Prevalence, types and determinants of anemia among pregnant women in Sudan: A systematic review and meta-analysis

BMC Hematology, Volume 18, No. 1, Year 2018

Interpretation

Background: Anemia during pregnancy is a public health problem especially in developing countries and it is associated with maternal and perinatal adverse outcomes. There is no meta-analysis on anemia during pregnancy in Sudan. The current systemic review and meta-analysis was conducted to assess the prevalence, types and determinant of anemia during pregnancy in Sudan. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. The databases (PubMed, Cochrane Library, Google Scholar, CINAHL, and African Journals Online) were searched using; anemia, pregnancy related anemia and Sudan. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) and Modified Newcastle – Ottawa quality assessment scale were used for critical appraisal of studies. The pooled Meta logistic regression was computed using OpenMeta Analyst software. Results: Sixteen cross-sectional studies included a total of 15, 688 pregnant women were analyzed. The pooled prevalence of anemia among pregnant women in Sudan was 53.0% (95%, CI = 45.9-60.1). The meta-analysis showed no statistical significant between the age (mean difference = 0.143, 95 CI = – 0.033 – 0.319, P = 0.112), parity (mean difference = 0.021, 95% CI = – 0.035 – 0.077, P = 0.465) between the anemic and no anemic women. Malaria was investigated in six studies. Pregnant women who had malaria infection during pregnancy were 1.94 times more likely to develop anemia than women who had no malaria infection (OR = 1.94, 95% CI =1.33-2.82). Six (37.5%) studies investigated type of anemia. The pooled prevalence of iron deficiency anemia (IDA) among pregnant women in Sudan was 13.6% (95% CI = 8.9-18.2). Conclusion: There is a high prevalence of anemia among pregnant in the different region of Sudan. While age and parity have no association with anemia, malaria infection was associated with anemia. Interventions to promote the strengthening of antenatal care, and access and adherence to nutrition, and malaria preventive measures are needed to reduce the high level of anemia among pregnant women in Sudan. Findings from published studies were used to conduct this systematic review and meta-analysis to determine the prevalence of anemia, types and its determinants (age, parity and malaria) among pregnant women in Sudan. The major databases of PubMed, Cochrane Library, Google Scholar, CINAHL, and African Journals Online were reviewed for all published studies relevant to anemia during pregnancy and its determinant factors. All studies that were published up to April 03/2018 were retrieved to be assessed for eligibility of inclusion in this review. In addition, the reference list of each included study was also searched, retrieved and assessed for inclusion eligibility. The terms that used for searching are: “anemia OR anemia during pregnancy OR determinants of anemia AND Sudan”. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for conduction of this systematic review and meta-analysis [25]. The primary outcome of this study was the prevalence of anemia during pregnancy. The WHO defines anemia in pregnancy as low blood hemoglobin concentration, below 11 g/dl or hematocrit level less than 33% dl [2]. The secondary outcomes were; types and determinants (age, parity and malaria) of anemia during pregnancy. The included studies were assessed by using Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) [26]. Modified Newcastle – Ottawa quality assessment scale for cross sectional studies was used to assess the quality of the study for inclusion [27]. The total score for the modified Newcastle – Ottawa scale for cross sectional studies is nine (9) stars as a maximum for the overall scale with the minimum of zero. A study was considered high quality if it achieved 7 out 9 and medium if it achieved 5out of 9, Table 1, Additional file 1. Summary and the assessment of the included studies Two reviewers (IA & YI) independently assessed the quality of each article for inclusion in the review. The disagreement arise between the reviewers was resolved through discussion and involvement of a third reviewer (OE). A tool for data extraction was developed to extract the most important relevant information for the review. It consists of tables that include information about the authors’ name, year of publication, study location, sample size, age of study participants, and number of pregnancies, malaria with pregnancy, type of anemia and presence and types of complications of anemia. OpenMeta Analyst software for Windows [28, 29] was used to perform all the meta-analyses of prevalence and determinants (age, parity and malaria) of anemia. The heterogeneity of the included studies was evaluated using Cochrane Q and the I2. Cochrane Q with P < 0.10 and I2 > 50 was taken as standard to indicate the presence of heterogeneity of the included studies [30]. Based on the results of the analysis of Cochrane Q and I2 the random effects or fixed model was used to combine the included studies accordingly. A sub-group analysis was performed to investigate the association between malaria and anemia.

AI Digest

Study Justification:

– Anemia during pregnancy is a public health problem, especially in developing countries.
– Anemia is associated with maternal and perinatal adverse outcomes.
– There is no meta-analysis on anemia during pregnancy in Sudan.

Study Highlights:

– The study conducted a systematic review and meta-analysis to assess the prevalence, types, and determinants of anemia during pregnancy in Sudan.
– Sixteen cross-sectional studies with a total of 15,688 pregnant women were analyzed.
– The pooled prevalence of anemia among pregnant women in Sudan was 53.0%.
– Age and parity were not found to be associated with anemia, but malaria infection during pregnancy increased the risk of anemia.
– The pooled prevalence of iron deficiency anemia (IDA) among pregnant women in Sudan was 13.6%.

