Abstract
BackgroundAnemia in pregnancy represents a global public health concern due to wide ranging maternal and neonatal adverse outcomes in all peripartum periods. We estimated the prevalence and factors associated with anemia in pregnancy at a national obstetrics and gynecology referral hospital in Uganda and in addition performed a systematic review and meta-analysis of the overall burden of anemia in pregnancy in Uganda.MethodsWe conducted a cross-sectional study among 263 pregnant women attending the antenatal care clinic of Kawempe National Referral Hospital, Kampala, Uganda, in September 2020. Anemia in pregnancy was defined as a hemoglobin level of < 11.0 g/dl and microcytosis as a mean corpuscular volume (MCV) of < 76 fL. We also performed a systematic review (PROSPERO Registration ID: CRD42020213001) and meta-analysis of studies indexed on MEDLINE, Embase, African Journal Online, ClinicalTrials.gov, ICTRP, and the Cochrane Library of systematic review between 1 January 2000 and 31 September 2020 reporting on the prevalence of anemia in pregnancy in Uganda.ResultsThe prevalence of anemia was 14.1% (n= 37) (95%CI 10.4–18.8), of whom 21 (56.8%) had microcytic anemia. All cases of anemia occurred in the second or third trimester of pregnancy and none were severe. However, women with anemia had significantly lower MCV (75.1 vs. 80.2 fL, p<0.0001) and anthropometric measurements, such as weight (63.3 vs. 68.9kg; p=0.008), body mass index (25.2 vs. 27.3, p=0.013), hip (98.5 vs. 103.8 cm, p=0.002), and waist (91.1 vs. 95.1 cm, p=0.027) circumferences and mean systolic blood pressure (BP) (118 vs 125 mmHg, p=0.014). Additionally, most had BP within the normal range (59.5% vs. 34.1%, p=0.023). The comparison meta-analysis of pooled data from 17 published studies of anemia in pregnancy in Uganda, which had a total of 14,410 pregnant mothers, revealed a prevalence of 30% (95% CI 23–37).ConclusionsDespite our study having a lower prevalence compared to other studies in Uganda, these findings further confirm that anemia in pregnancy is still of public health significance and is likely to have nutritional causes, requiring targeted interventions. A larger study would be necessary to demonstrate potential use of basic clinical parameters such as weight or blood pressure as screening predictors for anemia in pregnancy.
Highlights
Anemia in pregnancy, defined as hemoglobin level less than 11 g/dl, is a serious public health problem that is estimated by the World Health Organization (WHO) to affect approximately 40% of pregnant women globally [1]
The maternal mortality ratio in Uganda is as high as 336 deaths per 100,000 live births according to the Uganda Demographic Health Survey (UDHS), 2016 [3]
We aimed to determine the prevalence of anemia among pregnant women at Kawempe National Referral Hospital (KNRH) and to conduct a systematic review and meta-analysis to precisely define the prevalence of anemia in Uganda as a whole
Summary
Anemia in pregnancy, defined as hemoglobin level less than 11 g/dl, is a serious public health problem that is estimated by the World Health Organization (WHO) to affect approximately 40% of pregnant women globally [1]. From the global burden of disease study, there has been a slight decrease in the prevalence of anemia from 43% (39–47%) to 38% (34–43%) among pregnant women compared to 33% (29–38%) to 29% (24–35%) in nonpregnant women between 1995 and 2011 [2]. Irrespective of the etiology, anemia in pregnancy has been associated with serious adverse pregnancy outcomes, including high maternal and perinatal morbidity and mortality, antenatal and postnatal sepsis, maternal transfusion requirement, impaired cognitive development in children, increased risk of small for gestation age and low birth weight neonates, and prematurity [8, 9]. Anemia in pregnancy represents a global public health concern due to wide ranging maternal and neonatal adverse outcomes in all peripartum periods.
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