Felix Bongomin1,2, Ronald Olum3, Andrew Peter Kyazze4, Sandra Ninsiima5, Gloria Nattabi5, Lourita Nakyagaba3, Winnie Nabakka5, Rebecca Kukunda5, Phillip Ssekamatte6, Davis Kibirige5,7, Stephen Cose7,8, Annettee Nakimuli9, Joseph Baruch Baluku8,10, Irene Andia-Biraro4,7,11. 1. Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda. drbongomin@gmail.com. 2. Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda. drbongomin@gmail.com. 3. School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda. 4. Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda. 5. Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda. 6. Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda. 7. Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda. 8. Directorate of Programs, Mildmay Uganda, Wakiso, Uganda. 9. Department of Obstetrics & Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda. 10. Department of Internal Medicine, Mulago National Referral Hospital, Kampala, Uganda. 11. Department of Clinical Research, Faculty of Infectious and Tropical Disease (ITD), London School of Hygiene and Tropical Medicine, London, UK.
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.
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.
Authors: Richard E Sanya; Lawrence Muhangi; Margaret Nampijja; Victoria Nannozi; Prossy Kabuubi Nakawungu; Elson Abayo; Emily L Webb; Alison M Elliott Journal: Trop Med Int Health Date: 2015-06-01 Impact factor: 2.622
Authors: Naimo Khalif Mahamoud; Bashir Mwambi; Caesar Oyet; Farouk Segujja; Fred Webbo; John Charles Okiria; Ivan Mugisha Taremwa Journal: J Blood Med Date: 2020-01-20
Authors: Lawrence Muhangi; Patrick Woodburn; Mildred Omara; Nicholas Omoding; Dennison Kizito; Harriet Mpairwe; Juliet Nabulime; Christine Ameke; Linda A Morison; Alison M Elliott Journal: Trans R Soc Trop Med Hyg Date: 2007-06-06 Impact factor: 2.184