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Background: The World Health Organization recommends daily iron and folic acid (IFA) supplementation during pregnancy, but consumption remains low, and high prevalence of anemia among pregnant women (PW) persists., Objectives: This study aims to (1) examine factors at the health system, community, and individual levels, which influence adherence to IFA supplements; and (2) describe a comprehensive approach for designing interventions to improve adherence based on lessons learned from 4 country experiences., Methods: We conducted literature search, formative research, and baseline surveys in Bangladesh, Burkina Faso, Ethiopia, and India and applied health systems strengthening and social and behavior change principles to design interventions. The interventions addressed underlying barriers at the individual, community, and health system levels. Interventions were further adapted for integration into existing large-scale antenatal care programs through continuous monitoring., Results: Key factors related to low adherence were lack of operational protocols to implement policies, supply chain bottlenecks, low capacity to counsel women, negative social norms, and individual cognitive barriers. We reinforced antenatal care services and linked them with community workers and families to address knowledge, beliefs, self-efficacy, and perceived social norms. Evaluations showed that adherence improved in all countries. Based on implementation lessons, we developed a program pathway and details of interventions for mobilizing health systems and community platforms for improving adherence., Conclusion: A proven process for designing interventions to address IFA supplement adherence will contribute to achieving global nutrition targets for anemia reduction in PW. This evidence-based comprehensive approach may be applied in other countries with high anemia prevalence and low IFA adherence.

Anaemia is a global public health problem affecting 800 million women and children globally. Anaemia is associated with perinatal mortality, child morbidity and mortality, mental development, immune competence, susceptibility to lead poisoning and performance at work. The objective of this article is to identify whether antenatal care-seeking was associated with the uptake of iron supplementation among pregnant women, adjusting for a range of covariates. This article used data from the cross-sectional recent Demographic and Health Surveys (DHS) of 12 countries in Asia, Africa and Latin America & the Caribbean regions. The individual-level data from 273,144 women of reproductive age (15-49 years) were analysed from multi-country DHS. Multiple Logistic regression analyses were conducted using Predictive Analytics Software for Windows (PASW), Release 18.0. Receiving at least four antenatal care visits was significantly associated with the consumption of 90 or more iron-containing supplements in 12 low and middle income countries across three regions after adjusting for different household and respondent characteristics, while mass media exposure was found to be a significant predictor in India and Indonesia. Antenatal care seems to be the most important predictor of adherence to iron intake in the selected countries across Africa, Asia, Latin America and Caribbean regions., (© 2023 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Anemia is a largely preventable and curable medical disease if detected intime. This study aimed to assess maternal knowledge of anemia and its prevention strategies in the public health facilities of Pawi district, Northwest, Ethiopia. A health facility-based cross-sectional study was conducted from February 1/2020 to March 2/2020, among 410 antenatal care attendees in the public health facilities of the Pawi district. The data was collected by systematic random sampling technique and analyzed using SPSS 25.0 version. Logistic regression analyses were done to estimate the crude and adjusted odds ratio with a CI of 95% and a P -value of less than .05 considered statistically significant. Less than half, 184 ( 44.9%) [95% CI = 40.0-49.8] and almost half, 216 (52.7%) [95% CI = 47.8-57.5] of the pregnant women had good knowledge of anemia and good adherence to its prevention strategies respectively. Women who are found in the age group of 15 to 19, 20 to 24, and 25 to 29 years, rural residency, secondary, and above educational level, vaginal bleeding, third trimester of pregnancy, and medium and high minimum dietary diversification score were significantly associated with knowledge of anemia. On the other hand: women who are found in the age group of 15 to 19 years, secondary above educational level, primigravida women, having ≤2 and 3 to 4 family sizes, second and third trimester of pregnancy, high minimum dietary diversification score, and good knowledge of anemia were significantly associated with adherence to anemia prevention strategies. Maternal knowledge of anemia and adherence to its prevention strategies were low. Nutritional counseling on the consumption of iron-rich foods and awareness creation on the effects of anemia in pregnant women must be strengthened to increase the knowledge of anemia and adherence to its prevention strategies.

Background: Anaemia in pregnancy is a known public health problem in South Africa. Maternal, perinatal morbidity and mortality are known to be associated with anaemia in pregnancy. Very little is known from literature with regards to the progression of anaemia during the antenatal period of pregnancy., Objectives: To estimate haemoglobin levels, the prevalence and determinants of anaemia at different gestational ages and to show the trend., Method: A retrospective cohort (follow-up) study was conducted using the antenatal clinic register. Prevalence rates of anaemia (haemoglobin < 11 g/dl) at different gestational ages were measured. Factors associated with anaemia were assessed using chi-square test and stepwise multivariate logistic regression analysis., Results: A total of 801 pregnant women were enrolled at the booking visit and followed-up during their antenatal period. The prevalence of anaemia at the booking visit was 37%. The prevalence of anaemia at 20, 26, 32 and 36 weeks of gestation were 36.6%, 39.6%, 39.8% and 29.2% respectively. Binary logistic regression at the booking visit showed that teenage women were 2.5 times more likely to have anaemia (OR=2.5, p=0.005) than older women. Women who booked during the first trimester were 60% less likely to have anaemia (OR= 0.40, P=0.005) at the booking visit and 62% less likely to be anaemic at 36 weeks of gestation (OR=0.38, p=0.013) compared to those who booked late for antenatal care., Conclusion: Prevalence of anaemia during pregnancy was high. Early booking for antenatal care was a predictor for lower rate of anaemia. Thus, health education strategy should be encouraged for early antenatal booking., (© 2022 Hoque AM et al.)

Background: Anaemia in pregnancy is the leading cause of maternal morbidity and mortality and poor birth outcomes in low- and middle-income countries. The most common cause of anaemia during pregnancy is acute blood loss and iron deficiency due to physiological changes and increasing demand for iron on the mother and growing foetus. Iron and folic acid supplementation is the most widely employed strategy to alleviate iron deficiency anaemia during pregnancy. The mother's knowledge of anaemia and the benefit of iron-folic acid is crucial in reducing the magnitude of anaemia due to iron deficiency. In Woldia town, despite the efforts made to reduce iron deficiency anaemia during pregnancy, information on pregnant mother knowledge on anaemia and the benefit of iron-folic acid and its associated factors are scarce., Methods: A facility-based cross-sectional study design was conducted, on 414 pregnant mothers attending antenatal care in Woldia town, Northern Ethiopia. Systematic random sampling methods were used to select study participants. The data were entered into Epi-data version 4.2 and analysed using SPSS version 24. Bivariable and multivariable analysis was done to see the association between the dependent variable and independent variables., Results: This study revealed that 54.1% and 57.7% of pregnant women had good knowledge of anaemia and the benefit of iron-folic acid, respectively. Maternal education status (AOR = 2.19, 95% CI 1.32-3.64), good knowledge of iron-folic acid (AOR = 5.85, 95% CI 3.60-9.50) and residence (AOR = 5.43, 95% CI 2.36-12.51) were statistically associated with pregnant mothers knowledge on anaemia. Obtained counselling on the benefit of iron-folic acid (AOR = 2.04, 95% CI 1.11-3.75), having four or more antenatal care visit (AOR = 3.12, 95% CI 1.38-7.07) and good knowledge of anaemia (AOR = 5.88, 95% CI 3.63-9.50) was statistically associated with pregnant mothers knowledge on the benefit of iron-folic acid., Conclusions: Promoting frequent antenatal care visits and giving counselling on the benefit of iron-folic acid and cause, prevention and treatment of anaemia were essential strategies to raise knowledge of pregnant mother on anaemia and the benefit of iron-folic acid., (© 2022. The Author(s).)

