Abstract

Anemia in pregnancy is a risk factor for maternal and neonatal morbidity and mortality.    Interventions to reduce its burden start from the first antenatal visit and continue throughout pregnancy.

Previous studies report that anemia in pregnancy is a public health concern as early of anemia among pregnant women attending their first antenatal visit. Some methods Across-sectional study will be conducted at CITE VERTE DISTRICT HOSPITAL Questionnaires will be administer to collect socio-demographic data and risk factors of anemia in pregnancy. Blood will be used to measure hemoglobin concentration, malaria parasitemia and HIV serology.

Risk factors for anemia in pregnancy will be identified using univariable and multivariable analysis in logistic regression. P–values <0.05 will be considered statistically significant. To conclusion High prevalence of Anemia in pregnancy in this study demonstrates its public health importance in the first antenatal visit. Malaria infection and parity are strong modifiable and non-modifiable risk factors respectively. Prompt anti-malaria therapy in primigravida is critical in reducing anemia in pregnancy.

CHAPTER ONE

INTRODUCTION

1.1   BACKGROUND

Anemia is a global problem affecting people of all age groups in both low-income and high-income countries. Nevertheless, it is more prevalent in low-income countries among pregnant women and children. The World Health Organization (WHO) estimates that more than half of the pregnant women worldwide have a hemoglobin concentration less than 11.0gl/dl which is diagnostic of anemia in pregnancy. It is reported that, women in developing countries account for 95% of all anemic pregnancies in the world.

Despite this high burden of anemia in low-income countries, it is usually neglected both by individual patients and clinicians. The    etiology   of anemia   in pregnancy is multifactorial. Some identified causes include: micro-nutrient deficiencies for example folic acid and iron deficiency; infections and infestations by parasites for example hookworm, schistosomiasis,  malaria, HIV; haemoglobinopathies for example thalassemia and sickle cell disease; and physiological hemodilution in pregnancy which is maximum in the second trimester Anemia in pregnancy has adverse effects on both the mother and the fetus.

It contributes to over 20% of maternal deaths in Africa. Furthermore, severe anemia in pregnancy leads to a reduction in the blood flow to the fetus predisposing to fetal hypoxia which can lead to intra-uterine growth retardation, and neonatal death. A national survey of anemia in pregnancy in Cameroon reported a prevalence of 50.9%.

According to WHO classification a prevalence of anemia greater than 40% is a severe problem of public health significance. This clearly demonstrates that anemia in pregnancy is a severe problem of public health significance. Despite relentless efforts to curb down the incidence and prevalence of anemia in pregnancy, it still remains a severe public health problem in Cameroon. Interventions to reduce anemia 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 anemia 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 anemia in pregnancy, especially during the first antenatal visit in view of improving public health programs on how to target anemia in early pregnancy which is currently a public health problem.

Furthermore, reducing the burden of anemia in pregnancy requires good locally generated data of its prevalence and associated risk factor which is not readily available in Yaoundé. Thus, this study sought to measure the prevalence and identify risk factors of anemia among   pregnant women attending their first antenatal visit at CITE VERTE DISTRICT HOSPITAL

1.2 Possible Solutions from published works:

Educational Programs: Implementing community base educational interventions tailored for pregnant women can significantly improve knowledge about anemia and its risk factors. Studies shows that group sessions led by health care providers can enhance understanding and encourage preventive behaviors (Akinbami et al., 2021).

Screening and monitoring: Regular screening for anemia during antenatal care visits can help identify at risk women early. Integrating routine hemoglobin testing into ANC can facilitate timely interventions (Balarajan et al., 2019).

Nutritional Counselling: Providing targeted nutritional counselling about iron rich foods and supplements can address dietary deficiencies that contribute to anemia. Research indicates that dietary interventions can effectively improve hemoglobin levels in pregnant women (Kaur et al., 2020).

Utilizing Technology: Mobile health solutions, such as SMS reminders and health apps, can disseminate information on anemia, prevention and management to pregnant women, thereby increasing the awareness and adherence to recommended practices (Chib et al., 2022).

Community Engagement: Involving community health workers to disseminate information about anemia and its risk factors can enhance knowledge at the grassroot  level. Community based approaches have been shown to improve health literacy among pregnant women (Mumuni et al., 2023).

Knowledge Gaps

Limited research on risk factors: Existing literature often enhances general knowledge of anemia but lacks detailed exploration of specific risk factors particularly in diverse demographic groups (Ghosh et al., 2020).

Cultural beliefs and practices: There are a gap in understanding how cultural beliefs and practices influence knowledge and perceptions and anemia among pregnant women which can affect health seeking behaviors (Obi et al., 2021).

Longitudinal Studies: Few longitudinal studies track changes in knowledge and anemia prevalence over time among pregnant women attending ANC, limiting understanding of the effectiveness of intervention (Mali et al., 2022).

Impacts of socio-economic factors: Research often overlook the influence of socio-economic status on knowledge and awareness of anemia risk factors which is crucial for targeted interventions (Zhu et al., 2021).

Integration and mental health: There are a limited exploration of how mental health factors such as stress and depression may affect knowledge and management of anemia during pregnancy (Thompson et al., 2023).

1.3. Problem Statement:

Anemia during pregnancy is a significant public health issue particularly in low- and middle-income countries where it contributes to maternal morbidity, poor pregnancy outcomes, increase infant mortality, Pregnant women are at a higher risk of anemia due to increased nutritional demands, and various factors such as socio-economic status, diet, infections and prenatal care can exacerbate the conditions. Despite efforts to control and manage anemia, the prevalence remains high in many regions. However, there is a gap in understanding the level of knowledge pregnant women possess about anemia and the associated risk factors particularly those attending ANC. Knowledge plays a critical role in early detection, prevention and management of anemia, as well as adopting health seeking behaviors.

Without adequate awareness, pregnant women may not take proactive steps to prevent anemia, leading to adverse health outcomes. This research aims to assess the knowledge of anemia and its associated risk factors amongst pregnant women attending ANC, to identify gaps in awareness, and to exploit the relationship between knowledge levels and the prevalence of anemia. The findings will help inform targeted educational interventions that could improve maternal and neonatal health outcomes.

1.4. Significance of the study:

To the government: Policy development. Findings from the study can help government health policies by highlighting the prevalence of anemia and associated risk factors. This can lead to the formulation of targeted programs aim at reducing anemia in pregnant women.

To the researchers: Foundations for further research. This study can serve as a springboard for further research on anemia in pregnancy, including interventional studies aimed at improving knowledge and health outcomes.

To Participants: Increase awareness. Pregnant women participating in the study may gain awareness of anemia, its causes, symptoms and preventive measures, empowering them to make informed health decisions.

To the community: Community support. Increased awareness of anemia may foster a sense of community support among pregnant women, leading to shared experiences, resources and encouragement in adopting healthy behaviors.

1. To the hospital: Maternal and fetal outcomes. Understanding anemia’s impact can help reduce maternal mortalities and morbidities rates and improve fertile health outcomes, including growth and development.

1.5 Research Questions

 1.5.1. Main Research Question 

What is the knowledge on anemia and the associated risk factors among pregnant women attending ANC?

1.5.2 Specific Research Questions

1. What is the prevalence of anemia among pregnant women attending ANC?
2. What are the associated risk factors of anemia among pregnant women attending ANC?

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