CHAPTER ONE
INTRODUCTION1.0 Background
The health-conscious
world community has come to realize that anaemia, the majority of which is due
to iron deficiency, has serious health and functional consequences. And that it
is widespread especially among tropical low-income populations and that most of
its nutritional component is controllable with a very high benefit/cost ratio.
Women of reproductive age and pregnant, lactating as well as their infants and
young children are
particularly affected.1,2
In response to the
overwhelming evidence to this effect, world authorities have agreed that by the
end of this century, anaemia in pregnant women must be reduced by 1/3. The more
aggressive groups believe that with new approaches for the control of iron
deficiency, a reachable goal is to reduce iron deficiency anaemia to overall
levels below 10% in most populations.3
It is estimated that
about 2.15billion people are iron deficient, and that this deficiency is severe
enough to cause anaemia in 1.2 billion people globally.4About 90% of
all anaemias have iron deficiency components. In the developing world, nearly ½
of the population is iron deficient.3
About, 47% of
non-pregnant women and 60% of pregnant women have anaemia worldwide. In the
developed world as a whole, anaemia prevalence during pregnancy averages 18%,
and over 30% of these are iron deficient, with the poor mostly affected.2
Women in reproductive age and pregnant women are at high risk of incurring
negative balance and iron deficiency due to their increased iron needs because
of menstruation and demands of pregnancy. The average requirements of absorbed
iron are estimated to be
1.36mg/day and
1.73mg/day among adult and teenage menstruating females respectively. However,
15% of adult menstruating women require more than 2.0mg/day, and 5% require as
much as 2.84mg/day. The superimposition
of menstrual losses and growth in menstruating teenage girls increase the
demands for absorbed iron; 30% need more than 2.0mg/day; 10% as much as
2.65mg/day and 5% 3.2mg/day. These requirements are very difficult to meet even
with good quality iron fortified diets.4
Iron needs are
markedly increased during the second and especially during the third trimesters
up to an average of 5.6mg/day (approximate range of 3.54 - 8.80mg/day).4This
amount of iron needs cannot be met from food iron hence the importance of
prepregnancy iron reserves upon which to draw and iron supplementation during
pregnancy.
Iron deficiency during
lactation is mostly residual from that of pregnancy and delivery and can be
partially alleviated because of lactational amenorrhea, but once menstruation
returns, if lactation continues, iron requirements become higher. The risk of
iron deficiency in pregnancy and lactation begins with inadequate pregnancy
iron reserves among women in reproductive age.
Folate deficiency has
also been documented in pregnancy, often leading to combined iron-folate
deficiency anaemia. This is common among lower socioeconomic groups who consume
mostly cereal-based diets (poor in folate) aggravated by prolonged cooking and
reheating. Folate requirements double in the second half of pregnancy and are
markedly increased by processes that involve haemolysis, such as malaria and
haemoglobinopathies. Malabsorption
processes common among tropical, low socioeconomic groups impair folate
absorption.
Anaemia is one of a
wide spread public health problem in the world. WHO estimates the number of
anaemia, people worldwide to be a staggering 3.5 billion in the developing
countries and that approximately 50% of all anaemia can be attributed to iron
deficiency.5,6 The
global distribution of the disease burden of Iron deficiency anaemia is heavily
concentrated in Africa and WHO regional Southeast Asia-D. These regions bear
71% of the global mortality burden and 65 % of the disability-adjusted life
years lost.7Although estimates of the prevalence of anaemia vary, it
can be assumed that significant proportions of younger children and women of
the child bearing age are
anaemic.8,9 It
is the only nutrient deficiency that is also significantly prevalent in the industrialized
countries. Perusal of WHO global database on anaemia depicts that the most
affected groups are pregnant women (48%) and 5-14 year old children (46%).
Predictably, the prevalence of anaemia in developing countries is three to four
times higher than in industrialized countries. The most highly affected
population groups in developing countries are pregnant women (56%), school age
children (53%), and nonpregnant women (44%). In industrialized countries, the
most affected groups are pregnant women (18%) and preschool children (17%),
followed by non-pregnant women and older adults, both at 12%. Asia has the
highest prevalence of anaemia in the world; followed by Africa.9
About half of all anaemic women live in the Indian subcontinent where 88% of
them develop anaemia during pregnancy.
