Effectiveness of primary level antenatal care in decreasing anemia at term in Tanzania

Abstract

A prospective controlled intervention study was conducted between June 1991 and June 1992 (with follow-up until February 1993) in Tanzania to assess the effectiveness of reinforcing existing antenatal clinic routines for prevention and treatment of anaemia in pregnancy, combined with individual and community health education. The study was conducted in 2 antenatal clinics at primary level. At booking (median 24 weeks), 1045 women were screened for anaemia and followed-up to late pregnancy (gestational age 34 weeks). In addition to haematinic and malaria prophylaxis, extra interventions at the study clinic included retraining of staff, group and individual counselling of women and community health education in the area. There was a significant overall increase in median Hb from 10.1 g/dl at booking to 10.6 g/dl in late pregnancy, and prevalence of anaemia (Hb 10.5 g/dl) was reduced from 60% at booking to 47%, at both clinics, with 57% reduction in the proportion with severe anaemia (Hb <7.0 g/dl). Severely anaemic women increased their median Hb by 3.2 g/dl during antenatal care. No additional effect was observed from an individual and community information programme. It is concluded that ensuring an adequate supply of drugs seems to be the most important activity to achieve safe haemoglobin levels in pregnant women, but even an active antenatal programme has a limited effect when anaemia is highly prevalent and booking is late.