Abstract
BackgroundReducing the burden of anaemia is a critical global health priority that could improve maternal outcomes amongst pregnant women and their neonates. As more counties in Kenya commit to universal health coverage, there is a growing need for optimal allocation of the limited resources to sustain the gains achieved with the devolution of healthcare services. This study aimed to describe the spatio-temporal patterns of maternal anaemia prevalence in Kenya from 2016 to 2019.MethodsQuarterly reported sub-county level maternal anaemia cases from January 2016 – December 2019 were obtained from the Kenyan District Health Information System. A Bayesian hierarchical negative binomial spatio-temporal conditional autoregressive (CAR) model was used to estimate maternal anaemia prevalence by sub-county and quarter. Spatial and temporal correlations were considered by assuming a conditional autoregressive and a first-order autoregressive process on sub-county and seasonal specific random effects, respectively.ResultsThe overall estimated number of pregnant women with anaemia increased by 90.1% (95% uncertainty interval [95% UI], 89.9–90.2) from 155,539 cases in 2016 to 295,642 cases 2019. Based on the WHO classification criteria, the proportion of sub-counties with normal prevalence decreased from 28.0% (95% UI, 25.4–30.7) in 2016 to 5.4% (95% UI, 4.1–6.7) in 2019, whereas moderate anaemia prevalence increased from 16.8% (95% UI, 14.7–19.1) in 2016 to 30.1% (95% UI, 27.5–32.8) in 2019 and severe anaemia prevalence increased from 7.0% (95% UI, 5.6–8.6) in 2016 to 16.6% (95% UI, 14.5–18.9) in 2019. Overall, 45.1% (95% UI: 45.0–45.2) of the estimated cases were in malaria-endemic sub-counties, with the coastal endemic zone having the highest proportion 72.8% (95% UI: 68.3–77.4) of sub-counties with severe prevalence.ConclusionAs the number of women of reproductive age continues to grow in Kenya, the use of routinely collected data for accurate mapping of poor maternal outcomes remains an integral component of a functional maternal health strategy. By unmasking the sub-county disparities often concealed by national and county estimates, our study findings reiterate the importance of maternal anaemia prevalence as a metric for estimating malaria burden and offers compelling policy implications for achieving national nutritional targets.
Highlights
Reducing the burden of anaemia is a critical global health priority that could improve maternal outcomes amongst pregnant women and their neonates
As the number of women of reproductive age continues to grow in Kenya, the use of routinely collected data for accurate mapping of poor maternal outcomes remains an integral component of a functional maternal health strategy
By unmasking the sub-county disparities often concealed by national and county estimates, our study findings reiterate the importance of maternal anaemia prevalence as a metric for estimating malaria burden and offers compelling policy implications for achieving national nutritional targets
Summary
Reducing the burden of anaemia is a critical global health priority that could improve maternal outcomes amongst pregnant women and their neonates. Nutrition Report, the WHO target of a 50% reduction of maternal anaemia by 2025 was reported to be 100 years behind schedule [9, 10] despite the considerable economic and scientific advancement over the past two decades This ambitious, yet achievable, target still calls for a renewed focus on the optimal approaches necessary to improve the quality of care provided to women and their infants. In Kenya, maternal anaemia etiological diversity is affected by limited resources, leading to preventable morbidity and mortality at the subcounty level [15] To address this burden, national policy guidelines and interventions on combined iron and folic acid supplementation for pregnant women have sought to improve both neonatal and maternal outcomes. FANC offers targeted assessments useful for identifying potential birth complications, treating established disease and availing information critical for a positive pregnancy experience [16, 17]
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