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                                           CHAPTER ONE

                                         INTRODUCTION

1.1 BACKGROUND OF THE STUDY

This study “anemia in pregnancy” outlines varieties of physiological changes that women experience during pregnancy. Most especially, changes in the blood circulatory system are usually notable, permitting normal fetal growth. For instance, in a normal pregnant women, the hemoglobin concentration decreases with dilution according to the increase in the volume of circulating blood. Since iron and folic acid in amounts necessary to the fetus are preferentially transported to the fetus, the mother is likely to develop iron deficiency anemia and folic acid deficiency anemia. About 20% of pregnant women suffer anemia, and most of the cases are iron deficiency, folic acid deficiency, or both. Anemia is the most common nutritional deficiency disorder in the world. WHO has estimated that prevalence of anemia in developed and developing countries in pregnant women is 14 per cent in developed and 51 per cent in developing countries and 65-75 percent in India. Prevalence of anemia in all the groups is higher in India as compared to other developing countries. Anemia is a lack of functioning red blood cells (RBCs) that leads to a lack of oxygen-carrying ability, causing unusual complications during life time. These RBCs are produced in the bone marrow. They have a life expectancy of about 120 days. Among other things, the body needs iron, vitamin B12 & folic acid for erythropoiesis. If there is a lack of one or more of these ingredients or there is an increased loss of RBCs, anemia develops. Any patient with a Hb of less than 11 gm/dl to 11.5 gm/dl at the start of pregnancy will be treated as anemic. The reason is that as the pregnancy progresses, the blood is diluted and the woman will eventually become anemic. The dilution of blood in pregnancy is a natural process and starts at approximately at the eighth week of pregnancy and progresses until the 32nd to 34th week of pregnancy. Anemia is seen as one of the most commonly encountered medical disorders during pregnancy. In developing countries like Nigeria it is a cause of serious concern as, besides many other adverse effects on the mother and the fetus it contributes significantly high maternal mortality. According to United Nation declaration 1997, anemia is a major public health problem that needs total elimination. It is estimated that globally two billion people suffer from anemia or iron deficiency.   Pregnancy which is not just a matter of waiting to give birth but a joyful and a fulfilling period in a woman’s life. It can also be one of the experiences of misery and suffering when complications or adverse circumstances compromise the pregnancy, causing ill health or even death. Anaemia in pregnancy is a common and serious problem in developing countries. Anaemia is the term used to describe the condition in which there is a reduction in the concentration of hemoglobin in the blood stream to a level below 11gm/dl for pregnant women. Forty per cent of all maternal peri-natal deaths are linked to anaemia. Favorable pregnancy outcomes occur (30-45%) less often in anaemic mothers and their infants have less than one and a half of normal iron reserve. Anaemia, as defined by the World Health Organization (WHO) as a hemoglobin (Hb) level of < 12g/dl in adult non-pregnant women, occurs in 40-80% of pregnant women in Africa. Anaemia is one of the world’s leading causes of disability and constitutes a major global public health problem. It is estimated that anemia occurs in 42% of all women in the world and 52% of pregnant women in developing countries compared with 23% in the developed economies of the world. It has further been estimated that anaemia accounts for 3.7% and 12.8% of maternal deaths during pregnancy and child-birth in Africa and Asia, respectively and has been associated with low neonatal birth weight. Rdx bodybuilding weight lifting gloves gym with belt training strap new support ebay estanozolol 50mg bodybuilding with bodybuilding videos: bodybuilding: the best way to increase intensity.
1.2 STATE OF PROBLEM

Anemia is a global public health problem affecting both developing and developed countries; approximately 1.3 billion individuals suffer from it. Pregnant women are the most vulnerable groups to anemia.

Most pregnant women in developing countries, especially in the rural area where they prefers going to farm rather than going to antenatal, so as a result can become anemic because they are not enlightened about their nutritional intake. Which poses a lot of challenges during delivery, resulting to issues of congestive cardia failure, shock, excessive bleeding, miscarriages, still-birth, etc. Because the foetus in the feeds more during 3rd trimester, so a pregnant women can appear healthy while she is anemic, the only way to dictate  such case is during laboratory test (HB, PCV, ESR) etc. It is certain rule that in areas where malaria is not endemic, anaemia, due primarily to iron deficiency increases with parity. Especially in areas where malaria is endemic, anaemia is most severe for women in their first and second pregnancies and a major cause of anaemia for these women is malaria. Finally there may be other not yet investigated causes of anaemia. For instance, the high prevalence of HIV infection in Africa may be a factor aggravating anaemia, which raised the need to assess anemia among pregnant women in Nigeria.

