Abstract

Anaemia in pregnancy remains a major problem in Cameroon over the past decade. Early detection of anaemia in pregnancy is one of the components which is unsuccessfully implemented by nurse-midwives. This study aims to explore the challenges faced by nurses in the management of anaemia in pregnancy among pregnant women in the Limbe Regional Hospital.

To achieve these objectives, the study employed quantitative methods to sample 100 participants through convenient and simple random sampling techniques using a structured questionnaire. Collected data from the field were analysed descriptively using frequency and percentage distribution in an Excel sheet (2015).

Findings revealed that the majority of the respondents (74.0%) had good knowledge about anaemia disease in pregnant women. However, only (40.0%) were aware of iron deficiency as the major cause of anaemia in pregnancy, (43.0%) knew that the mainstay treatment of iron deficiency anaemia in pregnancy is folic acid supplementation, while 61.0% of the participants cited fatigue, weakness and pale skin as the cardinal signs and symptoms of anaemia in pregnancy.

Regarding the practices of nurses regarding the management of anaemia in pregnancy, it was revealed that (75.0%) of the nurses show good practices towards anaemia among pregnant women, with (42.0%) of the participants mentioning screening for anaemia among pregnant women should be done at every prenatal visit, (53.0%) revealed that mild anaemia in pregnant women should be managed by dietary changes and iron supplements, (70.0%) mentioned that moderate to severe anaemia in pregnancy is managed to manage with high dose and close monitoring.

The study further revealed that the major challenges faced by nurses in the management of anaemia among pregnant women were inadequate screening tools and poor communication with patients as major challenges encountered. The study recommended that health workers and pregnant women must work together to achieve optimal management of anaemia prevention.

CHAPTER ONE

INTRODUCTION

1.1 Background

Anaemia is a global problem affecting people of all age groups in both low-income and high-income countries (Getahun et al., 2017; WHO, 2008). Nevertheless, it is more prevalent in low-income countries among pregnant women and children (Getahun et al., 2017; WHO, 2008; Gebre et al.,2015).

The World Health Organization (WHO) estimates that more than half of pregnant women worldwide have a haemoglobin concentration of less than 11.0gl/dl which is diagnostic of anaemia in pregnancy (Idowu et al., 2005). It is reported that women in developing countries account for 95% of all anaemic pregnancies in the world (Marchant et al., 2004). Despite this high burden of anaemia in low-income countries, it is usually neglected both by individual patients and clinicians.

The aetiology of anaemia in pregnancy is multifactorial. Some identified causes include: micronutrient deficiencies for example folic acid and iron deficiency; infections and infestations by parasites for example hookworm, schistosomiasis, malaria, HIV; haemoglobinopathies for example thalassaemia and sickle cell disease (Ouma et al., 2007); and physiological haemodilution in pregnancy which is maximum in the second trimester (Aghajanian et al., 2007). Anaemia in pregnancy has adverse effects on both the mother and the foetus. It contributes to over 20% of maternal deaths in Africa (Buseri et al., 2008).

Furthermore, severe anaemia in pregnancy leads to a reduction in the blood flow to the foetus predisposing to foetal hypoxia which can lead to intra-uterine growth retardation, and neonatal death (Buseri et al., 2008). A national survey of anaemia in pregnancy in Cameroon reported a prevalence of 50.9 % (WHO, 2008).

According to WHO classification a prevalence of anaemia greater than 40% is a severe problem of public health significance (WHO, 2008). Studies have shown that anemia in pregnancy has adverse consequences that may not only affect the pregnant but also affects the neonate and infant (WHO, 2001). During pregnancy, anemia is associated with multiple adverse outcomes for both mother and infant, including an increased risk of hemorrhage, sepsis, maternal mortality, perinatal mortality, low birth weight (WHO, 2001) and reduced work capacity (Charles, 2012). Forty percent of all perinatal deaths are linked to anemia (WHO, 2001).

There is usually a 2 to 3 fold increase in perinatal mortality rate when maternal hemoglobin levels fall below 8.0 g/d1 and 8-10 folds increase when maternal hemoglobin levels fall below 5.0 g/dl (Karaoglu, 2010). This clearly demonstrates that anaemia in pregnancy is a severe problem of public health significance.

Despite relentless efforts to curb down the incidence and prevalence of anaemia in pregnancy, it still remains a severe public health problem in Cameroon (WHO, 2008). Interventions to reduce anaemia in pregnancy usually start from the first antenatal visit and continue throughout pregnancy. The first antenatal visit during pregnancy is critical because it is the moment when most pregnant women have their first contact with the health system during their current pregnancy.

Nevertheless, Current evidence suggests that anaemia in pregnancy is an established serious public health problem as early as the first antenatal visit. It is important to understand the burden and risk factors of anaemia in pregnancy, especially during antenatal visits in view of improving public health programs on how to target anaemia in pregnancy which is currently a public health problem. The Limbe Regional Hospital (LRH) is a tertiary hospital located in the Southwest Region of Cameroon, which provides health care services to the population of the Limbe municipality and surrounding areas.

The hospital has a maternity ward that caters to pregnant women, and anaemia is one of the leading causes of maternal morbidity and mortality in this population. Therefore, the management of anemia among pregnant women is a critical issue that requires attention. Therefore, the aim of this study is to assess the challenges faced by nurses in the management of anemia in pregnancy among pregnant women at the Limbe Regional Hospital in Cameroon.

1.2 Problem Statement

Anaemia is a significant maternal problem during pregnancy associated with a negative outcome for both the woman and the new-born reason why WHO adopted reducing maternal mortality as one of the three sustainable development goals.

Most of these women affected are from developing parts of West Africa, Cameroon. Most of these women are at risk of anemia during pregnancy. However, there is not enough reliable data c collected from the above study on how well informed they are on the preventive measures (Ononge et al., 2014).

Despite the high prevalence of anaemia among pregnant women in Cameroon and the potential adverse outcomes associated with this condition, there is a gap in the literature regarding the challenges faced by nurses in the management of anaemia in pregnancy among pregnant women attending ANC in the LRH.

Nurses play a crucial role in the prevention, early detection, and management of anaemia among pregnant women, as they are the primary health care providers who interact with these women during antenatal care visits and hospitalizations.

However, little is known about the knowledge, attitudes, and practices of nurses regarding the management of anaemia among pregnant women in this setting. Therefore, there is a need to explore the experiences and perceptions of nurses regarding the management of anaemia among pregnant women in the LRH maternity ward.

1.3 Research Questions

1. What level of knowledge do nurses have toward the management of anaemia among pregnant women attending ANC at the LRH?
2. What are the practices of nurses regarding the management of anaemia among pregnant women attending ANC at the LRH?
3. What are the challenges faced by nurses in the management of anaemia pregnancy among pregnant women attending ANC at the LRH?

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