INTRODUCTION:
Anaemia in pregnancy is an indirect
cause of maternal mortality.1 Researchers believe that anaemia is the driving force for lack of oxygen for mother
and fetus; a reduction below acceptable levels both decrease the ability of
blood to carry oxygen due to a decrease in the total number of erythrocytes and
a diminished concentration of haemoglobin per erythrocyte
or a combination of both. Generally, a haemoglobin
concentration below 11.0 g/dc or parked cell volume (PCV) of less than 33.0% is
regarded as Anaemia during pregnancy by the World
Health Organization (WHO).2
Anaemia in pregnancy is
believed to be one of the intractable public health challenges in the
developing countries and the commonest complications in pregnancy in
sub-Saharan Africa especially in the advent of HIV/AIDS pandemic.3
Furthermore, the WHO estimates that anaemia affects
over 50% of the pregnant women in developing countries, Nigeria inclusive.4
In addition, the prevalence of Anaemia in pregnancy
in Nigeria is 60.0% with approximately 7% of these gravid women said to be
severely anaemic.4 These factors contributing to anaemia in pregnancy
are multi-factional and are different across
the geographical regions of the
countries.4
Scholars have demonstrated that anaemia in pregnancy can be relative or absolute- due to
moral physiological phenomenon that occurs in pregnancy as a result of increase
in plasma volume (approximately 45.0% in injection and 50-60% in true
pregnancy) red cell mass accounts for the relative or physiological anaemia.5
However, for the absolute anaemia, it is being
explained from the point of view that true decrease in red cell mass, involving
an increase in red cell destruction as in haemoglobin,
nuclear and bacteria infection like urinary tract
infection Increased red cell destruction
as in bleeding or deceased red cell production as in nutritional deficiencies or
chronic diseases.3 Predisposing factor for anaemia
in pregnancy are: young age, gradmultiparity, low
socio-economic status, illiteracy, ignorance, and short inter-pregnancy
intervals.3
Aim:
To determine the prevalence anaemia
among pregnant women at booking at the Rivers State University Teaching
Hospital (RSUTH)
METHODOLOGY:
This was a six-month cross-sectional retrospective
study of pregnant women at booking at the RSUTH. Biodata and results of Packed
Cell Volume (PCV) were obtained from patients’ case notes. The cut-off level
for anaemia used for the study was PCV <33%. Data
was analysed using SPSS version 25.
Sample size:
The sample size is 370 was calculated using the Kish
Leslie formula for cross-sectional studies calculated, based on 60% prevalence
of pregnant women with anaeemia reported by the
Nigerian Demographic health survey and a confidence level of 95%.
n = Z2Pq/d2
n is the desired sample size
Z is the standard normal deviate usually set at 1.96
which corresponds to the confidence
Interval
P is the proportion of patients with anaemia which is 60%
q is the complementary
proportion equivalent to (1), that is 1 – 0.6 equal to 0.4
d is the degree of
accuracy desired which is 5.0% (0.05)
n = 1.962 x 0.6 (1-0.6)/0.052
= 368.8
This was rounded up to nearest whole number, the
sample size
= 370
Participants:
Descriptive cross-sectional study’
Inclusion criteria:
Pregnant women who gave consent
Exclusion criteria:
Sickle cell disease
Hepatic impairment
Coagulation disorder
Pregnant women who did not give consent for the
study
Ethics: Guidelines in line
with Helsinki’s declaration (revised 13th edition
RESULTS:
A total
of 370 pregnant women were attended to for the period under review. The mean
age was 31-years. The mean gestational age at booking was 19-weeks. The modal
parity was 2. Two hundred and sixty-four (71.4%) had tertiary level of
education, 95 (25.7%) secondary level of education while 7 (2%) of respondents
had primary level of education. 3 (0.85%) did not provide their level of
education. Two hundred and ninety (78.4%) of the pregnant women had PCV less
than 33%.
Table 1: Summary of results
|
Number
of subjects
|
350
|
|
Mean age (years)
|
31
|
|
Mean
gestational at booking (weeks)
|
19
|
|
Modal
parity
|
2
|
|
Prevalent
of PCV (%)
|
78.4
|
Table 2: Educational level of subjects
|
Educational
level
|
Number (n)
|
Percentage (%)
|
|
Tertiary
|
256
|
71.4
|
|
Secondary
|
90
|
25.7
|
|
Primary
|
7
|
2.0
|
|
Non specified
|
3
|
0.9
|
Table 3: Prevalence of Anaemia
according to educational level of subjects
|
Educational
Level
|
Number (n)
|
Percentage (%)
|
|
Primary
|
7
|
2.0
|
|
Secondary
|
80
|
22.9
|
|
Tertiary
|
187
|
53.5
|
|
Total
|
274
|
78.4
|
DISCUSSION
This study shows the prevalence of anaemia in pregnancy as 78.3% (table 1). When compared with
the finding gotten by Eli et al where they investigated 380 antenatal clinic
attendees in the study prevalence of anaemia at
booking amongst antenatal clinic attendees was 84% in some health facilities in
Ogoni, south-south Nigeria, this result was lower than that obtained in our
study which was 78.4%. A lot of factors might have contributed to this such as
compliant to their routine ante natal clinic medications, poverty, low economic
status, their level of education and the overall low economic status of women
in the rural community.1 In another study by Usang
were they evaluated prevalence of anaemia in urban
and rural settings in Cross Rivers state, prevalence were higher in rural
settings as high as 76% and as low as 40% in urban communities.2
In a research work conducted by Nonye-Enyidal
et al in which they reviewed 9990 antenatal mothers in at booking the
prevalence of anaemia was 86.4% at the Rivers State
University Teaching Hospital which was higher than the findings gotten in our
study which was 78.3%. In addition, the study showed a relationship with anaemia, the educational level of the woman and parity.3
Higher prevalence of anaemia
in pregnancy was linked with lower level of education and high parity.3 These
findings were similar with our research findings where all the patients with
primary level of education were anaemic (table 3).
