ABSTRACT
Anaemia is one of the adverse complications in pregnant women in the developing countries, which may affect both the mother and her child’s health. The present study was designed to determine the prevalence of anaemia in pregnant women and infants between the ages of 0 to 5 years in Umuahia North Local Government Area. One hundred (100) consenting pregnant women and one hundred and fifty (150) infants were used for the study. A semi-structured interviewer administered questionnaire was used to obtain information on sociodemographic and socioeconomic characteristics. Blood samples were collected under sterile condition and haemoglobin (Hb) concentrations, packed cell volume (PCV), red blood cell, mean corpuscular volume (MCV), platelets, selenium, iron, folate, vitamin B12, ascorbate and vitamin A were determined. Results showed that iron and selenium concentrations of pregnant women who attended Anelechi hospital were significantly (p<0.05) higher than those who attended FMC. The vitamin B12 concentration was significantly (p<0.05) lower for pregnant women who attended Anelechi Hospital compared to those who attended FMC. However, vitamin A and Vitamin B9 concentrations of pregnant women who attended Anelechi hospital were not significantly (p>0.05) different. Results showed that vitamin A, vitamin B12 and iron concentrations of infants who attended FMC were significantly (p<0.05) higher than those who attended both Anelechi and Healing Cross Hospitals, while Anelechi hospital was insignificantly (p>0.05) higher than Healing Cross Hospital. Results showed that the RBC of the pregnant women who attended FMC was significantly (p<0.05) higher than those who attended Anelechi hospital, while no significant (p>0.05) difference was observed for Hb and PCV. Results showed that Hb, PCV, MCV, Platelets, and RBC of infants who attended Anelechi, FMC and Healing Cross Hospitals were significantly (p<0.05) different. Results also showed that infants who attended Anelechi Hospital and FMC had significantly (p<0.05) higher Hb, PCV, and RBC compared to those who attended Healing Cross Hospital while the MCV of infants who attended Anelechi hospital was significantly higher (p<0.05) than those who attended both FMC and Healing Cross Hospitals. The evaluation of blood samples for parasitemia revealed 10% and 22% prevalence for both FMC and Anelechi Hospitals, respectively. Overall prevalence of anaemia observed among all pregnant women and infants was 14% and 18%, respectively. Severe anaemia was not observed in any of the participants. The study established that prevalence of anaemia among pregnant women and infants in the studied area was not high. Therefore, continuous education of women of reproductive age on early antenatal booking and compliance with the use of prescribed medications (iron supplements, folate and antimalarials) should also be emphasized to reduce to the barest minimum, the problem of anaemia in pregnancy.
TABLE
OF CONTENTS
Title Page i
Declaration ii
Certification iii
Dedication iv
Acknowledgements v
Table of Contents vi
List of Tables xi
List of Figures xi
Abstract xii
CHAPTER
1: INTRODUCTION 1
1.1 Background
of the Study 1
1.2 Statement
of the Problem 2
1.3 Aim
of the Study 3
1.4 Objectives
of the Study 3
1.5 Justification
of the Study 4
CHAPTER 2:
LITERATURE REVIEW 6
2.1 Overview
of Anaemia 6
2.2 Epidemiology of Anaemia 7
2.3 Anaemia
in Pregnant Women 9
2.4 Anaemia
in Infants 11
2.4.1 Iron
deficiency in infancy and early childhood 12
2.5 Causes of Anaemia 13
2.6 Clinical Features of Anaemia 17
2.6.1 Symptoms 17
2.6.2 Signs 18
2.7 Effects of Anaemia on Pregnancy Outcome 18
2.7.1 Effect of anaemia on maternal morbidity and
mortality 18
2.7.2 Effect of maternal anaemia on birth weight 20
2.8 Diagnosis and Assessment of Anaemia 21
2.8.1 Primary investigations in a patient with
anaemia 21
2.8.2 Secondary investigations in a
patient with anaemia 22
2.9 Management of Anaemia 23
2.9.1 Iron therapy 23
2.10 Haematological
Indices 25
2.10.1 Haemoglobin 26
2.10.1.1 Structure of haemoglobin 27
2.10.1.2 Function of haemoglobin 28
2.10.2 White blood cells (WBC) 28
2.10.3 Packed cell volume (PCV) 29
2.10.4 Red blood cells 29
2.11 Vitamins
and Minerals 29
2.11.1 Thiamine (B1) 30
2.11.2 Riboflavin (B2) 30
2.11.3 Niacin 30
2.11.4 Ascorbic Acid 31
2.11.5 Vitamin A 32
2.11.6 Vitamin E 32
2.11.7 Iron 32
2.11.8 Selenium 33
CHAPTER 3:
MATERIALS AND METHODS 34
3.1 Materials 34
3.1.1 List of chemicals/reagents used 34
3.1.2 List of equipment used 35
3.1.3 The
study area 36
3.2 Methods 37
3.2.1 Design of the study 37
3.2.2 Method
of data collection 37
3.2.3 Sample
collection and processing 37
3.2.4 Biochemical analyses 38
3.2.4.1 Determination of haematological parameters 38
3.2.4.2 Determination of folate 38
3.2.4.3 Determination of vitamin B12 39
3.2.4.4 Determination of iron 40
3.2.4.5Determination of vitamin A 41
3.2.4.6Determination of selenium
concentration 42
3.2.4.7 Rapid diagnostic test 43
3.3 Statistical
Analysis 44
CHAPTER 4: RESULTS
