CHAPTER ONE

INTRODUCTION

1.1 Background Of The Study

Anaemia is defined as a low level of haemoglobin in blood, as evidenced by fewer numbers of functioning red blood cells. Haemoglobin in red blood cells is an oxygen-carrying protein that binds oxygen through its iron component. Haemoglobin transports oxygen to most cells in the body to generate energy.  Globally, anaemia affects 1.62 billion people (25%), out of which 56 million are pregnant women (Balarajan, 2011; WHO/CDC, 2008). An estimation of 41.8% of pregnant women worldwide is anaemic and at least half of the anaemia burden is assumed to be due to iron deficiency. Iron deficiency anaemia is the most common nutritional disorder in the world affecting 2 billion people worldwide with pregnant women particularly at risk (WHO, 2012).

Anaemia during pregnancy is the major cause of morbidity and mortality in pregnant women and infants in developing countries (Akhtar and Hassan, 2012). In 2013, an estimated 289,000 women died worldwide. Developing countries account for 99% (286,000) of the global maternal death with sub-Saharan Africa region alone accounting for 62% (179,000). About 800 women a day are still dying from complication in pregnancy and childbirth globally (WHO, 2015). Anaemia contributes to 20% of all maternal deaths (WHO, 2015). Anaemia in pregnancy causes low birth weight (Banhidi et al., 2011), fetal impairment and infant deaths (Kalatvant, 2009). Iron deficiency anaemia affects the nation’s development by decreasing the cognitive and motor development of children and productivity of adults (Balarajan et al., 2011; Vivek et al., 2012). A deficiency in folic acid during pregnancy can result in developing neural tube defect that develops in embryos during the first few weeks of pregnancy leading to malformation of the spin, skull, and brain (Wolff et al., 2009).

The prevalence of anaemia in developing countries is 60% and about 7% of the pregnant women are severely anaemic (Agan et al., 2010). In Africa, 51.7% of pregnant women are anaemic (de Benoist et al., 2008). Sub-Saharan Africa is the most affected region with a prevalence of anaemia estimated to be 17.2 million among pregnant women. This is approximately 30% of the total global cases (WHO, 2008). Anaemia during pregnancy is considered severe when haemoglobin concentration (Hb) is less than 7.0g/dl, moderate when Hb concentration is 7.0 to 9.0g/dl and mild when Hb concentration is 10.0 to 10.9g/dl (Balarajan et al., 2011; Salhan et al., 2012; Esmat et al., 2010). When the prevalence of anaemia among pregnant women is 40.0% or more, it is considered a severe public health problem (McLean et al., 2008). Studies in the mount Cameroon area have shown that anaemia is a severe public health problem in pregnancy with a high prevalence of 57% (Anchang et al., 2017).

Anaemia during pregnancy has a wide variety of causes and contributing factors. Iron deficiency is the cause of 75% of anaemia cases during pregnancy (Balarajan et al., 2011; Haidar, 2010). Loss of appetite and excess vomiting during pregnancy and heavy menstruation flow before pregnancy are equally documented causes of anaemia during pregnancy (Noronha et al. 2010). Infectious diseases such as malaria, helminthes infestation and HIV are implicated with high prevalence of anaemia in sub-Saharan Africa (Ouedraogo et al., 2012 and Tolentino and Friedman, 2007). Socio-economic conditions, abnormal demands like multiple pregnancies, teenage pregnancies, maternal illiteracy, unemployment, short pregnancy intervals, age of gestation, primigravida and multigravida (Haniff et al., 2007; Noronha et al., 2010), excessive alcohol consumption, smoking are the main contributing factors of anaemia during pregnancy (Moosa and Zein, 2011; Esmat et al., 2010)

Iron and folate requirements increase during pregnancy and hence, the likelihood of developing iron and folate deficiency is high in the absence of supplementation during pregnancy (Marti-Carvaja et al., 2002). It is therefore recommended that all pregnant women should start taking iron and folic acid supplements as early as possible to avoid complications of iron and folic acid deficiency during pregnancy. Supplementation with folic acid has been shown to reduce the risk of congenital heart defects, cleft lips, limb defects, and urinary tract anomalies (Wilcox et al., 2007; and Goh and Koren, 2008). IFAS is a major strategy to reduce iron deficiency anaemia in pregnancy as well as risk of congenital malformations on the newborn.

