‘‘PREVALENCE OF ANEMIA AMONG PREGNANT WOMEN AND FACTORS ASSOCIATED WITH IT’’

A Term paper submitted to fulfill the partial requirement of BPH fourth semester

[Food and Nutrition-1 TPP 13.1]

SUBMITTED TO:

DEPARTMENT OF PUBLIC HEALTH,

LA GRANDEE INTERNATIONAL COLLEGE,

SIMALCHAUR-8, POKHARA

2012

SUBMITTED BY:

RAJESH KUMAR YADAV

SUNIL KUMAR ANURAGI

NAVEEN K. KHADKA

ARATI KUNWAR

SAGUN PAUDEL

Acknowledgement

The students of Bachelor of Public Health 4th semester of 2nd year like to express our humbly thanks to all those who have supported and helped us in accomplishing this term paper in the topic ‘‘PREVALENCE OF ANEMIA AMONG PREGNANT WOMEN AND FACTORS ASSOCIATED WITH IT’’.

We would like to convey our heartfelt thanks to all those who were directly or indirectly concerned with this and to all our well-wishers.

First of all we would like to thank our respected subject teacher Mr. Harikafle for giving us

opportunity to prepare this term paper. We are fully indebted to him for expert guidance, regular

supervision, untiring encouragement, inspiration and valuable suggestion and full support during

preparation of term paper.

This term paper is written in simple language, with every bit of necessary information related to

the topic so that studying independently also would not find any difficulties. We think that this

effort will help every individual to understand about the information of the related topic.

Table of content Acknowledgement ................................................................................................................................. 2

Table of content ...................................................................................................................................... 3

INTRODUCTION ....................................................................................................................................... 4

Objectives: .............................................................................................................................................. 5

General Objectives: ............................................................................................................................. 5

Specific Objectives: .............................................................................................................................. 5

Methodology: .......................................................................................................................................... 6

RESULT .................................................................................................................................................... 7

Finding and Discussion: ........................................................................................................................... 8

NEPAL .................................................................................................................................................. 9

Causes of Nutritional Anemia in South Asian Women ........................................................................ 10

CAUSES OF MATERNAL ANEMIA IN NEPAL ......................................................................................... 10

Nutritional Anaemia Prevention and Control on the Global Agenda ................................................... 11

Nepal ................................................................................................................................................. 11

Control of Anaemia............................................................................................................................ 11

CONCLUSION ......................................................................................................................................... 12

RECOMMENDATION .............................................................................................................................. 12

RFERENCES ............................................................................................................................................ 12

INTRODUCTION Nutritional status of people of Nepal is a public health problem all over the country. Even though progress made in nutrition programme but still problem in malnutrition, iron deficiency anemia and worm infestation among the children, adolescents and women. Anemia is defined as a low level of hemoglobin in the blood, as evidenced by a reduced quality or quantity of red blood cells. It has serious negative consequences, including increased mortality in women and children, decreased capacity to learn, and decreased productivity in all individuals.Anaemia is a global public health problem affecting both developing and developed countries with major consequences for human health as well as social and economic development. It occurs at all stages of life cycle, but is more prevalent in pregnant women and young children. It occurs when the concentration of haemoglobin falls below what is normal for a person´s age, gender and environment, resulting in the oxygen carrying capacity of the blood being reduced. Anaemia caused by iron deficiency is also a major public health problem in Nepal affecting all segments of the population. Anemia is one of the world’s most widespread health problems. It affects more than 2 billion people worldwide –onethirdof the world’s population – and is a significant public health problem throughout the developing world. In almost all developing countries, between one-third and one-half of the female and child populations are anemic. Anemia is the commonest medical disorder in pregnancy. This is particularly a major health problem in developing countries, where nutritional deficiency, malaria and worm infestation are common. A common etiological classification of anaemia identifies 3 major causative groups of anaemia; Nutritional, marrow disease and haemolytic disease. Nutritional anaemias are by far the most common type of anaemia worldwide and mainly include iron, folate and vitaminB12 deficiencies. Maternal anaemia in pregnancy is commonly considered a risk factor for poor pregnancy outcome and can result in complications that threaten the life of both mother and fetus. Current knowledge indicates that iron deficiency in pregnancy is a risk factor for preterm delivery subsequent low birth weight and possible inferior neonatal health.

Objectives:

General Objectives: • To find out the prevalence among pregnant women and risk factors associated with it.

