Dataset Information

Mapping of anaemia prevalence among pregnant women in Kenya (2016-2019).

ABSTRACT:

Background

Reducing the burden of anaemia is a critical global health priority that could improve maternal outcomes amongst pregnant women and their neonates. As more counties in Kenya commit to universal health coverage, there is a growing need for optimal allocation of the limited resources to sustain the gains achieved with the devolution of healthcare services. This study aimed to describe the spatio-temporal patterns of maternal anaemia prevalence in Kenya from 2016 to 2019.

Methods

Quarterly reported sub-county level maternal anaemia cases from January 2016 - December 2019 were obtained from the Kenyan District Health Information System. A Bayesian hierarchical negative binomial spatio-temporal conditional autoregressive (CAR) model was used to estimate maternal anaemia prevalence by sub-county and quarter. Spatial and temporal correlations were considered by assuming a conditional autoregressive and a first-order autoregressive process on sub-county and seasonal specific random effects, respectively.

Results

The overall estimated number of pregnant women with anaemia increased by 90.1% (95% uncertainty interval [95% UI], 89.9-90.2) from 155,539 cases in 2016 to 295,642 cases 2019. Based on the WHO classification criteria, the proportion of sub-counties with normal prevalence decreased from 28.0% (95% UI, 25.4-30.7) in 2016 to 5.4% (95% UI, 4.1-6.7) in 2019, whereas moderate anaemia prevalence increased from 16.8% (95% UI, 14.7-19.1) in 2016 to 30.1% (95% UI, 27.5-32.8) in 2019 and severe anaemia prevalence increased from 7.0% (95% UI, 5.6-8.6) in 2016 to 16.6% (95% UI, 14.5-18.9) in 2019. Overall, 45.1% (95% UI: 45.0-45.2) of the estimated cases were in malaria-endemic sub-counties, with the coastal endemic zone having the highest proportion 72.8% (95% UI: 68.3-77.4) of sub-counties with severe prevalence.

Conclusion

As the number of women of reproductive age continues to grow in Kenya, the use of routinely collected data for accurate mapping of poor maternal outcomes remains an integral component of a functional maternal health strategy. By unmasking the sub-county disparities often concealed by national and county estimates, our study findings reiterate the importance of maternal anaemia prevalence as a metric for estimating malaria burden and offers compelling policy implications for achieving national nutritional targets.

SUBMITTER: Odhiambo JN

PROVIDER: S-EPMC7685542 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Mapping of anaemia prevalence among pregnant women in Kenya (2016-2019).

Odhiambo Julius Nyerere JN Sartorius Benn B

BMC pregnancy and childbirth 20201123 1

<h4>Background</h4>Reducing the burden of anaemia is a critical global health priority that could improve maternal outcomes amongst pregnant women and their neonates. As more counties in Kenya commit to universal health coverage, there is a growing need for optimal allocation of the limited resources to sustain the gains achieved with the devolution of healthcare services. This study aimed to describe the spatio-temporal patterns of maternal anaemia prevalence in Kenya from 2016 to 2019.<h4>Meth ...[more]

PMID: 33228585

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Project description:Anaemia in pregnancy is a major health problem and an important cause of adverse foetomaternal outcomes in developing countries. Iron deficiency is the cause of the overwhelming majority of the cases of anaemia in pregnancy. Iron deficiency anaemia (IDA) has been linked with adverse foetal and maternal outcomes. This study investigated the prevalence of IDA and evaluated its effects on foetomaternal outcomes among parturients in Lagos, Nigeria. This was a cross-sectional study that enrolled 220 women aged 15-49 years with singleton gestation at term, between May 1, 2016, and March 31, 2017. Participants were selected by systematic sampling and baseline data were collected through interviews. Venous blood samples were obtained to measure haemoglobin and serum ferritin concentrations, and the associations between IDA (defined as anaemia and iron deficiency) and pregnancy outcomes were examined. A P-value <0.05 was considered as statistically significant. The prevalence of IDA was 12.3%. Routine antenatal iron supplementation (adjusted odds ratio 0.18, 95% confidence interval 0.07-0.46; P = 0.001) and interpregnancy interval of at least 2 years (adjusted odds ratio 0.20, 95% confidence interval 0.05-0.97; P = 0.021) have significant association with IDA. Iron deficiency anaemia was not significantly associated with adverse perinatal outcomes but there were significant associations with increased risk of blood transfusion (P = 0.001) and maternal infectious morbidities such as puerperal pyrexia (P = 0.041) and wound infection (P = 0.020). IDA is still a fairly common condition among parturients in Lagos and it's mostly associated with maternal peripartum morbidities. Adequate pregnancy spacing through the use of effective contraception and routine antenatal iron supplementations in pregnancy is a recommended preventive measure against IDA and its adverse sequelae. Future studies should adopt the use of transferrin saturation (TSAT) in compliment with serum ferritin assay as a more sensitive marker of iron deficiency.