In a study by Babah OC et
al were 11,582 pregnant women were evaluated for anaemia
in public hospitals in Lagos and Kano, the prevalence of anaemia
in pregnancy was 41.2%, this was lower than the figure gotten in our study.6
The study further revealed that 4 in 10 women had
moderate to severe anaemia during pregnancy.6
Scholars have revealed the prevalence of anaemia globally is 41.8%, in Africa 56% and Nigeria 55%;
these figures are all lower than that gotten from our study.2,4,5
This study revealed that anaemia
in pregnancy had a strong correlation with the educational level of the
pregnant (tables 2 and 3). All the women with primary level of education had anaemia in pregnancy, over 70% of the pregnant with
secondary level of education and approximately 50% of the pregnant women had anaemia in pregnancy. The findings was in agreement with
the study by Ekundare et al and Ajepe
et al.4,5
Irinyenikan TA et al in a study carried out among 400 ante natal clinic attendees at
University of Medical Sciences Ondo State south west Nigeria the prevalence of anaemia was 40%.7 This was not in agreement with
our research findings of 78.4%.
The prevalence of anaemia
among pregnant women at booking at the Rivers State University Teaching
Hospital as 78.4%. Pregnant women should be encouraged for ANC early, to be
compliant with their routine antenatal drugs as well preventing anaemia.
In Nigeria it is paramount that in clinical practice
ante natal policies should emphasize on routine screening for those with risk
factors for anaemia and individualize for pregnant
women incorporating dietary intervention, iron supplementation and referral to
specialized centres. Furthermore, those those involved in making policy should allocate resources
to make provisions for adequate ante natal care services including routine
screening for anaemia, especially among those
vulnerable, training of health care professionals and making sure iron
supplementation is available and affordable.
CONCLUSION:
The study revealed the prevalence of anaemia among pregnant women at booking at the Rivers State
University Teaching Hospital as 78.3%. Pregnant women should be encouraged for
ANC early, to be compliant with their routine antenatal drugs as well
preventing anaemia.
There is need to emphasize on the importance for
routine screening anaemia during antenatal visit
especially for those with risk factors and individualized management,
strategically targeting at risk pregnant women. This includes dietary intervention
with iron supplementation and referral to specialized clinic. In addition,
policy makers should allocate resources to ensure access to adequate antenatal
care services including routine screening anaemia,
particularly among vulnerable population, Training for health care
professionals and ebsuring availability and
affordability and accessible iron supplementation.
Conflict of interest: Authors have
declared that there was no conflict of interest.
Acknowledgement: Mother, Baby and
Adolescent Care Global Foundation.
REFERENCES
1.
Eli S, Tee GP, Kalio DGB, Briggs NCT, Okagua KE. Prevalence of Anaemia
at Booking among Antenatal clinic Attendees in some health facilicities
in Ogoni, south south Nigeria. JAMMR 2022;
33(16):176-182.
2.
Nigerian Demographic Health Survey 2018. The DHS Program. Https://dhsprogram,com>pdf...
(accessed 19/11/2024).
3.
Usang EA. Iron Status of
Pregnant Women in Rural and Urbam Communities of
Cross-Rivers State, south-south Nigeria. Nigeria J Physiol
Sci 2017; 31(2): 121-125.
4.
Nonye-Enyidah E, Altraide BOA, Jumbo A. Prevalence of anaemia
in pregnancy at antenatal care booking in a teaching hospital in Southern
Nigeria. International Journal of Reproduction 2021;10:9.
5.
Okundare KS, Oluwoselu FO, Oluwole AA, Oshodi VA. Prevalence and determinants of
Moderate-to-Severe anaemiain the third trimester of
pregnancy: a multicenter cross-sectional study in Lagos, Nigeria. Scientific
Reports 2024; 14; 1141.
6.
Ajepe AA, Okunade KS, Sekumade AI, Daramola ES et al. Prevalence and foetomaternal
effects of iron deficiency anaemia among pregnant
women in Lagos, Nigeria. PLoS One 2020; 23;15(1):e00227965.
7.
Babah OC, Akinalo OR, Benova L, Hanson C,Abioye AI et al. Prevalence of and risk factors for
deficiency among pregnant women with moderate or severe anaemia
in Nigeria: a cross-sectional study. BMC Pregnancy 2024;39:24.
8.
Irinyenikan TA, Folarin
BJ, Alabi BY, Bade-Adefioye
AM, Sani I. Prevalence of Anaemia among Antenetal Attendees at Attendees at A Tertiary Hospital in
South West Nigeria. Clinimed 2023;4(4):
274.
