Factors associated with anaemia among pregnant women in Rwanda: an analysis of the Rwanda demographic and health survey of 2020.
Humans
Female
Rwanda
/ epidemiology
Pregnancy
Adult
Anemia
/ epidemiology
Young Adult
Prevalence
Health Surveys
Adolescent
Pregnancy Complications, Hematologic
/ epidemiology
Risk Factors
Socioeconomic Factors
Health Services Accessibility
/ statistics & numerical data
Middle Aged
Cross-Sectional Studies
Logistic Models
Anaemia
Iron deficiency
Pregnancy
Rwanda
Women
Journal
BMC pregnancy and childbirth
ISSN: 1471-2393
Titre abrégé: BMC Pregnancy Childbirth
Pays: England
ID NLM: 100967799
Informations de publication
Date de publication:
27 Apr 2024
27 Apr 2024
Historique:
received:
22
11
2022
accepted:
17
04
2024
medline:
28
4
2024
pubmed:
28
4
2024
entrez:
27
4
2024
Statut:
epublish
Résumé
Anaemia in pregnancy is associated with several adverse outcomes for mothers and newborns, as well as their families. In this study, we assessed the prevalence of anaemia and the associated factors among pregnant women in Rwanda. Secondary data from the 2020 Rwanda Demographic and Health Survey (RDHS) was used. Multistage stratified sampling was used to select 435 pregnant women included in the study. Anaemia among pregnant women was defined as a haemoglobin value < 11 g/dL. Multivariable logistic regression was used to assess the associated factors with anaemia in pregnancy, using SPSS (version 26). Of the 435 pregnant women, 24.6% (95%CI: 21.1-29.3) were anaemic (1 in 4 pregnant women). Not working (AOR = 2.45; 95%CI: 1.14-5.26), being unmarried (AOR = 1.23; 95%CI: 1.24-3.57), low wealth index (AOR = 9.19; 95%CI: 1.64-51.56), having difficulty accessing a nearby health facility (AOR = 5.40; 95%CI: 2.21-13.23), and normal body mass index (AOR = 3.33; 95%CI: 1.46-7.59) were associated with higher odds of being anaemic. However, not taking iron supplements (AOR = 0.16; 95% CI: 0.04-0.67), having no exposure to television (AOR = 0.35; 95%CI: 0.14-0.91), being from the southern region (AOR = 0.14; 95% CI: 0.03-0.66), and low husband/partner's education (AOR = 0.08; 95% CI: 0.01-0.59) were associated with lower odds of being anaemic. The study findings indicate a high prevalence of anaemia in pregnancy, which was associated with several socio-demographics. There is a need for setting up mobile clinics and health facilities in hard-to-reach areas for easy accessibility to early anaemia screening services. Conducting mass screening for anaemia targeting pregnant women who are not working, the unmarried, and those with a low wealth index would also be beneficial. The intake of locally available iron rich foods and/ or bio-fortified foods is also recommended.
Sections du résumé
BACKGROUND
BACKGROUND
Anaemia in pregnancy is associated with several adverse outcomes for mothers and newborns, as well as their families. In this study, we assessed the prevalence of anaemia and the associated factors among pregnant women in Rwanda.
METHODS
METHODS
Secondary data from the 2020 Rwanda Demographic and Health Survey (RDHS) was used. Multistage stratified sampling was used to select 435 pregnant women included in the study. Anaemia among pregnant women was defined as a haemoglobin value < 11 g/dL. Multivariable logistic regression was used to assess the associated factors with anaemia in pregnancy, using SPSS (version 26).
RESULTS
RESULTS
Of the 435 pregnant women, 24.6% (95%CI: 21.1-29.3) were anaemic (1 in 4 pregnant women). Not working (AOR = 2.45; 95%CI: 1.14-5.26), being unmarried (AOR = 1.23; 95%CI: 1.24-3.57), low wealth index (AOR = 9.19; 95%CI: 1.64-51.56), having difficulty accessing a nearby health facility (AOR = 5.40; 95%CI: 2.21-13.23), and normal body mass index (AOR = 3.33; 95%CI: 1.46-7.59) were associated with higher odds of being anaemic. However, not taking iron supplements (AOR = 0.16; 95% CI: 0.04-0.67), having no exposure to television (AOR = 0.35; 95%CI: 0.14-0.91), being from the southern region (AOR = 0.14; 95% CI: 0.03-0.66), and low husband/partner's education (AOR = 0.08; 95% CI: 0.01-0.59) were associated with lower odds of being anaemic.
