Anaemia in pregnancy at booking: Prevalence, Risk Factors and Perinatal outcomes among Antenatal Clinic Attendees in a Secondary Healthcare Facility in North Central Nigeria: An Analytical Study

Anaemia in pregnancy at booking: Prevalence, Risk Factors and Perinatal outcomes among Antenatal Clinic Attendees in a Secondary Healthcare Facility in North Central Nigeria: An Analytical Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Anaemia in pregnancy at booking: Prevalence, Risk Factors and Perinatal outcomes among Antenatal Clinic Attendees in a Secondary Healthcare Facility in North Central Nigeria: An Analytical Study Mariam Abdulbaki, Fullaila Onazare Aliyu, Gbenga Joseph Adeleke, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6523545/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background: Anaemia during pregnancy is an unacceptable public health problem in most developing countries inclusive of Nigeria where access to adequate nutrition and healthcare services is limited. Objectives : This study aimed to determine the prevalence, severity of anaemia, associated factors (socio-demographics, maternal, medical history, obstetric history, gynaecological history, substance abuse and laboratory findings) at booking and perinatal outcomes among parturient who present for booking at the antenatal clinic of a secondary health facility in north-central Nigeria. Methods : An analytical study that involved 1,141 parturient who presented at the booking clinic between 14 October, 2022 and 14 October, 2023. With the aid of a pre-tested semi-structured interviewer administered questionnaire, data on socio-demographic characteristics, obstetrics and gynaecological history, substance abuse, 24-hour dietary recall and other relevant histories, were collected from consecutive parturient who fulfilled the inclusion criteria and consented to the study. A sample of venous blood was collected using aseptic technique to obtain a packed cell volume by microhaematocrit method. Diagnosis of anaemia at booking was based on the World Health Organization definition of anaemia in pregnancy: haemoglobin concentration less than 11g/dl in the first and third trimester and 10.5g/dl in the second trimester. All parturient who had anaemia were also investigated for the aetiology of the anaemia; full blood count, rapid diagnostic test for malaria, Human Immunodeficiency Virus screening, hepatitis B surface antigen, hepatitis C, urinalysis and stool microscopy. Parturient whose condition was amenable to treatment during pregnancy were treated while others were counselled and referred to appropriate clinics following delivery. All parturient however received haematinics throughout the duration of pregnancy. The results were analysed using SPSS version 24, Chi-square test and logistic regression analysis were used to identify the independent determinants of anaemia at booking Results: Out of 1,141 parturient who participated in this study, 728(63.8%) had anaemia at booking. Majority (56.4.0%) had microcytic hypochromic anaemia. Socio demographic characteristics that were significantly associated with anaemia at booking were: occupation (p<0.001), religion (p<0.001), level of education (p=0.001), social class (p<0.001) and women’s dietary diversity score (p<0.001). Medical, obstetrics and gynaecological history of study participants that showed significant relationship with anaemia at booking were: gravidity (p<0.001), history of miscarriage (p=0.001), number of children alive (p<0.001), history of pre conceptional counselling and care (p<0.001), history of use of herbal medication (p<0.001), history of substance abuse (p=0.001), history of use of insecticide treated net (p<0.001), history of haematinics use (p<0.001). Laboratory parameters showed that hook worm infestation, human immunodeficiency virus infection, hepatitis B & C virus infection, and malaria parasite infection all had significant relationships (p<0.001) with anaemia at booking. There was a significant improvement in the packed cell volume at the end of twelve weeks following treatment (p<0.001). After adjusting for co-founders, variables that were associated with increased risk of anaemia at booking were: presence of ova of hookworm (AOR) of 7.990 (95% CI, 4.004 to 15.946); HIV status (AOR) of 8.367 (95% CI, 2.577 to 27.167); positive malaria parasite test (AOR) of 139.308 (95% CI, 64.819 to 299.068), use of ITN (AOR) of 5.976 (95% CI, 2.718 to 13.137); substance abuse (AOR) of 1.746 (95% CI, 1.249 to 2.441) and WDDS (AOR) of 43.449 (95% CI, 29.911 to 63.114) Conclusion: This study found that malaria infection, hookworm infection, human immunodeficiency virus infection, hepatitis B and C surface antigen virus, urinary tract infection, gravidity, history of miscarriage or abortion among others are factors contributing to anaemia in pregnant women. Therefore a more comprehensive approach that will address the factors associated with anaemia at booking including pre-conceptional counselling and care, early ante natal care booking, routine use of haematinics, eating balanced diet, early screening and treatment of organisms that can cause anaemia, use of ITN, discouragement of use of herbal medication and substance abuse in pregnancy will allow for early diagnosis and prompt treatment of anaemia at booking and this will improve the overall wellbeing of pregnant women, their developing foetus and perinatal outcomes. Prevalence Anaemia Pregnancy Risk factors Secondary healthcare facility Booking Figures Figure 1 Figure 2 Introduction Anaemia in pregnancy is an important public health challenge in most developing countries and the commonest complication seen in pregnancy in sub-Saharan African where access to good healthcare services and adequate nutrition is limited 1 . Even though the risk of anaemia significantly decreases with improved socioeconomic status and development, the burden in sub-Saharan Africa is still worse than expected 2 . Anaemia in pregnancy is a condition in which the total number of red blood cells or the haemoglobin concentration within an individual is less than normal 1 . The function of haemoglobin is to carry oxygen to the body’s tissues, hence a reduction in the oxygen carry capacity of the red blood cells is not only deleterious to the mother but it can cause significant foetal morbidity and mortality 1 . It is defined by the Centre for Disease Control (CDC) and World Health Organization (WHO) as haemoglobin concentration of less than 11g/dl or haematocrit of < 33% in the first and third trimester and less than 10.5g/dl or haematocrit of < 32.0% in the second trimester 3 , 4 The world health organization estimates that worldwide, 37.0% of pregnant women and 30.0% of women aged 15–49 years are anaemic with significant variation across the world 1 . In addition, the prevalence of anaemia varies even within the same region and country 1 . For instances, studies carried out in the north central part of Nigeria shows a prevalence of 72.6% in Bida 5 and 60.4% in Ilorin 6 . The aetiology of anaemia in pregnancy is diverse and multifactorial with nutritional deficiency following inadequate dietary multivitamin particularly iron deficiency implicated as the most prevalent risk factor 7 . It may also be due to inadequate absorption of nutrients, infections (e.g. malaria, parasitic infections, tuberculosis, human immunodeficiency virus), inflammation, chronic diseases, gynaecological and obstetrics conditions, and inherited red blood cell disorders 7 . To combat the high burden of anaemia particularly in low- and middle-income countries, the WHO recommends the use of intermittent iron and folic acid supplementation in women of reproductive age group living in areas with prevalence of anaemia that is greater than or equal to 20.0% 1,3 . However, compliance with haematinics is poor and in most cases, they are already anaemic prior to conception 8 , 9 . Furthermore, the HIV/AIDS pandemic, high malaria burden, rising incidence of substance abuse by young adults, unhealthy diet, consumption of herbal concoction whose constituents is largely unknown, preference for large family size, short inter pregnancy interval, poor socio economic status and low purchasing power, lack of national health insurance cover for most dwellers in low and middle income countries are some of the contributing factors has made eradication of anaemia in pregnancy difficult 9 , 10 . Severe outcomes of anaemia at booking observed during delivery, such as preterm birth, intra uterine growth restrictions, placental abruption, severe postpartum haemorrhage, maternal shock, maternal and neonatal death among others 11 need to be prevented, by ensuring that every pregnant woman who present for booking is not anaemic and those with anaemia at booking are promptly identified and promptly treated by identifying factors responsible for the anaemia. It is therefore very important to identify factors responsible for anaemia and treating these factors in order to improve the overall outcome. So also is the fact that routine screening and counselling for substance abuse among pregnant women despite its contribution to anaemia, maternal and perinatal morbidity and mortality is almost non-existent in most developing countries, inclusive of Nigeria. This study therefore aims at determining the prevalence of anaemia at booking, levels of anaemia, and associated risk factors including socio demographic characteristics, maternal levels of anaemia following treatment and perinatal outcomes at a secondary health care facility in Ilorin, Kwara state. Findings from this study will serve as a guide to antenatal service providers and other stake holders to help in the implementation of safe motherhood initiative through measures that will primarily prevent anaemia at booking. METHODS Study area and settings: The study was carried out at the antenatal clinic of General Hospital, Ilorin, Kwara State, which currently serves as a training institution for post graduate medical students in the Department of Obstetrics and Gynaecology. The Hospital offers specialist care and serves as a referral centre to the people of Kwara State and parts of the neighbouring states of Kogi, Niger, and Oyo. Patients who present for booking are attended to on Mondays, while those who present for routine antenatal care are seen from Tuesdays through Thursdays at the antenatal clinics while Fridays is for post-natal clinic. An average of 75 pregnant women were seen weekly at booking clinic from previous year record. Study design and population. This was a prospective analytical study carried out between 14 October, 2022, and 13 October, 2023. A pretested semi-structured interviewer administered questionnaire was used to obtain socio-demographic characteristics and other relevant information by four trained research assistant while 5 ml of venous blood sample were collected from the median cubital vein by two trained laboratory technicians from consecutive parturient who consented to participate in the study. The blood samples were analysed for haemoglobin levels (PCV), genotype, blood group, full blood count/peripheral blood film, rapid diagnostic test for malaria, human immunodeficiency virus (HIV) screening, hepatitis B surface antigen, hepatitis C, urinalysis and stool microscopy. Anaemia was defined based on the World Health Organization definition of anaemia (haemoglobin concentration less than 11g/dl (first and third trimester) and 10.5g/dl (second trimester) 3 . Sample Size Determination Using the prevalence of anaemia in a study conducted in north-central Nigeria (72.6%) 5 , the estimate from this study was desired to be within five percent of the actual prevalence with 95 percent confidence level. The sample size was calculated using the Kish Leslie formula for cross-sectional studies 12 : n=Z 2 Pq/d 2 , Where n is the desired sample size and Z is the standard normal deviate usually set at 1.96, which corresponds to the 95% confidence interval. P is the proportion of pregnant women with anaemia, which is 72.6%. q is complementary proportion equivalent to one (1) minus P ; that is, 1 − 0.6 equal to 0.4. d is the degree of accuracy desired (absolute precision), which was 2.5% (0.025). n=3.84×0.726×0.326/0.0009 n=0.9088/0.0009 n=1,009.9 n=1,010 Participant Recruitment The attendance register’ of the parturient who presents for booking at each booking clinic served as the sampling frame. Each booking clinic attendees were given a tally number at every booking clinic. These numbers were then thoroughly mixed in a container from where the first parturient was picked randomly by balloting. If the woman did not meet the inclusion criteria, a new number was drawn until one met the criteria. The remaining numbers of women were selected through systematic sampling, at fixed intervals (sampling interval = 75/3=25; 25* 4=100; 100*12=1,200) of every third number on the sampling frame to make up to the 25 women recruited per week. Inclusion Criteria We included pregnant women who presented for the first time at the ante natal clinic for booking and were willing to participate in the study. Exclusion Criteria Pregnant women at their follow-up antenatal clinic visit, those who had received blood transfusions in the index pregnancy or were already receiving treatment for anemia in pregnancy before their booking visit, recent or on-going vaginal bleeding, and known sickle cell disease patient were excluded. Data collection tools, procedure and quality control Data were collected from 14 October 2022, to 13 October 2023, during which 1,141 pregnant women were recruited at their first antenatal visit. The parturient were interviewed with pre-tested semi-structured questionnaire by the researcher and four trained research assistants in the Department of Obstetrics and Gynaecology to ensure that all the necessary information were obtained. The following information was recorded: maternal age, gravidity, parity, estimated gestational age, last childbirth, last menstrual period, level of education and occupation of the women and their husband, history of fever in the index pregnancy, presence of any chronic illnesses, drug history, ingestion of herbal medication, history of substance abuse (kolanut, shisha, marijuana and alcohol), history of use of hematinic, history of vaginal bleeding in present pregnancy and 24-hour dietary recall. Each study participant was allotted to one of the five social classes based on her level of education and her husband's occupation according to a scoring system designed by Olusanya et al 13 . The social class for single or separated women was based on their occupation and their educational status. Social classes 1 and 2 were classified as upper class, represented the elites, the professionals like the doctors, lawyers, bankers, and those in managerial position. Class 3 represented the middle class of nurses, clerks, technicians, artisans, and so forth, while classes 4 and 5 represented the lowest rung on the socioeconomic ladder. From each of the recruited parturient, 5 ml of venous blood was collected using sterile techniques from the median cubital vein using plastic disposable syringes into sample bottles containing ethylene diamine-tetra acetic acid (EDTA). Each participant had packed cell volume (PCV) done using a microhaematocrit method, blood group and genotype, rapid diagnostic test for malaria, full blood count/peripheral blood film, urinalysis, stool microscopy (to identify hookworm infection), HIV testing (was done after counselling), hepatitis B surface antigen and hepatitis C virus screening by two skilled laboratory technicians. The packed cell volume was repeated at 12 weeks following treatment. All parturient received routine haematinics and were followed-up until delivery. The packed cell volume was measured using a microhaematocrit reader. Stool samples were collected from each participant using a clean, wide-mouthed, leak-proof stool cup. A stool wet mount was prepared with saline and/or iodine and examined microscopically within 30 min of collection to identify hookworm infection. Comprehensive training was also provided to data collectors and supervisors to ensure consistent and clear data collection. 