January 2000, Volume 54, Issue 1, Pages 3 - 8

Original Communication

Anaemia in pregnancy: possible causes and risk factors in Nepali women GT Bondevik1, B Eskeland2, RJ Ulvik3, M Ulstein4, RT Lie5, J Schneede6 & G Kvåle1 1Centre for International Health, University of Bergen     2Section for General Practice, University of Bergen     3Laboratory of Clinical Biochemistry, University of Bergen     4Obstetric and Gynaecological Department, University of Bergen     5Section for Medical Statistics, University of Bergen;      6Department of Pharmacology, University of Bergen, Norway     Correspondence to: GT Bondevik , Centre for International Health, Armauer Hansens Building, University of Bergen, Norway. E-mail: gunnar.bondevik@cih.uib.no .     Contributors: GTB initiated the study, and was the person mainly responsible for all stages of the study, including the study design, literature searches, data collection, data entry, statistical analysis, interpretation of results and writing of the paper. BE assisted with the study design and literature searches, co-ordinated the laboratory investigations at Haukeland Hospital, was involved in interpretation of results and contributed to writing the paper. RJU advised on the laboratory methods used, participated in data interpretation and assisted in writing the paper. MU contributed to core ideas, was involved in the protocol formulation, study-design, interpretation of results and writing the paper. RTL discussed core ideas, advised on the statistical methods used, participated in data analysis, interpretation of results, and in writing the paper. JS assisted in the literature searches, participated in data interpretation, and contributed to writing the paper. GK supervised all aspects of the study, was involved in the study design, data interpretation and participated in writing the paper. All discussed and edited the final manuscript. Guarantors: GT Bondevik and G Kvåle.

Keywords

Nepal;   anaemia;   pregnancy;   nutritional deficiencies;   infection

Abstract

Objective: The aim of this study was to investigate the importance of nutritional deficiencies and infections in the development of anaemia in pregnant Nepali women. Design: Case-control study. Setting: Patan Hospital, Kathmandu, Nepal. Subjects: A sub-sample (n=479) of all pregnant women (n=2856) coming for their first antenatal visit in a 12 month period, 1994-1995. Women who had already received any micronutrient supplementation (n=82), and those whose serum samples showed macroscopic haemolysis (n=7) were excluded. The remaining women (n=390) were included in the statistical analysis. They were divided into three groups; a non-anaemic control group, haematocrit (Hct)>33% (n=82), and two case-groups: moderately anaemic, Hct 25-33% (n=254), and severely anaemic, Hct<25% (n=54). Results: We found high prevalences of nutritional deficiencies and intestinal infections, both among cases and controls. The prevalence of low s-ferritin was high, especially among the severely anaemic women (55.6%). In a multiple logistic regression model, the presence of low s-vitamin A, elevated s-C-reactive protein or hookworm infection was associated with a significantly increased risk of severe anaemia. The adjusted odds ratios (95% CI) were 8.38 (1.99, 35.30), 4.91 (1.22, 19.67) and 5.43 (1.20, 24.61), respectively. Conclusions: In addition to the present routine iron and folate supplementation to pregnant Nepali women, vitamin A supplementation needs to be considered. Prevention and treatment of infections should, together with dietary advice, be emphasized more strongly in the antenatal care. Sponsorship: The Norwegian Research Council and the Norwegian Universities Committee for Development, Research and Education. European Journal of Clinical Nutrition (2000) 54, 3-8

Received 30 March 1999; Revised 17 June 1999; Accepted 30 June 1999

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