Abstract
Background: Anaemia in pregnancy, which can lead to adverse maternal and fetal outcomes, is a significant global health problem. Despite Sri Lanka’s strong public health system and commitment towards prevention, maternal anaemia remains a major problem in the country. While prevention is focused on iron deficiency, detailed etiological studies on this topic are scarce. Moreover, estimates of socio demographic and economic factors associated with anaemia in pregnancy, which can provide important clues for anaemia control, are also lacking. This study aims to evaluate the hemoglobin distribution, spatial distribution, etiology and associated factors for anaemia in pregnant women in Anuradhapura, Sri Lanka. Methods: This is a cross sectional study of pregnant women in their first trimester registered for antenatal care from July to September 2019 in the Anuradhapura district. The minimal sample size was calculated to be 1866. Initial data collection has already been carried out in special field clinics for pregnant women between June to October 2019. An interviewer-administered questionnaire, a self-completed dietary questionnaire and an examination checklist were used for data collection. In addition, all participants underwent complete blood count testing. Further investigations are being conducted for predicting the etiology of anaemia based on a developed algorithm (such as high-performance liquid chromatography [HPLC] and peripheral blood film analysis). Discussion: Being the largest study on anaemia during pregnancy in a single geographical area in Sri Lanka, this study will provide important clues about geographical clustering of anaemia cases with similar etiology, associated factors and etiologies which would help to develop interventions to improve the health of pregnant women in the area. The possibility of selection bias is a potential limitation associated with the study design.
Highlights
Anaemia in pregnancy is associated with many adverse outcomes for the mothers as well as her offspring[1,2,3,4]
The Anuradhapura district is divided into 275 public health midwife (PHM) divisions within 22 medical officers of health (MOH) areas (Figure 1) which conduct village level antenatal clinics
Batch processing and testing of stored samples and data analysis is ongoing. This is the largest study on anaemia in pregnancy in a single district of Sri Lanka
Summary
Anaemia in pregnancy is associated with many adverse outcomes for the mothers (such as loss of productivity, heart failure and even death) as well as her offspring (such as low birth weight, anaemia and developmental problems)[1,2,3,4]. In 2018, 22.8% of pregnant women in the Anuradhapura district were identified as anemic during their initial visit to an antenatal clinic and despite routine interventions for iron deficiency anaemia, the prevalence was almost triple among the second trimester women[22]; amounting to a severe public health problem[23]. This raises the question of whether etiologies other than iron deficiency are significantly responsible for anaemia in this population. This study will explore the prevalence, distribution and etiologies of anaemia among first trimester pregnant women in the Anuradhapura district, Sri Lanka
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