Anaemia Project

CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND OF STUDY
Anaemia is a condition in which the number of red blood cells or their
oxygen-carrying capacity is insufficient to meet physiological needs, which
vary by age, sex and pregnancy status World Health Organization (WHO,
2015 ).
Anaemia in pregnancy is defined as haemoglobin (Hb) level of less than
10gmldL, it is a quantitative or qualitative deficiency of Hb and red blood
cells in circulation resulting in reduced oxygen carrying capacity of the
blood (Geraldine et al, 2012).
Anaemia ranges from mild, moderate to severe. The World Health
Organization Pegs haemoglobin level of each of these types of aneamia in
pregnancy as 10.0-10.9g/dL – mild degree of aneamia, 7 – 9 g/dL as
moderate aneamia, 4 – 7gldL as severe aneamia and less than 4gldL as very
severe (African Health Sciences 2008).
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About 1000mg of iron is required during pregnancy, 500-600mg for red
blood cells expansion, 300mg for fetus and placenta and the rest for the
growing uterus. Diet alone cannot provide the extra iron needed. But if iron
store are already deficient, iron deficiency aneamia manifest. This is the
commonest type of aneamia in pregnancy (Sharma, 2010).
Anaemia in pregnancy is a common and serious problem in developing
countries (Judith et al, 2008). In 1993, the World Bank ranked aneamia as
the leading cause of disease in pregnant women and the prevalence rates are
commonly estimated to be in the range of 40 – 60% (Mohammed, et al,
2013).
Worldwide, 41.8% of pregnant women are anemic as compared with 30.2%
non-pregnant. The most severely affected areas are South-East Asia (48.2%)
and Africa (57.1%). A large proportion of the 17.2million aneamia pregnant
women in Africa live in the West Africa sub-region. The prevalence rate in
some of the countries range from 50.2% in Togo, 66.7% in Nigeria, 66.3%
in Burkina Faso, 72.7% in Benin and 75% in Gambia. Local prevalence
studies from Nigeria range from 35.3% in Lagos and 72.0% in Kano State
(Geraldine et al, 2012).
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In Nigeria, the cause of anaemia is multi factorial and varies greatly by
geographical location, season and dietary intake, the most common causes
being nutritional deficiencies of iron and folate, parasitic disease such as
hookworm infestation and recently Human Immunodeficiency Virus
Infection (Geraldine et al, 2012).
In pregnancy, anaemia has a significant impact on the health of the foetus as
well as that of the mother. Therefore the research study on the incidence of
aneamia in pregnancy among women of child bearing age from 2012 -2016
in General Hospital, Bichi kano.
1.2 Statement of Problem
Anaemia had led to the death of mothers and foetus during pregnancy
despite the health education given to mothers on its prevention. Severe
anaemia is an important cause of morbidity and mortality in many parts of
the world. The burden is higher in Sub Saharan Africa where it has been
associated with an increased risk of morbidity and mortality. In East Africa
approximately 75% of children under five years are suffering from anaemia.
Within the National Health Management and Information System in Nigeria,
anaemia is responsible for 17.8% of deaths in hospitalized children under
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five years of age. In 2010, the Tanzania Demographic Health Survey
reported the prevalence of anaemia in children under five years to be 55% in
the Lake zone which carter about eight regions. It was necessary to find out
the burden of anaemia in children admitted at General Hospital, Bichi and
also information regarding associated factors is lacking. The increase in
mortality rate of pregnant women as a result of anaemia, motivated the
researcher to carry out a study on the incidence of anaemia in pregnancy
among women of child bearing age from 2012 -2016 in General Hospital
Bichi,kano. .
1.3 Objectives of the Study
i. To identify the causes of anaemia during pregnancy.
ii. To create awareness on its effects and danger associated with anaemia in
pregnancy.
iii. To suggest ways of reducing the incidence of anaemia in pregnancy
women attending ANC clinic at Bichi, General Hospital,kano.
1.4 Significance of the Study
To improve the knowledge of the researcher, to create awareness on anaemia
in pregnancy as a life threatening situation and to educate women of child
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bearing age and the public on the importance of antenatal care as a
preventive measure of anaemia in pregnancy.
The results of this study will help to determine the prevalence of mild,
moderate and severe anaemia, associated factors of severe anaemia as well
as morphological types of anaemia.
Findings of this study will help us to set prevention programs, update the
treatment protocols for proper management, follow up and care of children
with anaemia of all severity.
Also can be used to formulate the policy and make public awareness
regarding anaemia in this population.
1.5 Research Questions
i. What are the possible causes of anaemia in pregnancy?
ii. What are the effects of anaemia in pregnancy on maternal and fetal
health?
iii. How can anaemia in pregnancy be prevented?
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1.6 Scope and Limitation of the Study
This study inquires into the effect of anaemia in pregnancy among women of
childbearing age (16 – 45 years) at the incidence of aneamia in pregnancy
among women of child bearing age from 2012 -2016 in General Hospital,
Bichi Kano. The challenges encountered during the course of study are non-
cooperative attitude of respondent and financial constraint.
1.7 Definition of Operational Terms
Anaemia: A deficiency in either quality or quantity of red corpuscles in the
blood that reduces the oxygen carrying capacity of the blood.
Antenatal: A period before birth
Blood: A fluid that circulates through the heart and blood vessels, providing
a vehicle by which variety of different substances are transported between
the various organs and tissues.
Deficiency: An inadequacy or insufficiency of something essential to health.
Diet: A controlled regimen of food or drinks as to gain or lose weight that
influences health.
Disease: An abnormal condition of the body or mind that causes discomfort
or dysfunction.
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Foetus: The prenatal human between the embryonic state and its birth.
Haemoglobin (Hb): A substance contained within the red blood cells and
responsible for the colour composed of haem (an iron containing prophyrin)
linked to the protein, globin.
Infection: Invasion of the body by harmful organism (Pathogens) such as
bacteria, fungi, protozoa, rickettsaie or virus
Mortality: The death rate of a population.
Nutrition: An organic process by which an organism assimilates food for
growth and maintenance.
Oxygen: An odourless, colourless gas that makes up one fifth of the
atmosphere.
Pregnancy: The period during which women carries developing foetus
normally.
Perinatal: A period immediately before and after birth
Uterus: A thick-walled pear – shaped, hollow muscular organ in which the
fertilized ovum develops throughout the embryonic and foetal stages until
birth.
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CHAPTER TWO
LITERATURE REVIEW
2.0 INTRODUCTION
The purpose of this section of the study is to provide a review of relevant
literature that focuses on the incidence of aneamia in pregnancy among
women of child bearing age from 2015-2020 in General Hospital, Bichi
kano.
The literature review in relation to the study shall be discussed under the
following headings:
2.1 Definition of anaemia in pregnancy
2.2 Highlight on the incidence of anaemia in pregnancy globally
2.3 Epidemiology
2.4 Review of anatomy and physiology of the blood
2.5 Classification of Anaemia in Pregnancy
2.6 Causes of anaemia in pregnancy
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2.7 Pathophysiology of anaemia in pregnancy
2.8 Effects of anaemia in pregnancy
2.9 Clinical manifestation of anaemia in pregnancy
2.10 Diagnostic measures
2.11 Risk, and complications of anaemia in pregnancy
2.12 Management of anaemia in pregnancy
2.13 Preventive measures
2.14 Theoretical framework
2.1 DEFINITION OFANAEMIA IN PREGNANCY
Random House Kerneman Webstars College Dictionary, (2010), stated that
a reduction in the haemoglobin of red blood cells with consequent deficiency
of oxygen in the blood leading to weakness and pallor is termed anaemia.
Anaemia is defined as an absolute reduction in the quality of the oxygen-
carrying pigment that is, Haemoglobin (Hb) in the circulating blood
(Medscape, 2015).
According to Merriam Website, (2015), anaemia is a condition in which the
blood is deficient in red blood cells, haemoglobin or in total volume.
The Indian Journal of Anesthesia, (2010), defined anaemia in pregnancy as
haemoglobin level less than 10gldL, it is a qualitative or quantitative
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deficiency of haemoglobin and red blood cells in circulation resulting in
reduced oxygen carrying capacity of the blood.
The World Health Organization, (2013) defined anaemia in pregnancy as
haemoglobin concentration of less than 11gldL and Heamatocrit of less than
0.33.
Anaemia in pregnancy is defined as a haemeglobin concentration of less
than 10gldL in venous blood (Vikram, 2013).
Anaemia is the reduction in the haemoglobin concentration of the peripheral
blood below the normal range expected as a haemoglobin for age and sex of
an individual (Olomi; 2014).
2.2 HIGHLIGHT ON THE INCIDENCE OF ANAEMIA IN PREGNANCY
GLOBALLY,
According to Okeke (2016), anaemia is a global public health problem
affecting both developing and developed countries with major consequences
for human health as well as social and economic development. It occurs at
all stages of life cycle but is more prevalent in pregnant women and
children. It occurs when the concentration of haemoglobin falls below what
is normal for a person’s age, gender and environment resulting in the oxygen
carrying capacity of the blood being reduced.
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Nearly half of the pregnant women in the world are considered to be
anaemic, that is 52% as compared to 23% in industrialized countries. Recent
World Health Organization data shows that approximately 10.8million in
African countries, 9.7million in Western Pacific and 24.8million pregnant
women in South – East Asia are anaemic. The highest number being in
South-East Asia (Strivastava, 2013).
The World Health Organization (WHO, 2011) estimated that 56% of all
pregnant women in developing countries are anaemic. In South Asia,
prevalence of anaemia in pregnancy is 75% in contrast to what is obtained in
North America and Europe with about 75% prevalence. Furthermore, 5% of
pregnant women suffer from severe anaemia in the worst affected part of the
world.
Worldwide, it is estimated that about 20% of maternal death are caused by
anaemia, in addition, anaemia contributes partly to 50% of all maternal
deaths. Similar situation is found in sub-Saharan Africa where anaemia
reportedly accounted for about 20% of maternal death brought about by the
three main mechanisms;
i. Anaemia resulting for blood loss during or after birth makes women
susceptible to deaths by lowering the hematological reserve.
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ii. Severe anaemia associated with increased susceptibility to infection
due to lowered resistance to disease.
iii. Haemoglobin level of less than 4g/dl is associated with high risk for
cardiac failure and death particularly during delivery or soon after, if
prompt intervention is not instituted (Kayode et al, 2012)
World Health Organisation (WHO, 2016) estimated that in developing
countries, prevalence rates in pregnant women are common in range of 40 –
60%. Around half of those with anaemia are suffering from iron deficiency
anaemia, that is having deficient body iron stores. But without frank
anaemia, the latter are therefore considered to be at risk of iron deficiency
anaemia. Folate deficiencies and other causes account for the remaining
anaemia.
In Nigeria, the prevalence rate for anaemia amongst pregnant women was
found to be 62.6% with 32.8% in the west particularly Oyo state and 48.1%
