Prevalence and risk factors of preconception anemia: A community based cross sectional study of rural women of reproductive age in northeastern Tanzania

Omari A Msemo, Ib C Bygbjerg, Sofie L Møller, Birgitte B Nielsen, Lars Ødum, Kathrine Perslev, John P A Lusingu, Reginald A Kavishe, Daniel T R Minja, Christentze Schmiegelow, Omari A Msemo, Ib C Bygbjerg, Sofie L Møller, Birgitte B Nielsen, Lars Ødum, Kathrine Perslev, John P A Lusingu, Reginald A Kavishe, Daniel T R Minja, Christentze Schmiegelow

Abstract

Background: Anemia is a major public health problem that adversely affects pregnancy outcomes. The prevalence of anemia among pregnant women before conception is not well known in Tanzania. The aim of this study was to determine the prevalence, types, and risk factors of preconception anemia in women of reproductive age from a rural Tanzanian setting.

Methods: Trained field workers visited households to identify all female residents aged 18-40 years and invited them to the nearby health facility for screening and enrolment into this study. Baseline samples were collected to measure hemoglobin levels, serum ferritin, vitamin B12, folate, C-reactive protein, alanine amino-transferase, the presence of malaria, HIV, and soil transmitted helminth infections. Anthropometric and socio-economic data were recorded alongside with clinical information of participants. Logistic regression analysis was used to determine the adjusted odds ratios (AOR) for the factors associated with preconception anemia.

Findings: Of 1248 women enrolled before conception, 36.7% (95% confidence interval (CI) 34.1-39.4) had anemia (hemoglobin <12 g/dL) and 37.6% (95% CI 34.9-40.4) had iron deficiency. For more than half of the anemic cases, iron deficiency was also diagnosed (58.8%, 95% CI 54.2-63.3). Anemia was independently associated with increased age (AOR 1.05, 95% CI 1.03-1.07), malaria infection at enrolment (AOR 2.21, 95% CI 1.37-3.58), inflammation (AOR 1.77, 95% CI 1.21-2.60) and iron deficiency (AOR 4.68, 95% CI 3.55-6.17). The odds of anemia were reduced among women with increased mid-upper arm circumference (AOR 0.90, 95% CI 0.84-0.96).

Conclusion: Anemia among women of reproductive age before conception was prevalent in this rural setting. Increased age, iron deficiency, malaria infection and inflammation were significant risk factors associated with preconception anemia, whereas increased mid-upper arm circumference was protective against anemia. Interventions to ensure adequate iron levels as well as malaria control before conception are needed to prevent anemia before and during pregnancy and improve birth outcomes in this setting.

Trial registration: NCT02191683.

Conflict of interest statement

The authors have declared that no competing interest exist.

Figures

Fig 1. Flow chart of participants in…
Fig 1. Flow chart of participants in FOETALforNCDprepregnancy cohort.
Fig 2. Trendline graphs of proportions of…
Fig 2. Trendline graphs of proportions of anemia by age, MUAC, hip circumference, s-ferritin and CRP among non-pregnant women in Korogwe.

