SOCIO DEMOGRAPHIC OF PREGNANT WOMEN AS CORRELATES OF ANAEMIA IN PREGNANCY AT BOOKING IN SELECTED HEALTH CARE CENTRES

SOCIO DEMOGRAPHIC OF PREGNANT WOMEN AS CORRELATES OF ANAEMIA IN PREGNANCY AT BOOKING IN SELECTED HEALTH CARE CENTRES

TABLE OF CONTENTS

ABSTRACT

CHAPTER ONE

INTRODUCTION

Background of the Study

Statement of Problem

Purpose of the Study

Objectives of the Study

Research Questions

Research Hypothesis

Scope of the Study

Significance of the Study

Operational Definition of Terms

CHAPTER TWO: LITERATURE REVIEW

Conceptual review

Pregnancy

Anaemia

Causes of Anaemia in Pregnancy

Symptoms of Anaemia during Pregnancy

The Consequences of Anaemia

Prevention and management of anaemia in pregnancy

Empirical Review

Theoretical framework

Summary of Literature

CHAPTER THREE: RESEARCH METHODOLOGY

Research Design

Area of Study

Study Population

Sample Size Determination

Inclusion Criteria

Instrument for Data Collection

Validity of the Instruments:

Reliability of the Instruments

Ethical Consideration

Procedure for Data Collection

Method of Data Analysis

CHAPTER FOUR: PRESENTATION OF RESULTS

Test of hypotheses

CHAPTER FIVE: DISCUSSIONS OF FINDINGS

Discussion of Major Findings

Summary of study

Conclusion

Recommendations

References

CHAPTER ONE

INTRODUCTION

1.1          Background to the Study

Anaemia is a global public health problem affecting both developing and developedCountries with major negative consequences on human health, social and economic development, (Oyedeji, 2012).

Anaemia occurs at all stages of life cycle but is more prevalent, more devastating and debilitating in pregnancy and young children. It occurs when the concentration of haemoglobin falls below what is normal; The cut off figure ranges from 110 g/L for pregnant women and children 6 months–5 years of age, to 120 g/L for non-pregnant women, to 130 g/L for men.

Haemoglobin concentration varies with a person’s age, gender and environmental factors resulting in the reduction of oxygen carrying capacity of the blood haemoglobin. Anaemia in pregnancy is a serious public health problem worldwide (WHO 2011).

SOCIO DEMOGRAPHIC OF PREGNANT WOMEN AS CORRELATES OF ANAEMIA IN PREGNANCY AT BOOKING IN SELECTED HEALTH CARE CENTRES

It is estimated that more than half of pregnant women in developing countries have a haemoglobin level indicative of anaemia (< 110g/L or PVC < 33%). Women often become anaemic during pregnancy because the demand for iron and other vitamins is increased due to physiological burden of pregnancy. (Okoh, Iyalla, Omunakwe, et al2016).

Anaemia is defined as a low blood haemoglobin concentration, has been shown to be a public health problem that affects low, middle and high-income countries and has significant adverse health consequences, as well as adverse impacts on social and economic development (Stevens, Finucane, De-Regil, Paciorek , Flaxman, Branca et al,2013).

Although the most reliable indicator of anaemia at the population level is blood haemoglobin concentration, measurements of this concentration alone do not determine the cause of anaemia.

Anaemia may result from a number of causes, with the most significant contributor being iron deficiency. It has been further estimated that 90,000 deaths in both sexes and all age groups are due to iron deficiency anaemia alone (WHO 2014)

Approximately 50% of cases of anaemia are considered to be due to iron deficiency, but the proportion probably varies among population groups and in different areas, according to the local conditions. Other causes of anaemia include other micronutrient deficiencies (e.g. folate, riboflavin, vitamins A and B12), acute and chronic infections (e.g. malaria, cancer, tuberculosis and HIV), and inherited or acquired disorders that affect haemoglobin synthesis, red blood cell production or red blood cell survival (e.g. haemoglobinopathies) (Balarajan, Ramakrishnan , Ozaltin , Shankar , Subramanian,2011).

Anaemia resulting from iron deficiency adversely affects cognitive and motor development, causes fatigue and low productivity (Stoltztus, 2004) and, when it occurs in pregnancy, may be associated with low birth weight and increased risk of maternal and perinatal mortality (Kozuki, 2012).

During pregnancy, growth of the foetus, the placenta and the larger volume of circulating blood in the expectant mother, lead to an increase in the demand for nutrients especially iron and folic acid (Lutter et al 2011).

The majority of women in the developing countries start pregnancy with depleted body stores of these nutrients and this means that their extra requirement is even higher than usual (Piel, Patil, Howes & Ngangiri, 2010). Anaemia in pregnancy may be relative or absolute. (Bukar, Audu, Sadauki, Elnafaty, Mairig,2009).

Relative anaemia is a normal physiological phenomenon that occurs in pregnancy due to larger increase in plasma volume (approximately 45.0% in singleton and 50.0–60.0% in twin gestation) than in red cell mass, resulting in the well-known physiological anaemia of pregnancy.

Absolute anaemia involves a true decrease in red cell mass, involving increased red cell destruction as in haemoglobinopathy, malaria, and bacterial infection like urinary tract infection; increased red cell loss as in bleeding; or decreased red cell production as in nutritional deficiency or chronic disease (Goelhoed, 2006).

