Publications

Anemia in pregnancy is one of the most prevalent, multifactorial, and preventable contributors to maternal mortality in Africa. This comparative review synthesizes epidemiologic evidence, biological mechanisms, health-system determinants, and intervention strategies to examine how anemia exacerbates maternal mortality risks across diverse African contexts. Iron deficiency remains the leading cause globally, yet in Africa its impact is magnified by malaria, helminth infections, HIV, tuberculosis, nutritional deficiencies, and hemoglobinopathies such as sickle cell disease. The synergistic interaction between pre-existing anemia and obstetric hemorrhage is identified as a key pathway to maternal death. Comparative analysis highlights regional differences: malaria and SCD dominate in West Africa, hookworm and dietary insufficiencies in East Africa, HIV-related anemia in Southern Africa, and dietdriven anemia in North Africa. Health-system factors including limited antenatal care coverage, fragile blood transfusion services, and supply-chain gaps further amplify risks. While proven interventions exist, including ironfolic acid supplementation, intermittent preventive treatment in pregnancy, deworming, intravenous iron therapy, and strengthened blood systems, their impact is often undermined by low coverage, poor adherence, and systemic weaknesses. Addressing these challenges requires integrated, context-sensitive strategies, robust data systems, and sustained policy commitment. This review underscores anemia as a central determinant of maternal survival and proposes a pragmatic agenda for reducing preventable maternal deaths in Africa.