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      Determinants of Anemia in Pregnancy: Findings from the Ethiopian Health and Demographic Survey

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          Abstract

          In Ethiopia, anemia during pregnancy is a major public health problem and affects both the mother's and their child's health. There is a scarcity of community-based evidence on determinants of anemia among pregnant women in the country. Therefore, this study aimed to assess the determinants of anemia among pregnant women in Ethiopia. Method. This study was based on the 2016 Ethiopian Demographic Health Survey (EDHS) that used a two-stage stratified cluster sampling technique. A cross-sectional study was conducted among 3080 pregnant women. Data analysis was done using STATA v.14. Variables with P value <0.05 in the bivariate analysis were candidates for the multivariable analysis to identify independent determinants of anemia among pregnant mothers. Odds ratios (OR) were calculated at 95% confidence interval (CI). Results. The overall prevalence of anemia among pregnant women was 41% of which 20% were moderately anemic, 18%, mildly anemic, and 3%, severely anemic. The following were significantly associated with anemia during pregnancy: an age of 30–39 years, receiving no education (AOR = 2.19; 95% CI 1.45, 2.49), belonging to the poorest wealth quintile (AOR = 1.29; 95% CI 1.22, 1.60), being a Muslim (AOR = 1.59; 95% CI 1.69, 2.65), number of house members being 4–6 (AOR = 1.44; 95% CI 1.05, 1.97), number of under-five children being two (AOR = 1.47; 95% CI 1.10, 1.97), head of the household being a female (AOR = 2.02; 95% CI 1.61, 2.54), current pregnancy wanted later (AOR = 1.75; 95% CI 1.23, 1.63), no terminated pregnancy (AOR = 1.49; 95% CI 1.15, 1.93), and an age of 13–17 years at the first sexual intercourse (AOR = 1.97; 95% CI 1.291, 3.00). Conclusions. The study revealed that more than one-third of the pregnant women in Ethiopia were found anemic. Its prevalence varied among regions in which the highest (62.7%) and the lowest (11.9%) were from Somali and Addis Ababa, respectively. Hence, efforts should be made by concerned bodies to intervene in terms of the identified risk factors.

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          Determinants of intra-household food allocation between adults in South Asia – a systematic review

          Background Nutrition interventions, often delivered at the household level, could increase their efficiency by channelling resources towards pregnant or lactating women, instead of leaving resources to be disproportionately allocated to traditionally favoured men. However, understanding of how to design targeted nutrition programs is limited by a lack of understanding of the factors affecting the intra-household allocation of food. Methods We systematically reviewed literature on the factors affecting the allocation of food to adults in South Asian households (in Afghanistan, Bangladesh, Bhutan, India, Islamic Republic of Iran, Maldives, Nepal, Pakistan, Sri Lanka) and developed a framework of food allocation determinants. Two reviewers independently searched and filtered results from PubMed, Web of Knowledge and Scopus databases by using pre-defined search terms and hand-searching the references from selected papers. Determinants were extracted, categorised into a framework, and narratively described. We used adapted Downs and Black and Critical Appraisal Skills Programme checklists to assess the quality of evidence. Results Out of 6928 retrieved studies we found 60 relevant results. Recent, high quality evidence was limited and mainly from Bangladesh, India and Nepal. There were no results from Iran, Afghanistan, Maldives, or Bhutan. At the intra-household level, food allocation was determined by relative differences in household members’ income, bargaining power, food behaviours, social status, tastes and preferences, and interpersonal relationships. Household-level determinants included wealth, food security, occupation, land ownership, household size, religion / ethnicity / caste, education, and nutrition knowledge. In general, the highest inequity occurred in households experiencing severe or unexpected food insecurity, and also in better-off, high caste households, whereas poorer, low caste but not severely food insecure households were more equitable. Food allocation also varied regionally and seasonally. Conclusion Program benefits may be differentially distributed within households of different socioeconomic status, and targeting of nutrition programs might be improved by influencing determinants that are amenable to change, such as food security, women’s employment, or nutrition knowledge. Longitudinal studies in different settings could unravel causal effects. Conclusions are not generalizable to the whole South Asian region, and research is needed in many countries.
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            Magnitude of Anemia and Associated Risk Factors among Pregnant Women Attending Antenatal Care in Shalla Woreda, West Arsi Zone, Oromia Region, Ethiopia

