Maternal anaemia as an indicator for monitoring malaria control in pregnancy in sub-Saharan Africa.
METHODS
Malarial anaemia is a major problem in many developing countries and often occurs more frequently in first pregnancies, as primigravidae are more susceptible to Plasmodium falciparum malaria and are at excess risk of malarial anaemia.


OBJECTIVE
To analyse the excess risk of anaemia in primigravidae as a potential indicator of malaria control and exposure in pregnant women living in sub-Saharan Africa. The sensitivity, specificity and predictive values for anaemia in first compared with later pregnancies are calculated for 27 studies from malarious and 7 studies from nonmalarious areas.


METHODS
Surveys of pregnancy anaemia reported for highly malarious and nonmalarious areas.


RESULTS
In malarious areas, the weighted odds ratio for excess anaemia (haemoglobin [Hb] <11 g/dl) in primigravidae compared with multigravidae for all studies was 1.34 (95% CI 1.14-1.58). At an Hb cutoff below 8 g/dl, the weighted odds ratio was 1.79 (95% CI 1.52-2.10). In nonmalarious areas, there was no increased risk of anaemia in primigravidae with Hb below 11 g/dl (OR 0.80; 95% CI 0.63-1.90) or below 8 g/dl (OR 0.82, 95% CI 0.51-1.28).


CONCLUSIONS
In view of the consistency of results across highly malarious areas compared with nonmalarious areas, maternal anaemia has the potential to be used for surveillance of malaria control in pregnancy. Based on the analysis, an anaemia nomogram is developed for use as a surveillance indicator in malarious areas in sub-Saharan Africa.
Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK.
E J
EJ
Savage
K
K
Msyamboza
S
S
Gies
U
U
D'Alessandro
B J
BJ
Brabin
D000353:Africa, Southern; D000740:Anemia / Q000469:parasitology*; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000517:prevention & control*; D016017:Odds Ratio; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000469:parasitology*; D015597:Pregnancy Complications, Parasitic / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity