|Year : 2016 | Volume
| Issue : 3 | Page : 332-336
The prevalence of anemia in pregnancy at booking in Abakaliki, Nigeria
Chidi OU Esike, Okechukwu B Anozie, Robinson C Onoh, Uchechi C Sunday, Okechukwu S Nwokpor, Odidika UJ Umeora
Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
|Date of Web Publication||8-Feb-2017|
Chidi OU Esike
Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi State
Source of Support: None, Conflict of Interest: None
Background: Anemia is the most common hematologic abnormality diagnosed in pregnancy. It continues to be a major health problem in many developing countries and is associated with increased rates of maternal and perinatal morbidity and mortality. We do not know the prevalence of anemia in our pregnant population at booking in Abakaliki despite the aforementioned devastation of anemia in pregnancy, hence the need for this study.
Materials and Methods: This is a retrospective study of 501 pregnant women who attended antenatal care at the Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria. Their antenatal case records were retrieved from the records department and the antenatal records unit of the hospital. All the relevant information were retrieved and analyzed.
Results: Using the World Health Organization criterion of 11 g/dl to define anemia in pregnancy, majority of our pregnant women at booking, 283 (56%) were anemic at booking with 196 (69.3%) being mildly anemic and 87 (30.7%) being moderately anemic. None of our patients was severely anemic. However, using the Lawson definition of anemia in pregnancy as a hemoglobin of below 10 g/dl as the cutoff, 16% of the pregnant women were anemic at booking with 75 (14.9%) being mildly anemic and 5 (6.3%) moderately anemic. None was severely anemic.
Conclusion: Anemia in pregnancy has an unacceptably high prevalence in our pregnant population at booking, and all efforts must be made to correct this widespread problem as early as possible using the most appropriate and expeditious means to avoid preventable calamities.
Keywords: Anaemia, Abakaliki, booking, Nigeria, pregnancy.
|How to cite this article:|
Esike CO, Anozie OB, Onoh RC, Sunday UC, Nwokpor OS, Umeora OU. The prevalence of anemia in pregnancy at booking in Abakaliki, Nigeria. Trop J Obstet Gynaecol 2016;33:332-6
|How to cite this URL:|
Esike CO, Anozie OB, Onoh RC, Sunday UC, Nwokpor OS, Umeora OU. The prevalence of anemia in pregnancy at booking in Abakaliki, Nigeria. Trop J Obstet Gynaecol [serial online] 2016 [cited 2019 Jun 19];33:332-6. Available from: http://www.tjogonline.com/text.asp?2016/33/3/332/199818
| Introduction|| |
Anemia is the most common hematologic abnormality diagnosed in pregnancy. It is said to be present when the blood hemoglobin value is below the reference value for the age, sex, and place of residence of the individual. Anemia in pregnancy is defined by the World Health Organization (WHO) as a hemoglobin concentration of <11 g/dl in a pregnant woman with 10–10.9, 7–9.9, and <7 g/dl classified as mild, moderate, and severe anemia, respectively. Most authors, however, consider anemia to be present in Africa in a pregnant woman if the hemoglobin concentration drops to below 10 g/dl or the hematocrit falls below 30%. Lawson found out that in African women, no untoward effects occurred in them or their babies at a hemoglobin level of 10 g/dl, hence his advocating for that value.
In many developing countries, endemic problems such as malaria, helminthic infections, together with problems of poor nutrition make anemia one of the most common pathologies in pregnancies. The United Nation's expert panel considered severe anemia (<7 g/dl) using WHO definition as an associated cause in up to half of maternal deaths worldwide. Anemia, therefore, continues to be a major health problem in many developing countries and is associated with increased rates of maternal and perinatal morbidity and mortality, premature delivery, low birth weight, and other adverse outcomes.,,,
Anemia which is reputed to be one of the most common nutritional deficiency diseases observed globally is estimated to affect more than a quarter of the world's population. It is estimated that 41.8% of pregnant women and close to one-third (30.2%) of none pregnant women are anemic worldwide. The prevalence of anemia in developing countries has been put at 33%–75%,,, with the predisposing factors noted to include grand multiparity, low socioeconomic status, malaria infestations, HIV infections, and inadequate child spacing among others., The prevalence of anemia in pregnant women varies from one region of the world to another, from country to country, and even in different parts of the same country. We do not know the prevalence of anemia in our pregnant population at booking in Abakaliki despite the aforementioned devastation of anemia in pregnancy. This necessitated this study.
