Abstract
BackgroundWomen of reproductive age 15–49 are at a high risk of iron-deficiency anemia, which in turn may contribute to maternal morbidity and mortality. Common causes of anemia include poor nutrition, infections, malaria, HIV, and treatments for HIV. We conducted a secondary analysis to study the prevalence of and associated risk factors for anemia in women to elucidate the intersection of HIV and anemia using data from 3 cycles of Zimbabwe Demographic and Health Survey (ZDHS) conducted in 2005, 2010, and 2015.MethodsDHS design comprises of a two-stage cluster-sampling to monitor and evaluate indicators for population health. A field hemoglobin test was conducted in eligible women. Anemia was defined as hemoglobin < 11.0 g/dL in pregnant women; < 12.0 in nonpregnant women. Chi-squared test and multivariable logistic regression analysis accounting for complex survey design were used to determine the prevalence and risk factors associated with anemia.ResultsPrevalence (95% confidence interval (CI)) of anemia was 37.8(35.9–39.7), 28.2(26.9–29.5), 27.8(26.5–29.1) in 2005, 2010, and 2015, respectively. Approximately 9.4, 7.2, and 6.1%, of women had moderate anemia; (Hgb 7–9.9) while 1.0, 0.7, and 0.6% of women had severe anemia (Hgb < 7 g/dL)), in 2005, 2010, and 2015, respectively. Risk factors associated with anemia included HIV (HIV+: 2005: OR (95% CI) = 2.40(2.03–2.74), 2010: 2.35(1.99–2.77), and 2015: 2.48(2.18–2.83)]; Residence in 2005 and 2010 [(2005: 1.33(1.08–1.65), 2010: 1.26(1.03–1.53)]; Pregnant or breastfeeding women [2005: 1.31(1.16–1.47), 2010: 1.23(1.09–1.34)]; not taking iron supplementation [2005: 1.17(1.03–1.33), 2010: 1.23(1.09–1.40), and2015: 1.24(1.08–1.42)]. Masvingo, Matebeleland South, and Bulawayo provinces had the highest burden of anemia across the three DHS Cycles. Manicaland and Mashonaland East had the lowest burden.ConclusionThe prevalence of anemia in Zimbabwe declined between 2005 and 2015 but provinces of Matebeleland South and Bulawayo were hot spots with little or no change HIV positive women had higher prevalence than HIV negative women. The multidimensional causes and drivers of anemia in women require an integrated approach to help ameliorate anemia and its negative health effects on the women’s health. Prevention strategies such as promoting iron-rich food and food fortification, providing universal iron supplementation targeting lowveld provinces and women with HIV, pregnant or breastfeeding are required.
Highlights
Women of reproductive age 15–49 are at a high risk of iron-deficiency anemia, which in turn may contribute to maternal morbidity and mortality
The mean age for women across the 3 cycles was 28 years and 76, 74 and 72% of women in each cycle were younger than 35 years (Table 1)
For underweight women (BMI < 18 kgs/m2) the prevalence decreased from 41.4% in 2005 to 28.0% in 2015, whereas in obese women (BMI > 30 kg/m2) the prevalence decreased from 33.6 to 23.4% for the same period
Summary
Women of reproductive age 15–49 are at a high risk of iron-deficiency anemia, which in turn may contribute to maternal morbidity and mortality. Common causes of anemia include poor nutrition, infections, malaria, HIV, and treatments for HIV. Especially those in their reproductive age, has been identified as a major public health problem, in low and middle-income countries (LMICs) such as Zimbabwe [1]. Physical weakness and increased susceptibility to infections, and exposes pregnant women to poor maternal health and sub-optimal capacity to breastfeed and care for their newborns, infants and young children [5]. Folate and iron deficiency anemia are associated with reduced productivity and increased maternal mortality [10]. The most common causes of anemia are poor nutrition (including iron, folic acid and vitamin deficiencies) and infections including Malaria and HIV. In anemia the number and size of red blood cells, or the hemoglobin concentration, falls below an established cutoff value, < 11.0 g/dL and < 12.0 g/dL in pregnant and non-pregnant women, respectively [2, 3], impairing the capacity of the blood to transport oxygen around the body [5]
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