Does Intestinal Parasite Infection Causes Anemia Among Pregnant Women in Ethiopia A Systematic Review and Meta-Analysis

Does Intestinal Parasite Infection Causes Anemia Among Pregnant Women in Ethiopia A Systematic Review and Meta-Analysis. Biomed

Geohelminth infections during pregnancy were associated with maternal anemia. Hookworm infection causes anemia among pregnant women and it also aggravates anemia in pregnant women [5]. Infections by helminthes leads to malnutrition, iron deficiency anemia, and increased vulnerability to other infections in infected pregnant women [6]. Other recent studies in Ethiopia have reported prevalence of anemia ranging from 16.6% in a facilitybased study in Gondar, northwest Ethiopia to 56.8% in Gode town, Eastern Ethiopia [6 ,7]. Prior studies in Ethiopia have reported significant associations between anemia in pregnancy and parasitic infections [e.g. schistosomiasis, hookworm infection], prior use of contraceptives, use of iron supplementation, birth spacing/ intervals, parity and gravidity, educational attainment, age, body weight, trimester of pregnancy and wealth status [6 -18]. Despite there are many researches done on anemia among pregnant women in Ethiopia, but data on intestinal parasitic infection and anemia among pregnant women in Ethiopia is not adequate. This systematic review and meta-analysis was conducted to assess the relationship between intestinal parasitic infection and anemia among pregnant women in Ethiopia.

Data Extraction
Three researchers were carried out the data extraction The extracted information were the name of the author, study area, the number and percentage of anemia, the number and percentage of intestinal parasitic infection.

Risk of Bias and Quality Assessment
To assess external and internal validity, a risk-of-bias tool was used. The tool has seven items:

7.
Other bias. All of these items are rated based on the author's subjective judgment given responses to the preceding seven items rated as low, moderate or high risk.
Three reviewers assessed independently the articles for inclusion in the review using risk-of-bias tool and guided by PRISMA checklist. A discrepancy that would face by reviewers on selection of studies and data extraction was resolved by discussion Additionally, all potential confounding variables were controlled by multivariable analysis in all included studies.

Measures
Outcome variable pregnant women with Hemoglobin level less than 11 g/dl are considered to be anemic [1].

Statistical Analysis
The

Pooled Effect Size
The

Discussion
In this systematic review and meta-analysis, pregnant women who were infected with intestinal parasite were 3.74 times more likely to be anemic than who were not infected by any intestinal parasite and this is consistent with previous studies, [6,[19][20][21][22][23][24]. The worm in the intestine may cause intestinal necrosis and blood loss as a result of the attachment to the intestinal mucosa and chronic infections lead to iron deficiency and anemia resulting from the excessive loss of iron [25]. Therefore, an effective intervention packages need to reduce anemia among pregnant women through iron supplementation, anthelmintic treatment and dietary diversification in the study area [26]. Our finding is similar with other previous study in Ethiopia [27] this possibly happen because most anemic pregnant women who are living in Ethiopia were farmers, bare foot walking is common among Ethiopian farmers, and the chance to be exposed for soil transmitted parasite is very high. Besides this, the low environmental sanitation status may also aggravate the chance of intestinal parasite infection. Parasitic diseases were known to play as a major contributing factor to anemia in pregnancy. For example, blood loss caused by hookworm puts mothers at high risk of iron deficiency anemia [28]. Our finding is similar with many previous studies conducted in Ethiopia and other developing countries that have shown the strong association of intestinal parasitic infection with anemia in pregnant women [23,[28][29][30][31][32][33] Parasitic infection has a devastating effect on the level of Hgb and causes anemia since they affect iron absorption by the intestine and consumes the red blood cells [34]. There was a strong significant association between intestinal parasitic infection and anemia in pregnant women.in previous studies [35], in Southern Ethiopia [19], Ghana [34], Nigeria [36], and Venezuela [37], Durame Town Ethiopia [38]. , in Yirgalem and Hawassa cities, Dessie town and Canada [27, 39. 33 ]., Shire Town , Tigray, Northern Ethiopia [40], in Shalla Woreda of Oromia region In Ethiopia [16]. This is expected as intestinal parasites, apart from their competition for nutrients, are known to cause blood loss, loss of appetite reduced motility of food through the intestine and damage to the wall of the intestine leading to mal-absorption of nutrients.

Conclusion
The likelihood of anemia among pregnant women is approximately four times higher among pregnant women who had intestinal parasitic infection than who did not have the infection.