Australia
| | - Melissa Buultjens
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia; (M.B.); (M.B.); (B.E.)
| | - Mehak Batra
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia; (M.B.); (M.B.); (B.E.)
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia; (M.B.); (M.B.); (B.E.)
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Bekele Y, Gallagher C, Batra M, Buultjens M, Eren S, Erbas B. Does oral iron and folate supplementation during pregnancy protect against adverse birth outcomes and reduced neonatal and infant mortality in Africa: A protocol for a systematic review and meta-analysis? Nutr Health 2024:2601060241256200. [PMID: 38778781 DOI: 10.1177/02601060241256200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Globally, one-third of pregnant women are at risk of iron deficiency, particularly in the African region. While recent findings show that iron and folate supplementation can lower the risk of adverse birth outcomes and childhood mortality, our understanding of its impact in Africa remains incomplete due to insufficient evidence. This protocol outlines the systematic review steps to investigate the impact of oral iron and folate supplementation during pregnancy on adverse birth outcomes, neonatal mortality and infant mortality in Africa. METHODS AND ANALYSIS MEDLINE, PsycINFO, Embase, Scopus, CINAHL, Web of Science, and Cochrane databases were searched for published articles. Google Scholar and Advanced Google Search were used for gray literature and nonindexed articles. Oral iron and/or folate supplementation during pregnancy is the primary exposure. The review will focus on adverse birth outcomes, neonatal mortality and infant mortality. Both Cochrane Effective Practice and Organization of Care and Newcastle-Ottawa Scale risk of bias assessment tools will be used. Meta-analysis will be conducted if design and data analysis methodologies permit. This systematic review and meta-analysis will provide up-to-date evidence about iron and folate supplementation's role in adverse birth outcomes, neonatal mortality and infant mortality in the African region. ETHICS AND DISSEMINATION This review will provide insights that help policymakers, program planners, researchers, and public health practitioners interested in working in the region. PROSPERO REGISTRATION NUMBER CRD42023452588.
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Affiliation(s)
- Yibeltal Bekele
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
- School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | - Claire Gallagher
- School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Mehak Batra
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Melissa Buultjens
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Senem Eren
- School of Humanities and Social Sciences, Ibn Haldun University, Istanbul, Turkey
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
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Abneh AA, Kassie TD, Gelaw SS. The magnitude and associated factors of immediate postpartum anemia among women who gave birth in Ethiopia: systematic review and meta-analysis, 2023. BMC Pregnancy Childbirth 2024; 24:317. [PMID: 38664625 PMCID: PMC11044590 DOI: 10.1186/s12884-024-06495-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/09/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND The immediate postpartum period is a very crucial phase for both the life of the mother and her newborn baby. Anemia is the most indirect leading cause of maternal mortality. However, anemia in the immediate postpartum period is a neglected public health problem in Ethiopia. Therefore, this systematic review and meta-analysis aimed to estimate the pooled magnitude of immediate postpartum anemia and the pooled effect size of associated factors in Ethiopia. METHODS Searching of published studies done through PubMed, Medline, Cochrane, African index Medicus, List of Reference Index, Hinari, and Google Scholar. This systematic review and meta-analysis follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) godliness. The quality of studies was assessed by using a Newcastle- Ottawa Scale (NOS) assessment tool. Analysis was performed using a random effect model by using STATA 17 version software. Egger's weighted regression and I2 test were used to evaluate publication bias and heterogeneity respectively. RESULTS In this systematic review and meta-analysis, a total of 6 studies were included. The pooled magnitude of immediate postpartum anemia in Ethiopia was 27% (95%CI: 22, 32). Instrumental mode of delivery (OR = 3.14, 95%CI: 2.03, 4.24), mid-upper arm circumference (MUAC) measurement < 23 cm (OR = 3.19, 95%CI: 1.35, 5.03), Antepartum Hemorrhage (OR = 4.75, 95%CI: 2.46, 7.03), postpartum hemorrhage (OR = 4.67, 95%CI: 2.80, 6.55), and no iron/foliate supplementation (OR = 2.72, 95%CI: 1.85, 3.60) were the identified factors associated with developing anemia in the immediate postpartum period. CONCLUSION The overall pooled magnitude of anemia in the immediate postpartum period among Ethiopian women was still a moderate public health problem. Instrumental mode of delivery, mid upper arm circumference (MUAC) measurement < 23 cm, antepartum hemorrhage, postpartum hemorrhage, and no iron/foliate supplementation were the identified factors associated with higher odds of developing anemia among immediate postpartum women in Ethiopia. Therefore, midwives, and doctors, shall focus on prevention of maternal hemorrhage, nutritional advice and counseling including iron /foliate supplementation, and avoid unnecessary instrumental delivery to prevent and reduce anemia related maternal mortality and morbidity in Ethiopia. PROSPERO REGISTRATION CRD42023437414 with registration date on 02/08/2023.
