CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
Anemia emerges as a prominent deficiency disorder related to nutrition that affects pregnant women globally, spanning both developed and developing nations (Suryanarayana et al., 2017). Anemia is a condition characterized by insufficient healthy red blood cells responsible for adequately transporting oxygen throughout the body. The term "Anemia" itself conveys its meaning, where "an" denotes "without" and "hema" signifies blood. Those afflicted by anemia experience constant fatigue and weakness. Anemia can be defined by the concentration of hemoglobin in the body, which varies based on individual and gender differences (Khalid & Nasrullah, 2019).
In 2008, the World Health Organization (WHO) established a criterion for anemia during pregnancy, stipulating that it is characterized by a hemoglobin (Hb) concentration lower than 11 g/dl. Anemia ranges in severity from mild to moderate and severe, with WHO setting hemoglobin levels for each category during pregnancy at 10.0 – 10.9g/dl (mild), 7 – 9.9g/dl (moderate), and below 7g/dl (severe). Pregnancy often leads to anemia due to the heightened demand for iron and other vitamins resulting from the physiological demands of gestation. Failure to meet these substance requirements due to dietary deficiencies or infections leads to anemia (Idowu et al., 2005).
According to the World Health Organization (WHO), anemia becomes a matter of public health significance when its occurrence within a population reaches 5.0% or exceeds this threshold. A prevalence rate of ≥40% is categorized as a grave public health problem (WHO, 2008). The prevalence of anemia during pregnancy exhibits significant variation across regions.
Globally, approximately 800 million women and children are estimated to be affected by anemia. Adolescent girls and pregnant women are particularly vulnerable due to menstruation and increased metabolic demands during pregnancy. Worldwide, around 42.0% of pregnant women experience anemia (Tunkyi & Moodley, 2015).
Within Southeast Asia, pregnant women experience a prevalence of anemia at a rate of 48.0%. Alarmingly, anemia during pregnancy stands as the culprit behind half of the global maternal deaths. In particular, a striking 80% of these deaths are concentrated in India, as indicated by Debnath et al. (2021) and Singh et al. (2015). Conversely, South America boasts the lowest prevalence, recorded at 24.1%. Meanwhile, Africa grapples with a notably high prevalence of anemia among pregnant women, measuring at 57.1% based on studies by Lebso et al. (2017). Notably, prior research in Tanzania has unveiled a wide spectrum of anemia prevalence rates during pregnancy, spanning from 18.0% to 68.0%, according to Kara et al. (2020).
The overall prevalence of anemia among pregnant women was reported as 41.0% in Ethiopia and 45.0% in Ghana (Wemakor, 2019; Woldegebriel et al., 2020). Despite limited data for Southern Africa, a study in South Africa found a prevalence of 42.7% (Tunkyi & Moodley, 2018). Notably, there is no available record of prior studies on anemia in pregnancy in Eswatini. According to the World Health Organization (WHO), anemia in pregnant women represents a significant health issue in low-income countries (LICs) (WHO, 2008).
Anemia during pregnancy poses a risk factor for adverse pregnancy outcomes, potentially giving rise to life-threatening complications for both the mother and the fetus. The repercussions for the fetus encompass stillbirths, low birth weight, intrauterine growth restriction, premature birth, perinatal mortality, and neonatal sepsis. In the later stages of pregnancy, anemia leads to insufficient fetal iron reserves, which can have irreversible impacts on the fetal brain and neurotransmitter systems, subsequently affecting postnatal babies and leading to developmental disorders (Dodzo et al., 2022).
The effects of pregnancy-related anemia might correlate with its severity. For instance, mild anemia might not immediately affect the ongoing pregnancy but could deplete maternal iron reserves and influence subsequent pregnancies. Furthermore, pregnant individuals with anemia are more susceptible to various complications, including reduced work efficiency, heightened risk of cardiovascular diseases, preterm labor and delivery, postpartum bleeding, compromised immune function, and maternal mortality. In developing countries, anemia during pregnancy has been estimated to contribute to 23% of the indirect causes of maternal deaths (Dodzo et al., 2022).
