Article type
Year
Abstract
Background:
Despite the high priority of maternal and child health programs in national health agendas, progress towards Millennium Development Goals 4 and 5 has been slow. One major obstacle to achieving these goals is anaemia.
Objectives:
We conducted a systematic review and meta-analysis of studies evaluating the association between maternal anemia and birth and health outcomes in low- and middle-income countries.
Methods:
MEDLINE, EMBASE, CINAHL, and the British Nursing Index were searched. Reference lists from relevant review articles and manual searches were also performed. Only cohort studies were included in our review. Meta-analysis, cumulative meta-analysis, and meta-regression were used to assess the trend of birth and health outcomes by country categories.
Results:
Of 6398 articles reviewed, 25 cohort studies met the inclusion criteria for meta-analysis; consisting of 0.32 million pregnant women. Our study found a significantly higher risk of low birth weight (risk ratio (RR) 1.32; 95% confidence interval (CI), 1.13 to 1.53), preterm birth (RR 1.55; 95% CI 1.24 to 1.93), perinatal mortality (RR 1.51; 95% CI 1.30 to 1.76), and neonatal mortality (RR 2.72; 95% CI 1.19 to 6.25) among pregnant women with anaemia. Sensitivity analyses confirmed a similar association after dropping a small number of highly influential studies. Anaemia was not statistically significantly associated with small for gestational age, gestational diabetes, pre-eclampsia, or caesarean delivery. An increasing trend of low birth weight, preterm birth, and perinatal mortality was found in low-income countries; a moderate declining trend in lower middle-income countries, and a stable trend in upper middle-income countries since 2003.
Conclusions:
Our findings indicate that maternal anaemia remains a significant health problem in low- and middle-income countries. To tackle these challenges, attention should focus on evaluating and monitoring maternal and child health programs, female education for increasing awareness, and universal health coverage for ensuring access and affordable care for the poor population.
Despite the high priority of maternal and child health programs in national health agendas, progress towards Millennium Development Goals 4 and 5 has been slow. One major obstacle to achieving these goals is anaemia.
Objectives:
We conducted a systematic review and meta-analysis of studies evaluating the association between maternal anemia and birth and health outcomes in low- and middle-income countries.
Methods:
MEDLINE, EMBASE, CINAHL, and the British Nursing Index were searched. Reference lists from relevant review articles and manual searches were also performed. Only cohort studies were included in our review. Meta-analysis, cumulative meta-analysis, and meta-regression were used to assess the trend of birth and health outcomes by country categories.
Results:
Of 6398 articles reviewed, 25 cohort studies met the inclusion criteria for meta-analysis; consisting of 0.32 million pregnant women. Our study found a significantly higher risk of low birth weight (risk ratio (RR) 1.32; 95% confidence interval (CI), 1.13 to 1.53), preterm birth (RR 1.55; 95% CI 1.24 to 1.93), perinatal mortality (RR 1.51; 95% CI 1.30 to 1.76), and neonatal mortality (RR 2.72; 95% CI 1.19 to 6.25) among pregnant women with anaemia. Sensitivity analyses confirmed a similar association after dropping a small number of highly influential studies. Anaemia was not statistically significantly associated with small for gestational age, gestational diabetes, pre-eclampsia, or caesarean delivery. An increasing trend of low birth weight, preterm birth, and perinatal mortality was found in low-income countries; a moderate declining trend in lower middle-income countries, and a stable trend in upper middle-income countries since 2003.
Conclusions:
Our findings indicate that maternal anaemia remains a significant health problem in low- and middle-income countries. To tackle these challenges, attention should focus on evaluating and monitoring maternal and child health programs, female education for increasing awareness, and universal health coverage for ensuring access and affordable care for the poor population.