Anaemia in pregnant Ghanaian women: importance of malaria, iron deficiency, and haemoglobinopathies

In sub-Saharan Africa, anaemia in pregnancy results from multiple causes in cluding malaria, iron deficiency and haemoglobinopathies. In a cross-sectio nal study among 530 pregnant women in Ghana in November-December 1998, red blood cell indices were analysed with respect to malaria, serum concentrati ons of ferritin and C-reactive protein (CRP), and the haemoglobin and alpha -globin genotypes. Anaemia (haemoglobin [Hb] <11 g/dL) was found in 54% of the women; 63% harboured malaria parasites at predominantly low numbers. F erritin levels were considerably influenced by malaria and inflammatory pro cesses (CRP >0(.)6 mg/dL). Depending on the definition applied, the prevale nce of iron deficiency ranged between 5% and 46%. The HbAS trait was observ ed in 14%, HbAC and elevated HbF in 7% each, and sickle cell disease in 1%. Heterozygous beta -thalassaemia was present in 1% of the women and alpha ( +)-thalassaemia in 33% (29% heterozygous, 4% homozygous). Women with HbAS h ad higher malaria parasite densities than those with HbAA. In individuals w ith highly elevated HbF (>10%), parasitaemia occurred in 27% only. Low grav idity, second trimester of pregnancy, malaria, raised CRP levels, and homoz ygous alpha (+)-thalassaemia were independent risk factors for anaemia in m ultivariate analysis, alpha (+)-Thalassaemia, however, was associated with a lesser degree of malarial anaemia when compared to non-thalassaemic women . Iron deficiency appears not to be a major health problem in this populati on. Haemoglobinopathies are common but, except for homozygous ai-thalassaem ia, do not substantially contribute to anaemia in pregnancy. alpha (+)-Thal assaemia ameliorates malarial anaemia in pregnant women.