24-hour Dietary Recall 24-hours dietary diversity was assessed using a 24-h food recall questionnaire adapted from the FAO 14 . The questionnaire was modified accordingly and was administered by the research assistants. Respondents were asked to mention all the foods (meals and snacks) eaten the previous day during the day and night. The food items mentioned were recorded in the spaces provided in the questionnaire. Using this information, it was determined whether they ate from the following 9 food groups: 1 ) starchy staples; 2 ) dark-green vegetables; 3 ) other fruit and vegetables; 4 ) organ meats; 5 ) meat and fish; 6 ) eggs; 7 ) legumes, nuts, and seeds; 8 ) milk and milk products; and 9 ) oil and fats. Measurement of variables Participant’s dietary diversity scores After the respondent recalled all the foods and beverages consumed, the foods were underlined with the corresponding foods in the list under the appropriate food group. Number “1” was assigned in the column next to the food group if ≥1 food in this group had been underlined, and “0” was assigned in the right-hand column of the questionnaire when it was certain that no foods in that group were eaten. Women's dietary diversity scores (WDDSs) were calculated by summing the number of food groups consumed by the individual respondent over the 24-h recall period 14 . Total scores ranged from 0 to 9. The mean score was calculated based on the number of food groups to indicate adequate or inadequate dietary diversity 14 . Therefore, a score from 0 to 4 was categorized as inadequate dietary diversity, whereas a score >4 was categorized as adequate dietary diversity. The WDDS is an indicator variable for whether a woman has eaten from ≥5 food groups out of 9 designated food groups within the last 24 h and is a measure of adequacy of micronutrients. Data Analysis Data were entered into a computer, which was pass-worded and analysed using SPSS version 24. The age was summarised as mean with standard deviations and further sub-grouped for analysis. The other socio-demographic variables were summarized as percentage and frequency. The association between the factors that contributed to anaemia at booking was evaluated using Chi-square and Fischer's exact tests as appropriate. The factors that were associated with anaemia was evaluated with adjusted odds ratio along with a 95% confidence interval, and all levels of statistical significance were set at a value less than 0.05. Ethical consideration Ethical approval was obtained from the ethical review committee of the General Hospital Ilorin Research Committee (GHI/IRC/246/VOL.I/08). Informed consent for this study was obtained from each participant and the data were anonymised. The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki and all the retrieved data were de-identified. The details of the study were thoroughly explained to all women booking for antenatal care at the beginning of the clinic. An informed consent was obtained in writing before recruiting each subject into the study. The participants retained the absolute right and freedom to decline from participating or withdrawing from the study at any time with no consequence to them. They were assured that opting out would not compromise the quality of care they receive from the antenatal clinic. The study was carried out under strict confidentiality as participants and their samples were identified by initials and serial numbers on their questionnaires, laboratory forms, and specimen bottles. Those that participated in the study had the benefit of early diagnosis of anaemia when present. This allowed for early treatment and ultimate prevention of the consequences of anaemia in the index pregnancy. Results General characteristics of the study participants A total of 1,141 parturient were studied with a mean age of 29.54 ±4.90 years. Most of the parturient were aged 26-30 years (414;36.3%), married (1100;96.4%), and traders (709;62.1%). Also, most of the parturient had tertiary levels of education (889; 77.9%) and were from the lower social class (768; 67.3%) (Table 1). Socio-demographics that were associated with anemia included maternal occupation (p<0.001), religion (p<0.001), maternal level of education (p=0.001), social class (P<0.001) and WDDS ((p<0.001) (Table 1). Medical, Obstetrics and Gynaecological history of study participants Based on the medical, obstetrics and gynecological history of the study participants, 667 (58.5%) were gravida 2 to 4; 187(16.4) has had between 3-4 abortions/miscarriage; 508(44.5) had at least one child alive; only 110(9.6%) had pre conceptional counselling and care; while 292(25.6%) used herbal preparations in this index pregnancy and 209(18.3%) abused substances in the index pregnancy (Table 2). Based on the maternal medical, obstetric and gynecological history, variables that were significantly associated with anemia included: gravidity (p<0.001), history of miscarriage/abortion (p=0.001), number of children alive (p<0.001), pre conceptional counselling and care (p<0.001), history of use of herbal medications (p<0.001), history of substance abuse (p=0.001), history of use of ITN (p<0.001), history of use of haematinics (p<0.001) (Table 2). Prevalence of anaemia and associated factors among the study participants Out of 1,141 participants, 728(63.8%) participants had anaemia at booking (Figure 1). Further breakdown (Figure 1) showed that 644(56.4%) had microcytic hypochromic anaemia, 65(5.7%) had normocytic normochromic anaemia while 19(1.7%) had macrocytic hypochromic anaemia. Class of anaemia Out of 728(63.8%) parturient who had anaemia, 42.8% had mild anaemia, 20.2% had moderate anaemia while 0.9% had severe anaemia (Figure 2). Relationship between anaemia and laboratory parameters Amongst the laboratory tests done at booking, presence of ova of hook worm in the stool (p<0.001), HIV status (p<0.001), presence of hepatitis B and C viruses (p<0.001), positive RDT for malaria parasite (p<0.001) and features of UTI on urinalysis (p<0.001) were significantly associated with anemia at booking (Table 3). Relationship between anaemia and perinatal outcome The most common maternal complication observed among the study participants was low birth weight with 76(6.7%) of the study participants having low birth weight babies while the least perinatal complications observed was per term babies accounting for 17(1.5%). Further break down of the perinatal outcome can be seen in table 4a. Relationship between poor perinatal outcome and substance misuse/abuse This study showed poorer perinatal outcome among parturient who had anaemia, used herbal medication, those who abused substance (kolanut, shisha, alcohol and cannabis) and those with poor WDDS. See table 4b for further details. Multivariable logistic regression factors associated with anaemia at booking among the participants After adjusting for the confounders, variables that were associated with an increased risk of anaemia at booking were: unemployment with an adjusted odds ratio (AOR) of 0.010 (95% CI, 0.010 to 0.1010), Muslim (AOR) of 1.925 (95% CI, 1.360 to 2.726), primary level of education (AOR) of 8.722 (95% CI, 2.006 to 37.916), primigravida (AOR) of 94.526 (95% CI, 23.982 to 372.582), primiparous (AOR) of 12.553 (95% CI, 4.571 to 34.475), history of 1-2 abortions (AOR) of 1.929 (95% CI, 1.034 to 3.598), history of 2-4 abortions greater than 2 number of children alive (AOR) of 2.692 (95% CI, 1.104 to 6.564), ova of hookworm (AOR) of 7.990 (95% CI, 4.004 to 15.946), use of herbal medications (AOR) of 0.393 (95% CI, 0.300 to 0.516), history of use of ITN (AOR) of 5.976 (95% CI, 2.718 to 13.137) and HIV infection (AOR) of 8.367 (95% CI, 2.577 to 27.167). See table 5 for further details. Discussion Diagnosing anaemia at booking and treating its predisposing factors is crucial in improving maternal health and reducing maternal and perinatal morbidity and mortality particularly in resource poor settings where this condition is endemic 2 . It also provides healthcare personnel with a very great opportunity to diagnose this condition early and institute immediate treatment or intervention so as to prevent complications associated with anaemia in pregnancy. This large hospital-based study examines the aetiology of anaemia at booking with a view to reveal previously unidentified associated factors to inform public health policy. The prevalence of anaemia in this study (63.8%) is unacceptably higher than WHO global prevalence of 36.5% 1 . This shows that the burden of anaemia in pregnancy is still greater than generally expected in the developing world, Nigeria inclusive. It is also higher than 56.0% quoted by WHO based on the 1988 data for prevalence of anaemia in Africa, suggesting that even after (more than three decades) 35 years, the burden of anaemia at booking has worsened 14 . It therefore calls for a more holistic approach in early detection and prompt treatment. Other studies from within Nigeria shows a prevalence of prevalence of 72.6% in Bida 5 and 60.4% in Ilorin 6 , both in north-central Nigeria. Majority (56.4%) had microcytic hypochromic anaemia, while only 1.7% had macrocytic hypochromic anaemia. This findings is similar to a study carried out in Siri lanka 15 . Microcytic hypochromic anaemia is generally associated with Iron deficiency anaemia and thalassaemia trait 15 . Deficiency of iron in pregnancy is most likely due to inadequate storage of iron to meet the increased demand of iron in pregnancy. Risk factors associated with iron deficiency anaemia especially in resource constraint setting includes: intestinal parasitic infection, HIV, malaria infection among others 16 . Therefore, screening for these risk factors early in pregnancy will aid prompt diagnosis and institution of early treatment. The highest prevalence of anaemia was observed among the 26-30 year age group. This is similar to studies carried out within and outside Nigeria 1,9 . This may be because this is the peak age of reproduction, therefore the rate of loss of iron is higher than the rate of replenishing lost iron stores 1,9,17 . More married women (96.0%) had anaemia at booking when compared to single women (4.0%). This finding could be due to the fact that the population of married women in this study was more than that of single women. Despite the high level of education of both parturient 889(77.9%) and their spouse 1050(92.0%), majority 768(67.3%) of the pregnant women who had anaemia at booking were in the lower social class. This finding is similar to a study carried out in Bida, north central Nigeria 5 . The low socioeconomic status of these women may significantly impact on the quality of food they consume and their health seeking habit. The economic down turn currently being experienced in most developing countries may further impact on diet leading to consumption of food that is high in carbohydrate and phytates but low in micronutrients, animal protein and vitamins as a result negatively impacting on intestinal absorption of iron and other important trace minerals such as calcium and zinc 5 . It is therefore important to incorporate dietary counselling in all antenatal care visit so as to better inform all pregnant women on its importance in reducing adverse feto-maternal outcome. Despite WHO report on the association between high parity (≥ five or more pregnancies) and anaemia, this study showed a higher prevalence of anaemia at booking among gravida 2-4, 415(57.0%), nulliparous women 257(35.3%) and women with no prior history of abortion or miscarriage 530(72.8%). The possible explanation may be because these women may have been anaemic prior to conception and their pregnancy state further worsened their condition. So also is the fact that the aetiology of anaemia is diverse and multifactorial 7 . This finding is in keeping with studies 18,19 which showed a high prevalence of anaemia among women of reproductive age group. Other factors that may have contributed to this conditions are: hook worm infestation, malaria infection, inflammatory and chronic diseases, HIV infection among others 7,19 . This study also shows that the mean gestational age at booking is 19.40±8.53 and 328(45.1%) of those who booked during the second trimester had anaemia when compared to 225(30.9%) and 175(24.0%) of those who booked during the first and third trimester respectively. This report is similar to a study carried out in south western Nigeria 19 . Late booking, lack of pre-conceptional counselling and care may be contributing factors. It is therefore important that pre-conceptional counselling and care including early antenatal care booking be incorporated into antenatal care services to improve the overall maternal and perinatal outcomes. The use of herbal medication in pregnancy has been well documented in previous studies 10 . This study shows that 68.0% of parturient who had anaemia at booking used herbal medication. Although the direct relationship between the herbal medication and anaemia is yet to be elucidated, caution needs to be exerted by pregnant women when consuming these herbal medication whose constituents are largely unknown and most often unregulated in the developing world. Substance miss-use and abuse is a significant public health risk in many developed country and was largely undocumented in the developing country. Recent study have shown increase abuse of substance among young women who increase their rate of drug consumption more rapidly than men when initiated 20 . For example chronic alcohol use can result in vitamin B and folate deficiency which can result in macrocytic anaemia 21 . This study shows a significant relationship between substance abuse and anaemia at booking as 94.0% of those who abuse substance had anaemia at booking. The fact that most of these illicit drugs pass easily through the placenta reaching the foetus thereby causing harmful effects on the unborn child should discourage its use 22 . Health education, pre-conceptional counselling and continuous antenatal counselling could help reduce its use. Also screening for substance abuse antenatally would help in early detection and prompt management. This study also showed that unemployment increases the risk of anaemia at booking. This is in keeping with findings from previous studies 23 . Unemployment has been documented to decrease women’s economic capability thereby decreasing their food consumption preference and hygienic practices 24 . This study has shown that hook worm infestation is significantly associated with anaemia in pregnancy. This is similar to findings obtained in a study conducted in Ethiopia 25 . It is therefore necessary to screen pregnant women with anaemia for hookworm infestation in order to promptly address and halt its effect on blood levels. Participants with history of ≥3 abortions showed a statistically significant relationship with anaemia at booking with a 4.8 times higher odds of becoming anaemic when compared with those with no such history. This is similar to findings from previous studies. The increased risk may be due to significant blood loss experienced during the process with little or time for the body to restore iron levels before the next pregnancy. This coupled with the low socio economic status may further worsen the haemodynamic state of the pregnant woman, therefore comprehensive medical and nutritional support is advisable for women who have had multiple abortion especially if it is unsafe 26 . Maternal Health. There is a significant relationship between the use of herbal medications and anaemia. The use of herbal medication in pregnancy has been well documented in a study. With the study showing an increased risk of congenital anomaly and anaemia in pregnant women who consume herbal medications especially those whose constituents are largely unknown 10 . Viral infections especially HIV infection has been well documented to increase the risk of anaemia in pregnancy 26 . This effects may be from lack of compliance with medications or the side effects of some of the antiretroviral drugs. This study showed an adjusted odds ratio of 8.4 between the risk of anaemia at booking and HIV infection. Conclusion This study identified the key factors contributing to the burden of anaemia at booking. Therefore, to prevent anaemia there must be collaboration between healthcare providers, government health institution and stake holders. Strategies include promoting insecticide-treated bed nets to combat malaria, cleaning swampy areas to reduce mosquito breeding grounds, provision of anthelmintic drugs to prevent hookworm