ABSTRACT
Anaemia in pregnancy is among the top health threats in developing countries. Nigeria has adopted several strategies over the years against anaemia but it remains a major cause of infant and maternal deaths. This paper assesses awareness of risk factors and Prevention of anaemia in Pregnancy among Pregnant women. A baseline survey was conducted on 28 pregnant women randomly selected from first 100 consistent antenatal attendees from March to July 2023 at antenatal clinic at Obada in Ewekoro local government. Ogun State. Respondents generally demonstrated awareness of some anemia risk factors, such as the family history of anemia (25%) and the perceived risk of developing anemia during pregnancy (67.59%). However, there were misconceptions and gaps in understanding, as seen in the responses related to the causes of anemia.The results show high anaemia consciousness with few respondents claiming no knowledge of the causes (3%) and effects (14%). The easily known cause of anaemia is poor diet (63%) followed by malaria (26%), worms (5%) and others (6%). Meanwhile, food sources that can fight anaemia are poorly known (18%). Cultural and religious beliefs in food restrictions exist and fairly a significant number of women (38%) are denied potential dietary nutrients. There are potential health risks (including anaemia) associated with existing practices since barriers to parasitic infections like malaria and worms via use of insecticide treated bed nets, intermittent preventive treatment, improved drinking water sources and effective hand washing are compromised. Respondents’ understanding on effective barriers against anaemia in pregnancy needs to be deepened.
TABLE
OF CONTENTS
Title
page i
Declaration ii
Certification iii
Dedication iv
Acknowledgement v
Table
of Content vi
Abstract ix
CHAPTER
ONE: INTRODUCTION TO THE STUDY
1.1 Background of the study 1
1.2 Statement of the Problem 4
1.3 Objectives of the study 5
1.4 Research questions 6
1.5 Research Hypothesis 6
1.6 Significance of the study 6
1.7 Scope of the study 7
1.8 Operational Definition of terms 9
CHAPTER TWO: LITERATURE REVIEW
2.0 Introduction 10
2.1 Conceptual Review 11
2.1.2 Overview of Anemia Pregnancy
12
2.1.3 Types of Anemia during Pregnancy 12
2.1.4 Sign and Symptoms of Anemia in Pregnancy 14
2.1.5 Anemia in Pregnancy: Causes and Consequence 15
2.1.6 Classification of Anemia in Pregnancy 20
2.1.7 Prevention of Anemia in Pregnancy 20
2.1.8 Diagnosis of the cause of Anemia 22
2.1.9 Treatment of Anemia during Pregnancy 23
2.1.10 Risk Factors for Anemia in Pregnancy 23
2.1.11 Effects of Anemia in Pregnancy 24
2.1.12 Management of Anemia in pregnancy 25
2.1.13 Impact of Anemia on Maternal and Fetal Health 27
2.1.14 Awareness of Anemia Prevention among Pregnant
women 27
2.1.15 Practices of Anemia Prevention among pregnant
women 28
2.1.17 Role of Antenatal care in promoting awareness
and practices 29
2.2 Theoretical Review 30
2.2.1 Health Belief Model Theory 30
2.2.2 Theory of Planned
Behaviour 32
2.2.3 Application of the theory 34
2.3 Empirical Review
35
CHAPTER
THREE: RESEARCH METHODOLOGY
3.0 Introduction
37
3.1 Research Design
37
3.2 Research Setting
37
3.3 Target Population
38
3.4 Sample Size and Sampling Technique
38
3.5 Instrument for data collection
38
3.6 Validity of Instrument
39
3.7 Reliability of Instrument 39
3.8 Method of Data Collection
39
3.9 Method of Data Analysis
39
3.10 Ethical Consideration 40
CHAPTER
FOUR: DISCUSSION OF FINDINGS
4.1 Demographic Characteristics among
Respondent 41
4.2 Awareness of Anemia and its Health Impact
44
4.3 Education on Anemia prevention during
antenatal visits
46
4.4 Healthcare
providers as information sources 49
CHAPTER FIVE: DISCUSSION OF
FINDINGS
5.1 Summary of findings
55
5.2 Implication of findings to nursing
practice
56
5.3 Limitation of the study
58
5.4
Conclusion 58
5.5 Recommendation
59
References
61
Appendix
I
64
Appendix
II
65
LIST OF TABLES
Table
4.1: Demographic Characteristics
among Respondent
41
Table
4.2: Awareness of Anemia and its
Health Impact
44
Table
4.3: Education on Anemia prevention
during antenatal visits 46
Table 4.4: Healthcare providers as information sources 49
CHAPTER ONE
INTRODUCTION
1.1
Background to the Study
Womanhood
is the period in a female's life after she passes through childhood and
adolescence, generally age 18. Pregnancy is a unique, exciting and often joyous
time in a woman's life as it highlights the woman's amazing, creative and
nurturing powers while providing a bridge to the future (Aruna, 2021).