Kano state in the north (Geraldine et al, 2012).
2.3 EPIDERMIOLOGY OF ANAEMIA IN PREGNANCY
Anaemia is the most common nutritional deficiency disorder in the world.
WHO has estimated that prevalence of anaemia in developed and developing
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countries in pregnant women is 14% in developed, 51% in developing
countries and 65-75% in India. About one third of the global population that
is over two billion are anaemic (Kakivani, 2009)
Prevalence of anaemia in all groups is higher in India as compared to other
developing countries. Prevalence of anaemia in South Asian countries is
among the highest in the world. WHO estimates that about half of the global
maternal deaths due to anaemia occur in South Asian countries (Kakivani,
2009).
In sub-Saharan African, it is estimated that 20% of maternal deaths are
associated with anaemia. It is also a major risk factor for infant. Iron
deficiency which has been associated with adverse effect on behavioural
and cognitive development of children and low birth weight, is one of the
main risk factor for infant mortality (Finch, 2009).
In Nigeria, prevalence rate among pregnant women was found to be 62.6%.
Studies have shown that anaemia contributes to the increased maternal
mortality recorded in the nation. Out of all the socio-demographic
characteristics, only socio-economic status was significantly associated with
anaemia in pregnancy. Poverty and low standard of living are still major
problems facing most developing countries. The inability of a woman to
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possess and control resources and make independent decisions about her
fertility, her health and health care also has an impact on maternal anaemia
(Geraldine et al, 2012).
Pregnant women are particularly considered to be the most vulnerable group
because of the additional demands made on maternal stores during
pregnancy (Finch, 2010).
2.4 REVIEW OF ANATOMY AND PHYSIOLOGY OF THE BLOOD
The blood is a fluid connective tissue. It circulates continually around the
body, allowing constant communication between tissues distant from each
other (Ross and Wilson, 2010).
According to Web (2014), the blood is a constantly circulating fluid
providing the body with nutrition, oxygen and waste removal. Blood is
mostly liquid with numerous cells and proteins suspended in it, making
blood thicker than pure water. The average person has about 5 litres of
blood. A straw-coloured half of the content of blood, blood plasma contains
glucose and other dissolved nutrients.
The blood volume is composed of blood cells;
 Red blood cells (erythrocytes)
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 White blood cells (leukocytes)
 Platelets (thrombocytes)
(Web, 2014).
2.4.1 Red Blood Cells (Erythrocytes)
The erythrocytes or red blood cells make up the largest number of blood
cells, numbering from 4.5 million to 6 million per cubic millimeter of blood.
They carry out the exchange of oxygen and carbondioxide between the lungs
and the blood tissues (Infroplease, 2016).
Red blood cells look like discs with indentations on top and on the bottom.
They can bend easily to squeeze through narrow blood vessels. They have
no nucleus in contrast to many other cells. Each red blood cell contains
hemoglobin, which can transport oxygen. In tiny blood vessels in the lungs,
the red blood cells pick up oxygen from inhaled air and carry it through the
blood stream to all part of the body (Pub Med Health, 2015).
The cells need oxygen for metabolism, which also creates carbondioxide as
a waste product. The red blood cells can pick up the carbondioxide and
transport it back to the lungs. There we exhale it when we breathe out. Red
blood cells can also pick up or release hydrogen and nitrogen. When picking
up or releasing hydrogen, they help to keep the pH level of the blood steady,
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by releasing nitrogen the blood level expand and blood pressure falls. Red
blood cells have a lifecycle of about 120 days. When they are too old or
damaged, they are broken down in the bone marrow, spleen or liver (Pub
Med Health, 2015).
2.4.2 White Blood Cells (Leukocytes)
According to Encyclopedia Britannica, (2015), white blood cells also called
leukocyte or white corpuscle, a cellular component of the blood that lack
haemoglobin, has a nucleus is capable of mortality, defends the body against
infection and diseases by ingesting foreign materials, cellular debris,
destroying infectious agents and cancer cells or by producing antibodies.
They account for only 1% of blood volume (Ross and Wilson, 2010).
All white blood cells are produced and derived from hemopoietic stem cell.
Leukocytes are found throughout the body including the blood and
lymphatic system (Dorserch, 2013).
An abnormal increase in white blood cell volume is known as leukocytosis,
whereas an abnormal decrease in volume is known as leukopenia
(Encyclopedia Britannica, 2015).
According to boundless anatomy and physiology, (2015) types of white
blood cells can be classified into two standard ways; Granulocytes also
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known as polymorphonuclear leukocytes and Agranulocytes or mononuclear
leukocytes.
GRANULOCYTES
There are three different types of granulocytes
Neutrophils
Basophils
Eosinophils
Neutrophils: neutrophils are the commonest types of white blood cells,
constituting 60-70% of the circulating leukocytes. They are usually first
responder to microbial infection. Their activity and death in large number
form pus. They have a multi-lobed nucleus, which consist of three to five
lobes connected by slender strands. This give the neutrophils the appearance
of having multiple nuclei, hence the name polymorphonuclear leukocytes.
Neutrophils are active in phagotosing bacteria. Neutrophils live average 6-
9hours in the blood stream and must be constantly replaced (Ross and
Wilson, 2010).
Eosinophils compose about 2-4% of white blood cells. It rises in response to
allergies, parasitic infections, collagen diseases and diseases of the spleen
and central nervous system. They are rare in the blood but numerous in the
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mucus membranes of the respiratory, digestive and lower urinary tracts
(Dorserch, 2013).
They are equipped with certain toxic chemicals stored in their granules,
which release when eosinophils binds to an infecting organism (Ross and
Wilson, 2010)
Eosinophils are also predominant inflammation cells in allergic reactions.
The most important causes of eosinophilia include allergies such as asthma,
hayfever and hives, and parasitic infection.
In general, the nucleus is bi-lobed. The lobes are connected by a strand. The
cytoplasm is full of granules that assume a characteristic pink-orange colour
with eosin straining (Dorserch, 2013).
Basophils: according to Ross and Wilson (2010) basophils plays an
important role in healing process, so that their number increases during
healing process.
Basophils are chiefly responsible for allergic reactions and antigen response
by releasing the chemical histamine causing the dilatation of blood vessels
(Boundless Anatomy and Physiology, 2015). The widening of the blood
vessel increase the flow of blood to injured tissue. Basophils also releases
heparin which is an important anticoagulant that inhibits blood clothing and
promotes the movement of white blood cells into an area. They can also
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release chemical signals that attract eosinophils and neutrophils to an
infection site. Basophils are the rarest type of blood cells making up only 1%
of the white blood cells (Histology guide, 2015).
AGRANULOCYTES
Agranulocytes also known as mononuclear leukocytes are white blood cells
with one lobed nucleus. They are characterised by absence of granules in the
cytoplasm, which distinguishes them from granulocytes. The two types of
agranulocytes in the blood circulation are:
Lymphocytes
Monocytes
Lymphocytes: Lymphocyte is a sub type of white blood cell that is part of
the immune system. There are two main types of lymphocytes B cells (Bone
marrow derived cells) and T cells (Thymus cells). The B cells are primarily
responsible for humoral immunity. They produce antibodies that are used to
attack invading bacteria, viruses and toxins. The T-cells are involved in cell-
mediated immunity. They destroy the body’s own cell that have being taken
over by viruses or become cancerous (Pub Med Health, 2016).
The national killer cells (NKcells) are a part of the inmate immune system
and play a major role in defending the host from both tumors and virally-
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infected cells. NKcells distinguish infected cells and tumors from normal
and uninfected cells (Dorserch, 2013)
Monocytes: Monocytes are the largest cells among the leukocytes like
neutrophils, monocytes are also motile and phargocytic in nature. They play
important role in defense of the body. These cells wonder freely in the blood
for 1-3days, and then migrate into body tissues where they are known as
macrophages. Monocytes presents pieces of pathogens to T-cells so that the
pathogens may be recognized and killed or so that an antibody response may
be mounted (Dorserch, 2013).
2.4.3 Platelets (Thrombocytes)
Platelets or thrombocytes are the formed element of the blood. They are
small, colourless, non-nucleated and moderately refractive bodies
(Ribmidieve, 2015). Platelets are essential part of the body clothing
mechanism. They are small fragments of cytoplasm without nuclei that
contain many granules. Most platelets are stored in the spleen before being
released into the circulation. They are about 150,000 to 400,000 platelets in
each milliliters of blood. They live approximately 10 days in circulating
blood (Burke et al, 2011).
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Platelets are only 20% of the diameter of red blood cells; they make up just a
tiny fraction of the body volume, they are also the lightest blood cells. The
principal function of platelets is to prevent bleeding (Evaren et al, 2015)
when there is an injury or cut, it is the platelets that react first. The tough
fibers surrounding the vessel walls like envelop attracts platelets like magnet
and platelets then clump into these fibers providing the initial seal to prevent
bleeding and the leak of red blood cells and plasma through the vessel injury
(Evarn et al, 2015).
An increase in the number of platelet beyond normal range that is having
more than 450,000 platelets is a condition called thrombocytosis, and having
below normal range less than 150,000 is known as thrombocytopenia
(Williams, 2015).
2.5 CLASSIFICATION OF ANAEMIA IN PREGNANCY
Anaemia can be classified as physiological according to the aetiology and
red blood cell morphology (Oliver and Olounfunto, 2012).
2.5.1 Physiological Classification
A. Blood loss
i. Acute
 Antepatum haemorrhage (e.g placenta previa, abruption placenta)
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ii. Chronic
 Hookworm infestation
 Bleeding hemorrhoids
 Peptic ulcer disease
B. Nutritional Anaemia
 Iron deficiency
 Folate deficiency
 Vitamin B12 deficiency
C. Bone Marrow Failure
 A plastic
 Isolated secondary failure of erythopoiesis
 Drug (e.g. Zidovudine)
D. Haemolytic
i. Inherited
 Haemoglobinopathes (e.g sickle cell disorders, thalassemia)
 Red cell membrane defects
 Enzyme deficiencies
ii. Acquired
 Immune hemolytic anaemia
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 Non immune hemolytic anaemia
 Acquired membrane defects
 Mechanical damage (e.g. micro angiopathic hemolytic anaemia)
 Secondary to systemic disease (e.g. renal disease, liver disease)
 Infections (example HIV, malaria).
2.5.2 Classification based on red blood cell morphology
A. Hypochromic Microcytic
 Iron deficiency
 Thalassemia
 Sideroblastic anaemia
 Anaemia of chronic disorders
 Lead poisoning
B. Macrocytic
 Folic acid deficiency
 Vitamin B12 deficiency
 Liver disease
 Myodema
 Chronic obstructive pulmonary disease
 Myelody splastic syndromes
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 Blood loss anaemia
C. Normocytic normochromic
 Autoimmune haemolytic anaemia
 Systemic lupus erythromatiasis
 Collagen vascular disorders
 Hereditary spherocytosis
 Haemoglobinopathies
 Bone marrow failure
 Malignancies
 Myelodspasia
 Blood loss anaemia

