Iron-Deficiency Anemia: Reexamining the Nature and

Magnitude of the Public Health Problem

An Analysis of Anemia and Pregnancy-Related Maternal Mortality1,2

Bernard J. Brabin,3 Mohammad Hakimi* and David Pelletier†

Liverpool School of Tropical Medicine, Liverpool, England and University of Amsterdam, Emma

Kinderziekenhuis, Academic Medical Centre, Amsterdam, Netherlands; *Gadjah Mada University, Yogyakarta,

Indonesia; and †

Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853

Abstrak

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 

Method

isted as a direct cause of death in 26% of these reports and as an indirect cause in the remainder. The definitions of anemia vary substantially between studies and many are based on clinical assessment alone; most (88.5%) are hospital based, with a high proportion of complicated deliveries. Anemia was given as a direct cause of between 1 and 46% (mean 10.0%) of maternal deaths in 23 studies. Many reports did not include anemia as a cause of death; most were from Latin America, but 52 studies were from Africa and 45 from Asia. No study lists anemia both as a direct cause for severe cases and indirect cause 

untuk mendapatkan naskah asli...

download di sini