Maternal anemia is a potential risk factor for anemia in children aged 6–59 months in Southern Africa: a multilevel analysis

Ntenda, Peter Austin Morton; Nkoka, Owen; Bass, Paul; Senghore, Thomas

doi:10.1186/s12889-018-5568-5

Cited by 67 publications

(97 citation statements)

References 46 publications

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“…The current study found that there is a higher odds of anemia among women in the anemia cluster (identi ed by SaTScan) than outside of the cluster. This in line was the ndings of other studies (38,39). The possible explanation is that women with anemia and anemic children live in a similar socioeconomic, cultural and health related environment (37,40).…”

Section: Discussionsupporting

confidence: 90%

Geospatial Inequality of Anemia Among Children in Ethiopia

Endris

Dinant

Gebreyesus

et al. 2020

Preprint

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Background: Anemia remains a severe public health problem among children in Ethiopia. The lack of progress in the trend of anemia infers the failure of national anemia prevention and control programs. If there are considerable geospatial differences in the prevalence of anemia in Ethiopia, targeted approaches, based on the distribution and specific risk factors for that setting are needed to efficiently target health interventions. This study aimed to identify and locate anemia hotspots among children in Ethiopia. Methods: Data analysis was performed using Ethiopia Demographic and Health Survey (EDHS) 2016 Data. Blood specimens for anemia testing were collected from children age 6-59 months. Hemoglobin analyses were placed in a HemoCue photometer and the results were recorded onsite for 9,268 children. The outcome variable anemia was categorized into a dichotomous variable (anemic and not anemic); a child was considered as anemic if the blood-hemoglobin count was less than 11.0 g/dl. We applied Kulldorf’s spatial scan statistics and used SaTScanTM to identify locations and estimate cluster sizes. In addition, we ran LISA (local indicator of spatial association) and the Getis-Ord Gi(d) local statistics to detect and locate hotspots of anemia. We ran multilevel multivariable analysis to identify risk factors for anemia clustering.Result: More than half (57%) of children aged 6-59 months were anemic in Ethiopia. Higher prevalence of anemia was found among children who live in Somali region (83%), in rural area (58%), in the lowest wealth quintile (68%), and among children of mothers’ with no education (59%). We found significant geospatial inequality of anemia among children in Ethiopia. We identified one anemia cluster (hotspot) in the eastern part of Ethiopia. Women anemia, stunting and high fertility were associated with anemia clustering.Conclusion: Anemia clustering was found in the eastern part of Ethiopia. We recommend that policy makers and programmers should especially target this area for accelerated reduction of anemia.

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Section: Discussionsupporting

confidence: 90%

Geospatial Inequality of Anemia Among Children in Ethiopia

Endris

Dinant

Gebreyesus

et al. 2020

Preprint

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“…Moreover, the usual definition of PPH (blood loss ≥500 mL during vaginal delivery and ≥1000 mL during cesarean section) may not be clinically relevant in sub‐Saharan Africa, where small amounts of blood loss may have detrimental outcomes in patients with preexisting severe (hemoglobin <7 g/d) or moderate anemia (hemoglobin 7‐9.9 g/d). Although never formally studied, this is important to note, since the prevalence of maternal anemia approaches 80% in some countries, compared to approximately 5% in the United States . Additionally, there is clinical evidence that anemia can increase the risk of surgical bleeding and PPH …”

Section: Introductionmentioning

confidence: 99%

“…Although never formally studied, this is important to note, since the prevalence of maternal anemia approaches 80% in some countries, compared to approximately 5% in the United States. [12][13][14][15] Additionally, there is clinical evidence that anemia can increase the risk of surgical bleeding and PPH. [16][17][18][19][20] In an effort to target interventions to prevent and treat PPH in Mozambique, we sought to define the rate of PPH and identify risk factors that contribute to PPH and mortality in Maputo Central Hospital, the largest university hospital in Mozambique.…”

Section: Introductionmentioning

confidence: 99%

Maternal death and postpartum hemorrhage in sub‐Saharan Africa – A pilot study in metropolitan Mozambique

