Effect of Personalized Support at Home on the Prevalence of Anemia in Pregnancy in Burkina Faso: A Cluster Randomized Trial

Abstract

Burkina Faso has high prevalence of anemia in pregnancy (hemoglobin < 11 g/dL), despite the implementation of the WHO recommended guidelines. This study aimed to test the effects of personalized support for pregnant women at home on the trend of anemia prevalence in pregnancy. A cluster randomized trial was conducted from January 2015 to August 2016 at Sindou health district in Burkina Faso. Data were collected from 617 women in their first or second trimester of pregnancy, including 440 and 177 women in the intervention and control groups, respectively. The intervention consisted of a monthly home-based visit to the pregnant woman, focusing on nutritional counseling and pregnancy management, alongside an improvement antenatal visit quality. Compared with the prevalence of anemia in pregnancy in the control group [64.0% (95% confidence interval [CI]: 52.1–74.4%)], that of the intervention group was significantly lower from the fifth home visit onward [36.8% (95% CI: 32.1–41.8%)] (P < 0.001). The adjusted difference-in-differences in anemia prevalence between the two groups was –19.8% (95% CI: –30.2% to –9.4%) for women who received more than four home visits (P < 0.001). The corresponding difference in hemoglobin levels was 0.644 g/dL (95% CI: 0.309–0.167; P < 0.001). Personalized support for pregnant women at home, combined with appropriate antenatal care, can significantly reduce anemia prevalence during pregnancy in rural Burkina Faso.

Effect of personalized home-based support for pregnant women on pregnancy outcomes: a cluster randomized trial

“…Initial research demonstrated that individualized home-based support for pregnant women, with an emphasis on nutritional counseling, iron supplementation, malaria and intestinal parasitosis prevention, in conjunction with proper antenatal care, reduced the prevalence of anemia in pregnancy. 11 Compared to the control group, the intervention group had greater proportions of preterm or low birth weight births and decreased abortion rates; nevertheless, the adjusted frequency differences between the two groups were not statistically significant. Alternatively, there was a modest decline in stillbirths.…”

“…The relative increase in the frequency of low birth weight in the intervention group may be attributable to the rise in this group's hemoglobin levels. 11 In fact, according to some writers, iron supplementation of non-anemic pregnant women is related with low birth weight, although this association remains controversial. 20 Other writers have claimed, contrary to ours, that measures to reduce low birth weight should be undertaken before or very early in pregnancy.…”

“…This chapter, more detailed in a previous publication, 11 here abridged, presents specific aspects related to secondary outcomes.…”

“…This study's findings were reported in a prior paper. 11 This article is predicated on the notion that decreasing the prevalence of anemia reduces the incidence of stillbirth, preterm birth, low birth weight, and abortion. It describes how the intervention affected these secondary outcomes.…”