Factors Associated With Anemia in Pregnant Women in 2014 in Parakou

Salifou K; Obossou AAA; Sidi IR; Hounkpatin Bib; Hounkponou Anf; Vodouhe M; Batchaneng NU; M Perrin RX

doi:10.4172/2376-127X.1000174

ISSN: 2376-127X

Journal of Pregnancy and Child Health

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Factors Associated With Anemia in Pregnant Women in 2014 in Parakou

*Salifou K¹, Obossou AAA^1, Sidi IR¹, Hounkpatin Bib², Hounkponou Anf¹, Vodouhe M¹, Batchaneng NU¹ and M Perrin RX²**
¹Mother & Child Department, Faculty of Medicine; University of Parakou, Republic of Benin
²Faculty of Health Sciences, University of Abomey-Calavi, Republic of Benin
Corresponding Author :	Awadé Afoukou Achille Obossou Obstetrician- Gynecologist, Assistant Professor Faculty of Medicine, University of Parakou Republic of Benin Tel: 229-95 85 32 79/97 06 78 52 E-mail: awadefr2000@yahoo.fr
Received March 16, 2015; Accepted June 29, 2015; Published July 04, 2015
Citation: Salifou K, Obossou AAA, Sidi IR, Bib H, Anf H, et al. (2015) Factors Associated With Anemia in Pregnant Women in 2014 in Parakou. J Preg Child Health 2: 174. doi: 10.4172/2376-127X.1000174
Copyright: © 2015 Salifou K, et al. 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.

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Abstract

Objective: Determine the prevalence and factors associated with anemia among pregnant women in Parakou in 2014.
Method: It was a descriptive cross-sectional study with analytical purpose. It had been conducted from July 1 to September 30, 2014. The included targets were pregnant women attending antenatal care in three public maternities of the District of Parakou.
Results: A total of 352 women were included in our study. The mean age was 5.9 ± 25.7years. The most represented age group was the one between 20 and 24 years (29.5). The Bariba ethnic group was the most represented (30.7%). The largest religion was Christianity (49.1%). They were married in 96.3% of the cases and not educated in 54.0% of cases. More than 79.5% of them were unemployed or poorly paid. One hundred and forty two female patients (40.3%) were anemic, including 56.3% (95% CI = [47.8 to 64.6] %) and 43.7% (95% CI = [35.4 to 52.2] %) suffering from moderate and mild anemia respectively. No severe anemia was recorded. Hb level was between 7.3 and 16.0g / dl with a mean concentration of 11.6 g / dl and 1.7 ± Hct level between 22 and 48% with an average estimated at 34.4% ± 5.1). 2. Risk factors related to socio-demographic characteristics were Fulani ethnic group, grand multiparity, low educational level and socioeconomic conditions. During pregnancy, the use of mosquito net (p <0.001) reduced anemia prevalence in pregnant women while consumption of Calabar limestone (<0.001) contributed to it. Women were more exposed to anemia in the third quarter of pregnancy (<0.001) than in the first and second quarters. There was a significant association between occurrence of anemia and lack of consumption of fruits and vegetables at least once a day (²χ = 12.3 and p <0.001).

Keywords

Anemia; Pregnancy; Risk factors; Mortality

Introduction

Pregnant woman’s anemia is a critical issue of public health due to its frequency, multifactorial nature and impact on pregnancy evolution. According to WHO estimates, 56 million pregnant women were anemic in 2005; more than half of them (57.1%) would be in Africa [1]. It contributes to the 20% of maternal deaths related to indirect causes [2]. In Benin, despite systematic iron and folic acid intake by pregnant women during their pregnancy monitoring, anemia frequency still varies between 42.2% and 68.3%. These high frequencies are due to socioeconomic and cultural conditions which are very variable from one region of the country to another [3,4]. This study thus aims to determine the prevalence and the factors associated with anemia in pregnant women attending consultation antenatal care in the public maternities of the District of Parakou in 2014.

