I PREVALENCE

1 A cross- sectional study was carried out in primary health centers in Rivers state,
Nigeria on Prevalence and socio-demographic factors associated with anaemia in
pregnancy among the 227 pregnant women whose ages ranged from 16 to 40
years with a mean age of 26.8 ± 4.3 years were recruited for the study. The results
of the syudy stated that the haemoglobin concentration ranged from 6 g/dL – 15
g/dL with a mean of 10.10 ± 1.27g/dL. A total of 142 (62.6%) participants were
anaemic and anaemia was observed to be least prevalent in women within the
extremes of reproductive age (≤ 20 years and 36–40 years). There was no
statistically significant association between age, educational level and marital
status (p > 0.05). The association of anaemia with social class was statistically
significant (p = 0.000). Severe anaemia was not a common finding amongst the
patients but it was significantly associated with educational status (p = 0.02) and
socio-economic status (p = 0.03). This study was concluded that the prevalence of
2 anaemia amongst the pregnant participants in the primary health centre was high
and out of all the socio-demographic characteristics, only socio-economic status
was significantly associated with anaemia. It is recommended that the socio-
economic status of women should be enhanced in line with the Millennium
Development Goals to prevent anaemia and to enhance pregnancy outcomes. .23
The National Nutrition Survey was conducted between February and
April, 2013 by UNICEF in partnership with the Ministry of Health of the
Republic of Azerbaijan and the State Statistical Committee of Azerbaijan, to
assess the nutrition and health status of children, non-pregnant women, and preg-
nant women. 3,926 household interviews were successfully completed as part of
the survey. In total 3351 women and 1455 children participated in the survey. The
survey showed positive progress in most nutrition indicators for children in
comparison with previous researches. Stunting rate among children aged 0-59
month declined from 25.1% (Demographic Health Survey 2006) to 18% in 2013,
wasting from 6.6% (DHS 2011) to 3.1% and underweight from 6.5% (DHS 2011)
3 to 4.9%. Only 10% of observed children had zinc deficiency and 8% vitamin A
deficiency. Anaemia prevalence among children aged 0-59 declined from 44.4%
(DHS 2011) to 24.2%. Along with the achievements the survey indicates areas
where efforts are needed to reach better nutritional results for children and
women. High prevalence of anaemia among pregnant and non-pregnant women
as well as children remains an issue of high public concern. 40% of pregnant and
38% of non-pregnant women were found to be anaemic during the survey. Of
anemic women, 62.8% were also iron deficient. 35% and 20% of non-pregnant
women observed to have folate and Vit.B12 deficiency respectively. 10

A longitudinal interventional study regarding ‘Does effective counseling

play an important role in controlling iron deficiency anaemia among

pregnant women’ was conducted from November 2014 to January 2016 in

Mungeli district, Chhattisgarh state,India. The main aim of this study was

to provide counseling to IDA pregnant women by effective

4
communication and to study the impact of counseling on hematological

indices.Pregnant women of rural population were first screened for IDA

and then IDA women were grouped into experimental and control group.

The experimental group women received counseling regarding benefits of

regular IFA supplementation and good hygiene practices while the

women in the control group were devoid of such counseling. Data on

hematological parameters, hygiene practices, and IFA supplementation

were taken from both groups and also after the end of the study. Data

were then analyzed for statistical significance. Statistically, the significant

of study shown that, improvement seen in anemic status among pregnant

women of the experimental group.2.10 (don’t include)

 A systemic review and meta-analysis regarding prevalence and
5 determinants of anemia among pregnant women was carried out in Sudan at
Northeast Africa. among 15, 688 pregnant women. The results revealed that The
prevalence of anemia among pregnant women in Sudan was 53.0% (95%, CI =
45.9–60.1). The meta-analysis showed no statistical significant between the age
(mean difference = 0.143, 95 CI = − 0.033 − 0.319, P = 0.112), parity (mean
difference =0.021, 95% CI=− 0.035 − 0.077, P = 0.465) between the anemic and
no anemic women. Malaria was investigated in six studies. Pregnant women who
had malaria infection during pregnancy were 1.94 times more likely to develop
anemia than women who had no malaria infection (OR = 1.94, 95% CI =1.33–
2.82). Six (37.5%) studies investigated type of anemia. The prevalence of iron
deficiency anemia (IDA) among pregnant women in Sudan was 13.6% (95% CI =
8.9–18.2). The study concluded that, there was a highly prevalence of anemia
among pregnant in the different region of Sudan. While age and parity have no
association with anemia, malaria infection was associated with anemia and
interventions to promote the strengthening of antenatal care, access and adherence
6 to nutrition, and malaria preventive measures are needed to reduce the high level
of anemia among pregnant women in Sudan. 24

