World Health Organization , 2015. The Global Prevalence of Anaemia in 2011. Geneva, Switzerland: WHO.
Rahman MM , Abe SK , Rahman MS , Kanda M , Narita S , Bilano V , Ota E , Gilmour S , Shibuya K , 2016. Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and meta-analysis. Am J Clin Nutr 103: 495–504.
Young MF , Oaks BM , Tandon S , Martorell R , Dewey KG , Wendt AS , 2019. Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta-analysis. Ann NY Acad Sci 1450: 47–68.
Muñoz M et al. 2018. Patient blood management in obstetrics: management of anaemia and haematinic deficiencies in pregnancy and in the post-partum period: NATA consensus statement. Transfus Med 28: 22–39.
Keats EC , Haider BA , Tam E , Bhutta ZA , 2019. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev 3: CD004905.
Singh JK , Acharya D , Paudel R , Gautam S , Adhikari M , Kushwaha SP , Park JH , Yoo SJ , Lee K , 2020. Effects of female community health volunteer capacity building and text messaging intervention on gestational weight gain and hemoglobin change among pregnant women in southern Nepal: a cluster randomized controlled trial. Front Public Health 8: 312.
Bharti S , Bharti B , Naseem S , Attri SV , 2015. A community-based cluster randomized controlled trial of “directly observed home-based daily iron therapy” in lowering prevalence of anemia in rural women and adolescent girls. Asia Pac J Public Health 27: NP1333–NP1344.
Ampofo GD , Tagbor H , Bates I , 2018. Effectiveness of pregnant women’s active participation in their antenatal care for the control of malaria and anaemia in pregnancy in Ghana: a cluster randomized controlled trial ISRTCTN88917252 ISRTCTN. Malar J 17: 238.
Scott S et al. 2019. Community-based malaria screening and treatment for pregnant women receiving standard intermittent preventive treatment with sulfadoxine-pyrimethamine: a multicenter (The Gambia, Burkina Faso, and Benin) cluster-randomized controlled trial. Clin Infect Dis 68: 586–596.
Kesteman T , Randrianarivelojosia M , Rogier C , 2017. The protective effectiveness of control interventions for malaria prevention: a systematic review of the literature. F1000 Res 6: 1932.
Institut National de la Statistique et de la Démographie (INSD) Burkina Faso, 2010. Enquête Démographique et de Santé et à Indicateurs Multiples (EDS MICS IV). Ouagadougou, Burkina Faso: INSD.
Meda N , Dao Y , Touré B , Yameogo B , Cousens S , Graham W , 1999. Évaluer l’anémie maternelle sévère et ses conséquences: la valeur d’un simple examen de la coloration des conjonctives palpébrales. Cah d’études Rech Francoph 9: 12–17.
Meda N , Coulibaly M , Nebie Y , Diallo I , Traore Y , Ouedraogo LT , 2016. Magnitude of maternal anaemia in rural Burkina Faso: contribution of nutritional factors and infectious diseases. Adv Public Health 2016: 1–7.
Black RE et al. 2017. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 8. summary and recommendations of the expert panel. J Glob Health 7: 010908.
ARES , 2016. Programme Interuniversitaire Ciblé. Available at: https://www.ares-ac.be/images/prd-pfs/rapports/ARES-PRD_Rapport-de-resultats-des-programmes-2008-2009.pdf. Accessed October 28, 2016.
Sanchis-Gomar F , Cortell-Ballester J , Pareja-Galeano H , Banfi G , Lippi G , 2013. Hemoglobin point-of-care testing. J Lab Autom 18: 198–205.
Brown AW , Li P , Brown MMB , Kaiser KA , Keith SW , Oakes JM , Allison DB , 2015. Best (but oft-forgotten) practices: designing, analyzing, and reporting cluster randomized controlled trials. Am J Clin Nutr 102: 241–248.
Donner A , Birkett N , Buck C , 1981. Randomization by cluster: sample size requirements and analysis. Am J Epidemiol 114: 906–914.
Donner A , Klar N , 2000. Design and Analysis of Cluster Randomization Trials in Health Research. London, UK: Arnold.
