Risks for preterm delivery and low birth weight are independently increased by severity of maternal anaemia

Objective. To estimate the effect of the severity of maternal anaemia on various perinatal outcomes. Design. A cross-sectional study. Setting. Labour Ward; Muhimbili National Hospital; Dar es Salaam; Tanzania. Methods. The haemoglobin of eligible pregnant women admitted for delivery between 15 November 2002 and 15 February 2003 was measu- red. Data on socio-demographic characteristics; iron supplementation; malaria prophylaxis; blood transfusion during current pregnancy; and current and previous pregnancy outcomes were collected and analysed. Anaemia was classified according to the World Health Organization (WHO) standards: normal - Hb =11.0 g/dl; mild - Hb 9.0 - 10.9 g/dl; moderate - Hb 7.0 - 8.9 g/dl; and severe - Hb 7.0 g/dl. Logistic regression analysis was performed to estimate the severity of anaemia. The following outcome measures were used: preterm delivery (37 weeks); Apgar score; stillbirth; early neonatal death; low birth weight (LBW) (2 500 g) and very low birth weight (VLBW) (1 500 g). Results. A total of 1 174 anaemic and 547 non-anaemic women were enrolled. Their median age was 24 years (range 14 - 46 years) and median parity was 2 (range 0 - 17). The prevalence of anaemia and severe anaemia was 68and 5.8; respectively. The risk of preterm delivery increased significantly with the severity of anaemia; with odds ratios of 1.4; 1.4 and 4.1 respectively for mild; moderate and severe anaemia. The corresponding risks for LBW and VLBW were 1.2 and 1.7; 3.8 and 1.5; and 1.9 and 4.2 respectively. Conclusion. The risks of preterm delivery and LBW increased in proportion to the severity of maternal anaemia

A community-Based Study on Utilisation in a Rural Zimbabwe

To estimate the degree and pattern of utilization of institutional maternity services in a rural area of Zimbabwe; a cross-sectional study was performed in Gutu district about 250 kilometers south of the capital Harare. In August; 1991; 12 out of 43 wards in the district were randomly selected and in each ward about 40 women (in total 520) who had delivered in the previous 12 months were randomly selected and interviewed. There was a high degree of utilization of institutional maternity services by the women (9679and 74) for antepartum; intrapartum and postpartum care respectively). Women sought this care from a multiplicity of sources depending on a variety of social; geographical and service factors. Very few women (17) had total pregnancy care at the rural health centre. There was a significant association between the actual place of delivery and nulliparity; whether the previous delivery took place at home; whether the family belonged to the Apostolic Faith sect; and whether the husband spent most time in urban area. For nulliparity; previous delivery at home and belonging to the Apostolic Faith sect the proportion of women delivering at home; at the rural health center/urban maternity clinic; and at hospital was statistically significant. The few maternity waiting shelters that were available lacked basic amenities and were unattractive to the mothers even though 65either used them or could have done so if they were available

Anaemia in Pregnancy : a Major Health Problem with Implications for Material Health Care

Women (n=2235) registering for antenatal care in two maternal and child health clinics in the Dar es Salaam area between June; 1991 and June 1992 had their haemoglobin (Hb) measured by use of a HaemoCuer haemoglobinometer. The prevalence of anaemia Hb10.5 g/dl) was 60while severe anaemia (Hb7.0 //dl) was present in 4. Young nullparous women; those who register for antenatal care late in the third trimester; and undernourished women constitute high risk groups also for severe anemia and require special attention. No single maternal characteristics or combination thereof was useful to identify a group of screening. The current national Hb level for referral to hospital (8.5 g/dl) identified 20of the pregnant population. Most of these can successfully be treated and followed at the primary care level. To comply with the available means for care in the Dar es Salaam area; it is proposed that the cutoff level for referral be changed to 7g/dl. Appropriate methods to screen for anemia at primary health care (PHC) level must be explored and instituted. Training of antenatal care (ANC) providers in clinical identification of anemia and supply of haematinics must be improved and early booking for ANC promoted. Public health measures to improve the general nutrition and iron intake of all women are necessary to reduce this serious health problem in pregnancy

Maternal mortality in Dar es Salaam; Tanzania: Socio-economic; obstetric history and accessibility of health care factors

A community-based incident case-referent study was performed in Ilala district; Dar es Salaam; Tanzania to estimate the social; obstetric history and accessibility of health care factors for maternal death. From February 1991 to January 1993 all female deaths in the reproductive ages were identified through the existing administrative information system. For every maternal death three live mothers was selected as referents matched for age. In cases a relative to the deceased mother and in referents the live mother herself was interviewed using a pretested questionnaire. Socio-economic factors were strongly related to the risk of maternal death. Single and divorced women were at an increased risk (odds ratio (OR) =5.1; 95 per cent confidence interval (CI): 2.8-9.3 and OR=28; 95 per cent CI: 6.5-118). Women with less than 3 years' education had a 3 fold higher risk than women with more than 7 years' schooling. Also women who were peasants and unskilled workers were at higher risk when compared with professionals and peasants and unskilled workers were at higher risk when compared with professionsls and skilled workers (OR=20; 95 per cent CI:7.4-51). An obstetric history with no previous live births (OR=36; 95 per cent CI: 8.239); more than one induced abortion (OR=36; 95 per cent CI; 9.7-132) or stillbirth (OR=4.8; 95 per cent CI:1.6-14) and unwanted pregnancy (OR=4.0; 95 per cent CI: 2.2-7.3) were; as expected; statistically significant risk factors for maternal death. Factors reflecting living standards such as type of housing; access to tap-water and electricity; availability of a toilet and the living standard as estimated by the interviewer were all statiscally significant for the risk of maternal death (OR=7.2; 2.7; 2.1; 8.3 and 6.2; respectively). Increased distance in meters from the house to a road and increased time in minutes taken to reach the nearest transport; clinic and hospital in minutes increased the risk for a maternal death significantly. The preventive activities require efforts from the whole community. The health care system can contribute by early identification of risk cases. e.g. women with previous stillbirths and miscarriages in the antenatal care