AND DISCUSSION 45
4.1 Results 45
4.1.1 Socio
demographic and socio economic analysis for pregnant
women
examined in Federal Medical Centre (urban) and Anelechi
Hospital
(semi-urban) 45
4.1.2 Micronutrient status of pregnant women
examined in Federal
Medical
Centre and Anelechi Hospital 47
4.1.3 Hematological indices of pregnant women
examined in Federal
Medical
Centre and Anelechi Hospital 48
4.1.4 Malaria parasite status of pregnant women
examined in Federal
Medical
Centre and Anelechi Hospital 49
4.2 Socio-economic
data of infants (0-5 Years) evaluated in Federal
Medical
Centre (Urban), Anelechi Hospital (Semi-urban) and Healing
Cross
Hospital (Rural) 49
4.2.1 Micronutrient
status of infants (0-5 Years) examined in Federal
Medical
Centre (urban), Anelechi Hospital (semi-urban) and Healing
Cross
Hospital (rural) 51
4.2.2 Haematological
indices of infants (0-5 years) in Federal Medical Centre
(urban),
Anelechi Hospital (semi-urban) and Healing Cross Hospital
(rural) 52
4.3 Discussion 53
4.3.1 Socio
demographic and socio economic characteristics of the respondents 53
4.3.2 Interaction
of infection and anaemia based on response of respondents 53
4.3.3 Haematological
parameters 54
4.3.4 Vitamins and minerals 56
4.3.5 Prevalence
of anaemia 59
CHAPTER 5:
CONCLUSION AND RECOMMENDATIONS 61
5.1 Conclusion 61
5.2 Recommendations 62
References 64
Appendices 79
LIST
OF TABLES
3.1: List of
chemicals and reagents and their manufacturers. 34
3.2: List of
equipment and their manufacturers. 35
4.1: Socio-Demographic
and Socioeconomic Characteristics of Respondents 79
4.2: Awareness
of Respondents to supplementation programs 80
4.3: Awareness
of Respondents to prevention and treatment for malaria 81
4.4: Result for vitamin and mineral status
assay for pregnant women 47
4.5: Result for haematological status of
pregnant women 48
4.6: Prevalence
of Parasitemia 49
4.7a: Prevalence of anaemia among pregnant women
attending FMC 82
4.7b: Prevalence of anaemia among pregnant women
attending Anelechi
Hospital 82
4.8: Socio-Demographic
Characteristics of Respondents (infants) 83
4.9: Nutritional
profile of the infants 84
4.10: Result of vitamin and mineral status for
infants 51
4.11: Result of hematology status for infants 52
4.12: Prevalence of anaemia among infants
attending FMC, Anelechi and
Healing Cross Hospitals 85
LIST OF FIGURES
PAGE
2.2: The
structure of the haem group and haemoglobin molecule 28
3.1: Map of the study locations 36
CHAPTER
1
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Anaemia is said to be one of the major global health
challenges which affects an estimated 42% of pregnant women worldwide (Tunkyi
and Moodley, 2015).
The World Health Organization (WHO) described anaemia as “a health condition in
which the amount of red blood cells or their oxygen-carrying capacity is
inadequate to meet the physiological needs of the individual” (WHO, 2011). Anaemia
is also one of the most common and widespread nutritional deficiency complaints
in the world. WHO global report on anaemia for 1995-2011 estimated a global
prevalence rate of anaemia among women of reproductive age at 29.4%, which
affects over 528.7 million women (Stevens et
al., 2013; WHO, 2011).
According
to Viteri (1994), the health-conscious world community has grasped that anaemia,
the mainstream of which is due to iron deficiency, has severe functional and
health consequences. This condition is prevalent mostly among tropical
low-income inhabitants, and has majority of its nutritional constituent
manageable with a very high advantage/cost ratio. Particularly women of
reproductive age, pregnant women, lactating mothers, their infants and young
children are the most vulnerable (Viteri, 1994).
John
(2014) reported that women who are still reproducing and pregnant women are at
highest risk of suffering negative balance and iron deficiency due to their
increased iron needs because of menstruation and demands of pregnancy. The
dangers of iron deficiency in pregnancy and lactation starts with inadequate
pregnancy iron reserves among women of reproductive age.
Pregnant women may be symptomatic at Hb levels lower
than the World Health Organization standard. The symptoms which are often
unclear may include tiredness, confusion, weakness, loss of consciousness, shortness of breath or a reduced
ability to exercise, or increased thirst (Janz et al., 2013).
In
reaction to the overwhelming evidence, world authorities have agreed that by
the end of this century, anaemia present in pregnant women must be reduced by
1/3 (Viteri, 1994). The more aggressive groups have confidence that with new
methods for the control of iron deficiency, a reachable aim is to reduce iron
deficiency anaemia to levels below 10% in most populations (Viteri, 1992). According to Onwuhafua et al. (2018), various measures, including health education and women
empowerment, have been put in place to remedy the high occurrence of anaemia
and other health hazards in women, their unborn babies and their children in
this environment.
