FACTORS CONTRIBUTING TO IRON DEFICIENCY ANEMIA AMONG PREGNANT WOMEN.

ABSTRACT

This study focused on assessing the factors contributing to iron deficiency anemia among pregnant women.  The study population comprised of  pregnant women attending antenatal clinic in general hospital Kabba.Kogi State. This was a cross sectional study of 406 women attending the antenatal clinic for their booking visit. The capillary technique was used for the estimation of the packed cell volume (PCV) to assess level of anaemia; Questionnaires were also administered to obtain demographic information- age, parity, social class and gestational age at booking were obtained and analyzed. Out of the 406 women studied, 229 were anaemic thus making the prevalence of anaemia to be 56.4%. Most, 89.5% were mildly anaemic, 10.5% were moderately anaemic while none of the women were severely anaemic. Two hundred and sixty, (64%) of the women booked in the first trimester, 33.3% booked in the second trimester while only 2.7% booked in the third trimester. More women were anaemic in the 2nd trimester of pregnancy, with a higher prevalence among the multigravidae (59.3%). Anaemia was highest among company workers and least among civil servants. The women who had birth intervals of ≤1 year had the highest prevalence of anaemia (53.3%), followed by those who had a birth inter of 2-4 years, while those women who had a birth interval of more than 4years had the least Prevalence (44.5%) of anaemia. The prevalence of anaemia amongst the participants was high. The parity, gestational age at booking, educational status and the birth interval are factors that were found to have affected the prevalence of anaemia in this study. Therefore educating women on early antenatal booking and compliance with the use of prescribed medications (Iron Supplements, Folate and Antimalarials) should also be emphasized to reduce the problem of anaemia in pregnancy in Nigeria.

FACTORS CONTRIBUTING TO IRON DEFICIENCY ANEMIA AMONG PREGNANT WOMEN.

 CHAPTER ONE

INTRODUCTION

1.1 Background of study

Anemia is defined as the condition in which there is decreased level of hemoglobin (Hb) or red blood cells than the normal value (Eltayeb et al., 2014). Anemia contributes to almost 120,000 maternal deaths globally and indirectly to almost a fifth (18%) of the burden of maternal mortality. In addition to maternal deaths, there are several adverse health outcomes associated with anemia including preterm delivery, intrauterine fetal death, stillbirths, neonatal mortality, low birth weight (LBW) and poor cognitive development in the offspring (Bhutta et al., 2012; Melku et al., 2014). In developing countries, maternal anemia during pregnancy is a product of many factors, such as maternal malaria, intestinal parasitic infection, recurrent infection, reduced dietary intakes, parity and micronutrient deficiencies just to name but few (Bhutta et al., 2012; Ugwuja, et al., 2011; Haidar, 2010). Among the micronutrient deficiencies the most common encountered are iron deficiency anemia (IDA) and folate deficiency 2 megaloblastic anemia. Of all anemia diagnosed during pregnancy, 75% are due to iron deficiency. Iron deficiency (ID) alone affects nearly 20% of the world’s population (Bick et al., 2006). The odds for developing anemia were 60% more likely in the iron-deficient and 40% more likely in the folic acid deficient. One in every three women had anemia and deficiency of folic acid while one in every two had iron deficiency, suggesting that deficiencies of both folic acid and iron constitute the major micronutrient deficiencies in Ethiopian women (Haidar, 2010). Apart from iron and folate deficiency cobalamin (Vit B12) deficiency has been shown to account for some cases of anemia (Morris et al., 2007; Khan et al., 2010).

Anaemia is a condition in which the number of red blood cells or their oxygen carrying capacity is insufficient to meet the physiological needs. It has been shown to be a public health problem that affects low, middle and high income countries and has significant adverse health and socio-economic consequences (Munasinghe, 2014).The most reliable indicator of anaemia at the population level is haemoglobin concentration although it does not indicate the cause (WHO, 2011). Haemoglobin is an iron containing oxygen transport protein in red blood cells of all vertebrates (Al Kahtani et al., 2012). It is composed of a protein group known as globin and four hem groups. Its function is to carry oxygen from the lungs to other parts of the body. It is produced by the bone marrow and destroyed by the spleen. Anemia can present in two forms symptomatic or asymptomatic. Dizziness, palpitation, easy fatigability are some of the symptoms a person can exhibit when suffering from anemia (Haas & Brownlie, 2001).

Anemia during pregnancy is a serious public health problem particularly in developing countries (Al Akanni, et al., 2014; Al Hassan, 2015). Some studies have shown that anaemia is a major contributor to maternal death especially in developing countries where a strong association between severe anaemia and maternal mortality has been observed (Al Kahtani et al., 2012). Pregnant women and children are the most vulnerable groups of getting anaemia This is as a result of the additional demand on maternal stores during pregnancy (Bencaiova, et al., 2012; Karkowsky, 2015). The World Health Organization (WHO) defines anaemia in pregnancy as Haemoglobin (Hb) level of less than 11g/dl (WHO, 2011).The most common type of anaemia in pregnancy is iron deficiency caused by low intake of iron and excessive iron loss (McLean et al.,2009; Bishop, 2007). A number of risk factors have been identified to cause anaemia during pregnancy and they include low iron consumption, frequent vomiting, multiple pregnancies, closely spaced pregnancies (WHO 2012). Nutritional causes of anaemia include folic acid, vitamin B12, pyridoxine, and ascorbic acid deficiency (Bottalico et al., 2015; Fernandes, 2014). Haemoglobin levels vary with age, sex, pregnancy and altitude. Symptoms of anaemia include dizziness, easy fatigability, palpitations and shortness of breath (Haas & Brown-lie, 2001). Anaemia is one of the most common nutritional problems we have globally. In subSaharan Africa the main causes of anaemia in pregnancy are iron deficiency and malaria, followed by micronutrient deficiencies and infection (Bernard et al., 2001). The burden of anaemia in pregnant women is still serious and unacceptably high (GHS, 2004). Anaemia in pregnancy is a condition that can easily be prevented and it is treatable (WHO, 2011). A number of preventable programs have been rolled out in Africa to tackle the root causes of anaemia including malaria, worm infestations, iron and folic acid supplements and these programs have been shown to be efficient and effective in reducing anaemia in pregnancy (Al Kahtani et al., 2012; Dai et al., 2015). The prevalence of anaemia in pregnancy is significantly high (42%) across the world and much higher in Africa (57.1%) (McLean et al., 2009).