infection, and providing comprehensive family planning services to prevent unplanned pregnancies. Additionally, offering preconception care and counselling on substance abuse will improve maternal and perinatal health outcomes and effectively addressing the burden of anemia in pregnant women. Strength of the study This study demonstrated a notable strength of 100% response rate with the use of multiple methods for data collection (questionnaires and laboratory tests). It also has a large sample size. Limitations It is a single centre study. Participants were not followed-up beyond the period of the study. The study did not account for other potential factors associated with anemia, such as genetic disorders. Abbreviations ANC-antenatal care AIDS- acquired immunodeficiency syndrome AOR- adjusted odds ratio CI- confidence interval GA- gestational age HIV- Human immunodeficiency virus WHO- world health organization Declarations Acknowledgements The authors express their gratitude to the nurses and midwives at the antenatal clinic, staffs of the records department, resident doctors in the department of obstetrics and gynaecology, the research assistants, and the nurses in the department of obstetrics and gynaecology and paediatrics, General Hospital Ilorin, Ilorin, Kwara State, Nigeria. Funding Statement Funding for this research was solely by the researchers. No external support was received Ethics approval and consent to participate Ethical approval was obtained from the ethical review committee of the General Hospital Ilorin Research Committee (GHI/IRC/246/VOL.I/08). Informed consent for this study was obtained from each participant and the data were anonymised. The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki. All the retrieved data were de-identified. The details of the study were thoroughly explained to all women booking for antenatal care at the beginning of the clinic. An informed consent was obtained in writing before recruiting each subject into the study. The participants retained the absolute right and freedom to decline from participating or withdrawing from the study at any time with no consequence to them. They were assured that opting out would not compromise the quality of care they receive from the antenatal clinic. The study was carried out under strict confidentiality. All the retrieved data were de-identified. Availability of data and materials The datasets used during this current study are available from the corresponding author on reasonable request Competing interest The authors declare that they have no competing interest Funding Funding was solely by the authors Authors’ Contribution AM: Concept, design, data collection, data interpretation, drafting, critical appraisal and approval of the final manuscript. FOA: Concept, design, data interpretation, drafting and approval of the final manuscript. AGJ: Concept, design, data interpretation, drafting and approval of the final manuscript. OBI: Concept, design, data interpretation, drafting, and approval of the final manuscript. References World Health Organization. 2024. Available at; https//www.who.int/health-topics/anaemia GBD 2021 Anaemia Collaborators. Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990-2021: findings from the Global Burden of Disease Study 2021. Lancet Haematol 2023;10(9):e713-e734 Guideline on haemoglobin cutoffs to define anaemia in individuals and populations. Geneva: World Health Organization; 2024. Licence: CC BY-NC-SA 3.0 IGO. Available at: https//www.who.int CDC recommendations to prevent and control iron deficiency in the United States. MMWR Recomm Rep 1998;47(No. RR-3):1-36 Ekpe AC, Adefemi SA, Pemi MD. Anaemia among Pregnant Women: Prevalence and Pattern at Booking Clinic of a Tertiary Health Care Facility in North Central Nigeria. West Afr J Med. 2022;39(3):228-236. Babatunde AS, Olawumi HO, Durotoye IA, Shittu AO, Adesina KT, Sani MA. Prevalence of Anaemia Among Pregnant Women At Antenatal Care Booking In Ilorin, North Central Nigeria. Trop. J. Health Sci. 2017;24(4) Karimi M, Chalesgar M, Salari N, Akbari H, Mohammadi M. Global Prevalence of Anaemia in Pregnant Women: A Comprehensive Systematic Review and Meta-Analysis. Matern Child Health J. 2022;26(7):1473-1487 Ayele AD, Belay HG, Kassa BG, Worke MD. Knowledge and utilization of preconception care and associated factors among women in Ethiopia: systematic review and meta-analysis. Reprod Health. 2021;18(1):78 Ugwu NI, Uneke CJ. Iron deficiency anemia in pregnancy in Nigeria-A systematic review. Niger J Clin Pract. 2020;23(7):889-896 Abdulbaki M, Oyewopo AO, Dare A, Aliyu FO, Adeniran AS, Ibrahim OR. Congenital anatomical variants in human fetal embryological development and its risk factors in low-resource setting: A longitudinal study. J Health Sci Res. 2024;9:66-71 Islam M. The safe motherhood initiatives and beyond. Bull World Health Organ. 2007;85(10):735 Anorlu RI, Oluwole AA, Abudu OO. Sociodemo-graphic factors in anaemia in pregnancy at booking in Lagos, Nigeria. J Obstet Gynaecol. 2006;26(8):773-776 Olusanya O, Okpere E, Ezimokhai M. The importance of social class in voluntary fertility control in developing countries. WAJM. 1985;4:205–207 Komolafe JO, Kuti O, Oni O, Egbewale BE. Socio demographic characteristics of anaemic gravidae at booking: a preliminary study at Liesha, Western Nigeria’ Niger J Med. 2005;14(2):151-154 Amarasinghe GS, Agampodi TC, Mendis V, Malawanage K, Kappagoda C, Agampodi SB. Prevalence and aetiologies of anaemia among first trimester pregnant women in Sri Lanka; the need for revisiting the current control strategies. BMC Pregnancy Childbirth. 2022;6;22(1):16 Völker F, Cooper P, Bader O, Uy A, Zimmermann O, Lugert R et al. Prevalence of pregnancy–relevant infections in a rural setting of Ghana. BMC Pregnancy Childbirth. 2017;17(1):172 Adinma JIB, Ikechebelu JI, Onyejimbe UN, Amilo G, Adinma E. Influence of antenatal care on the haematocrit value of pregnant Nigerian Igbo women. Trop J Obstet Gynaecol. 2002;19(2):68-70 Kinyoki D, Osgood-Zimmerman AE, Bhattacharjee NV, Local Burden of Disease Anaemia Collaborators; Kassebaum NJ, Hay SI. Anaemia prevalence in women of reproductive age in low- and middle-income countries between 2000 and 2018. Nat. Med. 2021;27(10):1761-1782 Iyanam V, Idung AU, Jumbo HE, Udonwa NE. Anaemia in pregnancy at booking: prevalence and risk factors among antenatal attendees in southern Nigerian general hospital. Ajmah. 2019;15(1):1-11 United Nations office on drugs and crime, 2017. Available at: https//www.unodc.org Gudeta TA, Regassa TM, Belay AS. Magnitude and factors associated with anaemia among pregnant women attending antenatal care in bench Maji, Keffa and Sheka zones of public hospitals, Southwest, Ethopia, 2018: a cross-sectional study. PLoS One;2019;14:e0225148 Jones HE, Fielder A. Neonatal abstinence syndrome: Historical perspective, current focus, future directions. Prev Med. 2015;80:12-17 Assefa E. Multilevel analysis of anaemia levels among reproductive age groups of women in Ethiopia. SAGE Open Med. 2021;9:0987375 Asaolu IO, Alaofe H, Gun JKL, Adu AK, Monroy AJ, Ehiri JE, et al. Measuring Women’s Empowerment in Sub-Saharan Africa: Exploratory and Confirmatory Factor Analysis of the Demographic and Health Surveys. Front Psycol 2018;9:994 Deriba BS, Bala ET, Bulto GA, Geleta TA, Ayalew AF, Gebru AA, et al. Determinants of anaemia among pregnant women at public hospitals in West Shewa, Central Ethopia: a case-control study. Anaemia. 2020:1-9 Yosef T, Gizachew A, Fetene G, Girma D, Setegn M, Tesfaw A. Infectious and obstetric determinants of anaemia among pregnant women in southwest Ethopia. Front. Glob. Womens health. 2024:5 Tables Table 1: Socio demographic Characteristics of Study Participants at booking Variable Total (%) n=1,141 Anaemia (%) n=728 No Anaemia (%) n=413 P value* Age group (Years) 0.280 ≤25 245(21.5) 169(23.2) 76(18.4) 26-30 414(36.3) 257(35.3) 157(38.0) 31-35 348(30.5) 216(29.7) 132(32.0) 36-40 134(11.7) 86(11.8) 48(11.6) Mean ± SD (Years) 29.54 ±4.90 Marital Status 0.347 Married 1100(96.4) 699(96.0) 401(97.1) Single 41(3.6) 29(4.0) 12(2.9) Occupation <0.001 Artisan 15(1.3) 12(1.6) 3(0.7) Civil Servant 340(29.8) 219(30.1) 121(29.3) Trading 709 (62.1) 460 60.3) 249(60.3) Unemployed 36 (3.2) 8 (1.1) 28(6.8) Others 41(3.6) 29(4.0) 12(2.9) Religion <0.001 Muslim 855(74.9) 569(78.2) 286(69.2) Christian 286(25.1) 159(21.8) 127(30.8) Level of Education 0.001 Primary 36 (3.2) 33(4.5) 3 (0.7) Secondary 216 (18.9) 130 (17.9) 86(20.8) Tertiary 889(77.9) 565 (77.6) 324(78.5) Level of Education of Partner/Husband 0.194 Primary 8(0.7) 6(0.8) 2(0.5) Secondary 83(7.3) 60(8.2) 23(5.6) Tertiary 1050(92.0) 662(90.9) 388(93.9) Social class <0.001 Upper Class 58(5.1) 56(19.4) 2(0.2) Middle Class 315(27.6) 65(22.5) 250(29.3) Lower Class Women’s dietary diversity score Adequate Inadequate 768(67.3) 494(43.3) 647(56.7) 168(58.1) 123(16.9) 605(83.1) 600(70.4) 371(89.8) 42(10.2) <0.001 Table 2: Medical, obstetrics and gynecological history of study participants Variables Categories Total (%) Anemia (%) No Anemia(%) P value* Gravidity Primigravida 269(23.6) 203(27.9) 66(16) <0.001 Gravida 2-4 667(58.5) 415(57.0) 252(61.0) Gravida 5-7 196(17.2) 109(15.0) 87(21.1) Gravida ≥8 9(0.8) 1(0.1) 8(1.9) Parity Nulliparous 382(33.5) 257(35.3) 125(30.3) 0.034 Primiparous 295(25.9) 195(26.8) 100(24.2) Para 2-4 412(36.1) 250(34.3) 162(39.2) Para 5-7 52(4.6) 26(3.6) 26(6.3) History of Miscarriage/Abortion No abortion 802(70.3) 530(72.8) 272(65.9) 0.001 1-2 abortion 152(13.2) 77(10.6) 75(18.2) 3-4 abortion 187(16.4) 121(16.6) 66(16.0) History of perinatal death No 1004(88.0) 649(89.1) 355(86.0) 0.111 Yes 137(12.0) 79(10.9) 58(14.0) Number of Children Alive 0 438(38.4) 298(40.9) 140(33.9) 4 55(4.8) 29(4.0) 26(6.3) EGA at Booking (Trimesters) 1 st (≤13 weeks) 343(30.1) 225(30.9) 118(28.6) 0.649 2 nd (14-27 weeks) 516(45.2) 328(45.1) 188(45.5) 3 rd (≥28 weeks) 282(24.7) 175(24.0) 107(25.9) Pre conceptional Counselling/Care No 1031(90.4) 710(97.5) 321(77.7) <0.001 Yes 110(9.6) 18(2.5) 92(22.3) History of use of herbal medications No 849(74.4) 495(68.0) 354(85.7) <0.001 Yes 292(25.6) 233(32.0) 59(14.3) History of substance abuse No 932(81.7) 574(78.8) 358(86.7) 0.001 Yes 209(18.3) 154 (21.2) 55(13.3) History of use of ITN No 1062(93.1) 724(99.5) 338(81.8) <0.001 Yes 79(6.9) 4(0.5) 75(18.2) History of use of hematinic No 1040(91.1) 682(93.7) 358(86.7) <0.001 Yes 101(8.9) 46(6.3) 55(13.3) *Chi square, ITN- Insecticidal treated net; EGA- Estimated Gestational Age Table 3: Relationship between anaemia and laboratory parameters (n=1,141) Variable Categories Total (%) Anaemia (%) No Anemia (%) P value* Stool microscopy Ova 119(10.4) 110(15.1) 9(2.2) <0.001 No ova 1022 (89.6) 618(84.9) 404(97.8) HIV Status Negative 1096 (96.1) 686 (94.2) 410 (99.3) <0.001 Positive 45 (3.9) 42 (5.8) 3 (0.7) Hepatitis B Virus Negative 962(84.3) 554(76.1) 408(98.8) <0.001 Positive 179(15.7) 174 (23.9) 5(1.2) Hepatitis C virus RDT Urinalysis PCV at 12 weeks(n=728) Negative 1056(92.6) 645(88.6) 411(99.5) <0.001 Positive Negative Positive UTI No UTI 85(7.4) 620(54.3) 521(45.7) 522(45.7) 619(54.3) 728(63.8) 83(11.4) 214(29.4) 514(70.6) 304(41.8) 424(58.2) 50(6.9) 2(0.5) 406(98.3) 7(1.7) 218(52.8) 195(47.2) 678(93.1) <0.001 <0.001 <0.001 * HIV-Human immunodeficiency virus; RDT-Rapid Diagnostic Test; UTI -Urinary Tract Infection; PCV- Packed Cell Volume Table 4a: Overview of Perinatal outcomes of study participants (n=1,141) Variable Total (%) Anaemia (%) No Anaemia (%) P value* 𝛘 2 Intrauterine foetal death 46(4.0) 35(4.8) 11(2.7) <0.001 48.423 Intrauterine growth restriction 32(2.8) 27(3.7) 5(1.2) Miscarriage 59(5.2) 54(7.4) 5(1.2) Low birth weight Grossly Normal baby Congenital anomaly Perinatal asphyxia Preterm delivery 76(6.7) 44(6.0) 32(7.7) 867(76.0) 7(0.6) 15(3.6) 17(1.5) 522(71.7) 7(0.6) 22(3.0) 17(2.3) 345(83.5) 0(0.0) 15(3.6) 0(0.0) *Chi square 𝛘 2 ; multiple response Table 4b: Relationship between Perinatal Outcomes, Pre-conceptional counselling and Substance Use Variable Categories No (%) Yes (%) Total (%) P 𝛘 2 Use of herbal medications IUFD 10(21.7) 36(78.3) 53(100.0) <0.001 475.203 IUGR 32(100.0) 0(0.0) 32(100.0) LBW 5(6.6) 71(93.4) 76(100.0) Miscarriage 5(8.5) 54(91.5) 59(100.0) Grossly normal baby 746(86.0) 121(14.0) 867(100.0) Perinatal asphyxia 37(100.0) 0(0.0) 37(100.0) Preterm delivery 11(64.7) 6(35.3) 17(100.0) Congenital anomaly 3(42.9) 4(57.1) 7(100.0) WDDS Categories Adequate (%) Inadequate (%) Total (%) P 𝛘 2 IUFD 11(23.9) 35(76.1) 46(100) <0.001 67.216 IUGR 5(15.6) 27(84.4) 32(100) LBW 31(40.8) 45(59.2) 76(100) Miscarriage 7(11.9) 52(88.1) 59(100) Grossly normal baby 424(48.9) 443(51.1) 867(100) Perinatal asphyxia 15(40.5) 22(59.5) 37(100) Preterm delivery 1(5.9) 16(94.1) 17(100) Congenital anomaly 0(0.0) 7(0.0) 7(100.0) Pre conceptional counselling and care Categories No (%) Yes (%) Total (%) P 𝛘 2 IUFD 43(93.5) 3(6.5) 46(100.0) <0.001 103.757 IUGR 32(100.0) 0(0.0) 32(100.0) LBW 44(57.9) 32(42.1) 76(100.0) Miscarriage 54(91.5) 5(8.5) 59(100.0) Grossly normal baby 798(92.0) 69(8.0) 867(100.0) Perinatal asphyxia 37(100.0) 0(0.0) 37(100.0) Preterm delivery 16(94.1) 1(5.9) 17(100.0) Congenital anomaly 7(100.0) 0(0.0) 7(100.0) Substance abuse Categories No (%) Yes (%) Total (%) P 𝛘 2 IUFD 10(21.7) 36(78.3) 46(100.0) <0.001 840.594 IUGR 32(100.0) 0(0.0) 32(100.0) LBW 5(6.6) 71(93.4) 76(100.0) Miscarriage 5(8.5) 54(91.5) 59(100.0) Grossly normal baby 840(96.9) 27(3.1) 867(100.0) Perinatal asphyxia 37(100.0) 0(0.0) 37(100.0) Preterm delivery 0(0.0) 17(100.0) 17(100.0) Congenital anomaly 3(42.9) 4(57.1) 7(100.0) * Multiple response; IUFD- Intrauterine Fetal Death; IUGR- Intra Uterine Growth Restriction; LBW- Low Birth Weight Table 5: Multivariable logistic regression of factors that are associated with anaemia at booking among the parturient Variable AOR 95%CI Unemployment 0.010 0.010, 0.1010 Muslim 1.925 1.360, 2.726 Primary level of education 8.722 2.006, 37.916 Primigravida 94.526 23.982, 372.582 Primiparous 12.553 4.571, 34.475 History of 2-4 abortion 4.818 2.347, 9.893 Greater than 2 children alive 2.692 1.104, 6.564 Ova of hook worm 7.990 4.004, 15.946 PCV at 12 weeks 1.043 1.027, 1.059 Urinalysis 1.599 1.223, 1.988 HIV Infection 8.367 2.577, 27.167 RDT 139.308 64.819, 299.068 Hepatits B Virus 0.039 0.016, 0.098 Hepatitis C Virus 0.038 0.009, 0.155 ITN Use 5.976 2.718, 13.137 Use of Herbal Med. 0.393 0,300. 