Anemia in Ugandan pregnant women: a cross-sectional, systematic review and meta-analysis study

Improving maternal and neonatal outcomes among pregnant women who are HIV-positive or HIV-negative through the Saving Mothers Giving Life initiative in Uganda: An analysis of population-based mortality surveillance data

HIV infection is associated with poor maternal health outcomes. In 2016, the maternal mortality ratio (MMR) in Uganda was 336/100,000, and the neonatal mortality rate (NMR) was 19/1,000. Saving Mothers, Giving Life (SMGL) was a five-year maternal and neonatal health strengthening initiative launched in 2012 in Uganda. We extracted maternal and neonatal data for 2015-2016 from the initiative's population-based mortality surveillance system in 123 health facilities in Western Uganda. We collected data on the facilities, HIV status, antiretroviral drug (ARV) use, death, birth weight, delivery type, parity, Apgar scores, and complications. We compared mother and baby outcomes between HIV-positive or HIV-negative, computed risk ratios (RR) for adverse outcomes, and used the chi-square to test for significance in differences observed. Among 116,066 pregnant women who attended and gave birth at SMGL-implementing facilities during 2015-2016, 8,307 (7.7%) were HIV-positive, of whom 7,809 (94%) used antiretroviral drugs (ARVs) at the time of delivery. During birth, 23,993 (21%) women experienced ≥1 complications. Neonate Apgar scores <7 (8.8%) and maternal haemorrhage during birth (1.6%) were the most common outcomes. Overall facility MMR was 258/100,000 and NMR was 7.6/1,000. HIV infection increased risk of maternal death (RR = 3.6, 95% Confidence Interval (CI) = 2.4-5.5), maternal sepsis (RR = 2.1, 95% CI = 1.3-3.3), and infant birth weight <2,500g (RR = 1.2, 95% CI = 1.1-1.3), but was protective against maternal complications (RR = 0.92, 95% CI = 0.87-0.97) and perinatal death (RR = 0.78, 95% CI = 0.68-0.89). Among the HIV-positive, ARV non-use increased risk of maternal death (RR = 15, 95% CI = 7.1-31) and perinatal death (RR = 2.3, 95% CI = 1.6-3.4). SMGL reduced facility MMR and NMR below national rates. HIV-infection was associated with maternal sepsis and death. Failure to use ARVs among women living with HIV increased the risk of maternal and perinatal death. Use of the SMGL approach and complementary interventions that further strengthen HIV care, may continue to reduce MMR and NMR.

ABO and Rh (D) blood group phenotype distribution pattern among blood donors at the Nekemte Blood Bank, Oromia, West Ethiopia: a retrospective cross-sectional study

OBJECTIVE

To determine the distribution of ABO and Rh (D) blood group phenotypes among blood donors.

METHODS

This retrospective cross-sectional study enrolled blood donors whose socio-demographic and blood group phenotype data were collected from blood bank donor records. Descriptive statistics were used to summarise the number and percentage distribution of categorical variables. To determine if the distributions of the ABO and Rh phenotypes differed, a chi-square test was employed.

RESULTS

Of 14,887 blood donors with a median age of 20 years (interquartile range = 18-30 years), 72.8% were males, and young donors (age range = 18-24 years) accounted for 61.7%. Group O (45.6%) was the most prevalent ABO blood phenotype, followed by A (29.5%), B (20.2%), and AB (4.7%). The dominant blood group was O positive (42.4%), followed by A positive (27.4%), B positive (18.9%), AB positive (4.3%), O negative (3.2%), A negative (2.1%), B negative (1.3%), and AB negative (0.4%). The overall Rh (D)-negative distribution rate was 7.0%.

CONCLUSION

This study showed that blood group O was the most common ABO phenotype, followed by A, B, and AB. Overall, 93.0% of the donors were Rh (D)-positive. These findings may help guide blood transfusion programmes.

Prevalence and risk factors of anemia in first, second and third trimesters of pregnancy in Iran: A systematic review and meta-analysis

