relationship between age, feeding and anaemia in pregnancy (a case study of pregnant women attending antenatal clinic at university of nigeria teaching hospital (unth) enugu)

RELATIONSHIP BETWEEN AGE, FEEDING AND ANAEMIA IN PREGNANCY (A CASE STUDY OF PREGNANT WOMEN ATTENDING ANTENATAL CLINIC AT UNIVERSITY OF NIGERIA TEACHING HOSPITAL (UNTH) ENUGU)

ABSTRACT

The study on anaemia in pregnancy was aimed at determining Packed Cell Volume (PCV) Haemoglobin (HB) level and Erythrocyte Sedimentation Rate (ESR) of pregnant women as well as the severity, significance of maternal age, educational level, occupation and gestational age to the occurrence of anaemia in pregnancy managed, diagnosed and admitted at the University of Nigeria Teaching Hospital (UNTH) Enugu.  The result showed that most of the patient had moderate to severe anaemia and that the cases were commonest in the age range 25 – 29 years.  Most of the patients were housewives and low level civil servants who lived in middle and lower class residential areas ad who had no formal education. It was discovered that he normal values for Erythrocyte Sedimentation Rate (ESR) tests was male = 0 – 5 mm/hr, female = 0 – 7mm/hr, for Packed Cell Volume (PCV) test is male 35 – 45 ml, female 32 – 35ml while normal value for Haemoglobin (Hb) is 11.5g/dl.

Anaemia in pregnancy was seen to occur most commonly in the third trimester.  It occurred all through the year, but mostly in the wet season and had the greatest positive association with malaria and nutritional deficiency.  Anaemia in pregnancy was seen not to be rampant in our today’s society due to the small number tested positive in the practical work conducted at University of Nigeria Teaching Hospital (UNTH) Enugu.  Anaemia in pregnancy was also seen not to have any effect on birth weight of babies.

CHAPTER ONE

Introduction                                                                                      1

1.1     Aims and Objectives                                                      4

1.2     The Limitation of Study                                                5

1.3     Hypothesis                                                                    6

1.4     Justification                                                                             6

CHAPTER TWO

Literature Review                                                                    7

CHAPTER THREE

Materials/Method                                                                    18

1.1     Collection of Samples                                                    18

1.2     Determination of Packed Cell Volume (PCV)                19

1.3     Determination of Haemoglobin (Hb)                             19

1.4     Determination of Erythrocute Sedimentation

Rate (ESR) By Westergren’s Method.                           20

1.5     Method of Data Collection                                            20

1.6     Method of Data Analysis                                                        22

CHAPTER FOUR

Results                                                                                    23

CHAPTER FIVE

Discussion                                                                               32

CHAPTER SIX

5.1     Conclusion                                                                     36

5.2     Recommendation                                                           37

5.3     Action by the Government                                            38

5.4     Action by the Community                                             38

5.5     Action by the Health Workers                                       39

5.6     Action by the Individuals                                              39

Reference                                                                       41

Appendix                                                                       43

LIST OF TABLES

TABLE 1:   Distribution of pregnant women by age

TABLE 2:   Mean age distribution of patients

TABLE 3:   Distribution of patients according to their

Occupation

TABLE 4:   Distribution of patients according to their educational level

TABLE 5:   Distribution of patiens according to severity

TABLE 6:   Distribution of patients according to gestational age

TABLE 7.   Distribution of cases according to associates conditions

TABLE 8:   Relationship of incidence of aneamia in pregnancy to outcome of patients

TABLE 9:   Relationship of incidence of Anaemia in pregnancy to Birth weight of Baby

TABLE 10: Result of PCV, Hb and ESR tests at University of Nigeria Teaching Hospital (UNTH) Enugu.

