Level of awareness of the causes and prevention of anaemia in pregnancy amongst pregnant mother’s attending antenatal clinic in poly sub district hospital

CHAPTER ONE

INTRODUCTION

Background of study

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).

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 knowledge level of pregnant women and their perceptions about the risk of anaemia in pregnancy. The study also explored adherence to iron supplementation.

RESEARCH OBJECTIVES

 Main objective

The general objective of the study was to investigate the level of awareness and prevention   of anaemia during   pregnancy  among pregnant women in Ibesikpo-Asutan LGA.

Specific objectives

1. To determine the obstetric history and development of anaemia in Ibesikpo-Asutan LGA.
2. To determine the relationship between spouse’s socio-demographic characteristics and occurrence of anemia.
3. To determine the relationship between antenatal care visit and taking of IFAS and development of anemia
4. To determine the relationship between participant’s awareness on consequences of anemia during pregnancy and development of anaemia
5. To determine the relationship between dietary habits and life style and occurrence of anaemia
6. To determine the relationship between food consumption based on 24 hours re-call and anaemia
7. To determine the relationships between health conditions of the participants and anemia
8. To determine the relationship between anthropometric measurements and anemia
9. To determine the factors independently associated with anaemia among pregnant women.

RESEARCH QUESTIONS

1. What is the level of awareness of pregnant women on the risk of anaemia in pregnancy?
2. What is obstetric history and development of anaemia?
3. What is the relationship between spouse’s socio-demographic characteristics and occurrence of anemia?
4. What is the relationship between antenatal care visit and taking of IFAS and development of anemia?
5. What is determine the relationship between participant’s awareness on consequences of anemia during pregnancy and development of anaemia?
6. What is the relationship between dietary habits and life style and occurrence of anaemia?
7. What is the relationship between food consumption based on 24 hours re-call and anaemia?
8. What are the relationships between health conditions of the participants and anemia?
9. What is the relationship between anthropometric measurements and anemia?
10. What are those factors independently associated with anaemia among pregnant women?

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 knowledge 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.

SCOPE OF STUDY

The study will be to ascertain the level of awareness and prevention of anaemia in pregnancy among pregnant women with special reference to Ibesikpo-Asutan LGA. 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.

Level of awareness of the causes and prevention of anaemia in pregnancy amongst pregnant mother’s attending antenatal clinic in poly sub district hospital