A Nationwide cross-sectional survey of pregnant women was conducted

at 24 hospitals from 16 provinces across China regarding prevalence of anaemia
and iron deficiency anaemiafrom 19 September to 20 November 2016. The
hospitals were selected according to the multi-stage sampling method. In total,
12,403 pregnant women were enrolled, including 1018 (8.2%) at the first
trimester, 3487 (28.1%) at the second, and 7898 (63.7%) at the third. Results
stated that overall, 19.8% of women were diagnosed with anemia and 13.9% were
diagnosed with IDA. The prevalence of anemia and IDA varied among regions
and increased by gestational month, peaking at the eighth gestational month
(24.0% for anemia and 17.8% for IDA). Pregnant women at advanced stage of
gestation, non-local residents, multiple gestations, multiparity, pre-pregnancy
underweight, and those experiencing severe nausea or vomiting during
 pregnancy, were associated with higher risks of anemia and IDA. The prevalence
of anemia and IDA during pregnancy are similar to those from developed
countries and vary across regions in China. 25

II A cross-sectional descriptive study was carried from May 1, 2016 to

March 31, 2017 in Lagos at Nigeria regarding Prevalence and foetomaternal
1 effects of iron deficiency anaemia among pregnant women. The participants were
recruited using the systematic sampling method in which every third woman who
met the inclusion criteria was selected. Inclusion criteria included was pregnant
women aged 15 to 49 years with a singleton pregnancy who were at a gestational
age of at least 37 weeks and gave informed written consent. A major proportion
(70.0%) of the women had up to the secondary level of education while a
significant proportion (40.9%) belonged to the upper socioeconomic status (Class
1 and 2). A large proportion of the women (62.7%) were of parity ≥1 with almost
4% being in the grand-multiparous (parity ≥5) category. Most of the women were
2 of the Yoruba ethnic group (36.8%) while the majority (81.2%). were booked
antenatal clients of the hospital. Results revealed that out of the 220 women in the
study, 44 (20.0%)were found to be anaemic and of these anaemic women, 61.4%
(27/44) had IDA. The overallprevalence of IDA among the study participants was
12.3% (27/220). The study concluded that, the prevalence of anaemia and iron
deficiency anaemia (IDA) recorded among parturients in this study were 20.0%
and 12.3% respectively. The prevalence of anaemia obtained is almost similar to
a previous study conducted in the same setting in Lagos. 26

CAUSE

A prospective cross-sectional study was conducted in the Hill State of Himachal

Pradesh in North India to assess the Etiology of Anemia Among Pregnant Women
among 172 anemic pregnant women, of these, 5.8% were in their first trimester,
3 20.93% were in the second trimester, and 73.25% were in the third trimester of
pregnancy. The results shown that the mean hemoglobin level among women in
this study was 8.87 g/dL with a standard deviation of 0.79. Out of 172
participants, most of the women had mild (50%) or moderate (48.8%) anemia
while only two (1.16%) had severe anemia. This study concluded that, Multiple
deficiencies should be treated simultaneously in anemic women such as Vitamin
B12 deficiency is an important contributor to anemia, in addition to iron and
folate deficiency. 27

A population- based prospective study was undertaken in Ha Nam, a rural

province in Northern Viet Nam, Australia; regarding Psychological and social
factors associated with late pregnancy iron deficiency anaemia among 378
women. Results revealed that he incidence risk of IDA in the third trimester was
13.2% (95% confidence interval (CI): 9.8-16.7). Persistent CMD was found in
16.9% (95% CI:13.1-20.7) pregnant women and predicted by intimate partner
III violence, fear of other family members, experience of childhood abuse,
coincidental life adversity, and having a preference for the sex of the baby. There
1 was a significant pathway from persistent CMD to IDA in late pregnancy via the
length of time that iron supplements had been taken. Receiving advice to take
iron supplements and higher household wealth index were indirectly related to
lower risk of late pregnancy IDA. Early pregnancy IDA and being multi-porous
also contributed to late pregnancy IDA. This study concluded that, antenatal IDA
is prevalent public health problems among women in Viet Nam. The link between
them suggests that while direct recommendations to use iron supplements are
important, the social factors associated with common mental disorders should be
addressed in antenatal care in order to improve the health of pregnant women and
their infants. 28