0.516 Substance Abuse 1.746 1.249; 2.441 WDDS 43.449 29.911, 63.114 Pre-conceptional counselling&care 0.088 0.052, 0.149 * PCV-Packed Cell Volume; HIV-Human Immunodeficiency Virus; ITN-Insecticide Treated Net; WDDS-Women’s Dietary Diversity Score; AOR- Adjusted Odds Ratio; CI- Confidence Interval Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6523545","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":460413112,"identity":"f83279c0-12a7-4ca0-be26-fb1ca444f502","order_by":0,"name":"Mariam Abdulbaki","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAElEQVRIiWNgGAWjYFACxgYGhgIoO4GBQY6BgYcYLQYILcZEaAEBAwQzsYGQFnPpw40fPhjY2MtPO/zsw4Oabekbjp89+OADg52cbgN2LZZ9ic2SMwzSEjfcTjOekXDsdu6GM3nJhjMYko3NDuBw0hnGNmYeg8MJBtIJxgwJbEAtB3LMpHkYDiRuw6flj8F/e/nZ6Z8ZEv7dTjc4/4YILQwGBxgbbucYMyS23U4wuEHAFssexmbJHoNkoF9yihkS+24bzrzxxthwhgFuv5jzsD/88KPCDuSwzYw/vt2W5zufY/jgQ4WdHE7vY4goHMAujkeLfANu1aNgFIyCUTAyAQA63F/R8/QnWgAAAABJRU5ErkJggg==","orcid":"","institution":"Kwara State University Teaching Hospital, Ilorin, Kwara State","correspondingAuthor":true,"prefix":"","firstName":"Mariam","middleName":"","lastName":"Abdulbaki","suffix":""},{"id":460413113,"identity":"05dc4aef-c77c-4187-a561-c3ce9186a7f2","order_by":1,"name":"Fullaila Onazare Aliyu","email":"","orcid":"","institution":"University of Ilorin","correspondingAuthor":false,"prefix":"","firstName":"Fullaila","middleName":"Onazare","lastName":"Aliyu","suffix":""},{"id":460413114,"identity":"b3fa59e8-ca35-4d83-adad-a79566f06267","order_by":2,"name":"Gbenga Joseph Adeleke","email":"","orcid":"","institution":"Kwara State University Teaching Hospital, Ilorin, Kwara State","correspondingAuthor":false,"prefix":"","firstName":"Gbenga","middleName":"Joseph","lastName":"Adeleke","suffix":""},{"id":460413115,"identity":"24d6b5cf-eed9-43d4-9552-49b43ea483a5","order_by":3,"name":"Bilkis Iyabo Owolabi","email":"","orcid":"","institution":"Kwara State University Teaching Hospital, Ilorin, Kwara State","correspondingAuthor":false,"prefix":"","firstName":"Bilkis","middleName":"Iyabo","lastName":"Owolabi","suffix":""}],"badges":[],"createdAt":"2025-04-24 20:23:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6523545/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6523545/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83480262,"identity":"c3254a17-8cf1-469d-b313-6a26360bb57a","added_by":"auto","created_at":"2025-05-27 06:32:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":85410,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eType of Anaemia\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKeys\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMicrocytic hypochromic anaemia (mha) = 644(56.4%)\u003c/p\u003e\n\u003cp\u003eMacrocytic anaemia (ma) = 19(1.7%)\u003c/p\u003e\n\u003cp\u003eNormocytic normochromic anaemia (nna) = 65(5.7%)\u003c/p\u003e\n\u003cp\u003eNo anaemia (na) = 413(36.2%)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6523545/v1/485175909c837e1ecdc53a2d.png"},{"id":83480266,"identity":"11617f5b-7c42-4d4d-a9c1-5a03ccb2b5f6","added_by":"auto","created_at":"2025-05-27 06:32:57","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":74860,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDegree of Anaemia\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKeys\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.00-no anaemia = 412(36.1%)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.00- mild anaemia = 488(42.8%)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.00-moderate anaemia = 231(20.2%)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.00- severe anaemia = 10(0.9%)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6523545/v1/38762c7a604d0237916527e2.png"},{"id":83480883,"identity":"7882d746-aa34-4519-9cd2-4aaf4bbbd801","added_by":"auto","created_at":"2025-05-27 06:40:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2453856,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6523545/v1/ddc7b44d-d6c2-4770-a8bb-a67ffa77730e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Anaemia in pregnancy at booking: Prevalence, Risk Factors and Perinatal outcomes among Antenatal Clinic Attendees in a Secondary Healthcare Facility in North Central Nigeria: An Analytical Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAnaemia in pregnancy is an important public health challenge in most developing countries and the commonest complication seen in pregnancy in sub-Saharan African where access to good healthcare services and adequate nutrition is limited\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Even though the risk of anaemia significantly decreases with improved socioeconomic status and development, the burden in sub-Saharan Africa is still worse than expected\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Anaemia in pregnancy is a condition in which the total number of red blood cells or the haemoglobin concentration within an individual is less than normal\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. The function of haemoglobin is to carry oxygen to the body\u0026rsquo;s tissues, hence a reduction in the oxygen carry capacity of the red blood cells is not only deleterious to the mother but it can cause significant foetal morbidity and mortality\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. It is defined by the Centre for Disease Control (CDC) and World Health Organization (WHO) as haemoglobin concentration of less than 11g/dl or haematocrit of \u0026lt;\u0026thinsp;33% in the first and third trimester and less than 10.5g/dl or haematocrit of \u0026lt;\u0026thinsp;32.0% in the second trimester\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e The world health organization estimates that worldwide, 37.0% of pregnant women and 30.0% of women aged 15\u0026ndash;49 years are anaemic with significant variation across the world\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. In addition, the prevalence of anaemia varies even within the same region and country\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. For instances, studies carried out in the north central part of Nigeria shows a prevalence of 72.6% in Bida\u003csup\u003e5\u003c/sup\u003e and 60.4% in Ilorin\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe aetiology of anaemia in pregnancy is diverse and multifactorial with nutritional deficiency following inadequate dietary multivitamin particularly iron deficiency implicated as the most prevalent risk factor\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. It may also be due to inadequate absorption of nutrients, infections (e.g. malaria, parasitic infections, tuberculosis, human immunodeficiency virus), inflammation, chronic diseases, gynaecological and obstetrics conditions, and inherited red blood cell disorders\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. To combat the high burden of anaemia particularly in low- and middle-income countries, the WHO recommends the use of intermittent iron and folic acid supplementation in women of reproductive age group living in areas with prevalence of anaemia that is greater than or equal to 20.0%\u003csup\u003e1,3\u003c/sup\u003e. However, compliance with haematinics is poor and in most cases, they are already anaemic prior to conception\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Furthermore, the HIV/AIDS pandemic, high malaria burden, rising incidence of substance abuse by young adults, unhealthy diet, consumption of herbal concoction whose constituents is largely unknown, preference for large family size, short inter pregnancy interval, poor socio economic status and low purchasing power, lack of national health insurance cover for most dwellers in low and middle income countries are some of the contributing factors has made eradication of anaemia in pregnancy difficult\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Severe outcomes of anaemia at booking observed during delivery, such as preterm birth, intra uterine growth restrictions, placental abruption, severe postpartum haemorrhage, maternal shock, maternal and neonatal death among others\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e need to be prevented, by ensuring that every pregnant woman who present for booking is not anaemic and those with anaemia at booking are promptly identified and promptly treated by identifying factors responsible for the anaemia. It is therefore very important to identify factors responsible for anaemia and treating these factors in order to improve the overall outcome. So also is the fact that routine screening and counselling for substance abuse among pregnant women despite its contribution to anaemia, maternal and perinatal morbidity and mortality is almost non-existent in most developing countries, inclusive of Nigeria. This study therefore aims at determining the prevalence of anaemia at booking, levels of anaemia, and associated risk factors including socio demographic characteristics, maternal levels of anaemia following treatment and perinatal outcomes at a secondary health care facility in Ilorin, Kwara state. Findings from this study will serve as a guide to antenatal service providers and other stake holders to help in the implementation of safe motherhood initiative through measures that will primarily prevent anaemia at booking.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy area and settings:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was carried out at the antenatal clinic of General Hospital, Ilorin, Kwara State, which currently serves as a training institution for post graduate medical students in the Department of Obstetrics and Gynaecology. The Hospital offers specialist care and serves as a referral centre to the people of Kwara State and parts of the neighbouring states of Kogi, Niger, and Oyo. Patients who present for booking are attended to on Mondays, while those who present for routine antenatal care are seen from Tuesdays through Thursdays at the antenatal clinics while Fridays is for post-natal clinic. An average of 75 pregnant women were seen weekly at booking clinic from previous year record.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design and population.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a prospective analytical study carried out between 14 October, 2022, and 13 October, 2023. A pretested semi-structured interviewer administered questionnaire was used to obtain socio-demographic characteristics and other relevant information by four trained research assistant while 5 ml of venous blood sample were collected from the median cubital vein by two trained laboratory technicians from consecutive parturient who consented to participate in the study. The blood samples were analysed for haemoglobin levels (PCV), genotype, blood group, full blood count/peripheral blood film, rapid diagnostic test for malaria, human immunodeficiency virus (HIV) screening, hepatitis B surface antigen, hepatitis C, urinalysis and stool microscopy.\u003c/p\u003e\n\u003cp\u003eAnaemia was defined based on the World Health Organization definition of anaemia (haemoglobin concentration less than 11g/dl (first and third trimester) and 10.5g/dl (second trimester)\u003csup\u003e3\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size Determination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUsing the prevalence of anaemia in a study conducted in north-central Nigeria (72.6%)\u003csup\u003e5\u003c/sup\u003e,\u0026nbsp;the estimate from this study was desired to be within five percent of the actual prevalence with 95 percent confidence level. The sample size was calculated using the Kish Leslie formula for cross-sectional studies\u003csup\u003e12\u003c/sup\u003e:\u003c/p\u003e\n\u003cp\u003en=Z\u003csup\u003e2\u003c/sup\u003ePq/d\u003csup\u003e2\u003c/sup\u003e,\u003c/p\u003e\n\u003cp\u003eWhere \u003cem\u003en\u003c/em\u003e is the desired sample size and \u003cem\u003eZ\u003c/em\u003e is the standard normal deviate usually set at 1.96, which corresponds to the 95% confidence interval. \u003cem\u003eP\u003c/em\u003e is the proportion of pregnant women with anaemia, which is 72.6%. \u003cem\u003eq\u003c/em\u003e is complementary proportion equivalent to one (1) minus \u003cem\u003eP\u003c/em\u003e; that is, 1 \u0026minus; 0.6 equal to 0.4. \u003cem\u003ed\u003c/em\u003e is the degree of accuracy desired (absolute precision), which was 2.5% (0.025).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003en=3.84\u0026times;0.726\u0026times;0.326/0.0009\u003c/p\u003e\n\u003cp\u003en=0.9088/0.0009\u003c/p\u003e\n\u003cp\u003en=1,009.9\u003c/p\u003e\n\u003cp\u003en=1,010\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipant Recruitment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe attendance register\u0026rsquo; of the parturient who presents for booking at each booking clinic served as the sampling frame. Each booking clinic attendees were given a tally number at every booking clinic. These numbers were then thoroughly mixed in a container from where the first parturient was picked randomly by balloting. If the woman did not meet the inclusion criteria, a new number was drawn until one met the criteria. The remaining numbers of women were selected through systematic sampling, at fixed intervals (sampling interval = 75/3=25; 25* 4=100; 100*12=1,200) of every third number on the sampling frame to make up to the 25 women recruited per week.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe included pregnant women who presented for the first time at the ante natal clinic for booking and were willing to participate in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePregnant women at their follow-up antenatal clinic visit, those who had received blood transfusions in the index pregnancy or were already receiving treatment for anemia in pregnancy before their booking visit, recent or on-going vaginal bleeding, and known sickle cell disease patient were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection tools, procedure and quality control\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected from 14 October 2022, to 13 October 2023, during which 1,141 pregnant women were recruited at their first antenatal visit. The parturient were interviewed with pre-tested semi-structured questionnaire by the researcher and four trained research assistants in the Department of Obstetrics and Gynaecology to ensure that all the necessary information were obtained. The following information was recorded: maternal age, gravidity, parity, estimated gestational age, last childbirth, last menstrual period, level of education and occupation of the women and their husband, history of fever in the index pregnancy, presence of any chronic illnesses, drug history, ingestion of herbal medication, history of substance abuse (kolanut, shisha, marijuana and alcohol), history of use of hematinic, history of vaginal bleeding in present pregnancy and 24-hour dietary recall. Each study participant was allotted to one of the five social classes based on her level of education and her husband\u0026apos;s occupation according to a scoring system designed by Olusanya et al\u003csup\u003e13\u003c/sup\u003e. The social class for single or separated women was based on their occupation and their educational status. Social classes 1 and 2 were classified as upper class, represented the elites, the professionals like the doctors, lawyers, bankers, and those in managerial position. Class 3 represented the middle class of nurses, clerks, technicians, artisans, and so forth, while classes 4 and 5 represented the lowest rung on the socioeconomic ladder.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFrom each of the recruited parturient, 5\u0026thinsp;ml of venous blood was collected using sterile techniques from the median cubital vein using plastic disposable syringes into sample bottles containing ethylene diamine-tetra acetic acid (EDTA). Each participant had packed cell volume (PCV) done using a microhaematocrit method, blood group and genotype, rapid diagnostic test for malaria, full blood count/peripheral blood film, urinalysis, stool microscopy (to identify hookworm infection), HIV testing (was done after counselling), hepatitis B surface antigen and hepatitis C virus screening by two skilled laboratory technicians. The packed cell volume was repeated at 12 weeks following treatment. All parturient received routine haematinics and were followed-up until delivery.\u003c/p\u003e\n\u003cp\u003eThe packed cell volume was measured using a microhaematocrit reader. Stool samples were collected from each participant using a clean, wide-mouthed, leak-proof stool cup. A stool wet mount was prepared with saline and/or iodine and examined microscopically within 30 min of collection to identify hookworm infection. Comprehensive training was also provided to data collectors and supervisors to ensure consistent and clear data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e24-hour Dietary Recall\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e24-hours dietary diversity was assessed using a 24-h food recall questionnaire adapted from the FAO\u003csup\u003e14\u003c/sup\u003e. The questionnaire was modified accordingly and was administered by the research assistants. Respondents were asked to mention all the foods (meals and snacks) eaten the previous day during the day and night. The food items mentioned were recorded in the spaces provided in the questionnaire. Using this information, it was determined whether they ate from the following 9 food groups: \u003cem\u003e1\u003c/em\u003e) starchy staples; \u003cem\u003e2\u003c/em\u003e) dark-green vegetables; \u003cem\u003e3\u003c/em\u003e) other fruit and vegetables; \u003cem\u003e4\u003c/em\u003e) organ meats; \u003cem\u003e5\u003c/em\u003e) meat and fish; \u003cem\u003e6\u003c/em\u003e) eggs; \u003cem\u003e7\u003c/em\u003e) legumes, nuts, and seeds; \u003cem\u003e8\u003c/em\u003e) milk and milk products; and \u003cem\u003e9\u003c/em\u003e) oil and fats.