CONCLUSIONS
CONCLUSIONS
The study findings indicate a high prevalence of anaemia in pregnancy, which was associated with several socio-demographics. There is a need for setting up mobile clinics and health facilities in hard-to-reach areas for easy accessibility to early anaemia screening services. Conducting mass screening for anaemia targeting pregnant women who are not working, the unmarried, and those with a low wealth index would also be beneficial. The intake of locally available iron rich foods and/ or bio-fortified foods is also recommended.
Identifiants
pubmed: 38678175
doi: 10.1186/s12884-024-06528-6
pii: 10.1186/s12884-024-06528-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
328Informations de copyright
© 2024. The Author(s).
Références
World Health Organization. Nutrition Landscape Information System (NLiS) country profile indicators: interpretation guide, 2nd edition 2019 [ https://www.who.int/publications/i/item/9789241516952 .
World Health Organization. Anemia in women and children 2022 [ https://www.who.int/data/gho/data/themes/topics/anaemia_in_women_and_children .
Fondjo LA, Addai–Mensah O, Annani-Akollor ME, Quarshie JT, Boateng AA, Assafuah SE, et al. A multicenter study of the prevalence and risk factors of malaria and anemia among pregnant women at first antenatal care visit in Ghana. PLoS ONE. 2020;15(8):e0238077.
pubmed: 32822409
pmcid: 7444479
doi: 10.1371/journal.pone.0238077
Maulide Cane R, Chidassicua JB, Varandas L, Craveiro I. Anemia in pregnant women and children aged 6 to 59 months living in Mozambique and Portugal: an overview of systematic reviews. Int J Environ Res Public Health. 2022;19(8):4685.
pubmed: 35457552
pmcid: 9029497
doi: 10.3390/ijerph19084685
McLean E, Cogswell M, Egli I, Wojdyla D, De Benoist B. Worldwide prevalence of anaemia, WHO vitamin and mineral nutrition information system, 1993–2005. Public Health Nutr. 2009;12(4):444–54.
pubmed: 18498676
doi: 10.1017/S1368980008002401
Initiatives D. The state of Global Nutrition. Development Initiatives Bristol, UK; 2021.
Arinda IK, Sserwanja Q, Kamara K, Mukunya D, Agnes N, Edirisa Juniour N, et al. Anemia and Associated factors among Lactating women in Sierra Leone: an analysis of the Sierra Leone Demographic and Health Survey 2019. Nutr Metabolic Insights. 2022;15:11786388221105732.
doi: 10.1177/11786388221105732
Zhang Q, Lu X-M, Zhang M, Yang C-Y, Lv S-Y, Li S-F, et al. Adverse effects of iron deficiency anemia on pregnancy outcome and offspring development and intervention of three iron supplements. Sci Rep. 2021;11(1):1–11.
Karami M, Chaleshgar M, Salari N, Akbari H, Mohammadi M. Global prevalence of Anemia in pregnant women: a comprehensive systematic review and Meta-analysis. Matern Child Health J. 2022:1–15.
Capanzana MV, Aguila DV. Philippines case study: government policies on nutrition education. Nutrition Education: strategies for improving Nutrition and healthy eating in individuals and communities. Volume 92. Karger; 2020. pp. 119–29.
Rahmah QJ, Salsabila RS, Astuti R. The Importance of Nutritional Food Education for Pregnant Women. JISE: Journal of Islamic Studies and Education. 2022;1(1).
Kaplan O, Wainstock T, Sheiner E, Staretz-Chacham O, Walfisch A. Maternal anemia and offspring failure to thrive–results from a large population-based cohort. J Maternal-Fetal Neonatal Med. 2021;34(23):3889–95.
doi: 10.1080/14767058.2019.1702018
Gusmaliza B. Anemia in pregnancy; the influence factors, responsibility and challenge of midwives. J Health Nurs Soc. 2022;2(1):8–18.
Adam I, Ibrahim Y, Elhardello O. Prevalence, types and determinants of anemia among pregnant women in Sudan: a systematic review and meta-analysis. BMC Hematol. 2018;18(1):1–8.
doi: 10.1186/s12878-018-0124-1
Means RT. Iron deficiency and iron deficiency anemia: implications and impact in pregnancy, fetal development, and early childhood parameters. Nutrients. 2020;12(2):447.
pubmed: 32053933
pmcid: 7071168
doi: 10.3390/nu12020447
Stephen G, Mgongo M, Hussein Hashim T, Katanga J, Stray-Pedersen B, Msuya SE. Anaemia in pregnancy: prevalence, risk factors, and adverse perinatal outcomes in Northern Tanzania. Anemia. 2018;2018.