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Affiliation(s)
- Aysheshim Asnake Abneh
- Department of public health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia.
| | - Tadele Derbew Kassie
- Department of public health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Sintayehu Shiferaw Gelaw
- Department of public health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
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Temesgen H, Woyraw W, Feleke FW, Mezgebu GS, Taye K, Awoke T. Iron folic acid supplementation adherence level and its associated factors among pregnant women in Ethiopia: a multilevel complex data analysis of 2019 Ethiopian mini demographic and health survey data. Front Nutr 2024; 11:1348275. [PMID: 38435097 PMCID: PMC10904579 DOI: 10.3389/fnut.2024.1348275] [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: 12/02/2023] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
Background Iron and folic acid deficiency is a worldwide public health concern, particularly in low and middle-income countries. In Ethiopia, adherence to iron and folic acid supplements is still very low. Despite the fact that a number of studies on IFA supplementation have been conducted in Ethiopia, they do not indicate a nationwide problem and do not use advanced models to demonstrate clustering effects. The purpose of this study was to assess the level of non-adherence to iron folic acid supplementation and predictors among pregnant women in Ethiopia. Objective To assess iron folic acid supplementation adherence level and its associated factors among pregnant women in Ethiopia using data from the 2019 Mini-Ethiopian demographic health survey. Methods The Mini Ethiopian Demographic and Health Survey 2019 data were obtained from the official database website of the Demographic and Health Survey program (http://dhsprogram.com). The analysis included a sample of 2,356 weighted study participants. A multivariable multilevel mixed-effects logistic regression model was used Variables with p-values less than 5%) was reported as statistically significant variables in the multivariable analysis. Results The proportion of mothers who did not adhere to iron and folic acid supplements was 81.03% (95 %CI, 79.39, and 82.56). Birth interval less than 2 years [AOR: 2.03; 95% CI: 1.12, 3.66], women ever born less than six children [AOR: 1.99; 95% CI: 1.09, 3.64], starting ANC visit during first trimester [AOR: 2.74; 95 %CI: 1.03, 7.30], region [AOR = 0.24; 95% CI: 0.10], and having a high no ANC visit in the community [AOR = 1.77; 95% CI: 1.08, 2.88] were statistically significant factors. There was Intra-Custer Correlation (ICC = 17.72%), indicating that 17.72% variability in non-adherence levels was due to clusters. Conclusion and recommendation In Ethiopia, nearly four out of every five pregnant women did not receive iron folic acid supplementation for the recommended periods. Birth intervals, number of children, timing of ANC visits, region, and community level no ANC service were significant factors for non-adherence IFAS. As a result, the community, govern metal and non-governmental sectors enacting on health should focus on reducing non-adherence through tailored interventions on factors that influence it.
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Affiliation(s)
- Habtamu Temesgen
- Department of Nutrition, College of Health Science, Debre Markos University, Debre Marqos, Ethiopia
- School of Human Nutrition, College of Agriculture, Hawassa University, Hawassa, Ethiopia
| | - Wubetu Woyraw
- Department of Nutrition, College of Health Science, Debre Markos University, Debre Marqos, Ethiopia
- School of Human Nutrition, College of Agriculture, Hawassa University, Hawassa, Ethiopia
| | - Fentaw Wassie Feleke
- School of Human Nutrition, College of Agriculture, Hawassa University, Hawassa, Ethiopia
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Getachew Sale Mezgebu
- School of Human Nutrition, College of Agriculture, Hawassa University, Hawassa, Ethiopia
| | - Kefyalew Taye
- School of Human Nutrition, College of Agriculture, Hawassa University, Hawassa, Ethiopia
- Department of Public Health, College of Health Science, Ambo University, Ambo, Ethiopia
| | - Tadesse Awoke
- Institute of Public Health, College of Health Science, University of Gondar, Gondar, Ethiopia
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Zhang H, Pan J, Jiang H, Xiong X, Huang L, Liu X, Wangzi WX, Chen L. A study on the correlation between MTHFR and folic acid combined with trace elements for the prevention of fetal malformations in the first trimester of pregnancy. Medicine (Baltimore) 2023; 102:e35330. [PMID: 37933013 PMCID: PMC10627646 DOI: 10.1097/md.0000000000035330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/31/2023] [Indexed: 11/08/2023] Open
Abstract
This study aims to elucidate and examine the intricate interrelation between 5,10-methylenetetrahydrofolate reductase (MTHFR), combined folic acid (FA), and trace element supplementation as a preventive strategy against fetal malformations during the inaugural trimester of pregnancy. Eighty pregnant women selected from our hospital's early obstetrics department from May 2021 to August 2021. Pregnant women are divided into the MTHFR combined group, FA, and trace element group. Comparing the basic data of patients, analyzing adverse reactions in pregnant women, and total birth risk situation, detecting MTHFR gene polymorphisms, and analyzing the correlation between MTHFR and FA in the prevention of fetal malformations in early pregnancy. Compared with the north, the southern region is more prone to FA deficiency. MTHFR degree of the MTHFR combined group was positively correlated with fetal malformations. The deformity rate was negatively correlated with FA and trace elements. Pregnant women in the first trimester may have fetal malformations, and the malformation rate is negatively correlated with FA and positively correlated with MTHFR level. Importantly, the inverse relationship between FA supplementation and malformation incidence underscores its significance as a preventive measure.
