An Analysis of
Anemia and Pregnancy-Related Maternal Mortality
Abstract
The relationship of
anemia as a risk factor for maternal mortality was analyzed by using
cross-sectional, longitudinal and case-control studies because randomized
trials were not available for analysis. The following six methods of estimation
of mortality risk were adopted: 1) the correlation of maternal mortality
rates with maternal anemia prevalence derived from national statistics; 2)
the proportion of maternal deaths attributable to anemia; 3) the
proportion of anemic women who die; 4) population-attributable risk of
maternal mortality due to anemia; 5) adolescence as a risk factor for
anemia-related mortality; and 6) causes of anemia associated with
maternal mortality. The average estimates for all-cause anemia attributable
mortality (both direct and indirect) were 6.37, 7.26 and 3.0% for Africa, Asia
and Latin America, respectively. Case fatality rates, mainly for hospital
studies, varied from <1% to >50%. The relative risk of mortality
associated with moderate anemia (hemoglobin 40–80 g/L) was 1.35 [95% confidence
interval (CI): 0.92–2.00] and for severe anemia (<47 g/L) was 3.51 (95% CI:
2.05–6.00). Population-attributable risk estimates can be defended on the basis
of the strong association between severe anemia and maternal mortality but not
for mild or moderate anemia. In holoendemic malarious areas with a 5% severe
anemia prevalence (hemoglobin <70 g/L), it was estimated that in
primigravidae, there would be 9 severe-malaria anemia-related deaths and 41
nonmalarial anemia-related deaths (mostly nutritional) per 100,000 live births.
The iron deficiency component of these is unknown.
(Fania Anjela)
(Fania Anjela)
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