Anemia in pregnancy remains a major problem in nearly all developing and many industrialized countries. In Mali, the subpopulation prevalence and etiology of anemia during pregnancy are largely unknown.
Objective
To examine the prevalence and likely etiologies of anemia in pregnancy in a poor urban population in Bamako, Mali.
Methods
Pregnant women (n = 190) were selected randomly. Hemoglobin, serum iron, and total iron-binding capacity were measured; blood smears were examined for Plasmodium falciparum malaria; and single stool and urine samples were examined for Schistosoma haematobium and hookworm. Gynecologic examinations were performed and interviews conducted to qualitatively assess food consumption and other socioeconomic characteristics. Associations among mild, moderate, and severe anemia; iron and parasite status; erythrocyte sedimentation rates; and the presence of abnormal vaginal discharge were evaluated. Differences in hemoglobin and serum iron concentrations, total iron-binding capacity, and anemia were compared according to trimester of pregnancy and between infected and noninfected women. The relative and attributable risks of anemia were calculated, and adjusted odds ratios for anemia and low serum iron were estimated by multivariate logistic regression.
Results
Of the 131 women for whom complete data were available, 47% had hemoglobin concentrations below 110 g/L; 13% had serum iron concentrations below 12 μmol/L; none had transferrin saturation values below 16%; 11%, 23%, and 8% harbored P. falciparum, S. haematobium, and hookworm, respectively; and 82% had an abnormal vaginal discharge. Food restrictions were reported by 45% of the women. Abnormal vaginal discharge correlated significantly with anemia (Pearson χ2 = 62.4; p < .01). Univariate and multivariate analyses found that infections were strongly associated with and predictive of anemia.
Conclusions
Our data suggest that infections and food accessibility contribute to the high rates of anemia during pregnancy in Mali.
World Health Organization. The prevalence of anemia in women. A tabulation of available information, 2nd ed. Geneva: WHO, 1992.
2.
World Health Organization. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series No. 854. Geneva: WHO, 1995.
3.
BouvierPDoumboODreslowNRobertCFMaurisAPicquetMKouribaBDembeleHKDelleyVRougemontA. Seasonality, malaria, and impact of prophylaxis in a West African village, I. Effect on anemia in pregnancy. Am J Trop Med Hyg1997;56:378–83.
4.
World Health Organization. Nutritional anemias. World Health Organ Tech Rep Ser 1968;405.
5.
Centers for Disease Control and Prevention (CDC). Recommendations to prevent and control iron deficiency in the United States. MMWR Morb Mortal Wkly Rep1998; 47:1–29.
6.
StoltzfusRJ. Iron deficiency: Global prevalence and consequences. Food Nutr Bull2003;24(Suppl):S99–103.
7.
AllenLH. Pregnancy and iron deficiency: Unresolved issues. Nutr Rev1997;55:91–101.
8.
LozoffBJimenezEWolfAW. Long-term developmental outcome of infants with iron deficiency. N Engl J Med1991;325:687–94.
9.
StoltzfusRJChwayaHMTielschJMSchulzeKJAlbonicoMSavioliL. Epidemiology of iron deficiency anemia in Zanzibari schoolchildren: The importance of hookworms. Am J Clin Nutr1997;65:153–9.
10.
DreyfussMLStoltzfusRJShresthaJBPradhanEKLeClerqSCKhatrySKShresthaSRKatzJAlbonicoMWestKPJr. Hookworms, malaria and vitamin A deficiency contribute to anemia and iron deficiency among pregnant women in the plains of Nepal. J Nutr2000;130:2527–36.
11.
van den BroekNRLetskyEA. Etiology of anemia in pregnancy in south Malawi. Am J Clin Nutr2000;72 (1 Suppl):247S–56S.
12.
International Council for Standardization in Haematology (Expert Panel on Blood Rheology). ICSH recommendations for measurement of erythrocyte sedimentation rate. J Clin Pathol1993; 46:198–203.
