The dangers associated with anaemia during pregnancy are well known.  But little is known about the impact of maternal anaemia on the survival of babies in the developing world.  Research in Tanzania clearly shows how severe anemia in a pregnant woman can significantly reduce her infant’s chances of surviving in the first year of life. Causes of anaemia are often multifactorial and health policy should further focus on preventative measures such as iron supplementation.

Using a demographic surveillance system, researchers with the Ifakara Health Research and Development Centre in Tanzania and the Swiss Tropical Institute investigated infant mortality, maternal health, us of insecticide-treated nets and socio-economic status.  They looked for evidence of a link between anaemia during pregnancy and the survival of children under twelve months of age.

Pregnant women in the Kilombero Valley of Tanzania were enrolled into the study. Their haemoglobin levels were collected along with other data on their health and socio-economic status.  An analysis was then done of infant mortality among the children born to these mothers.  Only 'singleton' children were included, as twins were seen to carry higher mortality risks.  This resulted in a sample of 301 'singleton' children, of whom 22 died during the study period - the infant mortality rate was 84.2/1 000 child years.  Detailed analysis of the potential contributory factors was conducted, and the results adjusted to take account of confounding factors such as the mother’s weight, age and educational level.

The results revealed that:

• Severe anaemia during pregnancy was associated with a three-fold increase in the likelihood of infant mortality after adjustment for confounding factors.
• No other variable included in the model was significant after adjustment.
• At all times throughout the first 12 months of life, children born to mothers without severe anaemia had higher chances of survival compared to those whose mothers were severely anaemic during pregnancy.

Severe anaemia has several causes, including iron deficiency, malaria, hookworm and limited access to food.  Studies suggest that severe anaemia (Hb<8g/dL) affects 11% of the population in some rural areas of Tanzania.  The findings presented in this study reveal significant health consequences of maternal anaemia for babies, as well as for women. In light of this, policy-makers should:

• continue to emphasise preventive measures, including malaria control and iron supplementation, which are already being implemented for the various causes of anaemia
• strengthen the distribution systems for anaemia reduction interventions
• increase the output and impact of health messages that encourage women to attend antenatal facilities from early pregnancy.

The findings reinforce anaemia in pregnancy as a priority area of concern. Policy should be aimed at improving access to preventive health services which tackle its causes.  This study suggests this could help reduce the number of infant deaths as well as improve the survival rate and health of mothers.

Source(s):
‘Anaemia in pregnancy and infant mortality in Tanzania’, Tropical Medicine and International Health 9(2): 262-266, by T. Marchant et al, 2004
'Anaemia in pregnancy in southern Tanzania', Annals of Tropical Medicine and Parasitology 96: 477-487, by T. Marchant, J.R.M. Armstrong Schellenberg, T. Edgar et al, 2002
'Anaemia during pregnancy and birth outcome: a meta-analysis', American Journal of Perinatology 17: 137-146, by X. Xiong, P. Buekens, S. Alexander et al, 2000

Funded by: Swiss Agency for Development and Cooperation, Government of Tanzania, Rudolph Geigy Foundation

id21 Research Highlight: 15 June 2004

Further Information:
Tanya Marchant
PO Box 1543
CHASE Project
Kahawa House
Moshi
Tanzania

Tel: +255 (0744) 646 642
Contact the contributor: Tanya_Marchant@hms.harvard.edu

Ifakara Health Research and Development Centre, Tanzania

Swiss Tropical Institute

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'Targeting the causes of perinatal mortality in a Kenyan hospital'

'Red alert! Anaemia is widespread among women in Andhra Pradesh'

'Maternal mortality in rural Gambia: levels, causes and contributing factors''

'Expecting infection? Preventing malaria and anaemia during pregnancy''

'Pumping iron – making prenatal iron supplementation work''

'Delivering on policy – preventing malaria in pregnancy in Malawi'