Anaemia is a global disease, affecting over 1 billion people worldwide; 12% of Australian women experience anaemia in pregnancy. Professional bodies/institutions recommend screening for and treating anaemia in pregnancy but there is inconsistency in recommendations for when to screen. A ten-year retrospective analysis was undertaken of 10 518 pregnancies where there was not a specific indication for repeat blood tests. Using a 28-week haemoglobin (Hb) threshold of ≥110 g/L, seven out of ten could safely forego a routine 36-week full blood count. Less than 2.5% would then be anaemic at 36 weeks, none of whom would have had a Hb < 90 g/L., (© 2022 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Background: Anemia has created attention worldwide because of its adverse effects on the mother and the fetus during pregnancy. A large body of evidence has shown that pregnant women are the most vulnerable group to anemia., Objectives: This study aims to determine the prevalence of anemia, and associated risk factors, among pregnant women attending antenatal care (ANC) at government and private hospitals in Bangladesh., Methods: This cross-sectional study included 424 pregnant women, who visited hospitals for ANC from January to July 2019. We used a simple random sampling technique to select study subjects. Data were collected using a structured questionnaire and participant's current medical record cards. SPSS software was used for analyzing data., Results: The prevalence of anemia was 62.5% and significantly (P < 0.001) higher in the subjects attending ANC in government hospitals (68.7%) than in private (55.0%) hospitals. The prevalence of the severity of anemia was 28.3% mild, 36.9% moderate, and 3.40% severe in government hospitals while in private hospitals was 14.7% mild, 39.8% moderate, and 0.5% severe anemia. Anemia was significantly associated with maternal age 20-25 years [adjusted odds ratio (AOR) = 1.9] and 26-30 years (AOR = 2.37), monthly family income (300-500) US$ (AOR = 2.76), and ANC in government hospitals (AOR = 2.02), the parity [multiparous (AOR = 1.92)], gravidity [multigravid (AOR = 1.63)], contraception [no contraception (AOR = 2.50), and iron supplement [no iron supplement (AOR = 0.64)., Conclusions: The result suggests that pregnant women should receive routine ANC and recognize iron supplementation during pregnancy. Finally, the results of this study are particularly relevant for pregnant women who are receiving ANC.

Background: Iron deficiency is a dominant source of anaemia in many settings. To evaluate the key cause of anaemia in the study area, the prevalence of anaemia due to major public health diseases was compared with anaemia due to iron deficiency., Methods: Pregnant women were recruited from ante-natal (n=490) and HIV clinics (n=217) with their personal data documented using a questionnaire. Microscopy of Giemsa-stained thick smears was used for detection of malaria parasites while helminths in stools were detected using direct smear method. Haematocrit values were determined by capillary method. Serum ferritin levels were determined using enzyme-linked immunosorbent assay. Data was analysed using SPSS version 22.0., Results: The mean age of the recruited women was 28.6±5.4 years old. There were 68.1% cases of anaemia of which 35.5% was due to infections only predominantly HIV and malaria, 14.9% from unknown sources while anaemia due to iron deficiency only was 7.1%., Conclusion: It can safely be inferred that malaria and HIV predispose to anaemia than iron deficiency in the study area. Although pregnant women are dewormed and given IPTp for helminths and malaria treatment respectively, there should be complementary routine malaria screening at ANC visits for those with HCT values <33% and those infected with HIV., (© 2020 Rabiu OR et al.)

Background: Anaemia and malaria are both major contributors to maternal and child mortality, and morbidity, with some of the worst outcomes occurring in sub-Saharan Africa. Point of care tests (POCT), if used appropriately, provide a simple, inexpensive form of diagnostic testing, as a reliable alternative when laboratory tests are not readily available. In such resource limited settings, clinical staff tend to rely on symptom-based diagnosis and presumptive treatment. This study uses qualitative methods to identify the current practice of POCT use for malaria and anaemia, to explore the enablers and barriers to effective implementation of these POCT, and to determine how relationships between each of the stakeholder groups may impact on POCT use., Methods: Staff (clinical and laboratory) and patients (pregnant women) at three antenatal care facilities within the Ashanti Region of Ghana participated in interviews and focus group discussions (FGDs). An initial coding framework was developed based on the pre-defined objectives of the study. Thematic analysis was used to identify subthemes and categories within each of the key themes., Results: At the time data were collected all three facilities used malaria POCT either as an adjunct to microscopy, or as their only form of malaria testing. Although all three facilities were familiar with haemoglobin colour scale (HCS), none of the facilities used them routinely. Clinical staff perceived symptom-based diagnosis was a quick way to diagnosis because access to POCT during consultations was unreliable, but recognized disadvantages associated with symptom-based diagnosis. Perceived advantages of malaria and anaemia POCT were user-friendliness, improved diagnosis and opportunity for patient engagement, as well as lower cost implication for patients. Perceived disadvantages included likelihood of missed diagnosis of mild anaemia, as well as likelihood of human error leading to in accurate diagnosis which could impact on patient trust. Poor communication and lack of trust between staff groups was also identified as a barrier to effective uptake of POCT., Conclusions: Consistent supply of POCT as well as staff training and staff and patient engagement, are fundamental to successful uptake of POCT for effective malaria and anaemia management.

Asymptomatic malaria and anemia during pregnancy increase the risk of negative birth outcomes. This cross-sectional study investigated the prevalence and correlates of asymptomatic malaria and anemia during first antenatal care (ANC) visit among pregnant women in a rural district, Tanzania. HIV-uninfected pregnant women without symptoms of malaria ( n = 819) attending their first ANC at Kibiti Health Centre were enrolled from February 2017 to February 2018. Asymptomatic malaria was detected by malaria rapid-diagnostic tests (mRDT) and real-time PCR. Hemoglobin concentration was determined by HemoCue Hemoglobin 201+. The study outcomes were the prevalence of asymptomatic malaria and anemia (Hemoglobin level <11 g/dL). The overall prevalence of asymptomatic malaria was 36.4% (95% CI: 33.1, 39.8). The monthly prevalence of asymptomatic malaria remained >25% throughout the year, and the highest prevalence (40%) was recorded during the rainy season. Asymptomatic malaria was significantly associated with primigravida, younger maternal age, and anemia. The prevalence of anemia was 68.5% (95% CI: 65.2, 71.6). Asymptomatic malaria, primigravida, younger maternal age and low Body Mass Index were significant predictors of low hemoglobin concentration. We report high prevalence of asymptomatic malaria and anemia among pregnant women on the first ANC visit. Screening of malaria and anemia during the first ANC visit is recommended for targeted interventions.

Objective: This study was performed to evaluate the application of fetal middle cerebral artery peak systolic velocity (MCA-PSV) for prediction of newborn anemia with umbilical cord blood hemoglobin concentration at birth (UCB-Hb) < 10.0 g/dL among infants born at gestational week (GW) ≥ 36 to unselected women., Materials and Methods: We reviewed the medical charts of 699 women giving birth to singleton infants at GW ≥ 36 with available data on MCA-PSV measured at GW ≥ 25 at the discretion of the attending physician. Multiple of the median (MoM) MCA-PSV (MCA-PSV MoM) > 1.5 was defined as a positive MCA-PSV test result., Results: The MCA-PSV test was applied 2309 times (313 and 1996 times during second and third trimesters, respectively) in 699 women. The results were positive in 4.4% (102/2309) of tests and at least once in 9.9% (69/699) of women. Anemic infants were born to one (1.4%) and six (1.0%) of 69 and 630 women with and without at least one positive test result, respectively. MoM determined 4, 3, and 2 weeks before birth showed significant weak negative correlations with UCB-Hb at birth (correlation coefficient: 0.298-0.325)., Conclusions: Among unselected women giving birth at or near term, the MCA-PSV test was unsatisfactory for prediction of newborn anemia in this retrospective observational study., (Copyright © 2019. Published by Elsevier B.V.)

