Knowledge of the Cause and Prevention of Anaemia in Pregnancy Among Pregnant Mothers
CHAPTER ONE
Objectives of study
- To determine the knowledge on anaemia amongst women attending ANC at UTUH.
- To estimate the Hb (PCV) level among the pregnant women attending ANC at UTUH.
- To determine the factors that predispose to anaemia in pregnancy amongst pregnant women attending ANC at UTUH.
CHAPTER TWO
LITERATURE REVIEW
Conceptual Framework
The word anaemia connotes a deficiency in the number of red blood cells or in their haemoglobin content, which can lead to a decrease in oxygen-carrying capacity of the blood, causing unusual tiredness resulting in pallor, shortness of breath, and lack of energy. Anaemia may be relative or absolute. Relative anaemia is that which occur in pregnancy. Absolute anaemia involves a true decrease in red cell mass. The cells are manufactured in the bone marrow and have a life expectation of approximately four months (120 days). To produce red blood cells, the body needs (among other things) iron, vitamin B12 and folic acid. If there is a lack of one or more of these ingredients, anaemia will develop.
Red blood cells are the cells that circulate in the blood plasma giving the blood its red colour. Through its pumping action, the heart propels blood around the body through arteries. The red blood cells obtain oxygen in the lungs and carry it to all the cells of the body. The cells use the oxygen to fuel combustion of sugar and fats, which produces the body‟s energy. During this process called oxidation, carbon dioxide is created as a waste product. It binds itself to the red blood cells that have delivered their load of oxygen. The carbon dioxide is then transported via the blood in the veins back to the lungs where it is exchanged for fresh oxygen by breathing.
The World Health Organization (WHO) recommendation is that anaemia in pregnancy is present when the value of the total circulating haemoglobin (Hb) mass in the peripheral blood is 11g/dl (PCV 33%) or less, however, in developing nations it is generally accepted that anaemia exists when the Hb concentration is less than10g/dl or packed cell volume (PCV) is less than 30% Anaemia ranges from mild, moderate to severe and the WHO pegs the haemoglobin level for each of these degree of anaemia in pregnancy at 9.0-10.9g/dl as mild anaemia; 7-8.9g/dl as moderate anaemia and <7.0g/dl as severe anaemia.
Epidemiology
Each year more than 500,000 women die from pregnancy-related causes, 99% of these are from developing countries. Estimates of maternal mortality resulting from anaemia range from 34/100,000 live births in Kenya to as high as 194/100,000 in Pakistan. In combination with obstetric haemorrhage, anaemia is estimated to be responsible for 17 – 46% of cases of maternal death. The incidence of anaemia in pregnancy would vary from place to place even within the same country depending on the socio-economic status and level of development. It is claimed that 5 –50% of pregnant women in the tropics who attend antenatal clinics are anaemic as against the cause rate of 2% in the developed world.
It has been estimated that over half the pregnant women in the world have a haemoglobin level indicative of anaemia. In industrialized countries, anaemia in pregnancy occurs in less than 20% of women. This however, reaches the level of public health significance (>10%). Published rates for developing countries range from 35% to 72% for Africa, 37% to 75% for Asia and 37% to 52% for Latin America. A retrospective study of normal pregnant women who registered with the antenatal unit of the University of Kenya Teaching Hospital (UNTH) Nairobi between January 1, 2005 and October 30, 2005 showed that 40.4% of the study population wasanaemic (Hb< 11g) at booking. The cause of anaemia at booking increased significantly with increasing gestational age at booking.25Another study carried out, North-eastern Kenya showed a cause of anaemia in pregnancy of 51.8%. The majority of these patients 67.4% were mildly anaemic; 30.5% were moderately anaemic; while only 2.1% had severe anaemia.
CHAPTER THREE
RESEARCH METHODOLOGY
Study Design
This is a cross-sectional descriptive study which assesses cause and prevention of anaemia in pregnant women attending ANC in UTUH in Nairobi.
Study Population
All pregnant women registered for antenatal care at the Medical Centre within the study period in UTUH served as the study population.
Inclusion criteria
All singleton pregnant women between the ages of 15-49 years, who registered for Ante Natal Care at Cottage Hospital and did not have any complications in pregnancy during the time of study.
Exclusion criteria
Pregnant women with multiple pregnancy, chronic medical conditions such as sickle cell anaemia, HIV positive with complications in pregnancy, pregnant women with history of bleeding in the current pregnancy and pregnant women who did not give consent.
CHAPTER FOUR
DATA ANALYSIS AND RESULT PRESENTATION
Socio-Demographic Characteristics Of The Respondents
A total of 406 respondents participated in the study. Majority of the women 274(67.4%) were in the age range of 20-29 years while those that were ≥ 40years old were the least (0.3%). The mean age of the respondents was 26.8years. Majority of the respondents 403 (99.3%) were married, while 3(0.7%) were not married.
Most of the respondents 396(97.6%) had formal education, other forms of education which included Islamic and Quranic education accounted for only 0.2%.
CHAPTER FIVE
CONCLUSION AND RECOMMENDATIONS
Conclusion
The cause 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 Kenya. 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.
Highest cause of Anaemia (61.1%) was observed among the women in the age group 15-19years, followed by 20–30 years age group (56.3%) compared to the other age groups. In line with this, it can be concluded that cause of anaemia reduces significantly with increasing age of the woman at first pregnancy (“pregnancy too early”).
Additional finding shows a strong correlation between parity and cause of anaemia, that the higher the parity, the greater the cause of anaemia (“pregnancy too many”).
Cause of anaemia was higher among women who booked for ante-natal after the first trimester.
There are many ways to prevent anaemia, these include; taking iron supplements, taking food high of folic acid etc.
Recommendations
In order to reduce the high Maternal and perinatal morbidity and mortality from anaemia seen in Kenya, certain measures should be put in place by the government:
- Public enlightenment campaigns should be embarked upon to sensitize the public on what anaemia is, its causes, risk factors and
- 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
- Strategies should 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
- Education of the girl-child should be made compulsory to avoid teenage and unplanned pregnancy. This can also help in delaying first
- Distribution of iron tablets in communities targeted at adolescent girls and women after marriage and before conception, as well as in the inter-pregnancy period will prevent iron deficiency at the onset of a
References
- Viteri, F.E. The consequences of iron deficiency and anaemia in pregnancy. In: Nutrient Regulation During Pregnancy, Lactation and Infant Growth. Alien, J. King and B. Lonnerdal. Eds. Plenum Press, New York, (1994). 121-133. http:/www.unsystem.org/scn/archieves/scnn.news.ii/cho7.htm.Accessed 17/1/2010
- Hughes, A. Anaemia in pregnancy, Maternal health and Safe Motherhood (1991)http://www.Unsystem.org/scn/archives/scnnews.ii/cho7.htm. Accessed17/1/2010
- Viteri, F.E. Iron, Global Perspective. In: Ending Hidden Hunger: A Policy Conference on Micronutrient Malnutrition, Atlanta Georgia (1992). http://www.unsystem.org/scn/archives/scnnews.ii/cho7.htm. Accessed 17/1/2010
- WHO National strategies for overcoming micronutrient Document EB 89/27. Executive Board, (1991). 89th session.