A Case-control study on Association of Zinc Deficiency with Iron Deficiency

 Anemia and its Symptoms was conducted by Internal Medicine Department,
Zagazig University Hospitals, Zagazig, EGY they selected 30 healthy individuals
and 30 patients with iron deficiency in this study. The Demographic
characteristics and biochemical findings of the patients. There was no significant
difference between the groups in terms of age or gender (p > 0.05).There was a
statistically significant difference between the groups in terms of Hb (p < 0.001),
MCV (p < 0.001), serum iron (p = 0.001), total iron binding capacity (p = 0.008),
and ferritin (p <0.001). Serum zinc levels were lower in IDA patients (43.4 ± 7.9
mg/dL) than in the control subjects (94.7 ± 16.75 mg/dL). The difference was
highly statistically significant between the two groups (p < 0.0001). The most
commonly reported symptom associated with IDA were fatigue (100%) followed
by cardiopulmonary symptom (tachypnea, tachycardia, palpitation, 60%),
epithelial manifestation (dermatitis, glossitis and diarrhea, 70%), mental
manifestation (irritability, headache and amnesia, 67%), and restless leg
syndrome (RLS, 6%). There has been a significantly lower zinc level in patients
with iron deficiency who had cardiovascular symptoms as tachycardia (p =0.04),
epithelial symptoms as dermatitis (p = 0.027), and restless leg syndrome (p =
2
0.000) Our results revealed a significant correlation between the serum zinc level
and MCV, MCH,total iron binding capacity (TIBC), serum iron, and serum
ferritin level in patients with IDA, but not in healthy control We suggest that
serum zinc levels should be evaluated in adults with IDA. With the help of our
studies, iron and zinc treatment instead of only iron replacement may be
considered in cases of iron deficiency particularly in patients with severe
epithelial dysfunctions. Further studies are still needed to evaluate the benefit of
zinc and iron supplementation in IDA patients with aggravated symptoms. 29

COMPLICATIONS

An observational study was conducted on impact of maternal anemia on perinatal

outcome among 643 pregnant ladiesin department of obstetrics and
 gynaecology PNS Shifa Karachi at Pakistana from the period of six months from
April to September 2017.Group A included all anemic ladies while non-anemic
patients werelabelled as group B. The results revealed that mean age of patient
was 25.8 ± 4.54, with maximum age 37 and minimum 20 years. Monthly income
was also calculated as it is important in etiology of anaemia. Income was divided
in 4 groups as <10,000 rupees per month, 10-15,000 rupees, between 15 and
20,000 rupees. It was found that93 (27.1%) cases in anaemic group and
54(17.94%) had earnings less than 10,000 rupees and 46 (13.4%) in anaemic and
49 (16.27%) patients were in above 20,000 rupees per month group. There were
229 (66.9%) cases of pretermdelivery in group A compared to 44 (14.66%)
ingroup B. Low birth weight (LBW) was observedin 124 (36.2%) cases in
anaemic group and in 44 (14.6%) cases in non-anemic group. There were 5
(1.4%) cases of stillbirth in anemic group as (46.81%) nonanaemic. In group A,
new born of 109 (31.8%) cases showed Appearance, Pulse, Grimace, Activity,
Respiration (APGAR) score <5 at 1 minute compared to 14 (4.6%) cases in the
3 other group. Similarly, the score <7 at 5 minutes was observed in 70 (20.4%)
deliveries in group A and 12(3.98%) in group B. In group A, 41 (12%) cases of
IUGR were observed whereas, 14 (5%) were in group B. This study concluded
that, maternal anaemia has increasedrisk of delivery of premature and LBW
babies, IUD, low APGAR score at 1 minute & 5minute. The study suggests that
routine ironsupplementation should be given during pregnancyand postpartum to
cover losses duringdelivery and lactation. Obstetricians, community health
workers and nurses play importantrole by making women aware of iron richdiet,
especially, green leafy vegetables duringtheir antenatal visits. 30

