KNOWLEDGE OF THE CAUSE AND PREVENTION OF ANAEMIA IN PREGNANCY AMONG PREGNANT MOTHERS

1.1 Introduction

Anemia is one of the most frequent complications related to pregnancy. The word implies a decrease in the oxygen-carrying capacity of the blood and is best charac- terized by a reduction in hemoglobin concentration. This may be either relative or absolute. It is known that there is a larger increase in plasma volume relative to red cell mass in almost all pregnancies, and it accounts for “physiologic anemia.” These alterations have been known for centuries, and the term “plethora gravidarum” from medieval ages indicates this condition. However, it is still an open question to what extent this “hydremia” is physiologic or pathologic.

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Limitations of the Study and Definition of technical terms.

1.2 Background of Study

Anaemia describes a situation in which there is a reduction of haemoglobin concentration in the blood of pregnant women to a level below 11g/dl. Anaemia is one of the most common nutritional deficiency diseases observed globally and affects more than a quarter of the world's population (WHO/CDC, 2008). Globally, anaemia affects 1.62 billion people (25%), among which 56 million are pregnant women (Balarajan, 2011; WHO/CDC, 2008). It is estimated that 41.8% of pregnant women worldwide are anaemic. At least half of this anaemia burden is assumed to be due to iron deficiency.

Iron deficiency anaemia (IDA) is the most common nutritional disorder in the world affecting 2 billion people worldwide with pregnant women particularly at risk (WHO guideline, 2012). In developing countries, the prevalence of anaemia during pregnancy is 60.0% and about 7.0% of the women are severely anaemic (Agan et al., 2010). In Africa 57.1% of pregnant women are anaemic (de Benoist et al., 2008). Sub-Saharan Africa is the most affected region, with prevalence of anaemia estimated to be 17.2 million among pregnant women.

This constitutes to approximately 30% of total global cases (WHO, 2008). In Nigeria the prevalence of anaemia among pregnant women is 55.1% and among non-pregnant women is 46.4% (Ministry of Health, 2013). Anaemia during pregnancy is considered severe when haemoglobin concentration is less than 7.0 g/dl, moderate when the haemoglobin concentration is 7.0 to 9.9 g/dl, and mild when haemoglobin concentration is 10.0 to 10.9 g/dl (Balarajan et al., 2011; Salhan et al., 2012; Esmat et al., 2010). When the prevalence of anaemia among pregnant women is 40.0% or more, it is considered as a severe public health problem (McLean et al., 2008).

Anaemia during pregnancy has a variety of causes and contributing factors. Iron deficiency is the cause of 75% of anaemia cases during pregnancy (Balarajan et al., 2011; Haidar, 2010). Infectious diseases such as malaria, helminthes infestations and HIV are implicated with high prevalence of anaemia in sub-Saharan Africa (Ouédraogo et al., 2012 and Tolentino and Friedman, 2007). Loss of appetite and excessive vomiting in pregnancy and heavy menstrual flow before pregnancy are also documented causes of anaemia during pregnancy (Noronha et al., 2010). Socio-economic conditions, abnormal demands like multiple pregnancies, teenage pregnancies, maternal illiteracy, unemployment/underemployment, short pregnancy intervals, age of gestation, primigravida and multigravida (Haniff et al., 2007; Noronha et al., 2010), smoking, excessive alcohol consumption, are the main contributing factors of anaemia during pregnancy (Moosa and Zein, 2011; Esmat et al. 2010).

Anaemia during pregnancy is a major cause of morbidity and mortality in pregnant women and infants in developing countries (Akhtar and Hassan, 2012). In 2013, an estimated 289,000 women died worldwide. Developing countries account for 99% (286 000) of the global maternal deaths with sub- Saharan Africa region alone accounting for 62% (179 000). About 800 women a day are still dying from complications in pregnancy and childbirth globally (WHOa, 2015). Anaemia contributes to 20% of all maternal deaths (WHOb, 2015).

Anaemia in pregnancy causes low birth weight (Banhidy et al., 2011), fetal impairment and infant deaths (Kalaivani, 2009). Iron deficiency anaemia affects the development of the nation by decreasing the cognitive and motor development of children and productivity of adults (Balarajan et al., 2011; Vivek et al., 2012). Deficiency of folic acid during pregnancy can result in developing neural tube defect that develops in embryos during the first few weeks of pregnancy leading to malformations of the spine, skull, and brain (Wolff et al., 2009).

Therefore, in Enugu State Primary Health Care (PHC) where the research was carried out, the activities that was conducted is to know the Knowledge of the Cause and Prevention of Anaemia in Pregnancy among Pregnant Mothers.

