Level of Awareness on the Prevention of Anaemia Among Pregnant Women

Level of Awareness on the Prevention of Anaemia Among Pregnant Women

Chapter One

Aims and Objectives

To determine the awareness on anaemia amongst women attending ANC
To estimate the Hb (PCV) level among the pregnant women attending ANC
To determine the factors that predispose to anaemia in pregnancy amongst pregnant women attending ANC.

CHAPTER TWO

LITERATURE REVIEW

Definition

The word anaemia connotes a deficiency in the number of red blood cells or in their haemoglobin content, which can lead to a decrease in oxygen-carrying capacity of the blood, causing unusual tiredness resulting in pallor, shortness of breath, and lack of energy. Anaemia may be relative or absolute. Relative anaemia is that which occur in pregnancy.²⁰ Absolute anaemia involves a true decrease in red cell mass. The cells are manufactured in the bone marrow and have a life expectation of approximately four months (120 days).²⁰To produce red blood cells, the body needs (among other things) iron, vitamin B12 and folic acid. If there is a lack of one or more of these ingredients, anaemia will develop.

Red blood cells are the cells that circulate in the blood plasma giving the blood its red colour. Through its pumping action, the heart propels blood around the body through arteries. The red blood cells obtain oxygen in the lungs and carry it to all the cells of the body. The cells use the oxygen to fuel combustion of sugar and fats, which produces the body‟s energy. During this process called oxidation, carbon dioxide is created as a waste product. It binds itself to the red blood cells that have delivered their load of oxygen. The carbon dioxide is then transported via the blood in the veins back to the lungs where it is exchanged for fresh oxygen by breathing.²⁰

The World Health Organization (WHO) recommendation is that anaemia in pregnancy is present when the value of the total circulating haemoglobin (Hb) mass in the peripheral blood is 11g/dl (PCV 33%) or less, however, in developing nations it is generally accepted that anaemia exists when the Hb concentration is less than10g/dl or packed cell volume (PCV) is less than 30%.²¹Anaemia ranges from mild, moderate to severe and the WHO pegs the haemoglobin level for each of these degree of anaemia in pregnancy at 9.0 -10.9g/dl as mild anaemia; 7-8.9g/dl as moderate anaemia and <7.0g/dl as severe anaemia.

Epidemiology

Each year more than 500,000 women die from pregnancy-related causes, 99% of these are from developing countries. Estimates of maternal mortality resulting from anaemia range from 34/100,000 live births in Nigeria to as high as 194/100,000 in Pakistan. In combination with obstetric haemorrhage, anaemia is estimated to be responsible for 17 – 46% of cases of maternal death. The incidence of anaemia in pregnancy would vary from place to place even within the same country depending on the socio-economic status and level of development.²³It is claimed that 5 –50% of pregnant women in the tropics who attend antenatal clinics are anaemic as against the prevalence rate of 2% in the developed world.

It has been estimated that over half the pregnant women in the world have a haemoglobin level indicative of anaemia. In industrialized countries, anaemia in pregnancy occurs in less than 20% of women. This however, reaches the level of public health significance (>10%).Published rates for developing countries range from 35% to 72% for Africa, 37% to 75% for Asia and 37% to 52% for Latin America. A retrospective study of normal pregnant women who registered with the antenatal unit of the University of Nigeria Teaching Hospital (UNTH) Enugu between January 1, 2005 and October 30, 2005 showed that 40.4% of the study population wasanaemic (Hb< 11g) at booking. The prevalence of anaemia at booking increased significantly with increasing gestational age at booking.²⁵Another study carried out in Gombe, North-eastern Nigeria showed a prevalence of anaemia in pregnancy of 51.8%. The majority of these patients 67.4% were mildly anaemic; 30.5% were moderately anaemic; while only 2.1% had severe anaemia.²⁶

