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Anemia in pregnancy in rural Tanzania: associations with micronutrients status and infections

European Journal of Clinical Nutrition volume 56, pages 192–199 (2002)Cite this article

Abstract

Objective: We studied the association between anemia in pregnancy and characteristics related to nutrition and infections.

Design: Cross-sectional study.

Setting: Four antenatal clinics in rural northern Tanzania.

Subjects/methods: A total of 2547 women were screened for hemoglobin (Hb) and malaria plasmodia in capillary blood and for infections in urine. According to their Hb, they were assigned to one of five groups and selected accordingly, Hb<70 g/l (n=10), Hb=70–89 g/l (n=61), Hb=90–109 g/l (n=86), Hb=110–149 g/l (n=105) and Hb≥150 g/l (n=50). The 312 selected subjects had venous blood drawn, were interviewed, and their arm circumference was measured. The sera were analyzed for ferritin, iron, total iron binding capacity (TIBC), cobalamin, folate, vitamin A, C-reactive protein (CRP), and lactate dehydrogenase (LD). Transferrin saturation (TFsat) was calculated. Urine was examined by dipsticks for nitrite.

Main outcome measures: Unadjusted and adjusted odds ratio (OR and AOR) of anemia with Hb<90 g/l.

Results: Anemia (Hb<90 g/l) was associated with iron deficiency (low s-ferritin; AOR 3.4). The association with vitamin deficiencies were significant in unadjusted analysis (low s-folate; OR 3.1, low s-vitamin A; OR 2.6). Anemia was also associated with markers of infections (elevated s-CRP; AOR 3.5, urine nitrite positive; AOR 2.4) and hemolysis (elevated s-LD; AOR 10.1). A malaria positive blood slide was associated with anemia in unadjusted analysis (OR 2.7). An arm circumference less than 25 cm was associated with anemia (AOR 4.0). The associations with less severe anemia (Hb 90–109 g/l) were similar, but weaker.

Conclusions: Anemia in pregnancy was associated with markers of infections and nutritional deficiencies. This should be taken into account in the management of anemia at antenatal clinics.

Sponsorship: The study was supported by the Norwegian Research Council (NFR) and the Centre for International Health, University of Bergen.

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Acknowledgements

This study was part of a population-based reproductive health project in Mbulu and Hanang in Tanzania, aiming to improve the health of mothers and their offspring. It was funded by the Norwegian Research Council and the Centre for International Health, University of Bergen. We are grateful to the staff of Haydom Lutheran Hospital, in particular the medical director Ole Halgrim Evjen Olsen and matron Selina Sanka, for generous support and hospitality throughout the fieldwork. The staff at the MCH clinic were very helpful in the process of data collection. We are indebted to our project staff for their invaluable assistance in collecting and handling the data.

The Commission for Science and Technology (COSTECH), the Regional Development Officer in Arusha, Regional Medical Officer in Arusha, the District Commissioners in Mbulu and Hanang, the District Medical Officers in Mbulu and Hanang districts, the MCH coordinators of Mbulu and Hanang districts, and the village leaders have given invaluable support and helped us with practical challenges during the fieldwork of this study. We are most grateful to all the women without whose consent this study would not be possible. Laboratory assistance was kindly given by Brit Edvardsen, and professor Lage Aksnes gave valuable help in analyzing vitamin A.

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Author notes

  1. SG Hinderaker and G Kvåle: Guarantors: SG Hinderaker and G Kvåle.

  2. SG Hinderaker, BE Olsen, RT Lie, PB Bergsjø, P Gasheka, GT Bondevik, R Ulvik and G Kvåle: Contributors: SGH and BEO were responsible for and took part in all stages of the study, including study design, data collection, data entry, statistical analysis, interpretation of results and writing the paper. RTL assisted in all stages of the study, and contributed to study design, statistical analysis and writing of the article. PB contributed to study design, interpretation of the results and writing the paper. PG contributed to data collection and data entry. GTB contributed to interpretation of results and writing the paper. RJU assisted in study design, laboratory methods used, and interpreting the results. GK supervised all aspects of the study, and contributed to study design, statistical analysis, interpretation of the results, and writing the paper. All authors approved the final manuscript.

Authors and Affiliations

  1. Centre for International Health, University of Bergen, Norway

    SG Hinderaker, BE Olsen, GT Bondevik & G Kvåle

  2. Haydom Lutheran Hospital, Tanzania

    SG Hinderaker, BE Olsen & P Gasheka

  3. Department of Obstetrics and Gynecology, Haukeland Hospital, University of Bergen, Norway

    PB Bergsjø

  4. Section for Medical Statistics, University of Bergen, Norway

    RT Lie

  5. Laboratory of Clinical Biochemistry, Haukeland Hospital, University of Bergen, Norway

    R Ulvik

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Correspondence to SG Hinderaker.

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Hinderaker, S., Olsen, B., Lie, R. et al. Anemia in pregnancy in rural Tanzania: associations with micronutrients status and infections. Eur J Clin Nutr 56, 192–199 (2002). https://doi.org/10.1038/sj.ejcn.1601300

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