 Anaemia of chronic disease
2.5.3 Classification of anaemia by degree of severity
DEGREE OF SEVERITY HAEMOGLOBIN LEVEL (g\

dh)
Normal haemoglobin level > 11g\dl
Mild Anaemia 9 – 11g\dl
Moderate Anaemia 7 – 9g\dl
Severe Anaemia 4 – 7g\dl
Very Severe Anaemia < 4g\dl
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2.6 CAUSES OF ANAEMIA IN PREGNANCY
The cause of anaemia truly comes down to how many red blood cells are
being produced in the body and how healthy they are. A fall in haemoglobin
level during pregnancy is caused by a greater expansion of plasma volume
compared with increase in red cell volume. (American Pregnancy
Association (APA), 2015).
The commonest causes of anaemia in developing countries particularly
among the pregnant women are:
 Nutritional disorder
 Acute or chronic blood loss
 Infections\parasitic infestations
 Chronic diseases
 Hemolytic anaemia
 Hemoglobinopathies
i. Nutritional Disorder: Nutritional disorder is a major cause of anaemia in
pregnancy in many parts of the world. Nutritional deficiencies of iron and folate
many occur as a result of low nutrient intake, poor absorption and increased
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nutrient loss or demand (Broek, 2016). Iron deficiency anaemia is the
commonest type of nutritional anaemia.
Iron deficiency anaemia accounts for the majority of causes of anaemia that are
identified and characterised by low mean cell volume (MCV). It is usually
caused by low intake of rich iron foods or low iron stores resulting from
previous pregnancy or previous heavy menstrual blood loss. Physiological
requirements for iron in pregnancy are three times higher that in non-pregnant
menstruating women and iron requirement increases as pregnancy advances
(Mary, 2016). Folate or folic acid deficiency can directly contribute to anaemia
during pregnancy (Traci, 2014).
During pregnancy, women need extra folate as they don’t get enough from their
diet. When they happens, the body cannot take enough normal red blood cell to
transport oxygen to tissues throughout the body thereby leading to anaemia.
Pregnant women in particular need a good supply of folic acid because it is
also used by the developing baby (Helen., 2014). Folate deficiency can directly
contribute to certain types of birth defects such as spinal bifida and low birth
weight (Traci, 2014).
Anaemia specifically caused by vitamin B 12 deficiency occurs in 100 to 28% of
uncompleted pregnancy (Tsegaye et al, 2014) pernicious anaemia or vitamin
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B12 deficiency anaemia usually do not complicate pregnancy. It is usually
associated with a strict vegeterian or other fad diet. During pregnancy, there is a
steady fall in the serum vitamin B12 level due to the rapid expansion of plasma
volume and the increased utilisation of vitamin B 12 and protein are important in
making red blood cells. Eating foods that come from animals such as milk,
eggs, meat and poultry can prevent vitamin B 12 deficiency (Tsegaye et al,
2014).
Vitamin A deficency in pregnancy is associated with premature birth,
intrauterine growth retardation and abruptio placentae. Weekly vitamin A
supplementation will reduce maternal morbidity by 40% (Tsegaye et al, 2014).
ii. Acute or chronic Blood loss: According to Oliver and Olounfunto, (2012)
acute blood loss as a result of etopic pregnancy, ante patrum haemorrhage
and abortions are common causes of anaemia in pregnancy. Chronic blood
from worm infestations, gastro intestinal ulcers and hemorrhoids results in
depletion of iron stores and effective erythropoesis.
iii. Infections/Parasitic infestations: Pregnant women are more prone to
infections as a result of depressed immunity. Anaemia due to infections is
usually as a result of products from the infecting organisms, causing ill
health fever, red cell destruction and reduced cell production. Bacterial
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infections used to be a leading cause of anaemia, however in the tropics and
developing countries malaria and more recently HIV/AIDS are leading
contributors of anaemia in pregnancy (Oliver and Olounfunto, 2012).
a. There is evidence that malaria can cause iron deficiency by several mechanism.
Possibly through immobilizing iron in haemazoin complexes and loss of urinary
iron as well as reducing intestinal iron absorption during the acute illness period
(Tsegaye et al, 2014).
Malaria specifically attacks red blood cells, invading them. Once replication
has been completed, the malaria parasite burst out of the red blood cells,
destroying its process. Over the course of an infection, this can destroy many
red blood cells resulting to anaemia in the tropics both in pregnant and non-
pregnant individuals (Oliver and Olounfunto, 2012).
Anaemia, hypoglycemia, pulmonary oedema and secondary infections due
to malaria in full term pregnancy leads to problem for both the mother and
the foetus (Srinvas, 2015).
b. Chronic Diseases example HIV/AIDS: Anaemia has been shown to be the most
commonly encountered hematological abnormality in HIV positive patients
with estimates climbing as high as 95%. Anaemia has being identified as a risk
factor for early death in patient with AIDs (Bankole et al, 2011).
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Waweru et al (2009), stated that human immune deficiency virus and acquired
immune deficiency syndrome among pregnant women furthermore increase risk
for anaemia prevalence and severity. HIV infected women have low
haemoglobin (Hb) and are more likely to be anaemic than the uninfected. The
HIV/AIDs infection is therefore associated with low Hb and higher anaemia is
multifactorial and may include the infiltration of the bone marrow suppression
by the virus, the use of myelosuppressive drug like zidovudine or drugs that
prevent the utilization of folate like cotrimazole decrease production of
erythropoietin, red cell destruction as a result of antibiotics to red blood cells,
blood cell reaction and nutritional deficiences (WHO, 2009).
Hemolytic Anaemia: Hemolytic anaemia in pregnancy is a specific form of
anaemia occurring during the latter months of pregnancy or during pueperium.
Pregnancy-induced hemolytic anaemia is a rare maternal complication that
occurs during pregnancy and resolves soon after delivery. This is of unknown
aetiology and the only factor clearly associated with the anaemia is the gravid
state. characteristic of this problem is the absence of any identifiable immune
mechanism or intracorpuscular defects despite the use of specific and sensitive
complement-fixation techniques and assay of all red blood cell enzymes
(Monika et al, 2014).
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Hemolytic anaemia is rarely reported in literature but can be dangerous for both
fetus and mother (Gerburtshite, 2015).
The pathogenesis of this anaemia is still not known also the condition is not
homogenous. Hemolytic anaemia needs tireless diagnostic and appropriate
treatment for optimum maternal-fetal outcome (Monika et al, 2014)
Hemoglobinopathy: according to Lara (2014), hemoglobinopathies particularly
sickle cell anaemia, Beta-thalassemia, Alpha-thalassemia disease during
pregnancy can worsen maternal and perinatal outcomes. Pre-existing sickle cell
disease, particularly if severe increases risk for maternal infection (most often
pneumonia, urinary tract infectious and endometritis), pregnancy-induced
hypertension, heart failure and pulmonary infarction. Fetal growth retardation,
preterm delivery and low birth weight are common anaemia almost always
becomes more severe as pregnancy progresses. Sickle cell tract increases the
risk of urinary tract infection but is not associated with severe pregnancy related
complication.
2.7 PATHOPHYSIOLOGY OF ANAEMIA IN PREGNANCY
According to Evans et al (2010) anaemia is a disease in treatment of
haemoglobin and red blood cell. Anaemia is a relatively normal finding in
pregnancy. Plasma is the watery, non cellular component of blood in
30
pregnancy, there is an increase in plasma volume of blood in order to supply
oxygen and nutrients for mother and baby. There can be 20% increase in the
total number of red blood cell, amount of plasma increases even more
causing more dilution of those red blood cells in the body. A haemoglobin
level in pregnancy naturally lower to 10.5gmldl representing a normal
anaemia in pregnancy.
Nevertheless, the body needs a maximum amount of haemoglobin to supply
the oxygen needs of the body which it is lacking, the symptoms of anaemia
include:
 Feeling tired
 Short of breath at activity or rest
 A rapid heard rate and pale appearance of the skin.
 Light headiness or dizziness may occur when standing up quickly or
trying to physically exault, symptoms may occur because the body’s
oxygen requirement cannot be met by a decreased amount of
haemoglobin contained in the fewer number of red blood cells. If the
pregnant mother had heavy pre-pregnancy menstrual flow, she may be
anaemic entering pregnancy; a growing baby may make the anaemia
more pronounced. If there are two pregnancies close together, the
31
mother’s body may not yet have recovered, increasing its chances of
anaemia. It also can be difficult getting enough nutrition and iron with
morning sickness and the risk of anaemia in pregnancy is even greater
with multiple pregnancies such as twin or triplets.
2.8 EFFECTS OF ANAEMIA IN PREGNANCY
It has been clearly demonstrated that the anaemic pregnant woman is at
greater risk of death during the pre-natal period. About 500,000 maternal
deaths ascribed to childbirth or early post partum occur every year. Anaemia
is a major contributing or sole cause in 20-40% of such deaths. In many
regions, anaemia is a factor in almost all-maternal death (Fernada et al,
2014).
According to Sherma (2010), there is increase incidence of abortion, growth
retardation, abruption placentae and pre-eclanpsia in folate deficiencies
anaemia in pregnancy. Anaemia increases pre-natal risks for mothers,
neonates and increases overall infant mortality. The odds for fetal growth
restriction and low birth weight are tripled. The odds for preterm delivery
32
are more than doubled. Even a moderate hemorrhage in an anaemic pregnant
woman can be fatal (Vikram , 2015).
33
2.8.1 Effect of anaemia on mother
Women with mild or moderate anaemia are often asymptomatic, as anaemia
is detected on screening alone. As anaemia advances, the symptoms of
fatigue, irritability, generalized weakness, shortness of breath, frequent sore
throats, headache, brittle nails, pica, decreased appetite and dysphagia due to
postericoid oesophageal web may occur. Clinical signs of anaemia include
pallor, blue sclera, pale conjunctiva, skin and nail changes, leg oedema, gum
and tongue changes (Glossitis and stomatitis), tarchycardia and functional
heart murmur (Vikram, 2015).
2.8.2 Effect of anaemia on fetus and neonate
The basic principle of neonatal iron biology, is that it is prioritized to red
blood cells at the expense of other tissues including brain. When iron supply
does not meet iron demand, the fetal brain may be at risk even if the infant is
not anaemic. Although dietary deficiency may be contributory, the majority
of cases of iron deficiency anaemia in infancy and childhood is maternal
iron deficiency anaemia in pregnancy (Vikram, 2015).
Folate deficiency anaemia leads to megaloblastic anaemia and a number of
birth defects such as spinal bifida or low birth weight as folate plays
34
important role in development of healthy foetus, formation of spinal cord
(Aayesha, 2015).
Anaemia adversely affects cognitive performance behaviour and physical
growth of infants, pre-school and school aged children. Anaemia depresses
the immune status and increase the mortality and morbidity from infections
in all age groups. It adversely affects the use of energy sources by muscles,
thus the physical capacity and work performance of adolescent and adults
(Vikram, 2015).
2.9 CLINICAL MANIFESTATION OF ANAEMIA IN PREGNANCY
There may be no signs especially in mild anaemia, pallor glossitis and
stomatitis may occur as it progresses to moderate anaemia (Sharma et al,
2010)
Symptoms of anaemia during pregnancy can be mild at first and often go
unnoticed. However as it progresses, the symptoms worsen.
Some common symptoms of anaemia are;
 Weakness or fatigue
 Dizziness
 Shortness of breath
35
 Rapid or irregular heart beat
 Chest pain
 Pale skin, lip and nail
 Cold hands and feet
 Trouble concentrating
(American Pregnancy Association (APA), 2016).
Sharma et al, (2010) stated that there may be no symptoms especially in
mild and moderate anaemia. Patient may complain about feelings of:
 Weakness
 Exhaustion
 Lassitude
 Indigestion
 Loss of appetite
 Palpitation
 Dyspnoea
 Giddiness
 Oedema
 Congestive cardiac failure in severe cases
36
2.10 DIAGNOSTIC MEASURES IN ANAEMIA IN PREGNANCY
According to Ananya (2012), diagnosis begins with a detailed history,
physical examination and diagnostic test.
2.10.1 History Taking
The physician enquires about;
 Dietary habits to determine lack of vitamin B12 or folates in diet
 Menstrual patterns and history of heavy bleeding
 Bleeding ulcer as a result of aspirin medications
2.10.2 Physical Examination
 Palpitation of the abdomen for enlarged spleen or liver
 Auscultation for heart murmur to indicate heart failure. This occurs
when the heart is not pumping blood around the body efficiently
 A rectal examination that entails insertion of a lubricated gloved
finger into the rectum to detect rectal bleeding.
 Checking of the conjunctiva for pallor
37
2.10.3 Laboratory Diagnostic Test
Diagnosis of anaemia includes the following laboratory test
 Routine blood test for WBC
 Ferritin stores
 Blood test include Mean Cell Volume (MCV)
 Red blood cells Distribution Width (RDW)
 Reticulocyte count
 Vitamin B12 and folate levels in blood
 Bone marrow analysis
 Iron binding capacity
 Genetic test and electrophoresis of blood
2.11 RISK AND COMPLICATIONS OF ANAEMIA IN PREGNANCY
Monika et al, (2014), stated that anaemia in pregnancy has multi-factorial
aetiology. It has a common risk and complication for most developing
countries and major cause of morbidity and mortality rates.
2.11.1 Risk of Anaemia in Pregnancy
Risk for anaemia in pregnancy are more likely if they are;
38
 Strict vegetarians or vegans as a result of B12 deficiency
 Women who have celiac disease or crohns disease or have had weight
loss surgery where the stomach has been removed
According to Trevine and Heather, (2016), women are more likely to get
iron-deficiency anaemia in pregnancy if they;
 Have two pregnancy close together
 Have frequent vomiting because of morning sickness
 Are not getting enough iron from their diet and prenatal vitamins
 Have heavy menstrual periods before pregnancy
2.11.2 Complications of Anaemia in Pregnancy
Women with anaemia in pregnancy have been shown to have complications
such as;
 Maternal death
 Fetal death
 Premature delivery
 Low birth weight babies
 Susceptibility to infection
 Poor work capability/performance
 Babies with development problem

