ANEMIA, BLOOD-TRANSFUSION PRACTICES, HIV AND MORTALITY AMONG WOMEN OFREPRODUCTIVE AGE IN WESTERN KENYA

Severe anaemia among women in sub-Saharan Africa is frequently treated with blood transfusions. The risk of transmission of human immunodefi ciency virus (HIV) through blood products has led to a re-evaluation o f the indications for transfusions. Prospective surveillance of women admitted to a district hospital in western Kenya was conducted from 1 December 1990 to 31 July 1991, for haemoglobin (Hb) transfusion status , and outcome. Of the 2986 enrolled women (mean Hb 10.4 g/dL, sD+/-2.6 , median age 24.4 years), 6% were severely anaemic (Hb <6.0 g/dL). Sev ere anaemia was associated with a higher mortality rate (10.7% vs. 14% , odds ratio (OR)=8.2, 95% confidence interval (CI) 2.6, 34.2) compare d with women with Hb greater than or equal to 6.0 g/dL. Decreased mort ality rates in hospital were observed with increasing Hb values (OR=0. 43, 95% CI 0.19, 0.98), but blood transfusions did not improve surviva l in hospital(OR=1.56, 95% CI 0.22, 11.03). The attributable mortality due to HIV infection and severe anaemia was 75% and 31%, respectively . Maternal/child health care services must include prevention strategi es for HIV transmission and the prevention, recognition, and treatment of severe anaemia.