Multiple factors have been identified as contributors to anemia among pregnant women. The foremost cause is iron deficiency, often accompanied by deficiencies in other vital nutrients. Roughly 40% of women start their pregnancies with insufficient iron stores, which fail to meet the heightened iron demands during gestation (Wiegersma et al., 2019). Other contributing factors encompass physiological hemodilution, underlying inflammatory conditions, and malnutrition, leading to inadequate intake of essential vitamins, proteins, iron, and iodine. Furthermore, in Sub-Saharan Africa (SSA), infections like malaria, helminths, and human immunodeficiency virus (HIV) also play a role in causing anemia during pregnancy (Mishra et al., 2021).
Addressing anemia during pregnancy presents a potentially viable and cost-effective strategy to mitigate the risks of maternal, fetal, and perinatal mortality and morbidity. The effective management of anemia hinges upon identifying its underlying causes, as appropriate treatment is necessary to prevent recurring instances of anemia. Generally, the approach to managing anemia in pregnant individuals is contingent upon factors such as the pregnancy's stage, the severity of the anemia, and the presence of obstetric, medical, or combined complications (Oliver and Olufunto, 2012).
This study aims to delve into the prevalence and strategies for managing anemia among pregnant women in Portharcourt, located in Rivers State, Nigeria.
1.2 Statement of the Problem
Anemia during pregnancy exhibits a significant global prevalence, particularly in developing nations like Nigeria. Within Nigeria, local prevalence rates vary, ranging from 35.3% in Lagos to 72.0% in Kano State. In countries like Nigeria, where development is ongoing, the primary causes of anemia are largely preventable, encompassing deficiencies in nutrients like iron and folate, parasitic infections such as malaria and hookworm, hemoglobin disorders, and more recently, human immunodeficiency virus (HIV) infection.
Despite the implementation of iron and folate supplementation as well as anti-malarial prophylaxis, the substantial prevalence of anemia during pregnancy underscores the presence of other underlying factors that contribute to its high occurrence in Nigeria. An often overlooked factor is socio-economic deprivation, which has been shown to be linked to the onset, severity, and outcomes of numerous medical conditions. Maternal anemia gives rise to health challenges and fatalities both for the mother and the unborn child. To counter this, the World Health Organization (WHO) has established strategies to manage anemia during pregnancy and reduce maternal mortality.
While anemia is a prevalent issue in Nigeria, it remains inadequately investigated. There is a scarcity of published research exploring the prevalence and management of anemia, particularly within various regions of Nigeria, including the location of the current study.
1.3 Aim of the Study
The aim of this study is to assess the prevalence of anaemia among pregnant women in Portharcourt, Rivers State, and to explore the existing management strategies.
1.4 Objectives of the Study
This study has the following objectives:
- To determine the prevalence of anaemia among pregnant women in Portharcourt, Rivers State.
- To identify the existing management strategies for anaemia in Portharcourt, Rivers State.
- To assess the effectiveness of current anaemia management strategies in the study area.
1.5 Research Questions
- What is the prevalence of anaemia among pregnant women in Portharcourt, Rivers State?
- What are the existing management strategies for anaemia in Portharcourt, Rivers State.
- How effective are the current strategies for managing anaemia in pregnant women?
1.6 Research Hypothesis
H0: The effectiveness of current anaemia management strategies in Portharcourt, Rivers State, is not positively correlated with better maternal and fetal health outcomes
Ha: The effectiveness of current anaemia management strategies in Portharcourt, Rivers State, is positively correlated with better maternal and fetal health outcomes
1.7 Justification of the Study
The significance of this study stems from the urgent need to address the prevailing issue of anemia among pregnant women in Portharcourt, Rivers State. Despite advancements in healthcare and nutrition, anemia continues to have a detrimental impact on maternal and fetal health, leading to adverse pregnancy outcomes and contributing to maternal mortality. By investigating the prevalence and management strategies for anemia within this specific population, this study aims to contribute valuable insights that can inform healthcare policies and interventions.
1.8 Scope of the Study
This study will focus exclusively on the prevalence and management of anemia among pregnant women in Portharcourt, Rivers State, Nigeria. It will encompass a comprehensive analysis of the prevalence rates, the strategies currently employed to manage anemia among pregnant women in the study area as well as their effectiveness.
