Detection & management of anaemia in pregnancy in an urban primary health care institution.

OBJECTIVE

In India, anaemia in pregnancy remains a major public health problem associated with increased risk of low birth weight deliveries. A study was carried out at an urban primary health institution in Delhi, to assess feasibility of screening all pregnant women attending antenatal clinic for anaemia, identifying those with moderate anaemia (haemoglobin between 5.0 - 7.9 g/dl), administering intramuscular (im) therapy to them in the out-patient department (OPD), and observing the impact on maternal haemoglobin (Hb) levels and birth weight of the infant.

METHODS

In the antenatal clinic all pregnant women were screened for anaemia. Women with Hb between 5.0- 7.9 g/dl were counselled and those who were willing, were given six intramuscular injections each consisting of iron sorbitol citric acid complex containing 150 microg elemental iron, 1500 microg folic acid, 150 microg hydroxocobalamine acetate (vitamin B1)). They were followed up through pregnancy and till delivery. Birth weight of infants of women who received therapy were compared with birth weight of infants born in DCMC.

RESULTS

Over 80 per cent of 3698 women who attended the antenatal clinic were anaemic; 745 (20.1%) had Hb between 5.0-7.9 g/dl. Of these, 419 women agreed to take im therapy as outpatients; 367 took all 6 injections. Metallic taste on the tongue, nausea, vomiting and pain at the injection site were the side effects reported. The mean Hb even 9 wk after completion of therapy was only 9.6 g/dl. Mean birth weight in 340 women who completed the treatment was 2.8 kg - significantly (P<0.001) higher than birth weight in women who had Hb <8.0 g/dl at the time of delivery, but lower than birth weight of infants born to non anaemic women.

CONCLUSIONS

In urban primary health care institutions, it is possible to screen pregnant women for anaemia, identify those with Hb between 5.0 and 7.9 g/dl and give them im therapy as outpatients. Use of a preparation with fewer and milder side effects, counselling and support of women who develop side effect may result in high compliance rates; 900 mg of elemental iron as iron sorbitol citric acid was insufficient to raise mean Hb beyond 9.6 g/dl. The dosage has to be increased to achieve optimal results in relation to maternal haemoglobin levels and birth weight.