Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
Department of Pathology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
PLoS One. 2022 Oct 6;17(10):e0274642. doi: 10.1371/journal.pone.0274642. eCollection 2022.
Globally, more than a third of pregnant women are anemic, and progress in its prevention and control is slow. Sri Lanka is a lower-middle-income country with a unique public health infrastructure that provides multiple interventions across the lifecycle for anemia prevention, despite which anemia in pregnancy remains a challenge. Studying the factors associated with maternal anemia in this context would provide unique information on challenges and opportunities encountered as low-and-middle-income countries attempt to control anemia by improving health care coverage. All first-trimester pregnant women registered for antenatal care in the Anuradhapura district between July 2019 to September 2019 were invited to participate in the baseline of a cohort study. Interviewer-administered and self-completed questionnaires were used. Anemia was defined using a full blood count. A hierarchical logistic regression model was built to identify factors associated with anemia. Out of 3127 participants, 451 (14.4%) were anemic. According to the regression model (Chi-square = 139.3, p<0.001, n = 2692), the odds of being anemic increased with the Period of gestation (PoG) (OR = 1.07, 95% CI = 1.01-1.13). While controlling for PoG, age and parity, history of anemia (OR = 3.22, 95%CI = 2.51-4.13), being underweight (OR = 1.64, 95%CI = 1.24-2.18), having the last pregnancy five or more years back (OR = 1.57,95%CI = 1.15-2.15) and having used intrauterine devices for one year or more (OR = 1.63, 95%CI = 1.16-2.30) increased the odds of anemia. Breast feeding during the last year (OR = 0.66, 95%CI = 0.49-0.90) and having used contraceptive injections for one year or more (OR = 0.61,95%CI = 0.45-0.83) reduced the risk of anemia. Proxy indicators of being in frequent contact with the national family health program have a protective effect over the socioeconomic disparities in preventing early pregnancy anemia. Maintaining the continuum of care through the lifecycle, especially through optimizing pre and inter-pregnancy care provision should be the way forward for anemia control.
全球超过三分之一的孕妇贫血，且其预防和控制进展缓慢。斯里兰卡是一个中低收入国家，拥有独特的公共卫生基础设施，为预防贫血提供了整个生命周期的多种干预措施，但妊娠期间的贫血仍然是一个挑战。在中低收入国家试图通过改善医疗保健覆盖范围来控制贫血的情况下，研究与该地区产妇贫血相关的因素将提供关于所遇到的挑战和机遇的独特信息。所有在 2019 年 7 月至 9 月期间在阿努拉达普拉区登记接受产前护理的初孕妇都被邀请参加一项队列研究的基线调查。使用访谈员管理和自我完成的问卷。使用全血细胞计数来定义贫血。建立了分层逻辑回归模型来确定与贫血相关的因素。在 3127 名参与者中，有 451 名（14.4%）贫血。根据回归模型（卡方=139.3，p<0.001，n=2692），怀孕期（PoG）（OR=1.07，95%CI=1.01-1.13）与贫血的几率增加有关。在控制 PoG、年龄和产次的情况下，贫血史（OR=3.22，95%CI=2.51-4.13）、体重过轻（OR=1.64，95%CI=1.24-2.18）、上次怀孕五年或更长时间（OR=1.57，95%CI=1.15-2.15）和使用宫内节育器一年或更长时间（OR=1.63，95%CI=1.16-2.30）会增加贫血的几率。在过去一年中进行母乳喂养（OR=0.66，95%CI=0.49-0.90）和使用避孕注射一年或更长时间（OR=0.61，95%CI=0.45-0.83）会降低贫血的风险。与国家家庭健康计划频繁接触的代理指标对预防早期妊娠贫血具有保护作用，可以减轻社会经济差异。通过整个生命周期保持护理连续性，特别是通过优化孕前和孕期护理，应该是贫血控制的前进方向。
