Research Article: Hematological responses to iron-folate supplementation and its determinants in pregnant women attending antenatal cares in Mekelle City, Ethiopia

Date Published: October 1, 2018

Publisher: Public Library of Science

Author(s): Ezra Belay, Asrat Endrias, Birhane Alem, Kedir Endris, Xiang Xue.

http://doi.org/10.1371/journal.pone.0204791

Abstract

To characterize anemia and evaluate hematological responses to universal iron-folic acid (IFA) supplementation in Ethiopian pregnant women.

A hospital- based prospective follow up study was done between December 2016 and June 2017. Hematological profiles were measured in pregnant women before and after a minimum of one-month IFA supplementation. Mean values and abnormal proportions of hematological profiles were compared before and after supplementation using paired t-test and McNemar test, respectively. Univariate and multivariate analysis were used to analyze the association between independent variables and poor treatment responses.

Lack of adequate hemoglobin response was found in 48.5%(95/196) of the participants. Prevalence of anemia and low hematocrit value were decreased significantly after IFA supplementation (p = 0.002, and p = 0.001, respectively). Normocytic hypochromic anemia was the commonest form of anemia found in this study followed by normocytic normochromic anemia. There was no statistically significant association between poor hemoglobin responses and all studied factors such as educational level, household size, parity, recent illness, stage of pregnancy, coffee consumption, and duration of iron treatment.

Our study revealed poor hemoglobin responses in nearly half of the study participants and a high proportion of anemias morphologically atypical of iron deficiency anemia. There is a need to consider anemia attributable to etiologies other than an iron deficiency in anemia intervention programs.

Partial Text

Anemia during pregnancy is a significant health problem in Ethiopia with a prevalence rate as high as 30% [1]. It poses a major threat to maternal and child survival, contributing to poor pregnancy outcomes, poor cognitive/physical development, and decreased work productivity [2, 3]. A large body of evidence suggested that anemia in pregnancy has an adverse effect on fetal growth which is an important predictor of children’s immediate and future health [4–7]. In combination with obstetric hemorrhage, anemia during pregnancy is estimated to be responsible for 17–46% of cases of maternal death in Africa [8]. Moreover, some studies revealed that anemia could play a secondary role in nearly all maternal cases in resource- poor setting [9].

Ahospital-based prospective follow up study was done in two government hospitals found in Mekelle city, Northern Ethiopia from November 2016 to June 2017.

Though several studies have determined the prevalence of anemia in Ethiopian pregnant women, data on specific anemia etiology is still limited. On the other hand, recent studies revealed that magnitude of anemia attributable to iron deficiency varied from region to region and several other factors could play a major role in low hemoglobin and anemia [28]. In this study, we tried to characterize anemia, and identify its causes using hematological responses to universal IFA supplementation and RBC morphology as a tool.

Our study revealed that poor hemoglobin responses in nearly half of the pregnant women participated in the study and a high proportion of anemias morphologically atypical of an iron deficiency anemia. There is a need to consider anemia attributable to etiologies other than iron deficiency in anemia intervention programs. The current universal iron supplementation program should be reassessed for possible changes into targeted supplementations.

 

Source:

http://doi.org/10.1371/journal.pone.0204791

 

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