Factors associated with anemia in pregnant women in Banke, Nepal
Authors: Ghosh Shibani , Trevino Johanna Andrews , Davis Dale , Shrestha Robin , Bhattarai Abhiygna , Anusree KC , Pokharel Ashish , Dulal Bishnu , Gurung Sabi , Paudel Krishna , Baral Kedar , Webb Patrick 
Published: November 2023

BackgroundAnemia through pregnancy is highly correlated with poor birth outcomes, especially low birth weight (LBW). The Nepal DHS 2011 reports prevalence of anemia in pregnant women at 48%.ObjectiveThe objectives are to determine anemia levels in pregnant women enrolled in a longitudinal birth cohort and understand the factors associated with low serum hemoglobin.MethodsData are from a rolling cohort study (n=1675 pregnant women) being conducted in the Banke District of Nepal. At recruitment, one venous blood sample was collected from each pregnant woman along with anthropometry (weight, height, mid‐upper arm circumference), hemoglobin, blood pressure, recent illness, maternal education and socio‐economic status. A wealth index was constructed using principal components analysis. A cut‐off of less than 11 g/dL was used to define anemia in pregnant women. Descriptive statistics, bivariate correlations and multivariate linear regression analysis were conducted using Stata® SE version 14.ResultsMean years of schooling ± SD was 4.77± 4.94 years and age (23.6 ± 4.77) with 20% under the age of 20. Mean hemoglobin was 11.2+/−1.3 g/dL, and anemia prevalence was 40%. Bivariate analyses showed significant negative relationships between serum hemoglobin and age (p=0.0001), use of iron supplements (p=0.003), received deworming medication (p=0.001), ante natal (ANC) visits (p=0.000) and trimester (p=0.000) and positive relationships with years of schooling (p=0.0001), access to an improved water source (p=0.039), first pregnancy (p=0.02), consumption of nuts and seeds (p=0.0059) and minimum dietary diversity (p=0.0022).Controlling ethnicity and geographic location, women between 30–34 years had significantly lower hemoglobin levels compared to women under 20 years. Women with secondary school education had significantly higher hemoglobin (p=0.031). Hemoglobin levels were significantly lower in the second (p=0.0000) and third trimester (p=0.0000). Consuming any iron supplement was associated with higher hemoglobin (p=0.043) while attending antenatal clinic was associated with lower hemoglobin (p=0.005) as was a low MUAC (p=0.005). Women in households with an improved water source and having achieved minimum dietary diversity had significantly higher hemoglobin levels (p=0.040 and p=0.003 respectively).ConclusionAnemia prevalence was high in pregnant women recruited for a longitudinal study in Banke, Nepal. Multivariate analyses show factors such as improved water source, achieving minimum dietary diversity, use of iron supplements and education positively associated with serum hemoglobin while increasing age, attending antenatal clinic, low MUAC were negatively associated. Women who had ANC visits were more likely to be anemic, possibly a function of health seeking behavior by those who are anemic. We find no other individual or household factors associated with the prevalence of anemia implying a condition that is pervasive across all the women in the sample.Support or Funding InformationThis study is supported by the USAID Feed the Future Innovation Lab for Nutrition, USAID Bureau for Food Security and USAID Nepal.