|Year : 2018 | Volume
| Issue : 1 | Page : 23-27
Prevalence of anaemia in the antenatal booking population at Ahmadu Bello University teaching hospital, Kaduna, Nigeria
Polite I Onwuhafua, Ijeoma C Ozed-Williams, Abimbola Omolara Kolawole, Marliya S Zayyan, Joel Adze
Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
|Date of Submission||25-Oct-2017|
|Date of Acceptance||13-Jun-2018|
|Date of Web Publication||23-Oct-2018|
Polite I Onwuhafua
Ahmadu Bello University Teaching Hospital, P. O. Box 8669, Zaria, Kaduna
Source of Support: None, Conflict of Interest: None
Background: Anaemia has been associated with poor materno-foetal performance among pregnant women in Nigeria. The objective, therefore, of this study is to determine the prevalence of anaemia at the time of antenatal booking and the associated factors in the hospital.
Methods: Four hundred and seventy-seven women were studied prospectively over 3 months in the antenatal booking clinic, and their characteristics compared with their haemoglobin (Hb) levels.
Results: Age range was 15–46 years, and mean Hb concentration was 10.76 g/dl. Nearly 53.05% of the study population had Hb <11.0 g/dl, but only 20.76% had Hb <10.0 g/dl. Nearly 1.89% had severe anaemia (Hb <8.0 g/dl) while 20.12% had Hb of 12.0 g/dl or more. The strongest association was last obstetric event occurring <1 year before current pregnancy (χ2 6.17, odds ratio 3.97 and P = 0.01). Older women (35 years or more) had a higher prevalence (30.95%) than younger women (19.77%). Only two of the 15 teenagers (13.33%) were anaemic. Six women (1.26%) had sickle cell Hb and it seemed the presence of Hb C tempered the anaemia. Parity and social class were not significant associations. With a mean booking gestational age of 22.49 weeks for the group, 77.77% of the anaemic women booked earlier than 28 weeks. Only two (2.03%) booked later than 34 weeks.
Conclusion: Anaemia is still highly prevalent in the society, and the existing mechanisms for its correction should be reassessed for effectiveness and adequate utilisation in the antenatal clinic. Most anaemic women booked early, therefore, allowing enough time for correction before delivery.
Keywords: Anaemia, antenatal booking population, haemoglobin, Kaduna, Nigeria
|How to cite this article:|
Onwuhafua PI, Ozed-Williams IC, Kolawole AO, Zayyan MS, Adze J. Prevalence of anaemia in the antenatal booking population at Ahmadu Bello University teaching hospital, Kaduna, Nigeria. Port Harcourt Med J 2018;12:23-7
|How to cite this URL:|
Onwuhafua PI, Ozed-Williams IC, Kolawole AO, Zayyan MS, Adze J. Prevalence of anaemia in the antenatal booking population at Ahmadu Bello University teaching hospital, Kaduna, Nigeria. Port Harcourt Med J [serial online] 2018 [cited 2018 Nov 16];12:23-7. Available from: http://www.phmj.org/text.asp?2018/12/1/23/243832
| Introduction|| |
Anaemia is a major global health problem affecting an estimated 42% of pregnant women worldwide. The consequences of anaemia are dire for both the mother and the unborn foetus, affecting every system in the mother and leading to maldevelopment and premature delivery in the foetus and may even extend to the postnatal life of the baby.,,,,, In developing countries, a prevalence of over 30% have been reported.,,,,,
African women were found not to be symptomatic at Hb levels lower than the World Health Organization standard and such slightly lower levels did not affect the foetus too adversely (at least as adjudged by birth weight). This was apparently due to a more prominent “physiological anaemia of pregnancy” in this race. Hb of 10.0 g/dl has therefore come to be accepted as the cut-off limit for anaemia in this environment. Various measures, including health education and women empowerment, have been put in place to remedy the high prevalence of anaemia and other health hazards in women, their children and their unborn babies in this environment. This study was aimed at assessing the effectiveness of these measures as evidenced by the prevalence of anaemia among pregnant women who presented for booking.
| Materials and Methods|| |
The study was done at the antenatal clinic of the Ahmadu Bello University Teaching Hospital, Kaduna. Data were collected over a 3 months period, from May 1, to July 31, 2000, using a pro forma filled out for each woman by the interviewer.
During this period, a total of 555 patients presented for booking, of which 78 were referred from other hospitals and were excluded from the study.
