Assessment Of Anaemia In Pregnancy A Case Study Of Pregnant Women Attending And In University Of Uyo Teaching Hospital (UUTH))
Abstract
Anaemia in pregnancy is a common problem in most developing countries and a major cause of morbidity and mortality especially in malaria endemic areas. In pregnancy, anaemia has a significant impact on the health of the foetus as well as that of the mother. 20% of maternal deaths in Africa have been attributed to anaemia. Anemia during pregnancy is highly preventable and treatable.
This study is aimed at determining the prevalence of anaemia among women attending ANC in University of Uyo teaching hospital.
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.
CHAPTER ONE
INTRODUCTION
1.0 Background to the study
The health-conscious world community has come to realize that anaemia, the majority of which is due to iron deficiency, has serious health and functional consequences. And that it is widespread especially among tropical low-income populations and that most of its nutritional component is controllable with a very high benefit/cost ratio. Women of reproductive age and pregnant, lactating as well as their infants and young children are particularly affected.
In response to the overwhelming evidence to this effect, world authorities have agreed that by the end of this century, anaemia in pregnant women must be reduced by 1/3. The more aggressive groups believe that with new approaches for the control of iron deficiency, a reachable goal is to reduce iron deficiency anaemia to overall levels below 10% in most populations.
It is estimated that about 2.15billion people are iron deficient, and that this deficiency is severe enough to cause anaemia in 1.2 billion people globally.4About 90% of all anaemias have iron deficiency components. In the developing world, nearly ½ of the population is iron deficient.
About, 47% of non-pregnant women and 60% of pregnant women have anaemia worldwide. In the developed world as a whole, anaemia prevalence during pregnancy averages 18%, and over 30% of these are iron deficient, with the poor mostly affected.2 Women in reproductive age and pregnant women are at high risk of incurring negative balance and iron deficiency due to their increased iron needs because of menstruation and demands of pregnancy. The average requirements of absorbed iron are estimated to be 1.36mg/day and 1.73mg/day among adult and teenage menstruating females respectively. However, 15% of adult menstruating women require more than 2.0mg/day, and 5% require as much as 2.84mg/day. The superimposition of menstrual losses and growth in menstruating teenage girls increase the demands for absorbed iron; 30% need more than 2.0mg/day; 10% as much as 2.65mg/day and 5% 3.2mg/day. These requirements are very difficult to meet even with good quality iron fortified diets.
Iron needs are markedly increased during the second and especially during the third trimesters up to an average of 5.6mg/day (approximate range of 3.54 – 8.80mg/day).4This amount of iron needs cannot be met from food iron hence the importance of prepregnancy iron reserves upon which to draw and iron supplementation during pregnancy.
Iron deficiency during lactation is mostly residual from that of pregnancy and delivery and can be partially alleviated because of lactational amenorrhea, but once menstruation returns, if lactation continues, iron requirements become higher. The risk of iron deficiency in pregnancy and lactation begins with inadequate pregnancy iron reserves among women in reproductive age.
Folate deficiency has also been documented in pregnancy, often leading to combined iron-folate deficiency anaemia. This is common among lower socioeconomic groups who consume mostly cereal-based diets (poor in folate) aggravated by prolonged cooking and reheating. Folate requirements double in the second half of pregnancy and are markedly increased by processes that involve haemolysis, such as malaria and haemoglobinopathies. Malabsorption processes common among tropical, low socioeconomic groups impair folate absorption.
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1.2 Problem Statement
Anaemia is one of a wide spread public health problem in the world. WHO estimates the number of anaemia, people worldwide to be a staggering 3.5 billion in the developing countries and that approximately 50% of all anaemia can be attributed to iron deficiency. The global distribution of the disease burden of Iron deficiency anaemia is heavily concentrated in Africa and WHO regional Southeast Asia-D. These regions bear 71% of the global mortality burden and 65 % of the disability-adjusted life years lost.7Although estimates of the prevalence of anaemia vary, it can be assumed that significant proportions of younger children and women of the child bearing age are
anaemic. It is the only nutrient deficiency that is also significantly prevalent in the industrialized countries. Perusal of WHO global database on anaemia depicts that the most affected groups are pregnant women (48%) and 5-14 year old children (46%). Predictably, the prevalence of anaemia in developing countries is three to four times higher than in industrialized countries. The most highly affected population groups in developing countries are pregnant women (56%), school age children (53%), and nonpregnant women (44%). In industrialized countries, the most affected groups are pregnant women (18%) and preschool children (17%), followed by non-pregnant women and older adults, both at 12%. Asia has the highest prevalence of anaemia in the world; followed by Africa. About half of all anaemic women live in the Indian subcontinent where 88% of them develop anaemia during pregnancy.
