Hindawi

Anemia
Volume 2018, Article ID 1846280, 9 pages
https://doi.org/10.1155/2018/1846280

Research Article
Anaemia in Pregnancy: Prevalence, Risk Factors, and Adverse
Perinatal Outcomes in Northern Tanzania

Grace Stephen,1 Melina Mgongo ,2,3 Tamara Hussein Hashim,2,4 Johnson Katanga,1,5
Babill Stray-Pedersen,3,6 and Sia Emmanueli Msuya1,2,7
1
Institute of Public Health, Department of Community Health, Kilimanjaro Christian Medical University College (KMUCO),
P.O. Box 2240, Moshi, Tanzania
2
Better Health for African Mothers and Children (BHAMC) Project, P.O. Box 8418, Moshi, Tanzania
3
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
4
Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
5
Ocean Road Cancer Institute, Directorate of Cancer Prevention Services, P.O. Box 3592, Dar es Salaam, Tanzania
6
Division of Gynaecology and Obstetrics, Oslo University Hospital, Rikshospitalet, 0863 Oslo, Norway
7
Department of Community Medicine, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania

Correspondence should be addressed to Melina Mgongo; linnabenny@yahoo.com

Received 19 July 2017; Revised 20 February 2018; Accepted 11 March 2018; Published 2 May 2018

Academic Editor: Aurelio Maggio

Copyright © 2018 Grace Stephen et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background and Objective. Anaemia in pregnancy is a public health problem in developing countries. This study aimed to determine
the prevalence, risk factors, and adverse perinatal outcomes of anaemia among pregnant women in Moshi Municipal, Northern
Tanzania. Methods. This was a follow-up study conducted from October 2013 to June 2015. A total of 539 pregnant women were
enrolled in this study. Interviews were conducted followed by determination of haemoglobin level. Women were followed up at
delivery and at 7 days and 28 days after delivery. Results. A total of 529 women were included in this analysis. Their mean age was
25.8 (SD 5.73). The prevalence of anaemia was 18.0% and 2% had severe anaemia. The clinic of recruitment and low education
level of the women were the factors that were independently associated with anaemia during pregnancy. At delivery, there were 10
stillbirths, 16 low birth weight (LBW) newborns, and 2 preterm birth cases. No association was found between anaemia and LBW,
preterm birth, or stillbirths. Conclusion. Anaemia in pregnancy was a mild public health problem in the study setting of Northern
Tanzania.

1. Introduction prevalence of anaemia is highest among pregnant women

in Sub-Saharan Africa (SSA) (57%), followed by pregnant
Anaemia during pregnancy is a public health problem women in Southeast Asia (48%), and lowest prevalence
especially in developing countries and is associated with (24.1%) was found among pregnant women in South America
adverse outcomes in pregnancy [1]. World Health Organi- [3]. Tanzania Demographic and Health Surveys reported a
zation (WHO) has defined anaemia in pregnancy as the slight decrease in the prevalence of anaemia among pregnant
haemoglobin (Hb) concentration of less than 11 g/dl [2]. women from 58% in 2004/05 to 53% in 2010 [4, 5]. Other
According to WHO, anaemia is considered to be of a public studies conducted in Tanzania have reported a higher preva-
health significance or problem if population studies find the lence of anaemia among pregnant women: 68% in Dar es
anaemia prevalence of 5.0% or higher. Prevalence of anaemia Salaam and 47% in Moshi [6, 7].
of ≥40% in a population is classified as a severe public health The causes of anaemia during pregnancy in developing
problem [3]. countries are multifactorial; these include micronutrient defi-
Global data shows that 56% of pregnant women in low ciencies of iron, folate, and vitamins A and B12 and anaemia
and middle income countries (LMIC) have anaemia [1]. The due to parasitic infections such as malaria and hookworm or
2 Anemia