Haemoglobin (Hb) and genotype testing are routine parts of antenatal booking. Hb check is with the Hb ometer at the antenatal side laboratory, while genotype is determined by electrophoresis.
Anaemia in this study is defined as Hb of <10 g/dl or packed cell volume of <0.3 ml.
Gestational age was determined by Naegele's Rule and confirmed by clinical examination. If these disagreed, the date by ultrasonography was used.
Social class was determined by the Social Class based on Occupation Classification since this was more easily ascertained. Most of the women just claimed to be homemakers.
Descriptive statistics were used for data analysis, and the relevant statistical tests of significance were applied including Chi-squared tests, odds ratio (OR) and risk ratio (RR).
| Results|| |
The mean Hb for the population studied was 10.76 g/dl with a standard deviation of 1.30 and the range was from 6.8 g/dl to 16.3 g/dl.
[Table 1] shows the Hb distribution.
The Hb level was <10.0 g/dl in 20.76% and these were classified as anaemic. About 1.89% had severe anaemia (Hb <8.0 g/dl). Nearly 59.12% of the women had values from 10.0 to 11.9 g/dl, while 20.12% had Hb of 12.0 g/dl and above.
[Table 2] shows the relationship between anaemia and the sociodemographic characteristics of the women.
|Table 2: Sociodemographic characteristics of anaemic and non-anaemic patients|
Click here to view
Prevalence of anaemia by age groups
The age range of the sample was 15–46 years, but they were broadly divided into two age groups for the purpose of analysis. The younger age group (age 35 years and below) comprised 91.19% (435) of the sample, while the older group were 8.81% (42) [Table 2]. Among the 42 older women, 13 (30.95%) were anaemic, while the mean Hb for the group was 10.35 g/dl but the mean Hb for the younger age group was 11.17 g/dl, with only 86 of them (19.77%) having values <10.0 g/dl. It was noted that only 15 of the younger women were teenagers, of whom only 2 (13.33%) had anaemia. Older age appeared to be significantly associated with anaemia. When a cross tabulation was done, the Chi-square value was 2.91 although P value was 0.09. The RR of exposure (older age) to outcome (anaemia) was 1.57, and the 95% confidence limit for RR was 0.96< RR <2.56.
Prevalence of anaemia by parity
The range of parity for the subjects was 0–13 with a mean of 1.65. Nulliparous women constituted the largest group, being 198 (41.51%), while grand multipara were 56 (11.74%). No particular association was found between anaemia and parity. The prevalence was almost similar in the different parities. Para 1 had the lowest prevalence (18.18%), while the multipara had the highest (21.77%).
Anaemia and last obstetric event
The last obstetric events in this study included previous delivery, induced or spontaneous abortion and ectopic pregnancy. The prevalence of anaemia was highest (50%) among those who had an obstetric event <1 year before the current pregnancy. No particular trend was noticed in the other groups. Further analysis examined those who had a previous obstetric event (n = 325) and compared the association with anaemia of event occurring <1 year and that occurring after 1 year. There was a significant difference in the effect on anaemia of events occurring <1 year and those occurring >1 year before pregnancy. The RR of outcome (anaemia) to exposure (last event <1 year) was 2.48 and the 95% confidence limit for RR was 1.35< RR <4.58. The OR was 3.97, Chi-square was 6.17 and P value was 0.01.
Prevalence of anaemia in different social classes
The study population was divided into upper (comprising the Registrar General's Classes I and II), middle (class III) and lower (classes IV and V) social classes. There was no significant difference in both the mean Hb and the prevalence of anaemia between the different social classes, though the upper class appeared to have a slightly higher prevalence of 24.50% as against 18.52% for the lower class.
Anaemia and genotype
The genotype of most of the sample was either AA (366) or AS (100). Only six had sickle cell disease (genotype SS or SC). This number was too small for any reasonable comparison. However, the distribution of the anaemic and nonanaemic groups among the different genotypes is illustrated by [Figure 1]. It was noted that all four women with SS genotype had severe anaemia, while one of the two women with SC genotype was anaemic. The highest observed Hb concentration of 16.3 g/dl was in a 27-year-old para 1 + 0 woman of genotype AS, in her 26th week of pregnancy.