| Materials and Methods|| |
This is a retrospective study of 501 pregnant women who attended antenatal care at the Federal Teaching Hospital Abakaliki, Ebonyi State in Southeast Nigeria. Their antenatal case records were retrieved from the records department and the antenatal records unit of the hospital. We included all pregnant women who booked in our center with the exclusion criteria including women with multiple pregnancies, hypertensive diseases of pregnancy, women who came with complaints related to anemia in pregnancy, renal and cardiac diseases, and all the women who bled during the pregnancy. All the relevant information including their sociodemographic characteristics - age, parity, occupation, gestational age at booking, etc., and the booking hemoglobin levels were retrieved and analyzed using tables and percentages. The WHO defined anemia in pregnancy as a hemoglobin level <11 g/dl while some authorities including Lawson defined anemia in the third world countries as an hemoglobin level of <10 g/dl in pregnancy. The hemoglobin of these women was analyzed using these two hemoglobin levels. Using the WHO criteria to judge anemia, only half, 218 of the women who were not anemic using Lawson's criteria, 421 were not anemic [Figure 1].
|Figure 1: Comparison of nonanemic pregnant women at booking using World Health Organization and Lawson criteria|
Click here to view
The Federal Teaching Hospital, Abakaliki, where this work was done metamorphosed from the former Ebonyi State University Teaching Hospital and The Former Federal Medical Center all in Abakaliki, Ebonyi State, Nigeria, in May 2012 to form a mega hospital and the only tertiary/teaching hospital in Ebonyi State of Nigeria. It serves Ebonyi State and the surrounding states such as Enugu, Cross River, Abia, and Imo States. It has an Obstetrics and Gynaecology Department that is run by Consultants and Residents with other health professionals. The department has five units and ten teams with two teams consulting each working day of the week. The hospital has 52 obstetric beds and an average yearly delivery of 2700.
Abakaliki, where this hospital is located, is the capital of Ebonyi State, one of the 36 states that make up Nigeria. It is located in the Southeast Geopolitical zone of Nigeria. From the 2006 Census, Abakaliki has a population of 278,560 made up of a healthy mix of civil servants, traders, businessmen and women, artisans, students, farmers, homemakers, etc. There are 146,467 females and 132,153 males. The health needs of this population are served by government-owned health centers, a missionary maternity hospital and privately owned hospitals, and maternity homes with the Federal Teaching Hospital as the only tertiary referral hospital.
| Results|| |
Majority of our patients, 227 (45.3%) as seen in [Table 1] were in the 26–30 years age bracket followed by the 31–35 years group, 131 (26.1%) were civil servants. The majority of our study participants, 215 (43%) were civil servants followed by the business/trading group, 92 (18.4%). Majority of our patients, 293 (58.5%) were in the para 1–4 group followed by primigravidas who were 177 (35.3%). Three hundred and six (70.6%) women booked at a gestational age of 14–27 weeks.
Using the WHO's criterion of 11 g/dl to define anemia, majority of our pregnant women at booking, 283 (56.5%) as seen in [Table 2] and [Figure 2] were anemic at booking with 196 (69.3%) of them being mildly anemic and 87 (30.7%) being moderately so. None of our patients was severely anemic. Two hundred and eighteen women (43.5%) of them were not anemic.
|Figure 2: Anemic and nonanemic pregnant women at booking using World Health Organization criteria|
Click here to view
However, using the Lawson's definition of anemia in pregnancy as a hemoglobin of below 10 g/dl as the cutoff, majority of our patients as shown in [Table 3] and [Figure 3], 421 (84%) were not anemic. Only 80 (16%) of the pregnant women were anemic at booking with 75 (93.75%) being mildly so and only 5 (6.25%) being moderately anemic. None of the women was severely anemic.
|Table 3: Degree of anemia in pregnant women at booking using World Health Organization criteria|
Click here to view
|Figure 3: Anemic and nonanemic pregnant women at booking using Lawson criteria|
Click here to view
The mean hemoglobin of pregnant women at booking in our center was 10.7 g/dl which using the WHO criterion is anemia but using the Lawson criteria is not.
| Discussion|| |
Anemia in pregnancy from this study is very prevalent at booking in our antenatal population. This is more so if we use the WHO's criterion of hemoglobin below 11 g/dl to define anemia. In this case, majority of our pregnant women, 283 (56.5%) were anemic at booking. This could be attributed to many of the risk factors for anemia such as multiparity, poverty, low socioeconomic status, and illiteracy that abound in third world countries , being present in our practice environment which is a third world country. The prevalence of anemia in our study population agrees with the quoted range of anemia in pregnancy in the developing countries of between 33% and 75%. Our prevalence of 56.5% agrees with the 55.3% that Lamina and Sorunmu got in their antenatal population in Shagamu  and the 58% got by Owolabi et al. in Ogbomosho. This similarity could be attributable to our practicing in the same environment in the same country with the pervading harsh socioeconomic conditions against the background of unrelenting poverty and diseases. It also agrees with the WHO's average estimate of anemia in pregnancy as 56% for pregnant women in developing countries. This could be attributable to the fact that our center is in Nigeria which is a developing country. Our prevalence also agrees with the 57% got by Okube et al. in Kenya. This similarity could be attributed to the fact that their work was done in a developing country like our own. Their operating environment was most likely similar to ours.