1.3 Statement of the Problem

Investigation revealed that in Nigeria, the prevalence of anaemia among pregnant women is 55.1%. If the prevalence of anaemia among pregnant women is 40.0% or more, it is considered as a severe public health problem (McLean et al., 2008). Anaemia is a major cause of morbidity and mortality in pregnant women and increases the risks of foetal, neonatal and overall infant mortality (Akhtar and Hassan, 2012). In 2013, an estimated 289,000 women died worldwide. Developing countries account for 99% (286 000) of the global maternal deaths with sub- Saharan Africa region alone accounting for 62% (179 000).

About 800 women a day are still dying from complications in pregnancy and childbirth globally (WHOa, 2015). Anaemia during pregnancy contributes to 20% of all maternal deaths (WHOb, 2015). According to the KDHS 2008-09, maternal deaths increased from 414/100,000 in 2003 to 488/100,000 in 2008-09 far from meeting MDG target goals for maternal mortality. From this information it can be estimated that the high prevalence of anaemia among pregnant women in Nigeria is considered to be the main factor for maternal death.

Anaemia during pregnancy is also a major risk factor for low birth weight, preterm birth and intrauterine growth restriction (Banhidy F et al., 2011and Haggaz et al., 2010). Deficiency in folic acid during pregnancy can result in serious neural tube defect (Wolff et al., 2009), heart defects and cleft lips (Wilcox et al., 2007), limb defects, and urinary tract anomalies (Goh and Koren, 2008).

Pregnant women attending antenatal clinics in Nigeria are routinely put on iron supplementation throughout their pregnancy. However, the prevalence of anaemia among pregnant women is still high. Moreover the available data concerning prevalence and specific ethologic factors of anaemia during pregnancy in Nigeria are limited.

1.4 Aim and Objectives of the Study

The aim of the study is to determine the Knowledge of the Cause and Prevention of Anaemia in Pregnancy among Pregnant Mothers using Enugu State Primary Health Care as a case study. In achieving this aim, the following objectives were laid out as follows:

1. To identify factors associated with anaemia among pregnant women attending antenatal clinic during the second and third trimesters,
2. To examine the effect of Anaemia on Pregnant women during Antenatal Care Service,
3. To investigate the causes of anaemia among pregnant women attending Enugu State Primary Health Care Service, and
4. To determine the prevalence of anaemia among pregnant women attending antenatal clinic during the second and third trimesters at Enugu State Primary Health Care Service.

1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• Are the factors associated with anaemia among pregnant women attending antenatal clinic during the second and third trimesters?
• Does an Antenatal Care visit provide opportunities to promote lasting health about anaemia, offering benefits that continue beyond the pregnancy period?
• What are the effects of Anaemia on Pregnant women during Antenatal Care Service?
• What are the causes of anaemia among pregnant women attending Enugu State Primary Health Care Service?
• What is the prevalence of anaemia among pregnant women attending antenatal clinic during the second and third trimesters at Enugu State Primary Health Care Service?

1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: There are no significant factors associated with anaemia among pregnant women attending ANC during the second and third trimesters at Enugu State PHC.
• H1: There are significant factors associated with anaemia among pregnant women attending ANC during the second and third trimesters at Enugu State PHC.

1.7 Significance of Study

This study is significant because it will help the women in debunking their various belief and taboo about the procedure which has been one of the reasons why they have been levistant to approve of it so that the rate of maternal and fetal mortality will be reduced to the bearest minimum.

This study will be of immense benefit to other researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study contributes to knowledge and could serve as a guide for other study.

1.8 Scope of Study

The study focuses on the Knowledge of the Cause and Prevention of Anaemia in Pregnancy among Pregnant Mothers in Enugu State Primary Health Care (PHC) Service.

1.9 Limitations of the Study

During the course of this study, many things militated against its completion, some of which are:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Establishment Policies: Establishment policies posed a serious limitation as most staffs are not ready to release information needed for this project work. There were lots of information needed from the staffs of this establishment to enhance the study which took them time to release or they did not release at all for security purposes, hence the scope was reduced.
3. Research material: availability of research material is a major setback to the scope of the study.
4. Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
5. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

1.10 Operational Definition of Terms

Anaesthesia: The state in which one is unable to feel anything especially pain by injecting drug into the body.

Attitude: The way one behaves towards somebody or something that shows how you think or feel.

Knowledge: To have information about something because you have experience or because you have learned it or be told.

Macrosomia: Large babies weighing more than 40kg at birth especially in diabetic mothers.

Mortality: The number of death in a particular situation or period of time.

Perception: To notice something in a particular way or hold a view about something.