Anaemia In Pregnancy (A Case Study Of Pregnant Women Attending Antenatal Clinic At University Of Nigeria Teaching Hospital (Unth) Enugu)

Project and Seminar Material for Public Health

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. The researcher studied the management of anemia among pregnant women attending antenatal care in University of Nigeria Teaching Hospital (UNTH), Enugu. The study adopted a descriptive cross-sectional design and a self-designed questionnaire was the research instrument used for data collection. The researcher determined the sample size of 220 respondents for the study using Taro Yamane sample size formula.

From the findings, the knowledge about anaemia and its causes, in this study is low (21.2%), majority of the respondents said they had never heard of anaemia. Most pregnant women in Elele 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 anaemia patient (28.3%). Increasing access to health information and quality services will greatly affect health seeking behavior and utilization of health services. The results indicated that the major challenge was finances with a response rate of 84.1%, followed by time constraint (62.3%), lack of support from family/friends (59.3%), and accessibility to ANC services (56.9%). The most valid strategy for manging anaemia was that regular medical checkup is necessary during pregnancy (70.4%)

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 and its effect on pregnancy outcome in Nigeria.

Table Of Content

Preliminary Page(s)

Title page
Certification page
Dedication
Acknowledgement
Abstract
Table of content

Chapter One:

Introduction

1.1 Background To The Study
1.1 Background To The Study
1.2 Statement Of Problem
1.3 Objectives Of The Study
1.4 Research Questions
1.5 Significance Of The Study
1.6 Justification Of The Study
1.7 Scope Of Study
1.8 Definition Of Terms

Chapter Two:

Literature Review

2.1 Conceptual Review
2.2 Causes Of Anaemia In Pregnancy
2.3 Management Of Anaemia
2.4 Theoretical Review
2.5 Empirical Review

Chapter Three:

Methodology

3.1 Research Design
3.2 Target Population
3.3 Sample Size
3.4 Sampling Technique
3.5 Instruments For Data Collection
3.6 Validity Of Instrument
3.7 Reliability Of Instrument
3.8 Method Of Data Analysis
3.9 Method Of Data Analysis
3.10 Ethical Consideration

Chapter Four:

Results and Discussion

4.1 Results
4.2 Discussion

Chapter Five:

Summary, Conclusion and Recommendations

5.1 Summary
5.2 Conclusion
5.3 Recommendations
References
Appendix I
Appendix II

Chapter One

1.0 Introduction

1.1 Background To The Study

Pregnancy is an important experience for mothers and women in general, but also one of the experiences of misery and suffering can be when complications and adverse circumstances endanger pregnancy, leading to illness or death (Patil, 2013). The reduction in hemoglobin is often accompanied by a decrease in the number of red blood cells and hematocrit (PCV, hematocrit) (WHO, 2011). For a person of a certain sex, age and place of residence, the hemoglobin in the blood must be below the reference level for the condition is described as anemic. Anemia itself is not a disease, but an indication of an underlying disease or condition (Okoro, 2015).

Anemia is a major public health problem worldwide, especially for women of childbearing potential in developing countries. In most countries around the world, an estimated 56 million pregnant women are anemic. It is estimated that the overall prevalence of anemia in pregnancy is approximately 41.8%, which differs from a minimum of 5.7% in the USA, up to 75% in Gambia (Chathuranga, Balasuriya and Perera, 2014). In the US, it was estimated that the anemia in pregnancy would increase from 1.8% to 27.4% in the first and third trimesters. Some women become anemic before pregnancy, while others become increasingly anemic during pregnancy (Goonewardene, Shehata and Hamad, 2012).

Anemia in pregnancy is 61% in developing countries (WHO / FHE / MSM / 93.5) with a high incidence and severity in pregnant women living in malaria areas and Africa accounts for about 20% of maternal deaths due to pregnancy anemia in fetuses high risk of premature birth, low birth weight, and perinatal mortality as a result of deterioration of placental oxygen (Idowu, Mafiana, and Dapo, 2015). Women often become anemic during pregnancy as there is a high demand for iron and other vitamins due to the physiological burden of pregnancy; inability to meet the required level of these substances either as a result of malnutrition or infection, leading to anemia (Van den Broek, 2016).

