Anaemia in pregnancy: possible causes and risk factors in Nepali women.
OBJECTIVE
The aim of this study was to investigate the importance of nutritional deficiencies and infections in the development of anaemia in pregnant Nepali women.


METHODS
Case-control study.


METHODS
Patan Hospital, Kathmandu, Nepal.


METHODS
A sub-sample (n=479) of all pregnant women (n=2856) coming for their first antenatal visit in a 12 month period, 1994-1995. Women who had already received any micronutrient supplementation (n=82), and those whose serum samples showed macroscopic haemolysis (n=7) were excluded. The remaining women (n=390) were included in the statistical analysis. They were divided into three groups; a non-anaemic control group, haematocrit (Hct)>33% (n=82), and two case-groups: moderately anaemic, Hct 25-33% (n=254), and severely anaemic, Hct<25% (n=54).


RESULTS
We found high prevalences of nutritional deficiencies and intestinal infections, both among cases and controls. The prevalence of low s-ferritin was high, especially among the severely anaemic women (55.6%). In a multiple logistic regression model, the presence of low s-vitamin A, elevated s-C-reactive protein or hookworm infection was associated with a significantly increased risk of severe anaemia. The adjusted odds ratios (95% CI) were 8.38 (1.99, 35.30), 4.91 (1.22, 19.67) and 5.43 (1.20, 24.61), respectively.


CONCLUSIONS
In addition to the present routine iron and folate supplementation to pregnant Nepali women, vitamin A supplementation needs to be considered. Prevention and treatment of infections should, together with dietary advice, be emphasized more strongly in the antenatal care.


BACKGROUND
The Norwegian Research Council and the Norwegian Universities Committee for Development, Research and Education. European Journal of Clinical Nutrition (2000) 54, 3-8
Bondevik
G T
GT
Centre for International Health, University of Bergen, Norway. gunnar.bondevik@cih.uib.no
Eskeland
B
B
Ulvik
R J
RJ
Ulstein
M
M
Lie
R T
RT
Schneede
J
J
Kvåle
G
G
D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000145:classification / Q000453:epidemiology / Q000209:etiology*; D016022:Case-Control Studies; D005260:Female; D006400:Hematocrit; D006725:Hookworm Infections / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007410:Intestinal Diseases / Q000453:epidemiology / Q000209:etiology; D016015:Logistic Models; D009390:Nepal / Q000453:epidemiology; D009748:Nutrition Disorders / Q000150:complications* / Q000453:epidemiology; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index