Materials and Methods

It was a cross-sectional descriptive study with analytical purpose conducted over three months from July 1 to September 30, 2014. The study population consisted of pregnant women who attended antenatal care in three government-owned maternities in the District of Parakou. They were included in the study when attending their first antenatal care due to pregnancy in one of the three selected public maternities of the District; they had been living in the town of Parakou for at least six months. Those who had not given their consent or who were not able to answer questions or were in labor were excluded. The sampling technique is the one of a two-stage survey with simple random sampling without replacement at each stage. At the first stage, three out of the six maternities of the District were selected by means of simple random sampling i.e. 50% of those maternities. At the second stage, one out of two pregnant women was selected by simple random sampling in each maternity selected during the collection period (from July 7 to August 15, 2014) ; i.e. also 50% of the women who attended ANC during that period. Collection initially consisted in putting questions to the women who attended ANC and subsequently in submitting them to venous blood collection for biological examinations (Hemoglobin and Hematocrit levels). As a dependent variable, anemia was defined by the hemoglobin (Hb) value < 11.0 g/dl in the first and third quarters of pregnancy and Hb values < 10.5 g/dl in the second quarter. Depending on the severity of anemia, a pregnant woman with Hb level (10 g/dl ≤ Hb <11 g/dl) in the first and third quarters and (10 g/dl ≤ Hb <10.5 g/ dl) in the second quarter was classified among mild anemias. Those with an Hb value (7 g/dl ≤ Hb <10 g/dl) and (Hb <7 g/dl) were respectively considered as having a mild and severe anemia. The hematocrit (Hct) level was used as an index for HB level control; and its value is three times the one of Hb level [36]. The independent variables were linked to socio-demographic characteristics ; socio-economic and those related to eating habits. Data were captured with the software Epi data 3.1. They were analyzed by means of Epi info version 7 software. Tables and figures had been produced with Microsoft Office Excel 2007 version software. As regards quantitative variables, averages were presented with their standard deviations and as far as qualitative variables are concerned, percentages with their 95% confidence intervals (CIs). Chi-square statistical test (χ²) of Pearson, Yates or Fischer was used to compare ratios or proportions with a statistical significance threshold of p < 0.05.

Results

Of the 356 pregnant women eligible according to inclusion criteria during the collection period, four had not given consent, i.e. a 98.9% participation rate. A total of 352 women were included in our study including 141 (40.0%) at the CSC (District Health Center) referral maternity, 115 (32.7%) at Kpébié CS maternity and 96 (27.3%) at the one of Zongo CS. Blood samples were taken from all the 352 subjects. The study rate for the examinations of hemoglobin and hematocrit levels was 100.0%.

The surveyed pregnant women were aged 15 to 50 years; mean age was 25.7years ±5.9. The most represented age group was the one between 20 and 24 years (29.5%) followed by the one from 25 to 29 years (29.3%); women aged 40 years and more were the least represented (2.3%). The most represented ethnic group was the Bariba (30.7%). Christianity was the largest religion (49.1%). 96.3% were married and 54.0% were not educated. On average, they had 1.4 children ± 2 with extremes from 0 to 8 children. More than 79.5 % of them were jobless or poorly paid. 52.3 % of them had an income generating activity.

Anemia prevalence and characteristics of anemic women

Out of 352 sampled women, 142 had hemoglobin deficiency (40.3% ) with a 95 % confidence interval (IC_95%) = [35.2 – 45.7]% of whom 56.3% (IC_95%= [47.8-64.6]%) and 43.7% (IC_95%= [35.4-52.2]%) suffered from mild and light anemia respectively. No severe anemia was recorded.

Hb level was between 7.3 and 16.0g/dl with an average concentration of 11.6 g/dl ±1.7 and Hct between 22 and 48 % with an average of 34.4 % ±5.1). The average level of mean Hb was 12.2g/dl±1.6 in the first quarter of pregnancy, 11.5g/dl±1.8 in the second quarter and 11.0g/ dl±1.6 in the third quarter.

They were often aged 20 to 29 years (58.4%). They were particularly women from the Bariba (33.8%), Fon (19.7%) or Fulani (14.1%) ethnic groups. They were married (94.4%), muslim (50.7%) and christian (47.7%); uneducated (66. 2%), often without an income generating activity (60.6%).

Factors associated with anemia in pregnant women

Socio-demographic characteristics such as age, religion and marital status did not seem to be associated with anemia in the pregnant woman (p > 0.05). The same applied to obstetrical history and consumption of tea, coffee and meat. However, women from the Fulani ethnic group seemed to be more exposed to the risk of anemia than women from other ethnic groups (p < 0.05). Grand multiparity (p < 0.01) on the one hand, lack of education or illiteracy (p < 0.01) on the other hand and low Socioeconomic conditions (p < 0.01) are significantly related to anemia in the pregnant woman. Table I shows the socio -demographic factors associated with anemia in pregnant women (Table 1)

The use of mosquito net (p<0.001) substantially reduced anemia prevalence in the pregnant woman while consumption of Calabar limestone (<0.001) contributed to it. In the third quarter of pregnancy, women (<0.001) were more likely to experience anemia than those who were in the first and second quarter of their pregnancy.