Project description:IntroductionAdverse birth outcomes particularly preterm births and congenital anomalies, are the leading causes of infant mortality globally, and the burden is highest in developing countries. We set out to determine the frequency of adverse birth outcomes and the risk factors associated with such outcomes in a cohort of pregnant women in Kenya.MethodsFrom October 2017 to July 2019, pregnant women < 28 weeks gestation were enrolled and followed up until delivery in three hospitals in coastal Kenya. Newborns were examined at delivery. Among women with birth outcome data, we assessed the frequency of congenital anomalies defined as gastroschisis, umbilical hernia, limb abnormalities and Trisomy 21, and adverse birth outcomes, defined as either stillbirth, miscarriage, preterm birth, small for gestational age, or microcephaly. We used log-binomial regression to identify maternal characteristics associated with the presence of at least one adverse outcome.ResultsAmong the 2312 women enrolled, 1916 (82.9%) had birth outcome data. Overall, 402/1916 (20.9%; 95% confidence interval (CI): 19.1-22.8) pregnancies had adverse birth outcomes. Specifically, 66/1916 (3.4%; 95% CI: 2.7-4.4) were stillbirths, 34/1916 (1.8%; 95% CI: 1.2-2.4) were miscarriages and 23/1816 (1.2%; 95% CI: 0.8-1.9) had congenital anomalies. Among the participants with anthropometric measurements data, 142/1200 (11.8%; 95% CI: 10.1 - 13.8) were small for gestational age and among the participants with ultrasound records, 143/1711 (8.4%; 95% CI: 7.1-9.8) were preterm. Febrile illnesses in current pregnancy (adjusted risk ratio (aRR): 1.7; 95% CI: 1.1-2.8), a history of poor birth outcomes in prior pregnancy (aRR: 1.8; 95% CI: 1.3-2.4) and high blood pressure in pregnancy (aRR: 3.9, 95% CI: (1.7-9.2) were independently associated with adverse birth outcomes in a model that included age, education, human immunodeficiency virus status and high blood pressure at enrolment.ConclusionWe found similar rates of overall adverse birth outcomes, congenital anomalies, and small for gestational age but higher rates of stillbirths and lower rates of prematurity compared to the rates that have been reported in the sub-Saharan Africa region. However, the rates of adverse birth outcomes in this study were comparable to other studies conducted in Kenya. Febrile illnesses during the current pregnancy, previous history of poor birth outcomes and high blood pressure in pregnancy are predictive of an increased risk of adverse birth outcomes.

