|Year : 2012 | Volume
| Issue : 1 | Page : 30-34
A study of prevalence of anemia and sociodemographic factors associated with anemia among pregnant women in Aurangabad city, India
Pushpa O Lokare1, Vinod D Karanjekar1, Prakash L Gattani2, Ashok P Kulkarni3
1 Department of Community Medicine, Dr. Panjabrao Deshmukh Memorial Medical College, HFWTC, Amravati, India
2 Department of Community Medicine, Government Medical College, Aurangabad, India
3 Department of Community Medicine, Maharashtra University of Health Sciences, Nashik, Maharashtra, India
|Date of Web Publication||28-Aug-2012|
Pushpa O Lokare
Staff quarter No. 4, Panchawati, Dr. Panjabrao Deshmukh Memorial Medical College, Amravati-444603, Maharashtra
| Abstract|| |
Background: Anemia in pregnancy accounts for one fifth of maternal deaths worldwide and is a major factor responsible for low birth weight. In India, 16% of maternal deaths are attributed to anemia. The association between anemia and adverse pregnancy outcome, higher incidence of preterm and low-birth weight deliveries have been demonstrated. However, high prevalence of anemia among pregnant women persists in India despite the availability of effective, low-cost interventions for prevention and treatment. A knowledge of the sociodemographic factors associated with anemia will help to formulate multipronged strategies to attack this important public health problem in pregnancy.
Aim: To study the prevalence of anemia and the various sociodemographic factors associated with anemia among pregnant women at an urban health center in Aurangabad city, India.
Setting: Urban Health Center (UHC) of Government Medical College, Aurangabad, India.
Study Design: Descriptive cross-sectional study.
Materials and Methods: The study was carried out from August 2006 to July 2008. A total of 352 pregnant women were selected using a systematic random sampling technique. The participants were included only after confirmation of the pregnancy.
Statistical Analysis: Chi-square test, Chi-square test for trend.
Results: Overall prevalence of anemia among the pregnant women was found to be 87.21%. Factors such as religion, level of education of women and their husbands and socioeconomic status were found to be significantly associated with the prevalence of anemia in pregnancy ( P < 0.05).
Conclusion: Low socioeconomic class, illiteracy, Hindu religion were significantly associated with high prevalence of anemia during pregnancy in Indian women.
Keywords: Anemia in pregnancy, literacy, religion, socioeconomic class
|How to cite this article:|
Lokare PO, Karanjekar VD, Gattani PL, Kulkarni AP. A study of prevalence of anemia and sociodemographic factors associated with anemia among pregnant women in Aurangabad city, India. Ann Nigerian Med 2012;6:30-4
|How to cite this URL:|
Lokare PO, Karanjekar VD, Gattani PL, Kulkarni AP. A study of prevalence of anemia and sociodemographic factors associated with anemia among pregnant women in Aurangabad city, India. Ann Nigerian Med [serial online] 2012 [cited 2014 Dec 19];6:30-4. Available from: http://www.anmjournal.com/text.asp?2012/6/1/30/100213
| Introduction|| |
Anemia in pregnancy accounts for one fifth of maternal deaths and is a major factor responsible for low birth weight. In India, 16% maternal deaths are attributed to anemia. The association between anemia and adverse pregnancy outcome, higher incidence of preterm and low birth weight deliveries has been demonstrated.  In view of the low dietary intake of iron and folate, high prevalence of anemia and its adverse health consequences, India became the first developing country to take up a National Nutritional Anemia Prophylaxis Program (NNAP) to prevent anemia among pregnant women. NNAPP was initiated in 1970 during the fourth 5-year health plan with the aim of reducing the prevalence of anemia to 25%. The Government of India recommends a minimum dose of total 100 iron and folic acid tablets to be prescribed during pregnancy.  Public health program of distribution of the iron tablets to the pregnant women (during last trimester) and preschool children is in operation in India as part of Maternal and Child Health (MCH) services.  However, high prevalence of anemia among pregnant women persists despite the availability of this effective, low-cost intervention for prevention and treatment.  Unfavorable sociodemographic factors are the major barriers to the efforts put in place for the prevention of anemia during pregnancy. Knowledge of the sociodemographic factors associated with anemia in pregnancy can be used to formulate a multipronged strategy to attack this important public health problem.
| Materials and Methods|| |
The present cross-sectional study was carried out at Urban Health Center (UHC) established by Government Medical College in Aurangabad, India, to determine the prevalence of anemia and the association of the various sociodemographic factors with anemia in pregnant women.