Pregnancy comes with some cost, however, for the pregnant woman also needs to
be a responsible woman to best support the health of her future child. The
growing foetus depends entirely on its mother's healthy body for all needs.
Consequently, pregnant women must take steps to remain as healthy and
well-nourished as they possibly can. Pregnant women should take into account
the many healthcare and lifestyle considerations since pregnant women need healthy
and nutritious food in order for their baby to be healthy (Baby, Venugopal et,
2019).
The lack of nutritional and other factors may cause
many of the problems during the antenatal period. One of the major problems
that can be detected in antenatal mothers in developing countries is anaemia
during pregnancy (Aruna, 2021). Anaemia has been defined by the World Health
Organization (WHO) as “a condition in which the number of red blood cells
(RBCs) or their oxygen-carrying capacity is inadequate to meet physiologic
demands in the body, in which the haemoglobin level may vary by age, sex,
altitude, smoking, and pregnancy status (WHO, 2019). Anaemia in pregnancy is
identified by the WHO as haemoglobin level less than 11g/dl and is divided into
three levels of severity, Mild anaemia (Hb level, 9 - 10.9g/dl), Moderate
anaemia (Hb level, 7 - 8.9g/dl) and severe anaemia (Hb level 7 - 4.5 g/dl)
(Margwe, 2018). Pregnancy is a period of a significant increase in iron
requirement, and hence the risk of suffering from anaemia is higher than in
non-pregnant state. Although iron requirements are reduced in the first
trimester because of the absence of menstruation, they rise steadily thereafter
from approximately 0.8 mg per day in the first month to approximately 10 mg per
day during the last 6 weeks of pregnancy (Tay et al., 2021). The demand is
higher due to physiological changes in maternal red blood cell mass and also
due to the needs of the development and growing of the placenta and foetus.
Despite increased iron requirements, pregnancy is also a period of increased
risk for anaemia; so far reduction and control of anaemia prevalence among
women remains prioritized as a public health problem, especially in women of
childbearing age worldwide (Margwe, 2018). During pregnancy women might suffer
anaemia during first trimester (Bardishi 2018), second trimester (Alene and Dohe, 2014) as well as third trimester (Lealem, 2017).
Anaemia is a major public health problem throughout
the world (Adznam Zedek, 2018). Anemia is defined as decrease in Hb
levels to below the normal range of 13.5 gm/dl (men), 11.5 gm/dl (women), and
11.0 gm/dl (children and pregnant women). The effect on the individual will
depend on the severity and speed of onset of anemia and the degree to which the
oxygen-carrying capacity of the blood is diminished Baby, (Venugopal et al, 2018). Signs and symptoms include
pallor of the mucous membrane, fatigue, dizziness and fainting, headache,
exertion, shortness of breath, tachycardia, and palpitation. Very severe anemia
is defined as an Hb level <4 gm/dl in pregnant women; this is a medical
emergency due to the risk of congestive heart failure and maternal death (World Health Organization, 2014).
Moreover, malaria infection contributes to anaemia
throughout the life, especially during pregnancy, and it is estimated that in
sub-Saharan Africa 23 million pregnant women are exposed to malaria infection
annually and approximately 400 000 pregnant women develop moderate or severe
anaemia each year (Margwe, 2018). There are so many factors that cause anaemia
during pregnancy among them parasitic infection is major in developing
countries (Roberts et al. 2011). Despite anaemia having been identified as a
global public health problem for several years, no rapid progress has been
observed, and the prevalence of the disease is still high globally (Margwe,
2018).
