Anaemia is a multifactorial disease that can occur as a result of nutritional deficiency, heavy blood loss, multiple pregnancies, postpartum haemorrhage, gastric ulcers, acute and chronic infections such as malaria, HIV, and parasitic infections, HARRT drugs and haemoglobinopathies 1–3. It is more prevalent in children, adolescents, pregnant women, and other women of reproductive age4. Women of reproductive age are at increased risk for iron deficiency anaemia because of blood loss during their monthly periods, pregnancy, and delivery, and this condition occurs in 1 in 5 women (15–49) 5. Based on its public health status, anaemia can be categorized as severe for greater than 40%, moderate for 20–39%, or mild for 5–19% of the public health problems 6.
Globally, approximately 2 billion people are estimated to suffer from anaemia, approximately 50% of which is caused by iron deficiency (IDA) 7,8. According to the WHO, worldwide anaemia is an important public health concern, estimated at 24.8% 8. Globally, in 2016, severe public health problems were estimated to exist in many countries worldwide; for example, the prevalence of anaemia among pregnant women, nonpregnant women, and all women of reproductive age was 40%, 32.5%, and 32.8%, respectively 9–11. In Africa, a large proportion of nonpregnant women were reportedly anaemic in West and Central Africa (48%), and the highest prevalence was in East Africa (28%) (19) and Ethiopia (27%) 4. It has been reported that nearly 510,000 maternal deaths occur annually associated with childbirth or early postpartum birth. Approximately 20% of maternal deaths are caused by anaemia, and the majority of deaths occur in developing countries 12,13.
Anaemia is the most important clinical problem in people living with HIV/AIDS 5,14–16, and the epidemiology of anaemia among HIV-infected women in developing countries is likely to be quite different from that in more developed countries 15. Previous studies from developing countries have shown that anaemia is the most common haematologic manifestation, affecting 30% of HIV-infected patients with an asymptomatic infection and 75–80% of HIV-infected patients with late-stage disease 17. A cohort study performed in the USA showed that 37% of HIV-positive women were anaemic 18. In another study in India, the rates of anaemia among HIV-positive participants were 64.7% in women and 49.2% in men 15. A study performed in Ethiopia indicated that 62% of women living with HIV/AIDS were anaemic, and factors that are often associated with anaemia among people living with HIV/AIDS include the use of an ART regimen, the presence of opportunistic infections (OIs), sociodemographic status, duration of ART, advanced stage of HIV disease and a CD4 count < 200 cells/dL 8.
According to the 2016 EDHS report, the prevalence of anaemia in pregnant women in Ethiopia is 23% and 29%. In Ethiopia, there is a moderate public health problem for both pregnant and nonpregnant women of reproductive age, ranging from 16–59%, and a high incidence is found in the eastern and northeastern regions 9,12. Ethiopia is one of the HIV/AIDS-affected countries in sub-Saharan Africa, with a high prevalence among women of reproductive age. The prevalence of HIV among the general population is 0.9%, and reports from HIV-related estimates and projections for Ethiopia 610,335 people are living with HIV (PLHIV) more prevalent among adult women (15–59 years), and 1.2% have a twofold higher HIV prevalence than men (0.6%) 19,20. HIV/AIDS may be a major causative factor in the development of anaemia, and anaemia is likely associated with severe or progressive disease 2.
The Ethiopian Federal Ministry of Health (FMoH) has been struggling to prevent anaemia by focusing on pregnant women by providing iron and folic acid, providing nutritional education, providing drugs for deforming, promoting sanitation, and preventing and treating malaria; however, in the last 15 years, the trend of anaemia has remained inconsistent. According to a 2011 DHS report, the incidence of all forms of anaemia decreased from 27% in 2005 to 17% in 2011 and increased to 23% in 2016 9,13.
Anaemia, HIV, and being a woman of reproductive age living in resource-limited countries such as Ethiopia will be a double burden 18,8,21. Reducing anaemia among women of reproductive age is recognized as one of the key components in the improvement of the intergenerational benefits of women and their children’s good health, economy, and community development. In Ethiopia, insufficient studies have been performed on anaemia among women of reproductive age attending ART clinics, and anaemia has not been extensively studied. Thus, the prevalence of and factors associated with this disease have rarely been investigated. Hence, this study was conducted to assess the prevalence of anaemia and associated factors among women of reproductive age attending ART clinics.