ASSESSMENT OF THE PREVALENCE AND ASSOCIATED RISK FACTORS OF ANAEMIA AMONG INTERNALLY DISPLACED PREGNANT WOMEN IN THE MUEA COMMUNITY

ABSTRACTS

Background: Anaemia is a public health problem and women in the reproductive age are among the most affected population. Its consequences include; low birth weight, and maternal mortality. Internally displaced pregnant women (IDPW) have a unique risk of developing anaemia due to often limited diet, new infection, overcrowding and inadequate sanitation and hygiene. Aim: This study aimed to assess the prevalence and associate risk factors of anaemia among internally displaced pregnant women in the Muea community. Methods: A cross sectional study was used to achieve the aim of the study. A total of 100 internally displaced pregnant women were enrolled in this study. A pre-tested structured questionnaire was used to collect relevant information on anaemia in pregnancy. The hemoglobin levels measured using a portable Hb meter (URIT, medical electronic Co., Ltd,China)). Data was entered in Excel version 10 and analyzed using SPSS 25. A chi square test was used to establish the association between variables. Statistical significance was set at P<0.05. Results: The prevalence of anaemia among IDPW was 51.0% ( 95% CL: 45.8-55.7)  and significantly associated with the inability of IDPW to eat balanced diet, low income, low level of education, trimester of pregnancy and poor adherence to ANC visits. Conclusion: The prevalence of anaemia was significantly high. There are still some maternal and health system related factors predisposing IDPW to anaemia. Based on these findings, policy makers should make ANC completely free for IDPW (including all the tests done at initiation and hematinic supplements). Also, IDPW should be empowered financially and intellectually so as help them eat well and follow ANC.

CHAPTER ONE

INTRODUCTION

1.1 Background

Anaemia is defined as having an abnormally low haemoglobin concentration. The low concentration of haemoglobin results in inefficient oxygen transport and leads to fatigue, loss of learning potential and economic productivity. In its severe form, is a life threatening condition. The prevalence of anaemia, defined by low haemoglobin or hematocrit, is commonly used to assess the severity of iron efficiency in a given population. In order to define anaemia, a criterion is applied according to age and gender group. In pregnant women, a  haemoglobin below 11.0g/dl or hematocrit below 33% is considered as anaemia. (Seal et al., 2005).

In pregnancy, infections are a key cause of anaemia and can be prevented by sleeping under a bednet and taking intermitlent preventive treatment (IPTP) for malaria, deworming pills and iron folic acid (IFA) supplements. In 2011, 54% of pregnant women in Cameroon consumed 90 or more iron folic acid tablets. Despite this, the prevalence of anaemia among pregnant women over years (2013, 2014, 2015, and 2016) has tend not to change (49.80%, 49.60%, 49.40%, and 49.30%, respectively) (WHO, 2016).

In Africa the prevalence of anemia is estimated to be about 45% in Uganda, 20% in Ghana and 30% in Nigeria (WHO). In Cameroon prevalence of anemia among pregnant women was reported at 49.300% in December 2016 the data reached an all-time high of 56.700% in 1991 and a record low of 49/300% in 2016. Prevalence of anemia in pregnant women 1% data remains active status in Census and Economic Information Center (CEIC) and is reported by World Bank. At the Muea Sub-Divisional medicalized centre, anaemia is one of the leading cause of maternal and fatal mortality and morbidity rate. Out of 10 pregnant women (in which 7 are the internally displaced) about 7 are suffering from anemia. (Muea sub-divisional medicalised centre, 2020).This project aimed at assessing the prevalence and associated risk factors of anemia among IDPs pregnant women is based on determining the Prevalence and associated risk factors of aneamia thereby bringing out some of the reasons why this health threatening condition is high among them.

The upsurge in hostilities has compounded pre-existing vulnerabilities for women, girls and children in Cameroon’s English –speaking regions.           No fewer than 21,000 people have fled to neighbouring Nigeria, according to the United Nations Office for the coordination of Humanitarian Affaires (OCHA), while in the South-West region alone, the international organization for Migration (IOM) estimates that 246,000 people have been internally displaced. In the South West region, entire communities have been raised by fire, leaving locals desperate for shelter and safety. Most internally displaced families have abandoned their homes, seeking shelter in nearby bush land or safer parts of the country. In some cases, women have been abandoned by their husbands who have joined the secessionist forces. As a result, approximately 68% of Cameroon’s IDPs are said to be lactating and pregnant women (UNHCR, 2018).

