The geo-spatial perspective of biological, social and environmental determinants of early pregnancy anaemia in rural Sri Lanka: Need for context-specific approaches on prevention

Submitted: 1 June 2022
Accepted: 4 November 2022
Published: 29 November 2022
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We provide a novel approach to understanding the multiple causations of maternal anaemia in a geospatial context, highlighting how genetics, environment and socioeconomic disparities at the micro-geographical level lead to the inequitable distribution of anaemia. All first-trimester pregnant women registered for the antenatal care programme in Anuradhapura District, Sri Lanka from July to September 2019 were invited to the Rajarata Pregnancy Cohort (RaPCo), which assessed the prevalence of anaemia in early pregnancy. The combination of the prevalence of anaemia and minor haemoglobinopathy-related anaemia (MHA) with the poverty headcount index of the 22 health divisions in the district was investigated using GeoDa spatial K-means clustering. Sociodemographic and economic data at the divisional level were compared between identified clusters. Combining the analysis with the geographical and environmental characteristics of the region, further hypotheses regarding anaemia in this community were formulated. The study included data from 3,137 pregnant women in early pregnancy. The anaemia and MHA prevalence varied from 13.6 to 21.7% and from 2.6% to 5%, respectively. We identified four distinct spatial clusters. The cluster with the highest anaemia prevalence also included high poverty and the highest prevalence of MHA. The clusters had significant differences with regard to ethnic distribution, access to water, sanitation and dietary patterns. Areas supplied by major irrigation projects had significantly low levels of anaemia, probably attributable to internal migration and improved livelihood. It was evident that genetic, socioeconomic and environmental risk factors were grouped at the divisional level, and that their complex interactions make controlling anaemia with blanket interventions unsuccessful. Analysis of the distribution of heterogeneous risk factors at the micro-geospatial level helped identify context-specific approaches to tackle anaemia in pregnancy.

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Adesogan AT, Havelaar AH, McKune SL, Eilittä M, Dahl GE, 2020. Animal source foods: Sustainability problem or malnutrition and sustainability solution? Perspective matters. Glob Food Sec 25,100325. DOI: https://doi.org/10.1016/j.gfs.2019.100325
African Development Bank, Asian Development Bank Department for International Development, & United Kingdom Directorate-General for Development, 2004. Poverty and Climate Change Reducing the Vulnerability of the Poor through Adaptation. https://lib.icimod.org/record/11215/files/1307.pdf?type=primary
Agampodi TC, Wickramasinghe ND, Prasanna RIR, Irangani MKL, Banda JMS, 2020. The Rajarata Pregnancy Cohort (RaPCo): study protocol. BMC Pregnancy Childbirth 20,374. DOI: https://doi.org/10.1186/s12884-020-03056-x
Agegenehu CD, Tesema GA, Teshale AB, Alem AZ, Yeshaw Y, Kebede SA, Liyew AM, 2021. Spatial distribution and determinants of iron supplementation among pregnant women in Ethiopia: a spatial and multilevel analysis. Arch Public Health 79:143. DOI: https://doi.org/10.1186/s13690-021-00669-2
