Risk factors for anemia among women enrolling for antenatal care for the first time at Juba Teaching Hospital, South Sudan

Abstract

Anemia during pregnancy is a global public health problem affecting developing and developed countries. It is one of the major causes of prenatal and maternal morbidity and mortality globally, contributing to 20% of all maternal deaths. It also contributes to preterm deliveries, low birth weights, fetal growth restriction and infant mortality. In South SudanSouth SudanSouth SudanSouth SudanSouth SudanSouth SudanSouth SudanSouth SudanSouth SudanSouth SudanSouth Sudan, the burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be higthe burden of anemia is presumed to be high, but there is no documentation of its magnitude. Knowledge from an epidemiologic study of anemia in this setting is important to assist in formulating policies for prevention and management of anemia, and thus contribute to a reduction of the disease burden. OBJECTIVE: To determine the associated risk factors for anemia among pregnant women attending antenatal clinic for the first visit at Juba Teaching Hospital in South Sudan. Study design and sitting: This was an unmatched case control study which compared 120 antenatal mothers whose hemoglobin levels were less than 11g/dl (cases) against 120 with hemoglobin levels equal or more than 11g/dl (controls). Carried out at antenatal clinic at Juba Teaching hospital; South Sudan Study population: 240 eligible women attending antenatal clinic for the first time at Juba Teaching Hospital in South Sudan and who had consented for the study. Data collection and management: A structured questionnaire was administered to all eligible antenatal mothers to determine their sociodemographic, socioeconomic and obstetrics characteristics. Blood sampling for hemoglobin level was done and women found to have hemoglobin level of equal to or more than 11g/dl were classified as non-anemic (controls), while women found to have hemoglobin levels of less than 11g/dl were classed anemic (cases). Blood for malaria parasite, HIV testing and stool analysis

for ova and cyst of parasitic worms such as hookworms was done. Data was analyzed using SPSS software version 21 RESULTS: A total of two hundred and forty (240) antenatal mothers were enrolled for this study, in which 120 were cases and 120 were controls. Majority was primigravidae (56%), aged between 25-29 years (80%) and married (95.8%). 182 were housewives. 130 started antenatal care late at second trimester. Anemia in pregnancy was significantly associated with certain sociodemographic, obstetric and socioeconomic characteristics. Young age and lack of education significantly increased risk of anemia in pregnancy. The risk of anemia was reduced in those aged above 24 years (OR 0.28, 95% CI 0.1-0.75, P value 0.005). Higher level of education decreased anemia risk during pregnancy (OR 0.28, 95% CI 0.10-0.78, P value 0.015 for college education). Gestational age more than 13 weeks (OR 2.42, 95% CI 1.10-5.32, P value 0.028) as well as higher parity (OR 6.84, 95% CI, 2.35-19.89, P value < 0.001 for grand multiparity) were significantly associated with increased risk of anemia. With regards to diet, 3 or more meals per day (OR 0.17, 95% CI 0.06-0.47, P value 0.001), diet containing liver (OR 0.15, 95% CI 0.08-0.28, P value <0.001) and diet rich in fruits (OR 0.24, 95%CI 0.13-0.43, P value<0.001) significantly reduced risk of anemia. Infections such as malaria and hookworms in index pregnancy significantly increased risk of anemia in the subsequent pregnancy (OR 7.17, 95% CI 2.66-19.33, P value<0.001) and (OR 10.9, 95% CI 2.49-47.7, P value 0.002) respectively. Conclusion: The study found that age below 24 years, lack of education, grand multiparty and higher gestation more than 13 weeks, maternal infections such as malaria and hookworms and low socioeconomic status were significantly associated with increased risk of anemia in pregnancy. While diet containing iron such as liver, fruits and eating 3 or more meals per day were significantly associated with decreased risk of anemia in pregnancy