Anaemia impairs health and well-being in women and
increases the risk of maternal and neonatal adverse outcomes. Mild anaemia may
not have any effect on pregnancy and labour except that the mother will have
low iron stores and may become moderately-to-severely anemic in subsequent
pregnancies. Moderate anaemia may cause increased weakness, lack of energy,
fatigue and poor work performance. Severe anaemia, however, is associated with
poor outcome. The woman may have palpitations, tachycardia, breathlessness,
increased cardiac output leading on to cardiac stress which can cause
de-compensation and cardiac failure which may be fatal. Maternal anaemia also
contributes to an increase in perinatal mortality, low birth weight, still
birth and foetal wastage. Anaemia in pregnancy reduces tolerance to blood loss
and leads to impaired function and cardiac failure (Anlaakuu
at Anto, 2017). Increased incidence of pre-term labour (28.2%),
pre-eclampsia (31.2%) and sepsis have been associated with anaemia. Adverse
perinatal outcome in the form of pre-term and small-for-gestational-age babies
and increased perinatal mortality rates have been observed in the neonates of
anaemic mothers.
Awareness refers to the “fact" "state or
level of consciousness where sense data can be confirmed by the observer"
or can be defined more broadly and simply as" knowledge or perception of a
situation or fact" (Anthony, 2019). Knowledge
is the springboard for action (Ethiopia mini
demographic and health survey, 2017). It is believed that improving
awareness motivates behavioural change and it is possible that limited
knowledge about anaemia interferes with ANC attendance, iron supplements use,
dietary practices and the use of anti-helminthes medicine (Duko et al, 2018).
In order to prevent anaemia, mothers must not only understand the problem but
also social circumstances that give rise to it (Aruna, 2021). Based on these
facts, this study aims at Assessing the awareness and practices of anaemic
prevention among pregnant woman attending antenatal clinic in federal medical
centre Abeokuta, Ogun State
This
study focuses on assessing the awareness and practices of anemia prevention
among pregnant women attending antenatal clinics at the Federal Medical Centre
(FMC) in Abeokuta, Nigeria. FMC Abeokuta is a major healthcare facility that
serves a large population, including women from both urban and rural settings.
Understanding the level of awareness and the types of preventive practices
adopted by these women is essential for identifying gaps in knowledge and
barriers to effective anemia prevention. The findings from this study are
expected to provide valuable insights that can guide the development of more
effective health education programs and interventions, ultimately leading to
better maternal and child health outcomes in the region.
1.2 Statement of Problem
Anemia
during pregnancy is a significant public health concern globally, including at
Federal Medical Centre Abeokuta Ogun State Anemia in pregnant women can lead to
severe health complications, including increased risk of maternal and fetal
mortality, preterm delivery, low birth weight, and impaired cognitive and
physical development in infants. Despite the availability of preventive
measures, the prevalence of anemia among pregnant women remains high,
suggesting gaps in awareness and the adoption of recommended practices for
anemia prevention.
There
is a need to assess the awareness levels and practices related to anemia
prevention among pregnant women to identify the factors contributing to the
persistence of anemia. Many pregnant women may not be fully informed about the
importance of iron supplementation, proper nutrition, and regular prenatal check-ups.
Cultural beliefs, socio-economic status, educational background, and access to
healthcare services may also influence their knowledge and practices.
Understanding these factors is crucial for developing targeted interventions
that can effectively address the gaps in knowledge and practices, ultimately
reducing the incidence of anemia in pregnant women. This study aims to assess
the awareness and practices of anemia prevention among pregnant women at
Federal Medical Centre Abeokuta Ogun State identify barriers to effective
prevention, and recommend strategies to enhance anemia prevention efforts.
1.3 Objective of the
Study
The
Main Objective
The main objective of the study is to
enhance the Federal Medical Centre Abeokuta Ogun State
Specific
Objectives:
i.
To determine the extent
of awareness pregnant women have regarding anemia, its causes, symptoms, and
potential health impacts on both the mother and the fetus in Federal Medical
Centre, Abeokuta, Ogun State.
ii.
To investigate the
current practices adopted by pregnant women for the prevention of anemia in
Federal Medical Centre, Abeokuta, Ogun State.
iii.
To identify the primary
sources through which pregnant women receive information about anemia
prevention in Federal Medical Centre, Abeokuta, Ogun State.
iv.
To identify the barriers
that hinder the effective prevention of anemia among pregnant women, including
cultural beliefs, accessibility to healthcare services, and economic
constraints.
1.4 Research Questions
The
following research question will be answered in this study:
i.
What is the level of
awareness among pregnant women regarding anaemia and its health impacts?
ii.