A retrospective Cohort study was conducted to assess the effect of iron

deficiency anaemia early in the third trimester on small for gestational age and
low birth weight among 4800 pregnant women in Kayseri City Hospital in
Kayseri at Turkey. The results found that out of 4800, 80 had severe anemia, 320
had moderate anemia, 1300 had mild anaemia, and 3100 were healthy controls.
All pregnant women in the study except the control group had low serum ferritin
 level (<15 mcg/L).Maternal age (p <0.130), BMI <30 kg/m2 rates (p < 0.440),
nulliparity rates (p <0.800), and previous cesarean delivery rates (p < 0.975) were
similar among groups. Ethnicity (Caucasian and non-Caucasian) was significantly
different in the severe and moderate anemia groups (p < 0.001). Gestational age at
delivery (weeks) was similar among groups (p < 0.540). Male gender rates and
vaginal delivery rates were similar among groups (p < 0.780 and p < 0.840,
respectively). Mean fetal weight was 2900 ± 80 g in the severe anemia group,
3050 ± 100 g in the moderate anemia group, 3350 ± 310 g in the mild anemia
group, and 3400 ± 310 g in the control group. Fetal weight was significantly
lower in the severe and moderate anemia groups compared to the mild anemia
4 and control groups (p < 0.001). Fetal weight was significantly lower in the severe
anemia group compared to the other groups (<0.001). The SGA rate was 18.7%
in the severe anemia group, 12.1% in the moderate anemia group, 5.3% in the
mild anemia group, and 4.9% in the control group. SGA was significantly higher
in the severe and moderate anemia groups compared to the mild anemia and
control groups (p < 0.001). In addition, SGA was significantly higher in the
severe anemia group compared to the moderate anemia group (p < 0.001). When
compared with the control group, SGA was found to be increased by 3.8-fold in
the severe anaemia group and 2.4-fold in the moderate anemia group. The
conclusion of this study indicated that early third trimester severe and moderate
iron deficiency anemia is associated with SGA. When compared with the control
group, SGA was found to be increased by 3.8-fold in the severe anemia group and
2.4-fold in the moderate anemia group. Iron deficiency anemia in pregnant
women may lead to low birth weight. The study suggests to conduct further
prospective studies with a greater number of patients. 31

A prospective study was conducted on maternal iron-deficiency is

associated with premature birth and higher birth weight despite routine antenatal
iron supplementation among pregnant womenat Johannesburge;in South Africa
between March 2016 and November 2017. The results stated that the prevalence
of anaemia, iron depletion (ID) and iron deficiency erythropoiesis (IDE) was
 29%, 15% and 15%, respectively, and increased significantly with pregnancy
progression. Anaemia and ID at 22 weeks, as well as IDE at 36 weeks were
associated with higher birth weight (β = 135.4; 95% CI: 4.8, 266.1 and β = 205.4;
95% CI: 45.6, 365.1 and β = 178.0; 95% CI: 47.3, 308.7, respectively). Women in
the lowest ferritin quartile at 22 weeks gave birth to babies weighing 312 g (95%
CI: 94.8, 528.8) more than those in the highest quartile. In contrast, IDE at 22
weeks was associated with a higher risk for premature birth (OR: 3.57, 95% CI:
1.24, 10.34) and women in lower haemoglobin quartiles at <18 weeks had a
shorter gestation by 7 days (β = -6.9, 95% CI: -13.3, -0.6) compared to those in
the highest quartile.This study concluded that, Anaemia, ID and IDE prevalence
increased during pregnancy despite routine iron supplementation. ID and anaemia
at mid-pregnancy were associated with higher birth weight, while IDE was
associated with premature birth. These results suggest that current antenatal
screening and supplementation practices in South Africa need to be revisited. 32

A quantitative research approach and descriptive research design to assess the

level of knowledge among antenatal mothers regarding selected health problems
complicating pregnancy. The study was conducted in the antenatal clinic of
upgraded primary health center, at Andimadam which is situated in Perambalur
District, Tamil Nadu, India. This primary health center covers a population of
IV 29,536 and four additional primary health centers. The data analysis shows that,
 91(91%) antenatal mothers had inadequate knowledge and 9(9%)
1 antenatal mothers had moderately adequate knowledge on gestational
diabetes mellitus. None of them had adequate knowledge.
 74 (74%) antenatal mothers had inadequate knowledge and 25 (25%)
antenatal mothers had moderately adequate knowledge and only one
antenatal mother had adequate knowledge on iron deficiency anemia.
 81 (81%) antenatal mothers had inadequate knowledge and 19 (19%)
antenatal mothers had moderately adequate knowledge and none had
adequate knowledge on pregnancy induced hypertension.
 The overall knowledge of mothers on selected health problems
 complicating pregnancy. Out of 100 mothers, 83 (83%) antenatal mothers
had inadequate knowledge on gestational diabetes, iron deficiency anemia
and pregnancy indeed hypertension and 17 (17%) mothers had moderately
adequate knowledge and none had adequate knowledge on the above
aspects. The lack of awareness of the health problems complicating
pregnancy gave direction to the researcher to intensify the knowledge of
mothers through health education regarding selected health problems
complicating pregnancy.
This study was concluded that, to assess the knowledge of antenatal
mothers regarding selected health problems complicating pregnancy with a view
to find how far the antenatal mother are aware of the health problems that
complicate pregnancy , and their participation in utilizing maternal services
provided in their area in order to prevent maternal mortality and morbidity.2.1(not
to include)