The UHC is situated in an overcrowded area of the city and provides medical care to the majority of the inhabitants. The total population covered by this center is approximately 60,000 people. The Ante Natal Care (ANC) clinic is conducted weekly on every Friday. Registration of the pregnant women visiting the ANC is maintained by the health worker separately for the first and the subsequent visit of the pregnant women. The study was carried out from August 2006 to July 2008. A total 352 pregnant women visiting the health center for the first time were included in the study by systematic random sampling technique. The participants with the history of amenorrhea underwent a urine pregnancy test and vaginal examination in doubtful cases to diagnose pregnancy. Pregnant women with multiple pregnancies, history of high-grade fever in the last 3 months, passing worms in the stool, bleeding disorder in the previous pregnancy and taking iron and folic acid tablets before registration were excluded from the study. Informed consent was obtained and explanation as to the purpose of the study was offered. A pilot study was conducted with the predesigned proforma and necessary modifications were made. Thus, pregnant women were interviewed with the predesigned, pretested proforma and clinical examination was done. A detailed demographic profile of the women, that is, age, age at first pregnancy, religion, type of family, family size, educational level of a woman and her husband, occupation of a woman and her husband, was collected. Socioeconomic classification suggested by B.G. Prasad was adopted and updated.  A dietary history was taken with the help of 24-h recall method and also assessed about various food items avoided, especially during pregnancy. 
Gestational age was assessed from the last menstrual period. For those women who did not remember the last menstrual period date, gestational age was co-related to the local calendar events and assessing fundal height. The height and weight were measured using a detecto weighing scale, which has in-built adjustable height measures.
Hemoglobin level was estimated by Sahli's acid hematin method of hemoglobin estimation.  According to World Health Organization (WHO), hemoglobin level below 11 g/dL is labeled as anemia during pregnancy and classified as mild (10.0-10.99 g/dL), moderate (7.0-9.9 g/dL), and severe (<7.0 g/dL) anemia. The same criteria were used for diagnosing anemia in pregnancy.  Individual discussion with each mother about anemia, importance of regular treatment with iron/folic acid tablets and correction of faulty dietary practices was conducted. Those women who had severe anemia as well as high-risk pregnancies were referred to the Government Medical College for further investigations and treatment with the referral slip. Ethical approval for the study was obtained from the ethical committee at the Government Medical College, Aurangabad.  Whenever pathology was detected, appropriate treatment was given and referral advised.
Sample size determination
Minimum sample size required for the study was calculated with the help of practical manual for sample size determination by S.K. Lwanga and S. Lemeshow at 10% relative precision and 95% confidence level.  Data analysis was performed using Epi info software version 3.5.1. Descriptive statistics, including mean, range, and standard deviations, were calculated for all variables. Proportions were compared using Chi- square tests and chi square for trend at 0.05 level of significance.
| Results|| |
In the present study, the mean duration of married life of pregnant women was 4.3 years. Mean age at menarche was found to be 13.2 years. Similarly mean values for gravid status and parity were 2.3 and 1.0, respectively. Mean spacing interval was 1.7 years. Mean height and weight of the study subjects were 152.1 cm and 48.9 kg, respectively. Average calorie consumption per day was 1551 calories with deficit in 18.1%. The demographic characteristics of the study subjects are summarized in [Table 1].
The majority of the subjects were between ages 20 to 29 years with an average age of 22.7 years. About 2% of all the pregnancies occurred among teenagers and 5% were among women aged 30 years and above. It was observed that the maximum number of the study subjects 182 (51.7%) were Muslim. The study subjects who belonged to joint family were 160 (45.4%) followed by nuclear family were 133 (37.7%). The maximum numbers of women were from social classes III and IV (30.3% and 30.9%, respectively).
As shown in [Figure 1], the overall prevalence of anemia among pregnant women was found to be 87.2%. The prevalence of mild, moderate, severe anemia were observed as 24.7%, 54.5%, and 7.9%, respectively. Thus the prevalence of moderate anemia was high in comparison to the other degrees of anemia.
