Abstract
Aim
Explored the factors that influence knowledge and attitudes toward anemia in pregnancy (AIP) in southeastern Nigeria.
Subjects and Methods
We surveyed 1500 randomly selected women who delivered babies within 6 months of the survey using a questionnaire. Twelve focus group discussions were held with the grandmothers and fathers of the new babies, respectively. Six in-depth interviews were held with health workers in the study communities.
Results
Awareness of AIP was high. Knowledge of its prevention and management was poor with a median score of 10 points on a 50-point scale. Living close to a health facility (p = 0.031), having post-secondary education (p <0.001), being in paid employment (p = 0.017) and being older (p = 0.027) influenced knowledge of AIP. Practices for the prevention and management of AIP were affected by a high level of education (p = 0.034) and having good knowledge of AIP issues (p <0.001). The qualitative data revealed that unorthodox means were employed in response to anemia in pregnancy. This is often delayed until complications set in. Many viewed anemia as a normal phenomenon among pregnant women.
Conclusion
AIP awareness is high among the populations. However, management is poor because of poor knowledge of signs and timely appropriate treatment. Prompt and appropriate management of AIP is germane for positive pregnancy outcomes. Anemia-related public education is an urgent need in Southeast Nigeria. Extra consideration of the diverse social development levels of the populations should be taken into account when designing new and improving current prevention and management programs for anemia in pregnancy.
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References
Abrams ET, Kwiek JJ, Mwapasa V, Kamwendo DD, Tadesse E, Lema VM, Molyneux ME, Rogerson SJ, Meshnick SR (2005) Malaria during pregnancy and foetal haematological status in Blantyre, Malawi. Malar J 4:39
Aluka C, Amadi AN, Kamanu CI, Feyi-Waboso WP (2001) Anaemia in pregnancy in Abia State University Teaching Hospital Aba. JOMIP 2:58–61
Balarajan Y, Ramakrishnan U, Özaltin E, Shankar AH, Subramanian S (2011) Anaemia in low-income and middle-income countries. Lancet 378(9809):2123–35. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0140673610623045
Bencaiova G, Burkhardt T, Breymann C (2012) Anemia—prevalence and risk factors in pregnancy. Eur J Intern Med [Internet]. European Federation of Internal Medicine. 23(6):529–33. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0953620512000957
Chikwendu MC, Nkemena B, Udigwe GO, Obiechina NJA, Nnaji G (2015) A study of risk factors for anaemia in pregnancy at the first antenatal clinic visit at Nnamdi Azikiwe University Teaching Hospital, Nnewi. Trop J Obstet Gynaecol 32:14–26
Dim CC, Onah HE (2007) The prevalence of anemia among pregnant women at booking in Enugu, South Eastern Nigeria. MedGenMed 9(3):11
Ekanem EI, Agan TU, Efiok EE, Ekott MI, Okodi E. (2010) A study of anemia in women with asymptomatic malaria parasitaemia at their first antenatal care visit at the General Hospital, Ikot Ekpene, Akwa Ibom State, Nigeria. Asian Pac J Trop Med. Hainan Medical College 3(7):567–70. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emed9&AN=2010407278\n http://eleanor.lib.gla.ac.uk:4550/resserv?sid=OVID:embase&id=pmid:&id=doi:10.1016%2FS1995-7645%252810%252960137-X&issn=1995-7645&isbn=&volume=3&issue=7&spage=567&pag
Federal Republic of Nigeria. Countdown strategy 2010 to 2015 (2010) Millennium Development Goals (MDGs) [Internet]. Abuja, Nigeria. Available from: http://www.sparc-nigeria.com/RC/files/4.2.2_Countdown_Strategy_2012_to_2015_Achieving_the_MDGs.pdf
Gangopadhyay R, Karoshi M, Keith L (2011) Anemia and pregnancy: A link to maternal chronic diseases. Int J Gynecol Obstet 115(Suppl. 1):S11–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22099433
Goonewardene M, Shehata M, Hamad A (2012) Anaemia in pregnancy. Best Pract Res Clin Obstet Gynaecol 26(1):3–24. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1521693411001593
Hoque M, Hoque E, Kader SB (2009) Risk factors for anaemia in pregnancy in rural KwaZulu-Natal, South Africa: Implication for health education and health promotion. South African Fam Pract 51(1):68–72. Available from: http://www.safpj.co.za/index.php/safpj/article/view/990/1396\n http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed9&NEWS=N&AN=2009233816
Idowu OA, Mafiana CF, Dapo S (2005) Anemia in pregnancy: a survey of pregnant women in Abeokuta Nigeria. Afr Health Sci 5(4):295–9
Lamina MA (2003) Prevalence of anemia in pregnant women attending the antenatal clinic in a Nigerian University Teaching Hospital. Nig Med Pract 44(2):39–42
Liu X, Associates A, Levin A, Makinen M, Day J (2003) OPV vs IPV: Past and Future Choice of Vaccine in the Global Polio Eradication Program. 2003
Matteelli A, Donato F, Shein A (1994) Malaria and anemia in pregnant women in Urban Zanzibar Tanzania. Ann Trop Med Parasitol 88:475–83
Msuya SE, Hussein TH, Uriyo J, Sam NE, Stray-Pedersen B (2011) Anaemia among pregnant women in northern Tanzania: prevalence, risk factors and effect on perinatal outcomes. Tanzan J Health Res 13(1):33–9
National Population Commission (2004) National policy on population for sustainable development [Internet]. Abuja, Nigeria. Available from: http://aafpng.org/wp-content/uploads/2015/07/National-Policy.pdf
