1.1. BACKGROUND

Anaemia, a condition in which the number of red blood cells or the concentration of haemoglobin contained in red blood cells is lower than normal and defined by the World Health organization as haemoglobin level < 11g/dl, is estimated to affect over 40% of pregnant women globally [1]. Low- and middle-income countries are affected most with a higher prevalence of anaemia in reproductive-age women [2]. Estimates from the demographic and Health Survey of Cameroon2018 found a prevalence of anaemia of 40% amongst the reproductive age group (15-49 years) in Cameroon [3]. According to the World Health Organization (WHO) classification, this puts Cameroon into the “Severe” category of anaemia in which countries have a national prevalence of anaemia greater or equal to 40%. Anaemia in pregnancy causes several adverse maternal and fetal/neonatal outcomes. In a systematic review[3],  several poor outcomes were associated with maternal haemoglobin less than 11g/dl. Poor outcomes at delivery included low birth weight, premature delivery, stillbirth and perinatal mortality for the newborn and postpartum haemorrhage, preeclampsia and increased rate of blood transfusion and maternal mortality. Nutritional deficiencies especially iron deficiency are the main cause of anemia[1]. Other causes include folic acid and vitamin B1 deficiencies, hemoglobinopathies, and infections such as malaria and hookworms. Iron supplementation is highly recommended during pregnancy to prevent anaemia. Armed conflicts affect nutritional status and health as a whole, of women in the affected areas[4,5]. As a result of the conflict, food supply, drug supply as well as delivery of health services are limited which explains the poor health status of pregnant women. For women who are menstruating and reside in areas where anaemia prevalence is 20% or higher, the World Health Organization (WHO) suggests intermittent iron and folic acid supplementation, and daily iron and folic acid supplementation for pregnant women as part of antenatal care to prevent anaemia in pregnancy[6].Physiologically, plasma volume expands by 25–80% of pre-pregnancy volumes between the second and middle of the third trimester of pregnancy. This induces a modest decrease in Hb levels during pregnancy[7]. Anemia is a condition in which the quantity of red blood cells in the body is insufficient to meet its physiological needs, and consequently, by their capacity to supply oxygen. Age, gender, residence elevation above sea level (altitude), smoking habit, and various phases of pregnancy are all associated with varied physiological needs. The most common cause of anemia worldwide is thought to be iron deficiency. However, anemia can also result from other nutritional deficiencies (such as those related to folate, vitamin B12, and vitamin A), acute and chronic inflammation, parasitic infections, and inherited or acquired disorders that affect the synthesis of hemoglobin, the production of red blood cells, or the survival of red blood cells)[8].Reduced red blood cell count (anaemia) is typified by a reduction in haemoglobin levels or a change in the shape of red blood cells. Anaemia has a wide range of pathophysiological causes and is frequently complex. Numerous investigations have revealed a correlation between reduced cognitive performance and iron-deficiency anaemia (IDA). Impaired tissue oxygen supply can cause symptoms such as weakness, exhaustion, trouble focusing, or low work output[9].Low hemoglobin levels, or anaemia, impair cognitive and motor development and result in exhaustion and low productivity. Low levels of haemoglobin during pregnancy have been linked to low birth weight and size as well as a higher risk of maternal and neonatal death Together, maternal and neonatal deaths account for between 2.5 and 3.4 million fatalities globally and are a leading cause of mortality in poor nations. While there are some negative impacts linked to high haemoglobin concentrations, the majority occur throughout a range of low concentrations, where lower concentrations are linked to worse outcomes. Concentrations that equate to moderate-to-severe anemia may be the limit of other effects[10].

1.2. PROBLEM STATEMENT

Because it affects a large percentage of pregnant women, maternal anemia is a major global public health concern. The prevalence of maternal anaemia remains alarmingly high, particularly in low- and middle-income countries, leading to adverse health outcomes for both mothers and infants. Due to the growing baby and placenta, the body needs more iron.Anaemia during pregnancy is a risk factor for poor pregnancy outcomes for both the mother and the fetus. Current local evidence on factors associated with anaemia in pregnancy is lacking. The incidence of maternal anaemia remains high and risk factors at the Bamenda Regional Hospital (BRH) which serves as a referral hospital for the northwest region have not yet been studied.

1.3. JUSTIFICATION

Several conditions can lead to anaemia including poor diets, poor nutrient absorption, infections (such as malaria, parasitic infections, TB, and HIV), inflammation, chronic illnesses, gynaecological and obstetrical conditions and hereditary red blood cell disorders[11].

Cameroon has a high rate of anaemia and a lack of knowledge about the risk factors that contribute to most poor outcomes may hinder efforts to further reduce the occurrence of maternal anemia.

Therefore, an improved understanding of the risk factors of maternal anaemia in our settings is an important step for targeting strategies for its reduction as well as improving maternal and child health care[12].

1.4. RESEARCH GOAL

The goal of this study was to identify the factors associated with maternal anaemia and provide data to help raise awareness and reduce the rate of anaemia in the northwest region. Reducing maternal mortality and morbidity: addressing anaemia, which is a significant risk factor for maternal mortality and morbidity. This research can contribute to improving maternal health outcomes.

1.5. RESEARCH QUESTIONS

1) What is the prevalence of anaemia during the third trimester of pregnancy at the BRH?

2) What are the factors associated with anaemia during the third trimester of pregnancy at the BRH?

3)What is the severity of anaemia during the third trimester of pregnancy at the BRH?