Malaria Is More Prevalent Than Iron Deficiency among Anemic Pregnant Women at the First Antenatal Visit in Rural South Kivu

Abstract

Anemia is common during pregnancy and is associated with poor outcomes. Objectives were not only 1) to determine the prevalence of anemia and iron deficiency (ID) but also 2) to identify other factors associated with anemia in pregnant women from South Kivu province, in the eastern Democratic Republic of Congo. Between December 2013 and March 2014, 531 women attending the first antenatal visit in their second trimester of pregnancy were recruited. Sociodemographic, clinical, and biological data were collected. Hemoglobin (Hb) was determined by a portable photometer (Hemocue Hb201+), and anemia was defined as altitude-adjusted Hb < 110 g/L. ID was defined as serum ferritin < 15 μg/L adjusted for inflammation status (C-reactive protein [CRP] > 5 mg/L and/or α-1-acid glycoprotein > 1 g/L) whereas hypoalbuminemia was defined as serum albumin < 35 g/L. A Giemsa-stained blood smear was used to diagnose malaria. The median age (interquartile range ) was 25.5 (21.1-31.3) years, with anemia in 17.6% and ID in 8%. Malaria was present in 7.5% and hypoalbuminemia among 44%. Soluble transferrin receptor concentration was higher in the presence of inflammation and/or malaria. In the final logistic regression model, factors independently associated with anemia were malaria (adjusted odds ratio [aOR]: 11.24 (4.98-25.37) < 0.001), hypoalbuminemia [aOR: 2.14 (1.27-3.59); = 0.004] and elevated CRP [aOR: 1.94 (1.10-3.45); = 0.022]. ID was not highly prevalent and not associated with anemia in our population. Effective control of anemia during pregnancy in this region should consider fighting malaria and other infectious diseases in combination with measures to improve women's nutrition, both before and during pregnancy.

Inflammation throughout pregnancy and fetal growth restriction in rural Nepal

“…The levels of AGP in our study are similar to those previously noted in studies of pregnant women [20–22], including another in Nepal [11]. In contrast to CRP, AGP normally decreases over pregnancy [10, 20], as our study also observed.…”

Malaria and Iron Load at the First Antenatal Visit in the Rural South Kivu, Democratic Republic of the Congo: Is Iron Supplementation Safe or Could It Be Harmful?

“…In South Kivu, ID does not seem to be common among women, regardless of pregnancy. 5,6 A similar low ID prevalence was also found in preschool children in the same area. 4,5 As mentioned previously, elsewhere IS has been associated with a higher risk of malaria during pregnancy 9 and a higher risk of morbidity and mortality due to infectious diseases, including malaria, among preschool children.…”

“…Characteristics of the women and others results are reported elsewhere. 6 More than a quarter of the study population were primigravidae and half were in their fourth or higher pregnancy. Nearly 38% (199/530) and 16.5% (86/522) reported fever and antimalarial treatment, respectively, within the previous 3 months, whereas 63.8% (336/527) reported sleeping under insecticide-treated mosquito net (ITN) the prior night.…”

“…In South Kivu, prevalence of ID was 5.4% among nonpregnant women 5 and 7.6% among pregnant women. 6 Yet, in this same province, malaria remains common among pregnant women. 7 There might be an interaction between iron load and malaria, but it remains unclear whether high iron loads predispose to malaria and whether iron depletion is protective.…”

“…Sampling methods are published elsewhere. 6 A thick blood smear stained with 3% Giemsa for 30 minutes was used to diagnose malaria and a thin blood smear for species identification, according to WHO guidelines. Serum ferritin (SF), soluble transferrin receptor (sTfR), C-reactive protein (CRP), and α1-acid-glycoprotein (AGP) were determined by a sandwich enzyme-linked immunosorbent assay technique on a venous blood sample.…”