39
(Ilayley et al, 2016).
2.12 MANAGEMENT OF ANAEMIA IN PREGNANCY
2.12.1 Dietary Requirement
A modified diet rich in folate, vitamin B12 and iron is essential for the rapid
rise in haemoglobin level (Truptishirole, 2016).
Folate is commonly present in liver, kidney, spinach, cabbage, yeast, nuts,
fruits.
Vitamin B12 is exclusively present in foods of animal origin such as meat,
liver, eggs.
The recommended dietary allowance (RDA) of iron during pregnancy is
30mgs. Here are some foods rich in iron, food that provides 0.5-1.5mgs of
iron. They are green pears, chicken, broccoli, brussels, spouts, whole wheat
bread, dried apricots and raspberries.
Foods that provide 1.6-3mg of iron: baked potato with skin, kidney beans,
oatmeal, liver, raisons.
Foods that provide 3-12mgs of iron; oysters, spinach, fortified cereal, soya
bean flour, apples, figs, pears, almonds, carrot, black grapes, eating ripe
bananas mixed with honey daily are believed to increase the levels of
haemoglobin.
40
It is preferable to have most of the listed components (except meat) raw.
Cooking may destroy iron content by as much as half. Cooking with cast
iron pots can add 50-80% more iron to the food (Truptishirole, 2016).
2.12.2 Iron Supplementation
Iron supplementation is necessary in correcting existing iron deficiency in
pregnancy that is because dietary changes alone are not sufficient (Shaikh et
al, 2015)
If 120mg of supplemental iron per day is prescribed, recommend dose is
60mg tablet twice a day (National Academics of Sciences, 2016).
2.12.3 Transfusion
Severe or very severe anaemia requires the immediate hospitalization of the
woman and management of heart failure. Transfusion of packed cells. Once
the emergency is averted, the iron requirement is given as in mild to
moderate anaemia (Oliver and Olunfunto, 2012).
2.12.4 Intermittent Antimalarial Therapy
Intermittent preventive therapy refers to provision of two doses of an anti-
malarial drug (sulphadoxine pyrimathanine) to women during pregnancy,
through antenatal care services. Treatment of malaria in pregnancy by this
41
method has been shown to reduce the prevalence of both severe anaemia and
low birth weight infants. Insecticide-treated bed net use, is the key
intervention for malaria infection and has demonstrated a positive effect on
the prevalence of malaria and anaemia in pregnant women (Tsegaye et al,
2014).
2.13 PREVENTIVE MEASURES
Anaemia often emanates from nutritional and disease related causes such as
malaria or intestinal helminth infections along with iron deficiency anaemia
should be addressed through an integrated package of interventions
including;
 Universal daily iron, folic-acid supplementation for pregnant women
using the recommended doses of 60mg of iron and 400mg of folic acid
 Micronutrient fortification of common consumed local food product such
as soya bean, crayfish, spinach, pumpkin and other leafy vegetables.
 Control of malaria in pregnancy by intermittent preventive treatment,
long-lasting insecticide treated bed net, indoor residual spraying and
artemisinin combination therapy.
42
 Control of hookworms though use of deworming preventive treatment
such as albendazole and mebenclazole as a routine of antenatal care
where hookworm prevalence in more than 20%.
 Optimal birth spacing of at least 2 years (USAID, 2008).
 Compulsory Haemoglobin estimation by cyanmeth haemoglobin method
using semi-auto analyser or photo cabrimeter at 14-16 weeks, 20-24
weeks, 26-30 weeks of pregnancy for all mothers (Annekure, 2010).
2.14 THEORITICAL FRAMEWORK
Nola Pender’s health promotion model guided the study. The rationale for
selecting Pender’s model is that it relates to health promotion and protection
in prevention of anaemia among pregnant women.
The health promotion model was designed by Nola Pender to be a
complimentary to models of health protection and it is directed towards
improving patient level of well being.
It defines health as a positive dynamic state rather than simply the absence
of disease.
Pender’s model focuses on three areas:
 Individual characteristics and experience
 Behaviour specific cognitions and effect
43
 Behaviour outcomes
The theory notes that each person has unique personal characteristics and
experiences that affect subsequent actions. The set of variables that
behaviour specific knowledge and affect have important significance and the
variables can be modified through nursing actions.
In modification of behaviours and personal characteristics of individuals
through nursing actions, the health promotion model makes four
assumptions:
i. Individuals seek actively to regulate their own behaviour: This
assumption can be related to the attendance of antenatal clinics by the
pregnant women in order to know the best behaviour or action to be
taken during pregnancy for a good pregnancy outcome and delivery.
ii. Health professionals such as nurses constitute a part of the interpersonal
environment which exerts influence on people through their life span.
Nurses have vital role to play in the prevention of anaemia in pregnancy
among women of childbearing age.
Roles of PHC workers in Promotion of Health in Pregnancy
 The nurse creates a good rapport with the pregnant woman in order to
enable her understand the importance of improving her health and
44
personal hygiene to prevent anaemia in the course of pregnancy, she also
enlightens her on the importance of active and passive exercise in the
course of pregnancy for a good outcome. She also emphasizes on the
importance of taking the medications given to her at antenatal, which
includes iron supplement, folates, vitamin supplement, antihelminthics
and antimalarial therapy as they improve and promote her health and that
of the foetus during and after pregnancy.
 The nurse assist the pregnant woman in decision making, acquiring skills
and knowledge to improve health for better pregnancy outcome, skills,
like preparing available nutritious food can be carried out in the antenatal
clinic for better understanding.
iii. Self initiated reconfiguration of the person environment: Interactive
patterns are essential to changing behaviour. This encourages patient to
share her learned ideas with her family in order to involve them in
promoting her health behaviour and social lifestyle
iv. Individuals in all their bio-psycosocial complexity interact with the
environment progressively transforming the environment as well as being
transformed overtime. As the pregnant women are being enlightened,
through the knowledge and skills acquired during the antenatal clinic, it
influences their environment as their personal hygiene, environmental
45
sanitation and eating habit are progressively improved. This help to
curtail the prevalence of anaemia in pregnancy and its effect.
The health promoting behaviour is the endpoint or action directed toward
attaining a positive health outcome such as optimal well being, personal
fulfilment and productive living. This behaviour should result in improved
health, enhanced functional ability and better quality of life at all stages of
development (Petiprin, 2015).
46
CHAPTER THREE
RESEARCH METHODOLOGY
3.0 INTRODUCTION
This chapter gives the complete methodology adopted in conducting this
research work.
It contains subsection which include the research design, research settings,
target population, sampling techniques and instrument for data collection
and ethnical consideration.
3.1 RESEARCH DESIGN
The research design used is retrospective survey?
3.2 RESEARCH SETTING
The research study was carried out at General Hospital Karshen Kwalta
Rigasa. General Hospital Rigasa was established January – 2010 by Former
Governor Late Patrick Ibrahim Yakowa. The Hospital had working staff
strength 109 with 6 Wards, the Hospital has the following Department
47
Medical Record, Laboratory, Dental Clinic, Pharmacy, X-ray/Sonography,
Social Well Fare, Antenatal Clinic.
3.3 TARGET POPULATION
The target population of this research were the entire population of pregnant
women who came to the hospital with anaemia from January 2012 to
December 2016, two hundred (200) clients were seen and all were used.
3.4 THE SAMPLE TECHNIQUE AND SAMPLE SIZE
The sample technique used in this research was the stratified sampling
technique. The sample comprise of pregnant women who had anaemia in
pregnancy that came to General Hospital Rigasa from January 2012 to
December 2016 all the available data were classified according to the years
recorded. Thus 200 cases were used.
3.5 INSTRUMENT FOR DATA COLLECTION
The data was collected through the past medical records of anaemia in
pregnancy between January 2012 to December 2016.
3.6 VALIDATION OF INSTRUMENT AND ITS RELIABILITY
48
The instrument for data collection was validated by my supervisor and a
specialist in the obstetric field.
3.7 METHOD OF DATA COLLECTION
Data was collected using the hospital past medical records. The records were
sorted out and appropriate information, were grouped according to the
affected years 2012 to 2016.
3.8 METHOD OF DATA ANALYSIS
The data was analyzed using appropriate table, bar charts, pie-chart and
presented in percentages. The component angle of pie chart

