ABSTRACT

Background: Anemia is one of the most serious and common nutritional deficiency disorders of public health. Anemia cases are due to iron deficiency, though the proportion varies among population groups and in different areas, according to the prevailing local conditions. Common signs and symptoms of anemia in children are dizziness, fatigue and body tension, general body weakness, loss of appetite, low body weight. This study was aimed at assessing mothers’ knowledge on anemia in children from 0-5years in Manuka. Method: A cross sectional study was carried out at Manuka community, Tiko. The targeted population were mothers of aged (15-49years) with children under the age of 5years attending infant welfare care in PMI Health center Manuka, Tiko. Data was collected using self-administered structured questionnaires, which was analyzed using Microsoft excel 2013. Results: A total of 85 respondents participated in the study. Most of the participants were in the age range 12-20year? (36.5%). Most of them 53(62.4%) knew the definition of anemia which cited that anemia is decrease of RBC, majority 27 (31.76%) stated hemolytic anemia as a type of anemia. A good number 81 (95.3%) cited that, given iron-rich foods can help prevent anemia in children. Conclusion: The study highlight that majority of the participants had adequate knowledge on anemia though to an extent. Health professionals should give more health educations during IWC visit on the prevention of anemia in children.

CHAPTER ONE

INTRODUCTION

1.1 Background

Anemia is one of the most serious and common nutritional deficiency disorders of public health concern in developing countries (R.M.L Semede et al 2014). Approximately 50% of anemia cases are due to iron deficiency, though the proportion varies among population groups and in different areas, according to the prevailing local conditions (WHO et al 2011).  Anemia is defined as a decrease in the concentration of circulating red blood cells concentration and a concomitant impaired capacity to transport oxygen (WHO et al 2011). Anemia diagnosis is classified as mild (Hb=10.0-10.9 g/dl), moderate (Hb=7.0-9.9 g/dl), severe (Hb<7.0g/dl), and normal (Hb≥11.0 g/dl) Hb level concentration for children aged 6 to 59 months (WHO et al 2011)

Inspired of anemia being preventable, it has caused a lot of morbidity and mortality in children under five years (S.P Scott et al 2011)Anemia has adverse effects on children, especially in the first two years of life, such as behavioral delay, reduced cognitive development (impaired learning and decreased school achievement), low immunity and growth weight, fatigue, difficulty with concentration, lethargy, increased mortality, and susceptibility to infection (WHO et al 2011, O. Ngesa et al 2014 and R. Ofori-asenso). Common signs and symptoms of anemia in children are dizziness, fatigue and body tension, general body weakness, loss of appetite, low body weight, paleness of the skin, eyes and palms, and under severe conditions, unconsciousness, and finally death (GOHS et al 2014).

Globally, it is estimated that 273 million (approximately 42.6%) of children under five years are anemic, whilst 60.2% of children under five years in the African region are anemic (WHO et al2014). In Kenya, a population-based cross-sectional study revealed that low iron diet intake and malaria were the main causes of anemia (O. Ngesa et al 2014). Parasitic infections (hook worm and tapeworm), acute or chronic inflammations, inherited or acquired disorders that affect Hb synthesis, red blood cell production, or red blood cell survival and nutritional deficiencies were other factors that were identified to be associated with anemia among children under five years (G. Egbi et al 2014). In a similar but unrelated study, it was established that unemployment among caretakers, malaria parasitaemia, and presence of sickle Hb were the risk factors associated with severe anemia among children under five years in Tanzania (R.H simbauranga et al 2015). Meanwhile, male sex, 9–11 months of age, poor dietary diversity, stunting, diarrhea, early initiation of complementary food, and lowest wealth quintile were the risk factors associated with anemia among children under five years in Ethiopia (H. Woldie et al 2016).

In Ghana, the prevalence of anemia (percentage of children with Hb concentration <110 g/L) among children aged 6 to 59 months was 76% in the year 2011 and was reported to be of severe public health significance (WHO et al 2011) Although the prevalence of anemia decreased, it only decreased with increase in age (GDHS et al 2014) meaning that children were still in danger of being anemic. The prevalence for anemia among children aged 6 to 59 months in the year 2014, according to Ghana Demographic and Health Survey [GDHS et al (2014) report, was 66%, with the Volta Region’s rate superseding the national prevalence rate (69.9%). As such, the Ministry of Health (MoH), Ghana, in partnership with the Ghana Health Service (GHS), and other private organizations have developed policies and interventions that are multispectral and integrated approach to help prevent anemia. These policies and programmed designed for the prevention of anemia are mostly for children, pregnant women and women in reproductive age (Ghana Health et al 2016) The targeted interventions for anemia are malaria control which includes distribution and use of Long Lasting Insecticide treated Nets (LLINs), Indoor Residual Spraying (IRS), Intermittent Preventive Treatment of Pregnant Women (IPTp), and diagnosis, and iron folic acid supplementation to pregnant women and treatment of malaria with Artemisinine-based Combination Therapy (ACT).

