ASSOCIATION OF ANEMIA WITH PARASITIC INFESTATION IN PREGNANT NEPALESE WOMEN: RESULTS FROM A HOSPITAL-BASED STUDY DONE IN EASTERN NEPAL

Authors

  • Binay Kumar Shah
  • Lubna A. Baig

Abstract

Background: Anemia is a major contributor to maternal deaths in developing countries. Association of anaemia with helminthic infestations has been seen in the world and by eliminating it, anemia may be reduced with positive effects on maternal outcome. Methodology: A comparative cross-sectional study was done to assess the association of anemia with parasitic infestation, and other significant risk factors in eastern Nepal. One hundred and twelve pregnant women with and without anemia were enrolled in the study at the antenatal clinic at Dhankuta District Hospital, Nepal from May 2001 to July 2001. The data on social and demographic variables was collected through a structured questionnaire. Hemoglobin estimation and stool examination for parasitic infestation was done for all these women. Results: Anemia was found in 66 (58.9%) women and 52 (46.5%) had helminthic infestation. Anemia was significantly related to hookworm infestation. There was a highly significant relationship between education and the knowledge of women regarding effect of helminthic infestations (P<0.000), transmission and spread of infestations (P<0.000). The knowledge of women regarding effect of helminthic infestation was significantly (P<0.001) related to the occurrence of parasitic infestations but its association with anaemia was not significant. Conclusion: Hookworm infestation in pregnancy was significantly related with anaemia. Hence all women coming to antenatal clinics should be screened for hookworm infestation. The antenatal care should include de-worming with correction and prevention of anaemia.Key Words: hookworm infestation, anaemia, pregnancy

References

Centers for Disease Control and Prevention. Recommendations to prevent and control iron deficiency in the United States. MMWR Morb Mortal Wkly Rep. 1998; 47(RR-3):1-36.

World Health Organization. The prevalence of anaemia in women: a tabulation of available information, 2nd Ed., Geneva: WHO, 1992.

World Health Organization, UNICEF & UNU Iron Deficiency: Indicators for Assessment and Strategies for Prevention 1998 World Health Organization Geneva.

Dreyfuss ML, Stoltzfus RJ, Shrestha JB, Pradhan EK, LeClerq SC, Khatry SK et al. Hookworms, Malaria and Vitamin A Deficiency contribute to anemia and iron deficiency among pregnant women in the plains of Nepal. Journal of Nutrition 2000;130 (10):2527-36.

Stratton JA, Miller RD, Schmidt P. Effect of maternal parasitic disease on the neonate. Am J Reprod Immunol Microbiol 1985;8(4):141-2.

AbouZahr C, Royston E. Maternal mortality. A global factbook. World Health Organization, Geneva, 1991.

His Majesty’s Government, Nepal/World Health Organization. Research report on prevention of maternal mortality in hospitals of Nepal. Kathmandu, 1992.

Roy S, Chakravorty PS. Maternal and perinatal outcome in severe anaemia. J Obstet Gynae Ind 1992;42: 743-50.

Bondevik GT, Ulstein M, Lie RT, Rana G, Kvale G. The prevalence of anemia in pregnant Nepali women--a study in Kathmandu. Acta Obstet Gynecol Scand 2000;79(5):341-9.

Ulstein M, Rana G, Yangzom K, Gurung R, Karki A, Gurung G et al. Some fetal and pregnancy parameters in Nepal. Acta Obstet Gynecol Scand 1988;67: 47-52.

Shah BK, Gupta P.Weekly versus daily iron and folic acid supplementation in adolescent Nepalese girls. Archives of Adolescent Pediatric Medicine 2002;156(1):131- 5.

Murthy GL, Sahay RK, Srinivasan VR, Upadhaya AC, Shantaram V, Gayatri K. Clinical profile of falciparum malaria in a tertiary care hospital. J Indian Med Assoc. 2000;98(4):160-2, 169.

Singh N, Shukla MM, Sharma VP. Epidemiology of malaria in pregnancy in central India. Bull World Health Organ. 1999;77(7):567-72.

Verhoeff FH, Brabin BJ, Chimsuku L, Kazembe P, Russell WB, Broadhead RL. An evaluation of the effects of intermittent sulfadoxine-pyrimethamine treatment in pregnancy on parasite clearance and risk of low birth weight in rural Malawi. Ann Trop Med Parasitol. 1998;92(2):141-50.

Hawdon JM, Hotez PJ. Hookworm: developmental biology of the infectious process. Curr Opin Genet Dev. 1996;6(5):618-23.

Curtale F, Nabil M, el Wakeel A, Shamy MY. Anaemia and intestinal parasitic infections among school age children in Behera Governorate, Egypt. Behera Survey Team. J Trop Pediatr. 1998;44(6):323-8.

Prual A, Daouda H, Develoux M, Sellin B, Galan P, Hercberg S. Consequences of Schistosoma haematobium infection on the iron status of schoolchildren in Niger. Am J Trop Med Hyg. 1992;47(3):291-7.

World Health Organization. Prevention and management of severe anemia in pregnancy. Report of a technical working group, Geneva 1991. WHO/FHE/MSM/93.5. Geneva: WHO, 1993.

Jinabhai CC, Taylor M, Coutsoudis A, Coovadia HM, Tomkins AM, Sullivan KR.A health and nutritional profile of rural school children in KwaZulu-Natal, South Africa. Ann Trop Paediatr 2001;21(1):50-8.

Grover JK, Vats V, Uppal G, Yadav S. Anti-helminthics: a review. Trop Gastroenterol 2001;22(4):180-9.

Curtale F, Tilden R, Muhilal, Vaidya Y, Pokhrel RP, Guerra R. Intestinal helminthes and risk of anaemia among Nepalese children. Panminerva Med. 1993;35(3):159-66.

Bauerfeind P, Allemann A, Gyr N Differential diagnostic value of occult blood in stool in hookworm infection in the Third World. Study from Papua New Guinea] Z Gastroenterol. 1992;30(11):791-4. [Article in German].

Geerligs PP, Brabin B, Mkumbwa A, Broadhead R, Cuevas LE. The effect on haemoglobin of the use of iron cooking pots in rural Malawian households in an area with high malaria prevalence: a randomized trial. Trop Med Int Health. 2003;8(4):310-5.

Charoenlarp P, Dhanamitta S, Kaewvichit R, Silprasert A, Suwanaradd C, Na-Nakorn S, et al. A WHO collaborative study on iron supplementation in Burma and in Thailand. Am J Clin Nutr 1988;47(2):280-97.