Timing of antenatal hemoglobin testing and associated maternal and neonatal characteristics at public hospitals in Lusaka, Zambia
Authors: Ogah Adenike Oluwakemi , Mwando Chrispin , Chanda Kenneth , Nganjo Selia 
Published: February 2025

Background

The identification and mitigation of anaemia during pregnancy constitutes a significant public health priority. The assessment of hemoglobin values during antenatal is intended to be a standard practice. However, this may not reflect the actual practices observed in public hospitals within developing countries.

Subject and methods

This is a secondary analysis of a cross-sectional study of 489 mother-singleton, term newborn pairs, who were consecutively recruited from the admission wards of six public hospitals in Lusaka, Zambia. The presence or absence and timings of antenatal hemoglobin testing documented in the maternal hospital records was utilized as a metric to evaluate the quality of antenatal care provided. The relationship between the variables was explored using Chi-square tests and a binary logistic regression model. The findings were reported in terms of p-values, odds ratios, and 95% confidence intervals.

Results

Maternal antenatal hemoglobin data were obtained from the hospital records of 239 (48.9%) out of the 489 mothers in the study. Of these 239, 156 (65.3%) maternal most recent hemoglobin levels were determined more than 4 weeks before delivery and only 83 (34.7%) were determined within 4wks prior to delivery. Additionally, 250 (51.1%) of the 489 mothers had no file record of antenatal hemoglobin testing. An increase in maternal body mass index was associated with a decreased likelihood of missing antenatal hemoglobin records (p<0.001; OR=0.468; [95%CI 0.355, 0.617]).

Mothers with a documented history of previous miscarriage, low antenatal hemoglobin levels (Hb < 11 g/dL), underlying medical conditions, lower level of education and babies with low hemoglobin (<15g/dl) were more likely to have their most recent antenatal hemoglobin test conducted more than four weeks prior to delivery; OR 2.65 (p=0.015; 95% CI 1.211, 5.780); OR 2.22 (p=0.010; 95% CI 1.213, 4.070); OR 4.612 (95%CI 1.342, 15.851); OR 2.182 (95%CI 0.593, 8.022) and (p<0.001; OR 2.89; 95%CI 1.590, 5.236), respectively. The analysis revealed that mothers with more than one prior miscarriage (18 out of 26, accounting for 69.2%, p = 0.018) were 3.134 times more likely (95% CI: 1.195, 8.218) to belong to the group of mothers lacking documented antenatal hemoglobin test.

HIV rate in pregnancy was 3.9% in this study. All (except diabetes mellitus) the medical conditions documented were either associated with remote (more than 4weeks) or no hemoglobin testing before delivery.

Conclusion

The significant proportion of mothers who did not undergo antenatal hemoglobin testing, coupled with those whose hemoglobin levels were assessed remotely, indicates a deficiency in antenatal care within the study population. Mothers, who presented with absent or remotely conducted antenatal hemoglobin assessments were more likely to exhibit characteristics such as low body mass index (BMI), reduced hemoglobin levels, a history of previous miscarriages, lower educational attainment, and underlying medical conditions, as well as giving birth to newborns with low hemoglobin levels. Consequently, it is imperative that these specific groups of mothers receive closer monitoring. There exists an urgent need to enhance the standard of antenatal care provided in public health facilities to prevent adverse maternal and neonatal health outcomes.