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RÉSUMÉ
Introduction. Les complications liées à l’anémie sévère de la grossesse sont fréquentes au Burkina Faso. L’objectif de l’étude était d’identifier les facteurs associés à l’anémie sévère en grossesse à l’échelle d’une région au Burkina Faso. Méthodes. Il s’agissait d’une étude de cohorte rétrospective sur des cas d'anémie de la grossesse admis entre 2009 et 2011 dans les maternités des hôpitaux publics de référence de la région des Cascades au Burkina Faso. Les données de l’étude ont été recueillies en mai 2012. Résultats. Sur 1815 cas d'anémie biologique inclus dans l’étude, il y avait 27,5% de cas d’anémie sévère. Les facteurs sociodémographiques associés à l’anémie sévère étaient le jeune âge (OR=2,08; IC 95%: 1,22 - 3,52), les 1ers trimestres de grossesse (OR=6,26; IC 95%: 4,78 - 8,20), la résidence en milieu rural (OR=3,61; IC 95%: 2,64 - 4,95) et le faible niveau de revenus (OR=3,33; IC 95%: 1,41 - 7,84). Les signes cliniques associés à la fréquence élevée de l’anémie sévère étaient la pâleur conjonctivale, les œdèmes des membres inférieurs, la tachycardie, l’asthénie et les vertiges. L’anémie sévère de la grossesse était plus fréquente chez les femmes qui avaient une tension artérielle basse. Conclusion. L’anémie sévère de la grossesse était fréquente dans les hôpitaux au Burkina Faso. Les facteurs associés identifiés dans cette étude pourront orienter son diagnostic précoce.
ABSTRACT
Background. Complications associated to severe anemia in pregnancy are largely common in Burkina Faso. Our study aimed to identify factors associated with severe anemia in pregnant women at a regional level in Burkina Faso. Materials and Methods. This was a retrospective cohort study of cases of anemia in pregnant women admitted between 2009 and 2011 in maternity wards of public referral hospitals in the Cascades region of Burkina Faso. The data were collected in May 2012. Results. Among 1815 cases of biological anemia in pregnancy included in the study, there were 27.5% cases of severe anemia. Sociodemographic factors associated with the high frequency of severe anemia were young age (OR = 2.08; CI 95%: 1.22-3.52), 1st trimester of pregnancy (OR = 6.26; CI95%: 4.78-8.20), rural residence (OR = 3.61; CI 95%: 2.64-4.95), and low income (OR = 3.33; CI95%: 1.41-7.84). Clinical signs associated with the high frequency of severe anemia were conjunctival pallor, edema of the lower limbs, tachycardia, asthenia, and dizziness. Severe anemia in pregnancy was less frequent in women with normal or low diastolic blood pressure. Conclusion. Severe anemia in pregnancy was common in hospitals in Burkina Faso. The factors associated with anemia that were identified in our study may help its early diagnosis.
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References
- Rahman MM, Abe SK, Rahman MS, Kanda M, Narita S, Bilano V, et al. Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and meta-analysis1,2. Am J Clin Nutr. 2016 Feb 1;103:495–504.
- Daru J, Zamora J, Fernández-Félix BM, Vogel J, Oladapo OT, Morisaki N, et al. Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis. Lancet Glob Heal. 2018 May;6(5):e548–54.
- Chen C, Grewal J, Betran AP, Vogel JP, Souza JP, Zhang J. Severe anemia, sickle cell disease, and thalassemia as risk factors for hypertensive disorders in pregnancy in developing countries. Pregnancy Hypertens. 2018;13(March):141–7.
- Clautaire I, Olivia Firmine N, Gauthier Régis Jostin B, Ariane Glore N, Jules César M, Neli Yvette N, et al. Parturient Anemic: Epidemiology and Outcome of Pregnancy in Three Maternities of Brazzaville (Republic of Congo). J Gynecol Obstet. 2019;7(4):116.
- Ouedraogo I, Zamané H, Sawadogo AY, Kiemtoré S, Kain DP, Ouattara A, et al. Anaemia in Pregnancy in an African Setting after Preventive Measures. Open J Obstet Gynecol. 2019 Jan 4;09(01):10–20.
- Bara M, Srivastava M, Samuel A. Prevalence of anemia in pregnancy: A retrospective study at Tertiary care hospital in Jharkhand, India. IOSR J Dent Med Sci e-ISSN. 2018;17(4):25–8.
