{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T16:47:06Z","timestamp":1789750026198,"version":"4.0.1"},"reference-count":60,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T00:00:00Z","timestamp":1665014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Accelerating Higher Education Expansion and Development (AHEAD) Operation of the Ministry of Higher Education, Sri Lanka funded by the World Bank","award":["DOR STEM HEMS [6026-LK\/8743-LK"],"award-info":[{"award-number":["DOR STEM HEMS [6026-LK\/8743-LK"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Globally, more than a third of pregnant women are anemic, and progress in its prevention and control is slow. Sri Lanka is a lower-middle-income country with a unique public health infrastructure that provides multiple interventions across the lifecycle for anemia prevention, despite which anemia in pregnancy remains a challenge. Studying the factors associated with maternal anemia in this context would provide unique information on challenges and opportunities encountered as low-and-middle-income countries attempt to control anemia by improving health care coverage. All first-trimester pregnant women registered for antenatal care in the Anuradhapura district between July 2019 to September 2019 were invited to participate in the baseline of a cohort study. Interviewer-administered and self-completed questionnaires were used. Anemia was defined using a full blood count. A hierarchical logistic regression model was built to identify factors associated with anemia. Out of 3127 participants, 451 (14.4%) were anemic. According to the regression model (Chi-square = 139.3, p&lt;0.001, n = 2692), the odds of being anemic increased with the Period of gestation (PoG) (OR = 1.07, 95% CI = 1.01\u20131.13). While controlling for PoG, age and parity, history of anemia (OR = 3.22, 95%CI = 2.51\u20134.13), being underweight (OR = 1.64, 95%CI = 1.24\u20132.18), having the last pregnancy five or more years back (OR = 1.57,95%CI = 1.15\u20132.15) and having used intrauterine devices for one year or more (OR = 1.63, 95%CI = 1.16\u20132.30) increased the odds of anemia. Breast feeding during the last year (OR = 0.66, 95%CI = 0.49\u20130.90) and having used contraceptive injections for one year or more (OR = 0.61,95%CI = 0.45\u20130.83) reduced the risk of anemia. Proxy indicators of being in frequent contact with the national family health program have a protective effect over the socioeconomic disparities in preventing early pregnancy anemia. Maintaining the continuum of care through the lifecycle, especially through optimizing pre and inter-pregnancy care provision should be the way forward for anemia control.<\/jats:p>","DOI":"10.1371\/journal.pone.0274642","type":"journal-article","created":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T17:32:41Z","timestamp":1665077561000},"page":"e0274642","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Factors associated with early pregnancy anemia in rural Sri Lanka: Does being \u2018under care\u2019 iron out socioeconomic disparities?"],"prefix":"10.1371","volume":"17","author":[{"given":"Gayani Shashikala","family":"Amarasinghe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7977-6578","authenticated-orcid":true,"given":"Thilini Chanchala","family":"Agampodi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasana","family":"Mendis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7810-1774","authenticated-orcid":true,"given":"Suneth Buddhika","family":"Agampodi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,10,6]]},"reference":[{"key":"pone.0274642.ref001","unstructured":"WHO. 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