ABSTRACT

Worldwide it is estimated that about half of all pregnant women are anaemic. In Cameroon, the incidence of pregnant women with anaemia has increased and this accounts for about 20% of maternal mortality. This study therefore sought to investigate the knowledge and perception of the risk of anaemia during pregnancy and adherence to iron supplements among pregnant women in Ibesikpo Asutan. A descriptive cross-sectional study was carried out among 384 pregnant women in Ibesikpo Asutan aged between 19 to 50 years to determine their knowledge and perceptions of the risk of anaemia in pregnancy as well as their level of adherence to iron preparations. Data were analysed using STATA version 13. Socio-demographic characteristics of the respondents were presented in tables and associations between independent variables such as age, marital status and occupation and the dependent variable knowledge of risk of anaemia were examined. A total of 384 pregnant women were interviewed. The study showed that 78% (301) had knowledge of risk of anaemia. Among the respondents who knew about the risk of anaemia in pregnancy, the majority (43%) were aged 21-30 years and about 43% (162) of them were married. The majority (90%) held positive perceptions about the condition and indicated that taking iron supplements was a measure to reduce the risk of anaemia in pregnancy. The level of adherence to iron supplements was found to be high (90%). There were statistically significant associations between age and knowledge of risk of anaemia (p=0.001) and educational level and knowledge of risk of anaemia (p=0.001). The study reports a high level of awareness of risk of anaemia in pregnancy, positive perceptions about anaemia and high adherence to iron supplementation.

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Pregnancy is almost certainly the greatest physiological stress and the most common major change of the normal biological process to which the woman is subjected during her life. Anemia is the most common nutritional problem among women and is on the whole rampant among pregnant women (Admad, Saeid, & Leila, 2008). However, anaemia is defined as a shortened amount of haemoglobin (Hb) in the blood. It is a shortage in the size or number of red blood cells (RBCs) or the quantity of Hb they contain (Mahan, Escott-Stump & Raymond 2012). Haemoglobin is a substance in the blood that carries oxygen from the lungs to all parts of the body. The most common type of anaemia, iron deficiency anaemia, is more often than not caused by low iron intake or absorption and/or excessive iron loss (Thomas & Bishop, 2007).

Iron forms an indispensableconstituent of the Hb molecule and nutritional anaemiafallout fromnot enough intake of iron, protein, vitamin B12, folic acid, pyridoxine, ascorbic acid, and copper(Mahan, Escott-Stump & Raymond, 2012).Anaemia is classified based on Hb content as hypochromic (pale colour from deficiency of Hb) and normochromic (normal colour),depicted according to cell size as macrocytic (larger than normal), normocytic (normal), and microcytic (small).Haemoglobin levels differ with age, sex, pregnancy, and lifestyle. Different levels of Hb are considered typically for different categories of people, under which an individual can be classified as anaemic. For example, the normal Hb level of pregnant women at sea level is 11g/dl or 110g/L. A pregnant woman that hasHb level below 11g/dl or 110g/L is said to be anaemic (WHO, 2008).

According to Ghana Health Service (2004), pregnant woman with anaemia will present with any of the following: angular stomatitis, pallor, glossitis spoon shaped nails, dizziness, fatigue and shortness of breath.Reducing this anaemia burden in pregnant women has improved minimally, especially in African countries and Nigeria is no exemption.The episode of anemia as a major public health problem all over the world isextensively recognized. In developing countries, the occurrence of anemia among pregnant women the averages is 56%, ranging between 35-100% among different regions of the world (GHS Annual Report 2004).

World Health Organization in 2008 estimation, approximately 500 million women in the world are iron deficient and in addition anemia affects so many women in the developing world, including two thirds of pregnant women (WHO, 2008).Anaemia is asignificant public health problem worldwide and the most susceptible group, are pregnant women and children.The causes of anaemiaconsist of genetic factors, nutritional deficiencies, and infectious agents. Of the nutritional causes of anaemia, iron deficiency is perhaps the most common and important because the physiological changes associated with pregnancy put fortha demand for additional iron needed for transfer to the foetus(Webster-Gandy, Madden&Holdsworth, 2012). Infections, together with malaria, worm infestations are as well involved in the pathogenesis of anaemia in pregnancy.

Pregnant women are on the wholevulnerable to malaria in endemic populations and often have higher prevalence as well as severity including anaemia (Amenger-Glover, Owusu&Akanmori, 2005). The changes in the immune system linkedwith pregnancy have been postulated as the reason mentioned above. Worm infestations however impair micronutrient absorption;consequently increasing the susceptibility of pregnant women to anaemia. The materialization of HIV is an additional risk factor for anaemia among pregnant women. A good number of studies aimed at identifying the causes ofanaemia in pregnancy have concentrated on specific categories of factors such as excessive blood loss and excessive breakdown of erythrocytes (Amenger-Glover, Owusu&Akanmori, 2005).Globally, anemia contributes to 20% of all maternal deaths. Although not always shown to have a causal link, severe anemia contributes to maternal morbidity and mortality. Anemia in pregnancy may moreover lead to premature births, low birth weight, fetal impairment and infant deaths. Besides, maternity-related complications, anemia has major consequences on human health and social and economic development. It adversely affects physical and cognitive development in children and is associated with increased frailty risk in community-dwelling older adults (WHO, 2008).

In recent times, increased risk of psychiatric disorders among children and adolescents with iron deficiency anemia has also been documented. Anaemiaarrays from mild, moderate to severe and WHOhangers the haemoglobin level for each of these types of anaemia in pregnancy at 10.0 – 10.9g/d1 (mild anaemia) 7 – 9.9g/dl (moderate anemia) and < 7g/dl (severe anaemia).Commonness of anaemia can be as high as 61% in developing countries; 14 with a high incidence and severity occurring among primigravidaeliving in malaria endemic areas. In pregnancy, anaemia has animportant impact on the health of the foetus as well as that of the mother. Twenty percent (20%) of maternal deaths in Africa have been attributed to anaemiaand over half of all women in the world experience anemia during their pregnancies.Foetuses are susceptible of preterm deliveries, low birth weights, morbidity and perinatal mortality due to the impairment of oxygen delivery to placenta and foetus(Amenger-Glover et al, 2005).

In Sub-Saharan Africa, the causes of anemia during pregnancy are multifactorial. These consist of an iron and folate deficient diet and infections such as malaria, hookworms, and increasingly human immunodeficiency virus. Most of these conditions can be prevented by creating awareness and providing affordable interventions.Determination of the magnitude of anemia among pregnant women helps to monitor health of the pregnant women, contributing to reduction in maternal morbidity and mortality. Also, assessment of factors predisposing to anemia in a local area enables to take targeted intervention activities. The management and control of anaemia in pregnancy is improved by the availability of local prevalence statistics, which is conversely not adequately provided in Cameroon. For that reason, this study aims at providing occurrence statistics of anaemia in pregnancy and to evaluate the effectiveness of antenatal care and awareness level in preventing anaemia among pregnant women in IbesikpoAsutan. Knowledge of the relative importance of the diverse etiological factors forms the basis for intervention strategies to control anemia. Therefore, this study also aimed at determining anemia and assessing associated risk factors among pregnant women attending antenatal care (ANC).