Maternal anemia in helminth-infected pregnant women: Dose-response with hookworm intensity and other risk factors in a Ugandan cross-sectional study.

BACKGROUND

Anemia remains a significant global public health challenge, affecting approximately 25% of the world's population and disproportionately impacting pregnant women, with an estimated 40% prevalence worldwide. Intestinal helminth infections exacerbate this burden, with anemia prevalence reported as high as 55.6% among infected pregnant women compared to 16.4% in those uninfected. This study aimed to determine the burden of anemia and its determinants among pregnant women with helminthiasis attending antenatal care at tertiary Hospitals in western Uganda.

Methods

A hospital-based cross-sectional study was conducted from 1st November 2022-1st March 2023, enrolling 420 pregnant women diagnosed with helminthiasis attending antenatal clinics. Data were collected via interviewer-administered questionnaires and laboratory records. Descriptive statistics and multivariable logistic regression analyses were performed using IBM SPSS version 23 to identify factors independently associated with anemia.

Results

The prevalence of anemia was 26.2% (95% CI: 22.2-30.6), with 39.1% (95% CI: 30.5-48.4) mild, 35.5% (95% CI: 27.1-44.7) moderate, and 25.5% (95% CI: 18.2-34.3) severe cases. Multivariate analysis showed that moderate and heavy hookworm intensities increased anemia risk nearly two-fold (aOR = 1.90, 95% CI: 1.16-3.54; p = 0.028) and 2.4-fold (aOR = 2.40, 95% CI: 1.06-5.41; p = 0.041), respectively. Protective factors included being a student (aOR = 0.17, 95% CI: 0.05-0.63; p = 0.008), deworming ≥3 months prior (aOR = 0.11, 95% CI: 0.01-0.88; p = 0.038), using borehole water (aOR = 0.60, 95% CI: 0.36-1.00; p = 0.048), and gestational age 14-27 weeks (aOR = 0.57, 95% CI: 0.35-0.92; p = 0.020).

Conclusions

Maternal anemia showed a clear dose-response with hookworm intensity, with risk increasing from moderate to heavy infection. Delayed deworming and unsafe water increased odds, whereas being a student and second-trimester gestation were protective. Timely anthelminthic treatment, improved water access, and strengthened antenatal care are critical in endemic settings.