Infection with hookworm and intestinal helminths causes gastrointestinal blood loss resulting in depletion of the iron stores and consequently impaired erythropoiesis. They also lead to mal-absorption and inhibition of appetite, thereby worsening micronutrients deficiency and maternal anaemia. Predisposing factors include young age, grand multiparity, low socioeconomic status, illiteracy, ignorance, and short inter – pregnancy intervals (Okwu, Ukoha 2008)

In developing regions, maternal and neonatal mortality were responsible for 3.0 million deaths in 2013 and were important contributors to global mortality (UNICEF, 2013). Anaemia has a significant impact on the health of the foetus as well as that of the mother. (Ehiabor, 2013).Twenty per cent (20%) of maternal deaths in Africa have been attributed to anaemia.

Poor pregnancy outcomes results such as increased rates of maternal and perinatal mortality, for foetus; premature delivery, low birth weight, low Apgar scores, foetal physical growth and mental impairment and infant deaths due to impairment of oxygen delivery to the placenta and foetus (Lamina 2003). For mothers; anaemia may worsen the squeal of postpartum haemorrhage and predispose to puerperal infection both of which are leading causes of maternal mortality in developing countries (Broek, 2000).

1.2          Statement of Problem

The prevalence of anaemia in pregnancy in developing countries has remained persistently high, as indicated by the global prevalence of anaemia analysis report by the WHO in 2015.

Anaemia resulting from iron deficiency adversely affects cognitive and motor development, causes fatigue and low productivity (Balaraja, Ramakrishnan, Ozaltin, Shankar, Subramanian, 2011) and, when it occurs in pregnancy, may be associated with low birth weight and increased risk of maternal and perinatal mortality (Kozuki, Lee, Katz,2012).

In developing regions, maternal and neonatal mortality were responsible for 3.0 million deaths in 2013 and are important contributors to overall global mortality (UNICEF, WHO, 2014).

According to the WHO classification, any prevalence level of anaemia that exceeds forty per cent (< 40%) in any population group is an indicator of a severe public health problem, for which Nigeria qualifies at fifty eight per cent (58%) prevalence of anaemia in pregnancy (WHO,2015).

The WHO in 2015 clearly states that; any strategy implemented to prevent or treat anaemia should be tailored to local conditions, taking into account the specific aetiology and prevalence of anaemia in a given setting and population group.

1.3          Objectives of the Study

The specific objectives of this study are to;

1. To determine prevalence and severity of anaemia in pregnancy of mothers who booked in the health centre, Warri , Delta state.
2. assess mother’s parity as a correlate to anaemia in pregnancy in the study population
3. determine the correlation between mothers educational level and anaemia in pregnancy.
4. examine the correlation between the anaemia in pregnancy and gestational age at booking of mother in the health centres in Warri south, Delta state.

1.4          Research Questions

1. what is the prevalence of anaemia in pregnancy among mothers who booked at the health centres. Warri- south, Delta state?
2. What is the correlation between mothers parity and anaemia in pregnancy
3. What is the correlation between mothers educational status and anaemia in pregnancy.
4. What is the relationship between anaemia in pregnancy and the gestational age of mothers at booking in the study population

1.5          Research Hypotheses

The following research hypothesis is formulated to guide the study:

1. There is no significant relationship between anaemia in pregnancy and inter-pregnancy spacing of mothers who booked at the health centres, Warri south local government area of delta state.
2. There is no significant relationship between theanaemia in pregnancy and maternal age in the study population.

1.6          Scope of the Study

The study covers all pregnant women at first antenatal visit (booking) in the health centres, Warri, Delta state, south-south Nigeria. From January 2015 to December 2016.

The study covers, prevalence and severity of anaemia in pregnancy and correlations of anaemia in pregnancy to socio demographic factors like marital status, mothers educational status, mothers occupation, husband’s occupation inter pregnancy interval, maternal age and gestational age at booking.

1.6          Significance of the Study

The findings are intended to add to the baseline information on the prevalence of anaemia in pregnancy in central hospital Warri, Delta state. This finding will serve as a guide, to the state ministry of health, international organizations, non – governmental organizations and relevant stakeholders in planning, designing, implementing and evaluating health programme for prenatal women.

The social and economic factors such as; maternal age, educational statues, occupational status and parity as correlates to anaemia in pregnancy will give insight to the government, national primary health care development agency (NPHCDA) and the community health nurse in proper channelling of health promotion strategies to meet the socio demographic needs of the mothers in prevention and management of anaemia in pregnancy.

This will serve as a guide for organizing health promotion programmes and awareness campaigns to help enlighten mothers on adequate nutritional requirements especially before and during pregnancy to prevent anaemia and its adverse effect.

Conclusions

Based on the findings of the study, it is concluded that the prevalence of anaemia in pregnancy at booking in the health centres in Warri; Delta state is still unacceptably high considering the consequences and despite interventions on the ground to reduce prevalence. The high rate as is related to period to which the women booked for antenatal care, the parity, educational status as well as gestational age.

In the area it was identified that socio- demographic factors such as age and level of formal education have an impact on many medical conditions.

Armed by the findings of the study, I recommend that interventions such as mass media campaigns peer /outreach education and life skill programmes be introduced to educate women on causes and consequences of anaemia in pregnancy, the advantages of early ANC booking and compliance with the use of prescribed medication.

So, getting women to be more proactive in preventing or treating anaemia may be more effective.

It therefore becomes a clarion call on health care professional to aggressively educate the citizens on issues of anaemia in pregnancy.

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