Our prevalence of 56.5% is, however, lower than the 64.1% got by Ezugwu et al. in Enugu, Southeast Nigeria, 76.5% in Abeokuta, Southwest Nigeria, and 67.2% in Ilorin, North Central Nigeria. Our prevalence of anemia being lower than that found in these centers could be because they are in a different environment from us.
However, our prevalence of 56.5% is higher than the 30% got in Gombe in Northern Nigeria  and 21.6% got by Alem et al. in Northwest Ethiopia. This may be due to the fact that their works were done in a different environment from ours.
In grading anemia in pregnancy using the WHO criterion, majority of our women who had anemia in pregnancy, 196 (69.3%) had mild anemia in pregnancy while 87 (30.7%) had moderate anemia in pregnancy. None had severe anemia in pregnancy. The majority of our anemic patients having mild anemia followed by moderate anemia are in agreement with the works of Adewara et al. in Ilorin  and Alem et al. in Ethiopia  in whose works the majority of their anemic women had mild anemia followed by moderate anemia. This similarity could be because their works were done in a similar developing country environment as our own.
Using the Lawson criteria of hemoglobin level below 10 g/dl as anemia, 87 (16%) of our pregnant women as shown in [Table 4] were anemic at booking. Although this prevalence for anemia in pregnancy is still considered high in a population of women not suffering from any pathological abnormality, it seems to be a more realistic definition of an abnormal situation such as anemia in our environment. It is less than the 283 (56%) women that were anemic using the WHO criteria. This lower number seems more realistic and a better pointer or definition of problem among pregnant women in this regard since most of these women did not have any complaint at booking. This lower more manageable number defining the problem of anemia in pregnancy will assist health practitioners concentrate more on and manage the smaller number of women that are defined as having anemia in pregnancy in our environment better with our limited resources. Our prevalence of 16% is lower than the 32.6% that Zhang et al., who used the 10 g/dl cutoff criteria for defining anemia in pregnancy in their work, found in their pregnant women in East China. This difference could be due to the fact that their work was done in a different environment.
Using the 10 g/dl cutoff mark for defining anemia, 75 (93.75%) of our pregnant women who had anemia at booking had mild anemia and only 5 (6.25%) moderate anemia. None of the women had severe anemia using this criterion.
The mean hemoglobin of pregnant women at booking in our center was 10.7 g/dl which using the WHO criteria is anemia but using the Lawson criteria is not. This our mean hemoglobin level is higher than the 10.32 g/dl got by Okube et al. in Kenya. This difference could be accounted for by the fact that we are from a different environment.
| Conclusion|| |
Anemia in pregnancy has an unacceptably high prevalence in our pregnant population at booking. All efforts must be made to correct this widespread problem as early as possible in pregnancy using the most appropriate and expeditious means in other to avoid preventable calamities to the mother and/or fetus. Even more preferable will be efforts being made to correct this anomaly even before women get pregnant. This study, which has all the limitations of a retrospective study, therefore reinforces the need for establishment of preconception clinics in our areas of practice as this will help correct anomalies such as this that lead to increased risk of maternal and neonatal morbidities and mortalities at the best time that they will have the best salutary effects.
Although there is no doubt, an urgent need for controlled randomized trials that will firmly recommend which of these cutoff marks that should be used in our practice environment to define anemia; there is a need to avoid conferring pathology on a physiological condition. This will not only lead to unavoidable anxieties in both the pregnant women and their obstetricians but will also lead to unnecessary medicalization of pregnancy with unnecessary blood transfusion and the attendant costs and complications. Since anemia is said to be present when the blood hemoglobin value is below the reference value for the age, sex, and place of residence of the individual, and though 10 g/dl seems to be a better and more realistic definition of anemia in our environment, there is presently need for further studies to enable a more evidence-based recommendation. This makes a clarion call to the Society of Gynaecology and Obstetrics of Nigeria to lead other stakeholders to work assiduously to lead us out of this morass urgently.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Arias F, Daftary SN, Bhide AG, editors. Haemoglobinic disorders in pregnancy. In: Practical Guide to High-risk Pregnancy and Delivery. New Delhi: Elsevier; 2008. p. 465-88.