There was a significant link between occurrence of anemia and non-consumption of fruits and vegetables at least once per day (χ²=12.3 and p<0.001). Table II indicates the risk factors related to preventive care and gestational age (Table 2)

Discussion

The data analysis indicated that 40.3 % of the women subject to survey in the 3 health centers during antenatal care were anemic. This prevalence is around prevalences found in Benin in the general population and in Kano (Nigeria) with 42.2% and 41% [3,4] respectively. It is lower than the 57.1% estimates of the WHO in Africa [1] and prevalences found in the two areas in the southern part of the country in 2011 and 2012 with 61.2% and 68.3% [4,5]. That difference may be due to the difference of recruitment method and particularly to the one concerning data collection. Actually, some of those works had been carried out in the general population, sometimes in hospitals, among the populations with different socioeconomic conditions in different periods of malaria endemicity. High prevalence of anemia during the 3rd quarter shows that systematic iron supplementation performed during pregnancy monitoring does not help meet the iron needs of pregnant women since they significantly increase in the first two quarters of pregnancy and as most women enter pregnancy with low or zero levels of iron reserves. Besides, the association of anemia and grand multiparity in pregnant woman noted in this study (p <0.001) and in the one conducted in Kano (p=0.019) in 2011 [6] supports and confirms the theory of iron reserves exhaustion due to successive and often close pregnancies [7] even though we did not identify a relationship between the interval between two child deliveries and anemia in the pregnant women we investigated. It is therefore essential to improve the iron and folates status of the women of childbearing age, especially in grand multiparous and if pregnancy is desired. This strategy may be particularly interesting for women from the Fulani ethnic group which appears to be a very vulnerable group. In the Northwest of Vietnam, forr example, an exhaustive programme for iron supplementation and deworming dedicated to women of childbearing age helped reduce by 48 % anemia prevalence in target women within 12 months [8].

Moreover, the non-consumption of fruits and vegetables which is associated with anemia in pregnant woman suggests the insufficient promotion of balanced diet. In this regard, antenatal care must be an ideal opportunity to promote nutrition as a vector for mother and child survival. The information to be given to women on that occasion will focus on the avoidance of risk behaviors such as consumption of Calabar limestone known for its antagonism to intestinal absorption of iron. Account must also be taken of anemia as a parameter in the development of child delivery plans and complication plans during antenatal care. In addition, the use of mosquito net must be integrated to IEC/CBC actions since it appears to be a factor strongly associated with anemia in the pregnant woman (P<0.001). This relationship had also been reported by the study carried out in ShallaWoreda (Ethiopia) in 2013 (p=0.004) [9]. Beyond the use of mosquito net, it is the large part of malaria in the occurrence of anemia that is reflected. So, malaria-related anemia would be due not only to hemolysis but also to other factors associated with malaria, especially iron and/or folic acid deficiency. Actually, many studies show that iron deficiency may occur after insufficient absorption of iron during bouts of malaria (nauseas, vomiting), in severe form of malaria followed by hemoglobinuria and in general, due to the fact that a quantity of iron sequestered in parasites in the form of hemozoin [10-12]. Therefore, it is important to strengthen the policy of free distribution of mosquito nets impregnated with insecticide not only to pregnant women but also to all those of childbearing age. Simultaneously, antimalarial chemoprophylaxis must be improved by using more efficient molecules.

The reduction of anemia prevalence in pregnant women is also possible through the improvement of their income which appears here to be an important risk factor (<0.001). This significant relationship between anemia prevalence and woman income generating activity had been reported in the general population in Sidama in Ethiopia in 2014 (p= 0.01) [13]. These results confirm once again that women’s financial empowerment contributes to mother and child survival. It is necessary to improve the incomes of those women through political actions aimed at reducing their poverty.

In the long term, the adverse effects of those different factors could be mitigated if women were given a minimum of education. Indeed, the latter is significantly associated with anemia in this study (p=0.001) and other African research works [14,15]. School attendance, by improving women accessibility to information and education, will help break some taboos, and will enable some women to have access to better paid jobs and invest more efficiently in their health and in the one of their children.

Conclusion

The factors that contribute to the management of anemia among the pregnant women attending antenatal care (ANC) in the District of Parakou range from ethnicity to lack of education and risk eating behaviors. Those factors require concerted actions between the different government partners likely to contribute to improve the nutritional status of the population in general and the one of pregnant women in particular.