The determinants of anaemia in pregnancy in Lusaka Urban District, Zambia

Abstract

Anaemia is a major public health problem all over the world. Pregnant women in the developing world are mostly affected. Anaemia in pregnancy has serious consequences both to the mother and her baby. It leads to maternal death, reduced physical capacity, lowered resistance to infection, post partum haemorrhage, neurological dysfunction, reduced transfer of iron to the foetus, foetal death, abortion, prematurity, low birth weight and neonatal death.The purpose of this study was to determine the factors associated with anaemia in pregnancy in pregnant women attending antenatal clinics in Lusaka Urban District.A case-control study was conducted; the cases were the antenatal women who were found with the haemoglobin of less than 11 grams/dl of blood; the control group comprised of antenatal women who were found with the haemoglobin of more than 11 grams/dl of blood.The study was conducted in five health centres in Lusaka Urban District. These centres were selected using purposive sampling method from the 26 health centres which provide the antenatal care services. The study population included pregnant women in the second and third trimester of gestation, attending antenatal clinic in the five selected health centres in Lusaka Urban District. Each woman was taken as a sampling unit, assigned as either a case or control, depending on the haemoglobin level. The sample was selected by using a systematic sampling method. The cases and the controls were sampled separately. The cases were selected at an interval of 1 in 2 from the sampling list of cases. The controls were selected at the interval of 1 in 5 from the sampling list of controls.The study had two independent samples of 150 subjects each.Data was collected using a structured questionnaire administered to 300 antenatal women. Blood slides for malaria infection and stool for worm infestation was collected from 60 (30 cases and 30 controls) respondents for laboratory examination. The laboratory examination was done at Chawama health centre laboratory. In addition, the review of records for Hb estimation and HIV status was done. A checklist was used to record the laboratory results.Data was analyzed using SPSS computer Software package. Chi-Squared (x^) test and Odds Ratio (OR) were used. Multivariate logistic regression analysis was used to control for confounding factors. Statistical significance was achieved if P< 0.05.The results revealed a significant association between employment status and anaemia in pregnancy, with more cases (91.3%) than controls (66.7%) among the respondents who were unemployed. The respondents who were unemployed were 23 times more likely to have had anaemia in pregnancy than those who were employed. Furthermore, a significant association was observed between the frequency of eating green vegetables (spinach, pumpkin leaves, sweet potato leaves green beans and 'bondwe') and anaemia in pregnancy, with more cases (82.7%) than controls (29.3%) among the respondents who ate green vegetables for 1-7 times in 7 days (low in take). Those who had green vegetables for 1-7 times in 7 days were 16 times more likely to have had anaemia in pregnancy than those who had green vegetables for 8-14 times in 7 days.Another significant association was observed between diet during pregnancy and occurrence of anaemia in pregnancy, with more controls (75.3%) than cases (26.0%) among the respondents who had had balanced diet during pregnancy. The results further revealed that the respondents who had balanced diet during pregnancy were eighty percent less likely to have had anaennia in pregnancy compared to those who had poor diet during pregnancy. Additionally, a significant association was observed between compliance with iron/folate supplementation and anaemia in pregnancy, with more controls (83.3%) than cases (43.2%) among the respondents who complied. The respondents who complied with iron/folate supplementation were eighty-nine percent less likely to have had anaemia in pregnancy compared to those who did not comply.Consequently, we conclude that unemployment status of respondents, low intake of green vegetables, poor diet during pregnancy and non-compliance with iron/folate supplementation are the determinants are the major factors influencing the occurrence of anaemia in pregnancy among pregnant women in Lusaka Urban District.There is need for policy makers, reproductive health care providers and other stakeholders to work together to reduce the burden of anaemia in pregnancy in the community by addressing the specific determinants.