chronic infections like TB and HIV [7–11]. Contributions of Enrolment of pregnant women was conducted in October
each of the factors that cause anaemia during pregnancy vary 2013 to April 2014 and follow-up of mothers and their infants
due to geographical location, dietary practice, and season. But up to 9 months was completed in June 2015 [20]. This paper
in Sub-Saharan Africa inadequate intake of diets rich in iron used data that was collected from enrolment up to seven days
is reported as the leading cause of anaemia among pregnant postdelivery.
women [10, 11]. Moshi Municipality has a population of 184,292 and
Anaemia during pregnancy is reported to have negative 56,848 women of reproductive age [21]. The total deliveries in
maternal and child health effect and increase the risk of Moshi Municipality in 2017 was 12040. There are 4 hospitals,
maternal and perinatal mortality [12, 13]. The negative health 8 health centres, and 32 dispensaries where 25 health facilities
effects for the mother include fatigue, poor work capacity, provide reproductive and child health services. The study
impaired immune function, increased risk of cardiac dis- was conducted at 2 government health centres, Majengo and
eases, and mortality [1, 13, 14]. Some studies have shown that Pasua, which include a huge population of pregnant woman
anaemia during pregnancy contributes to 23% of indirect in Moshi urban area and have the capacity to deliver about
causes of maternal deaths in developing countries [1]. 1301 and 955 women per year, respectively. The two clinics
Anaemia in pregnancy is associated with increased risk of provide services to approximately 3600 and 3000 pregnant
preterm birth and low birth weight babies [1, 6, 7, 15]. Preterm women in Majengo and Pasua, respectively. In 2017 Majengo
and LBW are still the leading causes of neonatal deaths in had 1343 deliveries and Pasua had 1001 deliveries.
developing countries like Tanzania contributing to 30% of the
deaths [16]. It has also been associated with increased risk of 2.2. Sample Size Calculations. Sample size was estimated by
intrauterine deaths (IUFD), low APGAR score at 5 minutes, using the following formula. The minimum sample that was
and intrauterine growth restriction (IUGR) which is a risk for required for this study was 390 pregnant women.
stunting among children of less than two years [6, 7, 17].
Tanzania as a country has strengthened different inter- 𝑍2 ∗ 𝑃 (1 − 𝑃)
ventions to reduce the burden of anaemia during pregnancy. 𝑁= , (1)
𝜀2
The interventions during pregnancy include anaemia screen-
ing during pregnancy and treatment, giving a combination where 𝑁 is estimated minimum sample size; 𝑍 is confidence
of folic acid (FeFo) and iron supplements for three months, level at 95% (standard value is 1.96); 𝑃 is proportion (preva-
deworming, intermittent prophylaxis treatment for malaria lence of anaemia during pregnancy 53% TDHS, 2010); 𝜀 is
(IPTp) with sulfadoxine pyrimethamine (SP) from 14 weeks, precision at 95% CI = 0.05.
free provision of mosquito treated nets, and health education
during the antenatal visits [18]. Few studies have evaluated (1.96)2 × 0.53 (1 − 0.53)
𝑁= . (2)
the burden of anaemia and its effect in pregnant outcomes (0.05)2
in Tanzania after scaling up of preventive interventions. Data
for studies by Kidanto et al. [6] and Msuya et al. [7] that have 2.3. Study Population and Procedures. The study popula-
shown prevalence of anaemia in pregnancy in Dar es Salaam tion included all pregnant women who were in their third
and Moshi Tanzania as well as TDHS of 2010 were collected trimester and attending for routine care at the two primary
between 2004 and 2010, before strengthening interventions health care clinics between October 2013 and April 2014. The
targeting anaemia in pregnancy and interventions improving study excluded women who reported they will relocate/move
overall maternal and neonatal health. There is a need of after delivery and those who did not consent.
having current information on burden and effects of anaemia Women were informed about the study aims and follow-
during pregnancy after these multiple interventions. There- up schedule and those agreeing to participate gave a
fore, this study aims to determine prevalence, risk factors, and signed consent. Face-to-face interviews using questionnaire
associated perinatal adverse perinatal outcomes of anaemia were conducted by trained research assistants who were
during pregnancy in Moshi Municipality. nurses/doctors and underwent one-week training. The inter-
views were conducted in Swahili language. The information
2. Methods collected included social demographic characteristics, eco-
nomic characteristics, reproductive health history, feeding
2.1. Study Design and Study Setting. The study was part of practices, and intended place of delivery. After the interviews,
larger cohort study that aimed to describe the effects of Sex- clinical examinations were conducted and blood sample was
ually Transmitted Infections/Reproductive Tract Infections collected for diagnosis of HIV, STIs, and haemoglobin levels
and anaemia on pregnancy outcomes and child growth in [19].
Moshi Municipality, Tanzania [19]. The study was conducted A total of 536 pregnant women were enrolled, but analysis
between October 2013 and June 2015 in two health care was done on 529 women who had complete information of
centres, that is, Majengo and Pasua health centres in Moshi haemoglobin levels; see Figure 1.
Municipality. The two clinics are the largest primary health
centres in Moshi Municipality. 2.4. Data Processing, Categorization, and Analysis. The data
The larger study enrolled women in their third trimester were entered, cleaned, and analysed by using SPSS version
of pregnancy and followed them at birth, at 7 days postde- 20. Descriptive statistics was used to summarize data. Pro-
livery, and monthly up to 9 months and every postdelivery. portions were used for categorical variables and mean or
Anemia 3