No of respondent
¿ X
Total no of respondent
0
10 0 C
ETHICAL CONSIDERATION
The researcher assumed all responsibility to protect the interest of
respondents as well as maintain has professional integrity.
Permission was sought first from the hospital management before gaining
access to the instrument.
49
There was not contact with the patients because past medical records were
used. All data and information collected were treated as confidential and
strictly used for the purpose of the research.
INCIDENCE OF ANAEMIA IN PREGNANCY AMONG WOMEN OF
CHILD BEARING AGE FROM 2012 -2016 IN GENERAL HOSPITAL
RIGASA, KADUNA
BY
KHADIJA IDRIS
MAT. NO B.M.P/010/045
SUBMITTED TO
THE DEPARTMENT OF BASIC MIDWIFERY

SCHOOL OF BASIC MIDWIFERY TUDUN WADA,
KADUNA
50
IN PARTIAL FULFILMENT OF THE REQUIREMENT OF
NURSING AND MIDWIFERY COUNCIL OF NIGERIA FOR
THE AWARD OF “REGISTERED MIDWIFE” CERTIFICATE
SEPTEMBER, 2017
51
CHAPTER THREE
RESEARCH METHODOLOGY
3.0 INTRODUCTION
52
This chapter describes the research design, setting, target population,
sampling technique, introduction for data collection, validity/reliability of
instrument, method of data collection, analysis and ethical consideration that
were employed in the study.
3.1 RESEARCH DESIGN
A descriptive survey design was used to address the study objectives. This
design was chosen because it helps to best describe, analyse and interpret the
variables that exist. A survey by means of a self-administered questionnaire
was used by the researcher to collect data to ultimately describe the effect of
anaemia in pregnancy among women of childbearing age (16-45 years).
3.2 SETTING
This research study was carried out in Primary Health Centre Television
Kaduna. The Primary Health Centre was set up by the state government to
make essential health care accessible to individuals and families in
Television Community.
3.3 TARGET POPULATION
53
The target population was hundred pregnant women attending antenatal
clinic at the Primary Health Centre Television Kaduna.
3.4 SAMPLING TECHNIQUE
The women are selected on accidental sampling technique. Accidental
sampling technique involves the use of most readily available persons. This
saves time and helps the researcher obtain accurate results.
3.5 INSTRUMENT FOR DATA COLLECTION
The instrument for data collection used for this study was a set of structural
questionnaire designed to obtain relevant information on the subject matter
from (100) hundred respondent.
3.6 VALIDITY/RELIABILITY OF INSTRUMENT

An initial pilot study was conducted to ascertain the validity and reliability
of the research instrument (questionnaire). The questionnaire was first
administered to a small population comprising of 10 women before it was
distributed to the target population
The questionnaire was however found to be reliable and valid, as
respondents understood all the questions, what it was intended for. The
54
questionnaire was designed and constructed by the researcher and given to
the project supervisor for approval.
3.7 METHOD OF DATA COLLECTION
Copies of questionnaire were distributed to the respondents by the researcher
100 copies were distributed and all were collected back as effort was made
by the researcher to collect all questionnaire, the researcher stayed with the
respondents to put them through and collect the questionnaire after been
filled properly.
3.8 METHOD OF DATA ANALYSIS
The data was organized and presented in a descriptive statistical method.
Tables, percentages and charts were used for analysis. The questionnaire
was analysed and tabulated. This technique was chosen due to its simplicity
for data analysis
The formular for the percentage that will be used to analyse the researcher
questions are as follows:-
x 100
P= ×
N 1
Where P = Percentage
x = Frequency of particular response
55
N = Total number of respondents
3.9 ETHICAL CONSIDERATION
During the process of research study, consent was obtianed from relevant
authorities, full explanation and confidentiality were carried out to protect
respondents against any negative consequence.
CHAPTER FOUR
DATA PRESENTATION AND ANALYSIS
4.0 INTRODUCTION
In this chapter, the response of the sampled population was carefully
examined and analyzed to unveil the opinion and viewpoints of the
respondents on the effect of anaemia in pregnancy.
A carefully structured questionnaire was prepared and distributed to the
respondents comprising the only pregnant women attending ANC at Bichi
General hospital,Kano.
56
In order to achieve the correct answers to the research questions collected
through the questionnaire appropriate analysis are presented below
4.1 DATA ANALYSIS
Table 4.1: Age distribution of respondents.

Age group (year) Respondents Percentage (%)
16-21 16 16
22-27 44 44
28-32 32 32
33-45 8 8
Total 100 100
The representation of the above data shows that 16 (16%) respondents were
chosen the age of 16-21years, 44 (44%) were within 22-27 years while 32
respondents (32%) are between 28-32 years and 8 (8%) respondents were 33
to 45 years.
This shows that most of the respondents were between the age of 22-27
years which is 44%.
Table 4.2: Religious Status of Respondents.

Religious Respondents Percentage
(%)
Muslim 100 100
57
Christian Nil Nil
Others Nil Nil

Total 100 100
The above table shows that 100 respondents were Christian while represent
100% of the sample population no percentage of the respondents are
Muslims nor practice other religion.
Table 4.3: Distribution according to marital status.
Status Respondents Percentage

(%)
Married 90 90
Single 10 10
Divorced Nil Nil
Total 100 100
The table above indicates that 90 (90%) respondents were married, 10 (10%)
unmarried while nil percentage of the respondents indicated divorced. This
indicates that most of the respondents are married.
58
Table 4.4: Respondents Educational status.
Educational Status Frequency Percentage (%)
Primary 44 44
Secondary 28 28
Tertiary 8 8
None 20 20
Total 100 100
Table 4.4 above shows that 44% of the respondents completed primary
school, 28% secondary, 8%. Tertiary while 20% had none.
This indicates that most of the respondents completed primary school
Table 4.5: Distribution according to the number of times respondents

have been pregnant.
Number of Pregnancy Frequency Percentage (%)

Once 76 76
Twice 8 8
Thrice 0 0
Four times and above 16 16
Total 100 100
The above table indicates that 76 (76%) respondents have been pregnant
once, 8 (8%) twice, no percentage of respondents have being pregnant thrice
while 16 (16%) respondents have being pregnant four times and above.
59
This depicts that the highest number of respondents which 76 (76%) have
been pregnant once.
Table 4.6: Respondents’ occupation.
Occupation Frequency Percentage (%)

Civil servant 8 8
Business woman 76 76
House wife 16 16
Students Nil Nil
Total 100 100
The above table indicates that 8 (8%) respondents are civil servants, 76
(76%) are business women, 16 (16%) are housewife and none of the
respondents are students. This explains that majority of the respondents are
business women.
60
ANSWERING RESEARCH QUESTIONS
RESEARCH QUESTION ONE: WHAT IS THE INCIDENCE OF
ANAEMIA IN PREGNANCY IN PRIMARY HEALTH CENTRE
TELEVISION KADUNA?
Table 4.7: How did you come to know of the term anaemia?
Options Frequency Percentage (%)
On television 20 20
On radio 15 15
In hospital / clinic 30 30
Newspaper magazine 7 7
Never heard 28 28
Total 100 100
61
The above table indicates that 20 (20%) respondents have heard of anaemia
television 15 (15%) from the radio, 30 (30%) in the hospital/clinic, 7 (7%)
newspaper/magazine while 28 (28%) respondents have never heard of the
term anaemia. This shows that most of the respondents have heard of the
term anaemia from the hospital/clinic.
Table 4.8: Have you been diagnosed with anaemia in pregnancy?

