Space-time cluster analysis of anemia in pregnant women in the province of Khyber Pakhtunkhwa, Pakistan (2014-2020)

Submitted: 8 February 2023
Accepted: 2 March 2023
Published: 5 October 2023
Abstract Views: 709
PDF: 331
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Anaemia is a common public-health problem affecting about two-thirds of pregnant women in developing countries. Spacetime cluster analysis of anemia cases is important for publichealth policymakers to design evidence-based intervention strategies. This study discovered the potential space-time clusters of anemia in pregnant women in Khyber Pakhtunkhwa Province, Pakistan, from 2014 to 2020 using space-time scan statistic (SatScan). The results show that the most likely cluster of anemia was seen in the rural areas in the eastern part of the province covering five districts from 2017 to 2019. However, three secondary clusters in the West and one in the North were still active, signifying important targets of interest for public-health interventions. The potential anemia clusters in the province’s rural areas might be associated with the lack of nutritional education in women and lack of access to sufficient diet due to financial constraints.



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Ali AA, Rayis DA, Abdallah TM, Elbashir MI, Adam I, 2011. Severe anaemia is associated with a higher risk for preeclampsia and poor perinatal outcomes in Kassala hospital, eastern Sudan. BMC Res Notes 4:1–5. DOI:
Ali SA, Khan U, Feroz AS, 2020. Prevalence and determinants of anaemia among women of reproductive age in developing countries. J Coll Physicians Surg Pak 30:177-86. DOI:
Allen LH, 2000. Anemia and iron deficiency: effects on pregnancy outcome. Am J Clin Nutr 71:S1280-4. DOI:
Baig-Ansari N, Badruddin SH, Karmaliani R, Harris H, Jehan I, Pasha O, Moss N, McClure EM, Goldenberg RL, 2008. Anemia prevalence and risk factors in pregnant women in an urban area of Pakistan. Food Nutr Bull 29:132–9. DOI:
Ballesteros P, Salazar E, Sánchez D, Bolaños C, 2021. Spatial and spatiotemporal clustering of the COVID-19 pandemic in Ecuador. Rev Fac Med 69:86476. DOI:
Birant D, Kut A, 2007. ST-DBSCAN: An algorithm for clustering spatial–temporal data. Data Knowl Eng 60:208–221. DOI:
BOS Khyber Pakhtunwa, 2019. Development statistics of Khyber Pakhtunkhwa.
da Roza DL, do Caccia-Bava MCGG Martinez EZ, 2012. Spatio-temporal patterns of tuberculosis incidence in Ribeirão Preto, State of São Paulo, southeast Brazil, and their relationship with social vulnerability: a Bayesian analysis. Rev Soc Bras Med Trop 45:607–15. DOI:
DHIS, 2020. District Health Information Khyber Pakhtunkhwa, Pakistan.
Figueiredo ACMG, Gomes-Filho IS, Silva RB, Pereira PPS, Da Mata FAF, Lyrio AO, Souza ES, Cruz SS, Pereira MG, 2018. Maternal anemia and low birth weight: a systematic review and meta-analysis. Nutr 10:601. DOI:
Gleason JA, Ross KM, 2022. Development and Evaluation of Statewide Prospective Spatiotemporal Legionellosis Cluster Surveillance, New Jersey, USA. Emerg Infect Dis 28;625-30. DOI:
Government of Pakistan UNICEF, 2019. National Nutrition Survey 2018 - Key Findings Report.
Greene SK, Peterson ER, Balan D, Jones L, Culp GM, Fine AD, Kulldorff M, 2021. Detecting COVID-19 clusters at high spatiotemporal resolution, New York City, New York, USA, June–July 2020. Emerg Infect Dis 27:1500-1504. DOI:
Kassa GM, Muche AA, Berhe AK, Fekadu GA, 2017. Prevalence and determinants of anemia among pregnant women in Ethiopia; a systematic review and meta-analysis. BMC Hematol 17:1–9. DOI:
Kulldorff M, 2001. Prospective time periodic geographical disease surveillance using a scan statistic. J Roy Stat Soc Ser A Stat Soc 164:61–72. DOI:
Kulldorff M, 2018. SaTScan v 9.6.
Kulldorff M, Athas WF, Feuer EJ, Miller BA, Key CR, 1998. Evaluating cluster alarms: A space-time scan statistic and brain cancer in Los Alamos, New Mexico. Am J Public Health 88:1377–80. DOI:
Kulldorff M, Heffernan R, Hartman J, Assuncao R, Mostashari F, 2005. A space-time permutation scan statistic for disease outbreak detection. PLoS Med 2:216–224. DOI:
Kulldorff M, Hjalmars U, 1999. The Knox method and other tests for space‐time interaction. Biometrics 55:544–552. DOI:
Levine N, 2006. Crime mapping and the Crimestat program. Geogr Anal 38:41–56. DOI:
Liu Y, Li X, Wang W, Li Z, Hou M, He Y, Wu W, Wang H, Liang H, Guo X, 2012. Investigation of space-time clusters and geospatial hot spots for the occurrence of tuberculosis in Beijing. Int J Tuberc Lung Dis 16:486–91. DOI:
Lone FW, Qureshi RN, Emmanuel F, 2004. Maternal anaemia and its impact on perinatal outcome in a tertiary care hospital in Pakistan. East Mediterr Health J 10:801-7. DOI:
Shams S, Ahmad Z, Wadood A, 2017. Prevalence of iron deficiency anemia in pregnant women of district Mardan. Pakistan. J Preg Child Health 4:1–4. DOI:
Ullah A, Sohaib M, Saeed F, Iqbal S, 2019. Prevalence of anemia and associated risk factors among pregnant women in Lahore, Pakistan. Women Health 59:660–71. DOI:
Ullah I, Zahid M, Khan MI, Shah M, 2013. Prevalence of anemia in pregnant women in district Karak, Khyber Pakhtunkhwa, Pakistan. Int J Biosci 3:77–83. DOI:
Ullah S, Daud H, Dass SC, Fanaee TH, Kausarian H, Khalil A, 2020. Space-time clustering characteristics of tuberculosis in Khyber Pakhtunkhwa Province, Pakistan, 2015–2019. Int J Environ Res Public Health 17:1413. DOI:
Ullah S, Daud H, Zainuddin N, Dass SC, Khalil A, Fanaee HT, Khan I, 2021. Space-time cluster analysis of accidental oil spills in Rivers State, Nigeria, 2011–2019. Comput Mater Contin 66:3065–3074. DOI:
Ullah S, Nor NHM, Daud H, Zainuddin N, Gandapur MSJ, Ali I, Khalil,A. (2021). Spatial cluster analysis of COVID-19 in Malaysia (Mar-Sep, 2020). Geospatial Health 16:961. DOI:
WHO, 1992. Prevalence of anaemia in women: a tabulation of available information. Available from:
Xie Z, Yan J, 2008. Kernel density estimation of traffic accidents in a network space. Comput Environ Urban Syst 32:396–406. DOI:

How to Cite

Ullah, S., Burney, S. A. ., Rasheed, T., Burney, S., & Barakzia, M. A. K. (2023). Space-time cluster analysis of anemia in pregnant women in the province of Khyber Pakhtunkhwa, Pakistan (2014-2020). Geospatial Health, 18(2).