Anaemia in HIV positive mothers on antiretroviral therapy for prevention of mother-to-child transmission HIV in a tertiary health institution in North Central Nigeria
DOI:
https://doi.org/10.18203/2320-6012.ijrms20212216Keywords:
HIV positive, Pregnant mothers, Anaemia, Thrombocytopenia, LeukopeniaAbstract
Background: Anaemia in pregnancy and HIV infection are two common public health issues in sub-Saharan African with Nigeria bearing the greatest burden. The duo occurring together poses a higher risk of morbidity and mortality for both the foetus and the mother. We therefore conducted this study to determine the burden of anaemia and other haematological abnormalities among HIV positive pregnant mothers on antiretroviral therapy who attended antenatal clinical services in our health institution.
Methods: A 10-year retrospective review from January 2010 to December 2019 of medical records of HIV positive mothers on highly anti-retroviral therapy in attendance for antenatal clinical services in our health institution was carried out for the above objectives. Information extracted were, age, HIV status, gestational age at delivery, type of antiretroviral drugs used, duration of use, haemoglobin level, platelet, and complete blood count at booking of the positive mothers.
Results: Of a total of 330 HIV positive mothers seen during the review period, 82.7% were from rural communities, 88.8% were from middle socio-economic class, 80.0% were Christians, and 80.3% started their highly active antiretroviral therapy before their index pregnancy. Most, 51.5% and 42.7% were on zidovudine, lamivudine and nevirapine, and tenofovir with lamivudine and lopinavir boasted ritonavir combinations, while 94.2% were on 1st line antiretroviral medication. Their mean age, gestational age at delivery, and parity were 31.11±4.7 years, 38.57±3.1 weeks, and 2.0±1.6 respectively. The prevalence of anaemia, thrombocytopenia and leucopoenia were 36.1%, 4.8%, and 6.7% respectively while their mean CD4 cell count and viral loads at the point of booking were 543.63±283.7 cells/μl, and 2953.02±1619.9 copies/ml. The two maternal variables that showed significant relationship with haemoglobin concentration of <10 gm/dl was mother’s level of education x2=6.29, p=0.043, and her socio=economic class, x2=10.162, p=0.006.
Conclusions: There is high burden of anaemia among HIV positive mothers on antiretroviral therapy in our environment. The prevalence of thrombocytopenia and leucopoenia was much lower. The burden of maternal anaemia was associated with maternal level of education and her socio-economic class.
References
Adesina O, Oladokun A, Akinyemi O, et al. Risk of anaemia in HIV positive pregnant women in Ibadan, South West Nigeria. Afr J Med Med Sci. 2011;40(1):67-73.
Odhiambo C, Zeh C, Angira F. Anaemia in HIV-infected pregnant women receiving triple antiretroviral combination therapy for prevention of mother-to-child transmission: a secondary analysis of the Kisumu breastfeeding study (KiBS). Trop Med Int Hlth. 2016;21(3):373-84.
World Health Organization. Micronutrient deficiencies. Iron deficiency anaemia; 2008. Available from: www:who.int.who. int/nutrition/topics/ida/en/index.html. Accessed on 1 Jan. 2020.
Uneke CJ, Duhlinska DD, Igbinedion EB. Prevalence and Public-health Significance of HIV Infection and Anemia among Pregnant Women Attending Antenatal Clinics in South-eastern Nigeria. J Health Popul Nutr. 2007;(3):328-35.
Osungbade KO, Oladunjoye AO. Anaemia in developing countries: burden and prospects of prevention and control. 2012;3:116-29.
WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. 2011.
National Department of Health. Saving mothers 2010-2013: sixth report of confidential enquiries into maternal deaths in South Africa. Pretoria: NDOH. 2013.
Bruno B, Mclean E, Egli I, Cogswell M. World prevalence of anemia 1993‑2005. WHO global database on anemia. Geneva: World Health Organisation, WHO/WH/155; 2008.
Yaya S, Shibre G, Idriss-Wheeler D, Uthman OA. Women’s Empowerment and HIV Testing Uptake: A Meta-analysis of Demographic and Health Surveys from 33 Sub-Saharan African Countries. Int J Matern Child Heal AIDS. 2020;9(3):274-86.
Dabis F, Ekpini ER. HIV-1/AIDS and maternal and child health in Africa. Lancet. 2002;359:2097-104.
Sloan N, Jordan E, Winikoff B. Effects of iron supplementation on maternal hematologic status in pregnancy. Am J Public Health. 2002;92:288-93.
Van den Broek N. Anaemia and micronutrient deficiencies. Br Med Bull. 2003;67:149-60.
Agarwal D, Chakravarty J, Chaube L, Rai M, Agrawal NR, Sundar S. High incidence of zidovudine induced anaemia in HIV infected patients in eastern India. Indian J Med Res. 2010;132:386-9.
Kumarasamy N, Venkatesh KK, Devaleenol B. Safe substitution to zidovudine among HIV-infected patients initiated on stavudine-containing highly active antiretroviral therapy from a resource-limited setting. Int J Infect Dis. 2009;13:e360-4.
Curkendall S, Richardson JT, Emons MF, Fisher AE, Everhard F. Incidence of anaemia among HIV-infected patients treated with highly active antiretroviral therapy. HIV Med. 2007;8:483-90.
Okechukwu AA, Gambo D, Okechukwu OI. Prevalence of anaemia in HIV-Infected children at the University of Abuja Teaching Hospital, Gwagwalada. NJM. 2010;19(1):50-7.
Emdex. Based on WHO model formulary. The complete drug formulary Xfor Nigerian health professionals with guide to drug administration. Lindox Book Int’l, Mississauga, Canada. 2007;330.
Weiss G, Goodnough LT. Anaemia of chronic disease. N Engl J Med. 2005;352:1011-23.