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasurement of variables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipant\u0026rsquo;s dietary diversity scores\u003c/p\u003e\n\u003cp\u003eAfter the respondent recalled all the foods and beverages consumed, the foods were underlined with the corresponding foods in the list under the appropriate food group. Number \u0026ldquo;1\u0026rdquo; was assigned in the column next to the food group if \u0026ge;1 food in this group had been underlined, and \u0026ldquo;0\u0026rdquo; was assigned in the right-hand column of the questionnaire when it was certain that no foods in that group were eaten. Women\u0026apos;s dietary diversity scores (WDDSs) were calculated by summing the number of food groups consumed by the individual respondent over the 24-h recall period\u003csup\u003e14\u003c/sup\u003e. Total scores ranged from 0 to 9. The mean score was calculated based on the number of food groups to indicate adequate or inadequate dietary diversity\u003csup\u003e14\u003c/sup\u003e. Therefore, a score from 0 to 4 was categorized as inadequate dietary diversity, whereas a score \u0026gt;4 was categorized as adequate dietary diversity. The WDDS is an indicator variable for whether a woman has eaten from \u0026ge;5 food groups out of 9 designated food groups within the last 24 h and is a measure of adequacy of micronutrients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were entered into a computer, which was pass-worded and analysed using SPSS version 24. The age was summarised as mean with standard deviations and further sub-grouped for analysis. The other socio-demographic variables were summarized as percentage and frequency. The association between the factors that contributed to anaemia at booking was evaluated using Chi-square and Fischer\u0026apos;s exact tests as appropriate. The factors that were associated with anaemia was evaluated with adjusted odds ratio along with a 95% confidence interval, and all levels of statistical significance were set at a value less than 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the ethical review committee of the General Hospital Ilorin Research Committee (GHI/IRC/246/VOL.I/08). Informed consent for this study was obtained from each participant and the data were anonymised. The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki and all the retrieved data were de-identified. The details of the study were thoroughly explained to all women booking for antenatal care at the beginning of the clinic. An informed consent was obtained in writing before recruiting each subject into the study. The participants retained the absolute right and freedom to decline from participating or withdrawing from the study at any time with no consequence to them. They were assured that opting out would not compromise the quality of care they receive from the antenatal clinic. The study was carried out under strict confidentiality as participants and their samples were identified by initials and serial numbers on their questionnaires, laboratory forms, and specimen bottles. Those that participated in the study had the benefit of early diagnosis of anaemia when present. This allowed for early treatment and ultimate prevention of the consequences of anaemia in the index pregnancy.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eGeneral characteristics of the study participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 1,141 parturient were studied with a mean age of 29.54 ±4.90 years. Most of the parturient were aged 26-30 years (414;36.3%), married (1100;96.4%), and traders (709;62.1%). Also, most of the parturient had tertiary levels of education (889; 77.9%) and were from the lower social class (768; 67.3%) (Table 1). Socio-demographics that were associated with anemia included maternal occupation (p\u0026lt;0.001), religion (p\u0026lt;0.001), maternal level of education (p=0.001), social class (P\u0026lt;0.001) and WDDS ((p\u0026lt;0.001) (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMedical, Obstetrics and Gynaecological history of study participants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the medical, obstetrics and gynecological history of the study participants, 667 (58.5%) were gravida 2 to 4; 187(16.4) has had between 3-4 abortions/miscarriage; 508(44.5) had at least one child alive; only 110(9.6%) had pre conceptional counselling and care; while 292(25.6%) used herbal preparations in this index pregnancy and 209(18.3%) abused substances in the index pregnancy (Table 2). Based on the maternal medical, obstetric and gynecological history, variables that were significantly associated with anemia included: gravidity (p\u0026lt;0.001), history of miscarriage/abortion (p=0.001), number of children alive (p\u0026lt;0.001), pre conceptional counselling and care (p\u0026lt;0.001), history of use of herbal medications (p\u0026lt;0.001), history of substance abuse (p=0.001), history of use of ITN (p\u0026lt;0.001), history of use of haematinics (p\u0026lt;0.001) (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of anaemia and associated factors\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eamong the study participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of 1,141 participants, 728(63.8%) participants had anaemia at booking (Figure 1). Further breakdown (Figure 1) showed that 644(56.4%) had microcytic hypochromic anaemia, 65(5.7%) had normocytic normochromic anaemia while 19(1.7%) had macrocytic hypochromic anaemia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClass of anaemia\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of 728(63.8%) parturient who had anaemia, 42.8% had mild anaemia, 20.2% had moderate anaemia while 0.9% had severe anaemia (Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between anaemia and laboratory parameters\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmongst the laboratory tests done at booking, presence of ova of hook worm in the stool (p\u0026lt;0.001), HIV status (p\u0026lt;0.001), presence of hepatitis B and C viruses (p\u0026lt;0.001), positive RDT for malaria parasite (p\u0026lt;0.001) and features of UTI on urinalysis (p\u0026lt;0.001) were significantly associated with anemia at booking (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between anaemia and perinatal outcome\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe most common maternal complication observed among the study participants was low birth weight with 76(6.7%) of the study participants having low birth weight babies while the least perinatal complications observed was per term babies accounting for 17(1.5%). Further break down of the perinatal outcome can be seen in table 4a.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between poor perinatal outcome and substance misuse/abuse\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study showed poorer perinatal outcome among parturient who had anaemia, used herbal medication, those who abused substance (kolanut, shisha, alcohol and cannabis) and those with poor WDDS. See table 4b for further details.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMultivariable logistic regression factors associated with anaemia at booking among the participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter adjusting for the confounders, variables that were associated with an increased risk of anaemia at booking were: unemployment with an adjusted odds ratio (AOR) of 0.010 (95% CI, 0.010 to 0.1010), Muslim (AOR) of 1.925 (95% CI, 1.360 to 2.726), primary level of education (AOR) of 8.722 (95% CI, 2.006 to 37.916), primigravida (AOR) of 94.526 (95% CI, 23.982 to 372.582), primiparous (AOR) of 12.553 (95% CI, 4.571 to 34.475), history of 1-2 abortions (AOR) of 1.929 (95% CI, 1.034 to 3.598), history of 2-4 abortions greater than 2 number of children alive (AOR) of 2.692 (95% CI, 1.104 to 6.564), ova of hookworm (AOR) of 7.990 (95% CI, 4.004 to 15.946), use of herbal medications (AOR) of 0.393 (95% CI, 0.300 to 0.516), history of use of ITN (AOR) of 5.976 (95% CI, 2.718 to 13.137) and HIV infection (AOR) of 8.367 (95% CI, 2.577 to 27.167). See table 5 for further details.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDiagnosing anaemia at booking and treating its predisposing factors is crucial in improving maternal health and reducing maternal and perinatal morbidity and mortality particularly in resource poor settings where this condition is endemic\u003csup\u003e2\u003c/sup\u003e. It also provides healthcare personnel with a very great opportunity to diagnose this condition early and institute immediate treatment or intervention so as to prevent complications associated with anaemia in pregnancy. This large hospital-based study examines the aetiology of anaemia at booking with a view to reveal previously unidentified associated factors to inform public health policy. The prevalence of anaemia in this study (63.8%) is unacceptably higher than WHO global prevalence of 36.5%\u003csup\u003e1\u003c/sup\u003e. This shows that the burden of anaemia in pregnancy is still greater than generally expected in the developing world, Nigeria inclusive. It is also higher than 56.0% quoted by WHO based on the 1988 data for prevalence of anaemia in Africa, suggesting that even after (more than three decades) 35 years, the burden of anaemia at booking has worsened\u003csup\u003e14\u003c/sup\u003e. It therefore calls for a more holistic approach in early detection and prompt treatment. Other studies from within Nigeria shows a prevalence of prevalence of 72.6% in Bida\u003csup\u003e5\u003c/sup\u003e and 60.4% in Ilorin\u003csup\u003e6\u003c/sup\u003e, both in north-central Nigeria. Majority (56.4%) had microcytic hypochromic anaemia, while only 1.7% had macrocytic hypochromic anaemia. This findings is similar to a study carried out in Siri lanka\u003csup\u003e15\u003c/sup\u003e. Microcytic hypochromic anaemia is generally associated with Iron deficiency anaemia and thalassaemia trait\u003csup\u003e15\u003c/sup\u003e. Deficiency of iron in pregnancy is most likely due to inadequate storage of iron to meet the increased demand of iron in pregnancy. Risk factors associated with iron deficiency anaemia especially in resource constraint setting includes: intestinal parasitic infection, HIV, malaria infection among others\u003csup\u003e16\u003c/sup\u003e. Therefore, screening for these risk factors early in pregnancy will aid prompt diagnosis and institution of early treatment. The highest prevalence of anaemia was observed among the 26-30 year age group. This is similar to studies carried out within and outside Nigeria\u003csup\u003e1,9\u003c/sup\u003e. This may be because this is the peak age of reproduction, therefore the rate of loss of iron is higher than the rate of replenishing lost iron stores\u003csup\u003e1,9,17\u003c/sup\u003e. More married women (96.0%) had anaemia at booking when compared to single women (4.0%). This finding could be due to the fact that the population of married women in this study was more than that of single women.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDespite the high level of education of both parturient 889(77.9%) and their spouse 1050(92.0%), majority 768(67.3%) of the pregnant women who had anaemia at booking were in the lower social class. This finding is similar to a study carried out in Bida, north central Nigeria\u003csup\u003e5\u003c/sup\u003e. The low socioeconomic status of these women may significantly impact on the quality of food they consume and their health seeking habit. The economic down turn currently being experienced in most developing countries may further impact on diet leading to consumption of food that is high in carbohydrate and phytates but low in micronutrients, animal protein and vitamins as a result negatively impacting on intestinal absorption of iron and other important trace minerals such as calcium and zinc\u003csup\u003e5\u003c/sup\u003e. It is therefore important to incorporate dietary counselling in all antenatal care visit so as to better inform all pregnant women on its importance in reducing adverse feto-maternal outcome.\u003c/p\u003e\n\u003cp\u003eDespite WHO report on the association between high parity (\u0026ge; five or more pregnancies) and anaemia, this study showed a higher prevalence of anaemia at booking among gravida 2-4, 415(57.0%), nulliparous women 257(35.3%) and women with no prior history of abortion or miscarriage 530(72.8%). The possible explanation may be because these women may have been anaemic prior to conception and their pregnancy state further worsened their condition. So also is the fact that the aetiology of anaemia is diverse and multifactorial\u003csup\u003e7\u003c/sup\u003e. This finding is in keeping with studies\u003csup\u003e18,19\u003c/sup\u003e which showed a high prevalence of anaemia among women of reproductive age group. Other factors that may have contributed to this conditions are: hook worm infestation, malaria infection, inflammatory and chronic diseases, HIV infection among others\u003csup\u003e7,19\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThis study also shows that the mean gestational age at booking is 19.40\u0026plusmn;8.53 and 328(45.1%) of those who booked during the second trimester had anaemia when compared to 225(30.9%) and 175(24.0%) of those who booked during the first and third trimester respectively. This report is similar to a study carried out in south western Nigeria\u003csup\u003e19\u003c/sup\u003e. Late booking, lack of pre-conceptional counselling and care may be contributing factors. It is therefore important that pre-conceptional counselling and care including early antenatal care booking be incorporated into antenatal care services to improve the overall maternal and perinatal outcomes. The use of herbal medication in pregnancy has been well documented in previous studies\u003csup\u003e10\u003c/sup\u003e. This study shows that 68.0% of parturient who had anaemia at booking used herbal medication. Although the direct relationship between the herbal medication and anaemia is yet to be elucidated, caution needs to be exerted by pregnant women when consuming these herbal medication whose constituents are largely unknown and most often unregulated in the developing world. Substance miss-use and abuse is a significant public health risk in many developed country and was largely undocumented in the developing country. Recent study have shown increase abuse of substance among young women who increase their rate of drug consumption more rapidly than men when initiated\u003csup\u003e20\u003c/sup\u003e. For example chronic alcohol use can result in vitamin B and folate deficiency which can result in macrocytic anaemia\u003csup\u003e21\u003c/sup\u003e. This study shows a significant relationship between substance abuse and anaemia at booking as 94.0% of those who abuse substance had anaemia at booking. The fact that most of these illicit drugs pass easily through the placenta reaching the foetus thereby causing harmful effects on the unborn child should discourage its use\u003csup\u003e22\u003c/sup\u003e. Health education, pre-conceptional counselling and continuous antenatal counselling could help reduce its use. Also screening for substance abuse antenatally would help in early detection and prompt management.\u003c/p\u003e\n\u003cp\u003eThis study also showed that unemployment increases the risk of anaemia at booking. This is in keeping with findings from previous studies\u003csup\u003e23\u003c/sup\u003e. Unemployment has been documented to decrease women\u0026rsquo;s economic capability thereby decreasing their food consumption preference and hygienic practices\u003csup\u003e24\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study has shown that hook worm infestation is significantly associated with anaemia in pregnancy. This is similar to findings obtained in a study conducted in Ethiopia \u003csup\u003e25\u003c/sup\u003e. It is therefore necessary to screen pregnant women with anaemia for hookworm infestation in order to promptly address and halt its effect on blood levels. Participants with history of \u0026ge;3 abortions showed a statistically significant relationship with anaemia at booking with a 4.8 times higher odds of becoming anaemic when compared with those with no such history. This is similar to findings from previous studies. The increased risk may be due to significant blood loss experienced during the process with little or time for the body to restore iron levels before the next pregnancy. This coupled with the low socio economic status may further worsen the haemodynamic state of the pregnant woman, therefore comprehensive medical and nutritional support is advisable for women who have had multiple abortion especially if it is unsafe\u003csup\u003e26\u003c/sup\u003e. Maternal Health. There is a significant relationship between the use of herbal medications and anaemia. The use of herbal medication in pregnancy has been well documented in a study. With the study showing an increased risk of congenital anomaly and anaemia in pregnant women who consume herbal medications especially those whose constituents are largely unknown\u003csup\u003e10\u003c/sup\u003e. Viral infections especially HIV infection has been well documented to increase the risk of anaemia in pregnancy\u003csup\u003e26\u003c/sup\u003e. This effects may be from lack of compliance with medications or the side effects of some of the antiretroviral drugs. This study showed an adjusted odds ratio of 8.4 between the risk of anaemia at booking and HIV infection.