Study Recommendations:

– Interventions to strengthen antenatal care, improve access to nutrition, and promote malaria preventive measures are needed to reduce the high level of anemia among pregnant women in Sudan.

Key Role Players:

– Healthcare providers: Obstetricians, midwives, nurses, and nutritionists.
– Public health officials: Ministry of Health, Department of Maternal and Child Health.
– Researchers: Epidemiologists, statisticians, and public health researchers.
– Non-governmental organizations (NGOs): Organizations working in maternal and child health, nutrition, and malaria prevention.

Cost Items for Planning Recommendations:

– Strengthening antenatal care: Training healthcare providers, improving infrastructure, and ensuring the availability of necessary equipment and supplies.
– Improving access to nutrition: Implementing nutrition education programs, providing nutritional supplements, and supporting community-based interventions.
– Promoting malaria preventive measures: Distributing insecticide-treated bed nets, conducting malaria awareness campaigns, and providing antimalarial medications.
– Research and monitoring: Conducting further studies, collecting data, and evaluating the impact of interventions.
Please note that the actual cost of implementing these recommendations would require a detailed budget analysis and may vary depending on the specific context and resources available in Sudan.

Strength of Evidence

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is rated 8 because it provides a clear description of the methods used, including the databases searched and the tools used for critical appraisal. The abstract also presents the findings of the systematic review and meta-analysis, including the prevalence of anemia and its determinants. However, it could be improved by providing more details on the characteristics of the included studies and the statistical methods used for the meta-analysis.

Abstract

Findings from published studies were used to conduct this systematic review and meta-analysis to determine the prevalence of anemia, types and its determinants (age, parity and malaria) among pregnant women in Sudan. The major databases of PubMed, Cochrane Library, Google Scholar, CINAHL, and African Journals Online were reviewed for all published studies relevant to anemia during pregnancy and its determinant factors. All studies that were published up to April 03/2018 were retrieved to be assessed for eligibility of inclusion in this review. In addition, the reference list of each included study was also searched, retrieved and assessed for inclusion eligibility. The terms that used for searching are: “anemia OR anemia during pregnancy OR determinants of anemia AND Sudan”. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for conduction of this systematic review and meta-analysis [25]. The primary outcome of this study was the prevalence of anemia during pregnancy. The WHO defines anemia in pregnancy as low blood hemoglobin concentration, below 11 g/dl or hematocrit level less than 33% dl [2]. The secondary outcomes were; types and determinants (age, parity and malaria) of anemia during pregnancy. The included studies were assessed by using Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) [26]. Modified Newcastle – Ottawa quality assessment scale for cross sectional studies was used to assess the quality of the study for inclusion [27]. The total score for the modified Newcastle – Ottawa scale for cross sectional studies is nine (9) stars as a maximum for the overall scale with the minimum of zero. A study was considered high quality if it achieved 7 out 9 and medium if it achieved 5out of 9, Table 1, Additional file 1. Summary and the assessment of the included studies Two reviewers (IA & YI) independently assessed the quality of each article for inclusion in the review. The disagreement arise between the reviewers was resolved through discussion and involvement of a third reviewer (OE). A tool for data extraction was developed to extract the most important relevant information for the review. It consists of tables that include information about the authors’ name, year of publication, study location, sample size, age of study participants, and number of pregnancies, malaria with pregnancy, type of anemia and presence and types of complications of anemia. OpenMeta Analyst software for Windows [28, 29] was used to perform all the meta-analyses of prevalence and determinants (age, parity and malaria) of anemia. The heterogeneity of the included studies was evaluated using Cochrane Q and the I2. Cochrane Q with P 50 was taken as standard to indicate the presence of heterogeneity of the included studies [30]. Based on the results of the analysis of Cochrane Q and I2 the random effects or fixed model was used to combine the included studies accordingly. A sub-group analysis was performed to investigate the association between malaria and anemia.

Materials

Innovations

Based on the provided description, the following innovations could be recommended to improve access to maternal health in Sudan:

1. Strengthening Antenatal Care: Implementing interventions to enhance the quality and accessibility of antenatal care services can help identify and address anemia among pregnant women. This can include regular screening for anemia, providing iron and folic acid supplements, and offering counseling on nutrition and healthy lifestyle choices.

2. Improving Access to Nutrition: Promoting access to nutritious food and supplements, particularly iron-rich foods, can help prevent and treat anemia during pregnancy. This can be achieved through community-based programs that educate women on the importance of a balanced diet and provide support in accessing affordable and nutritious food options.

3. Malaria Prevention Measures: Given the association between malaria infection and anemia during pregnancy, it is crucial to prioritize malaria prevention measures. This can involve widespread distribution of insecticide-treated bed nets, provision of antimalarial medications, and implementation of effective vector control strategies.