Yes 36 36
No 64 64
Total 100 100
The above table depicts that 36 (36%) respondents have been diagnosed with
anaemia in pregnancy while 64 (64%) have not been diagnosed. This
indicates that most respondents had not been diagnosed with anaemia in
pregnancy.
Table 4.9: What are the signs of anaemia in pregnancy?

Dizziness 10 10
Pale skin, lip nail 38 38
Chest pain 8 8
62
Tiredness 12 12
All of the above 32 32
Total 100 100
The above table indicates that 10 (10%) respondents suggested that dizziness
is a sign of anaemia, 38 (38%) said, pale skin, lip and nails, 8 (8%) said
chest pain 12 (12%) suggested tiredness and 32 (32%) said all of the above.
This indicates that majority of the respondents are of the opinion that
dizziness, pale skin, lip and nail, chest pain and tiredness are signs of
RESEARCH QUESTION TWO: WHAT ARE THE POSSIBLE
CAUSES OF ANAEMIA IN PREGNANCY?
Table 4.10 What causes anaemia in pregnancy?

Poor nutrition 20 20
Diseases 27 27
Severe bleeding 13 13
Total 100 100
63
The above table indicate that 20 (20%) of the respondents are of the opinion
that poor nutrition causes anaemia in pregnancy, 27 (27%) suggested
diseases, 13 (13%) went for severe bleeding and 40 (40%) respondents went
for all of the above. This implies that majority of the respondents said poor
nutrition; diseases and severe bleeding are causes of anaemia in pregnancy.
Series 1
Figure 4.1: A bar chart showing causes anaemia in pregnancy.
Table 4.11 What are the factors that predisposes women to anaemia
during pregnancy?

Poverty 50 50
Ignorance 30 30
Poor child spacing 5 5
Nutritional deficiency 15 15
Total 100 100
64
Table 4.11 analysis indicated that 50 (50%) of the respondents are of the
opinion that poverty is a factor that predisposes women to anaemia during
pregnancy, 30 (30%) respondents suggested ignorance 5 (5%) went for poor
child spacing and 15 (15%) said nutritional deficiency. It is clearly seen that
majority of the respondents said poverty is the factor that predisposes
women to anaemia in pregnancy.
Series 1
Figure 4.2: A bar chart showing factors that predisposes women to

Table 4.12: What diseases are commonly found in your community that
leads to anaemia in pregnancy?
Malaria 48 48
65
HIV/AIDS 32 32
Sickle cells disease 15 15
Worm infestation 5 5
Total 100 100
The table above indicates that 48 (48%) respondents suggested malaria, 32
(32%) went for HIV/AIDS, 15(15%) opted for sickle cell anaemia and 5
(5%) said worm infestation. This implies that majority of the respondents are
of the opinion that malaria is the disease that is commonly found in their
community that leads to anaemia in pregnancy.
Figure 4.3 a linear graph showing the disease that are commonly found
in the community that leads to anaemia to pregnancy.
66
Table 4.13 Late attendance to antenatal clinic increase the risk of

Strongly agree 62 62
Agree 34 34
Disagree 4 4
Strongly disagree - -
Total 100 100
Table 4.13 analysis indicated that 62 (62%) of the respondents strongly
agree that late attendance to antenatal clinic increase the risk of anaemia
during pregnancy, 34 (34%) respondents agrees, 4 (4%) respondents
disagree. This implies that majority of the respondents strongly agree that
late attendance to antenatal clinic increase the risk of anaemia in pregnancy.
RESEARCH QUESTIONS THREE: WHAT ARE THE EFFECTS OF
ANAEMIA IN PREGNANCY?
Table 4.14 Can anaemia pregnancy affects the foetus?

Yes 98 98
No 2 2
67
Total 100 100
The table above indicates that 98 (98%) respondents are of the opinion that
anaemia in pregnancy can affect the foetus while 2 (2%) respondents said
anaemia in pregnancy cannot affect the foetus.
It can be deduced for the analysis that majority of the respondents are of the
opinions that anaemia in pregnancy affects the foetus.
Table 4.15: If yes, what are the effects of anaemia in pregnancy on the
foetus?

Premature birth 20 20
Low birth weight 26 26
Mal-development 10 10
No idea 4 4
Total 100 100
The table above indicates that 20 (20%) respondents suggested premature,
with 26 (26%) suggested low birth weight, 10 (10%) said all of the above
and 4 (4%) had no idea.
68
This means that majority of the respondents (40%) said that the effects of
anaemia in pregnancy on the foetus, were premature birth, low birth weight
and mal-development.
no idea; Sales; 4; 4% premature birth; Sales; 20;

20%
premature birth
all of the low birth weight
above; Sales; maldevelopment
40; 40% all of the above
no idea
low birth weight; Sales; 26;
26%
maldevelopment; Sales; 10; 10%
Figure 4.4: A Bar chart showing the effects of anaemia in pregnancy on

the foetus.
Table 4.16: What are the effects of anaemia in pregnancy on the

mother?
Miscarriage 10 10
Maternal susceptibility to ill 15 15
health
Death 20 20
Total 100 100
69
The table above indicates that 10 (10%) of the respondents were of the
opinion that miscarriages are the effects of anaemia in pregnancy on the
mother, 15 (15%) respondents said marital susceptibility to ill health, 20
(20%) went for death while 55 (55%) said all of the above. This implies that
the effects of anaemia in pregnancy on the mother are miscarriage, maternal
susceptibility to ill health and death.
RESEARCH QUESTION FOUR: HOW CAN ANAEMIA IN

PREGNANCY BE PREVENTED?
Table 4.17: What preventive measures would you taken to prevent

anaemia in
pregnancy?

Good nutrition 15 15
Proper child spacing 15 15
Attending ante natal clinic early 16 16
Treating malaria in pregnancy 19 19
No idea 35 35
Total 100 100
Table 4:17 Analysis indicates that 15 (15%) of the respondents are of the
opinion that good nutrition during pregnancy prevent malaria in pregnancy,
15 (15%) suggested proper child spacing, 16 (16%) said attending antenatal
70
clinic early, 19 (19%) respondents suggested treating malaria in pregnancy
while 35 (35%) respondent had no idea.
It can be deduced from the above analysis that majority of the respondents
have no idea of how to prevent anaemia in pregnancy.
Table 4:18 Iron supplements given in the antenatal clinic helps to:
Prevent anaemia in pregnancy 43 43
Promote food health of foetus 16 16
Promote good health of mother 17 17
None of the above - -
Total 100 100
Table 4:18 Analysis indicates that 43 (43%) of the respondents are of the
opinion of Iron supplement given in the ante natal clinic helps to prevent
anaemia in pregnancy, 16 (16%) said it helps to promote good health of
foetus, 17 (17%) said it helps to promote good health of mother, while 24
(24%) said all of the above. This implies that majority of the respondents are
of the opinion that iron supplement given in the antenatal clinic helps to
prevent anaemia in pregnancy.
Table 4:19: What health practices enhances the health of mother and
foetus in pregnancy?
71
Doing mild exercises 20 20
Eating nutritious food 27 27
Avoiding strenuous works 6 6
Practicing good hygiene 10 10
Total 100 100
The table indicates that 20 (20%) respondents said doing mild exercise
enhance the health of mother and foetus in pregnancy, 27 (27%) went for
eating nutritious food, 6 (6%) suggested avoiding strenuous work, 10 (10%)
respondents said practicing good hygiene, while 37 (37%) said all of the
above. This implies that most of the respondents (37%) are of the opinion
that doing mild exercise, eating nutritious food, avoiding strenuous work and
practicing good hygiene are health practices that enhances the health of
mother and foetus in pregnancy.
Table 4:20 What type of diet improve nutrition to prevent anaemia in

pregnancy?

Green vegetables 12 12
Meat and fish 9 9
Only rice 4 4
Fruits 14 14
72
Total 100 100
The above table indicates that 12 (12%) respondents said green vegetables
prevents anaemia pregnancy, 9 (9%) suggested meat and fish, 4 (4%) went
for only rice, 14 (14%) said fruits while 61 (61%) said all of the above. This
means that most of the respondents suggested that eating green vegetable,
meat and fish, rice and fruits improves good nutrition in pregnancy.
green vegetables; Sales; 12; 12%
meat and fish; Sales; 9;

9%
green vegetables
meat
only rice; and4;fish
Sales; 4%
only rice
all of the above;
Sales; 61; 61% fruits
all of the above
fruits; Sales; 14; 14%
Figure 4.5: A diagram showing the type of diet that improves nutrition
to prevent anaemia in pregnancy.
Table 4.21: Malaria is one of the causes of anaemia in pregnancy, what