PHARMACOLOGICAL MANAGEMENT

2 A prospective interventional clinical endpoint study conducted to assess the

efficacy, tolerability, and cost of different ironsupplements among eighty four
antenatal women (>14 weeks) with iron-deficiency anemia for 12 months
between February 2019 and February 2020 at Sri Venkateshwaraa Medical
College Hospital and Research Center which is tertiary care hospital in,
Puducherry. Results revealed the there was no statistically significant difference
observed between the four groups with respect to the mean age, gestational age,
and BMI on baseline and there was a significant increase in the mean Hb level
from 10.4 ± 0.4, 10.4 ± 0.5, 10.4 ± 0.5, and 8.5 ± 0.3 to 11.2 ± 0.6, 11.1 ± 0.6,
11.3 ± 0.8, and 10.9 ± 0.6 in Groups 1, 2, 3, and 4, respectively. On inter group
comparison using ANOVA followed by Bonferroni test, itwas found that there is
significant improvement in the meanchange in Hb concentration only in Group 4
when comparedwith Group 1, 2, and 3.The average cost effectiveness ratio, with
3 respect to Group 1(Ferrous Sulfate), Group 2 (Ferrous ascorbate), Group
3(Ferrous Fumarate), and Group 4 (Inj. Iron Sucrose), is Rs.675, Rs. 1782.9, Rs.
1110.7, and Rs. 786.7 per increase inHb%, respectively. Thus, ferrous sulfate can
be consideredas cost effective with a cost effectiveness ratio of Rs. 675 per%
increase in hemoglobin. There was a significantimprovement in the RBC count,
MCV, MCHC, and MCHparameters from baseline to end of treatment in all the
groups. The outcome of this study proved the effective role of variousoral ferrous
iron preparations and all of them were found to beequally efficacious in
improving the Hb concentration. However,the injectable iron sucrose showed a
significant improvementin mean hemoglobin percentage compared to the various
oralpreparations. The results of this study supported that, pharmacoeconomical
decision-making while selecting a costEffective iron supplement for treating iron-
deficiency anemia. 33

A quasi experimental study was conducted to assess the Effect of

community based health education on knowledge and attitude towards iron and
folic acid supplementation among 340 pregnant women in Kiambu County,
Kenya. The study results revealed that most (n = 212, 62.4%) respondents were
20–29 years of age, with mean age of 25.6 (SD ± 5.6), married (n = 288, 84.7%),
had a secondarylevel of education (n = 180, 53.4%), unemployed (n = 167,
49.1%), and earned less than USD100 per month (n = 305, 93%). Whereas only
5.9% (n = 20) had attained tertiary level of education,among the 28.2% (96) that
were in employment, only 3% (n = 10) were formallyemployed. In terms of
4 gravidity, most (n = 223, 67.6%) of the women were multigravida.There was no
statistical difference (p>0.05) in the characteristics of the pregnant women
atbaseline between the two comparison groups.

A faculty- based cross sectional study regarding Knowledge on anaemia

and benefits of iron folic acid supplementation was conducted on 414 pregnant
mothers attending antenatal care in Woldia town, Northeastern Ethiopia. The
results found that the mean age of study participants was 26.35 (+/_ 4.25 SD)
 years, all most all, 405 (97.8%) of the study participants were married,294
(71.0%) were Orthodox by religion and 386 (93.2%) were Amhara by ethnicity,
111 (26.9%) were at the college level and above, and 187 (45.2%) were
housewives. The majority, 359 (86.7%), of the respondents were from urban
residents, and 240 (58.0%) had 1–3 family size. More than half, 218 (52.7%), of
pregnant mothers were in the third trimester, and 237 (57.2%) were early
registered for ANC (< 16 weeks). Regarding gravidity and parity, more than two-
third, 278 (67.1%), of women were multigravida and 184 (44.4%) were
5 primiparous, only 33 (7.9%) of women had a history of anaemia in the current
pregnancy. Concerning the utilization of antenatal care, the majority, 356
(85.9%), of respondents had less than four ANC visits and 380 (91.8%) of
respondents did not have any previous medical Illness. Knowledge about
anaemia, whereas 239 (57.7%) of the respondents had good knowledge about the
benefit of iron and folic acid supplementation. The study concluded that the
mother had adequate information, this might be currently due to increase in
information access for pregnant mothers, and since the majority of the study
participants were from urban residents, being from an urban resident is strongly
associated with pregnant mother knowledge of anaemia. 34