4. Health Education and Awareness: Conducting targeted health education campaigns to raise awareness about the risks and consequences of anemia during pregnancy can empower women to seek appropriate care and take preventive measures. This can include educating women on the importance of regular antenatal check-ups, iron supplementation, and adherence to malaria prevention strategies.

5. Collaboration and Integration: Strengthening collaboration between healthcare providers, community organizations, and government agencies can facilitate the integration of maternal health services. This can ensure a comprehensive approach to addressing anemia during pregnancy, including early detection, treatment, and follow-up care.

It is important to note that these recommendations are based on the information provided and may need to be tailored to the specific context and resources available in Sudan.

AI Innovations Description

The recommendation that can be developed into an innovation to improve access to maternal health based on the findings of this systematic review and meta-analysis is to implement interventions that focus on strengthening antenatal care, improving access to nutrition, and promoting malaria preventive measures for pregnant women in Sudan.

These interventions can include:

1. Strengthening Antenatal Care: Enhancing the quality and availability of antenatal care services can help identify and manage anemia during pregnancy. This can involve training healthcare providers to screen for anemia, providing iron and folic acid supplementation, and conducting regular follow-ups to monitor the hemoglobin levels of pregnant women.

2. Improving Access to Nutrition: Ensuring pregnant women have access to a balanced and nutritious diet is crucial in preventing and managing anemia. This can be achieved through community-based nutrition programs that educate women about the importance of consuming iron-rich foods, promoting breastfeeding, and providing nutritional supplements when necessary.

3. Malaria Prevention: Given the association between malaria infection and anemia during pregnancy, it is essential to implement effective malaria prevention measures. This can include distributing insecticide-treated bed nets, providing antimalarial medication, and conducting regular malaria screenings for pregnant women.

4. Health Education and Awareness: Raising awareness among pregnant women and their families about the risks and consequences of anemia during pregnancy can encourage early detection and prompt seeking of healthcare services. Health education programs can be implemented through community outreach initiatives, utilizing various communication channels such as radio, television, and mobile technology.

5. Collaboration and Partnerships: To effectively address the issue of anemia during pregnancy, collaboration between different stakeholders is crucial. This can involve partnerships between government agencies, non-governmental organizations, healthcare providers, and community leaders to ensure the implementation and sustainability of interventions.

By implementing these recommendations, it is possible to improve access to maternal health and reduce the prevalence of anemia among pregnant women in Sudan.

AI Innovations Methodology

Based on the provided description, here are some potential recommendations to improve access to maternal health:

1. Strengthen Antenatal Care: Enhance antenatal care services by ensuring regular check-ups, providing comprehensive health education, and promoting early detection and management of anemia during pregnancy.

2. Improve Nutrition: Implement interventions to address nutritional deficiencies among pregnant women, such as promoting a balanced diet rich in iron, folic acid, and other essential nutrients. This can be done through counseling, nutritional supplementation programs, and community-based initiatives.

3. Malaria Prevention: Integrate malaria prevention measures into antenatal care, including the use of insecticide-treated bed nets, intermittent preventive treatment for malaria, and prompt diagnosis and treatment of malaria infections during pregnancy.

4. Health Education: Conduct targeted health education campaigns to raise awareness about the importance of antenatal care, proper nutrition, and malaria prevention among pregnant women and their families. This can be done through community outreach programs, media campaigns, and involvement of local healthcare providers.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Determine the key indicators that will be used to measure the impact of the recommendations, such as the prevalence of anemia among pregnant women, the uptake of antenatal care services, and the incidence of malaria during pregnancy.

2. Data collection: Collect baseline data on the selected indicators before implementing the recommendations. This can be done through surveys, interviews, and medical records review.

3. Intervention implementation: Implement the recommended interventions, ensuring proper training of healthcare providers, availability of necessary resources, and community engagement.

4. Monitoring and evaluation: Continuously monitor the implementation of the interventions and collect data on the selected indicators. This can be done through regular data collection, surveys, and monitoring visits.

5. Data analysis: Analyze the collected data to assess the impact of the interventions on the selected indicators. This can involve statistical analysis, such as calculating prevalence rates, comparing pre- and post-intervention data, and conducting regression analyses to identify factors associated with improved access to maternal health.

6. Interpretation and reporting: Interpret the findings of the data analysis and prepare a report summarizing the impact of the recommendations on improving access to maternal health. This report can be used to inform future decision-making and guide further interventions.

It is important to note that the specific methodology may vary depending on the context and available resources. Collaboration with relevant stakeholders, including healthcare providers, researchers, and policymakers, is crucial to ensure the validity and applicability of the findings.

Author

Dima Health

Statistics:

Citations: 25

Identifiers:

DOI: 10.1186/s12878-018-0124-1

Research Areas:

Community Interventions, Food Security, Genetics and Genomics, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Sexual and Reproductive Health, Social Determinants

Study Countries:

Sudan

Study Design:

Cross Sectional Study

Study Approach:

Systematic Review

Participants Gender:

Female