Specific Objectives: • To identify the prevalence of anaemia among pregnancy period.

• To find out the control strategies of anaemia in pregnant women.

• To study about the factors associated with maternal anaemia.

• To identify the causes of anaemia in pregnant women.

Methodology:

To prepare this term paper Google was used to retrieve journal and articles. The

articles that were relevant were downloaded. To collect the further information advanced Google

search was also done and various books from library were also studied for the preparation of the

term paper. This report was prepared by using various secondary data sources available on

internet.

RESULT Anemia prevalence among the non-pregnant women is 34%, pregnant 42%. Anemia trend reducing compare to the last five years due to the advocacy, iron supplementation, distribution of deworming tablet and improvement of nutritional food habit among the people. Nepal drastically reduces the prevalence of anaemia in pregnant women in the past five years from 75% to 42%.

Prevalence of anemia and its contribution to maternal mortality (November 2009)

Coverage of iron distribution to expected pregnant women at national level highly increased during FY 2066/67. At the regional level the iron distribution coverage has highly increased in FWDR, MWDR followed by CDR and slightly increased in EDR and WDR.

Finding and Discussion: The World Health Organization (WHO) estimated that in developing countries, prevalence rates in pregnant women are commonly in the range of 40 to 60 percent. Around half of those with anemia, are suffering from iron deficiency anaemia, that is having deficient body iron stores but without frank anaemia; the latter are therefore considered to be at risk of iron deficiency anaemia. Folate deficiencies and other causes account for the major proportion of the remaining anaemia.There are more than 2 billion people in the world with anemia – one third of the world’spopulation. It has long been recognized that anaemia is a major public health problem especially among poorer segments of the population in developing countries.More than 350 million women and up to twice as many infants, children and adolescents, around the world suffer from nutritional anaemia. The WHO has estimated that the prevalence of anaemia in developed and developing countries in pregnant women is 14 percent in developed countries and 51 percent in

developing countries. For example in India, anaemia was estimated at 65 to 75 percent (WHO 2004).

NEPAL Anemia has been recognized as a serious public health problem in Nepal for many years. Seventy-five percent of pregnant women were found to be anemic in the National Micronutrient Survey of 1998.Anemia prevalence among the non-pregnant women is 34%, pregnant 42%. Anemia trend reducing compare to the last five years due to the advocacy, iron supplementation, distribution of deworming tablet and improvement of nutritional food habit among the people.Nepal drastically reduces the prevalence of anaemia in pregnant women in the past five years from 75% to 42%. 1998, anaemia among pregnant women in Nepal was alarmingly high at 75%, and coverage of iron/folic acid supplementation was low. According to the Demographic Health Survey in 2006, the national coverage of iron supplementation has increased from 23% to 59%. Because of these improvements and other complementary measures, anaemia in pregnant women has been reduced from 75% to 42%.

Causes of Nutritional Anemia in South Asian Women Insufficient quantity of iron-rich foods and “iron enhancers” in the diet (foods rich in

vitamin C such as citrus fruits), and low bioavailability of dietary iron (e.g. foods containing only non-heme iron)

Excessive quantity of ‘iron inhibitors in diet, especially during mealtimes (e.g. tea, coffee; calcium- rich foods)

Iron loss during menstruation Poor iron stores from infancy and childhood deficiencies Iron loss from post-partum haemorrhage Increased iron requirement due to tissue, blood and energy requirements during

pregnancy, and in some areas, due to heavy workloads Teenage pregnancy Repeated pregnancies with less than 2 years’ interval Iron loss due to parasite load (e.g. malaria, intestinal worms) Poor environmental sanitation, unsafe drinking water and inadequate personal hygiene

CAUSES OF MATERNAL ANEMIA IN NEPAL The multiple causes of maternal anemia are well documented. The most common in Nepal are described below.

Inadequate intake of iron and other nutrients:This results from the usual Nepali diet that offers too little iron in a form that is poorly absorbed. This diet also lacks other nutrients that contribute substantially to anemia, including vitamins A and C, folate, riboflavin, and B12.

Poor absorption of iron: Because dietary components such as phytates in cereal foods bind with the little iron present in plant foods, much of it is unavailable for absorption. As a result, iron consumed cannot be readily absorbed and used.

Parasitic worms:Hookworm infection is prevalent, particularly in the Terai, and damages the lining of intestine, resulting in blood loss and hence loss of iron.