Enrolled at 3rd trimester

N = 536

Missing information on Hb
levels, N = 7

Had complete information on Hb level,

N = 529
Unit of analysis for prevalence and risk factors

Lost to follow-up,
N = 87

Delivery information,
N = 442
Unit of analysis for adverse pregnancy outcomes

Stillbirths, N = 10
Early neonatal deaths
(Within 7 days), N = 1
Lost to follow-up = 58

Seven days available

N = 372

Figure 1: Follow-up of pregnant women up to 7 days.

median with respective measures of dispersion for numerical early neonatal death is the death during the first 7 days of life
variables. The Odds Ratio (OR) with 95% Confidence Interval [22].
(CI) was used to measure the strength of association between
anaemia and exposure variables (sociodemographic, eco- 2.5. Ethical Consideration. The permission to conduct this
nomic, nutrition, and reproductive health characteristics) as study was sought from Kilimanjaro Christian Medical Uni-
well as association between anaemia and adverse pregnancy versity College committee. The study was granted ethical
outcomes (LBW, preterm, and stillbirth). Logistic regression clearance certificate number 945. Participants who were
analysis was performed to control for the confounders. The enrolled gave a signed consent. Participants who were found
𝑝 value of less than 0.05 was considered as a statistically to have anaemia received free treatment and counselling
significant result. according to Tanzania National treatment guidelines. Num-
Categorization of Variables. A pregnant woman was con- bers instead of names were used in all the questionnaires and
sidered anaemic if haemoglobin was <11 g/dl [2]. Sever- laboratory forms.
ity of anaemia was measured as follows: mild if Hb was
9.0–10.9 g/dl; moderate if Hb was 7.0–8.9 g/dl; and severe if 3. Results
Hb was <7.0 g/dl [2]. Age of participants which was col-
lected as numerical variable was categorized (14–24, 25–34, 3.1. Demographic and Reproductive Health Characteristics of
and 35–49), as well as income per month (<60,000 Tsh, the Women. The age of the 529 participants ranged from 15
60,000–200,000 Tsh, and >200,001 Tsh), partners age (15–24, to 46 years with mean age of 25.8 (SD 5.73) years. Majority
25–34, and 35+), being gravida (first, second, third, or more of the participants were married/cohabiting, 479 (89%) and
pregnancies), parity (1, 2, 3, 4, and 5+), frequency of antenatal unemployed, 209 (61.1%), and 355 (67.9%) had an income per
care visits (1, 2-3, and 4+), pregnancy interval (≤24 months month less than 60,000 Tanzanian shillings (Tsh).
and >24 months), gestation age at delivery (<37 and ≥37), and For majority of the 529 women (96.7%) this was their
number of meals per day (1, 2, or 3 or more meals per day). second or third antenatal visit, and 88% reported they have
Preterm delivery was categorized as <37 weeks of gestation received iron supplementation during current pregnancy,
age, low birth weight was categorized as < 2500 grams, and Table 1. Most of the women (89%) reported an interpregnancy
4 Anemia

Table 1: Sociodemographic and reproductive health characteristics of the pregnant women (𝑁 = 529).

