RELATIONSHIP BETWEEN AGE, FEEDING AND ANAEMIA IN PREGNANCY (A CASE STUDY OF PREGNANT WOMEN ATTENDING ANTENATAL CLINIC AT UNIVERSITY OF NIGERIA TEACHING HOSPITAL (UNTH) ENUGU)
The study on anaemia in pregnancy was aimed at determining Packed Cell Volume (PCV) Haemoglobin (HB) level and Erythrocyte Sedimentation Rate (ESR) of pregnant women as well as the severity, significance of maternal age, educational level, occupation and gestational age to the occurrence of anaemia in pregnancy managed, diagnosed and admitted at the University of Nigeria Teaching Hospital (UNTH) Enugu. The result showed that most of the patient had moderate to severe anaemia and that the cases were commonest in the age range 25 – 29 years. Most of the patients were housewives and low level civil servants who lived in middle and lower class residential areas ad who had no formal education. It was discovered that he normal values for Erythrocyte Sedimentation Rate (ESR) tests was male = 0 – 5 mm/hr, female = 0 – 7mm/hr, for Packed Cell Volume (PCV) test is male 35 – 45 ml, female 32 – 35ml while normal value for Haemoglobin (Hb) is 11.5g/dl.
Anaemia in pregnancy was seen to occur most commonly in the third trimester. It occurred all through the year, but mostly in the wet season and had the greatest positive association with malaria and nutritional deficiency. Anaemia in pregnancy was seen not to be rampant in our today’s society due to the small number tested positive in the practical work conducted at University of Nigeria Teaching Hospital (UNTH) Enugu. Anaemia in pregnancy was also seen not to have any effect on birth weight of babies.
1.1 Aims and Objectives 4
1.2 The Limitation of Study 5
1.3 Hypothesis 6
1.4 Justification 6
Literature Review 7
1.1 Collection of Samples 18
1.2 Determination of Packed Cell Volume (PCV) 19
1.3 Determination of Haemoglobin (Hb) 19
1.4 Determination of Erythrocute Sedimentation
Rate (ESR) By Westergren’s Method. 20
1.5 Method of Data Collection 20
1.6 Method of Data Analysis 22
5.1 Conclusion 36
5.2 Recommendation 37
5.3 Action by the Government 38
5.4 Action by the Community 38
5.5 Action by the Health Workers 39
5.6 Action by the Individuals 39
LIST OF TABLES
TABLE 1: Distribution of pregnant women by age
TABLE 2: Mean age distribution of patients
TABLE 3: Distribution of patients according to their
TABLE 4: Distribution of patients according to their educational level
TABLE 5: Distribution of patiens according to severity
TABLE 6: Distribution of patients according to gestational age
TABLE 7. Distribution of cases according to associates conditions
TABLE 8: Relationship of incidence of aneamia in pregnancy to outcome of patients
TABLE 9: Relationship of incidence of Anaemia in pregnancy to Birth weight of Baby
TABLE 10: Result of PCV, Hb and ESR tests at University of Nigeria Teaching Hospital (UNTH) Enugu.
LIST OF FIGURES
FIGURE 1: Histogram showing age distribution of pregnant women
FIGURE 2: Bar chart-showing distribution of patients according to their occupation
FIGURE 3: Pie chart-showing distribution of patients according to their occupation
FIGURE 4: Bar chart showing distribution of patients according to their literacy level
FIGURE 5. Pie chart showing distribution of patients according to severity
FIGURE 6: Bar chart showing distribution of cases according to associated condition
Anaemia is a common disorder in pregnancy. The definition gives by World Health Organization (WHO) shows that haemoglobin level of less than 11.5g%. Signifies anaemia, but in Nigeria it is regarded as the haemoglobin of less than 10.5g% or Packed Cell Volume (PCV) of less than 23%. Between January 1955 and April 1957, anaemia was directly instrumental for over 20% of all the maternal deaths from antepartum and postpartum hemorrhage and puerperal sepsis. The type of anaemia encountered in the pregnant women are identical with those encountered in the non-pregnant. However, there is no doubt that the increased nutritional and metabolic demands of pregnancy and the fact that for many women, it is the first time they come under detailed medical scruting, has the effect both of increasing the incidence and altering the pattern. Actiology determines the type of anaemia that is encountered. It can result from one or more of the following causes:-
- Hydraemia (Physiological anaemia)
- Anaemia due to inadequate production of red cells.
Different causes includes:-
- Nutritional or deficiency anaemia: This is caused by deficiency of essential factors for haemopioesis, iron, vitamin B12, folic acid and protein. Deficiency can be due to inadequate intake, poor absorption from gastro intestinal tract or increased demand during pregnancy. Physiological states may contribute to iron deficiency. There is greater than usual demand for iron in growing babies, growing adolescents, menstruation and pregnancy where iron is needed for the increased maternal red cell mass as well as for the foetus.
- Hypoplasia and Aplasia of the bone marrow :
These are frequently induced by drugs and radiation. Decreased production are also caused by the invasion of the bone marrow as found in Leukemia, Secondary Carcinoma and Fibrosis.
- Decreased Production of erythroprotein as found in renal diseases.
Anaemia due to excessive destruction of red cell can be subdivided into:-
- Heamolytic anaemia which occurs when red cell losses exceeds the capacity of the marrow to compensate. Other cause of Haemolytic anaemia includes:
- Congenital sphetocytosis
- Glucose – 6 – phosphate dehydrogenase deficiency
- Infection with malaria and Clostridium
The above causes of haemolytic anaemia could be classified either as inherited or acquired, and as intrinsic (due to abnormalities of the red cell itself) or extrinsic due to external insults).
- Haemoglobinopathies: The term haemoglobinopathies describes inherited abnormalities of one or more of the four globulin chains in haemoglobin. Example of Haemoglobinopathies. Includes:-
- Sickle cell disease (genotype Hbs)
- Sickle cell Hbc disease
- Thalassaemia ie disorder where the rate of synthesis is slow, but the structure of the chains produced is normal.
Anaemia from blood loss can be due to
- Hookworm infestation (Ancylostomiasis)
- Peptic ulcer
- Threatened abortion.
During pregnancy, the circulating blood volume markedly increases. It begins to do so in the first trimester, is more marked in the second, reaches its maximum about 3rd and 4th trimester.
Some women start pregnancy with deficiency iron stores. As pregnancy advances, the demands of the foetus and the mother may exceeds the supply of iron from her stores and from her diet and therefore, the mother suffers from iron deficiency. Therefore, grand multiparty and multiple pregnancies are at high risk. The usual daily dietary intake of iron by a non-pregnant woman is about 10mg of which 10% is. This balances the loss in urine and faeceo, from desquamation of skin (amounting of about 0.5mg daily) and from menstrual loss. It is advisable that a pregnant woman supplement here dietary intake of iron.
1.1 AIMS AND OBJECTIVES
This project work is aimed at the following to determine the haemoglobin level (Hb), Packed Cell Volume (PCV) and Erythrocyte Sedimentation Rate (ESR) of pregnant women. To determine the significance.