Nutrition News for Africa
Abstract - December 15, 2006
An article entitled "Determinants of anemia among pregnant
women in Mali" was published by Ag Ayoya et al. in the
Food and Nutrition Bulletin, vol 27, no.1.
Introduction: In Mali, regional surveys
estimate that the mean prevalence of anemia among pregnant
women is between 41% and 59%. The most common worldwide cause
of anemia during pregnancy is purported to be iron deficiency
due to chronically inadequate dietary iron that is exacerbated
by the high physiological demands of pregnancy. Iron absorption
and utilization can also be adversely affected by common states
of chronic infections and inflammation due to malaria and
multiple helminthic infections. A large cross-sectional study
was undertaken in Mali to examine the prevalence of anemia
during pregnancy and to look at the likely etiologic factors
associated with it in a presumable high-risk population. The
study was designed to assess the relationship among anemia,
malaria, and other parasitic disease, and to inform local
and regional nutrition policies, among others.
Methods: The study was conducted in Banconi,
a poor and densely populated suburb of Bamako, from June to
August 2002. The study population consisted of women aged
18 to 45, who were attending the community health center.
Eligibility criteria included pregnancy with no oral iron
or anthelmintic treatment since the beginning of the pregnancy,
and no blood transfusion within the three months preceding
entry into the study. Of the 190 women enrolled, 131 (69%)
provided all the necessary information and samples with complete
clinical and biochemical data available. All participants
were provided with sufficient supplements for a 30-day course
of ferrous fumarate and folate tablets containing 64mg of
elemental iron and 400 micrograms of folate. A 4-week course
of chloroquine was also provided as a preemptive treatment
against malaria.
Results: Food accessibility was constrained
in 45% of women because of culture- or self-imposed food restrictions
(e.g. eggs, milk, salt, banana, meat). Low serum iron was
observed in 13% of the analyzed sample and 11% of women had
abnormally low total iron-binding capacity. Hemoglobin level
was under 110g/L in 47% of the women and under 70g/L in 2%
of the women. Malaria parasitemia, S. haematobium, and hookworm
infections were detected in 11%, 23% and 8% of the women respectively,
and 82% of the women had an abnormal vaginal discharge.
Discussion: The results indicate that infections
and food constraints are probably important causes of anemia
in this population. It is not possible to rule out that iron
is the principal limiting factor accounting for the high rates
of anemia as other measurements of iron status such as serum
ferritin were not feasible in the study setting. Infections
were most strongly predictive of anemia. The findings that
55%, 32%, 13% and 10% of the anemia cases were attributable
to abnormal vaginal discharge, malaria, S. haematobium, and
hookworm respectively, stress the likely role infections play
and suggest that treatment with iron alone is unlikely to
be an effective strategy against anemia.
Conclusion: The authors conclude that vaginal
infections and parasitic diseases are important factors that
contribute to the high rates of anemia among women in that
study and that a stronger focus on their prevention, diagnosis
and treatment is needed, especially on the assessment of the
causal link between abnormal vaginal discharge and anemia.
The authors also advise that minimizing or eliminating unnecessary
self-or culturally-imposed food restrictions is also desirable.
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