13.
World Health Organization. Basic laboratory methods in medical parasitology. Geneva: WHO, 1991.
14.
World Health Organization. Bench aids in the diagnosis of intestinal parasites. Geneva: WHO, 1994.
15.
PetersPAMahmoudAAWarrenKSOumaJHSiongokTK. Field studies of a rapid, accurate means of quantifying Schistosoma haematobium eggs in urine samples. Bull World Health Organ1976;54:159–62.
16.
World Health Organization, UNICEF, UNU. Iron deficiency: indicators for assessment and strategies for prevention. Geneva: WHO, 1998.
17.
RothmanKJ. Epidemiology: an introduction. New York: Oxford University Press, 2002.
18.
IsahHSFlemingAFUjahIAEkwempuCC. Anaemia and iron status of pregnant and non-pregnant women in the guinea savanna of Nigeria. Ann Trop Med Parasitol1985;79:485–93.
19.
MockenhauptFPRongBGuntherMBeckSTillHKohneEThompsonWNBienzleU. Anaemia in pregnant Ghanaian women: Importance of malaria, iron deficiency, and haemoglobinopathies. Trans R Soc Trop Med Hyg2000;94:477–83.
20.
KalengaMKNyemboMKNshimbaMFoidartJM. Anemia associated with malaria and intestinal helminthiasis in Lubumbashi [in French]. Sante Publique2003;15:413–21.
21.
DHS: Cellule de Planification et de Statistique du Ministère de la Santé (CPS/MS), Direction Nationale de la Statistique et de l'Informatique (DNSI) et ORC Macro. 2002. Enquête Démographique et de Santé du Mali 2001. Calverton, MD, USA: CPS/MS, DNSI and ORC Macro, 2002.
22.
MeyersLDHabichtJPJohnsonCLBrownieC. Prevalences of anemia and iron deficiency anemia in black and white women in the United States estimated by two methods. Am J Public Health1983;73:1042–9.
23.
GarnSMSmithNJClarkDC. Lifelong differences in hemoglobin levels between blacks and whites. J Natl Med Assoc1975;67:91–6.
24.
HaasJDFairchildMV. Summary and conclusions of the International Conference on Iron Deficiency and Behavioral Development. Am J Clin Nutr1988;50:703–5.
25.
HaasJDBrownlieT. Iron deficiency and reduced work capacity: A Critical review of the research to determine a causal relationship. J Nutr2001;131:676S–90S.
26.
SchollTOHedigerMLFischerRLShearerJW. Anemia vs iron deficiency: Increased risk of preterm delivery in a prospective study. Am J Clin Nutr1992;55:985–8.
27.
RasmussenKM. Is there a causal relationship between iron deficiency or iron-deficiency anemia and weight at birth, length of gestation and perinatal mortality?J Nutr2001;131:590S–603S.
AsobayireFSAdouPDavidssonLCookJDHurrellRF. Prevalence of iron deficiency with and without concurrent anemia in population groups with high prevalences of malaria and other infections: A Study in Côte d'Ivoire. Am J Clin Nutr2001;74:776–82.
30.
BrabinBJGinnyMSapauJGalmeKPainoJ. Consequences of maternal anaemia on outcome of pregnancy in a malaria endemic area in Papua New Guinea. Ann Trop Med Parasitol1990;84:11–24.
31.
FlemingAF. The aetiology of severe anaemia in pregnancy in Ndola, Zambia. Ann Trop Med Parasitol1989; 83:37–49.
32.
MateelliADonatoFSheinAMuchiJALeopardiOAstoriLCarosiG. Malaria and anemia in pregnant women in urban Zanzibar, Tanzania. Ann Trop Med Parasitol1994;88:475–83.
33.
McGregorIA. Epidemiology, malaria and pregnancy. Am J Trop Med Hyg1984;33:517–25.
34.