Ahmed F, Khan MR, Shaheen N, Ahmed KMU, Hasan A, Chowdhury IA, Chowdhury R, 2018. Anaemia and iron deficiency in rural Bangladeshi pregnant women living in areas of high and low iron in groundwater. Nutr 51–52:46–52. DOI: https://doi.org/10.1016/j.nut.2018.01.014
Aimone AM, 2016. Geospatial Patterns and Associated Risks of Iron Deficiency and Infection among Young Ghanaian Children: Implications for the Safety of Iron Supplementation in Malaria Endemic Areas (Doctoral thesis, University of Toronto). https://tspace.library.utoronto.ca/handle/1807/77629
Alwan N, Hamamy H, 2015. Maternal Iron Status in Pregnancy and Long-Term Health Outcomes in the Offspring. J Pediatr Genet 4:111–23. DOI: https://doi.org/10.1055/s-0035-1556742
Amarasinghe G, Mendis V,Agampodi T, 2021. A cross-sectional study to assess aetiology and associated factors for anaemia during the first trimester of pregnancy in Anuradhapura District, Sri Lanka: a protocol. F1000 Research 10,223. DOI: https://doi.org/10.12688/f1000research.28226.2
Amarasinghe GS, Agampodi TC, Mendis V, Malawanage K, Kappagoda C, Agampodi, SB, 2022. Prevalence and aetiologies of anaemia among first-trimester pregnant women in Sri Lanka; the need for revisiting the current control strategies. BMC Pregnancy Childbirth 22,1–12. DOI: https://doi.org/10.1186/s12884-021-04341-z
Angastiniotis, M, Modell B, 1998. Global epidemiology of haemoglobin disorders. Ann N Acad Sci 850:251–69. DOI: https://doi.org/10.1111/j.1749-6632.1998.tb10482.x
Balarajan Y, Ramakrishnan U, Özaltin E, Shankar AH, Subramanian SV, 2011. Anaemia in low-income and middle-income countries. Lancet 378:2123–35. DOI: https://doi.org/10.1016/S0140-6736(10)62304-5
Belay DG, Adane SM, Ferede OL, Lakew AM, 2022. Geographically weighted regression analysis of anemia and its associated factors among reproductive age women in Ethiopia using 2016 demographic and health survey. PloS One 17,e0274995. DOI: https://doi.org/10.1371/journal.pone.0274995
Brannon PM, TaylorCL, 2017. Iron Supplementation during Pregnancy and Infancy: Uncertainties and Implications for Research and Policy. Nutr 9, https://doi.org/10.3390/nu9121327 DOI: https://doi.org/10.3390/nu9121327
Chaparro CM, Suchdev PS, 2019. Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Ann N Y Acad Sci 1450:15–31. DOI: https://doi.org/10.1111/nyas.14092
Clegg JB, WeatherallDJ, 1999. Thalassemia and malaria: new insights into an old problem. Proc Assoc Am Physicians 111:278–82. DOI: https://doi.org/10.1046/j.1525-1381.1999.99235.x
Cluster Analysis.2019. Retrieved January 8, 2022, from https://geodacenter.github.io/workbook/7b_clusters_2/lab7b.html
Colah R, Gorakshakar A, NadkarniA, 2010. Global burden, distribution and prevention of β-thalassemias and hemoglobin E disorders. Expert Rev Hematol 3:103–17. DOI: https://doi.org/10.1586/ehm.09.74
Cornelsen L, Alarcon P, Häsler B, Amendah DD, Ferguson E, Fèvre EM, Grace D, Dominguez-Salas P, Rushton J, 2016. Cross-sectional study of drivers of animal-source food consumption in low-income urban areas of Nairobi, Kenya. BMC Nutr 2(1):1–13. DOI: https://doi.org/10.1186/s40795-016-0109-z
Correa-Agudelo E, Kim HY, Musuka GN, MukandavireZ, Miller FDW, Tanser F, CuadrosDF, 2021. The epidemiological landscape of anemia in women of reproductive age in sub-Saharan Africa. Sci Rep 11:11955. DOI: https://doi.org/10.1038/s41598-021-91198-z
de Silva MWA. 2020. Drinking Water and CKD of Unknown Etiology in Sri Lanka: A Community Perspective. Ann Nutr Metab 76:37–42. DOI: https://doi.org/10.1159/000515018