Available data
indicate that up to 60% of pregnant Nigerian women, especially those in the
rural areas, are anaemic during pregnancy.10This anaemia is mostly
due to the nutritional deficiency of folic acid, iron, vitamin and trace
elements; hence it is more common among the poor and malnourished women.
Nutritional anaemia is a major cause of adverse outcomes of pregnancy in
Nigerian women. It is a direct and indirect cause of maternal and perinatal
morbidity and mortality. It causes intra-uterine fetal growth retardation, with
resulting increase in rates of stillbirth, neonatal and perinatal mortality.
Several Nigerian women
have died during pregnancy because of severe anaemia
(Hb<6 .0g="" l="" sup="">11
Despite the high incidence of anaemia as a cause of maternal mortality in
Nigeria, very few interventions currently address anaemia as a major safe
motherhood issue in Nigeria. To-date, only about 58% of pregnant Nigerian women
receive iron supplement during pregnancy.11
The report on maternal
health and safe motherhood by WHO showed that maternal mortality is
unacceptably high especially in developing nations and progress to reduce it in
most regions of the world is slow.13
Improving maternal
health is the fifth Millennium Development Goal (MDG) which aims at reducing by
three-quarters between 1990 and 2015, the maternal mortality ratio. Improving maternal health can in turn serve
as an instrument to achieve other MDGs, especially those that are health related.
The role of improved maternal health is therefore crucial to the achievement of
the MDGs. Close to 500,000 maternal deaths occur every year, 99% taking place
in the developing world. Anaemia is the
major contributory or sole cause of 20-40% of such deaths.14Anaemia
in pregnancy is an important public health problem worldwide. WHO estimates
that more than half of pregnant women in the world have a haemoglobin (Hb)
level indicative of anaemia (Hb<11 .0g="" 56="" 61="" as="" be="" countries.="" developing="" dl="" high="" however="" in="" may="" or="" prevalence="" sup="" the="">15
Estimates of maternal
mortality resulting from anaemia range from 34/100,000 live births in Nigeria
to as high as 194/100,000 in Pakistan.15,16 In many regions, anaemia is a factor in
almost all maternal deaths; it poses a five-fold increase in the overall risk
of maternal death related to pregnancy and delivery.16 The risk of death increases dramatically in
severe anaemia. From local studies done in Zaria, it was reported that
mortality for women during delivery or shortly after was 20% if their
haemoglobin concentration was <5 .0g="" 12.8="" 2.9="" 4.5="" 5.0g="" 6.0="" 6.0g="" 8.0="" and="" as="" average="" between="" concentration="" concentrations="" contrast="" decreased="" dl.="" dl="" for="" g="" hb="" in="" levels="" mortality="" nbsp="" of="" rose:="" sup="" to="">17These rates of maternal
deaths contrast with those in the developed world where maternal mortality is
100 times less and severe anaemia is very rare. A study of this nature has not
been carried out in this facility before, it is therefore, expected that findings
from this study and the appropriate recommendations if implemented, will be of
great help to the facility, Local Government and the country at large in
reducing maternal morbidity and mortality due to anaemia in pregnancy.
1.
What is the prevalence of Anaemia among among
pregnant women attending ANC in Jos south, Plateau state State?
2.
What is the relationship between Anaemia and
various demographic variables?
3.
What is the knowledge of anaemia among pregnant
women attending ANC in
Jos south General
Hospital, Plateau state State?
1.4.1 General Objective
1.4.2 Specific Objectives
1.5 Scope of the Study
This study was limited to pregnant women attending ANC at Jos south
General Hospital, Jos south, Plateau state state.
To assess the
prevalence of anaemia in pregnancy amongst pregnant women attending ANC atJos
south General Hospital,Jos south,Plateau state State.
1.
To determine the knowledge on anaemia amongst
women attending ANC at
Jos south General
Hospital,Jos south,Plateau state State.
2.
To estimate the Hb (PCV) level among the
pregnant women attending ANC at
Jos south General
Hospital,Jos south,Plateau state State.
3.
To determine the factors that predispose to
anaemia in pregnancy amongst pregnant
women attending ANC at
Jos south General Hospital,Jos south,Plateau state State.
================================================================
Item Type: Project Material | Size: 73 pages | Chapters: 1-5
Format: MS Word | Delivery: Within 30Mins.
================================================================
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.