Anaemia in pregnancy: a major health problem with implications for maternal health care.

Women (n=2235) registering for antenatal care in two maternal and child health clinics in the Dar es Salaam area between June, 1991 and June 1992 had their haemoglobin (Hb) measured by use of a HaemoCuer haemoglobinometer. The prevalence of anaemia Hb<10.5 g/dl) was 60% while severe anaemia (Hb<7.0 //dl) was present in 4%. Young nullparous women, those who register for antenatal care late in the third trimester, and undernourished women constitute high risk groups also for severe anemia and require special attention. No single maternal characteristics or combination thereof was useful to identify a group of screening. The current national Hb level for referral to hospital (8.5 g/dl) identified 20% of the pregnant population. Most of these can successfully be treated and followed at the primary care level. To comply with the available means for care in the Dar es Salaam area, it is proposed that the cutoff level for referral be changed to <7g/dl. Appropriate methods to screen for anemia at primary health care (PHC) level must be explored and instituted. Training of antenatal care (ANC) providers in clinical identification of anemia and supply of haematinics must be improved and early booking for ANC promoted. Public health measures to improve the general nutrition and iron intake of all women are necessary to reduce this serious health problem in pregnancy.