Bongomin Felix, Olum Ronald, Kyazze Andrew Peter, Ninsiima Sandra, Nattabi Gloria, Nakyagaba Lourita, Nabakka Winnie, Kukunda Rebecca, Ssekamatte Phillip, Kibirige Davis, Cose Stephen, Nakimuli Annettee, Baluku Joseph Baruch, Andia-Biraro Irene
Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda.
Trop Med Health. 2021 Mar 1;49(1):19. doi: 10.1186/s41182-021-00309-z.
Anemia in pregnancy represents a global public health concern due to wide ranging maternal and neonatal adverse outcomes in all peripartum periods. We estimated the prevalence and factors associated with anemia in pregnancy at a national obstetrics and gynecology referral hospital in Uganda and in addition performed a systematic review and meta-analysis of the overall burden of anemia in pregnancy in Uganda.
We conducted a cross-sectional study among 263 pregnant women attending the antenatal care clinic of Kawempe National Referral Hospital, Kampala, Uganda, in September 2020. Anemia in pregnancy was defined as a hemoglobin level of < 11.0 g/dl and microcytosis as a mean corpuscular volume (MCV) of < 76 fL. We also performed a systematic review (PROSPERO Registration ID: CRD42020213001) and meta-analysis of studies indexed on MEDLINE, Embase, African Journal Online, ClinicalTrials.gov , ICTRP, and the Cochrane Library of systematic review between 1 January 2000 and 31 September 2020 reporting on the prevalence of anemia in pregnancy in Uganda.
The prevalence of anemia was 14.1% (n= 37) (95%CI 10.4-18.8), of whom 21 (56.8%) had microcytic anemia. All cases of anemia occurred in the second or third trimester of pregnancy and none were severe. However, women with anemia had significantly lower MCV (75.1 vs. 80.2 fL, p<0.0001) and anthropometric measurements, such as weight (63.3 vs. 68.9kg; p=0.008), body mass index (25.2 vs. 27.3, p=0.013), hip (98.5 vs. 103.8 cm, p=0.002), and waist (91.1 vs. 95.1 cm, p=0.027) circumferences and mean systolic blood pressure (BP) (118 vs 125 mmHg, p=0.014). Additionally, most had BP within the normal range (59.5% vs. 34.1%, p=0.023). The comparison meta-analysis of pooled data from 17 published studies of anemia in pregnancy in Uganda, which had a total of 14,410 pregnant mothers, revealed a prevalence of 30% (95% CI 23-37).
Despite our study having a lower prevalence compared to other studies in Uganda, these findings further confirm that anemia in pregnancy is still of public health significance and is likely to have nutritional causes, requiring targeted interventions. A larger study would be necessary to demonstrate potential use of basic clinical parameters such as weight or blood pressure as screening predictors for anemia in pregnancy.
孕期贫血是一个全球性的公共卫生问题，因为在整个围产期会出现各种孕产妇和新生儿不良结局。我们估计了乌干达一家国家妇产科转诊医院孕期贫血的患病率及相关因素，此外还对乌干达孕期贫血的总体负担进行了系统评价和荟萃分析。
2020年9月，我们在乌干达坎帕拉卡韦姆佩国家转诊医院产前保健门诊的263名孕妇中开展了一项横断面研究。孕期贫血定义为血红蛋白水平<11.0 g/dl，小红细胞症定义为平均红细胞体积（MCV）<76 fL。我们还进行了一项系统评价（PROSPERO注册号：CRD42020213001），并对2000年1月1日至2020年9月31日期间在MEDLINE、Embase、非洲期刊在线、ClinicalTrials.gov、ICTRP以及Cochrane系统评价图书馆上索引的关于乌干达孕期贫血患病率的研究进行荟萃分析。
贫血患病率为14.1%（n = 37）（95%CI 10.4 - 18.8），其中21例（56.8%）为小细胞性贫血。所有贫血病例均发生在妊娠中期或晚期，且均无严重贫血。然而，贫血女性的MCV显著较低（75.1对80.2 fL，p<0.0001），人体测量指标也较低，如体重（63.3对68.9kg；p = 0.008）、体重指数（25.2对27.3，p = ;013）、臀围（98.5对103.8 cm，p = 0.002）、腰围（91.1对95.1 cm，p = 0.027）以及平均收缩压（BP）（118对125 mmHg，p = 0.014）。此外，大多数人的血压在正常范围内（59.5%对34.%.，p = 0.023）。对乌干达17项已发表的孕期贫血研究的汇总数据进行的比较荟萃分析显示，共有14410名怀孕母亲，患病率为30%（95%CI 23 - 37）。
尽管我们的研究患病率低于乌干达的其他研究，但这些发现进一步证实孕期贫血仍然具有公共卫生意义，并且可能由营养原因导致，需要有针对性的干预措施。有必要开展更大规模的研究，以证明体重或血压等基本临床参数作为孕期贫血筛查预测指标的潜在用途。
