title: Anaemia in pregnant Ghanaian women: importance of malaria, iron deficiency, and haemoglobinopathies.
abstract: In sub-Saharan Africa, anaemia in pregnancy results from multiple causes including malaria, iron deficiency and haemoglobinopathies. In a cross-sectional study among 530 pregnant women in Ghana in November-December 1998, red blood cell indices were analysed with respect to malaria, serum concentrations of ferritin and C-reactive protein (CRP), and the haemoglobin and alpha-globin genotypes. Anaemia (haemoglobin [Hb] < 11 g/dL) was found in 54% of the women; 63% harboured malaria parasites at predominantly low numbers. Ferritin levels were considerably influenced by malaria and inflammatory processes (CRP > 0.6 mg/dL). Depending on the definition applied, the prevalence of iron deficiency ranged between 5% and 46%. The HbAS trait was observed in 14%, HbAC and elevated HbF in 7% each, and sickle cell disease in 1%. Heterozygous beta-thalassaemia was present in 1% of the women and alpha(+)-thalassaemia in 33% (29% heterozygous, 4% homozygous). Women with HbAS had higher malaria parasite densities than those with HbAA. In individuals with highly elevated HbF (> 10%), parasitaemia occurred in 27% only. Low gravidity, second trimester of pregnancy, malaria, raised CRP levels, and homozygous alpha(+)-thalassaemia were independent risk factors for anaemia in multivariate analysis. alpha(+)-Thalassaemia, however, was associated with a lesser degree of malarial anaemia when compared to non-thalassaemic women. Iron deficiency appears not to be a major health problem in this population. Haemoglobinopathies are common but, except for homozygous alpha(+)-thalassaemia, do not substantially contribute to anaemia in pregnancy. alpha(+)-Thalassaemia ameliorates malarial anaemia in pregnant women.
authors.affiliation: Institut für Tropenmedizin, Medizinische Fakultät Charité, Humboldt Universität zu Berlin, Germany. frank.mockenhaupt@charite.de
authors.forename: F P
authors.initials: FP
authors.lastname: Mockenhaupt
authors.forename: B
authors.initials: B
authors.lastname: Rong
authors.forename: M
authors.initials: M
authors.lastname: Günther
authors.forename: S
authors.initials: S
authors.lastname: Beck
authors.forename: H
authors.initials: H
authors.lastname: Till
authors.forename: E
authors.initials: E
authors.lastname: Kohne
authors.forename: W N
authors.initials: WN
authors.lastname: Thompson
authors.forename: U
authors.initials: U
authors.lastname: Bienzle
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000453:epidemiology; D002097:C-Reactive Protein / Q000032:analysis; D003430:Cross-Sectional Studies; D005260:Female; D005293:Ferritins / Q000097:blood; D005869:Ghana / Q000453:epidemiology; D020073:Gravidity; D006453:Hemoglobinopathies / Q000097:blood / Q000453:epidemiology*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008288:Malaria / Q000097:blood / Q000453:epidemiology*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood / Q000453:epidemiology*; D015597:Pregnancy Complications, Parasitic / Q000097:blood / Q000453:epidemiology*; D012044:Regression Analysis; D012307:Risk Factors
chemical_list: D006454:Hemoglobins; D002097:C-Reactive Protein; D005293:Ferritins