            Background Anemia during pregnancy is a common problem in developing countries and affects both the mother's and her child's health. The main objective of this study was to determine the prevalence of and the factors associated with anemia among pregnant women. Methods Facility based cross-sectional study design was conducted from June to August, 2011 on 374 pregnant women. Mothers who came for ANC during the study period and who met the inclusion criteria were interviewed and a capillary blood sample was taken. Hemoglobin level was determined by using HemoCue photometer, and interviewer administered questionnaire was used to collect data. Data were cleaned, coded and fed into SPSS version 16.0 for analysis. Result The mean hemoglobin concentration was 12.05±1.5 g/dl and prevalence of anemia was 36.6%. Family sizes (COR=2.67, CI (1.65, 4.32), third trimester (COR=1.45, CI (1.11, 2.23), meat consumption <1x/wk (COR=3.47, CI (1.58, 7.64) and pica (COR=2.33, CI (1.52, 3.58) were significantly associated with anemia. Having five or more children (AOR=5.2, CI [1.29, 21.09]), intake of vegetables and fruits less than once per day (AOR= 6.7, CI [2.49, 17.89]), intake of tea always after meal (AOR = 12.83.CI [45-28.9]), and recurrence of illness during pregnancy (AOR=7.3, CI [2.12–25.39]) were factors associated with anemia. Conclusion This study showed that anemia is a moderate public health problem. Less frequent meat and vegetable consumption, parity ≥5 are risk factors for anemia. Therefore, reducing parity, taking balanced diet and use of mosquito nets during pregnancy are recommended.
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              Maternal anaemia and its impact on perinatal outcome.

              To find out the relationship between maternal anaemia and perinatal morbidity and mortality. A cohort of 629 pregnant women was studied from October 2001 to October 2002. Of these, 313 were anaemic (haemoglobin 11 g/dl at all times in pregnancy and were labelled as non-anaemic. Perinatal outcomes included preterm delivery, low birth weight (LBW) at delivery, intrauterine growth restriction, perinatal mortality, APGAR score at 1 and 5 min, intrauterine foetal demise (IUD). The risk of preterm delivery and LBW among exposed group was 4 and 1.9 times higher among anaemic women, respectively. Newborns of anaemic mothers had 1.8 times increased risk of having an APGAR score of <5 at 1 min and the risk of IUD was 3.7 times higher for anaemic women. Low maternal haemoglobin levels are associated with increased risk of preterm delivery, LBW babies, APGAR score <5 at 1 min and IUD.
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                Author and article information

                Contributors
                Journal
                Anemia
                Anemia
                ANEMIA
                Anemia
                Hindawi
                2090-1267
                2090-1275
                2020
                5 June 2020
                : 2020
                : 2902498
                Affiliations
                1Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
                2Adigrate University, Mekelle, Tigray, Ethiopia
                Author notes

                Academic Editor: Duran Canatan

                Author information
                https://orcid.org/0000-0001-9957-3199
                https://orcid.org/0000-0001-8978-5585
                https://orcid.org/0000-0002-1505-7451
                https://orcid.org/0000-0002-7608-0284
                Article
                10.1155/2020/2902498
                7293722
                32566286
                ad1b4206-bb2c-43c2-a011-c77bb72388b3
                Copyright © 2020 Ataklti Gebretsadik Woldegebriel et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 25 February 2020
                : 11 May 2020
                : 19 May 2020
                Categories
                Research Article

                Hematology
                Hematology

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