1.2 STATEMENT OF THE PROBLEM
Anaemia is said to be one of the commonest public
health problem affecting developing countries,
and studies of anaemia generally focus on children or pregnant women, among
whom the burden is highest (Adamu et al.,
2017). Anaemia in children continues
to be the main public health challenge in most developing countries, mostly in
Africa, and is believed to have serious negative consequences on the cognitive,
growth and development of children, which may continue even after treatment,
especially, in the early phases of life (Ewusie
et al., 2014). Data collected from all over the world indicate that a total
of 2170 million people (men, women and children) are anaemic by WHO criteria,
with the most affected groups, in approximately ascending order being adult
men, school children, the elderly and pregnant women (Munasinghe and van den
Broek, 2006). Prevalence rates in pregnant women, mostly in developing
countries, are commonly estimated to be within the range of 40%–60%. Among
non-pregnant women, it is 20%–40% and in adult men and school aged children,
the estimate is around 20% (WHO, 1992). Available
data indicate that up to 60% of pregnant Nigerian women, especially those in
the rural areas, are anaemic during their pregnancy (John, 2014). This anaemia
is mostly due to the nutritional deficiency of folic acid, iron, vitamins and
trace elements (da Silva Lopes et al.,
2018). Hence, it is more common among the poor and malnourished women.
Nutritional anaemia is the major cause of adverse outcomes of pregnancy in
Nigerian women. It is a direct and indirect cause of maternal and perinatal
morbidity and mortality (Brabin et al.,
2001).
Several Nigerian women have died
during pregnancy because of severe anaemia (Hb<6.0g/l) (WHO, 1982). 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 (WHO, 1982).
Anaemia has been termed the most
frequent maternal complication of pregnancy, hence, antenatal care should
therefore be concerned with its early detection and management. Also, the
knowledge of this disorder, detection, risk factors, resulting complication and
management is important, especially among the risked population (Townsley,
2013).
1.3 AIM OF THE STUDY
The aim of this study was basically
to ascertain the occurrence of anaemia in infants within the age range of 0-5
years and pregnant women within urban and semi-urban areas in Umuahia, North
L.G.A. of Abia State.
1.4 OBJECTIVES OF THE STUDY
i.
To ascertain anaemia in
both pregnant women and infants (0-5years) by screening their whole blood
samples for haemaglobin level, red blood cell count, packed cell volume and
mean corpuscular volume.
ii.
To determine the level of
malaria in blood samples of women attending antenatal.
iii.
To evaluate vitamins (A,
B9, B12) and minerals (iron and selenium) contents of the
patients’ blood samples
iv.
To establish presence of
double load of malnutrition and anaemia in the affected population
1.5 JUSTIFICATION OF THE STUDY
Anaemia in infants is of interest since it impairs
their mental, physical and social development. It also causes negative
cognitive and behavioral effects, resulting in poor school performance and work
ability in future (Ewusie et al.,
2014). The report on safe motherhood and
maternal health by WHO showed that maternal mortality is unacceptably high,
especially in developing nations and progress to reduce it in most parts of the
world is slow (Hill et al., 2007). Maternal
mortality has remained unacceptably high across much of the developing world,
constituting the area of least progress among all MDGs” (United Nations, 2009).
Moreover, with a few notable exceptions, little progress has been reported in
the global decline of maternal mortality over the past decade. Improving
maternal well-being is the fifth Millennium Development Goal (MDG) that aimed
at decreasing by three-quarters between 1990 and 2015, the maternal mortality
percentage. Improving maternal health will in turn serve as an instrument to
acquire other MDGs, especially the health related ones. The role of enhanced
maternal health is therefore vital to the achievement of the MDGs. About
500,000 maternal deaths arise every year, 99% taking place in the developing
world (Prata et al., 2010). In
Africa, two-third of every pregnant and half of every non-pregnant women have anaemia
(Hassan et al., 2014). Anaemia during
pregnancy is one of the primary causes of poor pregnancy outcomes in Nigeria
(Sholeye et al., 2017). One of the
most universally encountered medical conditions during pregnancy is anaemia.
According to the United Nation declaration (1997), anaemia is a major public
health challenge that needs to be completely eliminated. In developing
countries, it is a cause for serious concern because, besides many other
negative effects on the mother and the fetus, it contributes significantly high
maternal mortality. Estimation of two billion people suffer from anaemia or
iron deficiency globally (Massawe, 2002).
Data
obtained from this study will be helpful to evaluate patients with respect to anaemia
and provide them with need-based treatment, reproductive health information and
precautions, dietary and lifestyle advice. Also, it is expected that findings
from this study and the appropriate recommendations if implemented, will be of
great help to the healthcare providers/facilitators, Local Government and the
country at large in decreasing maternal mortality and morbidity due to anaemia
in pregnancy. Thus, any study conducted on this subject is of significance in
terms of public health and enhancing women’s health.
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