Evaluation of the Level of Awareness of the Dangers Associated With Anaemia in Pregnancy: a Case Study of Ilaro
CHAPTER ONE
Objectives of the study
The general objective of this is to evaluate the level of awareness of the dangers associated with anemia in pregnancy: a case study of Ilaro. Specifically, the study seeks to;
- Determine the level of awareness of anemia in pregnancy amongst pregnant women attending antenatal care in Ilaro community.
- Assess the strategies used by the pregnant women for the prevention and management of anemia in Ilaro community
- Determine the challenges encountered in the management of Anemia among pregnant women in Ilaro community
CHAPTER TWO
LITERATURE REVIEW
Conceptual Review
Concept of Anemia
Anemia is a frequent companion to pregnancy due to the relatively larger plasma volume expansion compared to red blood cells. Proper transport of oxygen from the maternal blood to fetal circulation is essential during childbirth to give birth to a viable baby and also saludable. Maternal morbidity is also affected by the degree of anemia that occurs during pregnancy. Therefore, anemia may precede conception, which is often aggravated by pregnancy, and occupational accidents may sustain it (Lawson and Steward, 2014). Therefore, it is an important public health issue that requires the most attention, as pregnancy and childbirth around the world are daily events and, in particular, we need to lower our high maternal mortality rate.
The word anemia connotes a deficiency in the number of red blood cells or hemoglobin content that results in a diminished ability to transport oxygen from the blood, causing unusual fatigue that generates pallor, respiratory distress and lack of energy. Anemia can be relative or absolute. Relative anemia occurs during pregnancy (Bolton et al., 2018). Absolute anemia implies a true decrease in the mass of red blood cells. The cells are produced in the bone marrow and have a life expectancy of approximately four months (120 days) (Bolton et al., 2018). The body needs iron, vitamin B12 and folic acid to produce red blood cells. Absence of one or more of these ingredients causes anemia.
Red blood cells are the circulating cells in the blood plasma, which give the blood its red color. Through its pumping action, the heart drives blood through the arteries through the body. Red cells absorb oxygen into the lungs and transport it to all body cells. The cells use oxygen to drive the burning of sugars and fats that produce the body’s energy. In this process called oxidation, carbon dioxide is produced as a waste product. It binds to red blood cells that have released their oxygen load. Carbon dioxide is then transported back to the lungs by the blood in the veins, where it is exchanged by breathing for fresh oxygen (Bolton et al., 2018).
The recommendation of the World Health Organization (WHO) is that anemia occurs in pregnancy when the value of the mass of hemoglobin (Hb) circulating in the peripheral blood circulating 11 g/dl (PCV 33%) or less but in developing countries it is generally accepted That anemia is present when the concentration of Hb is less than 10 g/dl or hematocrit (PCV) less than 30% (Akin Agboola 2018). Anemia ranges from mild to severe to moderate and WHO estimates hemoglobin levels for each of these degrees of anemia in pregnancy to be between 9.0 and 10.9 g/dl as mild anemia; 7-8.9 g/dl as moderate anemia and <7.0 g/dl as severe anemia (WHO, 2019).
Epidemiology
Every year more than 500,000 women die from pregnancy-related causes, 99% of them from developing countries. Estimates of maternal mortality from anemia range from 34 / 100,000 live births in Nigeria to 194 / 100,000 in Pakistan. Anemia is estimated to account for 17 to 46% of maternal deaths when combined with obstetric hemorrhage. The incidence of anemia in pregnancy varies from place to place, even within a country depending on socioeconomic status and level of development (Nynke van des Broeka 2018). It is between 5 and 50% of pregnant women in the tropics participating in prenatal clinics anemic compared to the prevalence rate of 2% in the developed world (Tropical Journal, 2018) claims that.
It is estimated that more than half of pregnant women in the world have hemoglobin levels indicative of anemia. In industrialized countries, anemia occurs in pregnancy in less than 20% of women. However, this is important for public health (> 10%). The quotas published for developing countries vary between 35% and 72% for Africa, between 37% and 75% for Asia, and between 37% and 52% for Latin America. A retrospective study of normal pregnant women were registered in the prenatal unit of the University Hospital of the University of Nigeria (UNTH) Enugu showed that 40.4% of the study population was isemica (Hb <11 g) in reserve. The prevalence of anemia in the reserve increased significantly with increasing gestational age in the reserve (Cyril and Hycinth, 2017). Another study conducted in Gombe in northeastern Nigeria found a 51.8% prevalence of pregnancy anemia. The majority of these patients 67.4% were mildly anemic; 30.5% were moderately anemic; while only 2.1% had severe anemia (Bukar et al., 2019).