Available data indicate that up to 60% of pregnant Nigerian women, especially those in the rural areas, are anaemic during pregnancy. This anaemia is mostly due to the nutritional deficiency of folic acid, iron, vitamin and trace elements; hence it is more common among the poor and malnourished women. Nutritional anaemia is a major cause of adverse outcomes of pregnancy in Nigerian women. It is a direct and indirect cause of maternal and perinatal morbidity and mortality. It causes intra-uterine fetal growth retardation, with resulting increase in rates of stillbirth, neonatal and perinatal mortality.
Several Nigerian women have died during pregnancy because of severe anaemia (Hb<6.0g/l). Despite the high incidence of anaemia as a cause of maternal mortality in Nigeria, very few interventions currently address anaemia as a major safe motherhood issue in Nigeria. To-date, only about 58% of pregnant Nigerian women receive iron supplement during pregnancy.
1.3Â Â Â Â Â Aims And Objectives
To assess the prevalence of anaemia in pregnancy amongst pregnant women attending ANC at University of Uyo teaching Hospital (UUTH). Specifically, the Objectives are
- To determine the knowledge on anaemia amongst women attending ANC at
University of Uyo teaching Hospital.
- To estimate the Hb (PCV) level among the pregnant women attending ANC at
University of Uyo teaching Hospital.
- To determine the factors that predispose to anaemia in pregnancy amongst pregnant women attending ANC at University of Uyo teaching Hospital.
1.4 Research Questions
- What is the prevalence of Anaemia among among pregnant women attending ANC in University of Uyo teaching Hospital?
- What is the relationship between Anaemia and various demographic variables?
- What is the knowledge of anaemia among pregnant women attending ANC in
University of Uyo teaching Hospital?
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1.5Â Significance of the study
The report on maternal health and safe motherhood by WHO showed that maternal mortality is unacceptably high especially in developing nations and progress to reduce it in most regions of the world is slow.
Improving maternal health is the fifth Millennium Development Goal (MDG) which aims at reducing by three-quarters between 1990 and 2015, the maternal mortality ratio. Improving maternal health can in turn serve as an instrument to achieve other MDGs, especially those that are health related. The role of improved maternal health is therefore crucial to the achievement of the MDGs. Close to 500,000 maternal deaths occur every year, 99% taking place in the developing world. Anaemia is the major contributory or sole cause of 20-40% of such deaths.14Anaemia in pregnancy is an important public health problem worldwide. WHO estimates that more than half of pregnant women in the world have a haemoglobin (Hb) level indicative of anaemia (Hb<11.0g/dl), the prevalence may however be as high as 56% or 61% in developing countries.15Estimates 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 many regions, anaemia is a factor in almost all maternal deaths; it poses a five-fold increase in the overall risk of maternal death related to pregnancy and delivery. The risk of death increases dramatically in severe anaemia. From local studies done in Zaria, it was reported that mortality for women during delivery or shortly after was 20% if their haemoglobin concentration was <5.0g/dl. Mortality decreased as Hb concentration rose: 4.5% for Hb levels between 6.0 and 5.0g/dl, average of 12.8% for Hb concentrations <6.0g/dl in contrast to 2.9% for Hb between 8.0 and 6.0g/dl.17These rates of maternal deaths contrast with those in the developed world where maternal mortality is 100 times less and severe anaemia is very rare. A study of this nature has not been carried out in this facility before, it is therefore, expected that findings from this study and the appropriate recommendations if implemented, will be of great help to the facility, Local Government and the country at large in reducing maternal morbidity and mortality due to anaemia in pregnancy.
1.6 Scope of the Study
This study was limited to pregnant women attending ANC at University of Uyo teaching Hospital (UUTH)
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