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Affiliation(s)
- Hong Zhang
- Department of Clinical Laboratory, Wuhan City Maternal and Child Health Care Hospital, Wuhan, Hubei Province, China
| | - Juan Pan
- Department of Clinical Laboratory, Wuhan Jiangan District Maternal and Child Health Care Hospital, Wuhan Jiangan District Maternal and Child Health Care Planning Service Center, Wuhan, Hubei Province, China
| | - Haoyu Jiang
- Department of Clinical Laboratory, Wuhan City Maternal and Child Health Care Hospital, Wuhan, Hubei Province, China
| | - Xiaobo Xiong
- Department of Clinical Laboratory, Wuhan City Maternal and Child Health Care Hospital, Wuhan, Hubei Province, China
| | - Lu Huang
- Department of Clinical Laboratory, Wuhan City Maternal and Child Health Care Hospital, Wuhan, Hubei Province, China
| | - Xin Liu
- Department of Clinical Laboratory, Wuhan City Maternal and Child Health Care Hospital, Wuhan, Hubei Province, China
| | - Wei Xin Wangzi
- Department of Clinical Laboratory, Wuhan City Maternal and Child Health Care Hospital, Wuhan, Hubei Province, China
| | - Lida Chen
- Department of Clinical Laboratory, Wuhan City Maternal and Child Health Care Hospital, Wuhan, Hubei Province, China
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Mengistu GT, Mengistu BK, Gudeta TG, Terefe AB, Habtewold FM, Senbeta MD, Sori SA, Jiru HD. Magnitude and factors associated with iron supplementation among pregnant women in Southern and Eastern Regions of Ethiopia: Further Analysis of mini demographic and health survey 2019. BMC Nutr 2022; 8:66. [PMID: 35850710 PMCID: PMC9295274 DOI: 10.1186/s40795-022-00562-3] [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: 04/08/2022] [Accepted: 07/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background Anemia is a global public health problem that affects pregnant women. The most common cause of anemia is iron deficiency which is extremely common in developing countries. World health organization reported that 36.5% of pregnant women are anemic globally. In Ethiopia, 27.08% of women of the reproductive age group are anemic. Therefore, this study aimed to identify the magnitude and factors associated with iron supplementation during pregnancy in the southern and eastern regions of Ethiopia. Methods The data used in this analysis were extracted from Mini Demographic and Health Survey 2019. The survey was conducted in 9 regional states and two city administrations. The data used in the analysis were extracted from individual women datasets, and 1780 study participants were included in this study. The logistic regression analysis including bivariate and multivariable logistic regression at a 95% confidence interval and a p-value less than 0.05 was used. Result The finding of the study shows that iron supplementation during pregnancy in Southern and Eastern parts of Ethiopia was 50.06%. Among those who received iron, only about 20% took it for 90 days and more during their pregnancy. Iron supplementation among the pregnant women was affected by secondary education [AOR = 2.20, 95%CI (1.325, 3.638)], residing in urban [AOR = 1.75, 95%CI (1.192, 2.574)], having media at home [AOR = 1.41, 95%CI (1.022, 1.946)], having antenatal care follow up [AOR = 9.27, 95%CI (4.727, 18.169)], having 4 and more ANC follow up [AOR = 2.01, 95%CI (1.468,2.760], having antenatal care follow up at government health institutions [AOR = 3.40, 95%CI (1.934, 5.982)], and giving birth at governmental health institutions [AOR = 1.70, 95%CI (1.236, 2.336)]. Conclusion Only one in two pregnant women was supplemented with iron during their recent pregnancy. The supplementation was affected by women's education, place of residence, presence of media at home, antenatal care follow-up, the number of antenatal care follow up, antenatal care follows up at governmental health institutions, and giving birth at the governmental health institution. The availability and accessibility of maternal care services and their functionality in providing maternal care services improve the supplementation.
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Affiliation(s)
- Girma Teferi Mengistu
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia.
| | - Bizunesh Kefale Mengistu
- Department of Statistics, College of Natural and Computational Science, Ambo University, Ambo, Ethiopia
| | - Tolesa Gemeda Gudeta
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Ayana Benti Terefe
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | | | - Mebratu Demissie Senbeta
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Seboka Abebe Sori
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Hirut Dinku Jiru
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
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