In West Africa, anaemia in pregnancy results from multiple causes, including iron and folate deficiency, malaria and hookworm infestation, infections such as HIV and haemoglobinopathies. Pica has been identified as a risk factor for anaemia in pregnancy.²⁷This could be applicable to this environment in which special clay of the kaolin group (called „nzu‟ in Igbo language) is easily accessible in the open markets, and some pregnant women crave it. The situation is particularly worse in southern Asia where ¾ of the pregnant women are anaemic (see table 2.1).Not only is anaemia common, it is often severe. From published reports available, it can be estimated that 2-7% of pregnant women have Hb values <7.0g/dl, and probably 15 – 20% have values<8.0g/dl. It has been suggested that the prevalence of anaemia may depend on the season, increasing relation to malaria transmission in the wet season or in relation to increased food shortage at the end of the dry season.

In 1993, the World Bank ranked anaemia as the eighth leading cause of disease in girls and young women of childbearing age in developing countries, though anaemia is assumed to be less common in non-pregnant women.

CHAPTER THREE

METHODOLOGY

Study Design

This is a cross-sectional descriptive study which assesses anaemia in pregnant women attending ANC in the Medical Centre Anatigha Calabar South one of the secondary level health facilities in Cross River State.

Sample Size Determination

The sample size was determined using the formula for sample size determination for proportion.⁴⁹ n = z2 (a-1)pq d²

Where: n = the desired sample size when the population is greater than 10,000.

z²= The standard normal deviate usually set at 1.96 which corresponds to 95% confidence interval.

The proportion in the target population estimated to have a particular characteristics. According to a previous similar study carried out in Enugu, South Eastern Nigeria, the prevalence of anaemia in pregnancy was found to be 40.4%.²⁵Using above formula, therefore:

0-p

d = Degree of accuracy desired, usually set at 0.05. Calculated from the formular⁴⁹

z²=1.96, p=40% (0.4), q=0.6, d=0.05.

If applied then, n ₌1.96² x 0.6 x 0.4 = 368.8 (0.05)²

In order to take care of attrition due to non-response 10% was added:

10 x 368.8 = 36.88

100

368.8 + 36.88 = 405.68 ≈ 406

This brings the required minimum sample size for the study to 406.

Sampling Technique

A systematic sampling method was used to select the required sample size. The health Facility runs ANC three days in a week and on each clinic day, an average of 150 pregnant women are seen. Therefore, a total average of 450 women are seen every week and 1,800 every month which is our study population. Sampling interval is calculated using the formula:

K = Study population =1800 = 4.4 ≈ 4

Minimum Sample size 406

CHAPTER FOUR

RESULTS

Four hundred and twelve respondents participated in the study out of which, data for this analysis was obtained from 406 respondents, giving a response rate of 98.5%. The respondents were asked questions concerning their socio-demographic data, their obstetric data and their awareness on anaemia. The results are presented in the following tables and figures.

Table 4.1: Socio-Demographic Characteristics Of The Respondents

CHAPTER FIVE

CONCLUSION AND RECOMMENDATIONS

Conclusion

The prevalence of anaemia was high (56.4%) among the pregnant women in this study. Assessment of anaemia during pregnancy is important, because it directly or indirectly contributes to the high Maternal and perinatal morbidity and mortality seen in Nigeria. It also affords one the opportunity to institute interventions to prevent complications especially when carried out at booking. Therefore, there is a need to identify the risk factors for anaemia.

Among other findings, the study showed that the lack of awareness of anaemia was almost universal.

Highest prevalence of Anaemia (61.1%) was observed among the women in the age group 15-19years, followed by 20–30 years age group (56.3%) compared to the other age groups. In line with this, it can be concluded that prevalence of anaemia reduces significantly with increasing age of the woman at first pregnancy (“pregnancy too early”).

Additional finding shows a strong correlation between parity and prevalence of anaemia, that the higher the parity, the greater the prevalence of anaemia (“pregnancy too many”).

Prevalence of anaemia was higher among women who booked for ante-natal after the first trimester.

