CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Anaemia is a medical condition characterized by a reduction in the concentration of haemoglobin or the number of red blood cells below the normal range required to meet the body's physiological needs (Eltayeb et al., 2014). According to a report by the World Health Organization (WHO, 2008), approximately 1.62 billion people worldwide, representing 24.8% of the global population, were affected by anaemia. Women who are of reproductive age, particularly those who are pregnant or have not yet reached menopause, face an increased risk of developing anaemia. This increased vulnerability is associated with blood loss during menstruation, the additional nutritional demands of fetal development, and blood loss during childbirth and the puerperium. These factors may be further aggravated by inadequate nutritional intake, which is prevalent in many developing countries (Bick et al., 2016).

Anaemia constitutes a significant global public health concern, particularly among women of reproductive age and pregnant women in developing countries. Estimates indicate that approximately 56 million pregnant women worldwide are affected by anaemia. The overall prevalence of anaemia during pregnancy has been estimated at approximately 41.8%, although considerable variations exist across countries, ranging from about 5.7% in the United States to as high as 75% in The Gambia (Chathuranga, Balasuriya, and Perera, 2014). In the United States, the prevalence of anaemia among pregnant women has been reported to increase from approximately 1.8% during the first trimester to 27.4% in the third trimester. While some women enter pregnancy with pre-existing anaemia, others experience a progressive decline in their haemoglobin levels as pregnancy advances (Goonewardene et al., 2019).

In developing countries, anaemia during pregnancy has been reported to affect approximately 61% of pregnant women (WHO/FHE/MSM/93.5). The prevalence and severity of the condition are particularly high among pregnant women residing in malaria-endemic areas. Africa accounts for a substantial proportion of maternal deaths associated with anaemia. Furthermore, anaemia during pregnancy may adversely affect fetal development by increasing the risk of premature delivery, low birth weight, and perinatal mortality. These outcomes may arise from reduced oxygen supply to the placenta and the developing fetus (Idowu et al., 2015). Pregnancy increases the body's demand for iron and other essential vitamins because of the physiological changes associated with fetal growth and maternal development. When these nutritional requirements are not adequately met due to malnutrition, infections, or other underlying conditions, pregnant women become more susceptible to anaemia (Van den Broek, 2016).

Iron deficiency is one of the principal causes of anaemia worldwide. According to the World Health Organization (2019), approximately 2.15 billion people are affected by iron deficiency, with a substantial proportion experiencing deficiency severe enough to contribute to anaemia. Iron deficiency accounts for a considerable percentage of anaemia cases globally, while nearly half of the population in some developing countries experiences inadequate iron levels (Viteri, 2019). Globally, approximately 47% of non-pregnant women and 60% of pregnant women have been reported to experience anaemia. In developed countries, the average prevalence of anaemia during pregnancy is approximately 18%, and more than 30% of affected pregnant women have iron deficiency. Women from economically disadvantaged backgrounds are particularly vulnerable to the condition (Hughes, 2016).

Women of reproductive age and pregnant women are especially susceptible to negative iron balance and iron deficiency because of the increased physiological demand for iron associated with menstruation and pregnancy. The average daily requirement for absorbed iron among adult women and menstruating adolescents has been estimated at 1.36 mg and 1.73 mg, respectively. However, approximately 15% of adult women who menstruate require more than 2.0 mg of absorbed iron daily, while about 5% require as much as 2.84 mg. Among menstruating adolescents, the combined effects of menstrual blood loss and physical growth further increase iron requirements. Approximately 30% may require more than 2.0 mg daily, 10% may need up to 2.65 mg, and 5% may require as much as 3.2 mg. Meeting these requirements can be difficult, even when diets contain good-quality sources of iron (WHO, 2019).

Iron requirements increase considerably during pregnancy, particularly in the second and third trimesters. During the third trimester, the average daily requirement for absorbed iron may rise to approximately 5.6 mg, with an estimated range of 3.54–8.80 mg per day. This increased demand highlights the importance of establishing adequate iron reserves before conception and providing appropriate iron supplementation during pregnancy when indicated.