Anaemia in pregnancy is attributed to outcomes such as maternal death, poor cognitive development in young children and reduced mother’s ability to work (Fischer et al., 1992; Alemu & Umeta, 2015). Anaemia in pregnancy can lead to complications both to the mother and the baby (Kozuki 2012; Ngnie-Teta, 2009; Zeng et al., 2009). Complications such as premature labour, low birth weight, dysfunctional labour, foetal distress, delayed growth and development in infant and children and increased susceptibility to infection are often attributed to anaemia (Al Kahtani et al., 2012; Bencaiova et al., 2012; Bottalico et al., 2015; Dai et al., 2015; Friedrisch & Cançado; Gafter-Gvili et al., 2015).

1.2 statement of problem

Anaemia have been identified as a major public health problem in both developed and less developed countries as about 2 billion people suffer from anaemia and it is reported to account for three-quarters of a million deaths per a year in Africa and South-East Asia (WHO, 2005). Studies across the world demonstrate a high prevalence of anaemia in pregnancy (Qureshi et al., 2014). However, the prevalence of anaemia in less developed countries is about four times more than developed countries (Hu et al., 2012). In less developed countries, anaemia affects over 50% of women who are pregnant (WHO, 2013). The condition affects pregnant women in all trimesters of pregnancy with varied causes of anaemia in pregnancy in sub-Saharan Africa (WHO, 2013). Iron deficiency, malaria, micronutrient deficiency and infection are the main causes of anaemia in pregnancy in subSaharan Africa (Bernard et al., 2001). Notable among the causes of anaemia are iron deficiency and malaria.

Anaemia is considered a severe public health problem in Nigeria with a prevalence of 70% which is unacceptably high (Bernard et al. 2001). This prevalence in pregnancy has remained high despite improved antenatal care (Ndukwu et al., 2014). Anaemia in pregnancy increases the risk of premature delivery and low birth weight babies (Brabin et al., 2001). Even though anaemia in pregnancy is treatable as demonstrated in Bangladesh where daily iron intake improved iron stores in pregnant women including non-pregnant women, the condition still accounts for several maternal deaths (Murphy et al., 2009; Khambalia, 2009). Even though, the World Health Organization recommends daily intake of iron during pregnancy, the reported gastro-intestinal side effects discourages some pregnant women from complying with the routine treatment (Anand et al., 2008). The study therefore sought to assess the Factors contributing to iron deficiency anemia among pregnant women in Nigeria.

1.3 Research Questions

• What is the prevalence of iron deficiency anaemia among pregnant women attending antenatal clinic in Nigeria?
• What are the risk factors associated with iron deficiency anaemia among pregnant women attending antenatal clinic in Nigeria?
• What are the health implications of iron deficiency anaemia among pregnant women attending antenatal clinic in Nigeria?

1.4  Objective of the Study

The primary objective of this study is to assess the factors contributing to iron deficiency anemia among pregnant women. The specific Objectives include:

• To determine the level of prevalence of iron deficiency anaemia among pregnant women attending antenatal clinic in Nigeria?
• To identify the risk factors associated with iron deficiency anaemia among pregnant women attending antenatal clinic in Nigeria?
• To examine the health implications of iron deficiency anaemia among pregnant women attending antenatal clinic in Nigeria?

 

1.5 significance of study

However, to better appreciate the issue of anaemia in pregnancy, an exploration of the awareness level of pregnant women as well as their perceptions of the issue will equip stakeholders target their campaign messages when planning health programs to reduce the incidence of anaemia among this vulnerable group of people.

Findings of the study will be useful in providing the requisite measures to reduce morbidity and mortality associated with maternal anaemia and may also be useful for advocacy, policy change and in designs of programs aimed at positive changes towards improved level of awareness on anaemia.

The study findings may also pave way for further studies into issues of improving awareness on risk of anaemia among pregnant women and their adherence to the iron supplements prescribed for them. This study may inform policy on prevention of anaemia among pregnant women in Nigeria.

1.6 scope of study

The study will assess the factors contributing to iron deficiency anemia among pregnant women in Nigeria.  Apart from the main objectives, the study seek to find out factors affecting the development of anaemia e.g factors like spouse’s demographic characteristics, Ante-natal care visit and taking of IFAS, awareness on consequences, dietary habits and life style, food consumption based on 24 hours re-call, health conditions and anthropometric measurements.

1.7 Organization of the Study

The study comprises of five chapters. Chapter one consists of the background to the study, statement of the problem, purpose of the study, objectives, research questions, significance, limitation of the study, delimitation of the study, basic assumptions, definitions of key terms and organization of the   study.   Chapter two   comprises of literature review theoretical and conceptual frameworks. Chapter three deals with research methodology, covering   research sampling, procedures, research instruments and their validity and reliability, procedures for data collection and data analysis. Chapter four comprises of findings and discussions which were generated by the study. Chapter five presents summary, conclusions and recommendations.

FACTORS CONTRIBUTING TO IRON DEFICIENCY ANEMIA AMONG PREGNANT WOMEN.

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