Intersection of HIV and Anemia in Women of Reproductive Age: a 10-year Analysis of Three Zimbabwe Demographic Health Surveys, 2005-2015

Background: Women of reproductive age 15-49 are at a high risk of iron-deficiency anemia, which in turn may contribute to maternal morbidity and mortality. Common causes of anemia include poor nutrition, infections, malaria, HIV, and treatments for HIV. We conducted a secondary analysis to study the prevalence of and associated risk factors for anemia in women to elucidate the intersection of HIV and anemia using data from 3 cycles of Zimbabwe Demographic and Health Survey (ZDHS) conducted in 2005, 2010, and 2015.

Methods: DHS design comprises of a two-stage cluster-sampling to monitor and evaluate indicators for population health. A field hemoglobin test was conducted in eligible women. Anemia was defined as hemoglobin < 11.0 g/dL in pregnant women; < 12.0 in nonpregnant women. Chi-squared test and multivariable logistic regression analysis accounting for complex survey design were used to determine the prevalence and risk factors associated with anemia.

Results: Prevalence (95% confidence interval (CI)) of anemia was 37.8(35.9-39.7), 28.2(26.9-29.5), 27.8(26.5-29.1) in 2005, 2010, and 2015, respectively. Approximately 9.4, 7.2, and 6.1%, of women had moderate anemia; (Hgb 7-9.9) while 1.0, 0.7, and 0.6% of women had severe anemia (Hgb < 7 g/dL)), in 2005, 2010, and 2015, respectively. Risk factors associated with anemia included HIV (HIV+: 2005: OR (95% CI) = 2.40(2.03-2.74), 2010: 2.35(1.99-2.77), and 2015: 2.48(2.18-2.83)]; Residence in 2005 and 2010 [(2005: 1.33(1.08-1.65), 2010: 1.26(1.03-1.53)]; Pregnant or breastfeeding women [2005: 1.31(1.16-1.47), 2010: 1.23(1.09-1.34)]; not taking iron supplementation [2005: 1.17(1.03-1.33), 2010: 1.23(1.09-1.40), and2015: 1.24(1.08-1.42)]. Masvingo, Matebeleland South, and Bulawayo provinces had the highest burden of anemia across the three DHS Cycles. Manicaland and Mashonaland East had the lowest burden.

Conclusion: The prevalence of anemia in Zimbabwe declined between 2005 and 2015 but provinces of Matebeleland South and Bulawayo were hot spots with little or no change HIV positive women had higher prevalence than HIV negative women. The multidimensional causes and drivers of anemia in women require an integrated approach to help ameliorate anemia and its negative health effects on the women's health. Prevention strategies such as promoting iron-rich food and food fortification, providing universal iron supplementation targeting lowveld provinces and women with HIV, pregnant or breastfeeding are required.