Anemia is a common health problem during pregnancy worldwide that has many short-term and long-term effects on women. This study examined the Prevalence and Risk factors of anemia in first, second and third trimesters of pregnancy in Iran between 2000 and 2021. PubMed, Medline, Scopus, Google Scholar, and national databases of Magiran and SID were searched for articles, which were then subjected to PRISMA-compliant screening. A systematic review and meta-analysis (using a random-effects model in STATA version 17) were conducted on the 18 eligible cross-sectional studies (published between July 23, 2000 and September 1, 2021) that revealed significant data on the prevalence of anemia in pregnant women. This study included 18 reports with a total of 25,831 individuals in which 15% of study subjects had anemia (95% CI: 12-19%). The pooled prevalence of anemia was 13% in people older than 26 years old (95% CI: 9-17%) compared to 22% in people younger than 26 years old (95% CI: 15-29). It was 18% (95% CI: 11-27%) for pregnant women having their second child in comparison to 20% (95% CI: 11-32%) for women who have had three or more children. Anemia was thought to affect 11% of housewives (95% CI: 2-26%) and 10% of working women (95% CI: 6-16%). Anemia frequency was 22%, 17% and 13% amongst first (22%), second (17%), and third (13%) trimesters, respectively. Nevertheless, it happened much less often after the second trimester. Moreover, poor education, a history of low birth weight in children, and a low socioeconomic level within women were associated with the prevalence of anemia. The pooled prevalence of anemia in pregnant women is marginally lower than in earlier report. However, it seems to be a health problem in developing countries including Iran currently. Therefore, the study suggest that health system should design comprehensive preventive and control measurements such as more effective treatments to minimize anemia in vulnerable segments of society, particularly mothers, and improve their health through increasing access to services for mothers.

Frequency and distribution of ABO and Rh blood group systems among blood donors at the Northern Zone Blood Transfusion Center in Kilimanjaro, Tanzania: a retrospective cross-sectional study

OBJECTIVES

ABO and Rh blood group systems are the major factors affecting the blood transfusion safety. The frequency and distribution of these blood group systems vary worldwide. We aimed to determine the frequency and distribution of ABO and Rh blood group systems among first-time blood donors at the Northern Zone Blood Transfusion Center in Kilimanjaro, Tanzania.

DESIGN

Cross-sectional descriptive population-based study.

SETTING

Data on ABO and Rh blood group systems were obtained and analysed from the Northern Zone Blood Transfusion Center among first-time blood donors.

PARTICIPANTS

There were 65 535 first-time blood donors aged 15-55 years who donated at the Northern Zone Blood Transfusion Center from January 2017 to December 2019.

OUTCOME MEASURES

The percentage of ABO and Rh blood group systems among different categories of blood donors was calculated.

RESULTS

Retrospective data from Blood Establishment Computer System of 65 535 first-time blood donors were analysed in the present study. The mean age of the blood donors was 30.6±11.2 years (range: 15-55 years). The vast majority of the blood donors 84.2% (n=55 210) were men. Also, the majority 69.6% (n=45 595) were aged ≥35 years. Blood group O was the most common blood group which was found in over half 52.4% (n=34 333) of the blood donors and majority 95.3% (n=62 461) of the donors were Rh positive. Moreover, the majority 78.3% (n=51 336) were voluntary donors and the remaining 21.7% (n=14 199) were replacement donors.

CONCLUSION

Majority of the donors had blood group O and also the vast majority of the donors were Rh positive. Considering the large size of our study population, this has provided a more comprehensive information regarding the frequency and patterns of ABO and Rh blood group systems in Tanzania. The observed association of blood group A with one of the regions from which donors were coming from, is intriguing and further studies may confirm possible related genetic evolution.

Improving Iron and Folic Acid Supplementation Among Pregnant Women: An Implementation Science Approach in East-Central Uganda

INTRODUCTION

To address maternal iron-deficiency anemia and low uptake of iron and folic acid supplementation (IFAS) among antenatal care (ANC) clinic attendees in East-Central Uganda, the Anemia Implementation Science Initiative embedded enhanced quality improvement (QI) activities into an integrated health project utilizing QI methodologies.

METHODS

To address 2 bottlenecks of stock-outs and inadequate health education for pregnant women during ANC, an enhanced QI intervention was implemented from July 2019 to September 2020 in 2 districts. We conducted a mixed-methods effectiveness quasi-experimental study to assess whether the intervention increased the availability of IFAS in the intervention districts. We used longitudinal facility-level data from 2 treatment districts and 1 comparison district for the quantitative results. Difference-in-difference estimation was used to measure the impact of the intervention on IFAS health education and IFA availability at the health facility. We used logistic regression modeling to control for factors associated with IFAS uptake and potential differences in baseline values. Researchers conducted exit interviews with ANC clients and in-depth interviews with providers and district managers for greater insights into the implementation process.

RESULTS

The intervention increased the probability, at a statistically significant level, of pregnant women both receiving IFAS and receiving health education on IFAS during ANC. According to inter-viewees, the intervention approach improved stakeholder engagement and buy-in, which brought about change at all levels of the health system.

DISCUSSION

The intervention successfully addressed the 2 main bottlenecks to availability of IFAS for pregnant women attending ANC-inadequate provision of IFAS education and a weak drug quantification process. Even without additional funds to purchase commodities, this approach improved district capacity to advocate for and manage IFAS commodities. It could also be used to strengthen overall ANC quality.