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study identified the key factors contributing to the burden of anaemia at booking. Therefore, to prevent anaemia there must be collaboration between healthcare providers, government health institution and stake holders. Strategies include promoting insecticide-treated bed nets to combat malaria, cleaning swampy areas to reduce mosquito breeding grounds, provision of anthelmintic drugs to prevent hookworm infection, and providing comprehensive family planning services to prevent unplanned pregnancies. Additionally, offering preconception care and counselling on substance abuse will improve maternal and perinatal health outcomes and effectively addressing the burden of anemia in pregnant women.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrength of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study demonstrated a notable strength of 100% response rate with the use of multiple methods for data collection (questionnaires and laboratory tests). It also has a large sample size.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt is a single centre study.\u003c/p\u003e\n\u003cp\u003eParticipants were not followed-up beyond the period of the study.\u003c/p\u003e\n\u003cp\u003eThe study did not account for other potential factors associated with anemia, such as genetic disorders.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eANC-antenatal care\u003c/p\u003e\n\u003cp\u003eAIDS- acquired immunodeficiency syndrome\u003c/p\u003e\n\u003cp\u003eAOR- adjusted odds ratio\u003c/p\u003e\n\u003cp\u003eCI- confidence interval\u003c/p\u003e\n\u003cp\u003eGA- gestational age\u003c/p\u003e\n\u003cp\u003eHIV- Human immunodeficiency virus\u003c/p\u003e\n\u003cp\u003eWHO- world health organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors express their gratitude to the nurses and midwives at the antenatal clinic, staffs of the records department, resident doctors in the department of obstetrics and gynaecology, the research assistants, and the nurses in the department of obstetrics and gynaecology and paediatrics, General Hospital Ilorin, Ilorin, Kwara State, Nigeria.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFunding Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding for this research was solely by the researchers. No external support was received\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the ethical review committee of the General Hospital Ilorin Research Committee (GHI/IRC/246/VOL.I/08). Informed consent for this study was obtained from each participant and the data were anonymised. The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki. All the retrieved data were de-identified. The details of the study were thoroughly explained to all women booking for antenatal care at the beginning of the clinic. An informed consent was obtained in writing before recruiting each subject into the study. The participants retained the absolute right and freedom to decline from participating or withdrawing from the study at any time with no consequence to them. They were assured that opting out would not compromise the quality of care they receive from the antenatal clinic. The study was carried out under strict confidentiality. All the retrieved data were de-identified.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used during this current study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding was solely by the authors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAM: Concept, design, data collection, data interpretation, drafting, critical appraisal and approval of the final manuscript.\u003c/p\u003e\n\u003cp\u003eFOA: Concept, design, data interpretation, drafting and approval of the final manuscript.\u003c/p\u003e\n\u003cp\u003eAGJ: Concept, design, data interpretation, drafting and approval of the final manuscript.\u003c/p\u003e\n\u003cp\u003eOBI: Concept, design, data interpretation, drafting, and approval of the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWorld Health Organization. 2024. Available at; https//www.who.int/health-topics/anaemia\u003c/li\u003e\n \u003cli\u003eGBD 2021 Anaemia Collaborators. Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990-2021: findings from the Global Burden of Disease Study 2021. Lancet Haematol 2023;10(9):e713-e734\u003c/li\u003e\n \u003cli\u003eGuideline on haemoglobin cutoffs to define anaemia in individuals and populations. Geneva: World Health Organization; 2024. Licence: CC BY-NC-SA 3.0 IGO. Available at: https//www.who.int\u003c/li\u003e\n \u003cli\u003eCDC recommendations to prevent and control iron deficiency in the United States. MMWR Recomm Rep 1998;47(No. RR-3):1-36\u003c/li\u003e\n \u003cli\u003eEkpe AC, Adefemi SA, Pemi MD. Anaemia among Pregnant Women: Prevalence and Pattern at Booking Clinic of a Tertiary Health Care Facility in North Central Nigeria. West Afr J Med. 2022;39(3):228-236.\u003c/li\u003e\n \u003cli\u003eBabatunde AS, Olawumi HO, Durotoye IA, Shittu AO, Adesina KT, Sani MA. Prevalence of Anaemia Among Pregnant Women At Antenatal Care Booking In Ilorin, North Central Nigeria. Trop. J. Health Sci. 2017;24(4)\u003c/li\u003e\n \u003cli\u003eKarimi M, Chalesgar M, Salari N, Akbari H, Mohammadi M. Global Prevalence of Anaemia in Pregnant Women: A Comprehensive Systematic Review and Meta-Analysis. Matern Child Health J. 2022;26(7):1473-1487\u003c/li\u003e\n \u003cli\u003eAyele AD, Belay HG, Kassa BG, Worke MD. Knowledge and utilization of preconception care and associated factors among women in Ethiopia: systematic review and meta-analysis. Reprod Health. 2021;18(1):78\u003c/li\u003e\n \u003cli\u003eUgwu NI, Uneke CJ. Iron deficiency anemia in pregnancy in Nigeria-A systematic review. Niger J Clin Pract. 2020;23(7):889-896\u003c/li\u003e\n \u003cli\u003eAbdulbaki M, Oyewopo AO, Dare A, Aliyu FO, Adeniran AS, Ibrahim OR. Congenital anatomical variants in human fetal embryological development and its risk factors in low-resource setting: A longitudinal study. J Health Sci Res. 2024;9:66-71\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eIslam M. The safe motherhood initiatives and beyond. Bull World Health Organ. 2007;85(10):735\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAnorlu RI, Oluwole AA, Abudu OO. Sociodemo-graphic factors in anaemia in pregnancy at booking in Lagos, Nigeria. J Obstet Gynaecol. 2006;26(8):773-776\u003c/li\u003e\n \u003cli\u003eOlusanya O, Okpere E, Ezimokhai M. The importance of social class in voluntary fertility control in developing countries. WAJM.\u003cem\u003e\u0026nbsp;\u003c/em\u003e1985;4:205\u0026ndash;207\u003c/li\u003e\n \u003cli\u003eKomolafe JO, Kuti O, Oni O, Egbewale BE. Socio demographic characteristics of anaemic gravidae at booking: a preliminary study at Liesha, Western Nigeria\u0026rsquo; Niger J Med. 2005;14(2):151-154\u003c/li\u003e\n \u003cli\u003eAmarasinghe GS, Agampodi TC, Mendis V, Malawanage K, Kappagoda C, Agampodi SB. Prevalence and aetiologies of anaemia among first trimester pregnant women in Sri Lanka; the need for revisiting the current control strategies. BMC Pregnancy Childbirth. 2022;6;22(1):16\u003c/li\u003e\n \u003cli\u003eV\u0026ouml;lker F, Cooper P, Bader O, Uy A, Zimmermann O, Lugert R et al. Prevalence of pregnancy\u0026ndash;relevant infections in a rural setting of Ghana. BMC Pregnancy Childbirth. 2017;17(1):172\u003c/li\u003e\n \u003cli\u003eAdinma JIB, Ikechebelu JI, Onyejimbe UN, Amilo G, Adinma E. Influence of antenatal care on the haematocrit value of pregnant Nigerian Igbo women. Trop J Obstet Gynaecol. 2002;19(2):68-70\u003c/li\u003e\n \u003cli\u003eKinyoki D, Osgood-Zimmerman AE, Bhattacharjee NV, Local Burden of Disease Anaemia Collaborators; Kassebaum NJ, Hay SI. Anaemia prevalence in women of reproductive age in low- and middle-income countries between 2000 and 2018. Nat. Med. 2021;27(10):1761-1782\u003c/li\u003e\n \u003cli\u003eIyanam V, Idung AU, Jumbo HE, Udonwa NE. Anaemia in pregnancy at booking: prevalence and risk factors among antenatal attendees in southern Nigerian general hospital. Ajmah. 2019;15(1):1-11\u003c/li\u003e\n \u003cli\u003eUnited Nations office on drugs and crime, 2017. Available at: https//www.unodc.org\u003c/li\u003e\n \u003cli\u003eGudeta TA, Regassa TM, Belay AS. Magnitude and factors associated with anaemia among pregnant women attending antenatal care in bench Maji, Keffa and Sheka zones of public hospitals, Southwest, Ethopia, 2018: a cross-sectional study. PLoS One;2019;14:e0225148\u003c/li\u003e\n \u003cli\u003eJones HE, Fielder A. Neonatal abstinence syndrome: Historical perspective, current focus, future directions. Prev Med. 2015;80:12-17\u003c/li\u003e\n \u003cli\u003eAssefa E. Multilevel analysis of anaemia levels among reproductive age groups of women in Ethiopia. SAGE Open Med. 2021;9:0987375\u003c/li\u003e\n \u003cli\u003eAsaolu IO, Alaofe H, Gun JKL, Adu AK, Monroy AJ, Ehiri JE, et al. Measuring Women\u0026rsquo;s Empowerment in Sub-Saharan Africa: Exploratory and Confirmatory Factor Analysis of the Demographic and Health Surveys. Front Psycol 2018;9:994\u003c/li\u003e\n \u003cli\u003eDeriba BS, Bala ET, Bulto GA, Geleta TA, Ayalew AF, Gebru AA, et al. Determinants of anaemia among pregnant women at public hospitals in West Shewa, Central Ethopia: a case-control study. Anaemia. 2020:1-9\u003c/li\u003e\n \u003cli\u003eYosef T, Gizachew A, Fetene G, Girma D, Setegn M, Tesfaw A. Infectious and obstetric determinants of anaemia among pregnant women in southwest Ethopia. Front. Glob. Womens health. 2024:5\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Socio demographic Characteristics of Study Participants at booking\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"627\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=1,141\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnaemia (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=728\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo Anaemia (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=413\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge group (Years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.280\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u0026le;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e245(21.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e169(23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e76(18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e26-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e414(36.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e257(35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e157(38.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e31-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e348(30.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e216(29.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e132(32.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e36-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e134(11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e86(11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e48(11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD (Years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e29.54 \u0026plusmn;4.90\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.347\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e1100(96.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e699(96.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e401(97.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e41(3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e29(4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e12(2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eArtisan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e15(1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e12(1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e3(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eCivil Servant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e340(29.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e219(30.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e121(29.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eTrading\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e709 (62.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e460 60.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e249(60.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e36 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e8 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e28(6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e41(3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e29(4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e12(2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e855(74.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e569(78.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e286(69.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e286(25.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e159(21.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e127(30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of Education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e36 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e33(4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e3 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e216 (18.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e130 (17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e86(20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e889(77.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e565 (77.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e324(78.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of Education of Partner/Husband\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.194\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e8(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e6(0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e2(0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e83(7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e60(8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e23(5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e1050(92.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e662(90.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e388(93.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial class\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eUpper Class\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e58(5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e56(19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e2(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eMiddle Class\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e315(27.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e65(22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e250(29.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eLower Class\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eWomen\u0026rsquo;s dietary diversity score\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Adequate\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Inadequate\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e768(67.3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e494(43.3)\u003c/p\u003e\n \u003cp\u003e647(56.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e168(58.1)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e123(16.9)\u003c/p\u003e\n \u003cp\u003e605(83.