Variable name Number (%)

Mothers characteristics
Age (years)
14–24 259 (49.0)
25–34 224 (42.3)
35–49 46 (8.7)
Level of education
None 12 (2.3)
Primary 320 (60.5)
Secondary or higher 197 (37.2)
Marital status
Married/cohabiting 479 (89.4)
Single/widow/divorced 56 (10.4)
Occupation (𝑁 = 327)∗
Unemployed 209 (61.1)
Employed 30 (8.8)
Businesswomen 103 (30.1)
Income category for women (𝑁 = 523)∗
<60,000 Tsh 355 (67.9)
60,000–200,000 Tsh 143 (27.3)
>200,000 Tsh 25 (4.8)
Alcohol intake
No 457 (86.4)
Yes 72 (13.6)
Gravida
First pregnancy 186 (35.2)
Second pregnancy 170 (32.1)
Third pregnancy and above 173 (32.7)
Interpregnancy interval (𝑁 = 301)
<24 months 32 (10.6)
≥24 months 269 (89.4)
Antenatal care visit current (𝑁 = 517)
1 visit 17 (3.3)
2-3 visits 339 (65.6)
4+ visits 161 (31.1)
Have received iron supplementation at current pregnancy (𝑁 = 356)∗
No 44 (12.4)
Yes 312 (87.6)
Pica habits during this pregnancy (𝑁 = 363)∗
No 138 (38.0)
Yes 225 (62.0)
HIV status at current pregnancy (𝑁 = 528)∗
Negative 496 (93.8)
Positive 32 (6.1)
∗
Variables with missing information.

interval of ≥24 months. Other demographic and reproductive 3.3. Factors Associated with Anaemia in Pregnancy. Table 2
health characteristics are shown in Table 1. shows association between anaemia and several predictor
variables. Women who were recruited from Pasua clinic
3.2. Prevalence of Anaemia among Pregnant Women. The had two times higher odds being anaemic (OR; 2.1; 95%
prevalence of anaemia was 18.0% (𝑛 = 95). Forty women had CI 1.3–3.3) compared to women who were recruited from
mild, 43 moderate, and 12 severe anaemia, Figure 2. Majengo health centre. Women with secondary education
Anemia 5

Table 2: Sociodemographic, nutrition, and reproductive characteristics factors associated with anaemia in pregnancy (𝑁 = 529).

Anaemia (Hb < 11 g/dl) Unadjusted

Variable 𝑁 𝑝 value
𝑛 (%) OR (95% CI)
Name of clinic enrolled
Majengo HC 235 29 (12.3) 1
Pasua HC 294 66 (22.4) 2.1 (1.28–3.31) 0.003
Age (years)
14–24 259 48 (18.5) 1
25–34 224 43 (19.2) 1.04 (0.66–1.65) 0.852
35–49 46 4 (8.7) 0.42 (0.14–1.22) 0.112
Level of education
None 12 5 (41.7) 1
Primary 320 61 (19.1) 0.33 (0.10–1.07) 0.660
Secondary or higher 197 29 (14.7) 0.24 (0.07–0.81) 0.022
Marital status∗
Married/cohabiting 472 84 (17.8) 1
Single/widow/divorced 56 10 (17.9) 1.0 (0.5–2.1) 0.991
Income category for women∗
<60,000 Tsh 355 65 (18.3) 1
60,000–200,000 Tsh 143 23 (16.1) 0.7 (0.5–1.4) 0.556
>200,001 Tsh 25 5 (20.0) 1.1 (0.4–3.1) 0.833
Gravida
1st pregnancy 187 34 (18.2) 1
2nd pregnancy 169 33 (19.5) 1.2 (0.7–2.0) 0.600
≥3rd pregnancy 173 28 (16.2) 1.3 (0.7–2.2) 0.435
Interpregnancy interval
<24 months 32 8 (25.0) 1
≥24 months 269 49 (18.2) 0.7 (0.3–1.6) 0.357
Have received iron
supplementation at current
pregnancy
No 44 13 (29.5) 1
Yes 312 63 (20.2) 0.6 (0.3–1.2) 0.160
HIV status at current pregnancy
Negative 496 90 (18.1) 1
Positive 32 5 (15.6) 0.8 (0.3–2.2) 0.719
Number of meals taken per day
1 meal per day 7 3 (42.9) 1
2 meals per day 29 3 (10.3) 0.2 (0.2–1.0) 0.550
3+ meals per day 315 68 (21.6) 0.4 (0.10–1.7) 0.197
History of food insecurity within
past 12 months
No 342 74 (21.6) 1
Yes 13 2 (15.4) 0.7 (0.1–3.0) 0.592
Pica habits
No 135 29 (21.5) 1
Yes 221 47 (21.3) 1.0 (0.6–1.7) 0.962
∗
Variables with missing information.
6 Anemia