An estimated 2.15 billion people are iron deficient and that this deficiency is severe enough to cause anemia in 1.2 trillion people worldwide (WHO, 2012). Components About 90% of all anemia types have iron deficiency. In developing countries, almost half of the population suffers from iron deficiency (Viteri, 2012). About 47% of non-pregnant women and 60% of pregnant women suffer from anemia worldwide. In the developed world as a whole, the prevalence of anemia during pregnancy averages 18% and over 30% of them are iron deficient, and the poor most affected (Hughes, 2011).

Women of childbearing potential and pregnant women are at high risk for a negative balance and iron deficiency due to their increased iron requirements due to menstrual and pregnancy requirements. The average demand for iron absorption in adult women and in menstruating adolescents is estimated to be 1.36 mg/day and 1.73 mg/day, respectively. However, 15% of adult women who have menses need more than 2.0 mg/day and 5% even 2.84 mg/day. The superposition of menstrual losses and the growth of menstruating adolescents increase the need for absorbed iron; 30% require more than 2.0 mg/day; 10% up to 2.65 mg/day and 5% 3.2 mg/day. These requirements are very difficult to meet, even in diets enriched with good quality iron (WHO, 2012). The iron requirement increases significantly in the second and especially in the third quarter to an average of 5.6 mg/day (approximate range of 3.54 – 8.80 mg/day) food, therefore, the importance of iron stores to extract before pregnancy and iron supplements during the Pregnancy.

Iron deficiency during breastfeeding is mainly due to pregnancy and childbirth and can be alleviated in part by lactating amenorrhea. However, once menstruation recommences, iron needs to increase as breastfeeding continues. The risk of iron deficiency during pregnancy and lactation begins with inadequate iron stores during pregnancy in women of childbearing age. Folate deficiency has also been documented during pregnancy, often leading to iron deficiency anemia and combined folate. This is common among lower socioeconomic groups, who consume mainly grain-based diets (poor folic acid), which are enhanced by prolonged cooking and reheating. The folate requirement doubles in the second half of pregnancy and increases significantly with hemolytic processes such as malaria and hemoglobinopathies. The malabsorption processes, which are common among tropical and low socioeconomic groups, affect the absorption of folic acid (WHO, 2012).

1.2 Statement Of Problem

Anemia is one of the most prevalent public health problems in the world. The WHO estimates that the number of anemia that affects people around the world is 3.5 trillion in developing countries and that about 50% of all anemia can be attributed to iron deficiency (WHO/UNICEF, 2014). The worldwide distribution of disease burden of iron deficiency anemia focuses mainly on Africa and the Southeast Asia-D region. These regions account for 71% of the global mortality rate and 65% of disability adjusted life years. While estimates of the prevalence of anemia may vary, a significant proportion of young children and women of childbearing age may be adopt anemic (WHO, 2012). It is the only nutrient deficiency that is also significant in industrialized countries.

The study of the global database on anemia WHO shows that the most affected groups are pregnant women (48%) and children 5 to 14 years (46%). As expected, the prevalence of anemia in developing countries is three to four times higher than in industrialized countries. The most affected populations in developing countries are pregnant women (56%), school-age children (53%) and non-pregnant women (44%). In developed countries, the most affected groups are pregnant women (18%) and preschoolers (17%), followed by non-pregnant women and seniors, both at 12%. Asia has the world’s highest prevalence of anemia. followed by Africa (WHO, 2012). Almost half of all anemic women live in the Indian subcontinent, where 88% of them develop anemia during pregnancy.

Available data show that up to 60% of pregnant women in Niger, especially those who live in rural areas, are anemic during pregnancy (WHO, UNICEF, UNFPA and World Bank, 2015). This anemia is mainly due to the deficiency of folic acid, iron, vitamins and trace elements. Therefore, it is more common in poor and malnourished women. Diet-related anemia is a major cause of unwanted pregnancy outcomes in Nigerian women. It is a direct and indirect cause of maternal and perinatal morbidity and mortality. It leads to a delay in intrauterine fetal growth and thus to an increase in mortality rates, neonatal and perinatal mortality.