Malaria:Particularly in pregnant women, malaria is an important cause of anemia where it is prevalent

Other infections, both chronic and systemic: Early and repeated pregnancies and inadequate birth spacing:The reproductive cycle

increases requirements for iron enormously. The greatly increased requirements for iron during pregnancy make it impossible for even iron-rich diets consumed in western countries to meet them. The period between pregnancies provides some opportunity to women to recover their iron supplies. But without adequate birth spacing and without

adequate quantities of absorbable iron in the regular diets of Nepali women, iron deficiency and anemia become the norm.

Genetic disorders: Although not a preventable cause, hemoglobinopathies such as the thalassemias and sickle cell trait are associated with iron status and anemia, and also with the response of these indicators to iron supplementation.

The common indirect causes of undernutritionalso contribute substantially to maternal anemia. Many of these causes are social, economic and cultural, including poverty, lack of education, lack of access to land for agriculture, and gender inequality.

Nutritional Anaemia Prevention and Control on the Global Agenda • The World Summit for Children:to reduce the rate of iron deficiency anaemia in pregnant women by one third of the 1990 levels by 2000. • International Nutritional Anaemia Consultative Group (INACG): Chief purpose is to guide activities aimed at reducing nutritional anaemia in the world. • Project Iron Deficiency Elimination Action (IDEA) of International Life Sciences Institute (ILSI) Micronutrient Deficiencies Program: develops and implements country-specific fortification strategies toreduce the incidence of iron deficiency anaemia • The Global Alliance for Improved Nutrition (GAIN): a new alliance of public and private sector partners was launched during The Special Session on Children (SSC) meeting seeking to save lives and improve health by eliminating vitamin and mineral deficiences

Nepal • At national level ensure the availability of iron/folate supplements for MoH and monitoring the availability of supplements throughout the country; development of radio and TV spots for broadcast throughout the country in order to increase general awareness about anaemia and to promote the use of iron supplements during pregnancy; developing a health facility treatment protocol for iron supplementation and promoting decentralisation of iron distribution outside of the health facilities utilising the existing extensive network of community-based female community health volunteers. • At community level: provides advocacy for iron supplementation during pregnancy where the Decentralised Planning for the Child Programme is implemented; encourages women to attend antenatal clinics; monitors the acceptability of supplements; establishes links to outreach activities.

Control of Anaemia • Increase coverage and compliance of iron/folate supplementation for pregnant women; • Reduce the burden of parasitic infestations (helminths, malaria and Kalazar); • Identify and implement food fortification to increase the dietary iron intake focusing on commercial as well as small-scale community based fortification initiatives; • Promote dietary diversification to improve the quality of food consumed with an emphasison bio-available iron; • Promote maternal care practices and services to improve health and nutritional status ofmother and babies;

• Identify and implement the effective modalities to address iron deficiency in youngchildren, adolescents and non-pregnant women of reproductive age.

CONCLUSION According to the Demographic Health Survey in 2006, the national coverage of iron supplementation has increased from 23% to 59%. Because of these improvements and other complementary measures, anaemia in pregnant women has been reduced from 75% to 42%.

RECOMMENDATION Prevalence of anemia among pregnant women is great challenges of the developing country. In order to decrease prevalence of anemia among the pregnant women following things should be taken into consideration:

Iron supplementation of pregnant women should be done. Fortification of food should be done. Infectious diseases should be timely controlled. Nutritional education should be given to pregnant women. Husband, family and community should be made aware of anemia and its associated risk

factors. Government should provide affordable and accessible health facility to rural area of

country.

RFERENCES http://www.unitedcalltoaction.org WHO Global Database on Anaemia Anaemia in pregnancy: possible causes and risk factorsin Nepali women, GT

Bondevik1*, B Eskeland2, RJ Ulvik3, M Ulstein4, RT Lie5, J Schneede6 and G KvaÊle1 Study of anaemia in pregnancy and its outcome in Nepal Medical College,Teaching

Hospital, Kathmandu, Nepal,RMarahatta (Khanal) Prevalence of anemia amongst adolescents in Nepal:a community based study in rural

and urban areas of Morang District, KP Baral and SR Onta Annual report 2066/67

THANKYOU

prepared by: sagun paudel

Do not forget to give comment or feedback for me……

mail4sagun@gmail.com

www.facebook.com/publichealthstudents

www.facebook.com/sagun.paudel

www.facebook.com/preventionisbest