Table 3: Logistic regression analysis of factors influencing anaemia in pregnancy.

Variable Adjusted OR (95% CI) 𝑝 value

Age group (years)
15–24 1
25–34 0.96 (0.59–1.53) 0.85
35–49 0.42 (0.14–1.24) 0.114
Education of the woman
None 1
Primary 0.28 (0.08–0.94) 0.04
Secondary or higher 0.21 (0.06–0.74) 0.015
Name of the clinic enrolled
Majengo HC 1
Pasua HC 2.06 (1.26–3.36) 0.004

90.0 82.0 Pasua health centre had twice the odds of being anaemic com-
80.0 pared to women from Majengo. Women with primary and
70.0 secondary education or more had 72% and 79% significantly
60.0 less odds of having anaemia compared to women with no
50.0
formal education.
(%)

40.0
30.0
20.0
3.4. Birth Outcomes among Women in Moshi Municipality.
10.0 7.6 8.1 Among 529 pregnant women who had complete information
2.3 on Hb, 83.6% (𝑛 = 442) had delivery information, Figure 1.
0.0
Normal Mild Moderate Severe There were no difference in anaemic status between those
Type of anaemia women who had information at delivery and those who did
not have information at delivery (𝑝 = 0.849).
Figure 2: Severity of anaemia in pregnancy among women in Moshi
Municipality. At delivery, there were 10 stillbirths (2.3%), 16 low birth
weight newborns (3.6%), and 2 (0.45%) preterm birth cases.
Two out of 432 infants died within the first 7 days (0.5%).
No association was found between anaemia and low birth
weight, preterm birth, or stillbirths in Moshi Municipality,
or higher had 76% less odds of having anaemia compared Table 4.
to others. Other factors like age, marital status, occupation,
income, and alcohol intake were assessed but were not
associated with anaemia during pregnancy. 4. Discussion
Women who attended ANC 4 or more times had lower The study findings showed that prevalence of anaemia
prevalence of anaemia (17.4%) than those who attended only during pregnancy from the two selected health centres in
once (35.3%); women who reported having received iron Moshi Municipal was 18.0%. The clinic of recruitment and
supplementation in current pregnancy had lower prevalence secondary or higher education among women were factors
(20.2%) than those who have not received any supple- that were associated with anaemia in pregnancy. Anaemia
mentation (29.5%), but the difference was not statistically in pregnancy was not associated with adverse pregnancy
significant. Other factors that were analysed but were not outcomes in this setting.
associated with anaemia during pregnancy include gravida, The prevalence of anaemia in the selected two clinics
parity, history of miscarriage, pica habits, HIV status, and was lower compared to 47.4% as reported by Msuya and
gestational age. colleagues who collected their data about twelve years ago
Food security or household characteristics (water source [7]. This may imply an improvement in maternal nutrition
for sanitation, owning toilet facility, household ownership, in this setting as well as general health and care during preg-
land ownership, history of food insecurity, number of meals nancy. Over the years, the government has strengthened the
taken per day, and intake of meat or fish) were assessed but antenatal care (ANC) services and every pregnant woman is
none was associated with anaemia in pregnancy. given iron supplementation to combat anaemia, deworming,
Table 3 shows the results of logistic regression analysis. malaria prophylaxis, and mosquito nets [23]. Nowadays preg-
Education and clinic of enrolment remained significantly nant women have to take malaria prophylaxis and deworms
associated with anaemia in pregnancy. Women enrolled at in front of the health care provider. This increases the uptake
Anemia 7

Table 4: Pregnancy outcomes by anaemia status (𝑁 = 442).

