Maternal anaemia and risk of neonatal and infant mortality in low- and middle-income countries: a secondary analysis of 45 national datasets.

Abstract

Background: Anaemia in pregnancy has been recognised worldwide as a growing public health concern and an important cause of adverse neonatal outcomes. However, only a limited number of studies have been done in low-income settings, which have the highest prevalence of anaemia. We aimed to investigate the association between maternal anaemia and neonatal and infant mortality in low- and middle-income countries.

Methods: Secondary analysis of pooled data from 45 national demographic and health surveys (2010-2020). We included all women between 15 and 49 years old, who had singleton live birth within 1 year preceding the survey, with a valid maternal measurement of haemoglobin. We used logistic regression models to estimate the crude and adjusted OR (aOR) with 95% CIs of the association between maternal anaemia (measured at the time of the survey) and the risk of neonatal and infant mortality.

Results: Among 106 143 women included in our analysis, there were 53 348 (50.5%) women with no anaemia, 24 670 (23.2%) with mild anaemia, 25 937 (24.3%) with moderate anaemia and 2188 (2.0%) with severe anaemia. Overall, there were 2668 (2.5%) neonatal and 3756 (3.5%) infant deaths. Moderate (aOR 1.20; 95% CI 1.06 to 1.35) and severe (aOR 1.89; 95% CI 1.46 to 2.44) maternal anaemia were associated with increased odds of neonatal mortality, respectively. Similar estimates were observed for moderate and severe anaemia and infant mortality. No increased risk was noted for mild anaemia.

Interpretation: Moderate and severe maternal anaemia in low- and middle-income settings are associated with increased risks of neonatal and infant mortality. Future research should examine how targeted interventions for prepregnancy and antenatal treatment of anaemia in reproductive-age women can enhance maternal and child health in low- and middle-income settings.