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

By Uneke, C. J.; Duhlinska, D. D. et al. | Journal of Health Population and Nutrition, September 1, 2007 | Go to article overview

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


Uneke, C. J., Duhlinska, D. D., Igbinedion, E. B., Journal of Health Population and Nutrition


INTRODUCTION

Despite the considerable improvement in healthcare- 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, conti-nues 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 factor 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. The extent of the contribution of HIV/AIDS to maternal mortality is difficult to quantify, as the HIV status of pregnant women in the subregion is not always known (21). HIV impacts on direct (obstetrical) causes of maternal mortality by an associated increase in pregnancy-related complications, such as anaemia, postpartum haemorrhage, and puerperal sepsis (8,21). Although anaemia is highly prevalent during pregnancy and is common during HIV infection, anaemia and iron status have not been well-characterized in HIV-infected pregnant women in most parts of sub-Saharan Africa (22). A relationship between HIV seropositivity and a decreased haemoglobin (Hb) concentration in pregnancy has been suggested, and the inclusion of HIV screening in differential diagnosis of anaemia is recommended (23). However, the paucity of comprehensive population- based data on anaemia and HIV infection in pregnancy in Nigeria and other parts of West Africa with a similar setting makes the formulation of policies that would transform into effective and sustainable intervention/control programmes for pregnant women an enormous challenge to health policy-makers.

This present study was, therefore, designed to provide scientific information on the prevalence of anaemia and HIV infection and associated factors to maternal anaemia, which can be used for directing policy development and control-programme implementation and also provide a baseline measurement on which the impact of interventions can be evaluated. …

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