Anaemia (Hb < 11 g/dl)

Variable 𝑁 𝑝 value
𝑛 (%)
Preterm delivery
No 440 89 (20.2)
Yes 2 0 (0.0) -
Low birth weight (<2500 gms)
No 426 89 (20.9)
Yes 16 0 (0.0) -
Stillbirth
No 432 79 (18.3)
Yes 10 1 (10.0) 0.508
Early neonatal death (𝑁 = 432)
No 430 79 (18.2)
Yes 2 0 (0.0) -

of medication and hence prevents anaemia that can be caused [6, 7], and researchers in Ethiopia, India, and Pakistan [15,
by mosquitoes or helminthes. The prevalence of anaemia 29, 30].
during pregnancy has been reported by other researchers to
range from 32% to 62.2% [6, 7, 24]. Strength and Weakness of the Study. Diagnosis of anaemia was
Women who had secondary or higher education were based on laboratory analysis and did not depend on clinical
less likely to be anaemic compared to their counterparts. assessment as reported by other researchers. Information on
Education has been reported to reduce the risk of being birth outcomes for women who were lost to follow-up from
anaemic in several studies. Educated pregnant women have enrolment to delivery might have affected the prevalence
better income and eat nutritious food and hence do not get of birth outcomes. It may be that those who were lost to
nutritional anaemia [5]. A study in Ethiopia also reported follow-up experienced negative pregnancy outcomes and did
higher prevalence of anaemia among pregnant women who not see the importance of returning for follow-up, hence
had no education [25]. Secondary and higher education had underestimating occurrence of pregnancy outcomes. The
been associated with several other good maternal and child other causes of negative birth outcomes like diabetes and
outcomes like higher frequency of exclusive breastfeeding, preeclampsia were not assessed.
attending for antenatal care visits for 4 or more recommended
visits, utilization of skilled attendance during delivery, and 5. Conclusion
health care seeking when the children have pneumonia or
malaria [5]. Women education and empowerment are not Anaemia in pregnancy was a mild public health problem in
within health sector and there is a need for multisectoral Northern Tanzania. The main risk factors were found to be
collaboration in combating anaemia and other maternal the place of residence and education level of the pregnant
health problems. woman. Ongoing interventions to target anaemia during
This study shows that women who were recruited from pregnancy seem to be working in this setting and they should
Pasua clinic were two times more likely to be anaemic than reach universal coverage. Further, we recommend ongoing
women who were recruited from Majengo clinic. Previous education about effects of anaemia especially among women
studies have shown that women living in Pasua have poor with low education and population of adolescent women and
living standards and low income of less than one dollar per women of reproductive age in general.
day compared to women at Majengo [7]. Poor income leads to
limited access to nutritious diets and is associated with poor Conflicts of Interest
eating habits that might lead to anaemia. A study in Ethiopia
showed that women with low income were more anaemic The authors declare that there are no conflicts of interest
than women with higher income [26, 27]. regarding the publication of this paper.
In this study there was low occurrence of negative preg-
nancy outcomes: LBW (3.6%), preterm births (0.5%), and Acknowledgments
stillbirth (2.3%). The occurrence of negative birth outcomes
was low compared to national prevalence of 13% for LBW The study was funded by Letten Foundation of Oslo, Norway.
and 12.7% for preterm birth [28]. This is contrary to findings The authors thank the women for participating in this
by other researchers in Dar es Salaam and Moshi, Tanzania study and the District Medical Officer for permission to
8 Anemia