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e600(70.4)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e371(89.8)\u003c/p\u003e\n \u003cp\u003e42(10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Medical, obstetrics and gynecological history of study participants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnemia (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo Anemia(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGravidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003ePrimigravida\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e269(23.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e203(27.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e66(16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eGravida 2-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e667(58.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e415(57.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e252(61.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eGravida 5-7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e196(17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e109(15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e87(21.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eGravida \u0026ge;8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e9(0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e1(0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e8(1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eNulliparous\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e382(33.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e257(35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e125(30.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003ePrimiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e295(25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e195(26.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e100(24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003ePara 2-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e412(36.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e250(34.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e162(39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003ePara 5-7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e52(4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e26(3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e26(6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of Miscarriage/Abortion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eNo abortion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e802(70.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e530(72.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e272(65.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e1-2 abortion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e152(13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e77(10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e75(18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e3-4 abortion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e187(16.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e121(16.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e66(16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of perinatal death\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1004(88.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e649(89.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e355(86.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0.111\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e137(12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e79(10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e58(14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Children Alive\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e438(38.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e298(40.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e140(33.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e508(44.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e294(40.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e214(51.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e3-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e140(12.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e107(14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e33(8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026gt;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e55(4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e29(4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e26(6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEGA at Booking (Trimesters)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e1\u003csup\u003est\u003c/sup\u003e\u0026nbsp; (\u0026le;13 weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e343(30.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e225(30.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e118(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0.649\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e2\u003csup\u003end\u003c/sup\u003e\u0026nbsp; (14-27 weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e516(45.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e328(45.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e188(45.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e3\u003csup\u003erd\u003c/sup\u003e\u0026nbsp; (\u0026ge;28 weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e282(24.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e175(24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e107(25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre conceptional Counselling/Care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1031(90.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e710(97.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e321(77.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e110(9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e18(2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e92(22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of use of herbal medications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e849(74.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e495(68.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e354(85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e292(25.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e233(32.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e59(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of substance abuse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e932(81.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e574(78.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e358(86.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;209(18.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e154 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e55(13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of use of ITN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1062(93.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e724(99.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e338(81.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e79(6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e4(0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e75(18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of use of hematinic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e1040(91.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e682(93.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e358(86.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e101(8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e46(6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e55(13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Chi square, ITN- Insecticidal treated net; EGA- Estimated Gestational Age\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Relationship between anaemia and laboratory parameters (n=1,141)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"600\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnaemia \u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo Anemia \u0026nbsp; (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStool microscopy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003eOva\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e119(10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e110(15.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e9(2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003eNo ova\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1022 (89.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e618(84.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e404(97.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003eNegative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1096 (96.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e686 (94.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e410 (99.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e45 (3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e42 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e3 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHepatitis B Virus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003eNegative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e962(84.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e554(76.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e408(98.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e179(15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e174 (23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e5(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHepatitis C virus\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eRDT\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eUrinalysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePCV at 12 weeks(n=728)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003eNegative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1056(92.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e645(88.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e411(99.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eUTI\u003c/p\u003e\n \u003cp\u003eNo UTI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e85(7.4)\u003c/p\u003e\n \u003cp\u003e620(54.3)\u003c/p\u003e\n \u003cp\u003e521(45.7)\u003c/p\u003e\n \u003cp\u003e522(45.7)\u003c/p\u003e\n \u003cp\u003e619(54.3)\u003c/p\u003e\n \u003cp\u003e728(63.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e83(11.4)\u003c/p\u003e\n \u003cp\u003e214(29.4)\u003c/p\u003e\n \u003cp\u003e514(70.6)\u003c/p\u003e\n \u003cp\u003e304(41.8)\u003c/p\u003e\n \u003cp\u003e424(58.2)\u003c/p\u003e\n \u003cp\u003e50(6.9)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2(0.5)\u003c/p\u003e\n \u003cp\u003e406(98.3)\u003c/p\u003e\n \u003cp\u003e7(1.7)\u003c/p\u003e\n \u003cp\u003e218(52.8)\u003c/p\u003e\n \u003cp\u003e195(47.2)\u003c/p\u003e\n \u003cp\u003e678(93.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e*\u003c/strong\u003e\u003cstrong\u003eHIV-Human immunodeficiency virus; RDT-Rapid Diagnostic Test; UTI -Urinary Tract Infection; PCV- Packed Cell Volume\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4a: Overview of Perinatal outcomes of study participants (n=1,141)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnaemia (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo Anaemia \u0026nbsp; (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value*\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e𝛘\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntrauterine foetal death\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e46(4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e35(4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e11(2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e48.423\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntrauterine growth restriction\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e32(2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e27(3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e5(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMiscarriage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e59(5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e54(7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e5(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLow birth weight\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eGrossly Normal baby\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCongenital anomaly\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePerinatal asphyxia\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePreterm delivery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e76(6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e44(6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e32(7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e867(76.0)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7(0.6)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15(3.6) \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17(1.5) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e522(71.7)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7(0.6)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e22(3.0)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17(2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e345(83.5)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15(3.6)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Chi square \u003cstrong\u003e𝛘\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e; multiple response\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4b: Relationship between Perinatal Outcomes, Pre-conceptional counselling and Substance Use\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"641\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e(%)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e𝛘\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse of herbal medications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eIUFD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e10(21.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e36(78.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e53(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e475.203\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eIUGR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e32(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e32(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eLBW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5(6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e71(93.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e76(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eMiscarriage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5(8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e54(91.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e59(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eGrossly normal baby\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e746(86.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e121(14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e867(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003ePerinatal asphyxia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e37(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e37(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003ePreterm delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e11(64.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e6(35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e17(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eCongenital anomaly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3(42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4(57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e7(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWDDS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdequate\u0026nbsp;\u003c/strong\u003e(%)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInadequate\u0026nbsp;\u003c/strong\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e𝛘\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eIUFD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e11(23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e35(76.