- Adam I, Ibrahim Y, Elhardello O. Prevalence, types and determinants of anemia among pregnant women in Sudan: a systematic review and meta-analysis. BMC Hematol. 2018 Dec 8;18:31.
- Muñoz M, Peña-Rosas JP, Robinson S, Milman N, Holzgreve W, Breymann C, et al. Patient blood management in obstetrics: management of anaemia and haematinic deficiencies in pregnancy and in the post-partum period: NATA consensus statement. Transfus Med. 2018 Feb;28(1):22–39.
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- WHO. The global prevalence of anaemia in 2011. World Health Organization. Geneva; 2015.
- Fournié A, Lefebvre-Lacoeuille C, Cotici V, Harif M, Descamps P. La mesure de la hauteur utérine dans les grossesses uniques et le dépistage des retards de croissance intra-utérins. Vol. 36, Journal de Gynecologie Obstetrique et Biologie de la Reproduction. 2007. p. 625–30.
- Sarin AR. Severe anemia of pregnancy, recent experience. Int J Gynecol Obstet. 1995;50:S45–9.
- Guyatt HL, Snow RW. The epidemiology and burden of Plasmodium Falciparum-related anemia among pregnant women in sub-Saharan Africa. In: American Journal of Tropical Medicine and Hygiene. 2001. p. 36–44.
- Beucher G, Grossetti E, Simonet T, Leporrier M, Dreyfus M. Iron deficiency anemia and pregnancy. Prevention and treatment. Vol. 40, Journal de Gynecologie Obstetrique et Biologie de la Reproduction. 2011. p. 185–200.
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- Anlaakuu P, Anto F. Anaemia in pregnancy and associated factors: a cross sectional study of antenatal attendants at the Sunyani Municipal Hospital, Ghana. BMC Res Notes. 2017 Dec 11;10:402.
- Sholeye O, Animasahun V, Shorunmu T. Anemia in pregnancy and its associated factors among primary care clients in Sagamu, Southwest, Nigeria: A facility-based study. J Fam Med Prim Care. 2017;6:323.
- Lestari PP, Sari BP, Wulandatika D. Education About Anemia And Nutrition In Adolescent Girls. Green Visioneers [Internet]. 2020;3(1):1–4. Available from: http://journal.greenvisioneers.or.id/index.php/comment/article/view/84/54
- Lebso M, Anato A, Loha E. Prevalence of anemia and associated factors among pregnant women in Southern Ethiopia: A community based cross-sectional study. PLoS One. 2017;12(12):1–11.
- Wemakor A. Prevalence and determinants of anaemia in pregnant women receiving antenatal care at a tertiary referral hospital in Northern Ghana. BMC Pregnancy Childbirth. 2019 Dec 11;19:495.
- Kassa GM, Muche AA, Berhe AK, Fekadu GA. Prevalence and determinants of anemia among pregnant women in Ethiopia; a systematic review and meta-analysis. BMC Hematol. 2017 Dec 17;17:17.
- Obai G, Odongo P, Wanyama R. Prevalence of anaemia and associated risk factors among pregnant women attending antenatal care in Gulu and Hoima Regional Hospitals in Uganda: A cross sectional study. BMC Pregnancy Childbirth. 2016;16(1):1–7.
- Sombié I, Méda ZC, Blaise Geswendé Savadogo L, Télesphore Somé D, Fatoumata Bamouni S, Dadjoari M, et al. La lutte contre la mortalité maternelle au Burkina Faso est-elle adaptée pour réduire les trois retards ? Sante Publique (Paris). 2018;30(2):273.
- Ridde V, Yaméogo P. How Burkina Faso used evidence in deciding to launch its policy of free healthcare for children under five and women in 2016. Palgrave Commun. 2018 Dec 2;4(1):119.
- Diassana M, Diassana M, Dembele S, Macalou B, Ndaou K, Sidibe A, et al. Audits de Décès Maternels dans un Hôpital Régional du Mali (Kayes), Place des 3 Retards et Impact sur le Service de Gynécologie-Obstétrique. Heal Sci Dis [Internet]. 2020 Oct 3;21(10):59–63. Available from: https://www.hsd-fmsb.org/index.php/hsd/article/view/2337
- Lin L, Wei Y, Zhu W, Wang C, Su R, Feng H, et al. Prevalence, risk factors and associated adverse pregnancy outcomes of anaemia in Chinese pregnant women: A multicentre retrospective study. BMC Pregnancy Childbirth. 2018;18:111.