Objective: The aim of the study was to determine level of anemia and other hematological profiles in pregnant women attending antenatal care clinic in Debre Berhan Referral Hospital, Ethiopia., Results: Prevalence of anemia was 2.8% and that of thrombocytopenia was 10.2%. Out of the anemic pregnant mothers, 5 (62.5%) were mildly anemic and 2 (25%) were severely anemic. The factor age < 20 years of mothers was significantly associated with anemia (P < 0.05). In addition, the occurrence of anemia in mothers who visited antenatal clinic two times is two times higher than those mother who visited the antenatal clinic three times. Moreover, the prevalence of anemia is two times more likely to occur in pregnant mothers who did not take iron supplements as compared to their counter parts. According to pregnancy periods; mean white blood cells count was (8.48 ± 3.09, 8.83 ± 2.73, 8.86 ± 2.67) × 10 9 /L for the first, second and third trimesters, respectively. Red blood cells and platelet counts in the first trimester were significantly higher than their corresponding values in third trimester (P < 0.01), whereas mean hemoglobin and hematocrit values were not statistically significant within trimesters (P > 0.05).

Background: Despite the significant benefits of early detection and management of pregnancy related complications during antenatal care (ANC) visits, not all pregnant women in Tanzania initiate ANC in a timely manner. The primary objectives of this research study in rural communities of Geita district, Northwest Tanzania were: 1) to conduct a population-based study that examined the utilization and availability of ANC services; and 2) to explore the challenges faced by women who visited ANC clinics and barriers to utilization of ANC among pregnant women., Methods: A sequential explanatory mixed method design was utilized. Household surveys that examined antenatal service utilization and availability were conducted in 11 randomly selected wards in Geita district. One thousand, seven hundred and nineteen pregnant women in their 3rd trimester participated in household surveys. It was followed by focus group discussions with community health workers and pregnant women that examined challenges and barriers to ANC., Results: Of the pregnant women who participated, 86.74% attended an ANC clinic at least once; 3.62% initiated ANC in the first trimester; 13.26% had not initiated ANC when they were interviewed in their 3rd trimester. Of the women who had attended ANC at least once, the majority (82.96%) had been checked for HIV status, less than a half (48.36%) were checked for hemoglobin level, and only a minority had been screened for syphilis (6.51%). Among women offered laboratory testing, the prevalence of HIV was 3.88%, syphilis, 18.57%, and anemia, 54.09%. In terms of other preventive measures, 91.01% received a tetanus toxoid vaccination, 76.32%, antimalarial drugs, 65.13%, antihelminthic drugs, and 76.12%, iron supplements at least once. Significant challenges identified by women who visited ANC clinics included lack of male partner involvement, informal regulations imposed by health care providers, perceived poor quality of care, and health care system related factors. Socio-cultural beliefs, fear of HIV testing, poverty and distance from health clinics were reported as barriers to early ANC utilization., Conclusion: Access to effective ANC remains a challenge among women in Geita district. Notably, most women initiated ANC late and early initiation did not guarantee care that could contribute to better pregnancy outcomes.

Background: The burden of malaria and anaemia in pregnancy remains high despite the availability of proven efficacious antenatal care interventions. Sub-optimal uptake of the interventions may be due to inadequate active participation of pregnant women in their antenatal care. It was hypothesized that providing opportunities for pregnant women to improve upon active participation in their antenatal care through malaria and anaemia point-of-care testing would improve adherence to ANC recommendations and interventions and lead to better pregnancy outcomes., Methods: Fourteen antenatal clinics in the Ashanti region of Ghana were randomized into intervention (pregnant women participating in their care plus current routine care) and control (current routine care) arms. Pregnant women attending the clinics for the first time were recruited and followed up until delivery. Haemoglobin levels and malaria parasitaemia were measured at baseline, 4-8 weeks after recruitment and at 36-40 weeks gestation. Birth weight and pregnancy outcomes were also recorded., Results: The overall mean age, gestational age and haemoglobin at baseline were 26.4 years, 17.3 weeks and 110 g/l, respectively, with no significant differences between groups; 10.7% had asymptomatic parasitaemia; 74.6% owned an ITN but only 48.8% slept under it the night before enrolment. The adjusted risk ratio by 8 weeks follow up and at 36-40 weeks gestation in the intervention versus the control was 0.97 (95% CI 0.78-1.22) and 0.92 (95% CI 0.63-1.34) for anaemia and 1.17 (95% CI 0.68-2.04) and 0.83 (95% CI 0.27-2.57) for parasitaemia. The adjusted risk ratio for low birth weight was 0.93 (95% CI 0.44-1.97) and for pregnancy complications (abortions, intrauterine fetal deaths and still births) was 0.77 (95% CI 0.17-3.52) in the intervention group versus controls., Conclusion: Although its potential was evident, this study found no significant beneficial effect of women participating in their malaria and haemoglobin tests on pregnancy outcomes. Exploring factors influencing health worker compliance to health intervention implementation and patient adherence to health interventions within this context will contribute in future to improving intervention effectiveness. Trial registration ISRTCTN88917252.

Objective: Strict compliance to iron and folic acid supplementation is vital for prevention of anemia in pregnancy. However, data are scarce in Ethiopia. So, we conducted this study to assess the level of compliance to iron and folic acid supplementation during pregnancy and its associated factors., Results: Of 418 women, over half, 231 (55.3%), adhered to the recommended iron and folic acid supplementation. Women who started antenatal care (ANC) follow up early [AOR; 95% CI 2.43 (1.12-5.26)], had more frequent number of ANC visit [AOR; 95% CI 2.73 (1.32-5.61)], took small number of tablets per visit [AOR; 95% CI 3.0 (1.21-7.43)], had history of anemia [AOR; 95% CI 1.9 (1.17-3.12)], and were from urban areas [AOR; 95% CI 2.2 (1.29-3.77)], were more likely to conform to recommended iron and folic acid supplementation. Therefore, there need to be prescription of the lowest possible number of tablets per visit. Furthermore, education targeting on increasing maternal health service utilization need to be in place. There need to also be further research aimed at determining the number of tablets to be prescribed per visit specific to individuals' background characteristics.

Background: Anemia is a condition in which the number of red blood cells or their oxygen-carrying capacity is insufficient to meet physiologic needs, which varies by age, sex, altitude, smoking, and pregnancy status. The study aim is to determine the prevalence and factors associated with anemia among pregnant women attending a hospital in southern Ethiopia using a structured interview administered questionnaire., Methods: Facility-based cross-sectional study was conducted from March 01-April 30 2015 at Butajira General Hospital, Ethiopia. A total of 217 women responded to the questionnaire and provided blood and stool samples for analysis. Data were analyzed using Statistical packages for social sciences version 20 for windows., Result and Conclusions: The overall burden of anemia in this study was 27.6%. Residence, ANC follow up, history of excess menstrual bleeding and interpregnancy interval were statistically associated with anemia among the pregnant women. Therefore, working in the identified gaps could reduce the current burden of anemia among pregnant women in the study area.