Anaemia during pregnancy is a public health problem especially in developing countries and is associated with adverse outcomes in pregnancy (WHO, 2017). The world Health Organisation (WHO) has defined anaemia in pregnancy as the haemoglobin (Hb) concentration of 11gld. According to WHO, anaemia is considered to be of a public health significance or problem if population studies find the anemia prevalence of 5.0% or higher. Prevalence of anaemia of greater than or equal to 40% in a population is classified as a severe public health problem. Global data shows that 56% pregnant women in low and middle income countries (LMIC) have anaemia. The prevalence of anaemia is highest among pregnant women in sub-Saharan Africa (57%), followed by pregnant women in South East Asia (48%) and lowest prevalence (24%) was found among pregnant women in South America. Tanzania Demographic and Health surveys reported a slight decrease in the prevalence of anaemia among pregnant women from 58% in 2004/05 to 53% in 2010 (WHO, 2000). Other studies conducted in Tanzania have reported a higher prevalence of anaemia among pregnant women: 68% in Dares Saloam and 47% in Moshi.

The causes of anaemia during pregnancy in developing countries are multifactorial; these include micronutrient deficiencies of iron, folate, and vitamin A and B12 and anaemia due to parasitic infections such as malaria and hookworm or chronic infections like TB and HIV (Hussein et al., 2011) contributions of each of the factors that causes anaemia during pregnancy vary due to geographical location, dietary practice, and season. But Sub-Saharan Africa inadequate intake of diets rich in iron is reported as the leading cause of anaemia among pregnant women (Meshnich et al., 2014).

Anaemia in pregnancy is reported to have negative maternal and child health effect and increase the risk of maternal and perinatal mortality (Allen, 2000). The negative health effects for the mother include fatigue, poor work capacity, impaired immune function, increase risk of cardiac diseases and mortality (Guyatt et al., 2004). Some studies have shown that anaemia during pregnancy contributes to 23% of indirect causes of maternal deaths in developing countries. 

Anaemia in pregnancy is associated with increased risk of preterm birth and low birth weight babies (Levy et al., 2005). Preterm and LBW are still the leading causes of neonatal deaths in developing countries like Cameroon contributing to 30% of the deaths (Guyatt et al, 2004). It has also been associated with increased risk of intrauterine deaths (IUFI) low APGAR score at 5 minutes, and intrauterine growth restriction (IUGR) which is a risk for stunting among children of less than two years (Gebre et al., 2015).

1.2 Statement of the Problem 

Globally 56 million (41.8%) pregnant women presented with anemia in pregnancy WHO, 2016. Low maternal risk perception, poor dietary practice and low adherence to iron tablets among pregnant women are major contributions for high burden of anaemia in pregnancy. (Oumer et al., 2014). The percentage of pregnant women who are anaemic in Cameroon is higher than global average, thus placing her among the countries with high incidence of anaemia in pregnancy (WHO, 2016).

According to (Nkwebong, 2015), the prevalence of anaemia in pregnancy in Cameroon is 49.3% and it is one of the major causes of maternal morbidity and mortality rate. Maternal anaemia is also associated with poor inter uterine growth and increased risk of preterm births, low birth weight and higher infant mortality rate which is an abnormal burden.

Despite anaemia having been identified as a global public health problem for several years, no rapid progress has been observed and the prevalence of the disease is still high globally among pregnant women (WHO, 2016). Strategies for the reduction and control of anaemia among pregnant women are one of the public health concerns worldwide. This study is deemed relevant given the vital role played by pregnant women in the prevention of anaemia in pregnancy.

1.3 Rationale

Very few studies have been done on the prevalence and associated risk factors of anaemia among internally displaced pregnant women in the media community. It is because of this reason that the researcher decided to carry out the study in order to get a clear picture of the prevalence associated risk factors of anaemia.

1.4 Research Questions

• What is the prevalence of anaemia among IDPW in the MUEA community?
• What are the risk factors of anaemia among IDPW women in the Muea community?