BMJ Global Health | 2021
The need for standard definitions in global data comparison: lessons from studying the prevalence of anaemia during pregnancy in Sri Lanka
Abstract
Correspondence to Prof Suneth Buddhika Agampodi; sunethagampodi@ yahoo. com © Author(s) (or their employer(s)) 2021. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. Despite continuous efforts to combat anaemia in pregnancy, many countries are still far from controlling this global health issue. Daru et al have reported that even in the past decade, the odds of death among pregnant women with severe anaemia were 2.36 compared with other pregnant women. Though alarming, even these odds have been pointed out to be an underestimation of the actual magnitude of the problem calling for comprehensive strategies to address anaemia in pregnancy. Exerting universal consensus on definitions for anaemia in pregnancy is of utmost importance as such strategies require correct quantification of the disease burden and its distribution. With its focus on universal healthcare, Sri Lanka has been able to achieve good maternal care indicators both in care coverage as well as outcomes. However, the Global Health Observatory Data Repository has placed Sri Lanka as a country with poor performance with regard to maternal anaemia, with more than 100 countries performing better than Sri Lanka. In 2018, prevalence of anaemia among Sri Lankan pregnant women was reported as 29.1%, and 8 of its 25 districts reported that more than onethird of their pregnant population was anaemic. These prevalence data are compiled based on the National Guidelines for Maternal Care which recommends haemoglobin assessment at the booking visit and around 28 weeks of period of gestation (POG). In accordance with the previous WHO recommendations, the national pregnancy care programme uses a universal haemoglobin cutoff of 110 g/L to identify anaemia throughout the pregnancy period. However, the revised WHO guideline recommends using a lower haemoglobin cutoff of 105 g/L during the second trimester of pregnancy. 6 Similar recommendations are being practised elsewhere in the world including the USA, UK and Australia. A recent large communitybased pregnancy cohort study conducted in Sri Lanka (Rajarata Pregnancy Cohort) provided comprehensive data on the probable overestimation of anaemia in pregnancy due to the differences in the threshold values used. The study was conducted in Anuradhapura, a district where the reported prevalence of anaemia in pregnancy was almost 50%. According to the maternal health statistics of the district, the cohort had included 86% of its pregnant population registering for antenatal care from July to September 2019. Among 1366 Summary box