Effect of Antenatal Services During Pregnancy on Prevalence of Anemia Amongst Pregnant Women in Lucknow
Sandhya Mishra1*, Amit Nandan Mishra2
1 Assistant Professor, Dept. of Community Medicine Integral Institute of Medical Sciences & Research, Integral University& Lucknow, India.
2 Associate Professor, Dept. of Orthopaedics Era’s Lucknow Medical College, Lucknow, India.
Research Assistant & Rehabilitation Psychologist,
Department of Social Work,
University of Kashmir,
Hazratbal, Jammu and Kashmir, India.
Article Type: Research Article
Received: May 05, 2014; Accepted: May 27, 2014; Published: May 31, 2014
Citation: Mishra A, Mishra AN. (2014). Effect of Antenatal Services During Pregnancy on Prevalence of Anemia Amongst Pregnant Women in Lucknow, Int J Translation Community Dis, 02(03), 27-31. doi: dx.doi.org/10.19070/2333-8385-140005
Copyright: Mishra A© 2014 . This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Objective: To study the effect of antenatal care services (ANC) during pregnancy on prevalence of anemia amongst pregnant women in Lucknow.
Study design: Cross-sectional study
Study area: Urban and rural areas of Lucknow.
Study subjects: A total of 455 pregnant women residing in urban and rural areas.
Results: More than half (62.2%) of the pregnant women received ANC services at any health facility. The overall prevalence of anemia was 67.5%. Of these, the moderate anemia was 47.6%, mild was 43.6% and severe was 8.8%. The prevalence was almost similar in urban (73.3%) and rural (62.4%) pregnant women as well as in Hindu (64%) and Muslim (74.2%) women. Age at marriage did not affect in the prevalence of anemia among pregnant women. The education of women had significant association with the prevalence of anemia as the anemia was significantly (p<0.0001) higher in illiterate (81%) women than literates.
Conclusion: The ANC service is still not at par, it is to be promoted that every pregnant woman should get ANC services in time. This will decrease the anaemia prevalence.
3.Materials and Method
3.3.Total period of Study
3.9.Tool of data collection
3.10.Pre-testing of the interview schedule
5.1.Antenatal care services
5.2.Prevalence of anemia
Pregnant Women; Anemia; ANC Services; Demographic-Characteristic.
Anaemia is a major public health problem. It is now one of the most frequently observed nutritional diseases in the world. It is especially prevalent in women of reproductive age, particularly during pregnancy. DLHS-III (2007-08) survey reported that around 96 percent of the pregnant women in India are suffering from some degree of anaemia. It includes 51 percent of women who are suffering from mild anaemia, 42 percent from moderate anaemia and 3 percent from severe anaemia.
Khosla et al (2002) conducted a study at rural north India on 5124 delivered women and of these 386 patients (7.5%) were severely anemic (Hb<6.0 g/dl). 1083 units of blood were transfused to these patients, a mean of 2.80 units to each patient. There were 2 maternal deaths due to severe anemia. Of the 386 patients, 246 could be interviewed in detail and their demographic details were compared with 100 normal pregnant women with haemoglobin levels of 10 g/dl or more. In the anemic group, 62.1% had no antenatal checkup and in non-anemic group, 24% had no antenatal checkup. Agarwal et al (2007) in their study found that the prevalence of anemia was found to be significantly higher among women without antenatal care (95.8%) than those seeking antenatal care (53.9%).
Materials and Method
As per NFHS-3 UP (2005-06), prevalence of anemia in reproductive was 51.6 percent. Taking 80% power, 5% significance level, and the total sample size calculated was375. Taking non- response to be 10%, the final sample size came out to be 420. A total of 455 pregnant women were included in the study.
Households not having pregnant women and not residing in that area for the last 6 months. Also, pregnant women with other complications of pregnancy like ante partum haemorrhage, hyper emesis gravid arum etc.
First household was selected randomly and then consecutive household was surveyed till the desired number of study units completed. Each participant was explained about the purpose of the study prior to administration of tool. Informed consent was taken from each participant.
Sahli’s Method was used for Hb estimation. The graduated tube placed between the brown glass standard of Sahli’s haemoglobinometer was filled with N/10 hydrochloric acid up to lowest mark (mark 2). Blood sample obtained from the finger prick or from the vein was drawn into Sahli’s pipette till 20 mm-3 mark and added into graduated tube containing N/10 hydrochloric acid. The blood and acid are mixed thoroughly with a glass stirrer and allowed to stand for 3 minutes for acid hematin to form. Distilled water was added drop by drop mixing it with a stirrer until color in the graduated tube was matched with the brown glass standard.
The data collected was entered in Microsoft Excel and checked for any inconsistency. The dichotomous/categorical variables were analyzed by using Chi-square statistics. The p-value<0.05 was considered as significant. All the analysis was carried out by using SPSS 15.0 version.
