Use this URL to cite or link to this record in EThOS:
Title: Maharashtra Anaemia Study : an investigation of factors associated with adolescent health and pregnancy-related outcomes in women from Maharashtra State, India
Author: Ahankari, A. S.
ISNI:       0000 0004 7228 3011
Awarding Body: University of Nottingham
Current Institution: University of Nottingham
Date of Award: 2017
Availability of Full Text:
Access from EThOS:
Full text unavailable from EThOS. Restricted access.
Access from Institution:
Maharashtra Anaemia study (MAS) was conducted as a part of the PhD programme of Dr Anand Ahankari through a joint collaboration of the University of Nottingham, UK and Halo Medical Foundation, India. The main goal of the study was to establish baseline epidemiological data for anaemia research in pregnant women and adolescent girls in Maharashtra state of India. Iron deficiency anaemia is the most common form of anaemia observed in India, and assessed based on haemoglobin (Hb) levels in blood. Clinically, anaemia is categorised in mild, moderate and severe form based on Hb levels. The project had three main sections, a) Adolescent girls cross sectional survey, b) Pregnant women prospective study, and c) Maharashtra state birth registry analysis. The study aimed to investigate individual and village level risk factors of anaemia in adolescent girls (13 to 17 years), and pregnant women (3 to 5 months) living in rural Maharashtra. Data from pregnant women were also used to examine risk factors associated with low birth weight (LBW). A recently introduced non-invasive haemoglobin (Hb) technology (known as NBM 200) was validated in this Indian setting by comparing Hb measurements obtained from the NBM 200 with reference blood measurements. In the adolescent survey, Sahli’s hemometer (finger prick technique) was used to estimate reference Hb values, while in pregnant women venous blood samples were obtained to measure Hb using an automated analyser. Anaemia was defined using Hb levels based on the following cut offs, (a) Hb < 12.0 g/dl in adolescent girls, and in (b) Hb < 11.0 g/dl in pregnant women. Multivariable regression technique was used to identity risk factors associated with anaemia and LBW. The Maharashtra state birth registry records covering a 32-year period (1980 to 2011) were investigated to assess temporal changes in the sex ratio at birth to investigate impacts of sex determination prevention legislations (known as PNDT 1994 and PCPNDT 2003). The adolescent girls’ survey showed a very high prevalence of anaemia (87%). Of 45 factors assessed in the survey, four were associated with adolescent anaemia. Anaemia likelihood increased significantly with age (Odds Ratio [OR] 1.41 per year, 95% CI: 1.17 to 1.70). Factors associated with decreased risk of anaemia were higher mid upper arm circumference (> 22 cm) (OR 0.51, 95% CI: 0.31 to 0.82), and ≥3 days/week consumption of fruit (OR 0.35, 95% CI: 0.23 to 0.54). At village level piped water supply was associated with higher Hb levels (β coefficient 0.61 g/dl, 95% CI: 0.39 to 0.82). Results from the NBM 200 reported wide agreement levels in the Bland-Altman analysis (mean difference of -2.70 g/dl, 95% CI: -2.84 to -2.55) demonstrating an overestimation of Hb by the NBM 200 compared to Sahli’s hemometer. The NBM 200 showed low sensitivity (23.6%) and moderate specificity (61.8%) for the diagnosis of anaemia in the adolescent population. Findings from pregnant women showed high anaemia prevalence (77%). Of 51 factors assessed in the study, three were associated with maternal anaemia. Increased risk of anaemia was seen in women with consanguineous marriages (OR 2.41, 95% CI: 1.16 to 5.01). Post-delivery data from full-term singleton live births showed the prevalence of LBW babies was 7%. Consanguineous marriage was a major risk of LBW babies in our study population (OR 5.68, 95% CI: 1.58 to 20.32). Village level risk factors showed lower likelihood of maternal anaemia with regular access to government nurses (OR 0.48, 95% CI: 0.25 to 0.93). The NBM 200 validation showed overestimation of Hb levels and underestimation of anaemia. Bland-Altman analysis showed a mean difference of -1.8 g/dl (95% CI: -2.06 to -1.71) indicating a systematic overestimation by the NBM 200 compared to venous Hb measurements. The device showed low sensitivity (33.7%) but high specificity (91.8%) for the diagnosis of anaemia in the pregnant woman population. The 32 years of longitudinal birth registry data showed a significant increase in the sex ratio at live birth from 1980 to 2004, and then a subsequent decrease in sex ratio. The annual state male:female sex ratio of Maharashtra increased from a baseline of 1.11 in 1980 to a maximum value of 1.23 in 2003, before decreasing to 1.16 in 2011. This represented an increase in the annual sex ratio at live birth from 1980 to 2004 of 0.005 units per year (p < 0.001), and a decrease of 0.009 units per year after 2004 (p < 0.01). The increase in the sex ratio was consistent with the hypothesis of both increasing availability and acceptability of ultrasound scanning during this period, enabling foeticide of females in utero. The probable cause for the decrease in sex ratio after 2004 is likely to be due to the strengthening of the legislation banning sex-specific foeticide.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: WH Hemic and lymphatic system