An interventional study was conducted on increased birth weight associated with

regular pre-pregnancy deworming and weekly iron folic acid supplementation for
pregnant women in Vietnam at Australia. The study investigated the association
between neonatal birth weight and a 4-monthly deworming and weekly iron-folic
acid supplementation program given to women of reproductive age in north-west
Vietnam. The program was made available to all women of reproductive age
(estimated 51,623) in two districts in Yen Bai Province for 20 months prior to
commencement of birth weight data collection. The results found that the birth
weights of 463 infants born in district hospitals in the intervention (168) and
6 control districts (295) were recorded. Twenty-six months after the program was
started, the prevalence of low birth weight was 3% in intervention districts
 compared to 7.4% in control districts (adjusted odds ratio 0.29, 95% confidence
interval 0.10 to 0.81, p = 0.017). The mean birth weight was 124 g (CI 68 - 255 g,
p,0.001) greater in the intervention districts compared to control districts. The
findings of this study suggest that providing women with regular deworming and
weekly iron-folic acid supplements before pregnancy is associated with a reduced
prevalence of low birth weight in rural Vietnam and recommended to conduct
more extensive randomized-controlled trial. 35

A cross-sectional study was carried out regarding iron supplementation during

pregnancy among 207 participants in four German states in 2015. The results
stated that of 207 participants, 65.2% had supplemented iron. 84.4% reported to
have done this because of a diagnosed iron deficiency/anaemia. Iron intake
7 ranged from 5 to 200 mg/day, and duration of supplementation varied between
two weeks and throughout gestation. Of women who reported to have been
diagnosed with iron deficiency/anaemia, 47.5% had supplemented ≥80 mg/day
iron, while 26.2% had taken iron in lower amounts ≤40 mg/day. Six percent of
the participating women had not supplemented iron in spite of a diagnosed iron
deficiency/anaemia, whereas 19.7% of women without iron deficiency/anaemia
still had supplemented iron (range: 7 to 80 mg/day). This study concluded that,
the majority of pregnant women used iron supplements in case of a diagnosed
iron deficiency/anaemia. However, not all women with iron deficiency/anaemia
supplemented (sufficient amounts of) iron, while there was also indiscriminate
use of iron supplements in women without iron deficiency/anaemia. It supports
that natural food supplements can be used to increase the haemoglobin level of
V pregnant women for those who have noncompliance to iron sullementation. 36

1 A randomized hybrid effectiveness- implementation trial study was

conducted on intravenous versus oral iron for iron deficiency anaemiaamong
pregnant women in Nigeria among 1056 pregnant women at 20–32 weeks’
gestational age with moderate or severe anaemia (Hb< 10g/dl). In this study the
interventional treatment was one 1000-mg dose of intravenous ferric
 carboxymaltose at enrolment; the control treatment is thrice daily oral ferrous
sulphate (195 mg elemental iron daily), from enrolment till 6 weeks postpartum.
7 Outcome measures of the study were (1) the prevalence of maternal anaemia at 36
weeks and (2) infant preterm birth (<37weeks’ gestation) and will be analysed by
intention-to-treat. Maternal full blood count and iron panel will be assayed at 4
weeks post-enrolment, 36 weeks’ gestation, delivery, and 6 weeks postpartum.
Implementation outcomes of acceptability, feasibility, fidelity, and cost will be
assessed with structured questionnaires, key informant interviews, and focus
group discussions.11.12 (not complete)

