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The study of anaemia & its related socio-demographic factors amongst pregnant women in rural community of Uttar Pradesh.

INTRODUCTION: Anaemia is the most common nutritional deficiency disorder in the world. According to WHO in developing countries the prevalence of Anaemia among pregnant women averages 56% ranging between 35 to 100% among different region of the world (1). Various studies from different region of India have reported the prevalence of anaemia to be between 33 to 100% (2, 3).

In India, Anaemia contribute directly to 20% material death and indirectly to further 20% (4, 5). The main causes of Anaemia in the developing countries includes deficiency of iron in-takes and poor absorption, hook worms infestation, infections such as Malaria, blood loss during delivery and heavy menstrual blood loss (6,7).

Iron deficiency & Anaemia during pregnancy are associated with low birth weight babies, premature birth, increased perinatal and neonatal mortality and inadequate iron store in new born. Anaemia increases the risk of maternal morbidity & mortality and adverse maternal outcome such as puerperal sepsis, ante partum haemorrhage and post-partum haemorrhage (8,9,10).

National Nutritional Anaemia prophylaxis programme (NNAPP) was initiated in 1970 during the fourth five year plan with the aim to reduce the prevalence of Anaemia to 25% (11). Subsequent evaluation has shown no change in the situation. Since 1992 the daily dosage of elemental iron for prophylaxis and therapy has been increased to 100 mg & 200 mg, respectively under Child Survival and Safe Motherhood Programme (CSSM Programme).

The present study was carried out to determine the prevalence of the Anaemia in pregnant women and the socio demographic factorsb associated with anaemia in rural areas.

MATERIAL AND METHODS: The present cross sectional study was carried out at Rural Health Training Centre, khera, Rama Medical College Hospital & Research centre Ghaziabad, from October 2012 to June 2013. Total 321 pregnant women with gestational period 12-20 weeks, visiting Antenatal Clinic RHTC were registered for the study, as more Haemodilution occurs after this period. Pregnant women giving history of worms infestation, bleeding disorder, taking iron tablets in last 3 months and had bleeding in last pregnancy were excluded from the study.

The pregnant women were interviewed using pre structured, pretested schedule after taking their consent. Haemoglobin estimation was done by sahli's method. Anaemia was classified as per WHO criteria (12). Haemoglobin below 11 gm/dl is labeled as anaemia during Pregnancy. Typing of anaemia was done as per standard peripheral smear examination (13). Socioeconomic status was assessed according to modified B.G. Prasad Classification (14-15). Severely anaemic pregnant women were referred to Rama Medical College Hospital, Hapur for further management. Data was analyzed by using Chi-Square Test. P-value less than 0.05 were considered significant.

RESULTS: In the present study, 321 pregnant women were studied. The socio-demographic profile of the study population is shown in Table 1. Majority of them (47.35%) were below 20 years of age, 75.70% were Hindus, 47.97% & 39.25% were from joint & Nuclear family respectively and majority were from Class III (29.59%) and class IV (31.77%) socioeconomic class.

As shown in table no. 2, 79.75% subjects were found to have anemia. The prevalence of mild moderate and severe anaemia was observed as 20.56%, 44.21% & 14.98% respectively. Majority of the pregnant women were moderately anaemic (65.75%) below the age of 20 years of age, 17.77% were severely anaemic between 20-24 years age and 7.14% were severely anaemic above the age of 30 years. Mild anaemia was observed between 20-24 years age (26.66%), between 25 to 29 years of age (30.76%) and more than 30 years of the age (28.5%). The observed difference was found statistically significant (x2 = 35.35 P-value <0.05)

Amongst Primipara pregnant women, 58.38% were moderately anaemic and 24.27% were mildly anaemic . 37% of the Multipara pregnant women were found severely anaemic . Majority of the second Para pregnant women were moderately anaemic (39.58%). Significant difference was found--(x2 = 32.56 p-value <0.05) as shown in table no. 3.

The proportion of pregnant women suffering from anaemia in class I & II were less (27.77% & 55.55%) as compared to class III-V (85.26%, 90.19%, 92.30%) respectively. Statistically significant difference was found amongst the various social classes and anaemia (x2=261.06, p-value <0.05) as shown in table no. 4.

DISCUSSION: The high prevalence of Anaemia (79.75%) was observed in pregnant women in this study which is similar to earlier studies (2,3) Majority of them were less than 20 year of age and most of them had moderate anemia. The result was in contrast to the similar study in rural area of Delhi where maximum pregnant women were between 20-24 years of age group (16).

Majority of the primipara pregnant women had moderate Anaemia (58.58%) and most of them were less than 20 years of age which indicate haemoglobin deficient status of the Adolescent Girl's. Majority of the Multipara (37%) were severely anaemic and most of them were from joint family, indicate Nutritional (dietary) deficiency of the pregnant women.

It is obvious in this study that lower the socioeconomic status, higher the prevalence of anaemia in pregnancy and vice versa. Anaemia in pregnant women is inversely related to the socioeconomic status as seen in earlier studies (17,18)

Normocytic hypochromic and Microcytic hypochromic type of Anaemia in pregnancy was predominantly present which is consistent with other studies except for dimorphic blood picture (19). It indicates deficient iron intake and absorption irrespective of age, type of family & parity.

CONCLUSION: High prevalence of Anaemia in less than 20 years of age between 12-20 weeks of gestation, calls for further studies of Anaemia in adolescent girls.

--Dietary counselling and Nutritional education to all the pregnant women is recommended at Rural Health Centre.

--Early detection of anaemia in pregnancy, effective and affordable management and supplement of iron to all pregnant women should be implemented.

Table No. 2 shows that 256 subjects (79.75%) were anaemic. Majority of the subjects were of moderate anaemia (44.21%), however 65.75% moderate anaemic pregnant women were below 20 yrs. of age. Severe anaemia was seen in 14.98% and majority of them were between 20-24 yrs. of age (17.77%). The chi-square test revealed significant association. (P <0.05)

Table No. 3 shows that amongst primipara pregnant women, 58.38% were of moderate anemia& 24.27% were mildly anaemic while 37% of multipara were severely anaemic. Second Para were moderatly anaemic (39.58%). Statistically significant difference was observed between different parity in the subject.(P <0.05)

Table No. 4 shows that in Class III-V subjects prevalence of anaemia was 85.26%, 90.19% and 92.30% respectively. Class III (52.63%) & Class IV (55.88%) subject were moderately anaemic and Class V (17.30%) subjects were severely anaemic . Significant association was seen in various classes of anaemic subjects. (P <0.05),

ACKNOWLEDGEMENT: This study "The study of Anaemia and its related socio-demographic factors amongst pregnant women in rural community of Uttar Pradesh" is conducted at RHTC Rama Medical College Hospital and Research Center, Ghaziabad. I am thankful to the principal and professor, HOD department of community medicine for allowing me to the carry out this study. I am thankful to my colleagues, laboratory staff, nursing staff member, social workers and statistician for their coordination & co-operation during the study. Last but not the least I am thankful to all the subjects for their co-operation during the study.

REFERENCES:

(1.) World Health Organization. The prevalence of anaemia in women WHO/MCH/MSM/92.2. Geneva: WHO, 1992.

(2.) Luwang NC, Gupta VM, Khanna S. Anaemia in pregnancy in rural community of Varanasi, Ind J Prev Soc Med 1980; 11:83-8.

(3.) Agrawal V, Tejwani S. Prevalence of iron deficiency anaemia in India antenatal women especially in rural area. Ind Med Gaz 1999, 900-3.

(4.) World Health Organization. Prevention and management of anaemia in pregnancy. WHO/FHE/MSM/93.5 Geneva: WHO, 1993.

(5.) B. J. Brabin, M. Hakimi, et al. J Nutr 2001; 131(2S-2): 604S - 15S.

(6.) Karine Tolentino, Jennifer F. Friedman. An update on Anaemia in less developed countries. Am. J. Trop. Med. Hyg, 2007; 77(1): 44-51

(7.) World Health Organization, Iron deficiency Anaemia; Assessment, Prevention and control. Geneva: WHO, 2001.

(8.) Scholl T, Hediger M, Fischer R, et al. Anaemia vs iron deficiency: increased risk of preterm delivery. Am J. Clin. Nutr. 1992; 55: 985-8.

(9.) Roy S, Chakravorty PS. Maternal and Perinatal out come in severe anaemia. J Obstet Gynae Ind, 1992; 42: 743-50.

(10.) Rangnekar AG, Darbari R. Fetal outcome in anaemia during pregnancy. J Obstet Gynae Ind, 1993; 43: 172-6.

(11.) Agrawal DK, Agrawal KN, et al. Targets in National Anaemia prophylaxis programme pregnant women. Indian Paediatric 1988; 25: 319-22.

(12.) Preventing and controlling iron deficiency anaemia through primary health care, Geneva: WHO, 1989.

(13.) Firkin F, Chesterman C, et al. Clinical Haematology in Medical Practice, oxford university press, 5th edition 1990, P.31

(14.) The text book of preventive and social medicine. In: Mahajan, Gupta, editors. 3rd ed. 2003 P. 117-8.

(15.) Economic survey 2000-2001. Govt. of India, Ministry of Finance, Economic Division.

(16.) Gautam VP, Bansal Y, et al. Prevalence of anaemia in pregnant women and its socio demographic associate is a rural area of Delhi. Ind J. community medicine Vol XXVII No. 4, oct dec, 2002.

(17.) Thangaleela T, Vijayalakshmi P. Prevalence of anaemia in Pregnancy. Ind J. Nutr Dietet 1994; 31: 26-4.

(18.) Shah SNA, Baksh Ali, Rauf A, Ahmad M et al. Incidence of iron deficiency anaemia in rural population of Kashmir. IJPH 1982; 26(3): 144-54.

(19.) Dass A, Bhatt, Dhaliwal B. Megaloblastic anaemia in pregnancy (in Delhi). J. Obstet Gynae Ind 1967; 17.

M Shams Khan [1], Anupama Srivastav [2], Anil K. Dixit [3]

AUTHORS:

[1.] M Shams Khan

[2.] Anupama Srivastav

[3.] Anil K. Dixit

PARTICULARS OF CONTRIBUTORS:

[1.] Associate Professor, Department of Community Medicine, Rama Medical College Hospital & RC, Gaziabad.

[2.] Assistant Professor, Department of Community Medicine, Rama Medical College Hospital & RC, Kanpur.

[3.] Professor & HOD, Department of Community Medicine, Rama Medical College Hospital & RC, Gaziabad.

NAME ADDRESS EMAIL ID OF THE CORRESPONDING AUTHOR:

Dr. M Shams Khan, 301, Utkarsh Shikhar Apart., Near Upvan Hotel, Mount Road, Sadar, Nagpur-440001.

Email-mohmmed.k1954@yahoo.com

Date of Submission: 14/12/2013.

Date of Peer Review: 16/12/2013.

Date of Acceptance: 19/12/2013.

Date of Publishing: 01/01/2014

M Shams Khan [1], Anupama Srivastav [2], Anil K. Dixit [3]
Table 1: Distribution of socio demographic
profile of the subjects. (n = 321)

Parameter                 Number    Percentage

1. Age in group (yrs.)

< 20 yrs.                   152       47.35
20-24 yrs.                  90        28.03
25-29 yrs.                  65        20.24
> 30 yrs.                   14         4.36

2. Religion

Hindu                       243       75.70
Muslim                      39        12.14
Christian                   12         3.73
Other                       27         8.41

3. Type of family

Nuclear                     126       39.25
Joint                       154       47.97
Extended Family             41        12.77

4. Socio economic class

Class I                     18         5.60
Class II                    54        16.82
Class III                   95        29.59
Class IV                    102       31.77
Class V                     52        16.19
Total                     321 (n)      100

Table 2: Distribution of Anaemic pregnant women according
to their age

Age              Normal    Mild    Moderate   Severe   Total
                          Anemia    Anemia    Anemia

< 20 yrs.          11       18       100        23      152
                  7.2%    11.84%    65.75%    15.13%

20 yrs-24 yrs.     28       24        22        16      90
                 31.11%   26.66%    24.4%     17.77%

25 yrs-29 yrs.     22       20        15        8       65
                 38.84%   30.76%    23.07%    12.30%

> 30 yrs.          4        4         5         1       14
                 28.57%   28.5%     35.71%    7.14%

Total              65       66       142        48      321
                 20.24%   20.56%    44.21%    14.98%

(n = 321)

Table 3: Distribution of Anaemic pregnant women according
to parity

Parity      Normal    Mild    Moderate   Severe   Total
                     Anemia    Anemia    Anemia

              21       42       101        9
1           12.13%   24.27%    58.38%    5.25%     173
              24       3         19        2

2            50%     6.25%     39.58%    4.16%     48
              20       21        22        37

3 & above                                          100
             20%      21%       22%       37%

Total         65       66       142        48      321

(n = 321)

Table 4: Distribution of the Anaemic subject according to their
socioeconomic class

Socioeconomic   Anaemia n (%)                         Normal   Total
status

                 Mild    Moderate   Sever    Total

Class I           3         2         0        5        13      18
                16.66%    11.11%      0%     27.77%   72.22%

Class II          8         15        7        30       24      54
                14.81%    27.77%    12.96%   55.55%   44.44%

Class III         15        50        16       81       14      95
                15.78%    52.63%    16.84%   85.26%   14.75%

Class IV          19        57        16       92       10      102
                18.6%     55.88%    15.68%   90.19%   9.20%

Class V           21        18        9        48       4       52
                40.38%    34.61%    17.30%   92.30%   3.69%

Total             66       142        48      256       65      321

(n = 321)
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Article Details
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Author:Khan, M. Shams; Srivastav, Anupama; Dixit, Anil K.
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Report
Geographic Code:9INDI
Date:Jan 6, 2014
Words:2135
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