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ANAEMIA IN PREGNANCY_A CASE STUDY OF
ATTENDEES AT ANTE-NATAL CLINIC IN ALIMOSHO AREA OF LAGOS
CHAPTER ONE
INTRODUCTION
1.0
Background
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.1,2
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.3
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.3
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.4
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.
1.1 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.5,6
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.8,9
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.9
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.10This 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).11
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.11
1.2
Significance of 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.13
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.15,16
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.16 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.
1.3 Research
Questions
What is the prevalence of Anaemia among
among pregnant women attending ANC in Alimosho, Lagos State?
What is the relationship between Anaemia and
various demographic variables?
What is the knowledge of anaemia among
pregnant women attending ANC in
Alimosho
General Hospital, Lagos State?
1.4 Aims and Objectives
1.4.1
General Objective
To assess
the prevalence of anaemia in pregnancy amongst pregnant women attending ANC
atAlimosho General Hospital, Alimosho, Lagos State.
1.4.2 Specific Objectives
To determine the knowledge on anaemia
amongst women attending ANC at
Alimosho General
Hospital, Alimosho, Lagos State.
To estimate the Hb (PCV) level among the
pregnant women attending ANC at
Alimosho
General Hospital, Alimosho, Lagos State.
To determine the factors that predispose to
anaemia in pregnancy amongst pregnant
women
attending ANC at Alimosho General Hospital, Alimosho, Lagos State.
1.5 Scope of
the Study
This study
was limited to pregnant women attending ANC at Alimosho General Hospital,
Alimosho, Lagos state.
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