Young CR, Arnos DM, Matthews LT. A scoping review of interventions to address intimate partner violence in sub-saharan African healthcare. Glob Public Health. 2019;14(9):1335–46.
pubmed: 30648466
pmcid: 6635092
doi: 10.1080/17441692.2019.1567802
Kinyoki D, Osgood-Zimmerman AE, Bhattacharjee NV, Kassebaum NJ, Hay SI. Anemia prevalence in women of reproductive age in low-and middle-income countries between 2000 and 2018. Nat Med. 2021;27(10):1761–82.
pubmed: 34642490
pmcid: 8516651
doi: 10.1038/s41591-021-01498-0
Tirore LL, Mulugeta A, Belachew AB, Gebrehaweria M, Sahilemichael A, Erkalo D, et al. Factors associated with anaemia among women of reproductive age in Ethiopia: multilevel ordinal logistic regression analysis. Matern Child Nutr. 2021;17(1):e13063.
pubmed: 32761751
doi: 10.1111/mcn.13063
Gebre A, Mulugeta A. Prevalence of anemia and associated factors among pregnant women in North Western zone of Tigray, Northern Ethiopia: a cross-sectional study. Journal of nutrition and metabolism. 2015;2015.
Anlaakuu P, Anto F. Anaemia in pregnancy and associated factors: a cross sectional study of antenatal attendants at the Sunyani Municipal Hospital, Ghana. BMC Res Notes. 2017;10(1):1–8.
doi: 10.1186/s13104-017-2742-2
Tinago CB, Annang Ingram L, Blake CE, Frongillo EA. Individual and structural environmental influences on utilization of iron and folic acid supplementation among pregnant women in Harare, Zimbabwe. Matern Child Nutr. 2017;13(3):e12350.
pubmed: 27502366
doi: 10.1111/mcn.12350
Getahun W, Belachew T, Wolide AD. Burden and associated factors of anemia among pregnant women attending antenatal care in southern Ethiopia: cross sectional study. BMC Res Notes. 2017;10(1):1–7.
doi: 10.1186/s13104-017-2605-x
Correa-Agudelo E, Kim H-Y, Musuka GN, Mukandavire Z, Miller FD, Tanser F, et al. The epidemiological landscape of anemia in women of reproductive age in sub-saharan Africa. Sci Rep. 2021;11(1):1–10.
doi: 10.1038/s41598-021-91198-z
Arsenault JE, Olney DK. Review of the micronutrient situation in Rwanda. FoodNutr Bull. 2021;42(1):133–54.
Karema C, Wen S, Sidibe A, Smith JL, Gosling R, Hakizimana E, et al. History of malaria control in Rwanda: implications for future elimination in Rwanda and other malaria-endemic countries. Malar J. 2020;19(1):356.
pubmed: 33028337
pmcid: 7539391
doi: 10.1186/s12936-020-03407-1
National Institute of Statistics of. Rwanda - NISR MoH-M, ICF. Rwanda demographic and health survey 2019-20. 2021.
Habyarimana F, Zewotir T, Ramroop S. Prevalence and risk factors associated with anemia among women of childbearing age in Rwanda. Afr J Reprod Health. 2020;24(2):141–51.
pubmed: 34077100
Hakizimana D, Nisingizwe MP, Logan J, Wong R. Identifying risk factors of anemia among women of reproductive age in Rwanda–a cross-sectional study using secondary data from the Rwanda demographic and health survey 2014/2015. BMC Public Health. 2019;19(1):1–11.
doi: 10.1186/s12889-019-8019-z
Habyarimana F, Zewotir T, Ramroop S. Spatial distribution and analysis of risk factors associated with Anemia among women of reproductive age: case of 2014 Rwanda demographic and health survey data. The Open Public Health Journal. 2018;11(1).
Hakizimana D, Nisingizwe M, Logan J, Wong R. Risk factors of anemia among women of Reproductive Age in Rwanda: implications for designing better interventions. 2019.