Objective: The prevalence of maternal anaemia remains unacceptably high in developing countries. At the same time, the percentage of women who consume one or more Fe+folic acid (IFA) tablets during pregnancy remains persistently low. The objective of the present study was to identify where, within antenatal care (ANC) programmes, pregnant women falter in obtaining and consuming an ideal minimum of 180 IFA tablets., Design: Data from Demographic and Health Surveys were used to develop a schematic which identifies four sequential 'falter points' to consuming 180 IFA tablets: ANC attendance, IFA receipt or purchase, IFA consumption and the number of tablets consumed., Setting: Twenty-two countries with high burdens of undernutrition., Subjects: A sample of 162 958 women, 15 to 49 years of age, with a live birth in the past 5 years., Results: Across all countries, 83 % of all pregnant women had at least one ANC visit, 81 % of whom received IFA tablets. Of those receiving IFA tablets, 95 % consumed at least one. Overall adherence to the ideal supplementation regimen, however, was extremely low: only 8 % consumed 180 or more IFA tablets. There were only two countries in which the percentage of pregnant women consuming 180 or more tablets exceeded 30 %., Conclusions: While most women receive and take some IFA tablets, few receive or take enough. The analysis identifies where ANC-based distribution of IFA falters in each country. It enables policy makers to design and prioritize follow-up activities to more precisely identify barriers, an essential next step to improving IFA distribution through ANC.

Objective: To identify and compare implementation bottlenecks for effective coverage of screening for syphilis, HIV, and anemia in antenatal care in rural Tanzania and Uganda; and explore the underlying determinants and perceived solutions to overcome these bottlenecks., Methods: In this multiple case study, we analyzed data collected as part of the Expanded Quality Management Using Information Power (EQUIP) project between November 2011 and April 2014. Indicators from household interviews (n=4415 mothers) and health facility surveys (n=122) were linked to estimate coverage in stages of implementation between which bottlenecks can be identified. Key informant interviews (n=15) were conducted to explore underlying determinants and analyzed using a framework approach., Results: Large differences in implementation were found within and between countries. Availability and effective coverage was significantly lower for all tests in Uganda compared with Tanzania. Syphilis screening had the lowest availability and effective coverage in both countries. The main implementation bottleneck was poor availability of tests and equipment. Key informant interviews validated these findings and perceived solutions included the need for improved procurement at the central level., Conclusion: Our findings reinforce essential screening as a missed opportunity, caused by a lack of integration of funding and support for comprehensive antenatal care programs., (Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

Background: VHSND, a community platform bringing health, early childhood development, nutrition, and sanitation services by community engagement was affected by COVID-19 pandemic. Aims & Objectives: To assess the process of VHSND implementation during post-pandemic period in Assam. Methodology: This cross-sectional study was conducted as operational research in five districts of Assam, selected based on zonal representation; between Sept '2021- Aug '2022. Standard format (GOI) was used for VHSND monitoring. Descriptive analysis was done along with quarter-wise comparison of observations and knowledge of Auxiliary Nurse and Midwife (ANM). Results: A total of 370 VHSND sessions were observed. VHSND micro plan availability increased from 87.5% to 98.4% over four quarters. Displaying banners varied between 56.3% and 79.5%, and functional toilets increased from 41.3% to 77%. Height measurement improved from 58.8% to 88.5%. Haemoglobin estimation varied between 46.3% and 75.4%. Recognition of high-risk pregnancies due to severe anaemia increased from 60% to 91.8%. Regarding danger signs like bleeding from vagina increased from 50.0% to 95.1%. Conclusion: Notable progress could be documented in logistical readiness and ANM knowledge in different quarters in post-pandemic period. While service delivery and ANM counselling efforts have seen improvement, targeted interventions remain crucial for optimizing maternal and child health outcomes in the region. Keywords Village Health Sanitation and Nutrition Day/ VHND; Nutrition services; Assam; Antenatal Care; Supplies & Equipment [ABSTRACT FROM AUTHOR]

Objective: To compare the results of perinatal outcomes between Syrian refugees and Turkish women between 2016 and 2020. Methods: The birth results of 17,997 participants (Syrian refugees: 3579 and Turkish women: 14,418) who delivered in the Labor Department of our hospital between January 2016 and December 2020 were retrospectively analyzed. Results: Maternal age was younger (24.73 ± 6.08 vs. 27.4 ± 5.91 years, p < 0.001) and adolescent pregnancy rate was higher (19.4% vs. 5.6%, p < 0.001) in Syrian refuges than in Turkish women. Bishop scores on admission (4.6 ± 1.6 vs. 4.4 ± 1.1, p < 0.001), birth weight (3088.19 ± 575.32 g vs. 3109.76 ± 540.89 g, p = 0.044), low birth weight (11.3% vs. 9.7%, p = 0.004), and the rate of primary cesarean deliveries (10.1% vs. 15.8%, p < 0.001) were also statistically different. Additionally, the rates of anemia (65.9% vs. 29.2%, p < 0.001), preeclampsia (1.4% vs. 2.7%, p < 0.001), stillbirth (1.3% vs. 0.6%, p < 0.001), preterm premature rupture of membranes (2.7% vs. 1.9%, p = 0.002), and obstetric complications were different between the groups. Conclusions: This study showed that inadequate antenatal care, communication and language barrier problems in Syrian refugees caused some adverse perinatal outcomes. All birth data of Syrian refugees must be disclosed by the Ministry of Health to confirm the accuracy of our data. Significance: What is already known on this subject? Syrian refugees did not receive adequate antenatal care, and some adverse perinatal outcomes were observed more frequently due to communication and language barrier problems. What does this study add? This study showed that more planned-programmed antenatal care-follow-up services should be provided, communication and language problems should be minimized, refugees should benefit more from health services, and effective-appropriate contraception methods should be provided to reduce negative perinatal outcomes. [ABSTRACT FROM AUTHOR]

Background: Anemia is one of the contributing factors for morbidity and mortality during pregnancy in developing country including India, which eventually leads to fetal and maternal consequences. Growing fetus depends completely on mothers for all its growth and maturity. Anemia is one of the nutritional deficiency disorders and around 56% of women are suffering from anemia in India. It is one of the reasons for maternal deaths and fetal complication during pregnancy. Aim: The aim of the study was to assess the prevalence of anemia and to determine the risk factors of anemia among pregnant women in PBMH hospital, Bhubaneswar, Odisha. Materials and Methods: A descriptive cross-sectional study was conducted over a period of 1 month from October 11, 2022, to November 11, 2022, from the Department of Obstetrics and Gynecology of Pradyumna Bal Memorial Hospital KIMS, Bhubaneswar. A total sample comprised of 52 pregnant women who were interviewed by using self-structured questionnaire for data collection and classification of anemia was performed according to the Indian Council of Medical Research (ICMR) criteria. Results: A total of 52 antenatal mothers were admitted during this study period (October 11, 2022, to November 11, 2022), and all were selected as study sample. The incidence of anemia among antenatal mother in PBM hospital was found as follows: 17 (33%) mild, 04 (07%) moderate, and 02 (04%) were severe in this present study. The most common indication of anemia among antenatal mother as per the present study was found to be H/O infection (21%), chronic malaria (15%), hook worm (27%), and birth interval (42%). Conclusion: The study implies that the prevalence rate of Anemia is high, that is, 44.2%. Spacing between pregnancy and H/O infection plays a significant role in considering anemia in pregnant women, which eventually affects both maternal and fetal condition. [ABSTRACT FROM AUTHOR]

