Modifiable determinants of iron deficiency and anemia among primigravidae and multigravidae in western Kenya: a secondary analysis of the Mama SASHA cohort study on vitamin A Open Access
Kowalski, Alysse (2014)
Abstract
Background: Maternal anemia during pregnancy is an important public health problem.
Objective: This study aimed to identify determinants of iron deficiency (ID) and anemia among pregnant women in western Kenya.
Methods: Between March-April 2011, 505 pregnant women attending their first antenatal care visit from eight health facilities were enrolled in the Mama SASHA cohort study on vitamin A. Standardized questionnaires were used to collect data on household characteristics, food security and dietary diversity, obstetric history, and participation in existing water, sanitation, and hygiene programs. Capillary samples were drawn for purposes of determining hemoglobin (Hb), vitamin A, iron, and inflammation status. Vitamin A and iron status indicators were adjusted for inflammation using the correction factor approach described by Thurnham. Primary outcomes of interest were anemia defined as Hb <11.0 g/dL and ID defined as plasma ferritin <12 mg/L. Multivariable logistic regression was used to identify modifiable determinants of ID and anemia overall and by parity.
Results: The prevalence of ID was 22.6% and was significantly higher among primigravidae compared to multigravidae (29.4% vs. 19.7%, p=0.02). The prevalence of anemia was 31.5% and did not differ by parity. In multigravidae, the receipt of iron supplements in the pregnancy prior to the current one (POR 0.49 (0.27, 0.87)) and receipt of WASH interventions (POR 0.53 (0.29, 0.97) were each associated with reduced odds of ID. Stillbirth/miscarriage in the pregnancy prior to the current one and a birth interval of less than one year however were both associated with increased odds of ID (POR 5.54 (2.06, 14.87), and POR 4.25 (1.68, 10.74), respectively). Among primigravidae none the determinants considered were associated with ID or anemia. The only modifiable factor associated with anemia was early convalescence infection (POR: 5.23 (1.91, 14.29). No dietary or household food security indicators were associated with either ID or anemia in multiparas or primiparas.
Conclusion: Our results indicate the etiology of ID may differ by gravidity, although further research is needed to identify determinants associated with ID among primigravidae. Due to these etiological differences, different prevention and control strategies for primigravidae and multigravidae may be warranted. Furthermore we found evidence to support a lasting impact of WASH support programs, like LifeStraw in protecting against ID.
Table of Contents
Chapter 1: Literature Review
Chapter 2: Manuscript
Chapter 3: Public Health Implications
Table 1: Enrollment characteristics of the 505 pregnant women participating in the Mama SASHA COVA study, presented as mean ± standard deviation or N (%).
Table 2: Nutrition and diet characteristics of the 505 pregnant women participating in the Mama SASHA COVA study, presented as mean ± standard deviation or N (%).
Table 3: Biochemical indicators of the 504 pregnant women participating in the Mama SASHA COVA study by stage of infection, presented as mean ± standard deviation or N (%).
Table 4: Associations between modifiable determinants of ID and anemia among 505 pregnant women participating in the Mama SASHA COVA study, presented as prevalence odds ratio (CI).
Table 5: Associations between modifiable determinants of ID and anemia among 153 primigravidae participating in the Mama SASHA COVA study, presented as prevalence odds ratio (CI).
Table 6: Associations between modifiable determinants of ID and anemia among 352 multigravidae participating in the Mama SASHA COVA study, presented as prevalence odds ratio (CI).
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