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Effect Modification of HIV and Malaria on Association Between Pregnancy, Hemoglobin Concentration and Anemia in Sub-Saharan Africa

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Document pages: 28 pages

Abstract: Background: The prevalence of anemia in pregnancy in sub-Saharan Africa is high, and is associated with poor maternal and fetal outcomes. Effect modification by human immunodeficiency virus (HIV) and malaria on anemia in pregnancy is not well studied. The object was to delineate independent factors associated with anemia in women of reproductive age (pregnant and non-pregnant) in sub-Saharan Africa, and to explore effect modification due to HIV and malaria in the association between pregnancy and anemia.Methods: The cross-sectional analysis used data from sub-Saharan Africa Demographic and Health Survey (2014 Ghana, 2012 Mali and 2012 Ivory Coast). This was a population-based study. Data were collected using a multistage stratified sampling procedure that was applied in urban and rural areas, using enumeration area as the primary sampling units. Participants were women aged 15-49 years from selected households were interviewed. The surveys for the analyzed countries had an overall response rate of 97 . The primary outcome was the prevalence of anemia. HIV, malaria and hemoglobin were measured for each participant using ELISA, rapid diagnostic test, and HemoCue analyzer respectively.Results: Of 14373 women aged 15-49 year included, 1412 (10 ) were pregnant. The overall anemia prevalence was 16 , higher in pregnant women (59 ) than non-pregnant women (12 ). Independent factors associated with anemia were pregnancy, OR 11, 95 CI (9.7, 12.41, p<0.0001), malaria infection, OR 1.38, 95 CI (1.25, 1.53, p<0.0001) and HIV sero-positivity, OR 2.29, 95 CI (1.78, 2.91, p<0.0001). The association between pregnancy and anemia was stronger among women with malaria, OR 12.5, 95 CI (10.5, 14.9) than those without malaria, OR 9.8, 95 CI (8.2, 11.7), p for the OR difference = 0.058. This interaction was not observed for HIV infection.Conclusions: Pregnancy, HIV and malaria were associated with higher prevalence of anemia even after adjusting for each other. Pregnancy and anemia association was modified by malaria but not HIV: Association of pregnancy and anemia was stronger in malaria vs non-malaria women. Higher prevalence rates of anemia in pregnancy and the effect modification by malaria, confirm the importance of developing effective prevention and early treatment in the at-risk population.

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