References

    1. Balarajan Y, Ramakrishnan U, Ozaltin E, Shankar AH,Subramanian SV Anaemia in low-income and middle-income countries. Lancet 2011; 378: 2123–2135. 10.1016/S0140-6736(10)62304-5
    1. Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data. Lancet Glob.Health 2013; 1: e16–e25.
    1. World HealthOrganization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. (2011).Available from . 9-2-2018.
    1. World Health Organization. Global nutrition targets 2025: anaemia policy brief (2014).Available from . 25-1-2018
    1. Petry N, Olofin I, Hurrell RF, Boy E, Wirth JP, Moursi M et al. The Proportion of Anemia Associated with Iron Deficiency in Low, Medium, and High Human Development Index Countries: A Systematic Analysis of National Surveys. Nutrients 2016; 8.
    1. Haidar J. Prevalence of anaemia, deficiencies of iron and folic acid and their determinants in Ethiopian women. J.Health Popul.Nutr. 2010; 28: 359–368.
    1. Haile ZT, Kingori C, Teweldeberhan AK,Chavan B. The relationship between history of hormonal contraceptive use and iron status among women in Tanzania: A population-based study. Sexual & Reproductive Healthcare 2017; 13: 97–102.
    1. Wirth JP, Rohner F, Woodruff BA, Chiwile F, Yankson H, Koroma AS et al. Anemia, Micronutrient Deficiencies, and Malaria in Children and Women in Sierra Leone Prior to the Ebola Outbreak—Findings of a Cross-Sectional Study. PLoS One 2016; 11: e0155031 10.1371/journal.pone.0155031
    1. Low MS, Speedy J, Styles CE, De-Regil LM,Pasricha SR. Daily iron supplementation for improving anaemia, iron status and health in menstruating women. Cochrane.Database.Syst.Rev. 2016; 4: CD009747 10.1002/14651858.CD009747.pub2
    1. Suchdev PS, Williams AM, Mei Z, Flores-Ayala R, Pasricha SR, Rogers LM et al. Assessment of iron status in settings of inflammation: challenges and potential approaches. Am.J.Clin.Nutr. 2017; 106: 1626S–1633S. 10.3945/ajcn.117.155937
    1. Nyaradi A, Li J, Hickling S, Foster J,Oddy WH. The role of nutrition in children's neurocognitive development, from pregnancy through childhood. Frontiers in human neuroscience 2013; 7.
    1. Dewey KG,Oaks BM. U-shaped curve for risk associated with maternal hemoglobin, iron status, or iron supplementation. Am J Clin Nutr 2017; 106: 1694S–1702S. 10.3945/ajcn.117.156075
    1. Kozuki N, Lee AC,Katz J. Moderate to severe, but not mild, maternal anemia is associated with increased risk of small-for-gestational-age outcomes. J.Nutr 2012; 142: 358–362. 10.3945/jn.111.149237
    1. Ribot B, Aranda N, Viteri F, Hernandez-Martinez C, Canals J,Arija V. Depleted iron stores without anaemia early in pregnancy carries increased risk of lower birthweight even when supplemented daily with moderate iron. Hum.Reprod. 2012; 27: 1260–1266. 10.1093/humrep/des026
    1. Ronnenberg AG, Wood RJ, Wang X, Xing H, Chen C, Chen D et al. Preconception hemoglobin and ferritin concentrations are associated with pregnancy outcome in a prospective cohort of Chinese women. J.Nutr. 2004; 134: 2586–2591. 10.1093/jn/134.10.2586
    1. Wrottesley SV, Lamper C,Pisa PT. Review of the importance of nutrition during the first 1000 days: maternal nutritional status and its associations with fetal growth and birth, neonatal and infant outcomes among African women. J.Dev.Orig.Health Dis. 2016; 7: 144–162. 10.1017/S2040174415001439
    1. Ogundipe O, Hoyo C, Ostbye T, Oneko O, Manongi R, Lie RT et al. Factors associated with prenatal folic acid and iron supplementation among 21,889 pregnant women in Northern Tanzania: a cross-sectional hospital-based study. BMC Public Health 2012; 12: 481 10.1186/1471-2458-12-481
    1. Bellows AL, Smith ER, Muhihi A, Briegleb C, Noor RA, Mshamu S et al. Micronutrient Deficiencies among Breastfeeding Infants in Tanzania. Nutrients 2017; 9: 1258.
    1. Dixon JR The international conference on harmonization good clinical practice guideline. Quality Assurance: Good Practice, Regulation, and Law 1999; 6: 65–74.
    1. Papageorghiou AT, Kennedy SH, Salomon LJ, Ohuma EO, Cheikh IL, Barros FC et al. International standards for early fetal size and pregnancy dating based on ultrasound measurement of crown-rump length in the first trimester of pregnancy. Ultrasound Obstet.Gynecol. 2014; 44: 641–648. 10.1002/uog.13448
    1. Papageorghiou AT, Kemp B, Stones W, Ohuma EO, Kennedy SH, Purwar M et al. Ultrasound-based gestational-age estimation in late pregnancy. Ultrasound Obstet.Gynecol. 2016; 48: 719–726. 10.1002/uog.15894
    1. Vyas S,Kumaranayake L Constructing socio-economic status indices: how to use principal components analysis. Health policy and planning 2006; 21: 459–468. 10.1093/heapol/czl029
    1. Schmiegelow C, Minja D, Oesterholt M, Pehrson C, Suhrs HE, Bostrom S et al. Malaria and fetal growth alterations in the 3(rd) trimester of pregnancy: a longitudinal ultrasound study. PLoS One 2013; 8: e53794 10.1371/journal.pone.0053794
    1. World Health Organization. Waist circumference and waist-hip ratio: Report of a WHO expert consultation, Geneva, (2008). Available from . 16-12-2017.