Iron deficiency during breastfeeding is often associated with the nutritional demands of pregnancy and blood loss during childbirth. Lactational amenorrhoea, which refers to the temporary absence of menstruation during breastfeeding, may help reduce iron loss. However, once menstruation resumes, the need for iron increases, particularly when breastfeeding continues. The risk of iron deficiency during pregnancy and lactation may therefore originate from inadequate iron stores before conception and insufficient replenishment during pregnancy.

Folate deficiency has also been documented during pregnancy and may contribute to nutritional anaemia, particularly when it occurs alongside iron deficiency. This problem is more common among economically disadvantaged populations whose diets rely heavily on grains and other foods with inadequate folate content. Prolonged cooking and repeated reheating may further reduce the folate content of some foods. Folate requirements increase substantially during the second half of pregnancy and may rise further in conditions involving increased red blood cell destruction, including malaria and certain haemoglobin disorders. Additionally, malabsorption conditions, which are relatively common in some tropical and socioeconomically disadvantaged populations, can interfere with the absorption of folic acid (WHO, 2019).

1.2 Statement of the Problem

Anaemia remains one of the most widespread public health challenges worldwide, with a particularly substantial burden in developing countries. According to the World Health Organization and UNICEF (2014), billions of people are affected by anaemia, and iron deficiency accounts for a significant proportion of cases. The global burden of iron-deficiency anaemia is concentrated mainly in Africa and parts of Asia, particularly South and Southeast Asia. These regions account for a considerable proportion of global mortality and disability-adjusted life years associated with the condition. Although estimates of anaemia prevalence vary across populations and settings, young children and women of reproductive age remain among the groups most affected (WHO, 2019).

Anaemia is also a significant nutritional deficiency in industrialized countries, although its prevalence is generally higher in developing countries. Data from the WHO global database indicate that pregnant women and children are among the populations most affected by anaemia. Reported prevalence estimates include approximately 48% among pregnant women and 46% among children aged 5–14 years in some global assessments. Overall, the burden of anaemia in developing countries is estimated to be three to four times higher than that in industrialized countries. In developing countries, the groups particularly affected include pregnant women, school-age children, and non-pregnant women, with reported prevalence estimates of 56%, 53%, and 44%, respectively. In developed countries, the reported prevalence is approximately 18% among pregnant women, 17% among preschool children, and 12% among non-pregnant women and older adults (WHO, 2019). Asia has been identified as a region with a particularly high burden of anaemia, followed by Africa. A substantial proportion of affected women live in the Indian subcontinent, where anaemia during pregnancy remains a major health concern.

Available data further indicate that anaemia affects a considerable proportion of pregnant women in African countries. For example, estimates suggest that up to 60% of pregnant women in Niger, particularly those living in rural communities, experience anaemia during pregnancy (WHO, UNICEF, UNFPA, and World Bank, 2015). The condition is commonly associated with deficiencies of iron, folic acid, vitamins, and other essential micronutrients. Consequently, women experiencing poverty, food insecurity, and malnutrition are at an increased risk of developing anaemia.

In Nigeria, nutritional anaemia represents an important contributor to adverse pregnancy outcomes and maternal health complications. It may contribute directly or indirectly to maternal and perinatal morbidity and mortality. Anaemia during pregnancy can impair fetal growth, increase the likelihood of low birth weight and premature delivery, and contribute to neonatal and perinatal deaths. Severe anaemia can also endanger the life of the mother, particularly when appropriate preventive and therapeutic measures are not provided promptly. Despite the significant burden of anaemia among pregnant women in Nigeria, interventions specifically addressing the condition as a major maternal health challenge remain insufficient in some settings. Furthermore, available estimates suggest that only about 58% of pregnant Nigerian women receive iron supplementation during pregnancy (WHO, 2019).

These concerns demonstrate the importance of improving awareness, early identification, prevention, and management of anaemia among pregnant women. Adequate knowledge of the causes, risk factors, symptoms, preventive measures, and available treatment options may encourage women to adopt healthier nutritional practices and make appropriate use of antenatal care services.