- Lee AI, Okam MM. Anemia in Pregnancy. Hematol Oncol Clin North Am. 2011 Apr 1;25(2):241–59.
- Phillips J, Henderson AC. Hemolytic anemia: Evaluation and differential diagnosis. Am Fam Physician. 2018;98(6):354–61.
- Vieth JT, Lane DR. Anemia. Hematol Oncol Clin North Am. 2017;31(6):1045–60.
- Seravalle G, Dell’Oro R, Quarti-Trevano F, Spaziani D, Bertoli S, Airoldi F, et al. Sympathetic Overactivation in Patients With Essential Hypertension and Hepatic Iron Overload. Hypertension. 2020 Nov;76(5):1444–50.
- Kim MK, Baek KH, Song KH, Kang M Il, Choi JH, Bae JC, et al. Increased serum ferritin predicts the development of hypertension among middle-aged men. Am J Hypertens. 2012;25(4):492–7.
- Gould SA, Moore EE, Hoyt DB, Ness PM, Norris EJ, Carson JL, et al. The life-sustaining capacity of human polymerized hemoglobin when red cells might be unavailable. J Am Coll Surg. 2002;195(4):445–52.
References
Rahman MM, Abe SK, Rahman MS, Kanda M, Narita S, Bilano V, et al. Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and meta-analysis1,2. Am J Clin Nutr. 2016 Feb 1;103:495–504.
Daru J, Zamora J, Fernández-Félix BM, Vogel J, Oladapo OT, Morisaki N, et al. Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis. Lancet Glob Heal. 2018 May;6(5):e548–54.
Chen C, Grewal J, Betran AP, Vogel JP, Souza JP, Zhang J. Severe anemia, sickle cell disease, and thalassemia as risk factors for hypertensive disorders in pregnancy in developing countries. Pregnancy Hypertens. 2018;13(March):141–7.
Clautaire I, Olivia Firmine N, Gauthier Régis Jostin B, Ariane Glore N, Jules César M, Neli Yvette N, et al. Parturient Anemic: Epidemiology and Outcome of Pregnancy in Three Maternities of Brazzaville (Republic of Congo). J Gynecol Obstet. 2019;7(4):116.
Ouedraogo I, Zamané H, Sawadogo AY, Kiemtoré S, Kain DP, Ouattara A, et al. Anaemia in Pregnancy in an African Setting after Preventive Measures. Open J Obstet Gynecol. 2019 Jan 4;09(01):10–20.
Bara M, Srivastava M, Samuel A. Prevalence of anemia in pregnancy: A retrospective study at Tertiary care hospital in Jharkhand, India. IOSR J Dent Med Sci e-ISSN. 2018;17(4):25–8.
Adam I, Ibrahim Y, Elhardello O. Prevalence, types and determinants of anemia among pregnant women in Sudan: a systematic review and meta-analysis. BMC Hematol. 2018 Dec 8;18:31.
Muñoz M, Peña-Rosas JP, Robinson S, Milman N, Holzgreve W, Breymann C, et al. Patient blood management in obstetrics: management of anaemia and haematinic deficiencies in pregnancy and in the post-partum period: NATA consensus statement. Transfus Med. 2018 Feb;28(1):22–39.
World Health Organization. Prevalence of Anaemia in Pregnant Women [Internet]. Geneva; 2020 [cited 2020 Oct 8]. Available from: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/prevalence-of-anaemia-in-pregnant-women-(-)
WHO. The global prevalence of anaemia in 2011. World Health Organization. Geneva; 2015.
Fournié A, Lefebvre-Lacoeuille C, Cotici V, Harif M, Descamps P. La mesure de la hauteur utérine dans les grossesses uniques et le dépistage des retards de croissance intra-utérins. Vol. 36, Journal de Gynecologie Obstetrique et Biologie de la Reproduction. 2007. p. 625–30.
Sarin AR. Severe anemia of pregnancy, recent experience. Int J Gynecol Obstet. 1995;50:S45–9.
Guyatt HL, Snow RW. The epidemiology and burden of Plasmodium Falciparum-related anemia among pregnant women in sub-Saharan Africa. In: American Journal of Tropical Medicine and Hygiene. 2001. p. 36–44.
Beucher G, Grossetti E, Simonet T, Leporrier M, Dreyfus M. Iron deficiency anemia and pregnancy. Prevention and treatment. Vol. 40, Journal de Gynecologie Obstetrique et Biologie de la Reproduction. 2011. p. 185–200.
