AWARENESS OF CAUSES AND PREVENTION OF ANAEMIA AMONG PREGNANT WOMAN ATTENDING ANTENATAL CLINIC IN SELECTED PRIMARY HEALTH FACILITIES.

ABSTRACT

Background: It is estimated that 41.8% of pregnant women worldwide are anaemic. In Africa 57.1% of pregnant women are anaemic. In Nigeria the prevalence of anaemia among pregnant women was 55.1% which is a severe public health problem based on the World Health Organization classification of anaemia. Anaemia is a major cause of morbidity and mortality of pregnant women and increases the risks of foetal, neonatal and overall infant morbidity and mortality.

Objectives: The broad objective was to assess the prevalence and determinants of anaemia among pregnant women in the second and third trimesters of pregnancy attending antenatal clinic at Pumwani Maternity Hospital, Uyo.

Methodology: A cross-sectional study was conducted from 8^th June to 18^th August, 2015, on 258 pregnant women who attended antenatal clinic at Pumwani Maternity Hospital in Uyo. Systematic sampling method was used to select the study participants. The data was collected using pre-tested semi-structured questionnaire through interviews and an assessment of anthropometric and haemoglobin measurements. Descriptive analysis using means, frequency and proportions was computed. Chi-square test (p<0.05) and odds ratio with corresponding 95% confidence interval was used to determine the association between independent and dependent variables. Multivariable logistic regression analysis was performed to determine the independent factors associated with anaemia in these pregnant women.

Results: The findings of the study revealed that the prevalence of anaemia among the pregnant women was 57%. Of these, 2.7% were severely anaemic, 70.7% were moderately anaemic and 26.5% were mildly anaemic. Multivariable logistic regression analysis revealed that advanced maternal age (31yrs and above) [AOR=2.71; P=0.012], government or private employed [AOR=2.94; P=0.002] and self-employed [AOR=1.91; P=0.039], not taking iron and folic acid supplementation during the current pregnancy [AOR=2.04; P=0.016] and having mid upper arm circumference of less than 23cm [AOR=2.52; P=0.003] were factors independently associated with anaemia.

Conclusion: The prevalence of anaemia among pregnant women at Pumwani Maternity Hospital was 57% which is a severe public health problem. The study revealed that anaemia during pregnancy is caused by many factors, including late pregnancy, lack of formal employment and economic autonomy, poor nutritional status and not taking iron and folic acid supplementation during pregnancy. All these factors lead to poor health condition during pregnancy thus by the time such mothers attend for ante natal clinic, they are already in anaemic state.

Recommendations: Reproductive advice and education should be given to all reproductive age women to create awareness about the risk of developing anaemia with late pregnancy. Employed pregnant women should be given enough maternity leave before and after delivery from their employers. There is a need for interventions such as mass media campaigns, outreach education, life skill programmes to educate women on the importance of early ante natal clinic booking and compliance with the use of prescribed medications, consumption of more diversified extra meal and iron-rich foods during pregnancy than usual.

 

CHAPTER ONE

INTRODUCTION

1.1       Background Information

Anaemia describes a situation in which there is a reduction of haemoglobin concentration in the blood of pregnant women to a level below 11g/dl. Anaemia is one of the most common nutritional deficiency diseases observed globally and affects more than a quarter of the world’s population (WHO/CDC, 2008). Globally, anaemia affects 1.62 billion people (25%), among which 56 million are pregnant women (Balarajan, 2011; WHO/CDC, 2008). It is estimated that 41.8% of pregnant women worldwide are anaemic. At least half of this anaemia burden is assumed to be due to iron deficiency. Iron deficiency anaemia (IDA) is the most common nutritional disorder in the world affecting 2 billion people worldwide with pregnant women particularly at risk (WHO guideline, 2012). In developing countries, the prevalence of anaemia during pregnancy is 60.0% and about 7.0% of the women are severely anaemic (Agan et al., 2010). In Africa 57.1% of pregnant women are anaemic (de Benoist et al., 2008). Sub-Saharan Africa is the most affected region, with prevalence of anaemia estimated to be 17.2 million among pregnant women. This constitutes to approximately 30% of total global cases (WHO, 2008). In Nigeria the prevalence of anaemia among pregnant women is 55.1% and among nonpregnant women is 46.4% (Ministry of Health, 2013). Anaemia during pregnancy is considered severe when haemoglobin concentration is less than 7.0 g/dl, moderate when the haemoglobin concentration is 7.0 to 9.9 g/dl, and mild when haemoglobin concentration is 10.0 to 10.9 g/dl (Balarajan et al., 2011; Salhan et al., 2012; Esmat et al., 2010). When the prevalence of anaemia among pregnant women is 40.0% or more, it is considered as a severe public health problem (McLean et al., 2008).