Objective: To determine frequency and risk factors of low birth weight (LBW) among neonates at a tertiary care hospital in Karachi, Pakistan. Study Design: Cross-sectional study. Setting: Neonatal Intensive Care Unit (NICU) of National Institute of Child Health. Period: December 2022 to May 2023. Material & Methods: Neonates newly admitted in NICU were enrolled into study. In accordance with World Health Organization criteria, LBW was defined as birth weight <2500 grams. Clinical and demographic details of mothers were retrieved. Frequency and risk factors of LBW among neonates were noted. Results: In a total of 212 neonates, 117 (55.2%) were boys. Mode of delivery was spontaneous vaginal delivery in 118 (55.7%) cases. The median maternal age was 25.5 (IQR=22-30) years. There were 172 (81.1%) cases that were prebooked. Median birth weight was 2.8 (IQR=2.5-3.1) grams. The frequency of LBW was noted in 45 (21.2%). On multivariable regression model, maternal age, education, antenatal care visit, birth interval, presence of hypertension and anemia during pregnancy were found to be independent (p<0.05) predictors of LBW. Conclusion: The frequency of LBW among neonates admitted in NICU was high. Maternal age, educational status, antenatal care, birth interval, hypertension and anemia were independent predictors of LBW. [ABSTRACT FROM AUTHOR]

During pregnancy, women have an increased relative risk of exposure to infectious diseases. This study was designed to assess the prevalence of the co-occurrence of glucose-6-phosphate dehydrogenase deficiency (G6PDd) and sickle cell trait (SCT) and the impact on anemia outcomes among pregnant women exposed to frequent infectious diseases. Over a six-year period (March 2013 to October 2019), 8473 pregnant women attending antenatal clinics (ANCs) at major referral hospitals in Northern Ghana were recruited and diagnosed for common infectious diseases (malaria, syphilis, hepatitis B, and HIV), G6PDd, and SCT. The prevalence of all the infections and anemia did not differ between women with and without G6PDd (χ2 < 3.6, p > 0.05 for all comparisons). Regression analysis revealed a significantly higher proportion of SCT in pregnant women with G6PDd than those without G6PDd (AOR = 1.58; p < 0.011). The interaction between malaria and SCT was observed to be associated with anemia outcomes among the G6PDd women (F-statistic = 10.9, p < 0.001). Our findings show that anemia is a common condition among G6PDd women attending ANCs in northern Ghana, and its outcome is impacted by malaria and SCT. This warrants further studies to understand the impact of antimalarial treatment and the blood transfusion outcomes in G6PDd/SCT pregnant women. [ABSTRACT FROM AUTHOR]

Background: Anemia is one of the contributing factors for morbidity and mortality during pregnancy in developing country including India, which eventually leads to fetal and maternal consequences. Growing fetus depends completely on mothers for all its growth and maturity. Anemia is one of the nutritional deficiency disorders and around 56% of women are suffering from anemia in India. It is one of the reasons for maternal deaths and fetal complication during pregnancy. Aim: The aim of the study was to assess the prevalence of anemia and to determine the risk factors of anemia among pregnant women in PBMH hospital, Bhubaneswar, Odisha. Materials and Methods: A descriptive cross-sectional study was conducted over a period of 1 month from October 11, 2022, to November 11, 2022, from the Department of Obstetrics and Gynecology of Pradyumna Bal Memorial Hospital KIMS, Bhubaneswar. A total sample comprised of 52 pregnant women who were interviewed by using self-structured questionnaire for data collection and classification of anemia was performed according to the Indian Council of Medical Research (ICMR) criteria. Results: A total of 52 antenatal mothers were admitted during this study period (October 11, 2022, to November 11, 2022), and all were selected as study sample. The incidence of anemia among antenatal mother in PBM hospital was found as follows: 17 (33%) mild, 04 (07%) moderate, and 02 (04%) were severe in this present study. The most common indication of anemia among antenatal mother as per the present study was found to be H/O infection (21%), chronic malaria (15%), hook worm (27%), and birth interval (42%). Conclusion: The study implies that the prevalence rate of Anemia is high, that is, 44.2%. Spacing between pregnancy and H/O infection plays a significant role in considering anemia in pregnant women, which eventually affects both maternal and fetal condition.

In developing nations, anaemia is one of the most prevalent medical conditions. It has long been known that parasite infection during pregnancy is one of the main causes of anaemia and an elevated risk of maternal mortality. To ascertain the prevalence and risk factors related to parasite infections and anaemia among pregnant women receiving prenatal care in some selected public health facilities in Kaduna State, Nigeria, an eleven-month cross-sectional study of 180 consenting pregnant women was conducted from February to December 2017. A standardized questionnaire was used to interview the sampled pregnant women. Stool and blood samples of each consented pregnant woman were collected. Formal-ether sedimentation technique, thin and thick blood smears and haematocrit packed cell volume capillary methods were used to screen intestinal helminth parasites, plasmodium species and Packed Cell Volume (PCV) respectively. The result obtained showed parasitic infections prevalence of 102(56.7%) among the study population. Prevalence of Plasmodium species, hookworm, Ascaris lumbricoides and those with co-infection all occurred at 47.2%, 16.7%, 17.8% and 25.0% respectively. Age, educational level, trimester and parity were all significant predictors of Plasmodium species prevalence (p<0.005). Similarly, parity and educational level were significantly (p<0.005) associated with the prevalence of intestinal parasites and co-infection. Anaemia was present in 40.0% of the examined pregnant women. Trimester and educational level were highly significant (p<0.001) predictors of anaemia among the sampled pregnant women. Plasmodium species were the most common parasitic species associated with anaemia as 43.1% of Plasmodium species-infected pregnant women had anaemia compared to those with intestinal helminth infection (30.6%) and co-infection (13.3%). However, statistical analysis revealed a significant association (p<0.05) between the prevalence of anaemia and intestinal helminth infection. Therefore, measures such as improved sanitation and health education are needed to lessen the prevalence of parasitic infections and parasite-related anaemia in the study area. [ABSTRACT FROM AUTHOR]

Background: Despite concerted global efforts to reduce the burden of maternal anemia, it remains a major public health issue. Over 40% of pregnant women worldwide are anemic; low- and middle-income countries (especially those in sub-Saharan Africa) make a disproportionately higher contribution to the global burden. The condition can lead to undesirable outcomes for the mother and child. This study was conducted to determine the prevalence of anemia in pregnancy among women attending antenatal clinics in Chikun LGA, Kaduna. Methods: This study was conducted among 145 women attending antenatal clinics in Chikun LGA. Data were collected using a pretested, semi-structured interviewer-administered questionnaire. Hemoglobin (Hb) level was determined and anemia was defined using the World Health Organization-recommended cutoff of <11 g/dl. The results were presented in frequency tables. Data were analyzed using IBM SPSS Statistics version 26. Statistical significance was set at P < 0.05. Results: Fifty-five (37.9%) of the respondents were between the ages of 25 and 29 years. The mean age of the respondents was 28.61 ± 5.5 years. The majority, 107 (73.8%), had a household size of 2–4. Only 16 (11.0%) respondents were aware of anemia. Pregnant women were identified by half (50.0%) of the respondents as being more at risk of anemia. Only a quarter (25.0%) of respondents had good knowledge of anemia. Over two-fifth (42.8%) of the respondents were anemic. There was a statistically significant relationship between household size and anemia in respondents. Conclusion: A large proportion of the respondents were anemic; this underscores the need to strengthen the nutritional counseling and routine hematinics given during the antenatal period. Social drivers should also be addressed in terms of favorable public policies. [ABSTRACT FROM AUTHOR]