What practices do
pregnant women adopt for anaemia prevention, including diet and supplements?
iii.
What are the primary
sources of information about anaemia prevention for pregnant women?
iv.
How do socio-demographic
factors influence anaemia awareness and prevention practices among pregnant
women?
v.
What barriers hinder
effective anaemia prevention, and what strategies can improve awareness and
practices?
1.5 Research Hypotheses
H₀: There
is no significant relationship between the level of awareness of anaemia
prevention and the practices adopted by pregnant women attending antenatal
clinics at the Federal Medical Centre, Abeokuta.
1.6 Significance of the
Study
This
study is significant as it aims to improve maternal and fetal health by
identifying gaps in awareness and practices related to anaemia prevention among
pregnant women. Understanding these gaps will help in developing targeted
educational programs and interventions to enhance knowledge and encourage
effective preventive practices. The findings will provide valuable insights for
healthcare providers and policymakers to address barriers and improve access to
anaemia prevention resources. Ultimately, this study aims to reduce the
prevalence of anaemia during pregnancy, thereby decreasing the associated
health risks for both mothers and their babies.
1.7 Scope/
Delimitation of the Study
This study was delimited to 100 pregnant women
attending antenatal clinics in Federal Medical Centre Centre, Abeokuta, Ogun
State. It was delimited to respondents irrespective of their socio-economic
factors, parity, level of education and religious affiliation.
1.8 Definitions of Terms
·
Anaemia: Anaemia is a medical condition characterized by a deficiency of
red blood cells or hemoglobin in the blood, leading to reduced oxygen transport
to body tissues. In pregnancy, anaemia is often caused by iron deficiency and
is associated with fatigue, weakness, and increased risk of maternal and fetal
complications.
·
Anaemia Prevention: Refers to the strategies and practices aimed at reducing the risk
or occurrence of anaemia. These may include dietary adjustments, iron and folic
acid supplementation, early diagnosis, and proper antenatal care.
·
Awareness: Awareness refers to the knowledge and understanding that pregnant
women have about anaemia, its causes, risk factors, and methods of prevention.
It involves the level of information women possess about maintaining healthy
hemoglobin levels during pregnancy.
·
Practices: Practices refer to the actions or behaviors adopted by pregnant
women to prevent anaemia. This can include adherence to iron supplementation,
consumption of iron-rich foods, and regular antenatal care visits.
·
Pregnant Women: Women who are carrying one or more foetuses and are undergoing
physiological changes as a result of pregnancy. In this study, the term refers
specifically to those attending the antenatal clinic at the Federal Medical
Centre in Abeokuta.
·
Antenatal Care (ANC): Antenatal care is the routine health care provided to pregnant
women during their pregnancy. This includes medical check-ups, nutritional
guidance, health education, and monitoring for potential complications such as
anaemia.
·
Federal Medical Centre
(FMC), Abeokuta: A tertiary healthcare
facility located in Abeokuta, Ogun State, Nigeria. It provides specialized
medical services, including antenatal care for pregnant women.
·
Iron Deficiency: A condition where the body lacks enough iron to produce adequate
hemoglobin, leading to anaemia. In pregnant women, this is one of the most
common causes of anaemia and is preventable through diet and supplementation.
·
Haemoglobin: A protein in red blood cells responsible for transporting oxygen
from the lungs to the rest of the body. Low haemoglobin levels are a key
indicator of anaemia, which can adversely affect both maternal and fetal
health.
·
Iron Supplementation: The practice of taking additional iron in the form of tablets or
liquid to prevent or treat iron deficiency anaemia, particularly during
pregnancy when the body’s demand for iron increases.
·
Dietary Practices: Refers to the food consumption habits of pregnant women,
especially those practices aimed at preventing anaemia, such as eating
iron-rich foods (like leafy vegetables, meat, and legumes) and foods rich in
vitamin C to enhance iron absorption.
·
Maternal Mortality: The death of a woman during pregnancy, childbirth, or within the
postpartum period. Anaemia during pregnancy is a significant contributor to
maternal mortality, making prevention and management critical.
·
Fetal Complications: Health issues or risks that can affect the unborn child, such as
low birth weight, preterm birth, or developmental delays, often associated with
maternal anaemia.
·
Health Education: The process of providing pregnant women with knowledge and
information on anaemia prevention, including understanding symptoms, risk
factors, and the importance of dietary intake and supplementation.
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