conduct the study in Moshi Municipal. The authors would [15] A. Levy, D. Fraser, M. Katz, M. Mazor, and E. Sheiner, “Maternal
also like to thank Beatrice Kisanga, Anna-Maria Mlingi, anemia during pregnancy is an independent risk factor for
Adventina Mlaki, Simphorosa Mshanga, and Deo Kiwali for low birthweight and preterm delivery,” European Journal of
their different roles in this study. Obstetrics & Gynecology and Reproductive Biology, vol. 122, no.
2, pp. 182–186, 2005.
[16] H. L. Guyatt and R. W. Snow, “Impact of malaria during
References pregnancy on low birth weight in sub-Saharan Africa,” Clinical
Microbiology Reviews, vol. 17, no. 4, pp. 760–769, 2004.
[1] R. E. Black, C. G. Victora, S. P. Walker et al., “Maternal and child
undernutrition and overweight in low-income and middle- [17] A. Gebre and A. Mulugeta, “Prevalence of anemia and asso-
income countries,” The Lancet, vol. 382, no. 9890, pp. 427–451, ciated factors among pregnant women in north western zone
2013. of tigray, northern ethiopia: A cross-sectional study,” Journal of
[2] World Health Organization, Iron deficiency anaemia: assess- Nutrition and Metabolism, vol. 2015, Article ID 165430, 2015.
ment, prevention and control: a guide for programme managers, [18] Ministry of Health, Community Development, Gender, Elderly
2001. and Children (MoHCDGEC) [Tanzania Mainland], Ministry of
[3] World Health Organization, Worldwide prevalence of anaemia Health (MoH) [Zanzibar] National Bureau of Statistics (NBS);
1993-2005: WHO global database on anaemia, 2008. Office of the Chief Government Statistician (OCGS), and ICF
International 2016. Tanzania and Demographic Health Survey
[4] National Bureau of Statistics (NBS) [Tanzania] and ORC Macro,
and Malaria Indicator Survey (TDHS-MIS) 2015–2016; MoHSW,
Tanzania Demographic and Health Survey 2004–05, National
MoH, OCGS (MoHCDGEC), Dar es Salaam, Tanzania; ICF
Bureau of Statistics and ORC Macro, Dar es Salaam, Tanzania,
International: Rockville, MD, USA.
2005.
[19] J. Katanga, M. Mgongo, T. Hashim, B. Stray– Pedersen, and S.
[5] Bureau of Statistics (NBS) [Tanzania] and ICF Macro, Tanzania
Msuya, “Screening for Syphilis, HIV, and hemoglobin during
Demographic and Health Survey 2010, NBS and ICF Macro, Dar
pregnancy in Moshi municipality, Tanzania: How is the health
es Salaam, Tanzania, 2011.
system performing,” Science, vol. 3, no. 1, pp. 93–96, 2015.
[6] H. L. Kidanto, I. Mogren, G. Lindmark, S. N. Massawe, and
L. Nystrom, “Risks for preterm delivery and low birth weight [20] T. H. Hashim, M. Mgongo, J. Katanga et al., “Predictors of
are independently increased by severity of maternal anaemia,” appropriate breastfeeding knowledge among pregnant women
South African Medical Journal, vol. 99, no. 2, pp. 98–102, 2009. in Moshi Urban, Tanzania: A cross-sectional study,” Interna-
tional Breastfeeding Journal, vol. 12, no. 1, article no. 11, 2017.
[7] S. E. Msuya, T. H. Hussein, J. Uriyo, N. E. Sam, and B.
Stray-Pedersen, “Anaemia among pregnant women in northern [21] Population and Housing census: Population distribution by age
Tanzania: prevalence, risk factors and effect on perinatal out- and sex. National Bureau of Statistics Ministry of Finance Dar
comes.,” Tanzania Journal of Health Research, vol. 13, no. 1, pp. es salaam and office of chief Government Statistician president
33–39, 2011. office, Finance, Economy and Development Planning Zanzibar,
2013.
[8] O. T. Okube, W. Mirie, E. Odhiambo, W. Sabina, and M. Habtu,
