PREVALENCE AND ASSOCIATED FACTORS OF ANEMIA AMONG PREGNANT
WOMEN AGE 15-49YEARS ATTENDING ANC AT THE LAQUINTINIE HOSPITAL
DOUALA.
CHAPTER ONE
1.1 research background
(1) Nutritional anemia is the most common type of anemia worldwide and mainly includes iron,
folic acid, vitamin B12 and vitamin C deficiencies . Iron deficiency contributes for half of the
burden of anemia globally .Iron deficiency affects 1.3 to 2.2 billion persons out of those 50% are
women of reproductive age . In Ethiopia nearly 17% of women with age 15–49 are anemic of
these 22% are pregnant women .
(1) Anemia is affecting 1.62 billion people globally. The prevalence of anemia in developing
countries is estimated to be 43% and that of developed countries is 9%. Anemia is estimated to
contribute to more than 115 000 maternal deaths and 591 000 prenatal deaths globally per year .
Anemia occurs at all stages of the life cycle but its risk is higher in state of pregnancy due to an
increased iron requirement, physiological demand, loss of blood and due to infections .
The contextual factors contributing for anemia among pregnant women are different. Interaction
of multiple factors like women’s’ socio-demographic, socio- economic, nutritional and health
related factors cause anemia in pregnant women. There is no adequate information on factors
leading to anemia in pregnant women in Ethiopia and Mekele town in particular. Hence this
study aims to provide evidence-based estimates of the magnitude and associated factors of
anemia among pregnant women attending ANC in Mekelle town
(2)In all over the world, anemia is one of the public health problems and continued as a universal
top cause of frailty and the uppermost serious global health issues. This is because in a
pregnancy, it is tremendously major both in industrialized and unindustrialized countries. Current
suggestion from World Health Organization (WHO) document showed that, about 38% (32
million) of pregnant women are anemic in the word. Out of this, 46.3% (9.2 Million) of them are
in Africa . Nevertheless, the explanations of the rate frequently display inconsistency in the
world from place to place For example, there is considerable variation in the rate of anemia
during pregnancy within developed countries like United States in which the rate is 18%, in
Australia 20%, in Singapore 67.8% and in China 70%; while the rates upsurge over
trimesters .However, the extent of the rate is becoming greater in developing countries; for
instance, in Ethiopia 50.1%, in Sudan 53%, in Guinea 71% and in Pakistan 76.7%. These are
the basic rationale problems associated to anemia, which is one of the fundamental concerns of
public health issues in the world in over-all and in Africa specifically.
(2) These includes premature birth, low birth weight, abortion, delay psychomotor improvement,
impairment of cognitive recital and reduce totals on intelligence (IQ) test level of the newly born
baby which has an effect on the later life . Furthermore, the impact of Iron Deficiency Anemia
(IDA) in first stages of teenager and early youthful are not probably to be adapted by
considerable iron administration . This is because the iron dietary consumption upraises maternal
mean hemoglobin concentration reads from 4.59 to 5.46 g/L. Therefore, excessive intake of
dietary iron at first or successive trimester pregnancy is meaningfully associated with decrement
of the threat of anemia. This results in decreases of adverse birth outcome, premature birth and
LBW . Equally, women in Sub-Saharan Africa (SSA) consume low dietary iron, Calcium and
Folic-Acid having less than Recommended Dietary Allowances (DRA) requirements for a
woman during pregnancy for the reason that they were economically not recognized .
Various studies had examined multiple aspects upsetting anemia in pregnancy. The independent
predictors which include maternal age, residence, literateness, antenatal care visit, inter-
pregnancy interval, iron food consumption, dietary practice, micronutrient intake, dietary
diversity, iron supplementation, parasite infection and gravidity were documented as factors
associated with developing anemia in pregnancy . The finding of the study suggested that women
of third trimester pregnancy are more likely risky to develop anemia as compared to first and
second trimester . World Health Organization recommends day-to-day supplementation of 30–60
mg/d elemental iron (+ 400 μg) and folic acid to reduce the burden of anemia as a public health
problem .Finding of different studies also presented that compliance to Iron and Folic-Acid
Supplementation (IFAS) in Sub-Saharan Africa countries has a better position to some degree.
(2)
1.2research statement of problem
The causes of anaemia during pregnancy in developing countries are multifactorial; these include
micronutrient deficiencies of iron, folate, and vitamins A and B12 and anaemia due to parasitic
infections such as malaria and hookworm or chronic infections like TB and HIV . Contributions
of each of the factors that cause anaemia during pregnancy vary due to geographical location,
dietary practice, and season. But in Sub-Saharan Africa inadequate intake of diets rich in iron
and inadequate information on anaemia are reported as the leading cause of anaemia among
pregnant women .
