The prevalence of Anemia and Malaria, and their association, among pregnant women attending antenatal clinics in Laghman province, Afghanistan

Background Anemia in pregnancy is one of the commonest problems affecting pregnant women in developing countries and puts the mother and fetus at risk for death. In developing countries, anemia prevalence in pregnant women is reported to be between 40-60 %. Afghanistan Multiple Indicator Cluster Survey, 2000 shows that anemia (Hb<11g/dl) is widespread in all Afghanistan. Several factors contribute to anemia during pregnancy and due to complex etiology of pregnancy anemia the relative role of risk factors is difficult to estimate. In addition to nutritional deficiencies malaria, which is prevalent in Afghanistan, regarded as a major risk factor for anemia during pregnancy. The objective of the study was to estimate the prevalence of anemia and malaria in pregnant women, and to examine any relationship between anemia and malaria during pregnancy. Method The study was a cross-sectional survey with structure. This Survey of attending pregnant women to all (n=5) Comprehensive Health Centers was conducted during January – June, 2018 in Laghman province which is located in eastern part of Afghanistan and has 5 distracts Alingar, Alishang, Dawlatshah, Mehterlam, and Qarghaee having the overall population of 372,600(32). Pashton, Tajik and Pashaee are the major ethnicities. Laghman province was selected for the study, because of the high malaria endemicity with high proportion of anemic pregnant women. A sample of 830 pregnant women attending the CHCs between the ages 15 to 49 years was interviewed and tested for malaria and anemia. Clients attending for their first antenatal visits were included in the study regardless of the trimester of the pregnancy. Anemia, our dependent variable, was defined as per WHO criteria (hemoglobin level below 11g/dl in the first and third trimesters and below 10.5g/dl in the second trimester) and a mother was labeled with malaria parasitemia (the main exposure variable) if Plasmodium parasites seen by the direct microscopic visualization on the thick and thin blood smear slides. Thick smears were used to identify the parasites and thin smears for identifying the specific species. Mothers were considered as workers if working for last one year or more. Data were analyzed using SAS for windows version 9.1. Proportions of the anemia, malaria and other nominal variables were calculated. Binomial Logistic Regression and Linear Regression statistical methods were used in the univariate and multivariable levels to assess the relationship between the dependent and independent variables. Results: The overall prevalence of anemia in this population was 52.9 %, 95% CI = [49.5%-56.3%]. All anemic participants were moderately anemic and there were no severe anemic case. The prevalence of malaria parasitemia in the sample was 7.3%, 95% CI= [5.6%-9.1%]. All the malaria cases in this sample were Plasmodium vivax. In multivariable analysis, we found that pregnancy trimester, living in a particular type of district, and working to earn money were significantly associated with anemia. Conclusion: We estimated high prevalence of anemia (52.9%) and malaria (7.6%) among pregnant women. Third trimester, living in the rural areas, and working to earn money for last one year or more are important risk factors for anemia in pregnant women. Thus, control and prevention measures against anemia should be directed to all pregnant women, especially targeting working, rural population and women in their third trimester of pregnancy. Rural areas must given more attention, because most of the women working to earn money are from rural areas. Since malaria and anemia are preventable, antenatal care services could serve as a pivotal entry point for simultaneous delivery of inter¬ventions for the prevention and control of malaria infection and anemia in pregnant women.