is its mode of prevention?
73
Use of treated mosquito net 28 28
Intermittent anti-malarial 42 42
therapy 22 22
Use of insecticides 8 8
Use of local herbs
Total 100 100
The total above indicates that 28 (28%) of the respondents were of the
opinion that use of treated mosquito net would prevent malaria diary
pregnancy, 42 (42%) said intermittent anti-malaria therapy, 22 (22%) went
for use insecticide, while 8 (8%) went for use of local herbs. This shows that
majority of the respondents said intermittent anti-malaria therapy is the
mode of prevention of malaria during pregnancy.
74
Figure 4.6: Graph showing the mode of preventing malaria infection.
75
CHAPTER FIVE
DISCUSSION OF FINDINGS
5.0 INTRODUCTION
This chapter deals with the discussion of findings from the respondents at
the Bichi General Hospital, Kano on the effect of Anaemia in pregnancy
among women of child bearing age (16-45 years), the discussion of findings
in relation to other studies / literature review, its implication to nursing,
summary, conclusion, recommendation and suggestion for further studies.
5.1 MAJOR FINDINGS OF THE STUDY
The major findings of the study were;
 Thirty percent (30%) of the respondent have heard of anaemia from the
hospital/ clinic.
 Thirty six percent (36%) of the respondents have been diagnosed of
anaemia in pregnancy
 Forty percent (40%) of the respondents stated that poor nutrition,
diseases and severe bleeding are the causes of anaemia in pregnancy.
76
 Majority of the respondents (38%) said dizziness, pale skin, lip and nails,
chest pain, tiredness are all signs of anaemia in pregnancy
 Fifty percent (50%) of the respondents stated that poverty is a factor that
predispose women to anaemia in pregnancy.
 Forty eight percent (48%) of the respondents stated that malaria is a
disease that is commonly found in their community that predisposes
women to anaemia in pregnancy
 Sixty two (62%) of the respondents strongly agreed that late attendance
to antenatal clinic increases the risk of anaemia during pregnancy
 Ninety eight (98%) of the respondents stated that anaemia in pregnancy
can affect the foetus.
 Thirty five percent (35%) of the respondents had no idea on the
preventive measures of anaemia in pregnancy
 Forty percent (40%) of the respondents stated that premature birth, low
birth weight, mal-development are the effects of anaemia in pregnancy
on the foetus.
 Fifty five percent (55%) of the respondents stated that green vegetables,
meat, fish, rice and fruits are all diets when eaten prevent anaemia in
pregnancy.
77
 Thirty seven percent (37%) of the respondents indicated mild exercises,
eating nutritious food, avoiding strenuous work and practicing good
hygiene are health practices that enhances mother and foetus health in
pregnancy.
 Fifty eight percent (58%) which depicts majority of the respondents
indicates that malaria is a disease that causes anaemia in pregnancy.
 Forty two percent (42%) of the respondents agrees that intermittent anti-
malarial therapy is the mode of prevention of malaria.
5.2 DISCUSSION OF MAJOR FINDINGS IN RELATIONSHIP TO
OTHER STUDIES/LITERATURE REVIEW
From the analysis of the data in table 1 – 6 majority of the respondents age
ranges between 22 – 27 years, 90% married, 76% have been pregnant once,
and 76% of the respondents are business women.
RESEARCH QUESTION ONE: WHAT IS THE INCIDENCE OF
ANAEMIA IN PREGNANCY IN BICHI GENERAL HOSPITAL, KANO.
Based on the findings of this study, table 4.7 reveals that some of the
pregnant women, out of a hundred 36 had experienced anaemia in
78
pregnancy. This shows that anaemia in pregnancy is gradually on the
increase.
World Health Organization (WHO), (2011) estimated that 56% of all
pregnant women in developing countries are anaemic.
Geraldine, et al (2012) in agreement with the finding of a study carried out
in Nigeria, stated that the prevalence rate of anaemia among pregnant
women was found to be 62.6%.
Analysis by Geraldine, et al (2012) and World Health Organization, (2011)
also agrees with the research conducted at Primary Health Centre,
Television, Kaduna, that the incidence of anaemia in pregnancy among
women of childbearing is on the increase.
79
RESEARCH QUESTION TWO
WHAT ARE THE POSSIBLE CAUSES OF ANEAMIA IN
PREGNANCY?
The finding, in table 4.9 shows that anaemia is caused by poor nutrition,
diseases and severe bleeding. It was also discovered from the finding in
Table 4.10 that factors that predisposes women to anaemia during pregnancy
are ignorance, poor child spacing with poverty having the highest
percentage.
Broek, 2016 stated that nutritional deficiency is a major cause of anaemia in
pregnancy in many parts of the world. Also Oliver and Olounfunto, (2012)
stated that anaemia due to infections or disease causes ill health, fever, red
cell destruction, thereby leading to anaemia. According to Tsagaye et al,
(2014), malaria specifically attacks red blood cells, resulting to anaemia in
the tropics both in pregnant and non-pregnant individuals.
RESEARCH QUESTION THREE
WHAT ARE THE EFFECTS OF ANAEMIA IN PREGNANCY?
Table 4.14 and table 4.15 shows that anaemia in pregnancy has effect on the
mother and the foetus.
80
The effect of anaemia on the foetus include premature birth, low birth
weight, mal-development, while the effect of anaemia on the mother
include miscarriages, maternal susceptibility to ill health and death in severe
cases.
Aayesha, (2015) stated that folate deficiency anaemia leads to megaloblastic
anaemia and a number of birth defects, mal-development or low birth
weight.
Sherma, (2010) there is increase incidence of abortion, growth retardation,
abruptio placentae and pre-eclampsia in folate deficiency anaemia in
pregnancy. Aneamia also increases prenatal risk for mothers and neonates.
Also Fernanda et al, (2014) stated that about 500,000 maternal death
ascribed to childbirth occur every year and anaemia is a major contributing
or sole cause of such deaths.
RESEARCH QUESTION FOUR
HOW CAN ANAEMIA IN PREGNANCY BE PREVENTED?
As seen in table 4.16, good nutrition, proper child spacing, attending
antenatal clinc early, treating malaria in pregnancy would prevent anaemia
81
during pregnancy. From the finding, most of the respondents had no idea on
its prevention.
Findings also shows in table 4.19 that practicing good hygiene during
pregnancy, eating nutritious food, avoiding strenuous work are health
practices that would enhance mother and foetus health in pregnancy.
Fernanda et al, (2014) stated that anaemia often emanates from nutritional
and diseases related causes such as malaria or intestinal helminth infections
along with iron deficiency anaemia, it should be addressed through an
integrated package of intervention including control of malaria in pregnancy
by intermittent prevention treatment, optimal birth spacing, daily iron folic-
acid supplementation for pregnant women which should be given at the
antenatal clinics and eating good and nutritious food rich in iron and folate.
5.3 IMPLICATIONS TO NURSES
 Anaemia in pregnancy has a significant effect on both maternal and
foetal health it’s implication to nurses is based on improving knowledge
of nurses on the cause, effect and prevention of anaemia in pregnancy.
 Nurses are to create more awareness and educate women on local diet
and mode of preparation that will improve the nutrition of the pregnant
woman.
82
5.4 SUMMARY
The study was carried out in Bichi General Hospital, Kano state
It adopted a survey design and collected data from pregnant women at Bichi
General Hospital,Kano state. The total number of respondents used for the
study was one hundred (100).
The questionnaire developed by the researcher contained 22 questions
structured into section A and B. Written consent was obtained before
commencement of the research, 100 questionnaires were shared and all were
collected and analysed. Using percentages for answering the research
questions, the use of tables graphs, charts, for interpretation and presentation
of data.
In chapter one, the topic was briefly introduced as a general term meaning
low blood volume or deficiency in the number of red blood cell or in the
haemoglobin which leads to low oxygen carrying capacity causing clinical
manifestation such as tiredness, pallor, light headedness, colds and clammy
skin, dizziness and shortness of breath.
In chapter two various authors gave their opinion about anaemia in
pregnancy and causes which could to due to poor nutrition, infection,
83
malaria HIV/AIDS, haemoglobinopathies, hemorrhage, red blood cell
aplasia. Other features considered include, incidence classification, anatomy
and physiology of the blood, pathophysology, clinical features,
investigation, effects, risk and complications and prevention of anaemia in
pregnancy.
Chapter three deals with design used for the research which include a
descriptions survey design. The research setting, target population which
included pregnant women of child bearing age, 16 – 45 years attending the
Bichi General Hospital,kano. it also include the sample size used, which is
the questionnaire, the validity and reliability use to analyse the data.
Chapter four deals with the analysis, presentation and interpretation of data
collect by the researcher through questionnaires and those data were
represented on tables and graphs.
Chapter five deals with discussion of the findings made in the cause of the
study, the relationship with other nurses, action, summary conclusion and
recommendation.
From the foregone, it is seen that anaemia in pregnancy, can be eradicated
through good nutrition in pregnancy, preventing infections, prompt
84
treatment of malaria and other disease and early attendance to antenatal
clinic as well as child spacing.
5.5 RECOMMENDATION
For the reduction of the incidence of anaemia in pregnancy and its effects
among women of child bearing age (16 – 45 years), the following
recommendations were made based on the findings.
 There is need for nurses to stress more on awareness programmes to
enlighten the masses on the prevention of anaemia in pregnancy.
 The Government should provide more health facilities and employment
of qualified staffs at local communities. Medication should also be
provided at affordable cost in order to encourage pregnant women to
attend antenatal clinic, so as to reduce the complications of anaemia in
pregnancy.
5.6 CONCLUSION
85
This study revealed that the high rate of anaemia among pregnant women
and its effect or maternal and fetal growth was due to poor nutrition, malaria
infection and improper child spacing as well an lack of awareness.
The study shows that majority of women have no idea on the effect of
anaemia in pregnancy and its prevention.
This implies that nurses and other health workers, government and non-
governmental organization have much to do in the community to minimize
the incidence of anaemia in pregnancy due to its costly effects.
5.7 SUGGESTION FOR FURTHER STUDIES
From the data obtained from this study, the researcher made suggestion for
further studies are;
 The role of health education in the prevention of anaemia in pregnancy.
 The effects of good nutrition in pregnancy.
86
REFERENCES
Aayesha Hakin (2015) At Mom Junction Magazine on October 29, 2015
African Health Sciences (2008) Makerere University Medical School Nation

Center for biotechnology information Pike, Belhesda MD.
American Journal of Epidemiology (2016) Allen LH AM Jalin Nutrition 2000

Renewed by Rasmussen et al. J, Nur, 2001.
Blank C and Goonewardene M. (2014) American Society of hematology J. Med.
Bolhwel (2012) Purities Medical Journal.
Bruke, Motion-Brown (2011) Medical Surgical Nursing can USA.
Brunner, and Suddar this (2010) Textbook for Medical Surgical Nursing.
Burke, Mohn-Brown E. (2015) Medical Surgical Nursing Care USA: Published by

Julice Levin Alexander.
87
Dorserch H. (2013) P101 the Rising tide of Iron Deficiency Anaemia in
Pregnancy: Intravenous Iron Sucrose a viable alternative to the filed Iron
Folate Supplementation Program in India; J Gynecd Obstet 01/2009.
Sharvastava D, Satrupa, Mukherjec, Richa Lohana Sanjana Khemla (2013) Article

Volume 13 Published by Global Journals Inc (USA).
Ezechi Oliver and Olunfunto (2013) India Medical Journal.
Famakunwa T.T (2011) Synopsis of Medical Surgical Nursing Ehopma Nigeria for
Publisher.
Fedelma B. Rigby MD; Chief Editor Thomas Chih Chang (2015) Web. MD LLC.
Finch E. Joseph T. (2012) South Medical Journal.
Flema A. (2009) Article on America.
Geraldine C. Merch Manual. (2012) Article on the Pattern of Anaemia in Northern