CHAPTER THREE
METHODOLOGY
Research Design
Descriptive cross-sectional design will be used to evaluate the level of awareness of the dangers associated with anemia in pregnancy: a case study of Ilaro community, Ogun state. This design examines the characteristics, behaviours, attitude and intentions of a group (typically only a subset) to answer a series of questions. In this study, descriptive cross-sectional design is considered appropriate.
Area of study
Ilaro, Ogun State is a town in Ogun State, Nigeria. Ilaro town houses about 57,850 people. Ilaro is the headquarters of the Yewa South Local government, now known as YEWALAND which replaced the Egbado division of the former Western State, and later became a part of Ogun State of Nigeria. Ilaro town is about 50 km from Abeokuta, the Ogun State capital, and about 100 km from Ikeja, the capital city of Lagos State. Close to this monument is the town hall named after the honourable warrior “’Orona’ Hall”. The statue of Oronna and his Leopard are still there for tourists and lovers of history to see. Osata was an Ancient Ilaro ruler in the 19th century who sacrificed his own son for his people to enjoy abundance of rainfall at a time Ilaro was plagued with drought. The dialect spoken in Ilaro is the Egbado dialect. When Ilaro indigenes meets outside home, the shout of “Omo Oluwewun” has a magical power of unifying the “Ilu Aro” people.
Target population
The target population for this study will comprise of pregnant women attending antenatal care in Ilaro community, Ogun state, who will also be involved as participants in the data collection process for analysis. Data collated form the records unit of the Hospital showed an average of 500 pregnancy cases for a period of 6 months. For the purpose of this study, the inclusion criterion is stated as follows;
Inclusion criteria
- Willingness and informed consent to participate in the study.
- Availability at the time of data collection.
- Pregnant women attending antenatal care in Ilaro community at the time of the study.
Exclusion criteria
- Unwillingness and withdrawal of consent to participate in the study.
- Unavailability at the time of data collection.
- Pregnant women who were not registered or attending antenatal care in Ilaro community.
CHAPTER FOUR
DATA ANALYSIS AND INTERPRETATION
In this research study, 220 pregnant women attending antenatal care in Ilaro community, Ogun state were studied. All the questionnaires were correctly filled, retrieved and used in the research. Response rate therefore for this research was 100% for the questionnaire.
The demographic variables of the respondents are showed in table 4.1. Results showed that majority of the respondents 169 (76.6%) were in the age bracket of 20 – 30 years, 41 (18.5%) fell between 31 and 40 years, 10 (4.4%) between 30 – 34 years, and 1 (0.5%) >40 years. The modal age therefore was 20 – 30 years.
With regards to religion, majority 169 (76.6%) were of the Christian faith, 50 (23.2%) of the Islamic faith and 1 (0.8%) practiced other African traditional religion. Majority of the respondents (58.8%) engaged in petty trading, (23.7%) were housewives, 13 (10.3%) were teachers while (9.3%) were civil servants. Most of the respondents 145 (65.6%) had secondary education, (20.4%) attained tertiary level of education, (11.3%) had primary education while (2.5%) had no formal education at all.
CHAPTER FIVE
DISCUSSION OF FINDINGS, CONCLUSION AND RECOMMENDATIONS
In this chapter, the researcher discussed the result from the data analysis and relating interpretation to literature review in order to sharpen the focus of discussion using the research question.
Discussion of Findings
Research Question One: What is the knowledge of anemia in pregnancy amongst pregnant women attending antenatal care in Ilaro community?
The socio-demographic characteristics of the study population revealed that out of the 220 respondents, 169 of them were in the age range of 20-29 years while those that were 40years old and above were the least (0.3%). The minimum age of the respondents was 18years while the maximum age was 46years. The mean age of the respondents was 26.8years. About half of the women were self-employed, 26.8% were fulltime housewives, 13.5% were unemployed, and 4.9% were company workers, while 4.4% were Civil Servants. More than three-quarter of the respondents had one form of formal education or the other, while only a meager 2.2% had no any form of education at all. This certainly must have affected their level of awareness and health-seeking behavior hence, the least prevalence of anemia among those with tertiary education.