de Silva S, Fisher CA, Premawardhena A, Lamabadusuriya SP, Peto TEA, PereraG, Old JM, Clegg JB, Olivier NF, Weatherall DJ 2000. Thalassaemia in Sri Lanka: Implications for the future health burden of Asian populations. Lancet 355:786–91. DOI: https://doi.org/10.1016/S0140-6736(99)08246-X
DeClerck FAJ, Jessica F, Cheryl P, RoselineR, 2011. Ecological approaches to human nutrition. Food and Nutrition Bulletin, 32,S41-50. DOI: https://doi.org/10.1177/15648265110321S106
Department of Census and Statistics Sri Lanka, 2018. District Statistical HandBook. http://www.statistics.gov.lk/DistrictStatHBook.asp
di Cesare M, Ghosh S,Osendaarp S, Mozaffarian D, 2021. The burden of malnutrition - Global Nutrition Report. https://globalnutritionreport.org/reports/global-nutrition-report-2018/burden-malnutrition/
Endris BS, Dinant GJ, Gebreyesus SH, SpigtM, 2021. Geospatial inequality of anaemia among children in Ethiopia. Geospat Health 16,1036. DOI: https://doi.org/10.4081/gh.2021.1036
Family Health Burro Sri Lanka, 2020. Annual Report_2019. https://drive.google.com/file/d/1EsRRNgINb5uUxJMQLnwX3TfoAHa1Nc6q/view
Fenta HM, ZewotirT, Muluneh EK, 2021. Spatial data analysis of malnutrition among children under-five years in Ethiopia. BMC Med Res Methodol 21,232. DOI: https://doi.org/10.1186/s12874-021-01391-x
Fite MB, Assefa N, Mengiste B2021. Prevalence and determinants of Anemia among pregnant women in sub-Saharan Africa: a systematic review and Meta-analysis. Arch Public Health 79:219. DOI: https://doi.org/10.1186/s13690-021-00711-3
Gebretsadik GG, Adhanu AK, Mulugeta A, 2022. Magnitude and determinants of animal source food consumption among children aged 6–23 months in Ethiopia: secondary analysis of the 2016 Ethiopian demographic and health survey. BMC Public Health 22:1–10. DOI: https://doi.org/10.1186/s12889-022-12807-8
Goonewardene M, Shehata M, Hamad A, 2012. Anaemia in pregnancy. Best Pract Res Clin Obstet Gynaecol 26:3–24. DOI: https://doi.org/10.1016/j.bpobgyn.2011.10.010
Hasan MM, Soares Magalhaes RJ, Garnett SP, Fatima Y, Tariqujjaman M, Pervin S, Ahmed S, Mamun AA, 2022. Anaemia in women of reproductive age in low- and middle-income countries: progress towards the 2025 global nutrition target. Bull World Health Org 100,196. DOI: https://doi.org/10.2471/BLT.20.280180
Hernández-Vásquez A, Azañedo D, Antiporta DA, Cortés S, 2017. Spatial analysis of gestational anemia in Peru, 2015. Rev Peru Med Exp Salud Publica 34:43–51. DOI: https://doi.org/10.17843/rpmesp.2017.341.2707
Hopenhayn C, Bush HM, Bingcang A, Hertz-Picciotto I, 2006. Association between arsenic exposure from drinking water and anemia during pregnancy. J Occup Environ Med 48,635–643. DOI: https://doi.org/10.1097/01.jom.0000205457.44750.9f
Hotez P, 2008. Hookworm and poverty. Ann N Y Acad Sci 1136:38–44. DOI: https://doi.org/10.1196/annals.1425.000
International Food Policy Research Institute, 2010. Food security and climate change | IFPRI : International Food Policy Research Institute. https://www.ifpri.org/publication/food-security-and-climate-change
Ivers LC, Cullen KA, 2011. Food insecurity: special considerations for women. Am J Clin Nutr 94(6), 1740S. DOI: https://doi.org/10.3945/ajcn.111.012617
Jayatissa R, Fernando DN, de Silva H, 2017. National Nutrition and Micronutrient Survey of Pregnant Women in Sri Lanka 2015. Colombo: Medical Research Institute, 2017. https://scholar.google.com/citations?user=sN0qOkQAAAAJ&hl=en
