Abstract
To determine the prevalence of anaemia during pregnancy in Anuradhapura district and evaluate present screening methods for anaemia. Modified WHO 30 cluster sampling method with increased precision was used to estimate the prevalence of anaemia in the Anuradhapura district, Sri Lanka. Serum haemoglobin was measured using methemoglobin method. Clinical examination was carried out to evaluate the conjunctival method in anaemia screening. Values recorded from haemoglobin colour scale method used in the field antenatal clinics were collected. A total of 990 pregnant women participated in the study. In the first, second and third trimesters, prevalence of anaemia was 7.6%, 19.7% and 19.3% respectively. Gestational age adjusted anaemia prevalence among pregnant women in this study population was 14.1% (95% CI 12.0-16.4%). Mean and median haemoglobin concentration of the study sample was 11.8g/dL (SD 1.02g/dl and IQR 11.2-12.5g/dl). Among anaemic pregnant women, average values for Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), and Mean Corpuscular Haemoglobin Concentration (MCHC) were, 82.9 fl (SD 11.5), 27.6 (SD-3.6) pg/cell and 32.9g/dl (SD 1.8) respectively. Sensitivity and specificity of haemoglobin colour scale method was 50% (95% CI 29.0-71.0%) and 76.3% (95% CI 66.9-83.7%) respectively. Sensitivity and specificity of conjunctival method in detecting anaemia during pregnancy was 18.8% (95% CI 11.9-28.4) and 69.3% (95% CI 58.2- 78.6%). Prevalence of anaemia in the district of Anuradhapura was less than 50% of the estimated prevalence for Sri Lanka. Both haemoglobin colour scale and conjunctival method were having low validity in detecting anaemia in pregnancy.
Highlights
Anaemia in pregnancy has been a long known major maternal morbidity condition in Sri Lanka
Gestational age adjusted anaemia prevalence among pregnant women in this study population was 14.1%
Sensitivity and specificity of haemoglobin colour scale method was 50% and 76.3% respectively
Summary
Anaemia in pregnancy has been a long known major maternal morbidity condition in Sri Lanka. Most recent WHO estimates show that the prevalence of anaemia during pregnancy in Sri Lanka as 29.3% [1]. Sri Lanka Demographic and Health Survey (DHS) data in 2007 shows similar results with an overall anaemia prevalence of 34%, with 20.7% mild anaemia and 13.3% moderate to severe anaemia [2]. Sri Lankan maternal health programme contain several evidence based strategies to prevent anaemia during pregnancy. Malaria chemoprophylaxis, routine antihelminthic treatment, regular clinical examination and screening for anaemia using Hb colour scale (HCS) method. Though routine serum Hb measurements in the booking visit and around 34 weeks are recommended, lack of laboratory facilities and resources impede universal application of latter recommendation in Sri Lanka
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