2.1 ANAEMIA
IN PREGNANCY
The prevalence has been widely investigated Royston
(1982, Okoka et al 2006). In developing countries the highest prevalence
of anaemia is found in south Asia and Africa where it is estimated that almost
two-third of pregnant women and one-half of non-pregnant women are anaemic
(Winikoff 1998).
Hemoglobin and haematocrit levels are the most
commonly assessed measurements for anemia (although they do not distinguish
among iron deficiency and other courses of anaemia (Srisupondit 1983) serum
ferritin is thought to be the single measurement most indicative of iron
additives and thus iron deficiency. Increase in dietary iron is unlikely to
meet iron requirements during pregnancy. The daily food intake requirement for
iron in pregnancy range between 16.5mg and 35mg. daily iron intake of pregnant
women developing country like Nigeria is probably less then this. It is
estimated that 14.6% of dietary iron intake is absorbed by otherwise well
nourished pregnant women. The absorption rates are probably lower in developing
countries where parasitic diseases and malaria are prevalence, although
utilization of iron may be more efficient in response to the greater needs
created by these diseases. Supplemental iron is generally recommended during
pregnancy in both developed and developing countries in order to correct
baseline iron deficiencies developing or worsening. (Okaka 2006).
2.2 CAUSES
OF ANAEMIA
There are various factors that when present will lead
to anaemia in the pregnant state. They include the following:
-
Inadequate intake of foods
-
Blood loses due to parasitic infestations and malaria
- Iron,
folic and vitamin A deficiencies.
- Haemoragic
conditions.
INADEQUATE INTAKE OF FOODS
Anaemia has been defined as a reduction below normal
in the number or red corpuscles per cubic millimeter of bloods. This can easily
happen when there is inadequate intake of balanced food and other micro
nutrients. “Deficiency in the diet may be due to ignorance, superstitions and
taboos which are part of our cultural heritage in the tropics”. A. 0. Ojo and
W. Briggs (2006). Inadequate food intake could be due to low socio-economic
status or poverty. Due to poverty the pregnant mother is not able to provide
for nutrition food for herself and her unborn child. WHO (1999) said that “Low socio-economic
status limits the access of girls and mothers to education, good nutrition as
well as to economic resources needed to pay for health services”. The low
socio-economic status are as a result of mismanagement in most of the
developing nations. According to Father Godfry Nzamujo “Africa is extremely
rich but very poor because we have not translated our
• Demographic
endowments into dividends; we are largely a
consumer society we are dancing the music of other
people”.
IGNORANCE, SUPERSTITIONS AND CULTURAL FACTORS
Also due to illiteracy and ignorance the pregnant
mother may not be able to select the food combination that is most appropriate
for her even when they are available. Most of the mothers are illiterates; they
were not given opportunity of going to school. Sun newspaper of 2nd May 2010
said that “early marriage unions violate the basic human rights of the girls by
putting them into a life of isolation, service and lack of education, health
problems and abuse”. An adage says ‘train a girl, train a nation”. The girl
child that are supposed to be sent to school are forced into early marriage.
The under nourished girl child turns into an anaemic pregnant mother and the
circle continues. The national gender policy said that women are only given
tasks that are related only to household management. Continued by saying that
this prevents the women from pursing their carriers or education.
Equally superstition and cultural taboos causes poor food selection. Due to superstitious belief some of the notorious foods are avoided. In some hinter lands where snails are plentiful, they do not touch it even though it is a first class protein, for the mere reason that if the pregnant women eats it, her baby would be gushing out saliva. Also due to cultural taboos, woman and girls are not permitted to eat certain parts of meat. In some cultures the girls are only allowed to eat when the boys might have finished eating.
Equally superstition and cultural taboos causes poor food selection. Due to superstitious belief some of the notorious foods are avoided. In some hinter lands where snails are plentiful, they do not touch it even though it is a first class protein, for the mere reason that if the pregnant women eats it, her baby would be gushing out saliva. Also due to cultural taboos, woman and girls are not permitted to eat certain parts of meat. In some cultures the girls are only allowed to eat when the boys might have finished eating.
BLOOD LOSES DUE TO PARASITIC INFESTATIONS AND
MALARIA
It is a known fact that malaria disease is endemic in
the tropical countries of which Nigeria belongs.
Malaria is a big problem in pregnancy: It is one of
the causes of maternal and infant mortality. Malaria is caused by plasmodium
parasites which has four species. The most important one for this study is the
plasmodiun falciparum which is the chief cause of malaria in adults. A. 0. Ojo
and W. Briggs (2006).