Jones AD, Acharya Y, Galway LP, 2016. Urbanicity gradients are associated with the household- and individual-level double burden of malnutrition in sub-saharan Africa. J Nutr 146:1257–67. DOI: https://doi.org/10.3945/jn.115.226654
Jwa SC, Fujiwara T, Yamanobe Y, Kozuka K, Sago H, 2015. Changes in maternal hemoglobin during pregnancy and birth outcomes. BMC Pregnancy Childbirth 15,80. DOI: https://doi.org/10.1186/s12884-015-0516-1
Kafle K, BalasubramanyaS, Horbulyk T, 2019. Prevalence of chronic kidney disease in Sri Lanka: A profile of affected districts reliant on groundwater. Sci Total Environ 694,133767. DOI: https://doi.org/10.1016/j.scitotenv.2019.133767
Kandauda IC, Tennakoon S, Rathnayake PM, Maduwage K, Gunathilake T, 2020. Prevalence and aetiology of anaemia in pregnant women attending a tertiary care unit in srilanka, and its effect on the mother and newborn. Sri Lanka J Med 29,37. DOI: https://doi.org/10.4038/sljm.v29i2.223
Karunaweera ND, Ginige S, Senanayake S, Silva H, Manamperi N, Samaranayake N, Siriwardana Y, Gamage D, Senerath U, Zhou G, 2020. Spatial Epidemiologic Trends and Hotspots of Leishmaniasis, Sri Lanka, 2001-2018. Emerg Infect Dis 26:1–10. DOI: https://doi.org/10.3201/eid2601.190971
Khoigani MG, Goli S, Hasanzadeh A, 2012. The relationship of hemoglobin and hematocrit in the first and second half of pregnancy with pregnancy outcome. Iran J Nurs Midwifery Res 17:S165-70.
Kibret KT, Chojenta C, D’Arcy E,Loxton D, 2019. Spatial distribution and determinant factors of anaemia among women of reproductive age in Ethiopia: a multilevel and spatial analysis. BMJ Open, 9,e027276. DOI: https://doi.org/10.1136/bmjopen-2018-027276
Kinyoki, D, Osgood-ZimmermanAE, Bhattacharjee N, Schaeffer LE, Lazzar-Atwood A, Lu D, Ewald SB, Donkers KM, Letourneau ID, Collison M, Schipp MF, Abajobir A, Abbasi S, Abbasi N, Abbasifard M, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, Abdelalim A, Hay SI, 2021. Anemia prevalence in women of reproductive age in low- and middle-income countries between 2000 and 2018. Nat Med 27:1761–82.
Konradsen F, Amerasinghe FP, van der HoekW, Amerasinghe PH, 2000. Malaria in Sri Lanka. International Water Management Institute. https://publications.iwmi.org/pdf/H027692.pdf
Lai K, Huang G, Su L, He Y, 2017. The prevalence of thalassemia in mainland China: evidence from epidemiological surveys. Sci Rep 7,920. DOI: https://doi.org/10.1038/s41598-017-00967-2
Lebso M, Anato A, Loha E, 2017. Prevalence of anemia and associated factors among pregnant women in Southern Ethiopia: A community based cross-sectional study. PloS One 12,e0188783 DOI: https://doi.org/10.1371/journal.pone.0188783
Lover AA, Hartman M, Chia KS, Heymann DL, 2014. Demographic and spatial predictors of anemia in women of reproductive age in timor-leste: implications for health program prioritization. PLoS One 9,e91252. DOI: https://doi.org/10.1371/journal.pone.0091252
Mahaweli Authority of Sri Lanka, 2018. Socio-economic Statistics 2018.http://mahaweli.gov.lk/PDF/Statistical%20Book%20-%202018%20Final.pdf
Maps for Rates or Proportions. (2018). Retrieved January 8, 2022, from https://geodacenter.github.io/workbook/3b_rates/lab3b.html
Ness TE, Agrawal V, Bedard K, Ouellette L, Erickson TA, Hotez P, Weatherhead JE, 2020. Maternal Hookworm Infection and Its Effects on Maternal Health: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg 1031958–68. DOI: https://doi.org/10.4269/ajtmh.20-0503