In view of these challenges, it is necessary to assess the level of awareness of anaemia among pregnant women in Ilaro community, Ogun State. Such an assessment would help identify possible gaps in knowledge, examine the preventive and management strategies adopted by pregnant women, and determine the challenges that may hinder effective management of the condition. The findings could provide useful information for improving maternal health education and strengthening interventions aimed at reducing anaemia-related complications among pregnant women in the study area.

1.3 Objectives of the Study

The general objective of this study is to assess the level of awareness of anaemia among pregnant women in Ilaro community, Ogun State.

The specific objectives are to:

1. Determine the level of awareness of anaemia during pregnancy among pregnant women attending antenatal care in Ilaro community.

2. Assess the strategies adopted by pregnant women in Ilaro community for the prevention and management of anaemia.

3. Identify the challenges encountered in the prevention and management of anaemia among pregnant women in Ilaro community.

1.4 Research Questions

The following research questions are formulated in line with the problem and objectives of the study:

1. What is the level of awareness of anaemia during pregnancy among pregnant women attending antenatal care in Ilaro community?

2. What strategies do pregnant women in Ilaro community adopt for the prevention and management of anaemia?

3. What challenges do pregnant women in Ilaro community encounter in the prevention and management of anaemia?

1.5 Significance of the Study

The findings of this study are expected to provide information on the ways pregnant women in Ilaro community access routine healthcare services during pregnancy, particularly for the prevention, identification, and management of anaemia. The information obtained may help nurses, midwives, and other healthcare professionals improve maternal healthcare delivery and contribute to reducing maternal morbidity and mortality. This may be achieved through the improvement of maternal health services and the promotion of their utilization through evidence-based health education programmes.

Furthermore, the findings may assist healthcare professionals in developing and implementing awareness programmes that emphasize the importance of maternal health and the utilization of antenatal care services. Increased awareness and appropriate use of these services can help pregnant women maintain optimal health throughout pregnancy and ensure the timely identification and management of conditions such as anaemia when they occur.

The study may also provide useful information for policymakers, health authorities, and other stakeholders responsible for maternal healthcare planning and implementation. The findings could serve as a reference for policy development and the formulation of interventions aimed at improving the prevention and management of anaemia among pregnant women.

In addition, the study may help identify existing gaps in knowledge and healthcare practices relating to anaemia. Information on its prevention, management, and control among pregnant women could enable healthcare providers to develop more effective educational interventions. Such interventions may improve women's understanding of the benefits of early detection, appropriate nutritional practices, prescribed supplementation, and regular attendance at antenatal clinics.

Finally, the study will contribute to the existing body of knowledge on maternal health and anaemia awareness. It may also serve as a useful reference material for students, researchers, and other scholars undertaking further studies on anaemia, maternal healthcare, and related public health issues.

1.6 Scope of the Study

This study is limited to assessing the level of awareness of anaemia among pregnant women in Ilaro community, Ogun State. It focuses on pregnant women's knowledge of anaemia, the prevalence of anaemia during pregnancy as relevant to the study, factors that predispose pregnant women to the condition, and the strategies adopted for its prevention and management.

The study also examines the challenges that pregnant women encounter in preventing and managing anaemia. The investigation is restricted to the selected study population and geographical area and does not seek to generalize its findings to all pregnant women in Nigeria without considering differences in location and population characteristics.

1.7 Operational Definition of Terms

Anaemia: A condition in which the concentration of haemoglobin or the number of red blood cells is insufficient to meet the body's physiological oxygen requirements. The threshold used to identify anaemia varies according to factors such as age, sex, altitude, smoking status, and pregnancy. During pregnancy, haemoglobin thresholds are interpreted in accordance with the applicable clinical guidelines and the stage of pregnancy.

Management: This refers to the coordinated delivery of healthcare interventions, monitoring, communication, and support provided to individuals with a health condition. It also includes the active participation of patients in self-care practices and adherence to recommended treatment and preventive measures.

Pregnant Women: Women who are carrying one or more developing fetuses in the uterus, from conception until the end of pregnancy. For the purpose of this study, the term refers to pregnant women within the first, second, or third trimester who fall within the study population in Ilaro community.