LIST OF FIGURES

FIGURE 1:           Histogram showing age distribution of pregnant women

FIGURE 2:           Bar chart-showing distribution of patients according to their occupation

FIGURE 3:           Pie chart-showing distribution of patients according to their occupation

FIGURE 4:           Bar chart showing distribution of patients according to their literacy level

FIGURE 5.           Pie chart showing distribution of patients according to severity

FIGURE 6:           Bar chart showing distribution of cases according to associated condition

CHAPTER ONE

INTRODUCTION

          Anaemia is a common disorder in pregnancy.  The definition gives by World Health Organization (WHO) shows that haemoglobin level of less than 11.5g%.  Signifies anaemia, but in Nigeria it is regarded as the haemoglobin of less than 10.5g% or Packed Cell Volume (PCV) of less than 23%.  Between January 1955 and April 1957, anaemia was directly instrumental for over 20% of all the maternal deaths from antepartum and postpartum hemorrhage and puerperal sepsis.  The type of anaemia encountered in the pregnant women are identical with those encountered in the non-pregnant.  However, there is no doubt that the increased nutritional and metabolic demands of pregnancy and the fact that for many women, it is the first time they come under detailed medical scruting, has the effect both of increasing the incidence and altering the pattern.  Actiology determines the type of anaemia that is encountered.  It can result from one or more of the following causes:-

1. Hydraemia (Physiological anaemia)
2. Anaemia due to inadequate production of red cells.

Different causes includes:-

1. Nutritional or deficiency anaemia: This is caused by deficiency of essential factors for haemopioesis, iron, vitamin B₁₂, folic acid and protein. Deficiency can be due to inadequate intake, poor absorption from gastro intestinal tract or increased demand during pregnancy.  Physiological states may contribute to iron deficiency.  There is greater than usual demand for iron in growing babies, growing adolescents, menstruation and pregnancy where iron is needed for the increased maternal red cell mass as well as for the foetus.
2. Hypoplasia and Aplasia of the bone marrow :

          These are frequently induced by drugs and radiation.  Decreased production are also caused by the invasion of the bone marrow as found in Leukemia, Secondary Carcinoma and Fibrosis.

3. Decreased Production of erythroprotein as found in renal diseases.

Anaemia due to excessive destruction of red cell can be subdivided into:-

1. Heamolytic anaemia which occurs when red cell losses exceeds the capacity of the marrow to compensate. Other cause of Haemolytic anaemia includes:
2. Congenital sphetocytosis
3. Glucose – 6 – phosphate dehydrogenase deficiency

• Infection with malaria and Clostridium

The above causes of haemolytic anaemia could be classified either as inherited or acquired, and as intrinsic (due to abnormalities of the red cell itself) or extrinsic due to external insults).

2. Haemoglobinopathies: The term haemoglobinopathies describes inherited abnormalities of one or more of the four globulin chains in haemoglobin.  Example of Haemoglobinopathies.  Includes:-
3. Sickle cell disease (genotype Hbs)
4. Sickle cell Hbc disease

• Thalassaemia ie disorder where the rate of synthesis is slow, but the structure of the chains produced is normal.

Anaemia from blood loss can be due to

1. Hookworm infestation (Ancylostomiasis)
2. Bilhierziasis

• Haemorrhoids

1. Peptic ulcer
2. Threatened abortion.

During pregnancy, the circulating blood volume markedly increases.  It begins to do so in the first trimester, is more marked in the second, reaches its maximum about 3^rd and 4^th trimester.

Some women start pregnancy with deficiency iron stores.  As pregnancy advances, the demands of the foetus and the mother may exceeds the supply of iron from her stores and from her diet and therefore, the mother suffers from iron deficiency.  Therefore, grand multiparty and multiple pregnancies are at high risk.  The usual daily dietary intake of iron by a non-pregnant woman is about 10mg of which 10% is.  This balances the loss in urine and faeceo, from desquamation of skin (amounting of about 0.5mg daily) and from menstrual loss.  It is advisable that a pregnant woman supplement here dietary intake of iron.

1.1     AIMS AND OBJECTIVES

                This project work is aimed at the following to determine the haemoglobin level (Hb), Packed Cell Volume (PCV) and Erythrocyte Sedimentation Rate (ESR) of pregnant women.  To determine the significance.

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