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.(deniaprianichan)
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