Project description:BACKGROUND:Anaemia during pregnancy is a major public health problem in developing countries. It is important to regularly monitor haemoglobin level in pregnancy and factors associated with it to inform clinical and preventive services. The aim of this study was to assess the prevalence and determinants of anaemia in pregnant women attending antenatal clinic (ANC) of a tertiary referral hospital in Northern Ghana. METHODS:An analytical cross-sectional study involving 400 pregnant women receiving antenatal care in Tamale Teaching Hospital was conducted. Using a semi-structured questionnaire and 24-h dietary recall, data were collected on socio-demographic characteristics, health practices, dietary diversity, anaemia knowledge and haemoglobin level of the women. Anaemia was defined as haemoglobin concentration less than 11?g/dl. Chi-square test and logistic regression analysis were used to identify the independent determinants of pregnancy anaemia. RESULTS:The mean age and haemoglobin of the women were 28.3 (±4.5) years and 10.81 (±1.41) g/dl respectively. About half of the women 50.8% [95% Confidence Interval (CI): 45.8-55.7] were anaemic and the prevalence of anaemia increased with pregnancy trimester. Among a host of socio-demographic, dietary, and preventive health service factors evaluated, the women's knowledge on anaemia and pregnancy trimester at interview were the independent determinants of anaemia in pregnancy. Compared to women of the highest anaemia knowledge tertile, women belonging to the lowest (AOR?=?2.63, 95% CI: 1.50-4.61) and middle (AOR?=?1.92, 95% CI: 1.12-3.27) anaemia knowledge tertiles were about 3 and 2 times more likely to be anaemic respectively. Similarly, women in third trimester of pregnancy were about 4 times more likely to be anaemic compared to those in first trimester at the time of interview (AOR?=?3.57, 95% CI: 1.91-6.67). CONCLUSIONS:There is a high prevalence of anaemia, which increases with pregnancy trimester, in pregnant women attending ANC in a tertiary referral hospital in Northern Ghana. The women's knowledge on anaemia and pregnancy trimester at the time of interview are associated with their anaemia status. The high prevalence of anaemia in pregnancy needs urgent intervention to prevent the occurrence of adverse maternal and neonatal outcomes. Education on anaemia should be intensified at ANCs.

Project description:BackgroundAnaemia is associated with maternal and perinatal morbidity and mortality. The pooled prevalence of anaemia in the South African (SA) pregnant population was ascertained by systematically reviewing available literature. Severity, risk factors (HIV, tuberculosis, race, province, year of study), maternal morbidity and mortality (hypertensive disorders of pregnancy), birth outcomes (including low birth weight) and supplementation during pregnancy were also described.MethodsEligible studies reported on haemoglobin concentration or prevalence of anaemia in a SA pregnant population and were available in full text. Case-control and estimation studies were excluded with no restriction on the date of publication. PubMed, CINAHL, EMBASE, EBSCO, Ovid maternity and infant care databases, Cochrane Database of Systematic Reviews, Web of Science and SCOPUS were searched, using the keywords 'anaemia', 'haemoglobin', 'pregnancy', 'South Africa'. Risk of bias was conducted using the Hoy tool and the Doi plot and LFK ratio. Overall study quality was assessed using the GRADE tool. Due to heterogeneity amongst studies subgroup analyses were performed (random effects and quality effects model) using MetaXL addon tool for Microsoft Excel.ResultsThe initial search yielded 7010 articles and 26 were selected for inclusion. Twenty studies were cross-sectional, three were longitudinal and one a randomised control trial. Studies ranged in publication year from 1969 to 2020. The pooled prevalence of anaemia in pregnant women in SA was determined to be 31% (95% CI, 23-40%). Hypertensive disorders of pregnancy and low birth weight were associated with anaemia. While iron deficiency was reported as the main cause, other risk factors included HIV and other infections.DiscussionLimitationsThere was limited data reporting on prevalence of anaemia and direct maternal and foetal outcomes. Heterogeneity amongst studies was not explained by subgroup analysis. Majority of cross-sectional study designs reduced the ability to infer causality.InterpretationWhile the prevalence of anaemia remains high and of concern, risk factors are varied. Iron deficiency is still common but the presence of comorbidities also contributes to anaemia and should not be ignored. More longitudinal research into associations between anaemia and birth outcomes is needed due to a lack of available evidence.Systematic review registrationPROSPERO 2020: CRD42020157191.

Dataset Information

Mapping of anaemia prevalence among pregnant women in Kenya (2016-2019).

Background

Methods

Results

Conclusion

Publications

Mapping of anaemia prevalence among pregnant women in Kenya (2016-2019).

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