Study of Most Affected Age Group of Anemia among Pregnant Women Attending at El-Nuhud Teaching Hospital, West Kordufan State, 2019

Introduction

Anemia is common in both developing and industrialized nations. It affects about two billion people worldwide, i.e 30% of the inhabitants of the planet, according to data from the World Health Organization (WHO). Hence it is considered a public health problem. It greatly affects a person’s life, especially in its more severe forms. Anemia cause tiredness, weakness, malaise, and making routine tasks more difficult and painful. Anemia is a common problem in Africa, with prevalence ranging from 21.1% to 64.4%. It has significant impact on morbidity and mortality. The affected person may be drowsy, with less resistance to physical activities and deterioration in cognitive function and immunity [1].

Anemia defined as low blood hemoglobin concentration has shown to be public health problem that affects low- , middle- and high-income countries and has significant adverse impacts on social and economic development [2].

Globally anemia affects 32.4 million (38.4%) of pregnant women it is major public health problem in South Asia (48.7%) and Africa (46.3%) [3].

Pregnant woman’s anemia is a critical issue of public health due to its frequency, multifactorial nature and impact on pregnancy evolution. According to WHO estimates, 56 million pregnant women were anemic in 2005, more than half of them (57.1%) would be in Africa. It contributes to the 20% of maternal deaths related to indirect causes [4]. Anemia of pregnancy an important risk factor for fetal and maternal morbidity is considered a global health problem affecting almost 50% of pregnant women Achebe MM, et al. [5] Anemia is one of nutritional insufficiency disorder and affecting in Ethiopia the prevalence of anemia using a cut off level hemoglobin less than 11 g/dl (33% haematocrit) was 23.5% (72/ 306) [6]. In Africa the prevalence rate of anemia among antenatal women ranges from 35% to 72% while in Asia 37% to 75% [7]. Anemia is a global public health problem, but is more prevalent in pregnant women and young as stated by WHO [2]. Anemia among pregnant women worldwide was 38% and Sudan among countries considered with a moderate type of anemia during pregnancy [8]. In a cross – sectional study was conducted among pregnant women in Erbil city. The result of the study was showed the prevalence of manemia among pregnant women 46.2% [9]. In India anemia is the second most common cause and accounting for 20% of total maternal, the prevalence of anemia ranges from 33% to 89% among pregnant women and is more than women from 60% among adolescent girls with wide variations in different regions of countries Rajamouli j, et al. In fact over 20% of pregnant women in Europe are anemic during pregnancy [10]. The United Kingdom prevalence of maternal anemia in the antenatal period was estimated as 24 % in a recent cross-sectional study [11].

Objective

To determine the most affected age group of anemia among pregnant women attending at El Nuhud Teaching Hospital, West Kordufan State, Sudan-2019 Material & Method Study Design: A descriptive cross-sectional hospital- based study. Study area: El-Nuhud Teaching Hospital, West Kordufan State, Sudan.

Location: Study conducted at El-Nuhud Teaching Hospital, West Kordufan State - Sudan, 2019. El-Nuhud locality located between latitude 9.25-16.3o North and latitude 27-32o East it surrounded by many areas in the East Alkhewi locality and Abuzabad locality, in the West Wadbanda locality and in the South South Kordufan State, West Kordufan University, 2018. Building: El-Nuhud Teaching Hospital building were from stable material such as bricks and stone El-Nuhud Teaching Hospital, 2019. Health services: Regarding to health services there are 2governmental hospitals, 6 health centers, 12 private dispensaries and 8 private clinic El-Nuhud locality, 2018.

Education services: Education services in El-Nuhud locality include basic; higher secondary schools and universities; 194 basic, 15 higher secondary schools and two universities Education office, 2018.

Study Population: All pregnant women attending at El- Nuhud Teaching Hospital that fulfill the inclusion criteria during the data collection period was considered as study participants. The number population (327051) persons in El- Nuhud locality, (192961) of them as women, (78819) as age reproductive women and (13115) as pregnant women [17].

Sample Size: The sample size was determined by total coverage of pregnant women attending at El-Nuhud Teaching Hospital –West Kordufan State during three months (August- November 2019) to obtained 420 pregnant.

Methodology: Data collected using following tools: Questionnaire: In the form of administrated questionnaire filled by pregnant women attending at El-Nuhud Teaching Hospital, West Kordufan State. The questionnaire includes the following variables: -Socio-demographic factors (age, educational status, her husband education, her occupation, her husband occupation, family size, Gestation period and income).