    1. Bruneel A, Dehoux M, Barnier A,Boutten A External evaluation of the Dimension Vista 1500-« intelligent lab system. Journal of clinical laboratory analysis 2012; 26: 384–397. 10.1002/jcla.21539
    1. Thurnham DI, McCabe LD, Haldar S, Wieringa FT, Northrop-Clewes CA,McCabe GP. Adjusting plasma ferritin concentrations to remove the effects of subclinical inflammation in the assessment of iron deficiency: a meta-analysis. Am.J.Clin.Nutr. 2010; 92: 546–555. 10.3945/ajcn.2010.29284
    1. Namaste SM, Rohner F, Huang J, Bhushan NL, Flores-Ayala R, Kupka R et al. Adjusting ferritin concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am.J.Clin.Nutr. 2017; 106: 359S–371S. 10.3945/ajcn.116.141762
    1. De Benoist B Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies. Food and Nutrition Bulletin 2008; 29: S238–S244. 10.1177/15648265080292S129
    1. Mwakitalu ME, Malecela MN, Mosha FW,Simonsen PE Urban schistosomiasis and soil transmitted helminthiases in young school children in Dar es Salaam and Tanga, Tanzania, after a decade of anthelminthic intervention. Acta tropica 2014; 133: 35–41. 10.1016/j.actatropica.2014.01.012
    1. Suwansaksri J, Nithiuthai S, Wiwanitkit V, Soogarun S,Palatho P. The formol-ether concentration technique for intestinal parasites: comparing 0.1 N sodium hydroxide with normal saline preparations. Southeast Asian J.Trop.Med.Public Health 2002; 33 Suppl 3: 97–98.
    1. Douglas G.Altman Practical Statistics for Medical Research Chapman and Hall/CRC; 1991; 349.
    1. Schmiegelow C, Scheike T, Oesterholt M, Minja D, Pehrson C, Magistrado P et al. Development of a fetal weight chart using serial trans-abdominal ultrasound in an East African population: a longitudinal observational study. PLoS One 2012; 7: e44773 10.1371/journal.pone.0044773
    1. Zillmer K, Pokharel A, Spielman K, Kershaw M, Ayele K, Kidane Y et al. Predictors of anemia in pregnant women residing in rural areas of the Oromiya region of Ethiopia. BMC Nutrition 2017; 3: 65–
    1. Ghosh S, Trevino JA, Davis D, Shrestha R, Bhattarai A, Anusree KC et al. Factors associated with anemia in pregnant women in Banke, Nepal. The FASEB Journal 2017; 31: 788–32.
    1. Nguyen P, Ramakrishnan U, Katz B, Gonzalez-Casanova I, Lowe AE, Nguyen H et al. Mid-upper-arm and calf circumferences are useful predictors of underweight in women of reproductive age in northern Vietnam. Food and Nutrition Bulletin 2014; 35: 301–311. 10.1177/156482651403500303
    1. Hinderaker SG, Olsen BE, Lie RT, Bergsjo PB, Gasheka P, Bondevik GT et al. Anemia in pregnancy in rural Tanzania: associations with micronutrients status and infections. Eur.J.Clin.Nutr. 2002; 56: 192–199. 10.1038/sj.ejcn.1601300
    1. Khan MN, Rahman MM, Shariff AA, Rahman MM, Rahman MS,Rahman MA. Maternal undernutrition and excessive body weight and risk of birth and health outcomes. Archives of Public Health 2017; 75: 12 10.1186/s13690-017-0181-0
    1. World Health Organization. Guideline: daily iron supplementation in adult women and adolescent girls (2016).World Health Organization. Available at 31-5-2018
    1. Bermejo F,Garcia-Lopez S. A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases. World J.Gastroenterol. 2009; 15: 4638–4643. 10.3748/wjg.15.4638
    1. Zimmermann MB Methods to assess iron and iodine status. Br J Nutr 2008; 06/01: S2–S9.
    1. Ford J Red blood cell morphology. International Journal of Laboratory Hematology 2013; 35: 351–357. 10.1111/ijlh.12082
    1. World Health Organization. Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations (2011).World Health Organization. Available at . 19-1-2018.
    1. Engle-Stone R, Nankap M, Ndjebayi AO, Erhardt JG,Brown KH. Plasma ferritin and soluble transferrin receptor concentrations and body iron stores identify similar risk factors for iron deficiency but result in different estimates of the national prevalence of iron deficiency and iron-deficiency anemia among women and children in Cameroon. J.Nutr 2013; 143: 369–377. 10.3945/jn.112.167775
    1. Rohner F, Namaste SM, Larson LM, Addo OY, Mei Z, Suchdev PS et al. Adjusting soluble transferrin receptor concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am.J.Clin.Nutr. 2017; 106: 372S–382S. 10.3945/ajcn.116.142232
    1. National Bureu of Statistics. Tanzania Demographic and Health Survey and Malaria indicator survey 2015–2016 (2016). Available at 5-6-2018
    1. Ecker O, Weinberger K,Qaim M. Patterns and determinants of dietary micronutrient deficiencies in rural areas of East Africa. African Journal of Agricultural and Resource Economics 2010; 4: 175–194.
    1. The United Republic of Tanzania:Prime minister's office. National Multisectoral Nutrition Action Plan (NMNP)-From Evidence to Policy to Action (2016). Available at . 11-11-2018.
    1. Snow CF Laboratory diagnosis of vitamin b12 and folate deficiency: A guide for the primary care physician. Archives of Internal Medicine 1999; 159: 1289–1298.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit