A Cross Sectional Study on Prevalence of Anaemia and its Determinant Factors among Pregnant Mothers in a Rural Community

Anemia is the greatest common nutritional deficiency disorders affecting the pregnant women in the developing countries and determine the prevalence of anaemia among pregnant women in a rural community and determine the socio demographic factors and obstetric factors associated with anaemia. The objective of the study was to evaluation the prevalence of anemia between pregnant women and to regulate its association with maternal and fetal consequences. The care given by the health care provider to a pregnant woman during her pregnancy period (a period of 280 days) is known as antenatal care. This research was carried out in rural field practicing area, Sripuram Kanchepuram district of Tamilnadu. The pregnant mothers residing in this area were taken as the study subject. This study was conducted for a period of four month from June 2014 to September 2014. Anaemia is considered a severe public health problem by World Health Organization when anaemia prevalence is equal to or greater than 40% in the population. Iron deficiency is highest population subgroups that are at peak growth rates that is infant, children and pregnant mothers. Anaemia in pregnancy, the most common micro nutritional deficiency (disorder). It is estimated that more than 50% of pregnant women are anaemic and majority (90%) belongs to iron deficiency. The great incidence of anemia in pregnant women speciously increases the maternal and fetal risks. To increase maternal and fetal effect, it is suggested that the primary health care has to be strengthened, prevention, initial diagnosis, and treatment of anemia in pregnancy to be given priority. Original Research Article Abiselvi; JPRI, 33(41B): 61-68, 2021; Article no.JPRI.72106 62


INTRODUCTION
Anemia is the second most common cause of maternal death in India and contributing to about 80% of the maternal deaths caused by anemia in South East Asia. Anemia is also an established risk factor for intrauterine growth retardation, leading on to poor neonatal health and perinatal death. The inability to meet the required level for these substances either due dietary deficiencies, inadequate absorption or infection m conjunction with blood loss during pregnancy gives rise to anemia. Numerous factors influence indorse to the causes of anemia among pregnant women. In place of occurrence, geohelminth infections throughout pregnancy may be associated with maternal anaemia. Hookworm is known to be causes of anaemia among pregnant women and hookworm infection essentially aggravates anemia in pregnant women [13]. Infections by geohelminthes lead to malnutrition, iron deficiency anaemia, and increased susceptibility to other infections in infected pregnant women The prevalence of anaemia varies widely in different settings and accurate data are often lacking. In the millennium development goal five the target is to reduce the maternal mortality rate to three quarters by the year 2015. Those living in Asia and Africa are at greater risk. In developing countries every second pregnant women are estimated anaemi [4]. c. 13 Prevalence of anaemia m South Asian countries is highest in the world and among the South Asian countries, India has the highest prevalence of anaemia [59].
Anemia is multifactorial in etiology; the disease is assumed to be generally caused by iron absence in developing countries. In subSaharan Africa where iron deficiency is common, the prevalence of anemia has often been used as a substitution for iron deficiency anemia (IDA) [1014]. Further micronutrient insufficiency (vitamins A and B12, riboflavin, and folic acid) has also been a cause of anemia through pregnancy deaths due to anaemia in South Asia. In the early nineties the attempt to reduce the prevalence of anaemia in India was much lower than the neighbouring South and South East Asian countries.It is es tim at ed. h at about 20%40% of maternal deaths in India are due to anaemia, India contributes to about 50% of global maternal deaths due to anemia [ 15]. According to NFHS 3 (20052006) about 56 percent of pregnant women in south India were anaemic. Karnataka being 62.6 percent followed by Andhra Pradesh (58.5 percent) and Tamil Nadu (57 .8 percent) prevalence of anemia was least in Kerala (35 .2 perc ent ) [16].
Anaemia is a major public health problem, in spite of many interventional programs. About one third of the global population is anaemic (WHO 2010). Early detection and effective management of anaemia in pregnancy can lead to reduction in under nutrition in childhood, adolescence and improvement in adult health that is the future progeny will be a healthy citizen, thus improving the family and countries socio economic status. In spite of the extensive knowledge on the epidemiology of anemia, its control and prevention still it continues to be a m,· jor public health problem. Therefore a unique approach has to be redefined to bring down the prevalence of anemia among pregnant mothers [16,17].

MATERILAS AND METHODS
Study design: This is a population based cross sectional study in rural field practicing area, Sripuram Kanchepuram district of Tamilnadu. The pregnant mothers residing in this area were taken as the study subject. This study was conducted for a period of four month from June 2014 to September 2014.

Sampling Method
Pregnant women who were registered during the period of 1st September 2013 till 30 t h June 2014 were listed out from the antenatal register available at RHTC Sripuram attached to Sree· Balaji Medical College and Hospital (SBMCH). By using simple random technique, sample (270) was identified.

Pilot Study
Pretesting was carried out on thirty subjects for standardizing the questionnaire. Based on the observations made during the pilot testing, necessary changes were made in the questionnaire. The results of the pilot test were not included in the final analysis.

Tool for Data Collection
A structured questionnaire was prepared based on the questionnaire used in the studies done in the past. The questions were related to socio demographic and obstetric factors associated with anaemia and data related to haemoglobin level were recorded from the mother child protection card.

Inclusion criteria
All pregnant mothers residing in the rural field practice area (Sripuram) of the medical college at the time of survey were included in the study.

Exclusion criteria
Those who were not willing to participate and those who were not having their mother child protection card at the time of survey were excluded.

Data Collection Methods
The data were collected from 270 pregnant mothers. By making house to house visits all the selected subject were interviewed. The purpose of the study was clearly explained to them. Inform consent was obtained in local (Tamil) language before administering the questionnaire. A semi structured questionnaire was administered and the questions related t ocio demographic and obstetric factors were collected from the mother and the haemoglobin values were recorded from the mother child protection card.

Statistical Analysis
The data was collected and entered in an excel sheet. Then data was analysed using SPSS version 16. Prevalence of anaemia was expressed in frequencies. Various factors associated with anaemic status of the pregnant mothers were analysed usmg chi square for significance at 95% Confidence interval.  Table 2).

RESULTS AND DISCUSSION
Prevalence of anaemia in the participant Prevalence of anaemia in the current study 1s 41 .5% as depicted in Table 3.

Association of Socio Demographic Factors with Anaemia
The prevalence of anaemia in the study population 1s likely to be influenced by vanous soc10 demographic factors described. In this section the association of anaemia with various socio demographic factors has been brought out. In this study, pregnant women who have been exposed to passive smoking are 0.4 times at risk of getting anaemia (p< 0.004 and X 2a. 8.2). Study participants those who were vegetarians are 62tirhes more prone for anaemia than non vegetarians (p<0.009 and X 2 6.8). (Table.5)  The collected data were analysed using SPSS software version 16. A total number of 270 pregnant women residing in the Sripuram area have been interviewed with a predes ig ned , pretested profoma. A detailed demographic and obstetric profile of the women along with the haemoglobin level in their each visit was taken from their mother child protection card. Karin Gross et al., in his study used similar technique and obtained data from mother child protection card. 51 As defined by this study the age distribution of the study participant were between 15 to 35 years, majority belong between 15 to 24 years (48.5%). In this study proved that mothers who have short monthly family income were three times more likely to be anemic as associated to those with high monthly family income. This is in agreement with some studies and contradicted to other reports. According to the 2007 Ethiopian central statistical agency household income ingestion and expenditure survey, more than 57% of the total expenditure is spent on food [18] in the age group of 2024 years. Furthermore, in this study, 80% of study participants were from south east area suggesting that they are food net buyers. As income is low, the expenditure for food becomes low. Also, due to food price inflation, the obtaining power of income is low. So, low income groups did not get acceptable nutrition and thereby low family income groups were at risk of anemia. In this study, supplementation of iron sulphate, folic acid, and multivitamin throughout the presentday pregnancy period organized not expressively diminish the incidence of anemia as compared to those who did not take these supplementations. Finally, outcome was in contradiction with other studies [1923]

CONCLUSION
The prevalence of anaemia among pregnant mothers carried out in rural field practising area of Sree Balaji medical college was 41.5%. The prevalence of anaemia among primigravida (41.5%) and multi gravid (41.4%) was almost equal. About 50% of the participants were anaemic in the first trimester, 38% in the second trimester and 42.9% of them were anaemic in the third trimester. In this study passive smoking (0.004), diet (0.009), consumption of iron folic acid (p 0.0001) and deworming (p 0.0001) were found to be significantly associated with anaemia. Factors like age (p 0.190), education (p 0.132), type of family (p 0.539), toilet facility (p 0.221) and parity (0.981) were not significantly associated with anaemia.

CONSENT
Informed consent 1n the local language (Tamil) was obtained from the study participants before administering the questionnaire.

ETHICAL APPROVAL
The study w) 1: approved by institutional ethics committee of Sree Balaji Medical College dated 28/06/2014.