CHAPTER ONE

                                                    INTRODUCTION

Background Information

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).

 Problem Statement

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.

Hypothesis

HO: There are no factors associated with anaemia among pregnant women attending ANC during the second and third trimesters at UTUH cottage hospital

H1: There are factors associated with anaemia among pregnant women attending ANC during the second and third trimesters at UTUH cottage hospital

Research Questions

1.What is the prevalence of anaemia among pregnant women attending antenatal clinic during the second and third trimesters at UTUH cottage hospital?

2.What are the factors associated with anaemia among pregnant women attending antenatal clinic during the second and third trimesters at UTUH cottage hospital?

3.What are the causes of anaemia among pregnant women attending antenatal clinic during the second and third trimesters at UTUH cottage hospital

Objectives

Broad objective

To determine prevalence and factors associated with anaemia among pregnant women attending antenatal clinic during the second and third trimesters at UTUH cottage hospital, Nairobi.

Specific objectives

To determine the prevalence of anaemia among pregnant women attending antenatal clinic during the second and third trimesters at UTUH cottage hospital

To identify factors associated with anaemia among pregnant women attending antenatal clinic during the second and third trimesters at UTUH cottage hospital