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Interventions and public health nutrition

Determinants of anemia in postpartum HIV-negative women in Dar es Salaam, Tanzania

European Journal of Clinical Nutrition volume 67, pages 708–717 (2013)Cite this article

Subjects

Abstract

Objective:

The determinants of anemia during both pregnancy and postpartum recovery remain incompletely understood in sub-Saharan African women.

Subjects/methods:

In a prospective cohort study among pregnant women, we assessed dietary, biochemical, anthropometric, infectious and sociodemographic factors at baseline. In multivariate Cox proportional hazards models, we examined predictors of incident anemia (hemoglobin <11 g/dl) and iron deficiency anemia (anemia plus mean corpuscular volume <80fL), and recovery from anemia and iron deficiency anemia through 18 months postpartum at antenatal clinics in Dar es Salaam, Tanzania between 2001 and 2005. A total of 2364 non-anemic pregnant women and 4884 anemic women were enrolled between 12 and 27 weeks of gestation.

Results:

In total, 292 women developed anemia during the postpartum period and 165 developed iron deficiency anemia, whereas 2982 recovered from baseline anemia and 2044 from iron deficiency anemia. Risk factors for postpartum anemia were delivery complications (RR 1.6, 95% confidence interval (CI) 1.13, 2.22) and low postpartum CD4 cell count (RR 1.73, 95% CI 0.96, 3.17). Iron/folate supplementation during pregnancy had a protective relationship with the incidence of iron deficiency anemia. Absence of delivery complications, education status and iron/folate supplementation were positively associated with time to recovery from iron deficiency.

Conclusion:

Maternal nutritional status during pregnancy, prenatal iron/folate supplementation, perinatal care, and prevention and management of infections, such as malaria, are modifiable risk factors for the occurrence of, and recovery from, anemia.

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Acknowledgements

This work was supported by the National Institute of Child Health and Human Development (NICHD R01 37701), (clinicaltrials.gov #NCT00197548). CD was supported in part by NICHD K24HD058795. Research reported in this publication (AM) was supported by the Fogarty International Center of the National Institutes of Health under Award Number U2RTW008254. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Nutrition, Harvard School of Public Health, Boston, MA, USA

    P Petraro, C Duggan & W W Fawzi

  2. Division of Gastroenterology and Nutrition, Children’s Hospital Boston, Boston, MA, USA

    C Duggan

  3. Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

    W Urassa

  4. Department of Community Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

    G Msamanga & A Makubi

  5. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    D Spiegelman & W W Fawzi

  6. Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA

    D Spiegelman

  7. Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA

    W W Fawzi

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  1. P Petraro
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Correspondence to P Petraro.

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Petraro, P., Duggan, C., Urassa, W. et al. Determinants of anemia in postpartum HIV-negative women in Dar es Salaam, Tanzania. Eur J Clin Nutr 67, 708–717 (2013). https://doi.org/10.1038/ejcn.2013.71

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