Food Insecurity, Prenatal Care and Other Anemia Determinants in Pregnant Women from the NISAMI Cohort, Brazil: Hierarchical Model Concept

Abstract

To identify the prevalence of anemia and its relation to food insecurity (FI) and other determinants in pregnant women. A cross-sectional, cohort-nested study, with the participation of 245 pregnant women who were cared for at Family Health Units in the municipality of Santo Antônio de Jesus, Bahia, Brazil. The participants underwent blood tests for hemoglobin levels, anthropometric examinations, and answered a structured questionnaire. The hemoglobin (Hb) parameter (Hb< 11 g/dL) was used for the classification of the diagnosis of anemia. Food insecurity was evaluated using the North American short-scale food insecurity assessment. Logistic regression was adopted for the statistical analyses, based on a hierarchical conceptual model that enabled the measurement of the decomposition of the total effect of its non-mediated and mediated components using the proposed hierarchical levels. The prevalence of anemia in the studied population was of 21.8%, and the average hemoglobin was 12.06 g/dL (standard deviation [SD]: 1.27). Food insecurity was identified in 28.16% of the pregnant women. The average maternal age was 25.82 years (SD: 5.94). After ranking, the variables positively associated with anemia remained significant: FI (odds ratio [OR] =3.63; 95% confidence interval [95%CI]: 1.77-7.45); not undergoing prenatal care (OR = 5.15; 95%CI: 1.43-18.50); multiparity (OR = 2.27; 95%CI: 1.02-5.05); and non-supplementation of iron medication (OR = 2.45; 95%CI: 1.04-5.76). The results also indicated that the socioeconomic and environmental factors were largely mediated by food insecurity and factors regarding prenatal care. In the present study, the chance of occurrence of anemia in pregnant women was significantly higher, mainly among women: in situations of food insecurity, not undergoing prenatal care, not having received iron supplements, and who are multiparous.

Food insecurity and anaemia risk: a systematic review and meta-analysis

“…The present results agree with previous studies which showed that there was an overall positive relationship between food insecurity and anaemia risk ( 14 , 15 , 21 , 33 ) . Similar results were observed for IDA ( 20 , 30 ) .…”

“…1). A total of nineteen studies met the inclusion criteria to be included in the pooled analysis (13)(14)(15)(16)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) . Among these (58) describing the systematic literature search and selection of studies on food insecurity and anaemia risk Fischer et al…”

“…The risk ratios of 95993 individuals in these studies were pooled for the meta-analysis. These studies were published between 2006 and 2017, and performed in the USA ( 13 , 20 – 22 , 34 ) , Brazil ( 26 , 29 , 33 ) , Mexico ( 14 , 16 ) , China ( 28 ) , India ( 31 ) , Nepal ( 23 ) , Indonesia ( 24 ) , Canada ( 25 ) , Vietnam ( 27 ) , Ecuador ( 34 ) , Bangladesh ( 15 ) and Pakistan ( 30 ) . Table 1 summarizes the characteristics of the studies included.

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“…Food insecurity, through the causation of anaemia (13,21,30) , can lead to poor scholastic performance and cognitive impairment (41) and increase susceptibility to infection, morbidity and mortality in children (42) . Also, maternal anaemia can lead to poor pregnancy outcomes, including (34) Eicher-Miller et al (2009) (21) Osei et al (2010) (23) Campbell et al (2011) (24) Fischer et al (2014) (14) Pirkle et al (2014) (25) Shen et al (2015) (28) Lisbôa et al (2015) (26) Nguyen et al (2015) (27) Gubert et al (2016) (29) Jones et al (2016) (16) Weigel et al (2016) (32) Metallinos-Katsaras et al (2016) (13) Ghose et al (2016) (15) Habib et al (2016) (30) Nair et al (2016) (31) Demétrio et al (2017) (33) Overall (21) Park et al (2009) (22) Skalicky et al (2006) (20) Pirkle et al (2014) (25) Overall (I 2 = 0 . 0 %, P = 0 .…”

Morbidade Hospitalar, Associada Ao Aparelho Circulatório Em Santo Antônio De Jesus - Bahia

“…O município de Santo Antônio de Jesus apresenta uma área territorial de 261 km 2 e está localizada a 187 km do município de Salvador. Considerada um centro comercial e de serviços, localizado na região conhecida como Recôncavo, na costa sul do Estado da Bahia 7 . O município não pode ser considerado uma "cidade dormitório", com caráter residencial e deslocamentos pendulares daqueles que ali vivem 8 , visto que, de acordo com o Censo (2010) 6 , a maior parte da população adulta reside na zona urbana e trabalha no município.…”