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e46(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e67.216\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eIUGR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5(15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e27(84.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e32(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eLBW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e31(40.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e45(59.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e76(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eMiscarriage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e7(11.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e52(88.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e59(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eGrossly normal baby\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e424(48.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e443(51.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e867(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003ePerinatal asphyxia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e15(40.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e22(59.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e37(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003ePreterm delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1(5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e16(94.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e17(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eCongenital anomaly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e7(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre conceptional counselling and care\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e𝛘\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eIUFD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e43(93.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3(6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e46(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e103.757\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eIUGR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e32(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e32(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eLBW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e44(57.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e32(42.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e76(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eMiscarriage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e54(91.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5(8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e59(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eGrossly normal baby\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e798(92.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e69(8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e867(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003ePerinatal asphyxia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e37(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e37(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003ePreterm delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e16(94.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1(5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e17(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eCongenital anomaly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e7(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e7(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubstance abuse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e𝛘\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eIUFD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e10(21.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e36(78.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e46(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e840.594\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eIUGR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e32(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e32(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eLBW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5(6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e71(93.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e76(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eMiscarriage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5(8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e54(91.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e59(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eGrossly normal baby\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e840(96.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e27(3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e867(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003ePerinatal asphyxia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e37(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e37(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003ePreterm delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e17(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e17(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eCongenital anomaly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3(42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4(57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e7(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003eMultiple response; IUFD- Intrauterine Fetal Death; IUGR- Intra Uterine Growth Restriction; LBW- Low Birth Weight\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: Multivariable logistic regression of factors that are associated with anaemia at booking among the parturient\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eUnemployment\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.010, 0.1010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eMuslim\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1.925\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1.360, 2.726\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003ePrimary level of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e8.722\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e2.006, 37.916\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003ePrimigravida\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e94.526\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e23.982, 372.582\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003ePrimiparous\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e12.553\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e4.571, 34.475\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eHistory of 2-4 abortion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e4.818\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e2.347, 9.893\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eGreater than 2 children alive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e2.692\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1.104, 6.564\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eOva of hook worm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e7.990\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e4.004, 15.946\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003ePCV at 12 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1.027, 1.059\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eUrinalysis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1.599\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1.223, 1.988\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eHIV Infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e8.367\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e2.577, 27.167\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eRDT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e139.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e64.819, 299.068\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eHepatits B Virus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.016, 0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eHepatitis C Virus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.009, 0.155\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eITN Use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e5.976\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e2.718, 13.137\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eUse of Herbal Med.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.393\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0,300. 0.516\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eSubstance Abuse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1.746\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1.249; 2.441\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eWDDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e43.449\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e29.911, 63.114\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003ePre-conceptional counselling\u0026amp;care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.052, 0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003ePCV-Packed Cell Volume; HIV-Human Immunodeficiency Virus; ITN-Insecticide Treated Net; WDDS-Women\u0026rsquo;s Dietary Diversity Score; AOR- Adjusted Odds Ratio; CI- Confidence Interval\u003c/strong\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Prevalence, Anaemia, Pregnancy, Risk factors, Secondary healthcare facility, Booking","lastPublishedDoi":"10.21203/rs.3.rs-6523545/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6523545/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eAnaemia during pregnancy is an unacceptable public health problem in most developing countries inclusive of Nigeria where access to adequate nutrition and healthcare services is limited.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e: This study aimed to determine the prevalence, severity of anaemia, associated factors (socio-demographics, maternal, medical history, obstetric history, gynaecological history, substance abuse and laboratory findings) \u0026nbsp;at booking and perinatal outcomes among parturient who present for booking at the antenatal clinic of a secondary health facility in north-central Nigeria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: An analytical study that involved 1,141 parturient who presented at the booking clinic between 14 October, 2022 and 14 October, 2023. With the aid of a pre-tested semi-structured interviewer administered questionnaire, data on socio-demographic characteristics, obstetrics and gynaecological history, substance abuse, 24-hour dietary recall and other relevant histories, were collected from consecutive parturient who fulfilled the inclusion criteria and consented to the study. A sample of venous blood was collected using aseptic technique to obtain a packed cell volume by microhaematocrit method. Diagnosis of anaemia at booking was based on the World Health Organization definition of anaemia in pregnancy: haemoglobin concentration less than 11g/dl in the first and third trimester and 10.5g/dl in the second trimester. All parturient who had anaemia were also investigated for the aetiology of the anaemia; full blood count, rapid diagnostic test for malaria, Human Immunodeficiency Virus screening, hepatitis B surface antigen, hepatitis C, urinalysis and stool microscopy. Parturient whose condition was amenable to treatment during pregnancy were treated while others were counselled and referred to appropriate clinics following delivery. All parturient however received haematinics throughout the duration of pregnancy. The results were analysed using SPSS version 24, Chi-square test and logistic regression analysis were used to identify the independent determinants of anaemia at booking\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOut of 1,141 parturient who participated in this study, 728(63.8%) had anaemia at booking. Majority (56.4.0%) had microcytic hypochromic anaemia. Socio demographic characteristics that were significantly associated with anaemia at booking were: occupation (p\u0026lt;0.001), religion (p\u0026lt;0.001), level of education (p=0.001), social class (p\u0026lt;0.001) and women’s dietary diversity score (p\u0026lt;0.001). Medical, obstetrics and gynaecological history of study participants that showed significant relationship with anaemia at booking were: gravidity (p\u0026lt;0.001), history of miscarriage (p=0.001), number of children alive (p\u0026lt;0.001), history of pre conceptional counselling and care (p\u0026lt;0.001), history of use of herbal medication (p\u0026lt;0.001), history of substance abuse (p=0.001), history of use of insecticide treated net (p\u0026lt;0.001), history of haematinics use (p\u0026lt;0.001). Laboratory parameters showed that hook worm infestation, human immunodeficiency virus infection, hepatitis B \u0026amp; C virus infection, and malaria parasite infection all had significant relationships (p\u0026lt;0.001) with anaemia at booking. There was a significant improvement in the packed cell volume at the end of twelve weeks following treatment (p\u0026lt;0.001). After adjusting for co-founders, variables that were associated with increased risk of anaemia at booking were: presence of ova of hookworm (AOR) of 7.990 (95% CI, 4.004 to 15.946); HIV status (AOR) of 8.367 (95% CI, 2.577 to 27.167); positive malaria parasite test (AOR) of 139.308 (95% CI, 64.819 to 299.068), use of ITN (AOR) of 5.976 (95% CI, 2.718 to 13.137); substance abuse (AOR) of 1.746 (95% CI, 1.249 to 2.441) and WDDS (AOR) of 43.449 (95% CI, 29.911 to 63.114)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e \u0026nbsp;This study found that malaria infection, hookworm infection, human immunodeficiency virus infection, hepatitis B and C surface antigen virus, urinary tract infection, gravidity, history of miscarriage or abortion among others are factors contributing to anaemia in pregnant women. Therefore a more comprehensive approach that will address the factors associated with anaemia at booking including pre-conceptional counselling and care, early ante natal care booking, routine use of haematinics, eating balanced diet, early screening and treatment of organisms that can cause anaemia, use of ITN, discouragement of use of herbal medication and substance abuse in pregnancy will allow for early diagnosis and prompt treatment of anaemia at booking and this will improve the overall wellbeing of pregnant women, their developing foetus and perinatal outcomes.\u003c/p\u003e","manuscriptTitle":"Anaemia in pregnancy at booking: Prevalence, Risk Factors and Perinatal outcomes among Antenatal Clinic Attendees in a Secondary Healthcare Facility in North Central Nigeria: An Analytical Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-27 06:32:52","doi":"10.21203/rs.3.rs-6523545/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-18T17:30:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"20033602786985066526039383930977446969","date":"2026-05-07T09:40:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-30T06:06:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"231470068339553537785204793274057840430","date":"2025-05-29T18:09:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"279351178306184320653036354652642449959","date":"2025-05-28T04:21:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-22T11:29:20+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-28T10:50:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-26T02:25:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-26T02:24:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-04-24T20:15:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"097b2249-8c94-42ac-b0d0-a5496a45673f","owner":[],"postedDate":"May 27th, 2025","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-18T17:30:17+00:00","index":77,"fulltext":""},{"type":"reviewerAgreed","content":"20033602786985066526039383930977446969","date":"2026-05-07T09:40:20+00:00","index":74,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-05-27T06:32:52+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-27 06:32:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6523545","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6523545","identity":"rs-6523545","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}