NON PHARMACOLOGICAL

A cross sectional study was conducted to assess Nutrition factors associated

with Anaemia among pregnant women in Gombe at Nigeria among 146 pregnant
women. The majority (54%) of the women were in the third trimester. Blood
samples were obtained for determination of haematocrit and for measurement of
2 serum iron, total iron-binding capacity, ferritin, folate, vitamin B12, and
homocysteine. Malaria was present in 15 (9.4%) women. Based on a
haemoglobin value of <105 g/L, 44 (30%) women were classified as anaemic.
The major contributing factor to anaemia was iron deficiency based on the serum
concentration of ferritin (<10 ng/mL). Their mean age was 26.7 (range 15-45)
years, trimester of pregnancy with 5% (n=8) in the first trimester and 41% (n=59)
in the second trimester. Gravidum ranged from 1 to 17 with a median of 5. Parity
ranged from 0 to 11 with a median of 3 children. Forty-two percent of the
subjects took iron supplements, 30% folate supplements, and 33% multi-vitamins.
Fifteen (9.4%) women tested positive for malaria by microscopy of thick blood
smears at the time of the study. Approximately, 25% (n=37) of the women took
malaria prophylaxis. The majority (61%) reported having had no formal
education. This study concluded the main contributing factor to anaemia in these
women was iron deficiency and suboptimal vitamin B12 deficiency. It is
suggested that because of the importance of iron stores in maintaining iron
 balance during pregnancy, efforts should also be directed to improve the iron
stores of young women prior to pregnancy. 37
3

A structured research design was conducted on dietary association of

iron deficiency anaemia and related pregnancy outcome among 500 pregnant
women in Islamabad at Pakistan from September 2020 to January 2021..A well-
designed questionnaire was developed where different demographic factors,
dietary recalls, biomarkers, and other determinants were obtained. The data from
the questionnaires were later coded for the purpose of analysis in the statistical
package (SPSS) using chi-square test. This study results revealed that
approximately 63% of the subjects were having iron deficiency and 24.8% were
facing severe iron deficiency anemia. Only 12% of the subjects were considered
as normal. The high prevalence of anemia in our subjects was probably due to
low iron intake and poor dietary habits. It was concluded that Maternal anemia
still remains a major public health concern that requires more attention especially
in developing and under developing countries.11.6

A population- based retrospective cross-sectional study was conducted on

associations of food and nutrient intake with serum hepcidin and the Risk of
Gestational Iron-Deficiency Anemia among 1430 Pregnant Women aged 20~45
years with a singleton pregnancyin Taiwan in 2017~2019. Data from blood
VI biochemistry, 24-h dietary recall, and a food frequency questionnaire were
collected during a prenatal checkup. The results stated that in IDA women, serum
1 hepcidin levels were positively correlated with the intake frequency of Chinese
dim sum and related foods (β = 0.037 (95% CI = 0.015~0.058), p = 0.001) and
dark leafy vegetables (β = 0.013 (0.001~0.025), p = 0.040), but they were
negatively correlated with noodles and related products (β = -0.022 (-0.043~-
0.001), p = 0.038). Total carbohydrates [OR: 1.003 (1.000~1.006), p = 0.036],
proteins [OR: 0.992 (0.985~0.999), p = 0.028], gourds/shoots/root vegetables
[OR: 1.007 (0.092~1.010), p = 0.005], and to a lesser extent, savory and sweet
 glutinous rice products [OR: 0.069 (0.937~1.002), p = 0.067] and dark leafy
vegetables [OR: 1.005 (0.999~1.011), p = 0.088] predicted IDA. The study
concluded that the risk of IDA due to vegetable consumption decreased with an
increasing vitamin C intake (p for trend = 0.024) and carbohydrates and
vegetables may affect the gestational iron status through influencing hepcidin
levels. The study supports that consumption of green leafy vegetables may lower
the risk of gestational IDA during pregnancy. 11.22