Ekem I, Obed SA. Anaemia in pregnancy. In: Kwawukume EY, Emuveyan EE, editors. Comprehensive Obstetrics in the Tropics. Dansoman: Asante and Hittscher Printing Press; 2002. p. 297-302.
World Health Organization (WHO). The prevalence of anaemia in women: A tabulation of available information, WHO/MCH/MSM/92.2. Geneva, Switzerland: WHO; 1992.
Omigbodun AO. Recent trends in the management of anaemia in pregnancy. Trop J Obstet Gynecol 2004;21:1-3.
Walraven G. Treatment for iron deficiency anaaemia in pregnancy. RHL commentary (last revised 20 June 2007). The WHO Reproductive Health Library. Geneva, World Health Organisation.
Controlling Iron Deficiency Anaemia: A Report Based on an Administrative Committee on Coordination/Subcommittee on Nutrition Workshop. Nutrition State-of-the-art Series. Nutrition Policy Discussion Paper No. 9, Geneva. United Nations; 1991.
Mahomed K. Iron and folate supplementation in pregnancy. Cochrane database Syst Rev 2000 (2):CD001135.
van den Broek NR, Letsky EA. Etiology of anemia in pregnancy in South Malawi. Am J Clin Nutr 2000;72 1 Suppl:247S-56S.
WHO. WHO/CDC Worldwide Prevalence of Anaemia 1993-2005: WHO Global Database on Anaemia. Geneva, Switzerland: WHO Press; 2008.
Okube OT, Mirie W, Odhiambo E, Sabina W, Habtu M. Prevalence and factors associated with anaemia among pregnant women attending antenatal clinic in the second and third trimesters at Pumwani Maternity Hospital, Kenya. Open J Obstet Gynaecol 2016;6:16-27.
Ogunbode O. Anaemia in pregnancy. In: Okonofia F, Odunsi K, editors. Contemporary Obstetrics and Gynaecology for Developing Countries. Benin City, Nigeria. Women's Health and Action Research Center; 2003. p. 514-29.
Dim CC, Onah HE. The prevalence of anaemia among pregnant women at booking in Enugu South Eastern Nigeria. MedGenMed 2007;9:11.
Amadi AN, Onwere S, Kamanu CI, Njoku OO, Aluka C. Study on the association between maternal malaria infection and anaemia. J Med Invest Pract 2000;1:23-5.
Aluka C, Amadi AN, Kamanu CI, Feyi-Waboso PA. Anaemia in pregnancy in Abia state University Teaching Hospital Aba. J Med Invest Pract 2001;2:58-61.
Lamina MA, Sorunmu TO. Prevalence of anaemia in pregnant women attending the antenatal clinic in a Nigerian University Teaching Hospital. Niger Med Pract 2003;44:39-42.
Owolabi MO, Olaolorun DA, Owolabi AO. Socio-demographic factors in anaemia in pregnancy in South Western Nigeria. S Afr Fam Pract 2014;54:222-7.
Yesufu BM, Olatona FA, Abiola AO, Ibrahim MT. Anaemia prevention in pregnancy among antenatal clinic attendees in a general hospital in Lagos. Niger Q J Hosp Med 2013;23:280-6.
Ezugwu EC, Mbah BO, Chigbu CO, Onah HE. Anaemia in pregnancy: A public health problem in Enugu, Southeast Nigeria. J Obstet Gynaecol 2013;33:451-4.
Idowu OA, Mafiana CF, Dapo S. Anaemia in pregnancy: A survey of pregnant women in Abeokuta, Nigeria. Afr Health Sci 2005;5:295-9.
Adewara EO, Omokanye LO, Olatinwo AW, Durowade KA, Panti AA, Salaudeen AG. Prevalence of anaemia at booking in a semi-urban community in North-central Nigeria. Niger Postgrad Med J 2014;21:327-30.
Vanderjagt DJ, Brock HS, Melah GS, El-Nafaty AU, Crossey MJ, Glew RH. Nutritional factors associated with anaemia in pregnant women in Northern Nigeria. J Health Popul Nutr 2007;25:75-81.
Alem M, Enawgaw B, Gelaw A, Kenaw T, Seid M, Olkeba Y. Prevalence of anaemia and associated risk factors among pregnant women attending antenatal care in Azezo Health Center Gondar Town, North West Ethiopia. J Interdiscip Histopathol 2013;1:137-44.
Zhang Q, Li Z, Ananth CV. Prevalence and risk factors for anaemia in pregnant women: A population-based prospective cohort study in China. J Health Popul Nutr 2007;25:75-81.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4]