Meda N, Coulibaly M, Nebie Y, Diallo I, Traore Y, Ouedraogo LT. Magnitude of maternal anaemia in rural Burkina Faso: contribution of nutritional factors and infectious diseases. Adv Public Heal. 2016;2016:1–7.
Anlaakuu P, Anto F. Anaemia in pregnancy and associated factors: a cross sectional study of antenatal attendants at the Sunyani Municipal Hospital, Ghana. BMC Res Notes. 2017 Dec 11;10:402.
Sholeye O, Animasahun V, Shorunmu T. Anemia in pregnancy and its associated factors among primary care clients in Sagamu, Southwest, Nigeria: A facility-based study. J Fam Med Prim Care. 2017;6:323.
Lestari PP, Sari BP, Wulandatika D. Education About Anemia And Nutrition In Adolescent Girls. Green Visioneers [Internet]. 2020;3(1):1–4. Available from: http://journal.greenvisioneers.or.id/index.php/comment/article/view/84/54
Lebso M, Anato A, Loha E. Prevalence of anemia and associated factors among pregnant women in Southern Ethiopia: A community based cross-sectional study. PLoS One. 2017;12(12):1–11.
Wemakor A. Prevalence and determinants of anaemia in pregnant women receiving antenatal care at a tertiary referral hospital in Northern Ghana. BMC Pregnancy Childbirth. 2019 Dec 11;19:495.
Kassa GM, Muche AA, Berhe AK, Fekadu GA. Prevalence and determinants of anemia among pregnant women in Ethiopia; a systematic review and meta-analysis. BMC Hematol. 2017 Dec 17;17:17.
Obai G, Odongo P, Wanyama R. Prevalence of anaemia and associated risk factors among pregnant women attending antenatal care in Gulu and Hoima Regional Hospitals in Uganda: A cross sectional study. BMC Pregnancy Childbirth. 2016;16(1):1–7.
Sombié I, Méda ZC, Blaise Geswendé Savadogo L, Télesphore Somé D, Fatoumata Bamouni S, Dadjoari M, et al. La lutte contre la mortalité maternelle au Burkina Faso est-elle adaptée pour réduire les trois retards ? Sante Publique (Paris). 2018;30(2):273.
Ridde V, Yaméogo P. How Burkina Faso used evidence in deciding to launch its policy of free healthcare for children under five and women in 2016. Palgrave Commun. 2018 Dec 2;4(1):119.
Diassana M, Diassana M, Dembele S, Macalou B, Ndaou K, Sidibe A, et al. Audits de Décès Maternels dans un Hôpital Régional du Mali (Kayes), Place des 3 Retards et Impact sur le Service de Gynécologie-Obstétrique. Heal Sci Dis [Internet]. 2020 Oct 3;21(10):59–63. Available from: https://www.hsd-fmsb.org/index.php/hsd/article/view/2337
Lin L, Wei Y, Zhu W, Wang C, Su R, Feng H, et al. Prevalence, risk factors and associated adverse pregnancy outcomes of anaemia in Chinese pregnant women: A multicentre retrospective study. BMC Pregnancy Childbirth. 2018;18:111.
Lee AI, Okam MM. Anemia in Pregnancy. Hematol Oncol Clin North Am. 2011 Apr 1;25(2):241–59.
Phillips J, Henderson AC. Hemolytic anemia: Evaluation and differential diagnosis. Am Fam Physician. 2018;98(6):354–61.
Vieth JT, Lane DR. Anemia. Hematol Oncol Clin North Am. 2017;31(6):1045–60.
Seravalle G, Dell’Oro R, Quarti-Trevano F, Spaziani D, Bertoli S, Airoldi F, et al. Sympathetic Overactivation in Patients With Essential Hypertension and Hepatic Iron Overload. Hypertension. 2020 Nov;76(5):1444–50.
Kim MK, Baek KH, Song KH, Kang M Il, Choi JH, Bae JC, et al. Increased serum ferritin predicts the development of hypertension among middle-aged men. Am J Hypertens. 2012;25(4):492–7.
Gould SA, Moore EE, Hoyt DB, Ness PM, Norris EJ, Carson JL, et al. The life-sustaining capacity of human polymerized hemoglobin when red cells might be unavailable. J Am Coll Surg. 2002;195(4):445–52.