Malaria as a tropical disease is usually characterized
by general malais and hyperpyrexia which could result in abortion and
haemolysis of the red blood cells. A.0. Lucas also said that malaria is
characterized by fever hepatoniegaly splenornega,’, anaemia and even death in
many cases. Devidson lriekpen of this day newspaper equally said that “Inspite
of the Blackman’s vounted immunity to anopheles mosquito, kids and adults in
those places die everyday after succumbing to malaria attacks”. The effect also
of malaria on the new born or the foetus can not be over emphasized. G.J.
Ibralum said that: “In malarious areas, infections of the placenta with malaria
parasites results in low birth weight”. He also said that the incidence of
pregnancy anaemia in malarious areas are quite high. Apart from malaria
infestation, intestinal helminthes if it occurs frequently and in heavy doses
could also lead to anaemia in general but particularly during pregnancy. This
usually rampant within the low-socio economic group with poor hygiene
practices. David Morley et al said that owing to the lack of safe drinker water
and adequate sanitation intestinal parasites have high prevalence health
problems”. A.
0. Ojo and W. Briggs said that hookworm anaemia in pregnancy is very common in Uganda and other parts of East Africa.
0. Ojo and W. Briggs said that hookworm anaemia in pregnancy is very common in Uganda and other parts of East Africa.
IRON, FOLIC ACID AND VITAMIN A DEFICIENCIES
Iron deficiency Anaemia Pregnancy is a condition that
makes considerable nutritional demands on the mother M. Myles said that “During
pregnancy, the maternal plasma volume gradually expands by 50% while the red blood
cell increases by 25%”. A heamoglobin below 11g/dl is considered anaemic 90% of all anaemia in
pregnancy is due to iron deficiency curtsey (Iron deficiency web site).
Garey et al said that there is increased demand
for iron during pregnancy amounting to approximately 1, 230mg. he equally said
that. There is a saving of 220mg due to nine months amenorrhea, leaving the
amount of extra iron required at 1,010mg. There is reduction in ferritin
concentration. Iron deficiency could be due to various factors; reduced iron
intake could be due to poor diet or excessive morning sickness. Diminished
absorption. of iron could be due to reduced gastric acidity, lack of vitamin C
or dietary imbalance. Abnormal demand for iron could be due to multiple pregnancy,
multiparity, rapidly recurring pregnancy or haemorrhage in previous pregnancy.
The effects of iron deficiency anaemia on the pregnant
women cannot be over emphasized. Deficiency of iron affects the production of
some critical enzymes which affects various body system, decreases exercise
tolerance. Due to deficient iron in the body, any further loss during delivery
is usually disastrous. Iron deficiency equally makes the new infant prone to
anaemia within the first year of life and also to various infections.
FOLIC ACID DEFICIENCY ANAEMIA
Folic acid is needed in the formation of nucleic acid,
which is needed for increased cell growth of both mother and foetus, Deficiency
of folic acid could easily show in the bone marrow due to its constant production
of the red blood cell. Certain factors could easily lead to deficiency of folic
acid
- Improper food preparation destroys
folic acid eg 5mins cooking
of vegetative destroys the folic acid. (Folic acid
website)
- Chronic destruction of folic acid as in sickle cell disease,
- Chronic destruction of folic acid as in sickle cell disease,
thalassaemia;
- Reduced intake as in poor diet, excessive sickness.
- Reduced intake as in poor diet, excessive sickness.
- Diminished
absorption due to gastro intestinal upsets, oral
antibiotics.
- Diminished storage due to lack of vitamin C, hepatic diseases
- Diminished storage due to lack of vitamin C, hepatic diseases
- Excessive
demand as in multiparty, multiple pregnancy,
maternal
haemolytic conditions, Fetal haemolysis due to rhesus incompatibility and
sepsis.
- Diminished
utilization caused by analgesic soponfic antibiotics. Folio acid deficiency
anaemia is also known as megaloblastic or macrocytic anaemia. This means that
the blood cells are larger than normal.
VIT B12 DEFICIENCY ANAEMIA
Vitamin B12 deficiency anaemia is rare. It is the
least common torn of anameia. The predisposing factor to vitamin B12 is
pernicious anaernia. This is a condition whereby vitamin B12 cannot be absorbed
another the gut. Another malabsorption condition against vitamin B12lLeading to
its deficiency is tropical sprue.
HAEMORRHAGIC CONDITIONS
The Bailliere’s nurses’ Dictionary defined haemorrhage
as “an escape of blood from a ruptured blood vessel, externally or internally.
Haemorrhagic conditions of pregnancy otherwise is known as antepartum
heamonhage. It is defined by A.O. Ojo as “bleeding from the genital tract after
281h week of pregnancy and before the birth of the baby. There are two types of
antepartum haemonhage they include - Placenta praevia and placenta abruption.
PLACENTA PRAEVIA
This is also known as unavailable antepartum
haemonhage. It is bleeding from premature separation of the placenta which is
partially or wholly situated at the lower uterine segment. There are types 1-4
of placenta praevia. Types 3 and 4 could be dangerous if not well managed.