Iron has several vital functions in the body. It serves as a carrier of oxygen in red blood cells from the lungs to the tissue; it functions as a transport medium for electrons within cells, and as an integrated part of important enzyme systems in various tissues. Folic acid, a B vitamin (B12), plays a vital role in the production of red blood cells, synthesis of DNA, and it also acts as a co-factor in certain biological reactions (Weinstein et al., 2013). Folic acid is especially important in aiding rapid cell division and growth, such as in infancy and pregnancy. Birth defects occur within the first 3-4 weeks of pregnancy, usually before a woman even knows she’s pregnant. So it is important to have folic acid in the system during those early stages when the baby’s brain and spinal cord are developing (Folate: Dietary Supplement Fact Sheet, 2013).

 

1.2 Statement Of Problem

Anaemia increases the risks of foetal, neonatal and overall infant mortality (Akhtar and Hassan, 2012). The prevalence of anaemia among pregnant women in the mount Cameroon area was 57% (Anchang et al., 2017). Over the past 26 years, a maximum value of 56.7% was reached in 1991 and a minimum value of 49.3% in 2016 (Stevens et al., 2016). If the prevalence of anaemia is 40.0% or more, it is considered a severe public health problem (McLean et al., 2008). From this information, it can be estimated that high prevalence of anaemia among pregnant women in Cameroon is considered to be the main factor for maternal deaths.

Also, anaemia during pregnancy is a major risk factor for low birth weight, preterm birth and intrauterine growth restriction (Banhidy et al., 2011 and Haggaz et al., 2010). Deficiency in folic acid during pregnancy can result in serious neural tube defect (Wolff et al., 2009), heart defects and cleft lips (Wilcox et al., 2007), limb defects and urinary tract anomalies (Goh and Koren, 2008).

Pregnant women attending ANC clinics in Cameroon are routinely put on iron supplementation throughout their pregnancy. Malaria infection during pregnancy is also a major public health problem with substantial risk of anaemia for the mother, her foetus and the neonate as malaria destroys red blood cells and can be a leading cause of anaemia. Therefore, protection against malaria is usually achieved through the use of insecticide treated bed nets (ITNs), intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTs-SP) (WHO, 2004). This is to reduce maternal and foetal anaemia, low birth weight and neonatatal mortality but with all of these preventive measures, the prevalence of anaemia among pregnant women aged 18-48 is still high.

 

1.3 Rational Of The Study

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.

The epidemiology of anaemia during pregnancy is important for deciding control strategies. Data on prevalence and associated risk factors of anaemia remain important indicator of public health since anaemia is related to morbidity and mortality in the population especially in pregnant women. For instance, a community based trial from china found out that there was a 47% reduction in neonatal mortality in women who received IFA supplements compared to those who took folic acid along (Zeng et al., 2008).

In view of the problems caused by anaemia, more research is required to identify the risk factors in order to come up with appropriate measures that will ensure its reduction. Therefore, this study aims at providing prevalence and associated risk factors of anaemia among pregnant women aged 18-48 who attended ANC at Buea regional hospital.

 

1.4 Research Questions

1. What is the prevalence of anaemia among pregnant women attending antenatal clinic at the Buea regional hospital?
2. What are the risk factors associated with anaemia among pregnant women attending antenatal clinic at the Buea regional hospital?

 

1.5 General Objectives

To determine the prevalence and associated risk factors of anaemia among pregnant women attending antenatal care (ANC) in the Buea regional hospital.

 

1.5.1 Specific Objectives

1. To determine the prevalence of anaemia among pregnant women following ANC in the Buea regional hospital.
2. To identify risk factors associated with anaemia in pregnant women attending ANC in the Buea regional hospital