CHAPTER ONE

INTRODUCTION

1.1       Background to the study

Anemia is defined as the condition in which there is decreased level of hemoglobin (Hb) or red blood cells than the normal value (Eltayeb et al., 2014). According to the 2008 World Health Organization (WHO) report, anemia affected 1.62 billion (24.8%) people globally (WHO, 2008). The risk of anemia is high in women who are premenopausal and/or pregnant. This is mainly due to menstrual blood loss, increased demand to support the fetus, puerperal blood loss, and it is usually exacerbated by nutritional insufficiency that is common in developing countries (Bick et al., 2016).

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, 2018). The reduction in hemoglobin is often accompanied by a decrease in the number of red blood cells and hematocrit (PCV, hematocrit) (WHO, 2016). 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 et al., 2019).

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 et al., 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, 2019). Components About 90% of all anemia types have iron deficiency. In developing countries, almost half of the population suffers from iron deficiency (Viteri, 2019). 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, 2016).

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, 2019). 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, 2019).

 

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, 2019). 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, 2019). 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, 2019). 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, 2019). It is therefore imperative to study not just the prevalence of this concept, but the management and control measures, hence, this study on the evaluation of the level of awareness of the dangers associated with anemia in pregnancy: a case study of Ilaro community, Ogun state.

 

1.3       Objectives of the study

The general objective of this is to evaluate the level of awareness of the dangers associated with anemia in pregnancy: a case study of Ilaro. Specifically, the study seeks to;

1. Determine the level of awareness of anemia in pregnancy amongst pregnant women attending antenatal care in Ilaro community.
2. Assess the strategies used by the pregnant women for the prevention and management of anemia in Ilaro community
3. Determine the challenges encountered in the management of Anemia among pregnant women in Ilaro community

 

1.4       Research questions

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

1. What is the level of awareness of anemia in pregnancy amongst pregnant women attending antenatal care in Ilaro community?
2. What are the strategies used by the pregnant women for the prevention and management of anemia in Ilaro community?
3. What are the challenges encountered in the management of Anemia among pregnant women in Ilaro community?

 

1.5       Significance of the study

Findings from the study would generate data on how pregnant women in Ilaro community seek routine healthcare during pregnancy for management of anemia, 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 anemia, should they arise.