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      Prevalence of Anemia and Associated Risk Factors among Pregnant Women in Semarang, Indonesia, during COVID-19 Pandemic

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          Abstract

          Background

          The coronavirus disease-2019 (COVID-19) pandemic has caused several changes that affect overall health, including the prevalence of anemia in pregnant women. Several risk factors, including iron deficiency during pregnancy, diabetes, maternal smoking, preterm birth, low birth weight, and multiple pregnancies, can influence poor iron intake in infants. This study aims to analyze the prevalence and factors associated with anemia in pregnant women during the COVID-19 pandemic.

          Methods

          A cross-sectional study was conducted on 238 pregnant women from two districts in Semarang, Indonesia. The study population was selected using a cluster sampling technique. Trained enumerators collected data through interviews using the Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ) to estimate participants' food intake and anthropometric measurements. Additionally, hemoglobin levels were measured by trained nurses during antenatal care (ANC) visits. Univariate and multivariate analyses were performed using logistic regression to estimate the factors associated with anemia in pregnant women during the COVID-19 pandemic.

          Results

          Among all participants, 14.3% (n=34) were anemic, with 32.3% and 67.6% having moderate and mild anemia, respectively. Moreover, study variables such as less compliance with ANC (antenatal care) guidelines (p = 0.020), excessive phosphorus intake (p = 0.039), inadequate zinc intake (p = 0.003), and inadequate calcium intake (p = 0.043) were associated with anemia among pregnant women.

          Conclusion

          Anemia among pregnant women in Semarang, Indonesia, is a mild public health problem. Less compliance with ANC guidelines, excessive phosphorus intake, and inadequate zinc intake are significantly associated with anemia among pregnant women during the COVID-19 pandemic.

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          Most cited references37

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          Anemia epidemiology, pathophysiology, and etiology in low‐ and middle‐income countries

          Anemia affects a third of the world's population and contributes to increased morbidity and mortality, decreased work productivity, and impaired neurological development. Understanding anemia's varied and complex etiology is crucial for developing effective interventions that address the context-specific causes of anemia and for monitoring anemia control programs. We outline definitions and classifications of anemia, describe the biological mechanisms through which anemia develops, and review the variety of conditions that contribute to anemia development. We emphasize the risk factors most prevalent in low- and middle-income countries, including nutritional deficiencies, infection/inflammation, and genetic hemoglobin disorders. Recent work has furthered our understanding of anemia's complex etiology, including the proportion of anemia caused by iron deficiency (ID) and the role of inflammation and infection. Accumulating evidence indicates that the proportion of anemia due to ID differs by population group, geographical setting, infectious disease burden, and the prevalence of other anemia causes. Further research is needed to explore the role of additional nutritional deficiencies, the contribution of infectious and chronic disease, as well as the importance of genetic hemoglobin disorders in certain populations.
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            Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum.

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              Global changes in maternity care provision during the COVID-19 pandemic: A systematic review and meta-analysis

              Background The COVID-19 pandemic has had a profound impact on healthcare systems globally, with a worrying increase in adverse maternal and foetal outcomes. We aimed to assess the changes in maternity healthcare provision and healthcare-seeking by pregnant women during the COVID-19 pandemic. Methods We performed a systematic review and meta-analysis of studies of the effects of the pandemic on provision of, access to and attendance at maternity services (CRD42020211753). We searched MEDLINE and Embase in accordance with PRISMA guidelines from January 1st, 2020 to April 17th 2021 for controlled observational studies and research letters reporting primary data comparing maternity healthcare-seeking and healthcare delivery during compared to before the COVID-19 pandemic. Case reports and series, systematic literature reviews, and pre-print studies were excluded. Meta-analysis was performed on comparable outcomes that were reported in two or more studies. Data were combined using random-effects meta-analysis, using risk ratios (RR) or incidence rate ratios (IRR) with 95% confidence intervals (CI). Findings Of 4743 citations identified, 56 were included in the systematic review, and 21 in the meta-analysis. We identified a significant decrease in the number of antenatal clinic visits (IRR 0614, 95% CI 0486–0776, P <00001, I 2 =54.6%) and unscheduled care visits (IRR 0741, 95% CI 0602–0911, P  = 00046, I 2 =00%) per week, and an increase in virtual or remote antenatal care (IRR 4656 95% CI 7762–2794, P <00001, I 2 =90.6%) and hospitalisation of unscheduled attendees (RR 1214, 95% CI 1118–1319, P <00001, I 2 =00%). There was a decrease in the use of GA for category 1 Caesarean sections (CS) (RR 0529, 95% CI 0407–0690, P <00001, I 2 =00%). There was no significant change in intrapartum epidural use ( P  = 00896) or the use of GA for elective CS ( P  = 079) Interpretation Reduced maternity healthcare-seeking and healthcare provision during the COVID-19 pandemic has been global, and must be considered as potentially contributing to worsening of pregnancy outcomes observed during the pandemic.
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                Author and article information

                Journal
                Ethiop J Health Sci
                Ethiop J Health Sci
                Ethiopian Journal of Health Sciences
                Research and Publications Office of Jimma University (Jimma, Ethiopia )
                1029-1857
                2413-7170
                May 2023
                : 33
                : 3
                : 451-462
                Affiliations
                [1 ] Department of Nutrition Science, Faculty of Medicine, Diponegoro University
                [2 ] Department of Public Health and Prevention, Faculty of Medicine, Diponegoro University
                Author notes

                Funding: This study was supported by the Faculty of Medicine, Diponegoro University, under the faculty grant [grant numbers 7532/UN7.5.4.2.1/PP/2020]

                Competing Interests: The authors declare that this manuscript was approved by all authors in its form and that no competing interest exists.

                Article
                jEJHS.v33.i3.pg451
                10.4314/ejhs.v33i3.8
                10416334
                f7e6b732-66d1-4366-b7cc-500754e8ef47
                © 2023 Ani M., et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 14 July 2022
                : 19 March 2023
                Categories
                Original Article

                Medicine
                anemia,pregnant women,indonesia,covid-19
                Medicine
                anemia, pregnant women, indonesia, covid-19

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