Prevelance and determinants of anaemia among pregnant women using biomass fuel in rural Tamil Nadu: a cross-sectional study

Anaemia during pregnancy is a major public health concern in India. Biomass fuel use is common in a few rural areas of Tamil Nadu state and there is growing evidence that its use is associated with anaemia. The aim of this study was to estimate the prevalence of anaemia and to identify the coexisting determinants of anaemia among exclusive biomass-using rural pregnant women. We conducted a cross-sectional analysis of baseline data collected from 799 rural pregnant women (gestational age between 9 and 20 weeks) from two districts of Tamil Nadu, India. All study participants used biomass for cooking and were enrolled in a multi-country randomised controlled trial of a liquefied petroleum gas cookstove intervention. Haemoglobin (Hb) was measured in capillary blood using the HemoCue®201 point of care device. Hb was categorized as normal (Hb ≥ 11 g/dL), mild anaemia (Hb 10.0–10.9 g/dL), moderate anaemia (Hb 7.0–9.9 g/dL), or severe anaemia (Hb < 7.0 g/dL). Multinomial and binary logistic regressions were used to identify factors associated with anaemia. Overall, prevalence of any anaemia was 66.7% (95% confidence interval: 63.4–70%) and that of mild anaemia was 31.9% (28.7–35.1%), moderate anaemia 33.7% (30.4–36.9%), and severe anaemia was 1.1% (0.6–2.2%). Body mass index classified as underweight (< 18.5 kg/m2), being a multigravida, and no observed hand washing facility in the household were associated with a significantly higher odds of anaemia. This study population of exclusive biomass using pregnant women had higher rates of anaemia and underweight than that of rural estimates from recent NFHS reports for Tamil Nadu state, indicating the need to improve their overall anthropometric status and anaemia together, emphasizing the need for a transition to cleaner fuel.