THE INCIDENCE OF ANEMIA AMONG PREGNANT WOMEN IN RUMUEME L.G.A IN THE PORT HARCOURT METROPOLIS

CHAPTER ONE

INTRODUCTION

• Background to the Study

Anemia describes a situation in which there is a reduction of haemoglobin concentration in the blood of pregnant women to a level below 11g/dl. Anemia 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, Anemia 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 Anemia burden is assumed to be due to iron deficiency. Iron deficiency Anemia (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 Anemia 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 Anemia estimated to be 17.2 million among pregnant women. This constitutes to approximately 30% of total global cases (WHO, 2008).

In Kenya the prevalence of Anemia among pregnant women is 55.1% and among nonpregnant women is 46.4% (Ministry of Health, 2013). Anemia 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 Anemia among pregnant women is 40.0% or more, it is considered as a severe public health problem (McLean et al., 2008).

Anemia during pregnancy has a variety of causes and contributing factors. Iron deficiency is the cause of 75% of Anemia cases during pregnancy (Balarajan et al., 2011; Haidar, 2010). Infectious diseases such as malaria, helminthes infestations and HIV are implicated with high prevalence of Anemia 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 Anemia during pregnancy (Noronha et al., 2010). Socio-economic conditions, abnormal demands like multiple pregnancies, teenage pregnancies, maternal illiteracy, unemployment/underemployment, short pregnancy intervals, 2 age of gestation, primigravida and multigravida (Haniff et al., 2007; Noronha et al., 2010), smoking, excessive alcohol consumption, are the main contributing factors of Anemia during pregnancy (Moosa & Zein, 2011; Esmat et al. 2010).

Anemia 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).

Anemia contributes to 20% of all maternal deaths (WHOb, 2015). Anemia in pregnancy causes low birth weight (Banhidy et al., 2011), fetal impairment and infant deaths (Kalaivani, 2009). Iron deficiency Anemia 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).

Iron and folate requirements increase during pregnancy, therefore, the likelihood of developing iron and folate deficiency is high if there is no supplementation during pregnancy (Marti-Carvaja et al., 2002). It is therefore recommended that all pregnant women should start taking iron and folic acid supplementation as early as possible to avoid the complications of iron and folic acid deficiency during pregnancy. Supplementation with folic acid has also been shown to reduce the risk of congenital heart defects, cleft lips, limb defects, and urinary tract anomalies (Wilcox, et al., 2007 & Goh and Koren, 2008). IFAS is a major strategy to reduce iron deficiency Anemia in pregnancy as well as risk of congenital malformations on the newborn.

Iron has several vital functions in the body. It serves as a carrier of oxygen in red blood cells from the lungs to the tissues, as a transport medium for electrons within cells, and as an integrated part of important enzyme systems in various tissues. Folic acid, a B vitamin (B9), plays a vital role in the development of neural tube in the growing embryo, in the production of red blood cells, synthesis of DNA, repair of DNA, and it acts as a cofactor in certain biological reactions (Weinstein et al., 2013). It is especially important in aiding rapid cell division and growth, such as in infancy and pregnancy. Birth defects occur within the first 3-4 weeks of 3 pregnancy, usually before a woman even knows she’s pregnant. So it’s important to have folic acid in the system during those early stages when the baby’s brain and spinal cord are developing (Folate: Dietary Supplement Fact Sheet, 2013).

• Statement Of Problem

Anemia in pregnancy accounts for one fifth of maternal deaths worldwide and is a major factor responsible for low birth weight. In some parts of the world, over 16% of maternal deaths are attributed to anemia. The association between anemia and adverse pregnancy outcome, higher incidence of preterm and low-birth weight deliveries have been demonstrated. However, high prevalence of anemia among pregnant women persists in Nigeria despite the availability of effective, low-cost interventions for prevention and treatment. Knowledge of the sociodemographic factors associated with anemia will help to formulate multipronged strategies to attack this important public health problem in pregnancy. More importantly, knowledge of the measure of probability of occurrence of Anemia in a population within a specified period of time will emphasize the nature of the problem and the need for quick interventions.

• Research Questions

To effectively study the incidence of Anemia with relation to the given study population in question, the following questions are designed to guide the researcher;

1. What are the predisposing factors to anemia during pregnancy?
2. What is the incidence proportion of Anemia among pregnant women in selected study areas in Port Harcourt?
   • Research objectives

This research is broadly designed to study the incidence of Anemia among pregnant women in Rumueme L.G.A in the Port Harcourt metropolis.

Specific Objectives

To study the incidence of Anemia among pregnant women in the selected study area, this study will specifically touch the following areas;

1. Identification of women at risk of developing gestational Anemia
2. Identification of the incidence rate of gestational Anemia in the study area
3. Recommend therapeutic and preventive measures against Anemia in pregnancy
   • Scope Of Study

Contextually, this study is designed to investigate gestational Anemia, its causes, and implications during pregnancy, prevention, treatment and other concepts under Anemia; specifically as it relates to pregnancy.

Geographically, this study will investigate on the incidence of anemia in pregnancy, studying women attending the antenatal clinics in some selected health facilities in Rumueme province of Port Harcourt.

• Significance Of Study

The findings and result of this study will have a significant impact and relevance to the following persons, groups and field;

1. Health workers: public health workers, especially those involved in the provision of antenatal care will benefit primarily from this study as it will contribute greatly to their knowledge and enhance service delivery as it relates to obstetric care.
2. General pubic: the general public, more specifically, pregnant women and those involve in giving care to them, as well as family members will benefit from findings of this study, as it will expose them to more facts and figures as it relates to pregnancy and anemia.
3. Researchers/Academicians: Since this study will contribute greatly to the already existing body of knowledge; it will serve as a reference for researchers conducting related studies, and it also will serve as a learning aid as it will enhance knowledge and learning.
   • Organization Of Study

This study will be organized into five chapters, namely; the introduction, literature review, research methods, data analysis and presentation, and the chapter five which summarizes and concludes the study.

The chapter one basically describes background facts and figures motivating the study; while detailed in chapter two is a review of literature as it concerns the study; presented in chapter is the study design, while chapter four contains the data analysis and presentation; concluding the research is the chapter five which concludes, summarizes and offer recommendations based on the study.

• Conceptualization Of Terms

Anemia: Anemia is defined as a decrease in the total amount of red blood cells (RBCS) or hemoglobin in the blood.

Incidence: This is the occurrence, rate or frequency of a disease, crime or undesirable thing. The incidence rate is the number of new cases per population at risk in a given time period.

Pregnancy: Pregnancy, also known as gestation, is the time during which one or more offspring develops inside a woman.

Hemoglobin: Hemoglobin (Hb or Hgb) is a protein in red blood cells that carries oxygen throughout the body.

Malaria: Malaria is a mosquito-borne infectious disease affecting humans and other animals caused by parasitic protozoans (a group of single-celled microorganisms) belonging to the Plasmodium type. Malaria causes symptoms that typically include fever, feeling tired, vomiting, and headaches. In severe cases it can cause yellow skin, seizures, coma, or death.

Low birth weight: Low birthweight is a term used to describe babies who are born weighing less than 2,500 grams (5 pounds, 8 ounces). In contrast, the average newborn weighs about 8 pounds.

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