During pregnancy, women have an increased relative risk of exposure to infectious diseases. This study was designed to assess the prevalence of the co-occurrence of glucose-6-phosphate dehydrogenase deficiency (G6PDd) and sickle cell trait (SCT) and the impact on anemia outcomes among pregnant women exposed to frequent infectious diseases. Over a six-year period (March 2013 to October 2019), 8473 pregnant women attending antenatal clinics (ANCs) at major referral hospitals in Northern Ghana were recruited and diagnosed for common infectious diseases (malaria, syphilis, hepatitis B, and HIV), G6PDd, and SCT. The prevalence of all the infections and anemia did not differ between women with and without G6PDd (χ2 < 3.6, p > 0.05 for all comparisons). Regression analysis revealed a significantly higher proportion of SCT in pregnant women with G6PDd than those without G6PDd (AOR = 1.58; p < 0.011). The interaction between malaria and SCT was observed to be associated with anemia outcomes among the G6PDd women (F-statistic = 10.9, p < 0.001). Our findings show that anemia is a common condition among G6PDd women attending ANCs in northern Ghana, and its outcome is impacted by malaria and SCT. This warrants further studies to understand the impact of antimalarial treatment and the blood transfusion outcomes in G6PDd/SCT pregnant women.

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Anemia and micronutrient (MN) deficiencies in pregnant women are associated with adverse pregnancy outcomes. In Niger, 58.6% of pregnant women are anemic; however, MN statuses are unknown. The study objectives were to estimate the prevalence of MN deficiencies among pregnant women in Zinder, Niger and explore associated risk factors. Pregnant women living in randomly selected rural villages (n = 88) were included. Capillary and venous blood samples (n = 770) were analyzed for hemoglobin (Hb) and plasma ferritin, soluble transferrin receptor (sTfR), zinc (pZn), retinol binding protein (RBP), folate and vitamin B12. C-reactive protein and alpha-1-acid glycoprotein were measured to adjust for inflammation. The prevalence of MN deficiencies in pregnant woman was high, indicative of a severe public health problem. Prevalence of iron deficiency was 20.7% and 35.7%, by ferritin (8.3 mg/L), respectively. In total, 40.7% of women had low pZn (

Elisabeth Garcia Vilaplana,1,2 Patrick Petignat,2 Anne-Caroline Benski,2– 4 Adelia Soaroby,4 Jessica Sormani,2 Pierre Vassilakos,2,5 Nicole C Schmidt2,6 1Faculty of Medicine, University of Geneva, Geneva, Switzerland; 2Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland; 3Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; 4Centre Medical St Damien, Ambanja, Madagascar; 5Geneva Foundation for Medical Education and Research, Geneva, Switzerland; 6Catholic University of Applied Science, Munich, GermanyCorrespondence: Nicole C SchmidtCatholic University of Applied Science, Preysingstraße 95, Munich 81667, GermanyTel +49 89 48092-8499Email nicole.schmidt@ksh-m.deBackground: The estimated burden of maternal morbidities in lower-income countries, such as Madagascar, is high. However, there is still a lack of data on maternal morbidities, in part due to an absence of standardized assessment tools. This cross-sectional study aims to report maternal morbidities among 1015 women in the district of Ambanja, Madagascar, and to describe the advantages and limitations of a mHealth system.Methods: Data were collected using the PANDA (pregnancy and newborn diagnosis assessment) system, an mHealth device that incorporates the WHO recommendations for antenatal care (ANC). Data, including personal and medical information, but also clinical data such as hypertension, anemia or HIV were collected from more than 1000 women attending ANC.Results: A total of 1015 pregnant women were recruited from January 2015 to August 2018. The average age was 24.6 years old, and most women were married (82.3%). The majority lived in urban areas and were unemployed. Prevalence of hypertension and gestational diabetes was relatively low (4% vs 2.2%). Malaria infection was diagnosed in 2.2% and HIV was diagnosed in 1.2% of pregnant women. The most common morbidity was anemia (68.4%) and the only significant factor associated was being single compared to being married (OR 1.68, 95% CI 1.05– 2.70, p-value 0.032).Discussion: The prevalence of anemia in our study population was much higher than previously reported in Sub-Saharan Africa. This finding highlights the need for regular iron supplementation during pregnancy, especially in vulnerable (eg, single) women. The PANDA mHealth system provides unique opportunities due to its standardization of ANC and creation of a digital database accessible from a distance. However, one of the main challenges was that even a mHealth system such as the PANDA remains dependent on the local procurement chain. Therefore, future studies need to access opportunities of mHealth systems to support health service delivery.Trial Registration: Registered on ISRCTN on 14th October 2015, number ISRCTN18270380. Retrospectively registered.Keywords: maternal health, maternal deaths, anemia, antenatal care

Mohamed Omar Osman,1 Tahir Yousuf Nour,1 Hodan Mahamed Bashir,2 Abdurahman Kedir Roble,3 Abdikani Mawlid Nur,1 Abdilahi Omer Abdilahi1 1Department of Public Health, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia; 2Department of Food Science and Nutrition, College of Dryland Agriculture, Jigjiga University, Jigjiga, Ethiopia; 3Department of Midwifery, College of Medicine and Health Science, Jigjiga University, Jigjiga, EthiopiaCorrespondence: Mohamed Omar Osman P.O.BOX: 1020, Jigjiga, EthiopiaTel +251921424748Fax +251 25 775 5976Email Wehliye@jju.edu.etBackground: Anemia is a significant public health concern in many developing countries, particularly during pregnancy, and it has adverse effects on mother and fetus/baby.Objective: To determine the factors associated with anemia among pregnant women attending antenatal care in Jigjiga public health facilities, Somali Region, East Ethiopia.Methods: An institution-based unmatched case–control study was conducted. The sample size was 228 pregnant women; comprising 114 presenting with anemia and 114 controls. Hemoglobin levels were measured using a portable heme analyzer. Socio-demographic, dietary, medical history, and nutrition-related data were collected using a structured questionnaire. Data were entered into Epidata 3.1 and exported to Statistical Package for the Social Sciences (SPSS) version 23.0 for cleaning and analyses. Bivariate and multivariate logistic regression was performed and statistical significance was considered at a level of p< 0.05.Results: Three predictors of anemia among pregnant women were identified in this study. An inadequate intake of red meat (i.e. those who consumed red meat 1– 2 times a month [AOR=7.245; 95% CI=(2.007– 26.151)] or not at all [AOR=8.690; 95% CI=(1.795– 42.072)]), and insufficient consumption of green vegetables (i.e. 1– 2 times a week [AOR=2.970; 95% CI=(1.012– 8.716)] or 1– 2 times a month [AOR=8.057; 95% CI=(2.358– 27.526)]) were associated with anemia. Also, having a mid-upper arm circumference (MUAC) of less than 23 cm was strongly associated [AOR=16.432; 95% CI= (5.240– 51.526)] with anemia.Conclusion: This study revealed three key factors to be associated with anemia among pregnant women in Jigjiga Town, namely reduced intake of red meat and green vegetables, and low MUAC. Interventions including nutrition counselling and enrolling pregnant women with low nutritional status in nutritional programs should be the core components of anemia control strategies, needed to address the high prevalence of anemia during pregnancy in developing countries.Keywords: risk factors, anemia, pregnant women, antenatal care, Jigjiga Town

