Ehsanul Hoque

Prevalence of anaemia in pregnancy in the Uthungulu health district of KwaZulu-Natal, South Africa

Abstract Background An estimated 30% of the worlds population is affected with anaemia. Anaemia in pregnancy is a leading cause of maternal and perinatal deaths in developing countries. In developing countries, anaemia affects almost two thirds of the pregnant population. It is also estimated that anaemia is responsible for as much as 20% of all maternal deaths in sub-Saharan Africa. Maternal anaemia is a risk factor for infant iron deficiency anaemia and, if left uncorrected, can be associated with adverse behavioural and cognitive development in children. The prevalence of anaemia in pregnancy is estimated at between 35% and 75% in sub-Saharan Africa, however, the area-specific health problems during pregnancy are not known. In order to improve maternal health and the health of the foetus during pregnancy, knowledge of the prevalence or incidence of pregnancy-related conditions would be useful for district management teams, as well as for provincial and national maternal, child and womens health programme development. The objectives of this study were to describe haemoglobin levels and estimate the prevalence of anaemia among pregnant women at their booking visit. Methods A retrospective cross-sectional descriptive study was conducted using the antenatal clinic registers of primary healthcare (PHC) clinics in the Empangeni subdistrict of the Uthungulu Health District from July to December 2003. Data were gathered from 1 214 consecutive pregnant women who attended for antenatal care at three randomly selected primary healthcare clinics during the study period. We examined the distribution of Hb values to determine the percentages of women with anaemia (Hb < 10 gm/dL) and severe anaemia (Hb < 7 gm/dL), and compared this with the prevalence of anaemia according to the WHO definition (Hb < 11 gm/dL). Results In terms of the South African National Department of Health definition of anaemia in pregnancy, (haemoglobin < 10 gm/dL), 30.1% of the attendees were anaemic. According to the World Health Organisation (WHO) criteria (Hb < 11 gm/dL), the prevalence of anaemia was 57.3%. The difference in the prevalence of anaemia on the basis of the two different criteria was significant (p = 0.000). This finding was comparable to studies conducted in other Sub-Saharan African countries. Conclusion The prevalence of anaemia in pregnancy in this community is high. The prevalence of anaemia varied greatly when the WHO definition was used. The pregnant women of this community attend the healthcare facility very late for their booking visit, in spite of free maternity services at public health facilities. There is an urgent need for health education and health promotion programmes in this population for early booking for antenatal care. Further investigations are needed to establish the risk factors for, causes of and preventive interventions for anaemia in pregnancy.

Risk factors for anaemia in pregnancy in rural KwaZulu-Natal, South Africa: Implication for health education and health promotion

Abstract Background: Anaemia in pregnancy is a major public health problem in developing countries. It is associated with an increased risk of maternal and perinatal morbidity and mortality. A high rate of anaemia in pregnancy in the rural population of KwaZulu-Natal (30% according to national and 57% according to the World Health Organization [WHO] definition of anaemia in pregnancy) is observed. The risk factors for anaemia, particularly during pregnancy, are multiple and complex and their relative contributions are known to vary by geographic areas and by seasons. In order to design an intervention for treatment and prevention of anaemia in pregnancy, studies to assess the aetiological factors are necessary. The aim of this study was to evaluate the strength of association between intestinal helminthiasis, urinary schistosomiasis and HIV infection on anaemia in pregnancy. Methods: A retrospective case-control study design was used in a rural district hospital of South Africa. A total of 300 pregnant women, 100 of them with anaemia (haemoglobin less than 10 gm/dL according to the national definition of anaemia in pregnancy) referred as cases and 200 controls were studied from Empangeni Hospital. Both cases and controls were matched for age, parity and gestational age. Data were collected from the antenatal clinic and prevention of mother-to-child transmission of HIV (PMTCT) programme registers for cases and controls at their booking visit during the months of May, June and July of 2004. Univariate and multiple logistic regression were performed to analyse the data. Results: Of the cases, 48% and 1% among the controls had intestinal helminthiasis, resulting in the odds ratio of 42 (p = 0,000 and 95% CI 9,96–176.59). The risk of anaemia was related to urinary schistosomiasis, as 27% of the cases compared to 1% of controls was found with anaemia. The odds ratio was 12 (p = 0,000 and 95% CI 3.58 - 41.02). These parasitic infestations are known to cause chronic haemorrhage and iron deficiency resulting in the development of anaemia in pregnancy. Transmissions of intestinal parasitic infestation occur through the faecal-oral route. Personal hygiene and other environmental factors are therefore an important factor for the transmission of the disease. To reduce the transmission of faecal- oral diseases (e.g. intestinal helminthiasis and urinary schistosomiasis) key interventions recommended are: 1) safe disposal of human excreta, 2) hand-washing practices with soap after defecation, and 3) maintenance of drinking water free from faecal contamination. Similarly, HIV infection increased the chance of developing anaemia in pregnancy twofold as HIV infection was more common among cases (56%) than among controls (37%), resulting in an odds ratio of 2.11 (p = 0,003 and 95% CI 1.123–3.21). The prevention of HIV infection and transmission can be achieved through the improvement of knowledge of these conditions. These can be achieved through health education and health promotion. Conclusion: These findings confirm and conform to other studies on the association between anaemia in pregnancy and parasitic and HIV infections. Antenatal care should promote de-worming and education on personal hygiene and HIV (risk factors, mode of transmission, etc.). The provision of safe water supply and toilet facilities for the rural communities should be considered urgently to prevent and promote better health for all, including pregnant women.