Determinants of anemia among pregnant women in Mali.
BACKGROUND
Anemia in pregnancy remains a major problem in nearly all developing and many industrialized countries. In Mali, the subpopulation prevalence and etiology of anemia during pregnancy are largely unknown.


OBJECTIVE
To examine the prevalence and likely etiologies of anemia in pregnancy in a poor urban population in Bamako, Mali.


METHODS
Pregnant women (n = 190) were selected randomly. Hemoglobin, serum iron, and total iron-binding capacity were measured; blood smears were examined for Plasmodium falciparum malaria; and single stool and urine samples were examined for Schistosoma haematobium and hookworm. Gynecologic examinations were performed and interviews conducted to qualitatively assess food consumption and other socioeconomic characteristics. Associations among mild, moderate, and severe anemia; iron and parasite status; erythrocyte sedimentation rates; and the presence of abnormal vaginal discharge were evaluated. Differences in hemoglobin and serum iron concentrations, total iron-binding capacity, and anemia were compared according to trimester of pregnancy and between infected and noninfected women. The relative and attributable risks of anemia were calculated, and adjusted odds ratios for anemia and low serum iron were estimated by multivariate logistic regression.


RESULTS
Of the 131 women for whom complete data were available, 47% had hemoglobin concentrations below 110 g/L; 13% had serum iron concentrations below 12 micromol/L; none had transferrin saturation values below 16%; 11%, 23%, and 8% harbored P. falciparum, S. haematobium, and hookworm, respectively; and 82% had an abnormal vaginal discharge. Food restrictions were reported by 45% of the women. Abnormal vaginal discharge correlated significantly with anemia (Pearson chi2 = 62.4; p < .01). Univariate and multivariate analyses found that infections were strongly associated with and predictive of anemia.


CONCLUSIONS
Our data suggest that infections and food accessibility contribute to the high rates of anemia during pregnancy in Mali.
Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA.
Mohamed Ag
MA
Ayoya
Gerburg Maria
GM
Spiekermann-Brouwer
Abdel Kader
AK
Traoré
Rebecca Joyce
RJ
Stoltzfus
Cutberto
C
Garza
D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000097:blood / Q000453:epidemiology* / Q000209:etiology*; D018798:Anemia, Iron-Deficiency / Q000453:epidemiology / Q000209:etiology; D002149:Energy Intake; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006725:Hookworm Infections / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007407:Interviews as Topic; D007501:Iron / Q000097:blood*; D016015:Logistic Models; D016778:Malaria, Falciparum / Q000150:complications / Q000453:epidemiology; D008302:Mali / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000453:epidemiology*; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000453:epidemiology*; D015597:Pregnancy Complications, Parasitic / Q000097:blood / Q000453:epidemiology*; D012307:Risk Factors; D012553:Schistosomiasis haematobia / Q000150:complications / Q000453:epidemiology; D019522:Vaginal Discharge / Q000453:epidemiology
D006454:Hemoglobins; D007501:Iron