The knowledge about anemia and its causes, in this study is low (21.2%), majority of the respondents said they had never heard of anemia. This is in line with a similar study conducted in Raichur, India where knowledge about anemia in pregnancy is very low (6.48%) (Vijaynath et al, 2020). Most women who have heard of anemia were not able to correctly identify the causes. A major hurdle is the fact that anemia is not perceived a major health problem by many even by sufferers who ascribed its consequences to general fatigue. Even where the problem is recognized, there may be a reluctance to invest necessary funds owing to skepticism regarding the effectiveness of interventions for controlling it. Evidence of the independent effect of iron status on function would therefore, help in advocacy. The predisposing factors recognized to be responsible for anemia in pregnant women were parity (14.2%), adoption/miscarriage previously (28.1%), blood transfusion (23%), and being a sickle cell anemia patient (28.3%). This was in contrast to a study by Monif (2014) who revealed that women who had malaria during pregnancy were almost five times more likely to be anaemic. Similarly other studies have found almost the same association, which suggest that women who were anaemic during pregnancy were 3 times more likely to be anaemic (Monif et al., 2014; WHO 2016). This can be controlled by providing pregnant women with insecticide- treated bed nets (ITN) and intermittent preventive treatment (IPT) with anti -malarial medication.
Implications of findings to Nursing
This study has implication for nursing arising form the results and findings. The study indicated that knowledge about anemia and its causes, in this study is low implying a wide gap in the health education and information space. Health services and facilities should be made accessible for the pregnant women during antenatal care and for mothers during postnatal care to ensure that health linkages are strengthened between these two parties involved (the health beneficiaries and the health agents). This will ensure better health outcomes and safer pregnancies for women. High level of knowledge on anemia, its causes and management strategies should be disseminated and adequately discussed through awareness programmes, training sessions, workshops and sensitization campaigns which will be anchored by health workers, health educators and other healthcare professionals during their antenatal visit to hospital.
Summary
The purpose of the study was to determine the lack of awareness on prevention of anemia in pregnancy among pregnant women in Ilaro community, Ogun state. To achieve the purpose of the study, objectives and research questions were formulated. Related literature pertinent to the study was reviewed under conceptual review, theoretical review, and empirical headings.
From the findings, the knowledge about anemia and its causes, in this study is low (21.2%), majority of the respondents said they had never heard of anemia. Most pregnant women in Ilaro community have been exposed to secondary education but unfortunately, were not well informed with the condition of anemia in pregnancy. The predisposing factors recognized to be responsible for anemia in pregnant women were parity (14.2%), adoption/miscarriage previously (28.1%), blood transfusion (23%), and being a sickle cell anemia patient (28.3%). Increasing access to health information and quality services will greatly affect health seeking behavior and utilization of health services.
Recommendations
Based on the findings, the following recommendations were made;
- There is need for public enlightenment campaigns to sensitize the public on what anemia is, its causes, risk factors and complications. Strategies should also be put in place to increase awareness on anemia. These should include dissemination of information via antenatal and under-five clinics, public radio, and community development meetings conducted by extension workers.
- Health education and promotion, especially to encourage all pregnant women to book early for antenatal care and to take appropriate intervention measures. Information, Education and Communication (IEC) efforts should be directed towards increasing levels of awareness and commitment at all levels.
- All pregnant women should be intermittently screened for the presence of anemia during the antenatal care visit, instead of just at booking which is the practice in most health facilities.
Limitations of the Study
The constraints faced by the researcher include time constraint as the researcher had to combine this study with other academic activities and preparations, inadequate material of the study, stress and financial constraints. Also, this work was limited to Ilaro community and pregnant women attending antenatal care; this implies that a general inference cannot be made for other women and mothers on issues related to motherhood practices.
Suggestions for Further Studies
Based on the research findings, the researcher suggests the following areas for further studies. There is need for more research to analyze the role of risk factors and perception in management of anemia among pregnant women and mothers as a whole.
REFERENCES
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