Anemia in Ugandan pregnant women: a cross-sectional, systematic review and meta-analysis study

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Abstract

Background

Anemia 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.

Methods

We 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.

Results

The 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).

Conclusions

Despite 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.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41182-021-00309-z.

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Most cited references 41

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Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation

L Shamseer, D Moher, Suzanne M Clarke … (2015)

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2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8).

Paul James, Suzanne Oparil, Barry Carter … (2014)

Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes. There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes. Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.

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Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data

Gretchen Stevens, Mariel Finucane, Luz María De-Regil … (2013)

Summary Background Low haemoglobin concentrations and anaemia are important risk factors for the health and development of women and children. We estimated trends in the distributions of haemoglobin concentration and in the prevalence of anaemia and severe anaemia in young children and pregnant and non-pregnant women between 1995 and 2011. Methods We obtained data about haemoglobin and anaemia for children aged 6–59 months and women of childbearing age (15–49 years) from 257 population-representative data sources from 107 countries worldwide. We used health, nutrition, and household surveys; summary statistics from WHO's Vitamin and Mineral Nutrition Information System; and summary statistics reported by other national and international agencies. We used a Bayesian hierarchical mixture model to estimate haemoglobin distributions and systematically addressed missing data, non-linear time trends, and representativeness of data sources. We quantified the uncertainty of our estimates. Findings Global mean haemoglobin improved slightly between 1995 and 2011, from 125 g/L (95% credibility interval 123–126) to 126 g/L (124–128) in non-pregnant women, from 112 g/L (111–113) to 114 g/L (112–116) in pregnant women, and from 109 g/L (107–111) to 111 g/L (110–113) in children. Anaemia prevalence decreased from 33% (29–37) to 29% (24–35) in non-pregnant women, from 43% (39–47) to 38% (34–43) in pregnant women, and from 47% (43–51) to 43% (38–47) in children. These prevalences translated to 496 million (409–595 million) non-pregnant women, 32 million (28–36 million) pregnant women, and 273 million (242–304 million) children with anaemia in 2011. In 2011, concentrations of mean haemoglobin were lowest and anaemia prevalence was highest in south Asia and central and west Africa. Interpretation Children's and women's haemoglobin statuses improved in some regions where concentrations had been low in the 1990s, leading to a modest global increase in mean haemoglobin and a reduction in anaemia prevalence. Further improvements are needed in some regions, particularly south Asia and central and west Africa, to improve the health of women and children and achieve global targets for reducing anaemia. Funding Bill & Melinda Gates Foundation, Grand Challenges Canada, and the UK Medical Research Council.

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Author and article information

Contributors

Felix Bongomin:

ORCID: http://orcid.org/0000-0003-4515-8517

drbongomin@gmail.com

Journal

Journal ID (nlm-ta): Trop Med Health

Journal ID (iso-abbrev): Trop Med Health

Title: Tropical Medicine and Health

Publisher: BioMed Central (London )

ISSN (Print): 1348-8945

ISSN (Electronic): 1349-4147

Publication date (Electronic): 1 March 2021

Publication date PMC-release: 1 March 2021

Publication date Collection: 2021

Volume: 49

Electronic Location Identifier: 19

Affiliations

[1 ]GRID grid.11194.3c, ISNI 0000 0004 0620 0548, Department of Medicine, School of Medicine, , Makerere University College of Health Sciences, ; Kampala, Uganda

[2 ]GRID grid.442626.0, ISNI 0000 0001 0750 0866, Department of Medical Microbiology & Immunology, Faculty of Medicine, , Gulu University, ; Gulu, Uganda

[3 ]GRID grid.11194.3c, ISNI 0000 0004 0620 0548, School of Medicine, , Makerere University College of Health Sciences, ; Kampala, Uganda

[4 ]Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda

[5 ]GRID grid.11194.3c, ISNI 0000 0004 0620 0548, Department of Immunology and Molecular Biology, School of Biomedical Sciences, , Makerere University College of Health Sciences, ; Kampala, Uganda

[6 ]GRID grid.415861.f, ISNI 0000 0004 1790 6116, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, ; Entebbe, Uganda

[7 ]GRID grid.463428.f, Directorate of Programs, , Mildmay Uganda, ; Wakiso, Uganda

[8 ]GRID grid.11194.3c, ISNI 0000 0004 0620 0548, Department of Obstetrics & Gynecology, School of Medicine, , Makerere University College of Health Sciences, ; Kampala, Uganda

[9 ]GRID grid.416252.6, ISNI 0000 0000 9634 2734, Department of Internal Medicine, , Mulago National Referral Hospital, ; Kampala, Uganda

[10 ]GRID grid.8991.9, ISNI 0000 0004 0425 469X, Department of Clinical Research, Faculty of Infectious and Tropical Disease (ITD), , London School of Hygiene and Tropical Medicine, ; London, UK

Author information

Felix Bongomin http://orcid.org/0000-0003-4515-8517

Article

Publisher ID: 309

DOI: 10.1186/s41182-021-00309-z

PMC ID: 7919073

PubMed ID: 33648575

SO-VID: 653ebf32-d719-4bc8-b0b5-34b8c161a8dc

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 29 October 2020

Date accepted : 19 February 2021

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ScienceOpen disciplines: Medicine

Keywords: anemia,pregnancy,uganda

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ScienceOpen disciplines: Medicine

Keywords: anemia, pregnancy, uganda

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Anemia in Ugandan pregnant women: a cross-sectional, systematic review and meta-analysis study

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Abstract

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Most cited references 41

Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation

2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8).

Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data

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