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).

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.
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”.

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.

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.

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 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,
-           Reduced intake as in poor diet, excessive sickness.
-           Diminished absorption due to gastro intestinal upsets, oral
-           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.

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.

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.

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.

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.

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.

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).

Anaemia in pregnancy has negative effects both to the mother and the bady.
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.

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.
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