Anaemia during pregnancy has a variety of causes and contributing factors. Iron deficiency is the cause of 75% of anaemia cases during pregnancy (Balarajan et al., 2011; Haidar, 2010). Infectious diseases such as malaria, helminthes infestations and HIV are implicated with high prevalence of anaemia in sub-Saharan Africa (Ouédraogo et al., 2012 and Tolentino and Friedman, 2007). Loss of appetite and excessive vomiting in pregnancy and heavy menstrual flow before pregnancy are also documented causes of anaemia during pregnancy (Noronha et al., 2010). Socio-economic conditions, abnormal demands like multiple pregnancies, teenage pregnancies, maternal illiteracy, unemployment/underemployment, short pregnancy intervals, age of gestation, primigravida and multigravida (Haniff et al., 2007; Noronha et al., 2010), smoking, excessive alcohol consumption, are the main contributing factors of anaemia during pregnancy (Moosa and Zein, 2011; Esmat et al. 2010).

Anaemia during pregnancy is a major cause of morbidity and mortality in pregnant women and infants in developing countries (Akhtar and Hassan, 2012). In 2013, an estimated 289,000 women died worldwide. Developing countries account for 99% (286 000) of the global maternal deaths with sub- Saharan Africa region alone accounting for 62% (179 000). About 800 women a day are still dying from complications in pregnancy and childbirth globally (WHOa, 2015). Anaemia contributes to 20% of all maternal deaths (WHOb, 2015). Anaemia in pregnancy causes low birth weight (Banhidy et al., 2011), fetal impairment and infant deaths (Kalaivani, 2009). Iron deficiency anaemia affects the development of the nation by decreasing the cognitive and motor development of children and productivity of adults (Balarajan et al., 2011; Vivek et al., 2012). Deficiency of folic acid during pregnancy can result in developing neural tube defect that develops in embryos during the first few weeks of pregnancy leading to malformations of the spine, skull, and brain (Wolff et al., 2009).

Iron and folate requirements increase during pregnancy, therefore, the likelihood of developing iron and folate deficiency is high if there is no supplementation during pregnancy (Marti-Carvaja et al., 2002). It is therefore recommended that all pregnant women should start taking iron and folic acid supplementation as early as possible to avoid the complications of iron and folic acid deficiency during pregnancy. Supplementation with folic acid has also been shown to reduce the risk of congenital heart defects, cleft lips, limb defects, and urinary tract anomalies (Wilcox, et al., 2007 and Goh and Koren, 2008). IFAS is a major strategy to reduce iron deficiency anaemia in pregnancy as well as risk of congenital malformations on the newborn.

Iron has several vital functions in the body. It serves as a carrier of oxygen in red blood cells from the lungs to the tissues, as a transport medium for electrons within cells, and as an integrated part of important enzyme systems in various tissues. Folic acid,  a B vitamin (B₉), plays a vital role in the development of neural tube in the growing embryo, in the production of red blood cells, synthesis of  DNA, repair of DNA, and it acts as a cofactor in certain biological reactions (Weinstein et al., 2013). It is especially important in aiding rapid cell division and growth, such as in infancy and pregnancy. Birth defects occur within the first 3-4 weeks of pregnancy, usually before a woman even knows she’s pregnant. So it’s important to have folic acid in the system during those early stages when the baby’s brain and spinal cord are developing (Folate: Dietary Supplement Fact Sheet, 2013).

