Anaemia, blood transfusion practices, HIV and mortality among women of reproductive age in western Kenya.
Severe anaemia among women in sub-Saharan Africa is frequently treated with blood transfusions. The risk of transmission of human immunodeficiency virus (HIV) through blood products has led to a re-evaluation of the indications for transfusions. Prospective surveillance of women admitted to a district hospital in western Kenya was conducted from 1 December 1990 to 31 July 1991, for haemoglobin (Hb) transfusion status, and outcome. Of the 2986 enrolled women (mean Hb 10.4 g/dL, SD +/- 2.6, median age 24.4 years), 6% were severely anaemic (Hb < 6.0 g/dL). Severe anaemia was associated with a higher mortality rate (10.7% vs. 1.4%, odds ratio (OR) = 8.2, 95% confidence interval (CI) 2.6, 34.2) compared with women with Hb > or = 6.0 g/dL. Decreased mortality rates in hospital were observed with increasing Hb values (OR = 0.43, 95% CI 0.19, 0.98), but blood transfusions did not improve survival in hospital (OR = 1.56, 95% CI 0.22, 11.03). The attributable mortality due to HIV infection and severe anaemia was 75% and 31%, respectively. Maternal/child health care services must include prevention strategies for HIV transmission and the prevention, recognition, and treatment of severe anaemia.
Malaria Branch, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, GA 30333.
J R
JR
Zucker
E M
EM
Lackritz
T K
TK
Ruebush
A W
AW
Hightower
J E
JE
Adungosi
J B
JB
Were
C C
CC
Campbell
D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000097:blood / Q000401:mortality* / Q000628:therapy; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000401:mortality* / Q000635:transmission; D006454:Hemoglobins / Q000032:analysis; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D016015:Logistic Models; D015999:Multivariate Analysis; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood / Q000401:mortality; D011446:Prospective Studies
D006454:Hemoglobins