Risk Factors for Anaemia in Pregnancy in Rural KwaZulu-Natal – South Africa: Implication for Health Education and Health Promotion

Abstract

Background: Anaemia in pregnancy is a major public health problem in developing countries. It is associated with an increased risk of maternal and perinatal morbidity and mortality. A high rate of anaemia in pregnancy in rural population of KwaZulu-Natal (30% according to national and 57% according to WHO definition of anaemia in pregnancy) is observed. The risk factors for anaemia particularly during pregnancy are multiple and complex and their relative contributions are known to vary by geographic areas and by seasons. In order to design an intervention for treatment and prevention of anaemia in pregnancy, studies to assess the etiologic factors are necessary. The aim of this study was to evaluate the strength of association between intestinal helminthiasis, urinary schistosomiasis and HIV infection on anaemia in pregnancy. Methods: A retrospective case–control study design was used in a rural district hospital of South Africa. A total of 300 pregnant women, 100 of them with anaemia (haemoglobin less than 10 gm/dL according to national definition of anaemia in pregnancy) referred as cases and 200 controls were studied from Empangeni hospital. Both cases and controls were matched for age, parity and gestational age. Data were collected from antenatal clinic and PMTCT registers for cases and controls at their booking visit during the months of May, June and July of 2004. Univariate and multiple logistic regression were performed to analyze the data. Results: Of the cases 48% and 1% among the controls had Intestinal helminthiasis resulted the odds ratio of 42 (p = 0,000 and 95% CI, 9,96 – 176,59). The risk of anaemia was related to urinary schistosomiasis as 27% of the cases compared with 1% of controls was found with anaemia and the odds ratio was 12 (p =0,000 and 95% CI, 3,58 – 41,02). These parasitic infestations are known to cause chronic haemorrhage and iron deficiency resulting development of anaemia in pregnancy. Transmissions of intestinal parasitic infestation occur through oro-foecal route. Personal hygiene and other environmental factors are therefore an important factor for the transmission of the disease. To reduce transmission of faecal – oral diseases (e. g., intestinal helminthiasis and urinary schistosomiasis) key interventions recommended are; 1) safe disposal of human excreta, 2) hand washing practices with soap after defecation and 3) maintaining of drinking water free from faecal contamination. Similarly, HIV infection increased the chance of developing anaemia in pregnancy by two folds as HIV infection were common among cases (56%) than those of controls (37%) resulted odds ratio of 2.11 (p =0,003 and 95% CI, 1,123 – 3,21). The prevention of HIV infection and transmission can be achieved through improving knowledge on these conditions. These can be achieved through health education and health promotion Conclusion: These findings confirm and conform to other studies of the association between anaemia in pregnancy and parasitic and HIV infections. The antenatal care should promote de-worming, education on personal hygiene and HIV (risk factors, mode of transmission etc.). Provision of safe water supply and toilet facilities for the rural communities should be considered urgently to prevent and promote better health for all including pregnant women.