Donahue Angel M, Berti P, Siekmans K, Tugirimana PL, Boy E. Prevalence of iron deficiency and iron deficiency anemia in the northern and southern provinces of Rwanda. FoodNutr Bull. 2017;38(4):554–63.
Blaise G, Erigene R. Prevalence of Anemia and Associated Factors among pregnant women attending Kabgayi Hospital in Rwanda. J Med Nurs Public Health. 2021;4(1).
Liyew AM, Tesema GA, Alamneh TS, Worku MG, Teshale AB, Alem AZ, et al. Prevalence and determinants of anemia among pregnant women in East Africa; a multi-level analysis of recent demographic and health surveys. PLoS ONE. 2021;16(4):e0250560.
pubmed: 33905448
pmcid: 8078763
doi: 10.1371/journal.pone.0250560
Teshale AB, Tesema GA, Worku MG, Yeshaw Y, Tessema ZT. Anemia and its associated factors among women of reproductive age in eastern Africa: a multilevel mixed-effects generalized linear model. PLoS ONE. 2020;15(9):e0238957.
pubmed: 32915880
pmcid: 7485848
doi: 10.1371/journal.pone.0238957
Abriha A, Yesuf ME, Wassie MM. Prevalence and associated factors of anemia among pregnant women of Mekelle town: a cross sectional study. BMC Res Notes. 2014;7(1):1–6.
doi: 10.1186/1756-0500-7-888
Zou D, Lloyd JE, Baumbusch JL. Using SPSS to analyze complex survey data: a primer. J Mod Appl Stat Methods. 2020;18(1):16.
doi: 10.22237/jmasm/1556670300
Johnston R, Jones K, Manley D. Confounding and collinearity in regression analysis: a cautionary tale and an alternative procedure, illustrated by studies of British voting behaviour. Qual Quant. 2018;52(4):1957–76.
pubmed: 29937587
doi: 10.1007/s11135-017-0584-6
Croft T, Marshall A, Allen C. Guide to DHS statistics. Rockville: ICF; 2018. 2018.
World bank WWHO. Prevalence of Aneamia among pregnant women. 2019–2020.
Adjei-Banuah NY, Aduah VA, Ziblim S-D, Ayanore MA, Amalba A, Mogre V. Nutrition knowledge is associated with the consumption of iron rich foods: a survey among pregnant women from a rural district in northern Ghana. Nutr Metabolic Insights. 2021;14:11786388211039427.
doi: 10.1177/11786388211039427
Petry N, Wirth JP, Friesen VM, Rohner F, Nkundineza A, Chanzu E, et al. Assessing the coverage of biofortified foods: development and testing of methods and indicators in Musanze, Rwanda. Curr Developments Nutr. 2020;4(8):nzaa107.
doi: 10.1093/cdn/nzaa107
Awoleye AF, Alawode OA, Chima V, Okunlola DA, Obiesie S. Rural-urban differentials in the relationship between household wealth index and maternal anaemia status in Nigeria. Health Care Women Int. 2022:1–16.
Nankinga O, Aguta D. Determinants of Anemia among women in Uganda: further analysis of the Uganda demographic and health surveys. BMC Public Health. 2019;19(1):1–9.
doi: 10.1186/s12889-019-8114-1
Samuel S, Darebo T, Desta DT, Mulugeta A. Socio-economic and dietary diversity characteristics are associated with anemia among pregnant women attending antenatal care services in public health centers of Kembata Tembaro Zone, Southern Ethiopia. Food Sci Nutr. 2020;8(4):1978–86.
pubmed: 32328264
pmcid: 7174199
doi: 10.1002/fsn3.1485
Abdallah F, John SE, Hancy A, Paulo HA, Sanga A, Noor R, et al. Prevalence and factors associated with anaemia among pregnant women attending reproductive and child health clinics in Mbeya region, Tanzania. PLOS Global Public Health. 2022;2(10):e0000280.
pubmed: 36962486
pmcid: 10021601
doi: 10.1371/journal.pgph.0000280
Amarasinghe GS, Agampodi TC, Mendis V, Agampodi SB. Factors associated with early pregnancy anemia in rural Sri Lanka: does being ‘under care’iron out socioeconomic disparities? PLoS ONE. 2022;17(10):e0274642.
pubmed: 36201463
pmcid: 9536542
doi: 10.1371/journal.pone.0274642
Vatsa R, Ghimire U, Yasmin K, Hasan FJ. Determinants of under-and over-nutrition among reproductive-age women in Bangladesh: trend analysis using spatial modelling. 2022.