EFFECTIVENESS OF DRUMSTICK LEAVES

2 A quasi experimental study was conducted on effectiveness of drumstick
leaves soup on increasing level of hemoglobin among adolescent girls in selected
college at Coimbatore. The results of the study stated that 16(66.7%) were in the
age group of 17 years, the age at menarche of adolescent girls shows that
6(22.3%) adolescent girls had menarche at the age below 13years.and 21(77.7%)
had menarche at the age of 13-17years. Flow of menstruation of adolescent
girls shows that21(87.5%) of adolescent girls had normal menstrual flow and
2(8.3%) of adolescent girls had heavy menstrual flow, and 1(4.2%) had scanty
flow. The pattern of adolescent girl’s menstruation describes that majority
19(79.2%) of adolescent girls had regular menstrual flow and 6(22.3%) had
irregular menstrual flow.The days of menstruation of adolescent girls with
anaemia shows the days of menstruation of adolescent girls with anaemia which
implies 19(79.2%) had 3-5days of menstruation and 5(20.8%) had 6-8days of
menstruation. This study concluded that drumstick leaves soup was safe, simple,
easily available with rich iron component used to prevent and treat anaemia and
to improve the quality of life. This study supports that drumstick leaves
preparation can be to increase the haemoglobin level of antenatal mothers with
iron deficiency anaemia. 42
 A quasi experimental study was conducted to assess the Effect
of MoringaOleifera leaf powder supplementation on reducing anemia among 206
children below two years in Kisarawe District, Tanzania. In this study 49.5%
(n = 102) from intervention community and 50.5% (n = 104) from control
3 community were included. The results revealed that the overall mean age was
13.9 months (SD = 5.6), the mean Hb for all children was 8.7 g/dl (SD = 1.7),
which was 8.4 g/dl (95% CI: 8.1–8.9) for intervention community and 8.9 g/dl
(95% CI: 8.6–9.2) for control community. No significant difference was observed
on children birth weights (median of 3.1, IQR: 3–3.5) or breastfeeding (over 75%
of children still breastfed) between the two sites. Anemia prevalence was 91.4%
(94.7% (95% CI: 90.3%–99.2%) intervention site; 88.3% (95% CI: 82.2%–
94.5%) control site, p‐value = 0.1042). No significance difference was observed
between the two sites on mothers/caretakers age, education, and size of
households. A higher proportion of mothers/caretakers in intervention community
were involved in agriculture (67.6%) than in the control site (44.2%).The study
enrolled a total of 109 children, of these 14 (12.8%) were dropped due to lost to
follow‐up or sickness A total of 95 children were included in the final analysis,
of which 54 (56.8%) were males and 41 (43.2%) females. The control community
(Msimbu ward) had 52 children (27 males and 25 females) while the intervention
community (Kibuta ward) had 43 children (27 males and 16 females). Children
had an average age of 11.7 months (SD = 2.4) The mean Hb level at baseline was
8.1 g/dl (SD = 1.4) (intervention site: 8.3 g/dl [SD = 1.6]; control site: 7.9 g/dl
[SD = 1.3], p‐value = 0.0943). Of those recruited, 8.7% had mild anemia, 71.7%
had moderate, and 19.6% had severe anemia. The study concluded that the
proportions of different levels of anemia were not significantly different between
4 the two communities during the baseline period. 43

A randomized controlled research design study was conducted to assess

effectiveness of giving extracted Moringooleifera (Drumstick) leaves plus Royal
Jelly supplements on erythrocyte index of anaemia among63 pregnant woman in
 Polongbangkeng Utara Sub district,Takalar Regency, Indonesia. Out of 63
anemia pregnant women consisting of 21 subjects of Moringa Leaf Extract plus
Royal Jelly (MLERJ) group with the intervention of 1 capsule in the morning
with a dose of 500 mg MLE + 10 mg RJ, 21 subjects of Moringa Leaf Extract
(MLE) with the intervention 1 capsule in the morning with a dose of 500mg MLE
and the Placebo group 21 subjects with the intervention 1 placebo capsule in the
morning with a dose of 500mg starch flour, where all of the subjects consumed Fe
tablets at night with a dose of 1x60mg. Data were analyzed using the Chi-Square,
Mann-Whitney, Wilcoxon, Paied T-Test, Kruskal-Wallis and Post-Hoc Mann
Whitney tests. Results of the study is based on the characteristics of research
subjects based on age, education, occupation, income and parity, the three
research groups were not different or evenly distributed. The results showed an
increase in the erythrocyte index levels (MCV, MCH and MCHC) of the three
study groups. Where in the MLERJ group the levels of MCV, MCH and MCHC
experienced a significant increase, in the MLE group who experienced a
significant increase in MCV and MCHC levels, while in the Placebo group who
experienced a significant increase only in MCV levels. This study concluded that
supplementation of Moringa Leaf Extract Plus Royal Jelly is more effective at
increasing the erythrocyte index levels in anemic pregnant women so that it can
5 be used as an alternative treatment to treat anemia. The supports that drumstick
leaves extract can be used to increase the haemoglobin level of antenatal mothers
with iron deficiency anaemia. 44

A systemic review regarding effectiveness of drum stick leaves on

heamoglobin was among selected all 6 studies. In this review, it is identified that
effectiveness of drumstick leaves on hemoglobin level is clinically significant but
it has small effect size.The systematic review summarizes the data of
effectiveness of drumstick leaves on improving haemoglobin level. The systemic
review supports that drumstick leaves preparation are effective in improving
haemoglobin level. 45