Anaemia during pregnancy is reported to have negative maternal and child health effect and
increase the risk of maternal and perinatal mortality. The negative health effects for the mother
include fatigue, poor work capacity, impaired immune function, increased risk of cardiac
diseases, and mortality. Some studies have shown that anaemia during pregnancy contributes to
23% of indirect causes of maternal deaths in developing countries
Anaemia in pregnancy is associated with increased risk of preterm birth and low birth weight
babies , Preterm and LBW are still the leading causes of neonatal deaths in developing countries
like Cameroon contributing to 30% of the deaths. It has also been associated with increased risk
of intrauterine deaths (IUFD), low APGAR score at 5 minutes, and intrauterine growth
restriction (IUGR) which is a risk for stunting among children of less than two years.
1.3 Research question
General research question
what is the prevalence and associated factors of anemia among pregnant women attending ANC
at the Laquintinie Hospital Douala
Specific research questions
- What is the prevalence of anemia among women attending ANC at the Laquinitinie Hospital
Douala
- What are the factors associated with anemia in pregnant women at the Laquintinie Hospital
Douala .
1.4 Research hypothesis
- Null hypothesis
There is an increased prevalence and associated factors with regards to anemia in pregnant
women .
- Altenative hypothesis
There is a decreased prevalence and associated factors of anemia in pregnant women.
1.5 Research objectives
General objective
The main objective of the study is to acertain the prevalence and associated factors of anemia in
pregnant women attending ANC at the Laquintinie hospital Douala .
Specific objectives
To determine the prevalence of anemia among women attending ANC at the Laquintinie Hospital
Douala .
To determine the associating factors of anemia among women attending ANC at the Laquintinie
hospital Douala.
1.6 Scope of the study
It will last for two months, from the 1st of April to the 31st of May 2024.
1.7 Significance of the study.
The findings of this study will help improve pregnant women's knowledge on anemia ,in a way
that will decrease the rate of anemia among women attending ANC at the Laquintinie Hospital.
1.8 Contextual definition of terms
Anemia
Anemia is a condition that develops when your blood produces a lower-than-normal amount of
healthy red blood cells. If you have anemia, your body does not get enough oxygen-rich blood.
The lack of oxygen can make you feel tired or weak. You may also have shortness of breath,
dizziness, headaches, or an irregular heartbeat. According to the Centers for Disease Control and
Prevention(3)
CHAPTER TWO
LITERATURE REVIEW
2.1 INTRODUCTION
(3)Anemia is a pathophysiological condition in which there is a marked reduction in the
hemoglobin content of blood from the reference concentrations or in the number of red blood
cells or defective maturation of red blood cells ( Zhu, Wang, Su, Feng and Yang2018). It affects
all age groups, but pregnant women and children are more vulnerable (Obai, Odongo and
Wanyama2016; Lin et al. ). Anemia, during pregnancy, is a commonly encountered medical
disorder associated with adverse effects on the mother and the fetus ( Sharma and Shankar2010).
Several exploratory studies estimated that anemia is currently affecting over 1.62 billion people
of the world, a population of which 56 million are pregnant women . Stevens et al 2011) reported
that the global prevalence of anemia in pregnant women is 38%. The significant burden of
anemia is born in Asia and Africa were estimated that 60% and 52% of pregnant women,
respectively, are anemic, and between 1% and 5% are severely anemic (Leenstra et al.2004).
Anemia during pregnancy is more prevalent at 43% and 56% in developing countries compared
with 9% and 18% in developed countries, respectively (Balarajan et al.2014). Usually, anemia is
defined as a hemoglobin level <11.0 g/dl (Obai et al.2016). Previous studies have reported that
anemia in pregnancy has several contributing factors. Among them iron deficiency is the cause
of 75% of anemia. Insufficient intake and poor bioavailability of iron-rich foods also have
significant contributions to the onset of anemia during pregnancy (Cusick et al.2017). About
1000 mg of iron is required during per-pregnancy (Milman et al1999). Anemia in pregnancy is
considered a risk factor for poor pregnancy outcomes such as preterm birth (Levy et al.,
Reference Levy, Fraser, Katz, Mazor and Sheiner2005), low birth weight , fetal impairment, and
maternal and fetal deaths (Haas et 2001).