Shamim AA, Hossain MM, Akter F, Urmy NJ, Hanif AAM, Hasan M et al. Unhealthy foods and sugar-sweetened beverages consumption among Bangladeshi adolescents and their sociodemographic determinants: findings from a nationally representative cross-sectional study. Cureus. 2023;15(7).
Chai ZF, Gan WY, Chin YS, Ching YK, Appukutty M. Factors associated with anemia among female adult vegetarians in Malaysia. Nutr Res Pract. 2019;13(1):23–31.
pubmed: 30788053
pmcid: 6369109
doi: 10.4162/nrp.2019.13.1.23
Nwizu E, Iliyasu Z, Ibrahim S, Galadanci H. Socio-demographic and maternal factors in anaemia in pregnancy at booking in Kano, northern Nigeria. Afr J Reprod Health. 2011;15(4):33–41.
pubmed: 22571103
Jayaraman A, Chandrasekhar S, Gebreselassie T. Factors affecting maternal health care seeking behavior in Rwanda. 2008.
Fernández-Gaxiola AC, De-Regil LM. Intermittent iron supplementation for reducing anaemia and its associated impairments in adolescent and adult menstruating women. Cochrane Database Syst Rev. 2019;1(1):Cd009218.
pubmed: 30699468
(WHO) WHO. WHO recommendations on antenatal care for a positive pregnancy experience 2016. https://www.who.int/publications/i/item/9789241549912 .
National Institute of Statistics of Rwanda-NISR-Rwanda MoA-M-RaWFPN. MOA, and WFP. Rwanda 2015: Comprehensive food security and vulnerability analysis. 2016.
Zegeye B, Anyiam FE, Ahinkorah BO, Ameyaw EK, Budu E, Seidu A-A, et al. Prevalence of anemia and its associated factors among married women in 19 sub-saharan African countries. Archives Public Health. 2021;79(1):1–12.
doi: 10.1186/s13690-021-00733-x
Mehrotra M, Yadav S, Deshpande A, Mehrotra H. A study of the prevalence of anemia and associated sociodemographic factors in pregnant women in Port Blair, Andaman and Nicobar Islands. J Family Med Prim care. 2018;7(6):1288.
pubmed: 30613513
pmcid: 6293883
doi: 10.4103/jfmpc.jfmpc_139_18
BONDEVIK GT, ULSTEIN M, LIE RT, RANA G. The prevalence of anemia in pregnant Nepali women-a study in Kathmandu. Acta Obstet Gynecol Scand. 2000;79(5):341–9.
pubmed: 10830759
Khani Jeihooni A, Hoshyar S, Afzali Harsini P, Rakhshani T. The effect of nutrition education based on PRECEDE model on iron deficiency anemia among female students. BMC Womens Health. 2021;21(1):1–9.
doi: 10.1186/s12905-021-01394-2
Jolly SP, Roy Chowdhury T, Sarker TT, Afsana K. Water, sanitation and hygiene (WASH) practices and deworming improve nutritional status and anemia of unmarried adolescent girls in rural Bangladesh. J Health Popul Nutr. 2023;42(1):127.
pubmed: 37957706
pmcid: 10644610
doi: 10.1186/s41043-023-00453-8
Adugna DG, Kibret AA, Aragie H, Enyew EF, Dessie G, Melese M, et al. Prevalence and determinants of anemia among children aged from 6 to 59 months in Liberia: a multilevel analysis of the 2019/20 Liberia demographic and health survey data. Front Pead. 2023;11:1152083.
doi: 10.3389/fped.2023.1152083
Keokenchanh S, Kounnavong S, Tokinobu A, Midorikawa K, Ikeda W, Morita A et al. Prevalence of anemia and its associate factors among women of reproductive age in Lao PDR: evidence from a nationally representative survey. Anemia. 2021;2021.
Yang Y, Cai Z, Zhang J. The effect of prepregnancy body mass index on maternal micronutrient status: a meta-analysis. Sci Rep. 2021;11(1):1–17.
Mocking M, Savitri AI, Uiterwaal CS, Amelia D, Antwi E, Baharuddin M, et al. Does body mass index early in pregnancy influence the risk of maternal anaemia? An observational study in Indonesian and Ghanaian women. BMC Public Health. 2018;18(1):1–9.
doi: 10.1186/s12889-018-5704-2