Nigerian Pregnant.
Judith A.N, Erai AK, Vidy S, Savirhir R. (2008) Department of Maternal and
Child Health Nursing, College of Nursing Sultan Qabbos University Muscat
Oman.
Kalaivani K., Provenance and Consequences of Anaemia in Pregnancy, Indian J

Med. Res, November, 2009, Pp. 627-633.
Lara A Fried (2014) MSD Manual Merck Co, Inc. Kenilworth NJ USA.
Mayo Clinic Guide to a Healthy Pregnancy New York NY. Haper Collins
Publishers Inc.
88
Mohammed Yalwa G, Emanuel A, Ugwap, Gwargo C. (2013) Article on the
Pattern of Anaemia in Northern Nigerian Pregnant Women Department
Medical Laboratory Science Bayero University Kano.
Mustapha, Parsh and Sorach (2014) Indian J. Medical
Mustapha, R.O (2010) Textbook of simplified Anatomy and Physiology

Adewomin: Nigeria
New York Danforth’s Obstetrics and Gynecology Ninth edition Evaren scoot et al.
Oliver E and Olumfunto K. (2012) Management of Anaemia in Pregnancy, edited

by Donald Silverberry Published by Intech 29 February 2012.
Okeke P.U (2016) research Journal of Medical Sciences Published by Medical well
Publishers.
Ribmidieve, A. (2015) Health during Pregnancy Health Essay.
Sherma, J.B (2010) Anaemia in Pregnancy JIMSA October – December 2010 Vol.
23 No.4 Pp. 253 – 260.
Sifakis S. (2010) Department of Obstetrics and gynecology, University Hospital of

Heraklion, University of Crete Gracy.
Trevino and Heather M. (2016) Article of Health Encyclopedia Univeristy of

Rochester Medical Center.
Truphshirole, B (2016) Anaemia in Pregnancy. Best Dract Res Clinic Obslet

Gynaecol 2012: 26.2-24.
89
Tsegaye Ababiya (2014) Prevalence of Anaemia among Pregnant Women in
Ethopia and its Management. A review Int Res J Pharm 2014 Pp. 548-570.
Tsegaye, Kwarena Petal (2014) West African Medical Journal
Vikram Sinai T MD, (2014) University College Hospital, London UK Published

by Danla and David Bloomer.
WEB MED (2015) Article on Health and Pregnancy Published by Web.MD

Mobile News Letters.
Williams, J. Obstetrics (2015) Twenty-Seconded Cunningham F. Gay et al.
World Health Organization Stoltztus R, Dreyfuss M. Guidelines for the use of Iron
Supplement to Prevent and Treat Iron Deficiency Anaemia. International
Nutritional Anaemia Consultative Group (INACG).
90
Appendix I
91
APPENDIX II
RESEARCH QUESTIONNAIRE
School of Nursing,
St Gerard’s
Catholic,
Hospital,
Kaduna.
Dear respondents,
I am a final year student at the School of Nursing St Gerard Catholic
Hospital Kakuri Kaduna undertaking a research on “The effect of anaemia in
pregnancy among women of child bearing age (16 – 45years)” at the
Primary Health Care Centre Television Kaduna South.
Study the questions carefully and supply the necessary information as
required.
All information given will 8be used purely for academic purpose and will be
treated with absolute confidentiality.
Thanks for your co-operation.
92
SECTION A: PERSONAL DATA
Instructions: Please Tick (√) as appropriate.
1. Age-Range:
(a) 16 – 21 years [ ] (b) 22 – 27 years [ ]
(c) 28 – 32 [ ] (d) 33 – 45 [ ] (e) 45 and above [
2. Religion:
(a) Christian [ ] (b) Muslim [ ] (c) Others specify _____________
3. Marital Status:
(a) Married [ ] (b) Single [ ] (c) Divorced [ ]
4. How many time in total have you being pregnancy:
(a) Once [ ] (b) Twice [ ] (c) Thrice (d) Four Times and
Above
5. What level of education did you attain:
(a) Primary [ ] (b) Secondary [ ] (c) Tertiary [ ] (d)
None [ ]
6. Occupation:
93
(a) Civil Servant [ ] (b) Business Woman [ ] (c) House wife [ ] (d)
Student [ ]
7. How did you can to know of the term anaemia:
(a) On television [ ] (b) On radio [ ] (c) In hospital/clinic [ ] (d)
News paper/magazine [ ] (e) Never heard [ ]
8. Have you been diagnosed of anaemia in pregnancy?
(a) Yes [ ] (b) No [ ]
9. What are the signs at anaemia in pregnancy?
(a) Dizziness [ ] (b) Pale skin, lip and nail [ ] (c) Chest pin [ ] (d)
Tiredness [ ] (e) All of the above [ ]
10.What causes anaemia in pregnancy?
(a) Poor nutrition [ ] (b) Diseases [ ] (c) Severe bleeding [ ] (d) All of
the above [ ]
11.What are the factors that predisposes women to anaemia during
pregnancy?
(a) Poultry [ ] (b) Ignorance (c) Poor Child spacing [ ] (d) Nutritional
deficiency [ ]
12.What disease as commonly found in your community that leads to anaemia
in pregnancy?
94
(a) Malaria [ ] (b) HIV/AIDS [ ] (c) Sickle Cell anaemia [ ] (d)
Worm infestation
13.Late attendance to antenatal clinic increase risk of anaemia in pregnancy?
(a) Yes [ ] (b) No [ ]
14.Can anaemia in pregnancy affect the foetus?
(a) Yes [ ] (b) No [ ]
15.If yes what are the effects of anaemia in pregnancy on the foetus?
(a) Premature birth [ ] (b) Low birth weight [ ] (c) Mal-development
[ ] (d) All of the above [ ] (e) No Idea [ ]
16.What are the effects of anaemia in pregnancy on the mother?
(a) Miscarriages [ ] (b) Maternal susceptibility [ ](c) Death [ ]
(d) All of the above [ ]
17.What preventive measures would you take to prevent anaemia in

pregnancy?
(a) Good nutrition [ ] (b) Proper Child spacing [ ] (c) Attending
antenatal clinic early [ ] (e) No Idea [ ]
18. Iron supplement given in the antenatal clinic help to?

(a) Prevent anaemia in pregnancy [ ]
(b) Promote good health of foetus [ ]
95
(c) Promote good health of mother [ ]
(d) All of the above [ ]
19.What health practices enhances mother and foetus health in pregnancy?
(a) Doing mild exercises [ ] (b) Eating Nutritious food [ ] (c) Avoiding
Strenuous work [ ] (d) Practicing good hygiene [ ]
20.What type of diet improve nutrition to prevent anaemia in pregnancy.
(a) Green vegetables [ ] (b) Meat and Fish [ ] (c)Only rice [ ] (d)
Fruits [ ]
21.Malaria is one of the causes of anaemia in pregnancy what is its made of
prevention?
(a) Use of treated mosquito net [ ]

(b) Intermittent anti-malarial therapy [ ]
(c) Use of insecticides [ ]
(d) Use of Local herbs [ ]
22.If you notice signs of anaemia during pregnancy what do you do?
(a) Report to the hospital immediately [ ]

(b) Discuss it with a neighbor [ ]
(c) Take medications [ ]
(d) Take herbal concoction [ ]
96

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CHAPTER ONE

1.1 BACKGROUND OF STUDY

Anaemia is a condition in which the number of red blood cells or their

oxygen-carrying capacity is insufficient to meet physiological needs, which

Anaemia in pregnancy is defined as haemoglobin (Hb) level of less than

10gmldL, it is a quantitative or qualitative deficiency of Hb and red blood

cells in circulation resulting in reduced oxygen carrying capacity of the

blood (Geraldine et al, 2012).

Anaemia ranges from mild, moderate to severe. The World Health

Organization Pegs haemoglobin level of each of these types of aneamia in

pregnancy as 10.0-10.9g/dL – mild degree of aneamia, 7 – 9 g/dL as

severe (African Health Sciences 2008).

commonest type of aneamia in pregnancy (Sharma, 2010).

Anaemia in pregnancy is a common and serious problem in developing

commonly estimated to be in the range of 40 – 60% (Mohammed, et al,

Worldwide, 41.8% of pregnant women are anemic as compared with 30.2%

and Africa (57.1%). A large proportion of the 17.2million aneamia pregnant

in Burkina Faso, 72.7% in Benin and 75% in Gambia. Local prevalence

(Geraldine et al, 2012).

being nutritional deficiencies of iron and folate, parasitic disease such as

hookworm infestation and recently Human Immunodeficiency Virus

Infection (Geraldine et al, 2012).

In pregnancy, anaemia has a significant impact on the health of the foetus as

in General Hospital, Bichi kano.

1.2 Statement of Problem

despite the health education given to mothers on its prevention. Severe

anaemia is an important cause of morbidity and mortality in many parts of

associated with an increased risk of morbidity and mortality. In East Africa

Within the National Health Management and Information System in Nigeria,

anaemia is responsible for 17.8% of deaths in hospitalized children under

reported the prevalence of anaemia in children under five years to be 55% in

the burden of anaemia in children admitted at General Hospital, Bichi and

also information regarding associated factors is lacking. The increase in

mortality rate of pregnant women as a result of anaemia, motivated the

researcher to carry out a study on the incidence of anaemia in pregnancy

1.3 Objectives of the Study

i. To identify the causes of anaemia during pregnancy.

iii. To suggest ways of reducing the incidence of anaemia in pregnancy

women attending ANC clinic at Bichi, General Hospital,kano.

1.4 Significance of the Study

To improve the knowledge of the researcher, to create awareness on anaemia

in pregnancy as a life threatening situation and to educate women of child

preventive measure of anaemia in pregnancy.

moderate and severe anaemia, associated factors of severe anaemia as well

as morphological types of anaemia.

treatment protocols for proper management, follow up and care of children

with anaemia of all severity.

regarding anaemia in this population.

1.5 Research Questions

i. What are the possible causes of anaemia in pregnancy?

iii. How can anaemia in pregnancy be prevented?

childbearing age (16 – 45 years) at the incidence of aneamia in pregnancy

cooperative attitude of respondent and financial constraint.

1.7 Definition of Operational Terms

Anaemia: A deficiency in either quality or quantity of red corpuscles in the

blood that reduces the oxygen carrying capacity of the blood.

Antenatal: A period before birth

a vehicle by which variety of different substances are transported between