Gestational age at booking and anaemia
The mean gestational age at booking was 22.49 weeks with 76.10% booking before the 28th week of pregnancy. Only 2.10% of patients booked after the 34th week. [Table 3] shows the gestational age at booking for the 99 anaemic pregnant women. Their mean booking gestational age was 23 weeks. This was slightly later than the mean for the entire study population and that for the nonanaemic patients which was 22 weeks. Most (77.77%) booked earlier than the 28th week, but two anaemic women (2.03%) booked later than 34 weeks.
| Discussion|| |
The double standard posed by adopting a Hb level of 10.0 g/dl for African women already poses a problem as was anticipated. Despite that the prevalence of anaemia continues to be unacceptably high in the environment with most authors getting above 20% with a Hb cut-off of 10.0 g/dl and over 30% with 11.0 g/dl.,,
The main findings in this study include older women had a greater tendency to anaemia; however, this was not in tandem with the study by Dairo and Lawoyin, who noted that anaemia tended to decrease with increasing maternal age.
Parity also had no significant influence on anaemia in this series, as in that of Bukar et al. but Anorlu et al. and Okpani et al. found anaemia to be more common in the primigravidae, in whom the fatality tends to be higher. Hughes and Morrison suggested that the traditional problems associated with grand multiparity such as anaemia were not really determined by parity per SE but by other prevailing factors.
It is not surprising that the last obstetric event proved to be the strongest association with anaemia. Other authors also had similar findings., However, anaemia was found to be more prevalent if the last obstetric event was less than a year; however, a gap of >2 years seems to confer no further advantage. Desalegn reported that the nonuse of contraceptives was a factor in the development of anaemia in their series in Ethiopia.
The fairly uniform prevalence of anaemia between the social classes was also an unusual finding, since other reports., found anaemia to be more prevalent in the lower socioeconomic classes. In Nigeria of today, however, it is becoming quite difficult to allocate people to social classes based on occupation alone since the people of the so-called lower classes often have as good or even better income than those of the higher classes. Another explanation is that people of the upper socioeconomic classes shun the Health Education sessions of the ante-natal clinics which constitute the major source of awareness.,
Although the women of AS genotype were found to have a prevalence of 36%, AS genotype had been reported in the past as being able to protect from anaemia.,,,
Probably by protecting the individual from anaemia secondary to malaria parasitemia., This was also borne out in a study by Anorlu et al., who found out that women on haematinics and antimalarial drugs had higher Hb than those on haematinics alone. The presence of the Hb C has also been reported to ameliorate the effect of the HbS by Mashburn et al., Pepple and Odukogbe et al. While the present study seemed to suggest a similar finding, the number of sicklers was too small for meaningful analysis.
Gestational age at booking in this study (22.49 weeks) is close to the 23.55 weeks reported by Ekele and Audu. and Künzel et al. This would give adequate time for a less radical approach to correction of anaemia in most of the patients.
| Conclusion|| |
Anaemia in the booking clinic is an index of anaemia in the general population. Early booking and adequate antenatal care could resolve the problem in most but all the health education and prophylaxis done in the antenatal clinic should be extended to the general population and the effectiveness and the utilisation of the measures put in place for its correction continually reassessed.
The strength of this study lies in its prospective design. However, the main limitation remains the use of Hb level of 10 g/dl for the study which is still the practice in our country. This does not allow comparison with similar studies from developed countries which use a higher level of Hb to define anaemia in pregnancy. In future studies, an attempt will be made to use internationally adopted standards.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Tunkyi K, Moodley J. Prevalence of anaemia in pregnancy in a regional health facility in South Africa. S Afr Med J 2015;106:101-4.
Felt BT, Lozoff B. Brain iron and behavior of rats are not normalized by treatment of iron deficiency anemia during early development. J Nutr 1996;126:693-701.
Kilbride J, Baker TG, Parapia LA, Khoury SA, Shuqaidef SW, Jerwood D. Anaemia during pregnancy as a risk factor for iron-deficiency anaemia in infancy: A case-control study in Jordan. Int J Epidemiol 1999;28:461-8.
Lone FW, Qureshi RN, Emmanuel F. Maternal anaemia and its impact on perinatal outcome in a tertiary care hospital in Pakistan. East Mediterr Health J 2004;10:801-7.
Mahomed K. Iron and folate supplementation in pregnancy. Cochrane Database Syst Rev 2000;2:CD001135.
Chen MH, Su TP, Chen YS, Hsu JW, Huang KL, Chang WH, et al.