1.2 Problem Statement 

In Nigeria, the prevalence of anaemia among pregnant women is 55.1%. If the prevalence of anaemia among pregnant women is 40.0% or more, it is considered as a severe public health problem (McLean et al., 2008). Anaemia is a major cause of morbidity and mortality in pregnant women and increases the risks of foetal, neonatal and overall infant mortality (Akhtar and Hassan, 2012). In 2013, an estimated 289,000 women died worldwide. Developing countries account for 99% (286 000) of the global maternal deaths with sub- Saharan Africa region alone accounting for 62% (179 000). About 800 women a day are still dying from complications in pregnancy and childbirth globally (WHOa, 2015). Anaemia during pregnancy contributes to 20% of all maternal deaths (WHOb, 2015).

According to the KDHS 2008-09, maternal deaths increased from 414/100,000 in 2003 to 488/100,000 in 2008-09 far from meeting MDG target goals for maternal mortality. From this information it can be estimated that the high prevalence of anaemia among pregnant women in Nigeria is considered to be the main factor for maternal death.

Anaemia during pregnancy is also a major risk factor for low birth weight, preterm birth and intrauterine growth restriction (Banhidy F et al., 2011and Haggaz et al., 2010). Deficiency in folic acid during pregnancy can result in serious neural tube defect (Wolff et al., 2009), heart defects and cleft lips (Wilcox et al., 2007), limb defects, and urinary tract anomalies (Goh and Koren, 2008).

Pregnant women attending antenatal clinics in Nigeria are routinely put on iron supplementation throughout their pregnancy. However, the prevalence of anaemia among pregnant women is still high. Moreover the available data concerning prevalence and specific ethologic factors of anaemia during pregnancy in Nigeria are limited.

 

1.3 Justification 

Anaemia is a significant maternal problem during pregnancy, associated with a negative outcome for both the woman and the new-born. For this reason, WHO adopted reducing maternal mortality as one of the three health-related millennium development goals.

Epidemiology of anaemia during pregnancy is important for deciding control strategies. Data on prevalence and associated factors of anaemia remain important indicators of public health since anaemia is related to morbidity and mortality in the population especially pregnant women.  For example, a community based trial from China found that a 47% reduction in neonatal mortality in women who received IFA supplements compared with those who took folic acid alone (Zeng et al., 2008). The management and control of anaemia in pregnancy is therefore enhanced by the availability of local prevalence statistics which is however not adequately provided in Nigeria.

In view of the problems caused by anaemia, more research is required to identify the risk factors so as to come up with appropriate strategies that will ensure its reduction. Therefore, this study aims at providing prevalence and factors associated with anaemia among pregnant women who attended ANC at Pumwani Maternity Hospital, Uyo.

 

1.4 Hypothesis

H_O: There are no factors associated with anaemia among pregnant women attending ANC during the second and third trimesters at Pumwani Maternity Hospital

H₁: There are factors associated with anaemia among pregnant women attending ANC during the second and third trimesters at Pumwani Maternity Hospital

1.5  Research Questions

What is the prevalence of anaemia among pregnant women attending antenatal clinic during the second and third trimesters at Pumwani Maternity Hospital?

What are the factors associated with anaemia among pregnant women attending antenatal clinic during the second and third trimesters at Pumwani Maternity Hospital?

1.6. Objectives

1.6.1. Broad objective

To determine prevalence and factors associated with anaemia among pregnant women attending antenatal clinic during the second and third trimesters at Pumwani Maternity Hospital, Uyo.

1.6.2. Specific objectives  

To determine the prevalence of anaemia among pregnant women attending antenatal clinic during the second and third trimesters at Pumwani Maternity Hospital

To identify factors associated with anaemia among pregnant women attending antenatal clinic during the second and third trimesters at Pumwani Maternity Hospital

AWARENESS OF CAUSES AND PREVENTION OF ANAEMIA AMONG PREGNANT WOMAN ATTENDING ANTENATAL CLINIC IN SELECTED PRIMARY HEALTH FACILITIES.

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