Ayisi J, Van Eijk AM, Ter Kuile FO. The effect of dual infection with HIV and malaria on pregnancy outcome in western Kenya. AIDS. 2003;17:585-94.
Brooker S, Hotez PJ, Bundy DA. Hookworm-related anaemia among pregnant women: a systematic review. PLoS Negl Trop Dis. 2008;2:e291.
Federal Ministry of Health Nigeria. National Guidelines for Prevention of Mother to Child Transmission of HIV (PMTCT). Abuja: Federal Ministry of Health. 2010.
Federal Ministry of Health Nigeria. National Guidelines for Prevention of Mother to Child Transmission of HIV (PMTCT). Abuja: Federal Ministry of Health. 2018.
Omote V, Ukwamedua HA, Bini N, Kashibu E, Ubandoma JR, Ranyang A. Prevalence, Severity, and Correlates of Anaemia in Pregnancy among Antenatal Attendees in Warri, South-Southern Nigeria: A Cross-Sectional and Hospital-Based Study. Anemia. 2020.
National Agency for the Control of AIDS (NACA). Revised National HIV and AIDS Strategic Framework. 2019.
Erhabor O, Ejele OA, Nwauche CA. Some haematological parameters in human immunodeficiency virus (HIV) infected Africans: The Nigerian perspective. Niger J Med. 2005;14:33-8.
Okunade KS, Adegbesan-Omilabu MA. Anemia among pregnant women at the booking clinic of a Teaching Hospital in South-western Nigeria. Int J of Med Biomed Resea. 2014;3(2):114-20.
Harrison KA. Anemia in pregnancy. In: Lawson JB, Harrison KA, Bergsrom S (editors). Maternity Care in Developing countries. Roy Colle Obstet Gynaecol Press. 2000;2-128.
World Health Organization. The prevalence of anaemia in women: a tabulation of available information. Geneva: World Health Organization, 1992;100
Olusanya O, Okpere EE, Ezimokhai M. The Importance of Socio-economic class in voluntary fertility in the developing country. West Afr Med J. 1985;4:205-9.
Ohihoin AG, Musa J, Sagay AS, Uja IAO, Herberston EC, Ocheke A. Prevalence and determinants of anemia among HIV positive pregnant women attending ante-natal clinic at Jos University Teaching Hospital, Jos North Central Nigeria: BJM Med research. 2014;4(34):5348-56.
Eze IO, Innoeze CU, Ayogu ME, Stephen C, Eze SC. Prevalence and determinants of anemia amongst HIV positive pregnant women in a tertiary Hospital in Nigeria. Int J Reprod Contracept Obstet Gynecol. 2020;9(12):4825-33.
Tunkyia K, Moodleya J. Anaemia in pregnancy in a setting of high HIV prevalence rates. S Afr J Infect Dis. 2017;32(4):138-41.
Ndukwu GU, Dienye PO. Prevalence and socio-demographic factors associated with anaemia in pregnancy in a primary health center in River’s state, Nigeria. Afr J Prm Heal Car Fam Med. 2012;4(1):1-7.
Okeudo C, Ezem BU, Ojiyi EC, Anolue FC, Dike EI. Prevalence of anemia among HIV positive pregnant women at booking in Orlu, South-Eastern Nigeria: Afri Medic J. 2014;5(1):45-9.
Olatunbosun OA, Abasiattai AM, Bassey EA, James RS, Ibanga G, Morgan A. Prevalence of anaemia among pregnant women at booking in the University of Uyo Teaching Hospital, Uyo, Nigeria. Bio Med Resea Int. 2014;2014.
Nandlal V, Moodley D, Grobler A. Anaemia in pregnancy is associated with advanced HIV disease. PLoS ONE. 2014;9(9):e106103.
Grztchen A, Gernald I. Msamango, Donna S, Ernest JN, Urassa et al. Nutritional factors and infectious disease contribute to anemia among pregnant women with Human Immuno Deficiency Virus in Tanzania. J Nutrit. 2002;130:19050-57.
Moyle G. Anemia in persons with HIV infection: prognostic marker and contribution to morbidity. AIDS Rev. 2002;4(1):13-20.
Liebman HA, Stasi R. Secondary immune thrombocytopenic purpura. Curr Opin Hematol. 2007;14(5):557-73.
Sullivan PS, Hanson DL, Chu SY, Jones JL, Ciesielski CA. Surveillance for thrombocytopenia in persons infected with HIV: results from the multistate Adult and Adolescent Spectrum of Disease Project. J Acquir Immune Defic Syndr Hum Retrovirol. 1997;14(4):374-9.
Marks KM, Robin MA, Bussel JB, Talal AH, Glesby MJ. Risk factors for thrombocytopenia in HIV-infected persons in the era of potent antiretroviral therapy. J Acquir Immune Defic Syndr. 2009;52(5):595-9.
Munyazesa E, Emile I, Mutimura E, Hoover DR, Shi Q, McGinn AP et al. Assessment of haematological parameters in HIV-infected and uninfected Rwandan women: a cross-sectional study. BMJ. 2012;2:e001600.
Mekonnen FA, Ambaw YA, Neri GT. Socio-economic determinants of anemia in pregnancy in North Shoa Zone, Ethiopia. PLoS One. 2018;13(8):e0202734.
Nwizu EN, Iliyasu Z, Ibrahim SA, Galadanci HS. Socio-Demographic and Maternal Factors in Anaemia in Pregnancy at Booking in Kano, Northern Nigeria. Afr J Reprod Health. 2011;15(4):33-41.
Van den Broek. Anaemia in pregnancy in Southern Malawi: prevalence and risk factors. Brit J. Obstet Gynaecol. 2000;107:445-1.
