Abstract
Anemia is a significant risk factor for poor health outcomes for both the mother and neonate; however, the determinants of anemia in many epidemiological settings are poorly understood. Using a subset of a nationally representative cluster survey (2010 Demographic and Health Survey) in combination with other non-contemporaneous survey data, the epidemiology of anemia among women of reproductive age in Timor-Leste has been explored. Logistic regression was used to identify risk factors, population-level impacts were estimated as population attributable fractions and spatial analytics were used to identify regions of highest risk. The DHS survey found that ∼21% of adult women in Timor-Leste are anemic (49,053; 95% CI: 37,095 to 61,035), with hemoglobin <12.0 g/dL. In this population, the main risk factors (adjusted odds ratio; 95% CI) are: currently abstaining from sex for any reason (2.25; 1.50 to 3.38); illiteracy (2.04; 1.49 to 2.80); giving birth within the previous year (1.80; 1.29 to 2.51); consumption of fruits/vegetables low in vitamin A (1.57; 1.13 to 2.20); and the district-level confirmed malaria incidence (1.31; 1.15 to 1.49). A review of prior soil-transmitted helminth surveys in Timor-Leste indicates low-to-moderate prevalence with generally low egg counts, suggesting a limited impact on anemia in this setting, although comprehensive survey data are lacking. Examination of the population-level effects highlights the impacts of both recent births and malaria on anemia, with more limited impacts from diet; the evidence does not suggest a large contribution from geohelminths within Timor-Leste. These patterns are divergent from some other settings in the Asia-Pacific region and highlight the need for further focused research. Targeting high-burden districts and by increasing access to pre/postnatal care, raising literacy levels, increasing access to family planning, and improving malaria control should be prioritized to maximize inherently limited health budgets in reaching these populations.
Highlights
Anemia is both a cause and an indicator of poor health states among women, neonates, and children
The main risk factors for anemia in this population are currently abstaining from sex for any reason; and illiteracy (OR = 2.04; 95% 1.49 to 2.80)
It is important to note that abstinence from sex in Timor-Leste is generally associated with the postnatal period, and essentially all Timorese women in the overall Demographic and Health Survey (DHS) who recently gave birth (93 percent) are still abstaining from sex in the eight weeks after giving birth
Summary
Anemia is both a cause and an indicator of poor health states among women, neonates, and children. The primary risk factors globally are dietary deficiencies, high parity, diarrheal episodes, and parasitemia (malaria and geohelminths, especially hookworms) [1]. The World Health Organization (WHO) estimates that approximately 470 million non-pregnant women are anemic worldwide, with the largest contribution (39%) coming from the WHO Southeast Asian (SEARO) countries [2][3]. It has been estimated that anemia is the third largest contributor to total disability-adjusted life years (DALYs) among adult women (15–44 years) globally [4]. The dominant risk factors in the Southeast Asia Pacific region overall are dietary iron deficiency, followed by malaria and high fertility, with more limited impacts from hookworms and HIV/AIDS [1][5]
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