1.3 OBJECTIVES OF THE STUDY

The researcher intends to address the following objectives in the course of the study:

  1. i) To determine the prevalence of anemia and the principal causes in women of reproductive age.

ii). To identify significant reproductive risk factors (e.g. birth spacing, family size, contraceptive method and bad obstetric history) and healthy outcomes (e.g. Obstetric hemorrhage) related to anemia.

iii) To describe knowledge, attitudes and practices concerning health of women of reproductive age and health care providers particularly as regards to diet, pregnancy, lactation, family planning and anaemia.

  1. iv) To identify where, when, and why women of reproductive age have contact with existing health services including family planning.

1.4 RESEARCH HYPOTHESES

HO: Following doctors’ advice regarding adequate nutrition during pregnancy does not reduce the chances of contacting anemia.

H1: Following doctors’ advice regarding adequate nutrition during pregnancy does reduce the chances of contacting anemia.

HO: Women are not fully sensitized on anemia and not fully prepared to take appropriate steps in order to avoid anemia development during pregnancy

H2: Women are fully sensitized on anemia and are fully prepared to take appropriate steps in order to avoid anemia development during pregnancy

1.5 SIGNIFICANCE OF THE STUDY

The research unveils the adverse effect of anemia in pregnancy and it negatives implications during child birth, the study showcase that prenatal iron deficiency anemia in the third trimester affects child mental development. It is believed that the findings will be of benefit to the; Federal Ministry of Health, National Health Insurance Scheme Council (NHISC) in tackling the causes, challenges and constraints associated with anemia during pregnancy.

Specifically, the study is beneficial to pregnant women, to follow recommended steps and advices that will help fight anemia development. To doctors and mid-wives on administering necessary care, counselling, to pregnant women during antenatal and prenatal check-ups. To the women generally in the area of public-enlightenment, on the need to follow doctor’s directives on adequate nutrition during pregnancy. To future researchers, scholars for further research on the topic anemia in pregnancy.

1.6 SCOPE AND LIMITATION OF THE STUDY

The scope of this research centers on anemia among pregnant women at University of Uyo teaching hospital, stressing that the management of anemia in pregnancy is easy & worthwhile if the pregnant women & their guardians are always alert to protect the health of mother & baby. With the aid of proper antenatal checkup, perinatal & postnatal cares & following relevant medical advice. Emphasizing that, all pregnant women should be fully assessed at the start of their pregnancy so that any problems such as anemia will be picked up and treated. In the course of the study, the researcher encounters some constraints which limited the scope of the study;

Time: the time at the disposal of the researcher which was allocated for the study was a major limitation as the researcher had to combine other academic activities with the study.

Finance: The finance at the disposal of the researcher in the course of the study could not permit wider coverage as resources are very limited as the researcher has other academic bills to cover.

Availability of research material: The research materials available to the researcher at the time of this study were insufficient, thereby limiting the study.

1.7 DEFINITIONS OF TERMS

 Anaemia: Anemia, also spelled anaemia, is usually defined as a decrease in the total amount of red blood cells (RBCs) or hemoglobin in the blood. It can also be defined as a lowered ability of the blood to carry oxygen.

Haemoglobin: Hemoglobin is the protein molecule in red blood cells that carries oxygen from the lungs to the body’s tissues and returns carbon dioxide from the tissues back to the lungs. Hemoglobin is made up of four protein molecules (globulin chains) that are connected together.

Pregnancy: Pregnancy, also known as gestation, is the time during which one or more offspring develops inside a woman. A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy can occur by sexual intercourse or assisted reproductive technology.  Childbirth typically occurs around 40 weeks from the last menstrual period (LMP).

Trimester: Human pregnancy, which is frequently divided into three terms of about three months each to refer to the fetus’s development.

Erythropoiesis: Erythropoiesis (from Greek ‘erythro’ meaning “red” and ‘poiesis’ meaning “to make”) is the process which produces red blood cells (erythrocytes). It is stimulated by decreased O2 in circulation, which is detected by the kidneys, which then secrete the hormone erythropoietin.

Puerperium:  A postpartum period or postnatal period is the period beginning immediately after the birth of a child and extending for about six weeks. Less frequently used are the terms puerperium or puerperal period. The World Health Organization (WHO) describes the postnatal period as the most critical and yet the most neglected phase in the lives of mothers and babies; most deaths occur during the postnatal period.  

Child development: Child development entails the biological, psychological and emotional changes that occur in human beings between birth and the end of adolescence, as the individual progresses from dependency to increasing autonomy. It is a continuous process with a predictable sequence, yet having a unique course for every child.

Anemia pregnancy: During pregnancy, your body produces more blood to support the growth of your baby. If you’re not getting enough iron or certain other nutrients, your body might not be able to produce the amount of red blood cells it needs to make this additional blood.

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