Association between psychiatric disorders and iron deficiency anemia among children and adolescents: A nationwide population-based study. BMC Psychiatry 2013;13:161.
Kalaivani K. Prevalence & consequences of anaemia in pregnancy. Indian J Med Res 2009;130:627-33.
] [Full text]
Rahman MM, Abe SK, Rahman MS, Kanda M, Narita S, Bilano V, et al.
Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: Systematic review and meta-analysis. Am J Clin Nutr 2016;103:495-504.
Gebre A, Mulugeta A. Prevalence of anemia and associated factors among pregnant women in north western zone of Tigray, Northern Ethiopia: A cross-sectional study. J Nutr Metab 2015;2015:165430.
Ogbeide O, Wagbatsoma V, Orhue A. Anaemia in pregnancy. East Afr Med J 1994;71:671-3.
Dairo MD, Lawoyin TO. Socio-demographic determinants of anaemia in pregnancy at primary care level: A study in urban and rural Oyo state, Nigeria. Afr J Med Med Sci 2004;33:213-7.
Anorlu RI, Oluwole AA, Abudu OO. Sociodemographic factors in anaemia in pregnancy at booking in Lagos, Nigeria. J Obstet Gynaecol 2006;26:773-6.
Ojo OA. The pattern of anaemia in Western Nigeria. J Trop Med Hyg 1965;68:32-6.
Nnatu S. Epidemiology of foetal birth weights in Nigeria. Trop J Obstet Gynaecol 1990;8:31-4.
Reid HL. Physiological changes in packed cell volume and haemoglobin levels in Nigerian Igbo women during pregnancy. East Afr Med J 1986;63:201-7.
Ogunbode O. Anaemia in pregnancy. Trop J Obstet Gynaecol 1995;12:19-25.
Olatunbosun OA, Abasiattai AM, Bassey EA, James RS, Ibanga G, Morgan A, et al.
Prevalence of anaemia among pregnant women at booking in the University of Uyo Teaching Hospital, Uyo, Nigeria. Biomed Res Int 2014;2014:849080.
Alem M, Enawgaw B, Gelaw A, Kenaw T, Seid M, Olkeba Y. Prevalence of anaemia and associated risk factors among pregnant women attending antenatal care in Azezo Health Center Gondar Town, North West Ethiopia. J Interdiscipl Histopthol 2013;1:137-44.
Bukar M, Audu BM, Yahaya UR, Melah GS. Anaemia in pregnancy at booking in Gombe, North-Eastern Nigeria. J Obstet Gynaecol 2008;28:775-8.
Okpani AO, Ikimalo J, John CT, Briggs ND. Teenage pregnancy. Trop J Obstet Gynaecol 1995;5:34-6.
Hughes PF, Morrison J. Grandmultiparity – Not to be feared? An analysis of grandmultiparous women receiving modern antenatal care. Int J Gynaecol Obstet 1994;44:211-7.
Lazović N, Pocekovac P. The importance of time intervals between childbirth and anemia in pregnancy. Srp Arh Celok Lek 1996;124:307-10.
Desalegn S. Prevalence of anaemia in pregnancy in Jima town, Southwestern Ethiopia. Ethiop Med J 1993;31:251-8.
Massawe S, Urassa E, Lindmark G, Nyström L. Anaemia in pregnancy: Perceptions of patients in Dar-es-Salaam. East Afr Med J 1995;72:498-503.
Ekele BA, Audu LR. Gestational age at first antenatal attendance in Sokoto, Northern Nigeria. Trop J Obstet Gynaecol 1998;15:39-40.
Mashburn J, Graves BW, Gillmor-Kahn M. Hematocrit values during pregnancy in a nurse-midwifery caseload. J Nurse Midwifery 1992;37:404-10.
Pepple DJ. On the protective mechanism of the sickle cell trait (HbAS). Med Hypotheses 1992;39:284-5.
Odukogbe AA, Aken'Ova YA, Ojengbede OA. Outcome of twin pregnancies in patients with haemoglobinopathies – Case reports. West Afr J Med 1999;18:217-9.
Künzel W, Herrero J, Onwuhafua P, Staub T, Hornung C. Maternal and perinatal health in Mali, Togo and Nigeria. Eur J Obstet Gynecol Reprod Biol 1996;69:11-7.
[Table 1], [Table 2], [Table 3]