Nguyen PH, ScottS, Avula R, Tran LM, MenonP, 2018. Trends and drivers of change in the prevalence of anaemia among 1 million women and children in India, 2006 to 2016. BMJ Glob Health 3,e001010. DOI: https://doi.org/10.1136/bmjgh-2018-001010
Ogunsakin RE, Akinyemi O, Babalola BT, Adetoro G, 2021. Spatial pattern and determinants of anemia among women of childbearing age in Nigeria. Spat Spatiotemporal Epidemiol 36. DOI: https://doi.org/10.1016/j.sste.2020.100396
Osgood-Zimmerman A, Millear AI, Stubbs RW, Shields C, Pickering BV, Earl L, Graetz N, Kinyoki DK, Ray SE, Bhatt S, Browne AJ, Burstein R, Cameron E, Casey DC, Deshpande A, Fullman N, Gething PW, Gibson HS, Henry NJ, Hay SI, 2018. Mapping child growth failure in Africa between 2000 and 2015. Nature 555:41–7. DOI: https://doi.org/10.1038/nature25760
Owais A, Merritt C, Lee C, Bhutta ZA, 2021. Anemia among women of reproductive age: An overview of global burden, trends, determinants, and drivers of progress in low-and middle-income countries. Nutr 13(8), 2745. https://doi.org/10.3390/NU13082745/S1 DOI: https://doi.org/10.3390/nu13082745
Premawardhena A, de Silva S, Arambepola M, Olivieri N, Merson L, Muraco J, Allen A, Fisher C, Peto T, Vichinsky E, Weatherall D,2004. Thalassemia in Sri Lanka: a progress report. Hum Mol Genet 13:R203–R206. DOI: https://doi.org/10.1093/hmg/ddh250
Rajapakse S, Shivanthan MC, Selvarajah M, 2016. Chronic kidney disease of unknown etiology in Sri Lanka. Int J Occup Environ Health 22, 259. DOI: https://doi.org/10.1080/10773525.2016.1203097
Statistics Division of District Secretariat Anuradhapura, 2018. Anuradhapura District Statistical Hand Book-2018. www.statistics.gov.lk
Sun W, XueL, Xie X, 2017. Spatial-temporal distribution of dengue and climate characteristics for two clusters in Sri Lanka from 2012 to 2016. Sci Rep 7,12884. DOI: https://doi.org/10.1038/s41598-017-13163-z
Vilar-Compte M, Burrola-Méndez S, Lozano-Marrufo A, Ferré-Eguiluz I, Flores D, Gaitán-Rossi P, Teruel G, Pérez-Escamilla R, 2021. Urban poverty and nutrition challenges associated with accessibility to a healthy diet: a global systematic literature review. Int J Equity Health 20:40. DOI: https://doi.org/10.1186/s12939-020-01330-0
World Health Organization, 2014. Global nutrition targets 2025: anaemia policy brief. https://www.who.int/publications/i/item/WHO-NMH-NHD-14.4
World Health Organization, 2015. Anaemia. World Health Organization. http://www.who.int/topics/anaemia/en/
World Bank, 2019. Prevalence of anemia among pregnant women (%) - Fragile and conflict affected situations | Data. https://data.worldbank.org/indicator/SH.PRG.ANEM?locations=F1
Zerfu TA, Umeta M, Baye K, 2016. Dietary diversity during pregnancy is associated with reduced risk of maternal anemia, preterm delivery, and low birth weight in a prospective cohort study in rural Ethiopia. Am J Clin Nutr 103:1482–8. DOI: https://doi.org/10.3945/ajcn.115.116798
Suneth Buddhika Agampodi, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura

Chair Professor, Department of Community Medicine

How to Cite

Amarasinghe, G. S., Agampodi, T. C., Mendis, V., & Agampodi, S. B. (2022). The geo-spatial perspective of biological, social and environmental determinants of early pregnancy anaemia in rural Sri Lanka: Need for context-specific approaches on prevention. Geospatial Health, 17(2). https://doi.org/10.4081/gh.2022.1110

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