Background: Anemia is a global public health problem affecting both developing and developed countries. It is associated with increased morbidity and mortality in pregnant women and children. Nevertheless, information regarding the prevalence of anemia and associated factors among pregnant in the study area is limited. Therefore, this study was aimed to assess the prevalence of anemia and associated factors among pregnant women attending antenatal care clinic in Adare General Hospital, Southern Ethiopia. Method: A facility-based cross-sectional study was conducted from October 1, 2020, to December 15, 2020, among 340 pregnant women aged 15 to 49 years who came for focused antenatal care follow-up. Trained data collectors administered questionnaires, and collected capillary blood and stool samples. Data were coded and entered into EPI Info 7 and the analysis was done using SPSS version 20.0. Factors associated with anemia were assessed using binary logistic regression. Those variables that had a P -value less than.25 on bi-variable regression analysis were considered for multi-variable regression analysis. Statistical significance was declared with P <.05. Result: The prevalence of anemia among pregnant women was 24.1% (95% CI: 19.55%-28.69%). The majority of anemia cases were mildly anemic (62.2.0%). Increased odds of anemia was found among pregnant women with household monthly income ⩽2550 Ethiopian Birr (⩽69.67 United States Dollar) (AOR = 2.08; 95% CI: 1.15, 3.76), not attended formal education (AOR = 3.86; 95% CI: 1.42, 10.54), not using iron tablets (AOR = 2.64; 95% CI: 1.33, 5.27) and infected with Plasmodium vivax (AOR = 7.58; 95% CI: 3.11, 18.47). Conclusions: Anemia had moderate public health significance in the study. Low monthly family income, educational status, iron tablet consumption during pregnancy and Plasmodium vivax infection were found to be independent predictors for anemia in pregnancy. The burden of anemia should be alleviated through enhancing maternal socio-economic status, prevention of illnesses targeting pregnant women, and strengthening the expansion of prenatal iron-folate supplementation. [ABSTRACT FROM AUTHOR]

Anemia in pregnancy is a risk factor for maternal and neonatal mortality and morbidity. Iron deficiency anemia (IDA), the most common type of anemia in pregnancy, adversely affects the well-being of both the mother and the child. Iron--folic acid supplementation (IFAS), a cost-effective public health intervention of IDA in pregnancy recommended by the World Health Organization (WHO), is implemented globally with the Philippines included. However, only 19% of Filipino pregnant women take the recommended number of 180 IFAS tablets. This is considered a factor in the prevalence of anemia in pregnancy. Very low IFAS uptake was due to the behaviors and practices of both pregnant women and healthcare providers. Limited awareness on the impact of anemia in pregnancy and the significance of IFAS, late and less frequent antenatal care (ANC) visits, experience of side effects and unpleasant taste of the supplement, and not receiving or purchasing supplements were the identified factors to low IFAS compliance. Among healthcare providers, a low level of IFAS compliance was found to be related to the late reporting of pregnant women to the antenatal facility, and inability to motivate and provide appropriate counseling regarding the supplementation's use and significance. Behaviors and practices of pregnant mothers toward IFAS compliance appear to be a result of healthcare providers' inadequate healthcare services. Therefore, healthcare providers need to improve their ANC program and revisit their approaches on existing health and nutrition promotion programs, health education and counseling techniques, follow-up and monitoring strategies, and ANC visits promotion efforts. These efforts were found effective in well-informed and empowered pregnant women to IFAS compliance and other significant ANC access. Improved IFAS compliance will eventually contribute to lower the prevalence of anemia in pregnancy for better maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Objective: In this study, we aim to compare obstetric and perinatal outcomes between Turkish citizens and Syrian refugees who applied to a tertiary center in Izmir. Materials and Methods: Demographic characteristics, obstetric and neonatal outcomes of 8103 Syrian refugee pregnant women and 47 151 Turkish citizen pregnant women between January 2013 and December 2018 were retrospectively compared. Our primary aim was to compare the cesarean rates and obstetrical results between two groups and to decide antenatal care secondarily. Results: Syrian refugee pregnant women are statistically younger (p < 0.001), mean pregnancy duration and mean birth weight is statistically lower (p < 0.001 and p < 0.001, respectively). Adolescent pregnancy rates, preterm birth rates and anemia are statistically higher in refugee group (p < 0.001, p < 0.001, and p < 0.001, respectively). Primary cesarean section rates, combined and triple screening tests application rates, gestational diabetes screening rates are meaningfully lower in refugee group (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). Conclusion: Syrian refugees are at risk for inadequate antenatal care, adolescent pregnancy, and adverse pregnancy outcomes. Therefore, care should be given to these risks during pregnancy and childbirth to Syrian refugees. [ABSTRACT FROM AUTHOR]

Abstract Objective The aim of the study was to determine level of anemia and other hematological profiles in pregnant women attending antenatal care clinic in Debre Berhan Referral Hospital, Ethiopia. Results Prevalence of anemia was 2.8% and that of thrombocytopenia was 10.2%. Out of the anemic pregnant mothers, 5 (62.5%) were mildly anemic and 2 (25%) were severely anemic. The factor age 0.05).

Background: The estimated burden of maternal morbidities in lower-income countries, such as Madagascar, is high. However, there is still a lack of data on maternal morbidities, in part due to an absence of standardized assessment tools. This cross-sectional study aims to report maternal morbidities among 1015 women in the district of Ambanja, Madagascar, and to describe the advantages and limitations of a mHealth system. Methods: Data were collected using the PANDA (pregnancy and newborn diagnosis assessment) system, an mHealth device that incorporates the WHO recommendations for antenatal care (ANC). Data, including personal and medical information, but also clinical data such as hypertension, anemia or HIV were collected from more than 1000 women attending ANC. Results: A total of 1015 pregnant women were recruited from January 2015 to August 2018. The average age was 24.6 years old, and most women were married (82.3%). The majority lived in urban areas and were unemployed. Prevalence of hypertension and gestational diabetes was relatively low (4% vs 2.2%). Malaria infection was diagnosed in 2.2% and HIV was diagnosed in 1.2% of pregnant women. The most common morbidity was anemia (68.4%) and the only significant factor associated was being single compared to being married (OR 1.68, 95% CI 1.05– 2.70, p-value 0.032). Discussion: The prevalence of anemia in our study population was much higher than previously reported in Sub-Saharan Africa. This finding highlights the need for regular iron supplementation during pregnancy, especially in vulnerable (eg, single) women. The PANDA mHealth system provides unique opportunities due to its standardization of ANC and creation of a digital database accessible from a distance. However, one of the main challenges was that even a mHealth system such as the PANDA remains dependent on the local procurement chain. Therefore, future studies need to access opportunities of mHealth systems to support health service delivery. Trial Registration: Registered on ISRCTN on 14th October 2015, number ISRCTN18270380. Retrospectively registered. [ABSTRACT FROM AUTHOR]