As a result of the high prevalence rate of anemia in children in the Volta Region, studies have been conducted among children aged less than five years in the Cohoe Municipality on the subject (M. Kweku et al 2017 and P.A. Parbey et al 2017) The previous studies used cross-sectional approach to purposively sample four rural communities in the municipality to establish associated factors of anemia among children under five years of age in the Municipality. However, our study sought to use a case-control approach sampling health facilities from all seven sub municipalities within the municipality to give a true representation of all communities on the causal-effect relationship between anemia and its risk factors among the same study group. It also determines the Hb concentration level among children aged 6 to 59 months, the association between anemia and underlying factors of anemia, the association between anemia and intermediate factors, and the association between anemia and biological risk factors of anemia. was 0.92% (R. Ofori-Asenso2016) some previous studies reported that anemia was a risk factor for lower respiratory infections (Hussain et al. 2014 and Ramakrishnan et al 2006) and subclinical infections in children (sales et al. 2011). Anemia is associated with increased morbidity and mortality in children and women, poor birth outcomes, decreased work productivity in adults, and impaired cognitive and behavioral development in children. Anemia is a serious global public health problem that particularly affects young children and pregnant women. WHO estimates that 42% of children less than 5 years of age and 40% of pregnant women worldwide are anemic.

 Anemia can cause a range of symptoms including fatigue, weakness, dizziness and drowsiness. Children and pregnant women are especially vulnerable, with an increased risk of maternal and child mortality. The prevalence of anemia remains high globally, particularly in low-income settings, where a significant proportion of young children and women of childbearing age can be assumed to be anemic. Iron deficiency anemia has also been shown to affect cognitive and physical development in children and reduce productivity in adults.

Anemia is an indicator of both poor nutrition and poor health. It is problematic on its own, but it can also impact other global nutritional concerns such as stunting and wasting, low birth weight and childhood overweight and obesity due to lack of energy to exercise. School performance in children and reduced work productivity in adult’s due

While iron deficiency anemia is the most common form and is relatively easy to treat through dietary changes, other forms of anemia require health interventions that may be less accessible. Accurate characterization of anemia is critical to understand the burden and epidemiology of this problem, for planning public health interventions, and for clinical care of people across the life course.

How ever, in Cameroon studies conducted in the centre regionindicate that several programmed across all regions reduce the prevalence of anemia through treatment and prevention. These guidelines, policies and interventions aim to increase dietary diversity, improve infant feeding practices and improve the bioavailability and intake of micronutrients through fortification or supplementation with iron, folic acid and other vitamins and mineral. Social and behavior change communication strategies are used to change nutrition-related behaviors. Interventions to address the underlying and basic causes of anemia look at issues such as disease control, water, sanitation and hygiene, reproductive health and root causes such as poverty, lack of education and gender norms.  In 2016, WHO started a five-year project to review its global guidelines for hemoglobin cut-offs used to define anemia with the aim to provide evidence-informed recommendations on assessing anemia in individuals and populations.

1.2 Problem Statement

Anemia caused by Iron deficiency is one of most wide-spread diseases in the world. Globally, it is estimated that 273 million (approximately 42.6%) of children under five years are anemic, whilst 60.2% of children under five years in the African region are anemic (WHO et al 2014). In Kenya, a population-based cross-sectional study revealed that low iron diet intake and malaria were the main causes of anemia (O. Ngesa et al 2014). Anemia can cause a range of symptoms including fatigue, weakness, dizziness and drowsiness. Children are especially vulnerable, with an increased risk of child mortality. Anemia is an indicator of both poor nutrition and poor health. It is problematic on its own, but it can also impact other global nutritional concerns such as stunting and wasting, low birth weight and childhood overweight and obesity due to lack of energy to exercise. While iron deficiency anemia is the most common form and is relatively easy to treat through dietary changes, other forms of anemia require health interventions that may be less accessible. Accurate characterization of anemia is critical to understand the burden and epidemiology of this problem, for planning public health interventions, and for clinical care of people across the life course. Thus the study seeks to investigate mother’s knowledge on anemia in children from 0-5 years in Manuka Community Tiko.

1.3 Research Questions

1. What level of knowledge do mothers have on anemia in children 0-5 years in the Manuka community Tiko?
2. What are the socio-demographic factors affecting mothers’ knowledge on anemia in children 0-5 years in the Manuka community Tiko?
3. What strategies can be put in place to prevent anemia in children 0-5 years in the Manuka community Tiko?

1.4 Rationale

The reason for this research is to help prevent anemia in children from 0-5 years in Manuka Community Tiko.

1.5 Objectives of the Study

1.5.1 General Objectives

To assess mothers’ knowledge on anemia in children 0 – 5 years in the Manuka community

1.5.2 Specific objectives

1. To assess mothers’ knowledge on anemia in children 1 – 5 years in the Manuka community.
2. To identify the socio-demographic factors affecting anemia in children from 1– 5 years in the Manuka community Tiko.
3. To identify the strategies used to prevent anemia in children 1 -5 years in the Manuka community Tiko.