Another finding worthy of note here is the correlation between birth interval and prevalence of anaemia which showed that the prevalence of anaemia is inversely proportional to the birth interval.

From this study it can therefore, be concluded that the prevalence of Anaemia among pregnant women attending ANC in is high. It is highest among those within the Age 20-30years and also very high among the multiparous women. Factors contributing to this include Educational Status, Occupation, birth interval and parity.

Measures to improve and demonstrate maternal and child health (MCH) effectiveness through built-in evaluation procedures should thus go hand-in-hand with a drive to increase awareness of the need for iron supplements. Such an increased awareness will lead to an increased demand.

Ultimately, adherence with iron therapy at the user level is affected by interactions between policy, service system and user factors. As already mentioned, lack of awareness of the prevalence, health impact and economic cost of anaemia, and the efficacy of iron supplementation at all three levels (health policy makers, health care providers and among vulnerable groups within communities) are all significant problems.

Recommendations

In order to reduce the high Maternal and perinatal morbidity and mortality from anaemia seen in Nigeria, certain measures should be put in place by the government:

Public enlightenment campaigns should be embarked upon to sensitize the public on what anaemia is, its causes, risk factors and complications.
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.
Strategies should be put in place to increase awareness on anaemia. These should include dissemination of information via antenatal and under-five clinics, public radio, and community development meetings conducted by extension workers.
Education of the girl-child should be made compulsory to avoid teenage and unplanned pregnancy. This can also help in delaying first pregnancy.
Distribution of iron tablets in communities targeted at adolescent girls and women after marriage and before conception, as well as in the inter-pregnancy period will prevent iron deficiency at the onset of a pregnancy.
Government should encourage women to delay the first pregnancy, and space successive pregnancies by improving the availability and provision of appropriate family planning devices.
Commonly consumed foods in this part of the country should be fortified with iron.

Ante-natal services, including routine drugs and tests should be free in all government hospitals.
All pregnant women should be intermittently screened for the presence of anaemia (e.g. at the booking visit, thereafter at 28 weeks and again at 36 weeks) instead of just at booking which is the practice in most health facilities.
Government should distribute free insecticide treated nets to all pregnant women who attend ANC and ensure they sleep under the nets.
Antihelminthic drugs should be given to pregnant women in their second trimester in addition to the iron supplements and antimalarial drugs routinely.

References

Viteri, F.E. The consequences of iron deficiency and anaemia in pregnancy. In: Nutrient Regulation During Pregnancy, Lactation and Infant Growth. L.
Alien, J. King and B. Lonnerdal. Eds. Plenum Press, New York,(1994). 121133. http:/www.unsystem.org/scn/archieves/scnn.news.ii/cho7.htm.Accessed 17/1/2010

Hughes, A. Anaemia in pregnancy, Maternal health and Safe Motherhood (1991)http://www.Unsystem.org/scn/archives/scnnews.ii/cho7.htm.Accessed17/1/2010
Viteri, F.E. Iron, Global Perspective. In: Ending Hidden Hunger: A Policy Conference on Micronutrient Malnutrition, Atlanta Georgia (1992). http://www.unsystem.org/scn/archives/scnnews.ii/cho7.htm.Accessed 17/1/2010
WHO National strategies for overcoming micronutrient malnutrition. Document EB 89/27. Executive Board,(1991). 89^th
WHO IRIS: Iron deficiency anaemia. Study Group on Iron Deficiency Anaemia. http://www.who.int/iris/handle/10665/40447.Accessed 20/4/2012
WHO/UNICEF. Focusing on Anaemia towards an integrated approach for effective Anaemia control-A Joint statement. Geneva: World Health Organization 2004.
Stoltzfus RJ. Global prevalence and consequences. Food Nutrition Bulletin 2003; 24(Suppl): S99-103.
Anaemia and Micronutrient deficiencies. Br Med Bull (2003) 67 (1): . www. Who.int/ nutrition / topics/ ida /en/ index. html. Accessed 20/4/12

Related Topics:

Other Topics