Prevalence and Public-Health Significance of HIV Infection and Anaemia among Pregnant Women Attending Antenatal Clinics in South-Eastern Nigeria

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ABSTRACT

HIV infection and anaemia are major public-health problems in Africa and are important factors associated with an increased risk of adverse pregnancy outcomes. The objective of this study was to determine the prevalence of HIV infection and anaemia among pregnant women attending antenatal clinics in south-eastern Nigeria. To achieve this, a cross-sectional survey was conducted during July 2005 June 2006 using standard techniques. Of 815 pregnant women studied, 31 (3.8%, 95% confidence interval [CI] 2.5-5.1) were HIV positive. Maternal age and gestational age were not associated with HIV infection (p>0.05). The prevalence of anaemia (Hb <11.0 g/dL) was 76.9%, and 15 (1.8%, 95% CI 0.9-2.7) had severe anaemia (Hb <7.0 g/dL). A significantly higher prevalence of anaemia was observed among individuals in their second pregnancy trimester (p<0.05) and those infected with HIV (p<0.05). Since HIV and anaemia are preventable, antenatal care services could serve as a pivotal entry point for simultaneous delivery of interventions for the prevention and control of HIV infection and anaemia in pregnant women.

Key words: Anaemia; Cross-sectional surveys; HIV; HIV infections; Maternal health; Morbidity; Mortality; Pregnancy; Pregnancy outcomes; Prevalence; Risk factors; Nigeria

INTRODUCTION

Despite the considerable improvement in health-care-delivery services in many parts of the African continent, making motherhood safer, which is an urgent priority and one of several child-survival strategies applied through antenatal care, continues to be particularly challenging. Anaemia in pregnancy has been described as one of such enormous medical challenges because it is a major public-health problem in Africa and is an important f actor associated with an increased risk of poor pregnancy outcomes (1) and maternal morbidity and mortality in developing countries (2). In sub-Saharan Africa, a high prevalence (95.4%) of anaemia has been reported among pregnant women (3), with the mean prevalence of maternal anaemia in the subregion estimated to be 61% (4). Anaemia even when mild is associated with reduced productivity at work (5). During pregnancy, severe anaemia may result in circulatory changes that are associated with an increased risk of heart failure (6). During labour, women with severe anaemia are less able to endure even moderate blood loss and, as a consequence, are at a higher risk of requiring a blood transfusion during delivery (7,8). In addition, severe anaemia in pregnancy is an important direct and indirect cause of maternal death (9,10), and for the foetus, severe maternal anaemia may result in intrauterine growth retardation, stillbirth, and low birthweight (11-13).

The aetiology of anaemia in pregnancy in sub-Saharan Africa is complex and multifactorial (7). Apart from malaria, other causes of anaemia in pregnancy include an iron- and folate-deficient diet and infections, such as hookworm, and increasingly human immunodeficiency virus (HIV) (14). It has been suggested that infection with HIV during pregnancy may be associated with an increased risk of anaemia-related maternal death in developing-country settings due to the increasing severity of anaemia or due to the combined effects of anaemia and other infections (15). Anaemia also has been associated with progression of HIV disease (16). Concerning the global HIV epidemic, sub-Saharan Africa remains by far the worst-affected region with 25.4 million people living with HIV (just under two-thirds, i.e. 64% of all people living with HIV) (17). The HIV/AIDS epidemic is affecting females most severely in the subregion, and women of reproductive age make up almost 57% of adults living with HIV, accounting for up to 80% of HIV-infected women in the world (17,18), with HIV-prevalence rates sometimes exceeding 40% among pregnant women (19,20).

The HIV/AIDS epidemic intersects with the problem of maternal mortality in many circumstances in sub-Saharan Africa. …