ShulmanCEGrahamWJJiloHLoweBSNewLObieroJSnowRWMarshK. Malaria is an important cause of anaemia in primigravidae: Evidence from a district hospital in coastal Kenya. Trans R Soc Trop Med Hyg1996;90:535–9.
35.
GreenhamR. Anaemia and Schistosoma haematobium infection in the North-Eastern Province of Kenya. Trans R Soc Trop Med Hyg1978;72:72–5.
36.
OlsenAMagnussenPOumaJHAndreassenJFriisH. The contribution of hookworm and other parasitic infections to haemoglobin and iron status among children and adults in western Kenya. Trans R Soc Trop Med Hyg1998;92:643–9.
37.
BondevikGTEskelandBUlvikRJUlsteinMLieRTSchneedeJKyaleG. Anemia in pregnancy: Possible causes and risk factors in Nepali women. Eur J Clin Nutr2000;54:3–8.
38.
StephensonLSLathamMCKurzKMKinotiSNOduoriMLCromptonDW. Relationships of Schistosoma haematobium, hookworm and malarial infections and metrifonate treatment to haemoglobin level in Kenyan school children. Am J Trop Med Hyg1985;34:519–28.
39.
WilkinsHAGollPHMoorePJ. Schistosoma haematobium infection and haemoglobin concentrations in a Gambian community. Ann Trop Med Parasitol1985; 79:159–61.
40.
UrbaniCToureAHamedAOAlbonicoMKaneICheiknaDHamedNMontresorASavioliL. Intestinal parasitic infections and schistosomiasis in the valley of the Senegal river in the Islamic Republic of Mauritania [in French]. Med Trop (Mars)1997;57:157–60.
41.
MassaweSNRonquistGNystromLLindmarkG. Iron status and iron deficiency anemia in adolescents in a Tanzanian suburban area. Gynecol Obstet Invest2002;54:137–44.
42.
AllenHECromptonDWde SilvaNLoVerdePTOldsGR. New policies for using anthelmintics in high risk groups. Trends Parasitol2002;18:381–2.
OldsRG. Administration of praziquantel to pregnant and lactating women. Acta Trop2003;86:185–95.
45.
Lopez-MartinezRRuiz-SanchezDVertiz-ChavezE. Vaginal candidosis: Opportunistic factors and clinical correlation in 600 patients. Mycopathologia1984;85:167–70.
46.
MeansRTJr. Advances in the anemia of chronic disease. Int J Hematol1999;70:7–12.
47.
Ag AyoyaMTheophinCMooreEC. Nutrition in Mali: a qualitative study of knowledge, perceptions and practices. Report on preliminary and second analyses of data collected in June 1998 for the Groupe ad hoc Santé, Ministry of Health, Republic of Mali. Washington, DC: Chemonics International, 2001.
48.
HoudegbeA. Health problems facing rural women. Child Trop1985;159:57–61.
49.
IgbediohSO. Undernutrition in Nigeria: Dimension, causes and remedies for alleviation in a changing socioeconomic environment. Nutr Health1993;9:1–14.
50.
GoodburnL. Bangladesh women report postpartum health problems. Safe Mother.1994 Feb;(13):3.
51.
MarchantTArmstrong SchellenbergJREdgarTRonsmansCNathanRAbdullaSMukasaOUrassaHLengelerC. Anaemia during pregnancy in southern Tanzania. Ann Trop Med Parasitol2002;96:477–87.
52.
MenendezCToddJAlonsoPLFrancisNLulatSCeesaySM'BogeBGreenwoodBM. The effects of iron supplementation during pregnancy, given by traditional birth attendants, on the prevalence of anaemia and malaria. Trans R Soc Trop Med Hyg1994;88:590–3.
53.
BrabinBJPrinsen-GeerligsPDVerhoeffFHFletcherKAChimsukuLHNgwiraBMLeichOJBroadheadRL. Haematological profiles of the people of rural southern Malawi: An overview. Ann Trop Med Parasitol2004;98:71–83.