The initial bleeding are usually mild but subsequent
episodes could be profuse and dangerous. The initial episodes are regarded as
warning signs and are painless. M. Myles (2006) opined that “It is the profuse
bleeding that brings many illiterate patients to the hospital. Due to the low
lying placenta, the colour of the blood is usually bright red denoting fresh
bleeding.
PLACENTA ABRUPTIO
Another name for this type of bleeding is accidental
haemonhage it also means to tear apart. In other words it is bleeding from
premature separation of placenta situated at the upper uterine segment. “The
bleeding can either be reveled, concealed or both”. G. Sofoluwe at al. Garey at
al said that the aetiology of pacenta abruption is not known but that it is
associated with severe pre-eclampsia. If the bleeding is the concealed type,
the outcome could be more disastrous because it could not be estimated and
there may be delay in diagnosis M. Myles said that if the bleeding is much,
that fetal death is common; and the women may enter into hypovolaemic shock.
ABORTIONS
Abortion is the expulsion of the products of
conception before the 28th week of pregnancy Ojo, A.O. Briggs E. (2006) Abortions
could either be spontaneous or induced. The induced abortion could be
therapeutic or criminal. The criminal abortion could also be septic and runs
the risk of heavy bleeding. Criminal abortions and its consequences has been
one of the courses of maternal mortality. WHO (2005) in one of their write ups
said that “a woman living in a developing country faces a risk of death 250
times greater if she has to seek services from an untrained, unskilled,
abortionist”.
Thomas Basket (2003) said that “recent estimates suggest that around 15% of more than 500,000 pregnancy related deaths in the developing countries each year may result from complications of unsafely induced abortions and some reports put the figure higher”. Abortions could also develop into habitual putting the women into a state of constant anaemia due to frequent blood less.
Thomas Basket (2003) said that “recent estimates suggest that around 15% of more than 500,000 pregnancy related deaths in the developing countries each year may result from complications of unsafely induced abortions and some reports put the figure higher”. Abortions could also develop into habitual putting the women into a state of constant anaemia due to frequent blood less.
2.3 PREVENTION
OF ANAEMIA IN PREGNANCY
Intervention to reduce iron deficiency anaemia in
developing countries among pregnant women have included oral and parenteral
supplementation, food fortification and simultaneous malaria prophylaxis. While
food fortification provides a partially long-term method to improve the iron
status and has been relatively successful throughout the world.
Although it is possible to give iron in large doses
intramuscularly and intravenously, these approaches are not advisable public
health strategies because of their serious and potentially total side effects
such as anaphylaxes of HIV infection and hepatitis. Recent supplementation
studies of pregnant women have shown substantial reduction in anaemic (Up to
50%) and improve haemoglobin level (Up to 10-15% increase in mean values or approximately
lg/dl associated with daily supplements of 120-240mg iron and 5mg folic acid
during pregnancy (Flemmy 1974).
2.4 HEALTH IMPLICATION OF ANAEMIA IN PREGNANCY
Anaemia in pregnancy has negative effects both to the
mother and the bady.
TO THE MOTHER:
The aneamic pregnant mother would present various
signs and symptoms. She would suffer from weakness, breathlessness, low grade
fevers, ankle aedema, pallor, cough among others. She would not be able to take
care of her family. A.O. Ojo opined that anaemia in pregnancy “increases the
incidence of abortion, premature labour and intrauterine death of the foetus
with the delivery of a macerated foetus”.
The mother with anaemia in pregnancy may also go into
heart failure which she may not survive. She is also prone to puerperal sepsis.
Garey et al said that urinary or genital tract infection is twice more common
in anaemic mothers. A. 0. Lucas equally said that there is increase in post
partum maternal mortality due to haemorrhage. Due to the lowered immunity
caused by anaemia to the post partum mother, she is prone to infection which
may lead to blocked tubes. This in turn would put the women into secondary
infertility.
TO THE BABY
As anaemia in pregnancy affects the mother negatively,
it also affects the foetus in utero even after it is born if alive. As earlier
mentioned, the foetus may be aborted, born prematury or may altogether be still
born.
G.J. Ebrahim said the perinated loss in anaemic
mothers are more than twice than in non anaemic mothers. Pregnancy with anaemia
in situ causes under nutrition to the factus. M. Myles said that “The high
foetal loss rate in severe anaemia in pregnancy may be related to intra-uterine
hypoxia”. i.e. reduced oxygen supply to the foetus. She continued by saying
that low birth weight babies in anaemic mothers are 12.7% more, while still
births about l47per 1000 births. The baby born by an anaemic mother is also
prone to anaemia within the 1st year of life. The child is equally prone
to various childhood infections due to lowered immunity.