1.1 Introduction
Anaemia in pregnancy remains a significant public health concern worldwide, particularly in developing countries. The condition not only poses risks to maternal health but also jeopardizes the well-being of the unborn child. Despite considerable efforts to combat anaemia, its prevalence among pregnant women persists at alarming rates. Understanding the level of awareness and preventive measures concerning anaemia in pregnancy is crucial for effective intervention strategies. Despite the availability of preventive measures such as iron supplementation, dietary interventions, and health education programs, the awareness and adherence to these interventions among pregnant women vary widely across different populations. Socioeconomic factors, cultural beliefs, and access to healthcare services significantly influence the level of awareness and utilization of preventive measures.
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Limitation of the study and Definition of technical terms.
1.2 Background of Study
Anaemia in pregnancy remains a persistent global health issue with significant implications for both maternal and fetal health. The condition, characterized by a decrease in the concentration of hemoglobin in the blood, affects a substantial number of pregnant women worldwide. Iron deficiency is the leading cause of anaemia during pregnancy, although other factors such as nutritional deficiencies, chronic diseases, and socioeconomic factors also contribute to its prevalence.
Studies have shown that the level of awareness and utilization of preventive measures for anaemia in pregnancy varies among different populations and settings. Factors such as education, income, access to healthcare services, cultural beliefs, and dietary practices play critical roles in determining the effectiveness of preventive interventions. Furthermore, the success of anaemia prevention programs depends on the engagement of healthcare providers, community health workers, and policymakers in advocating for and implementing evidence-based strategies.
According to the World Health Organization (WHO), anaemia affects approximately 32 million pregnant women globally, with prevalence rates exceeding 40% in some regions. Anaemia during pregnancy is primarily attributed to iron deficiency, though other factors such as folate and vitamin B12 deficiencies, infections, and genetic disorders can also contribute. The consequences of untreated anaemia in pregnancy include increased maternal mortality, preterm birth, low birth weight, and impaired cognitive development in infants.
Anaemia is one of the most frequent complications related to pregnancy. The word implies a decrease in the oxygen-carrying capacity of the blood and is best charac- terized by a reduction in hemoglobin concentration. This may be either relative or absolute. It is known that there is a larger increase in plasma volume relative to red cell mass in almost all pregnancies, and it accounts for “physiologic anemia.” These alterations have been known for centuries, and the term “plethora gravidarum” from medieval ages indicates this condition. However, it is still an open question to what extent this “hydremia” is physiologic or pathologic.
Anemia is defined as the condition in which there is decreased level of hemoglobin (Hb) or red blood cells than the normal value (Eltayeb et al., 2014). According to the 2008 World Health Organization (WHO) report, anemia affected 1.62 billion (24.8%) people globally (WHO, 2008). Approximately 51% of pregnant women were expected to be anaemic in 2001(G.C.). The prevalence in developing countries was 56% and 18% in developed countries (Bick et al., 2006). The most recent global estimates suggest that the prevalence of anemia is 41.8% among pregnant women and 30.2% among non-pregnant women (WHO, 2008; Bhutta et al., 2012). In Africa, 57.1% of the pregnant women were anaemic.
According to Ethiopian Demographic Health Survey (EDHS) report of 2011, the numbers are stated to be lower putting the prevalence of anemia in pregnant women at 22% at the country level and 24.9% in Oromia Regional State encompassing the study area (CSA, 2011). The risk of anemia is high in women who are premenopausal and/or pregnant. This is mainly due to menstrual blood loss, increased demand to support the fetus, puerperal blood loss, and it is usually exacerbated by nutritional insufficiency that is common in developing countries (Bick et al., 2006). Anemia contributes to almost 120,000 maternal deaths globally and indirectly to almost a fifth (18%) of the burden of maternal mortality. In addition to maternal deaths, there are several adverse health outcomes associated with anemia including preterm delivery, intrauterine fetal death, stillbirths, neonatal mortality, low birth weight (LBW) and poor cognitive development in the offspring (Bhutta et al., 2012; Melku et al., 2014).
In developing countries, maternal anemia during pregnancy is a product of many factors, such as maternal malaria, intestinal parasitic infection, recurrent infection, reduced dietary intakes, parity and micronutrient deficiencies just to name but few (Bhutta et al., 2012; Ugwuja, et al., 2011; Haidar, 2010). Among the micronutrient deficiencies the most common encountered are iron deficiency anemia (IDA) and folate deficiency 2 megaloblastic anemia. Of all anemia diagnosed during pregnancy, 75% are due to iron deficiency. Iron deficiency (ID) alone affects nearly 20% of the world’s population (Bick et al., 2006). The odds for developing anemia were 60% more likely in the iron-deficient and 40% more likely in the folic acid deficient. One in every three women had anemia and deficiency of folic acid while one in every two had iron deficiency, suggesting that deficiencies of both folic acid and iron constitute the major micronutrient deficiencies in Ethiopian women (Haidar, 2010).
Apart from iron and folate deficiency cobalamin (Vit B12) deficiency has been shown to account for some cases of anemia (Morris et al., 2007; Khan et al., 2010). Studies show that iron intake in Ethiopia is adequate (Gibson et al., 2008), however anemia is still a health concern affecting 22% of pregnant women (WHO, 2008) leading to devastating outcomes of pregnancy and delivery necessitating studies to be conducted on other micronutrients which could play an important role on the occurrence of anemia. in the present study the socio-demographic and obstetric characters and plasma levels of iron, folate and cobalamin, was evaluated in anaemic (case) and non-anaemic (control) pregnant women to ascertain the impact these factors have on maternal anemia and the possible interactions among them.
Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Level of Awareness and Prevention of Anaemia in Pregnancy among Pregnant Women.
1.3 Statement of the Problem
Investigation revealed that anaemia is a major public health problem all around the world and even more in developing countries like Ethiopia with a prevalence of 22% (CSA, 2011). Anemia could be the consequence of many factors such as: infections, micronutrient deficiency, blood loss or genetic disorders (Bhuta et al., 2012; Ugwuja, et al., 2011; Haidar, 2010). Of all the micronutrients that are presumed to be predisposing factors ID has been extensively assessed but others like folate and cobalamin, should also be assessed as they have been shown to have great impact on development of anemia on researches done on other countries (Gibson et al., 2008; Khan et al., 2010; Knovich et al., 2008).
Furthermore, there is a lack of comprehensive understanding among pregnant women regarding the causes, consequences, and preventive measures of anaemia during pregnancy, leading to suboptimal utilization of available resources for prevention and management. Addressing these problems requires a multifaceted approach that encompasses health education, policy advocacy, healthcare infrastructure strengthening, and community engagement to improve awareness and preventive practices related to anaemia in pregnancy.
1.4 Aim and Objectives of the Study
The aim of the study is to assess the level of awareness and utilization of preventive measures for anaemia in pregnancy among pregnant women. In achieving this aim, the following objectives were laid out as follows:
- To determine the level of awareness among pregnant women regarding the causes and consequences of anaemia during pregnancy;
- To examine the role of healthcare providers in promoting awareness and adherence to preventive measures for anaemia in pregnancy;
- To identify barriers and facilitators to the utilization of available resources for anaemia prevention among pregnant women;
- To explore the socio-cultural factors influencing awareness and preventive practices related to anaemia in pregnancy; and
- To evaluate the effectiveness of existing anaemia prevention programs and policies in reaching and addressing the needs of pregnant women.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- Are there barriers and facilitators to the utilization of available resources for anaemia prevention among pregnant women?
- Are there socio-cultural factors influencing awareness and preventive practices related to anaemia in pregnancy?
- What is the effectiveness of anaemia prevention programs and policies in reaching the needs of pregnant women?
- What is the level of awareness among pregnant women regarding the causes and consequences of anaemia during pregnancy?
- What is the role of healthcare providers in promoting awareness and adherence to preventive measures for anaemia in pregnancy?
1.6 Research Hypothesis
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
Hypothesis One
- H0: There is no significant association between the level of awareness about anaemia in pregnancy and the utilization of preventive measures among pregnant women.
- H1: There is a significant association between the level of awareness about anaemia in pregnancy and the utilization of preventive measures among pregnant women.
1.7 Significance of Study
Anaemia in pregnancy is a significant public health concern with profound implications for maternal and child health outcomes. Understanding the level of awareness and utilization of preventive measures for anaemia among pregnant women is crucial for developing effective intervention strategies and reducing the burden of the condition. The significance of this study lies in several key areas:
- Improving Maternal Health: By identifying gaps in awareness and preventive practices, the study can contribute to initiatives aimed at improving maternal health outcomes by reducing the incidence of anaemia-related complications during pregnancy and childbirth.
- Enhancing Fetal Health: Adequate maternal iron status is essential for fetal growth and development. By promoting awareness and adherence to preventive measures for anaemia, the study may help mitigate the risk of adverse birth outcomes such as low birth weight and preterm birth.
- Informing Policy and Program Development: Findings from the study can inform the development and implementation of targeted interventions, policies, and programs aimed at addressing anaemia in pregnancy at both local and national levels. This includes strategies to improve access to prenatal care, iron supplementation, and health education for pregnant women.
- Reducing Health Inequalities: By examining socio-cultural factors influencing awareness and preventive practices, the study can contribute to efforts aimed at reducing health inequalities and disparities in anaemia prevalence among different population groups.
- Guiding Healthcare Practice: Insights from the study can inform healthcare providers about the specific needs and challenges faced by pregnant women in relation to anaemia prevention, enabling them to deliver more tailored and effective care.
- Contributing to Research and Knowledge Base: The study adds to the existing body of literature on anaemia in pregnancy, providing valuable insights into the factors influencing awareness and prevention. This knowledge can guide future research and interventions in the field.
1.8 Scope of Study
The study focuses on the Level of Awareness and Prevention of Anaemia in Pregnancy among Pregnant Women in Enugu State Primary Health Care (PHC) Service.
1.9 Limitations of the Study
During the course of this study, many things militated against its completion, some of which are:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Research Material: availability of research material is a major setback to the scope of the study.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
1.10 Operational Definition of Terms
Attitude: The way one behaves towards somebody or something that shows how you think or feel.
Knowledge: To have information about something because you have experience or because you have learned it or be told.
Macrosomia: Large babies weighing more than 40kg at birth especially in diabetic mothers.
Mortality: The number of death in a particular situation or period of time.
Perception: To notice something in a particular way or hold a view about something.
Placenta Previa: This is a condition in which the placenta of a fetus lies where the presenting part of the fetus is supposed to come out (the cervical OS).