Several Nigerian women have died from severe anemia during pregnancy (Hb <6.0 g / L) (WHO, 2012). Despite the high incidence of anemia as the cause of maternal mortality in Nigeria, very few interventions currently address anemia as a major problem of safe maternity in Nigeria. So far, only 58% of pregnant Nigerian women receive iron supplements during pregnancy (WHO, 2012). It is therefore imperative to study not just the prevalence of this concept, but the management and control measures, hence, this study on the management of anemia among pregnant women attending antenatal care in University of Nigeria Teaching Hospital (UNTH), Enugu.

1.3 Objectives Of The Study

The general objective of this is to assess anemia in pregnant using a case study of women attending antenatal care in University of Nigeria Teaching Hospital (UNTH), Enugu state.

Specifically, the study seeks to;

Determine the factors that predispose to anaemia in pregnancy amongst pregnant women attending antenatal care at UNTH.
Assess the strategies used by the pregnant women for the prevention and management of anaemia in UNTH
Determine the challenges encountered in the management of Anaemia among pregnant women in UNTH

1.4 Research Questions

The following questions were formulated based on the research problem and objectives;

What are the factors that predispose to anaemia in pregnancy amongst pregnant women attending antenatal care at UNTH?
What are the strategies used by the pregnant women for the prevention and management of anaemia in UNTH?
What are the challenges encountered in the management of Anaemia among pregnant women in UNTH?

1.5 Significance Of The Study

Findings from the study would generate data on how pregnant women in University of Nigeria Teaching Hospital seek routine healthcare during pregnancy for management of anaemia, and the eventual outcome. This information could serve as a basis for nurses, midwives, and other health workers to improve maternal health and reduce maternal morbidity and mortality. This could be done through improved maternal health care services and encouraged use through evidence based health education programmes. Also, findings will help the health care profession to create more awareness on maternal health and antenatal care services utilization targeted at mothers, because maternal health services when adopted will help maintain optimal health during pregnancy as well as timely management of problems like anaemia, should they arise.

1.6 Justification Of The Study

The study was conducted in University of Nigeria Teaching Hospital, Enugu state. The justification for the study was that the report on maternal health and safe motherhood by WHO showed that maternal mortality is unacceptably high especially in developing nations like Nigeria and progress to reduce it in most regions of the world is slow (WHO, 2014). These rates could be attributed to pregncancy relted complications, issues and concerns, hence the need for this study on to assess anemia in pregnant using a case study of women attending antenatal care in University of Nigeria Teaching Hospital with the aim of developing strategies to make for better health outcome for mother and infant.

1.7 Scope Of Study

This study is delimited to assessing the management of anemia among pregnant women attending antenatal care in Madonna University Teaching Hospital, Enugu. The variables covered in this study include the knowledge on anaemia amongst pregnant women, prevalence of anaemia in pregnancy among pregnant women, predisposing factors to anaemia in pregnancy amongst pregnant women, and strategies used by the pregnant women for the prevention and management of anaemia in Madonna University Teaching Hospital.

1.8 Definition Of Terms

Anaemia:

Is a condition in which the number of red blood cells or their oxygen-carrying capacity is insufficient to meet physiologic needs, which vary by age, sex, altitude, smoking, and pregnancy status. Anemia in pregnancy refers to a hemoglobin concentration of less than 110 g/L (less than 11 g/dL) in venous blood implying a reduction in the oxygen carrying capacity of the blood.

Management:

Refers to a system of coordinated healthcare interventions and communications for people with conditions/diseases in which patient self-care efforts are significantly required.

Pregnant Women:

This refers to women who are in their first to third semester of pregnancy; which is the time during which one or more offspring develops inside a woman.

Chapter Five

5.0 Summary, Conclusion And Recommendation

5.1 Summary

The purpose of the study was to assess anaemia in pregnancy among women attending antenatal clinic in University of Nigeria Teaching Hospital, Enugu. 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.

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 knowledge of anaemia was almost universal. 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”).

5.2 Conclusion

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.

5.3 Recommendations

Based on the findings, the following recommendations were made;

There is need for public enlightenment campaigns to sensitize the public on what anaemia is, its causes, risk factors and complications. Strategies should also 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.
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 anaemia during the antenatal care visit, instead of just at booking which is the practice in most health facilities.

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