Lancaster

Barnes

Correia

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Background Maternal mortality in sub‐Saharan Africa is approximately 500 to 1000 per 100 000 births (vs. approximately 5‐20 in developed countries). Postpartum hemorrhage (PPH) is deemed responsible for 30% to 50% of the deaths. Objective To study PPH, risk factors, and mortality in metropolitan Mozambique to inform future studies and intervention strategies. Materials/Methods Retrospective cross‐sectional data extraction from all charts available to us (n = 495) recording deliveries between January and June 2018 at Maputo Central Hospital. Data included age, maternal survival, HIV status, parity, delivery mode, complications, vital signs, laboratory values, and maternal/fetal data. PPH was determined by charted diagnosis, interventions for hemorrhaging, placental abruption, transfusion, or blood loss. Autopsy reports from all deceased patients (n = 35) were examined. Results Median age was 29 years with 17% HIV prevalence. Risk factors for PPH (frequency, 12%) included parity (adjusted odds ratios (AORs) for 3+ versus nulliparity, 7.20 (95% confidence interval [CI], 2.46‐21.10), gestation length (AOR, 0.86; CI, 0.81‐0.92 per week), and body temperature (AOR, 1.10; CI, 1.04‐1.16 per 0.1°C). Maternal mortality was strongly associated with PPH (AOR, 5.22; 95% CI, 2.26‐12.08) and HIV (AOR, 11.66; 95% CI, 4.72‐28.78). Laboratory values (n = 241) were available from mothers experiencing complications (approximately 50%). Anemia (prevalence 54%) was a strong predictor of PPH with an inverse relationship between hemoglobin levels on admission (AOR, 0.62; 95% CI, 0.50‐0.77 per g/dL higher hemoglobin) and the probability of later suffering from PPH. Mothers who died following PPH had lower median hemoglobin (6.2 g/dL) than mothers who survived (9.2 g/dL). Protocols to estimate peripartum blood loss were not used; antifibrinolytics and/or cryoprecipitate were unavailable. Conclusion Postpartum hemorrhage is a serious problem even in metropolitan areas of sub‐Saharan Africa, and anemia influenced bleeding and death substantially. To address this problem, it is critical to raise awareness and region‐specific prevention and intervention protocols.

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“…Maternal obesity increases the risk of various adverse pregnancy outcomes [3] and can affect offspring health [4,5]. Previous studies showed that maternal obesity had been linked to maternal anemia [6,7] and iron deficiency [8] that can predispose offspring to anemia [9,10]; maternal obesity could reduce the iron store of newborn [11][12][13][14] that likely leads to anemia in later life [15]. However, direct assessment of the association between maternal obesity and offspring anemia is lacking.…”

Section: Introductionmentioning

confidence: 99%

Association of maternal BMI during early pregnancy with infant anemia: a large Chinese birth cohort

Yin

Zhou

et al. 2020

Nutr Metab (Lond)

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Background: Infant anemia is prevalent in low-and middle-income countries. Maternal body mass index (BMI) is associated with serum ferritin in cord blood, but as yet has not been linked to infant anemia. The objective of this study was to examine the association of maternal BMI during early pregnancy with infant hemoglobin levels and anemia at 6 and 12 months in a Chinese birth cohort. Methods: The prospective cohort included 17,193 mother-infant pairs. Maternal weight and height prior to 20 gestational weeks as well as infant hemoglobin at 6 and 12 months were measured following standard procedures, and BMI was calculated as weight in kilograms divided by the square of height in meters. Women were categorized into underweight, normal weight (reference), overweight, and obesity. Infant anemia was defined as hemoglobin < 11.0 g/dl. Fractional polynomial regression was used to examine the relation between maternal BMI and infant hemoglobin, joinpoint regression to identify breakpoints, and logistic regression to estimate odds ratios (ORs). Results: In the cohort, 1160 (6.8%) were anemic at 6 months and 904 (5.3%) at 12 months. An inverse U-shaped relation of maternal BMI with infant hemoglobin was found at 6 months, at their maximum at maternal BMI of 22.4 kg/m 2 , and a similar relationship found again at 12 months. Maternal obesity rather than underweight was associated with an increased risk of anemia for infants at 6 months (adjusted OR 1.39, 95% CI 1.02, 1.88), but not at 12 months. Maternal anemia during mid-pregnancy augmented the risk at 6 months (adjusted OR 2.91, 95% CI 1.14, 7.46), but did not mediate the association (Z = − 1.102, P = 0.270). Conclusions: Maternal BMI during early pregnancy is correlated with infant hemoglobin in an inverse U-shaped profile, and obesity increases infant anemia risk that is aggravated by maternal anemia during pregnancy. This study enriched the epidemiological evidence on the adverse effect of high maternal BMI on long-term health of offspring. Optimizing maternal weight in obstetric care is necessary to improve offspring health.

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Maternal anemia is a potential risk factor for anemia in children aged 6–59 months in Southern Africa: a multilevel analysis

Cited by 67 publications

References 46 publications

Geospatial Inequality of Anemia Among Children in Ethiopia

Geospatial Inequality of Anemia Among Children in Ethiopia

Maternal death and postpartum hemorrhage in sub‐Saharan Africa – A pilot study in metropolitan Mozambique

Association of maternal BMI during early pregnancy with infant anemia: a large Chinese birth cohort

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