Ethnical consideration: Permission was taken from the pregnant women with her full consent and permission was obtained from the Ministry of Health, West Kordufan State, also permission was taken from the Hospital Medical Manger as well as an ethnical approval from the Department of Epidemiology, Faculty of Public and Environmental Health, University of Khartoum. Results Laboratory Investigation: Hemoglobin level determined using Colorimeter hemoglobin and all laboratory investigations were done by technician’s laboratory. Pregnant women was considered anemic when her hemoglobin less than 11gm/dl according (WHO).

Data Analysis: Data entered and analyzed by using computer-based operation practically (Statistic Package for Social Science) version 20 and Chi - Square test (x2) was used to check the differences between variables. The (P.value) less than 0.05 considered significant.

Table 1: Educational level among pregnant women in relation to anemia at El-Nuhud Teaching Hospital, West Kordufan State, 2019. (n= 420) X2= 45.163 p = 0.000 Table 1 shows high affected in illiteracy (77.6%) followed by primary (57.1%), Khalwa (50%), secondary (42.8%), university (26.7%) and post university (0%). This significant relation between educational level for pregnant woman and anemia among pregnant women, (p value = 0.000).

Table 2 shows high affected with housewife (62.6%) followed by worker (60%) and professional (10%). This significant relation between pregnant women’s job and anemia among pregnant women, (p value = 0.003).

Table 3: Gestation period among pregnant women in relation to anemia at El-Nuhud Teaching Hospital, West Kordufan State, 2019. (n=420) X2 = 14.945 p= 0.001 Table 3 shows high affected in third trimester 7-9 months (68%) followed by second trimester 4-6 months (50%) and first trimester 1-3 months (45.7%). This significant relation between gestation period and anemia among pregnant women, (p value = 0.001).

Discussion

This a cross-sectional descriptive hospital-based study was conducted at El-Nuhud Teaching, West Kordufan State with an objective to study the prevalence of anemia among pregnant women in period (August- November) 2019.

This study shows that (77.6%), (57.1%), (50%), (42.8%) and (26.7%) anemic of pregnant women’s educational level, (illiteracy, primary, Khalwa, secondary and university) respectively, a significant associated between pregnant women’s educational level and anemia (p value = 0.000) and this similar with study of Nwizu EN, et al. [18] he revealed that had statistically association with low education attainment and anemia among pregnant women (p value = 0.006), and also agree with study of Jufar AH, et al. [19] they revealed had significant association between education status and anemia in pregnancy, (p value = 0.037).

The study shows that statistically significant association between her husband’s educational level and anemia in pregnancy, (p value = 0.000) and this agree with study of Krupp K, et al. [20] they revealed anemia in pregnant women was associated with lower education among spouses (p value = 0.021).

This study shows that (61.6%), (60%) and (10%) anemic of pregnant women’s job, (housewife, worker and professional) respectively, statistically significant between pregnant women’s job and anemia in pregnancy, (p value =

0.003), this similar with study of Krupp K, et al. [20] they carried out anemia in pregnancy was associated with lower household income (p value = 0.022).

This study shows that (68%), (50%) and (45.7%) anemic of pregnant women their gestation period (7-9 months), (4-6 months) and (1-3 months) respectively, a significant associated between gestation period and anemia among pregnant women (p value = 0.001) and this similar with study of Selim NAA, et al. [21] they revealed that had statistically significant association with gestation period and in pregnancy, (p value = 0.001), also similar with study of Khan NAM, et al. [22] they revealed significantly associated between gestation period and anemia in pregnancy ( p value < 0.05), also agree with the study of Melku M, et al. [23] they revealed that anemia was high at third trimester (18.9%), also similar with the study of Jufar AH, et al. [19] they revealed had significant associated between gestation period (third trimester, p value = 0.041) and anemia in pregnancy and similar with the study of Alene KA, et al. [24] they carried out pregnant women in the third and second trimesters were 3.32 times more likely to be 58 affected by anemia as compared to pregnant women in the first trimester.

Conclusions

This a cross- sectional descriptive hospital-based study was conducted with an objective to study prevalence of anemia among pregnant women attending at El-Nuhud Teaching Hospital, West Kordufan State, 2019. The prevalence among pregnant women (61%). The most affected age group was more than 45years old (100%).

The more causes associated with anemia among pregnant women were age group, family size, latrine inside house, pregnant women’s educational level, her husband educational level, pregnant women’s job, gestation period, parity, stillbirth history, abortion history, complication during pregnancy, problem health, meals per day poultry eggs intake, fruits and vegetables intake, follow up during pregnancy and folic acid and iron intake during pregnancy.

Recommendation

• Implementation of health education programmes at all levels, especially nutritional education to change dietary habits and feeding practices.
• Provision adequate of quality and quantity of nutrients and food during pregnancy
• Encourage family planning
• Provision universal, perfect, affordable and accessible antenatal care services.