Abstract
Background: Anemia poses significant health risks, especially affecting women and children, leading to increased morbidity, mortality, and adverse birth outcomes. The COVID-19 pandemic has further exacerbated economic challenges and food insecurity, and weakened immune systems affecting vulnerable populations like pregnant, and lactating women, and children. This study aimed to assess factors associated with anemia among pregnant and lactating women during the covid-19 pandemic in the targeted municipalities of five provinces of Nepal.
Methods: A cross-sectional study was conducted from August, 2022-April, 2023 among 844 pregnant and lactating women (mean age 26.8±4.96 years) from five provinces of Nepal selected through cluster sampling. A semi-structured electronic questionnaire, a paper-based 24-hour dietary recall, and hemoglobin concentration in the blood were recorded. Bivariate and multivariate binary logistic regressions were used to estimate the crude odds ratios (cOR), and adjusted odds ratios (aOR) with 95% confidence intervals (CIs).
Results: The overall anemia prevalence was determined to be 41.2% with a mean hemoglobin level of 11.58 ± 1.59 g/dl. In the multivariate model, women aged 30-39 years (aOR = 0.667, 95% CI: 0.172-2.59) and pregnant women had lower anemia odds (aOR = 0.866, 95% CI: 0.645-1.162). Unskilled manual workers (aOR = 1.666, 95% CI: 0.708-3.924) and those with no formal education were more likely to be anemic (aOR = 3.251, 95% CI: 1.728-6.115). Anemia odds were higher for low-income (aOR = 1.601, 95% CI: 0.933-2.749, Muslim (aOR = 1.051, 95% CI: 0.577-1.916), Madhesi (aOR = 1.051, 95% CI: 0.577-1.916), Christian (aOR = 1.645, 95% CI: 0.683-3.960), and Buddhist (aOR = 1.497, 95% CI: 0.810-2.674) women. Women with low dietary diversity (aOR = 3.054, 95% CI: 2.248-4.15), not consuming fortified foods (aOR = 1.192, 95% CI: 0.689-2.065) and not consuming eggs (aOR = 1.23, 95% CI: 0.841-1.799) had higher likelihood of anemia. The study also revealed that the consumption of cereals and legumes remained unchanged, but a majority reported having a reduced intake of fruits, vegetables, milk, meat, and eggs during the pandemic.
Conclusions: A high prevalence of anemia, a severe public health problem, among the low-income pregnant and lactating women, with limited access to education and dietary diversity pointed out the urgent need for intervention to alleviate their nutritional and health status in targeted municipalities.