“Prevalence and Factors Associated with Anaemia among [22] Wolrd Health Organization, International statistical classification
Pregnant Women Attending Antenatal Clinic in the Second and of diseases and related health problems, 2011, http://www.who.int/
Third Trimesters at Pumwani Maternity Hospital, Kenya,” Open classifications/icd/ICD10Volume2 en 2010.pdf.
Journal of Obstetrics and Gynecology, vol. 06, no. 01, pp. 16–27, [23] H. Afnan-Holmes, M. Magoma, T. John et al., “Tanzania’s
2016. Countdown to 2015: An analysis of two decades of progress and
[9] S. Brooker, P. J. Hotez, and D. A. P. Bundy, “Hookworm-related gaps for reproductive, maternal, newborn, and child health, to
anaemia among pregnant women: a systematic review,” PLOS inform priorities for post-2015,” The Lancet Global Health, vol.
Neglected Tropical Diseases, vol. 2, no. 9, article e291, 2008. 3, no. 7, pp. e396–e409, 2015.
[10] E. M. McClure, S. R. Meshnick, P. Mungai et al., “The association [24] I. Adam, A. H. Khamis, and M. I. Elbashir, “Prevalence and
of parasitic infections in pregnancy and maternal and fetal risk factors for anaemia in pregnant women of eastern Sudan,”
anemia: a cohort study in coastal Kenya,” PLOS Neglected Transactions of the Royal Society of Tropical Medicine and
Tropical Diseases, vol. 8, no. 2, Article ID e2724, 2014. Hygiene, vol. 99, no. 10, pp. 739–743, 2005.
[11] S. Ononge, O. Campbell, and F. Mirembe, “Haemoglobin status [25] M. Melku, Z. Addis, M. Alem, and B. Enawgaw, “Preva-
and predictors of anaemia among pregnant women in Mpigi, lence and predictors of maternal anemia during pregnancy
Uganda,” BMC Research Notes, vol. 7, no. 1, article no. 712, 2014. in Gondar, Northwest Ethiopia: an institutional based cross-
[12] L. H. Allen, “Anemia and iron deficiency: effects on pregnancy sectional study,” Anemia, vol. 2014, Article ID 108593, 9 pages,
outcome,” American Journal of Clinical Nutrition, vol. 71, no. 5, 2014.
pp. 1280s–1284s, 2000. [26] A. Bekele, M. Tilahun, and A. Mekuria, “Prevalence of Anemia
[13] M. A. Mbule, Y. B. Byaruhanga, M. Kabahenda, and A. Lubowa, and Its Associated Factors among Pregnant Women Attending
“Determinants of anaemia among pregnant women in rural Antenatal Care in Health Institutions of Arba Minch Town,
Uganda.,” Rural and Remote Health, vol. 13, no. 2, p. 2259, 2013. Gamo Gofa Zone, Ethiopia: A Cross-Sectional Study,” Anemia,
[14] G. A. Stevens, M. M. Finucane, L. M. De-Regil et al., “Global, vol. 2016, Article ID 1073192, 2016.
regional, and national trends in haemoglobin concentration and [27] L. Gedefaw, A. Ayele, Y. Asres, and A. Mossie, “Anemia and
prevalence of total and severe anaemia in children and pregnant Associated Factors Among Pregnant Women Attending Ante-
and non-pregnant women for 1995–2011: a systematic analysis of natal Care Clinic in Wolayita Sodo Town, Southern Ethiopia,”
population-representative data,” The Lancet Global Health, vol. Ethiopian Journal of Health Sciences, vol. 25, no. 2, pp. 155–162,
1, no. 1, pp. E16–E25, 2013. 2015.
Anemia 9

[28] World Health Organization, UNICEF. Countdown to 2015

decade report (2000-2010) with country profiles: taking stock of
maternal, newborn and child survival.
[29] K. Kalaivani, “Prevalence &amp; consequences of anaemia in
pregnancy,” Indian Journal of Medical Research, vol. 130, no. 5,
pp. 627–633, 2009.
[30] F. Lone, R. Qureshi, and F. Emmanuel, “Maternal anaemia and
its impact on perinatal outcome in a tertiary care hospital in
Pakistan,” Eastern Mediterranean Health Journal, vol. 10, no. 6,
pp. 801–807, 2004.