Table-1 shows the distribution of pregnant women according to their family profile. More than half (65.9%) belonged to Hindu community and nuclear family type (68.1%). More than one third (49%) of the pregnant women had family size>4. Most of the pregnant women belonged to SES group IV (41.3%) and V (44.2%).
Table-2 shows the distribution of pregnant women according to Ante Natal Care services received. More than half (62.2%) of the pregnant women received ANC services, however, no significant difference was seen among urban (71%) and rural (54.7%) women. The number of ANC visits was two in 59.4% pregnant women followed by three or more visits (29.3%). The Nurse/ANM/Female health worker (68.2%) were the main health personnel in providing ANC services.
The overall prevalence of anemia among the pregnant women was 67.5% (Table not shown). Mild and moderate anemia was 43.6% and 47.6%. However, severe anemia was only in 8.8% pregnant women (Fig.1)
Table-3 shows the association between anemia& demographic profile of pregnant women. The prevalence was almost similar in urban (73.3%) and rural (62.4%) pregnant women as well as in Hindu (64%) and Muslim (74.2%) women. Age at marriage did not affect in the prevalence of anemia among pregnant women. The education of women had significant association with the prevalence of anemia as the anemia was significantly (p<0.0001) higher in illiterate (81%) women than literates. The occupation of women was also significantly (p<0.05) associated with the prevalence of anemia among pregnant women.
The present study indicates that 65.9% pregnant women were Hindu while 34.1% were Muslims. As per NFHS-3, 82.6% of households in Uttar Pradesh were Hindus and 16.3% Muslims. The reason for high Muslims representation in the study is because the catchment areas of urban and rural centre are Muslims predominate. In our study, 68.1% pregnant women belonged to nuclear family and 31.9% belonged to joint family. However, in urban area, 66.7% pregnant women belonged to nuclear family while 33.3% belonged to joint family and in rural area, 69.4% pregnant women belonged to nuclear family while 30.6% belonged to joint family. However, as per NFHS-3, 55.9% population had nuclear family and 44.1% had joint type of family. In urban area, 59.1% had nuclear family and 40.9% had joint family. In rural area, 54.8% had nuclear family and 45.2% had joint family. The percentage of type of nuclear and joint families was higher in our study as compared to the NFHS-3 findings. This may be due to small sample size in our study as compared to the NFHS-3 study.
According to our study, 44.2% pregnant women belonged to social class V. However, NFHS-3 (UP) reported that 27.8% of the population belonged to social class V. The reason behind higher percentage of the population belonged to social class V is because the catchment area of the urban and rural health training centrebelongs to low socio-economic group in our study.
According to our study, 62.2% of the women received ANC services. In urban area, 71% of the women received ANC services and in rural area, 54.7% received ANC services. The findings of the present study matched with the DLHS-III findings in which 64.4% women received ANC services (Urban-73.6% and Rural- 62.8%). However, more than three-quarters of women in India received antenatal care for their most recent birth during the five years preceding the survey (NFHS-3).
Anemia in pregnancy is an important and preventable cause of maternal and fetal morbidity and mortality. In the present study, the overall prevalence of anemia was 67.5%. Somewhat similar results have been reported where anemia in pregnant women were 96.5%, 85.6% and 74.8% (Virender et al, 2002, Toteja et al, 2006 and Ahmad et al, 2010). The World Health Organization also estimated that 58% of pregnant women in developing countries were anemic (Galloway et al, 2002).
In our study, more than one third of the pregnant women had mild anemia (47.6%) & 43.6% were moderate anemia and 8.8% of pregnant women were severely anemic. Somewhat similar results have been reported in a study conducted in a rural Indian population. In which severe anemia was observed to be 18%, mild anemia in 43.6% and moderate anemia in 47.6% of patients (Ahmad et al, 2010). In another study (Farzana et al, 2010)31 observed in study amongst pregnant women, 52% moderate, 36% were mildly anemic and 12% severe anemic. In which low percentage of mild anemia has been reported as compare with the finding of my study. In India, 55% of women were found to be anaemic. Thirty-nine percent of women are mildly anaemic, 16 percent are moderately anaemic, and 2 percent are severely anaemic (NFHS-3). The severity of anemia in our study and other studies in India and abroad are almost similar.
The ANC service is still not at par, it is to be promoted that every pregnant woman should get ANC services in time. This will decrease the anaemia prevalence.
- ADLHS-III. International institute of population Studies. Mumbay, 2007-08.
- Khosla AH, Dahiya P, Dahiya K (2002) Burden of chronic severe anemia in obstetric patients in rural north India. Indian J Med Sci. 56(5):222-4.
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- National Family Health Survey 2005-2006 (NFHS-3). Mumbai: International Institute of Population Science; 2007.
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- Farzana Rizwan, Qamarunisa, Habibullah, Amna Memon (2010) PREVALENCE OF ANEMIA IN PREGNANT WOMEN AND ITS EFFECTS ON MATERNAL AND FETAL MORBIDITY AND MORTALITY. Pak J Med Sci. 26(1): 92-95.