Background: Hookworm infection is a major public health problem in developing countries. The main way people become infected with hookworm's larva is through direct skin contact with contaminated soil when walking on barefoot. It is one of a major cause of anemia in pregnant women. The objective was to assess the prevalence and associated factors of hookworm infection among pregnant women who attended antenatal care at governmental health centers in Dembecha district, Ethiopia, 2017.Methods: Institutional based cross sectional study was conducted on 306 pregnant women. Study participants were selected by systematic random sampling technique from February 1 to March 30, 2017. Data collectors and supervisors were trained. Semi-structured Amharic version questionnaire was used to collect data using face to face interview technique and stool sample was examined. Collected data were entered by using Epi data version 3.1 and exported to SPSS. The exported data was analyzed and presented by using descriptive summary statistics and tables. After bivariate logistic regression analysis, all variables with a p-value < 0.25 were entered into multivariate logistic regression and p value < 0.05 considered as significantly associated with the outcome variable.Results: Prevalence of hookworm infection was 32.0%. There was a positive association of hookworm infection with living in single room [AOR =2.8; 95% CI; 1.32-5.81], living with domestic animals [AOR = 3.4; 95% CI; 1.35-8.76], monthly income ≤1500 Ethiopian birr [AOR = 3.7; 95% CI; 1.76-7.64], unavailability of latrine [AOR = 2.2; 95% CI; 1.03-4.55], habit of walking on barefoot [AOR = 4.3; 95% CI; 2.17-8.48] and not habit of hand washing before meal [AOR = 3.4; 95 CI; 1.14-10.12].Conclusion: This study showed high prevalence of hookworm infection among pregnant women in the study area. Living in single room, living with domestic animals, monthly income ≤1500 Ethiopian birr, unavailability of latrine, habit of walking on barefoot and not habit of hand washing before meal had positive association with hookworm infection. Public health measure should focus on availability latrine and separation of humans and domestic animals room to decrease prevalence of hookworm infection among pregnant women. [ABSTRACT FROM AUTHOR]

Background: Maternal morbidity is common in Bangladesh, where the maternal mortality rate has plateaued over the last 6 years. Maternal undernutrition and micronutrient deficiencies contribute to morbidity, but few interventions have measured maternal outcomes. We compared reported prevalence of antepartum, intrapartum, and postpartum complications among recently delivered women between maternal nutrition intervention and control areas in Bangladesh.Methods and Findings: We conducted a cross-sectional assessment nested within a population-based cluster-randomized trial comparing a nutrition counseling and micronutrient supplement intervention integrated within a structured home-based maternal, newborn, and child health (MNCH) program to the MNCH program alone in 10 sub-districts each across 4 Bangladesh districts. Eligible consenting women, delivering within 42-60 days of enrollment and identified by community-level health workers, completed an interviewer-administered questionnaire detailing the index pregnancy and delivery and allowed review of their home-based care register. We compared pooled and specific reported antepartum, intrapartum, and postpartum complications between study groups using hierarchical logistic regression. There were 594 women in the intervention group and 506 in the control group; overall, mean age was 24 years, 31% were primiparas, and 39% reported facility-based delivery, with no significant difference by study group. There were no significant differences between the intervention and control groups in household-level characteristics, including reported mean monthly income (intervention, 6,552 taka, versus control, 6,017 taka; p = 0.48), having electricity (69.6% versus 71.4%, p = 0.84), and television ownership (41.1% versus 38.7%, p = 0.81). Women in the intervention group had higher recorded iron and folic acid and calcium supplement consumption and mean dietary diversity scores, but reported anemia rates were similar between the 2 groups (5.7%, intervention; 6.5%, control; p = 0.83). Reported antepartum (69.4%, intervention; 79.2%, control; p = 0.12) and intrapartum (41.4%, intervention; 48.5%, control; p = 0.18) complication rates were high and not significantly different between groups. Reported postpartum complications were significantly lower among women in the intervention group than the control group (33.5% versus 48.2%, p = 0.02), and this difference persisted in adjusted analysis (adjusted odds ratio [AOR] = 0.51, 95% CI 0.32-0.82; p < 0.001). For specific conditions, odds of retained placenta (AOR = 0.35, 95% CI 0.19-0.67; p = 0.001), postpartum bleeding (AOR = 0.37, 95% CI 0.15-0.92; p = 0.033), and postpartum fever/infection (AOR = 0.27, 95% CI 0.11-0.65; p = 0.001) were significantly lower in the intervention group in adjusted analysis. There were no significant differences in reported hospitalization for antepartum (49.8% versus 45.1%, p = 0.37), intrapartum (69.9% versus 59.8%, p = 0.18), or postpartum (36.1% versus 29.9%, p = 0.49) complications between the intervention and control groups. The main limitations of this study are outcome measures based on participant report, non-probabilistic selection of community-level workers' catchment areas for sampling, some missing data for variables derived from secondary sources (e.g., dietary diversity score), and possible recall bias for reported dietary intake and supplement use.Conclusions: Reported overall postpartum and specific intrapartum and postpartum complications were significantly lower for women in intervention areas than control areas, despite similar rates of facility-based delivery and hospitalization for reported complications, in this exploratory analysis. Maternal nutrition interventions providing intensive counseling and micronutrient supplements may reduce some pregnancy complications or impact women's ability to accurately recognize complications, but more rigorous evaluation is needed for these outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background Anemia is a condition in which the number of red blood cells or their oxygen-carrying capacity is insufficient to meet physiologic needs, which varies by age, sex, altitude, smoking, and pregnancy status. The study aim is to determine the prevalence and factors associated with anemia among pregnant women attending a hospital in southern Ethiopia using a structured interview administered questionnaire. Methods Facility-based cross-sectional study was conducted from March 01–April 30 2015 at Butajira General Hospital, Ethiopia. A total of 217 women responded to the questionnaire and provided blood and stool samples for analysis. Data were analyzed using Statistical packages for social sciences version 20 for windows. Result and conclusions The overall burden of anemia in this study was 27.6%. Residence, ANC follow up, history of excess menstrual bleeding and interpregnancy interval were statistically associated with anemia among the pregnant women. Therefore, working in the identified gaps could reduce the current burden of anemia among pregnant women in the study area.

Abstract Background With more than 200 million cases a year, malaria is an important global health concern, especially among pregnant women. The forested tribal areas of Andhra Pradesh, Telangana and Chhattisgarh in India are affected by malaria and by an on-going chronic conflict which seriously limits access to health care. The burden of malaria and anemia among pregnant women in these areas is unknown; moreover there are no specific recommendations for pregnant women in the Indian national malaria policy. The aim of this study is to measure the burden of malaria and anemia among pregnant women presenting in mobile clinics for antenatal care in a conflict-affected corridor in India. Methods This is a descriptive study of routine programme data of women presenting at first visit for antenatal care in Médecins sans Frontières mobile clinics during 1 year (2015). Burden of malaria and anemia were estimated using rapid diagnostic tests (SD BIOLINE® and HemoCue® respectively). Results Among 575 pregnant women (median age: 26 years, interquartile range: 25-30) 29% and 22% were in their first and second pregnancies respectively. Mid-Upper Arm Circumference (MUAC) was below 230 mm in 74% of them. The prevalence of anemia was 92.4% (95% Confidence Intervals (CI): 89.9–94.3), while severe anemia was identified in 6.9% of the patients. The prevalence of malaria was 29.3% (95%CI: 25.7–33.2) with 64% caused by isolated P. falciparum, 35% by either P. falciparum or mixed malaria and 1% by either P. vivax, or P.malariae or P. ovale. Malaria test was positive in 20.8% of asymptomatic cases. Malaria was associated with severe anemia (prevalence ratio: 2.56, 95%CI: 1.40–4.66, p