Poverty is one of the risk factors for iron deficiency in pregnant women (Bodnar et al.2002). In
Bangladesh, previously conducted different studies and estimating the prevalence found as 37% ,
(Rahman et al., 2018), of anemia among pregnant women. Despite the known consequences of
anemia in pregnancy, there is scanty information on the ubiquity of anemia in pregnant women in
Bangladesh. Several published studies on the prevalence and associated risk factors of anemia in
pregnancy have received antenatal care (ANC) at the different levels of the health care system.
Most of the studies were secondary and tertiary health care facilities in private hospitals and
some are primary health care levels in government hospitals. Information from the literature
indicated that there were no published studies that have addressed to compare the prevalence and
associated risk factors of anemia in pregnant women attending ANC at government and private
hospitals. The prevalence of anemia in pregnancy varies in women with different socioeconomic
conditions, diets, lifestyles, or health-seeking behaviors across different cultures. Anemia during
pregnancy is more prevalent especially in poverty, improper nutrition, living in unhygienic
conditions, lack of education, women unemployment, lack of health care facilities, and no
knowledge of antenatal care. Most of the study subjects were housewives and more than half of
the pregnant women were secondary school education level. Most of the women are afforded a
low status in society, and their daily health needs were unnoticed. In addition, existing health
facilities may not be available to women in need. Besides, lack of education and understanding
about health-related issues contribute to delays in seeking care for managing life-threatening
pregnancy complications. Generally, pregnant women in the rural area of Bangladesh receive
ANC from the community health care center or government hospitals due to poverty. However,
to the best of our knowledge, there is no other study that has ever been conducted in the area we
are investigating regarding the prevalence of anemia during pregnancy.(4)
(4)Since 2011, there has been a rise in maternal mortality in Cameroon, with 782 deaths/100,000
live births occurring in 2011 . In furtherance, daily maternal mortality cases in the country stands
at 12-13 cases . This is an indication that Cameroon can be considered among sub-Saharan
African countries with the highest prevalence of maternal mortality . Anemia is one of the causes
of maternal mortality in Cameroon . According to USAID report, 39.5% of women of
reproductive age in Cameroon were anemic in 2011. Out of these, 30.2% and 8.7% were mild
and moderately anemic, while 0.6% were severely anemic .
Anemia among women has mostly been attributed to nutritional deficiency, specifically, iron
deficiency . To improve the use of iron supplementations in pregnant women, the theory of
planned behavior is often recommended . The theory of planned behavior was developed by
Fishbein and Ajzen and is categorized into attitude, subjective norms, behavioral intention, and
behavior . Attitude in the theory refers to a positive or negative evaluation of behavior that is
based on behavioral beliefs and an assessment of behavior outcomes and attitudes toward
behavior. Subjective norms have been described as an evaluation based on the assumption that
individuals are subjected to different social influences such as that from parents, a spouse, and
religious leaders. Behavioral intention refers to the decision and the will of the individual to
behave in a particular manner while behavior is an individual's observable response in a given
situation with respect to a given target . Beyond improving nutritional deficiency through
education and behavioral change, several studies have found individual/household level-maternal
level of education, occupation, partner's level of education and occupation, improved sanitation,
contraceptive use, pregnancy termination, parity, media exposure, wealth quintile economic
status and religion and community-level factors such as place of residence, region , and
community literacy level and socioeconomic status as predictors of anemia.(5)
Despite the diverse predictors of anemia, most of the studies have focused on single factors,
thereby not providing a holistic recognition of the factors associated with anemia among women
at both the individual/household and community levels. This problem can be resolved with the
use of multilevel analysis that takes into account the hierarchical levels of predictors of anemia.
Again, multilevel modelling helps to take into account the household/community-level factors
and how they interact with individual-level factors to predict anemia. A multilevel approach will
contribute to an understanding of both the individual/household and community-level factors that
predict anemia. In Cameroon, few studies related to anemia are available . However, their focus
is on pregnant women , covered limited area , and facility-based as well as hematological
aspects. To fill this gap, we were therefore motivated to investigate the individual/household and
community-level factors associated with anemia among women in Cameroon.(5)
CHAPTER THREE
3.1 - Study setting : area and site
This research will be carried out at the Laquintini Hospital Douala ,
3.2- study and study design
This research will be a cross sectional study ,involving the use of quantitative methods of data
[Link] was so because it is aimed at obtaining data on a representative sample of the
study population at a specific time at the laquintinie Hospital Douala.
3.3- target population
The population under this study will include pregnant women between 15-49 years attending
ANC at the Laquintinie Hospital Douala.
3.4- sample size calculation
3.5- sampling methods and requirement of participants
3.6- study variables and measurement data collection
3.8 data management
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