Niguse O, Andualem M, Gobena T (2013) Magnitude of anemia and associated risk factors among pregnant women attending antenatal care in Shalla. Ethiop J Health Sci 23(2):10–5
Njagi JK, Magnussen P, Estambale B, Ouma J, Mugo B (2003) Prevention of anaemia in pregnancy using insecticide-treated bednets and sulfadoxine-pyrimethamine in a highly malarious area of Kenya: a randomized controlled trial. Trans R Soc Trop Med Hyg 97(3):277–82. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15228241
NPC & ICF International (2014) Nigeria Demographic and Health Survey 2013 [Internet]. Abuja, Nigeria, and Rockville, Maryland, USA. Available from: https://dhsprogram.com/pubs/pdf/FR293/FR293.pdf
NPC & ICF Macro (2009) Nigeria Demographic and Health Survey 2008 [Internet]. Abuja, Nigeria, and Maryland, USA. Available from: http://www.unicef.org/nigeria/ng_publications_Nigeria_DHS_2008_Final_Report.pdf
Nwizu EN, Iliyasu Z, Ibrahim SA, Galadanci HS (2011) Socio-demographic and maternal factors in anaemia in pregnancy at booking in Kano, Northern Nigeria. Afr J Reprod Health 15:33–41
Okafor CB, Rizzuto R (1994) Women as health care providers: views of maternal practice and services in Nigeria. Stud Fam Plann 25(6):353–61
Okeibunor JC (2010) Community-directed intervention and health care provision in Nigeria. Enugu Report No.: Policy Paper 12. Available from: http://dspace.africaportal.org/jspui/bitstream/123456789/33362/1/Policypaper12.pdf?1
Okeibunor JC, Orji BC, Brieger W, Ishola G, Otolorin E, Rawlins B, Ndekhedehe EU, Onyeneho N and Fink G (2011) Preventing malaria in pregnancy through community-directed interventions: evidence from Akwa Ibom State, Nigeria. Malar J 10(1):227. Available from: http://www.malariajournal.com/content/10/1/227
Okonofua F (2010) Reducing maternal mortality in Nigeria: An approach through policy research and capacity building. Afr J Reprod Health 14(3):9–13. Available from: http://www.ajrh.info/vol14_no3_Special/14_3_editorial_english.php
OlaOlorun DA, Owolabi MO, Owolabi DO (2012) Sociodemographic factors in anaemia in pregnancy in south-western Nigeria. S Afr Fam Pract 1726–426x 54(3):222–7
Onoh RC, Ezeonu OP, Joannes Umeora OU, Onoh TJP, Anozie BO, Onyebuchi AK (2014) Anemia in pregnancy in Abakaliki, South East Nigeria. Int J Gynaecol Obstet International Federation of Gynecology and Obstetrics 125(3):280. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24629786
Onyeneho NG, Idemili-Aronu N, Okoye I, Ugwu C and Iremeka F (2014) Compliance with intermittent presumptive treatment and insecticide treated bets use during pregnancy in Enugu State, Nigeria. Matern Child Heal J 18(5):1169–75. Available from: https://cdn1.sph.harvard.edu/wp-content/uploads/sites/1922/2015/09/Compliance-with-IPT-and-ITN-Use-During-Pregnancy-in-Enugu-State-Nigeria-1.pdf
Shulman LM, Mendelson E, Anis E, Bassal R, Gdalevich M, Hindiyeh M, Kaliner E, Kopel E, Manor Y, Moran-Gilad j, Ram D, Sofer D, Somekh E, Tasher D, Weil M, Gamzu R and Grotto I (2014) Laboratory challenges in response to silent introduction and sustained transmission of wild poliovirus type 1 in Israel during 2013. J Infect Dis 210(suppl 1):S304–14. Available from: http://jid.oxfordjournals.org/lookup/doi/10.1093/infdis/jiu294
UNECA (2013). Report on progress in achieving the Millennium Development Goals in Africa. Addis Ababa, Ethiopia. www.ubcmun.org/assets/eca-background-guide-ubcmun-2016.pdf
UNFPA (2012) Sub-Saharan Africa’s maternal death rate down 41 per cent. Eastand Southern Africa; Available from: http://esaro.unfpa.org/news/sub-saharan-africas-maternal-death-rate-down-41-cent
Van de Broek N, Munasinghe S (2006) Anaemia in pregnancy in Malawi.pdf. Malawi Med J 18(4):160–75
WHO (1996) Revised 1990 estimate of maternal mortality: A new approach by WHo and UNICEF. Geneva, Switzerland
WHO (2001). Iron deficiency anemia: assessment, prevention, and control: A guide for programme managers. [Internet]. Geneva. Available from: http://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdf
WHO (2011) Micronutrient deficiencies: Iron deficiency anemia Available from: http://www.who.int/nutriton/topics/ida/en/
Wimbley J, Graham DY (2011) Diagnosis and management of iron deficiency anemia in the 21st century. TherAdvGastroenterol 4(3):177–84
Acknowledgments
The Japanese Medical & Pharmaceutical Association provided financial support for the fellowship for the Takemi Program in International Health under which this manuscript was prepared. The Takemi Program in International Health, Department of Global Health & Population, Harvard TH Chan School of Public Health, provided technical support for the analysis of data and preparation of the manuscript. The University of Nigeria Nsukka provided administrative support that made the uptake of the Takemi Fellowship possible and consequently its use for the analysis of data and preparation of the manuscript.
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Onyeneho, N.G., Subramanian, S.V. Anemia in pregnancy: Factors influencing knowledge and attitudes among mothers in southeastern Nigeria. J Public Health 24, 335–349 (2016). https://doi.org/10.1007/s10389-016-0730-y
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DOI: https://doi.org/10.1007/s10389-016-0730-y