LEVEL OF AWARENESS OF THE CAUSES AND PREVENTION OF ANAEMIA IN PREGNANCY AMONG PREGNANT MOTHERS

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LEVEL OF AWARENESS OF THE CAUSES AND PREVENTION OF ANAEMIA IN PREGNANCY AMONG PREGNANT MOTHERS

CHAPTER ONE

INTRODUCTION

BACKGROUND OF THE STUDY

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

1.1. Objectives and Methods

This study was therefore carried out to determine the prevalence of anaemia among pregnant women receiving antenatal care in two hospitals and a traditional birth home in order to obtain a broader prevalence data. Pregnant women were enrolled in the study at their first antenatal visit and were monitored through pregnancy for anaemia. Packed cell volume (PCV) was used to assess level of anaemia; Questionnaires were also administered to obtain demographic information.

Three hundred and sixty five (76.5%) of the women were anaemic at one trimester of pregnancy or another. Anaemia were more prevalent among primigravidae (80.6%) than the multigravidae(74.5%)(P>0.05). Two hundred and eleven women (57.8%) had moderate anaemia while 147 (40.3%) had mild anaemia and 7(1.9%) were severely anaemic (5 (71.4%) of which were primigravidae). All severely anaemic women were under 30 years old. Women attending TBH for antenatal care were found to be more anaemic (81.2%) (Even at various trimesters of pregnancy) than those attending the hospitals (72.5%) (P<0.05). However, in all the antenatal centers more women were anaemic in the 2nd trimester of pregnancy. Forty-seven (9.8%) of the enrolled women booked for antenatal care in the first trimester, while 303(63.5%) booked in the second trimester and 127(26.6%) in the 3rd trimester of their pregnancies. 62.5% of these women were already anaemic at the time of antenatal booking, with a higher prevalence among the primigravidae (69.7%)(P< 0.05). Absence of symptoms of ill health was the major reason for late antenatal booking. Anaemia was higher among unemployed women and those with sickle cell traits.

Educating women on early antenatal booking and including those in TBHs in health interventions is necessary to reduce the problem of anaemia in pregnancy in Nigeria.

1.2. BACKGROUND

This study has shown that anaemia in pregnancy is still a major health problem in Nigeria identifying primigravidaeas being more at risk than multigravidae. So also are women using TBH for antenatal care, pregnant teenagers and women that book late for antenatal care. The use of TBHs being a common practice in Nigeria indicates that the traditional health providers need to be enlightened on the need to include the use of iron and folate supplements in the management of their pregnant patients. Educating women on early ANC booking .Anaemia in pregnancy is an important public health problem worldwide. WHO estimates that more than half of pregnant women in the World have a haemoglobin level indicative of anaemia (< 11.0gldl), the prevalence may however be as high as 56 or 61% in developing countries 14. Women often become anaemic during pregnancy because the demand for iron and other vitamins is increased due to physiological burden of pregnancy. The inability to meet the required level for these substances either as a result of dietary deficiencies or infection give rise to anaemia 13.

Anaemia ranges from mild, moderate to severe and the WHO pegs the haemoglobin level for each of these types of anaemia in pregnancy at 10.0 – 10.9g/d1 (mild anaemia) 7 – 9.9g/dl (moderate anemia) and < 7g/dl (severe anaemia) 15. Prevalence of anaemia can be as high as 61% in developing countries 14 with a high incidence and severity occurring among primigravidae living in malaria endemic areas8. Studies in Nigeria have shown that malaria is still a major problem among pregnant women 6,8.

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 4. Foetuses are at risk of preterm deliveries, low birth weights, morbidity and perinatal mortality due to the impairment of oxygen delivery to placenta and foetus 1,2,4. The management and control of anaemia in pregnancy is enhanced by the availability of local prevalence statistics, which is however not adequately provided in Nigeria. Therefore, this study aims at providing prevalence statistics of anaemia in pregnancy and to assess the effectiveness of antenatal care in preventing anaemia among pregnant women in Enugu Nigeria.

Study area/Centres

The study was conducted in Enugu, Enugu State, Nigeria in three centers namely: UNTH, Enugu all in Enugu.

1.3. Ethical clearance and consent

Ethical clearance was obtained from the ethical committee in the hospitals used while approval was also obtained from the traditional birth healer for the use of the traditional birth home. The study was first introduced to the pregnant women on their first visit to the antenatal clinic in order to obtain their consent.

1.4. Sample collection

There was a continuous enrolment into the study for twelve months; as many as consented were enrolled in the study. Blood samples were collected from the pregnant women and haematological investigations were carried out to determine blood group genotype and packed cell volume. The subjects were subsequently examined monthly for PCV until delivery. Questionnaires were also administered to obtain demographic information, use of folate and birth interval. Typing of anaemia was carried out using WHO criteria 15. Gestation age was estimated from interview based on the date of last menstruation and estimation of fundal height.

1.5. Data analysis

All quatitative data was entered in computer and analysed using SPSS version 10.1 for windows. Descriptive statistics were computed for all relevant data. Association between anaemia and pregnancy was tested using chi-square. All significance are reported at P<0.05. Women that were anaemic at one trimester or the other during pregnancy were considered anaemic in pregnancy.

Four hundred and seventy-seven (477) women were enrolled in the study, 262 from the Federal Medical Centre and Enugu State General hospital (77 were primigravidae and 185 were multigravidae). Two hundred fifteen pregnant women were also enrolled from Araromi Traditional Birth Home (TBH); (78 primigravidae and 137 multigravidae). A total of 155 primigravidae and 322 multigravidae were enrolled. Anaemia was recorded in 365 (76.5%) of the enrolled women at one trimester of pregnancy or the other; Of these 125 were primgravidae and 240 multigravidae, constituting a prevalence of 80.6% and 74.5% anaemia among primigravidae and multigravidae respectively. Percentage anaemia was higher among women in the TBH (81.4%) than those in the hospitals (72.5% Table 1).

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