World Medical Association , 2018. WMA Declaration of Helsinki—Ethical Principles for Medical Research Involving Human Subjects. Available at: https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/. Accessed December 19, 2018.
Nguyen PH et al. 2018. Engagement of husbands in a maternal nutrition program substantially contributed to greater intake of micronutrient supplements and dietary diversity during pregnancy: results of a cluster-randomized program evaluation in Bangladesh. J Nutr 148: 1352–1363.
Etheredge AJ et al. 2016. Iron supplementation among iron-replete and non-anemic pregnant women: a randomized placebo-controlled trial in Tanzania Analee. JAMA Pediatr 169: 947–955.
Daru J , Cooper NAM , Khan KS , 2016. Systematic review of randomized trials of the effect of iron supplementation on iron stores and oxygen carrying capacity in pregnancy. Acta Obstet Gynecol Scand 95: 270–279.
Ahamed F , Yadav K , Kant S , Saxena R , Bairwa M , Pandav CS , 2018. Effect of directly observed oral iron supplementation during pregnancy on iron status in a rural population in Haryana: a randomized controlled trial. Indian J Public Health 62: 287–293.
Keats EC , Haider BA , Tam E , Bhutta ZA , 2019. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev 2019.
Pasricha SR , Drakesmith H , Black J , Hipgrave D , Biggs B-AA , 2013. Control of iron deficiency anemia in low- and middle-income countries. Blood 121: 2607–2617.
Nsibu CN , Manianga C , Kapanga S , Mona E , Pululu P , Aloni MN , 2016. Determinants of antenatal care attendance among pregnant women living in endemic malaria settings: experience from the Democratic Republic of Congo. Obstet Gynecol Int 2016: 1–7.
Ministère de la Santé_Burkina Faso, 2019. Annuaire Statistique 2018. Ouagadougou.
|Past two years||Past Year||Past 30 Days|
|Full Text Views||303||217||5|
Burkina Faso has high prevalence of anemia in pregnancy (hemoglobin < 11 g/dL), despite the implementation of the WHO recommended guidelines. This study aimed to test the effects of personalized support for pregnant women at home on the trend of anemia prevalence in pregnancy. A cluster randomized trial was conducted from January 2015 to August 2016 at Sindou health district in Burkina Faso. Data were collected from 617 women in their first or second trimester of pregnancy, including 440 and 177 women in the intervention and control groups, respectively. The intervention consisted of a monthly home-based visit to the pregnant woman, focusing on nutritional counseling and pregnancy management, alongside an improvement antenatal visit quality. Compared with the prevalence of anemia in pregnancy in the control group [64.0% (95% confidence interval [CI]: 52.1–74.4%)], that of the intervention group was significantly lower from the fifth home visit onward [36.8% (95% CI: 32.1–41.8%)] (P < 0.001). The adjusted difference-in-differences in anemia prevalence between the two groups was –19.8% (95% CI: –30.2% to –9.4%) for women who received more than four home visits (P < 0.001). The corresponding difference in hemoglobin levels was 0.644 g/dL (95% CI: 0.309–0.167; P < 0.001). Personalized support for pregnant women at home, combined with appropriate antenatal care, can significantly reduce anemia prevalence during pregnancy in rural Burkina Faso.
Financial support: This study was supported by the Coopération Universitaire pour le Développement (now Académie de Recherche et d'Enseignement Supérieur) of the Kingdom of Belgium for the follow-up of pregnant women and data collection.
Authors’ addresses: Bernard Ilboudo, Centre Muraz, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso, and Ecole de Santé Publique, Université libre de Bruxelles, Brussels, Belgium, E-mail: firstname.lastname@example.org. Léon G. B. Savadogo, Isidore Traoré, Clément Z. Méda, Maurice Kinda, and Issiaka Sombié, Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso, E-mails: email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, and email@example.com. Michèle Dramaix-Wilmet and Philippe Donnen, Ecole de Santé Publique, Université libre de Bruxelles, Brussels, Belgium, E-mails: firstname.lastname@example.org and email@example.com.