As shown in [Table 2], it was observed that proportion of pregnant women suffering from anemia was maximum (93.7%) in the age group 30 years and above followed by the age group below 20 years (88.3%). The observed difference was not statistically significant (P > 0.05).
|Table 2: Distribution of anaemia in pregnant women according to age (n = 352)|
Click here to view
[Figure 2] shows the prevalence of anemia in pregnancy with respect to religion. It was observed that 94.3% of Hindus were suffering from anemia when compared with 84.9% and 82.2% of Muslim and Buddhist women, respectively. The association observed between Hindus and other religions with the prevalence of anemia during pregnancy was statistically significant ( P < 0.05).
|Figure 2: Distribution of anemia in pregnant women by religion. Chi-square test (Hindus and other religions) = 7.79, d(f)1, P = 0.005, OR = 3.34 (1.37-8.50)|
Click here to view
[Table 3] shows that the proportion of pregnant women suffering from anemia in classes I and II were less (47.61% and 71.42%, respectively) as compared with the lower socioeconomic status (93.51%, 94.49%, and 94.11% in classes III-V, respectively). It was obvious that as the socioeconomic status decreased, the prevalence of anemia increased. Risk of anemia as compared with class I was 15.87 times higher in class III, 18.88 times higher in class IV and 17.60 times higher in class V. Thus, lower socioeconomic status is associated with the increase in the risk of development of anemia in pregnancy. This association between the socioeconomic status of the family and anemia in pregnancy was found to be statistically significant ( P < 0.05). [Table 4] revealed that proportions of pregnant women suffering from anemia were 96.4%, 94.8%, 92.1%, and 91.5% among illiterates, those educated up to primary, middle school, and high school, respectively. It was found that the lower the educational level of the women, the higher the probability of suffering from anemia during pregnancy. This relationship was found to be statistically significant ( P < 0.05). Among the pregnant women whose husbands were illiterate, the percentage of anemia was found to be 97.87. The proportion of the pregnant women suffering from anemia was found to be decreased in those whose husbands had higher education. The prevalence of anemia was almost 3 times higher in pregnant women whose husbands were literate up to high school, whereas it was 16 times higher in pregnant women whose husbands were illiterate as compared with the women whose husbands had education at intermediate levels and above. This association between the educational status of the husbands and anemia in the pregnant women was found to be significant statistically ( P < 0.05).
|Table 3: Distribution of anemia in pregnant women according to socioeconomic class (n = 352)|
Click here to view
|Table 4: Distribution of anemia among pregnant women according to their educational status (n = 352)|
Click here to view
| Discussion|| |
Although much effort has been taken to prevent anemia in Indian women, still the prevalence of anemia during pregnancy is found to be 87.2% from this study. A study carried out among 7 states by Nutrition Foundation of India had observed the overall prevalence of anemia as 84% among pregnant women similar to the present study.  "Indian Council of Medical Research (ICMR) Task Force Multicenter Study" revealed that the overall prevalence of anemia among pregnant women from 16 districts was 84.9% (range 61.0% -96.8%).  The prevalence observed is similar to that reported for pregnant women (60%-77%) in Dar es Salaam-Tanzania, ,, Sudan, , and Nigeria. 
In developed countries, the prevalence of anemia was only 18% among pregnant women as reported by WHO (1998).  The socioeconomic developments, higher standard of living, better utilization of health care facilities along with increasing literacy rate are associated with the low prevalence of anemia in developed countries. A high prevalence of anemia among pregnant Hindu women as compared with Muslim women was observed in the present study. The religion itself may not be the cause for this finding, but probably it works through different dietary patterns, food taboos, and so on. In India, pregnant Hindu women are advised to avoid non vegetarian diet during pregnancy as it generates heat. Low socioeconomic status was associated with a higher prevalence of anemia in pregnancy. A cross-sectional study in New Delhi had revealed that there was a trend of decreasing severity of anemia with higher per capita income as found in the present study.  In the present study, it was found that anemia increases steadily with decrease in the level of educational attainment. One study found that anemia was most common in illiterate women (53.7%) as compared with 37.1% in literate women.  A study conducted in 7 states with similar sample used in National Family Health Survey (NFHS) -2 had observed an association between the literacy status of husband with anemia in pregnant women. 
Unfavorable sociodemographic factors are the major barriers to the efforts in place for the prevention of anemia during pregnancy. Educating the women only will not produce any desirable change but increasing the degree of literacy of the family will definitely help to solve this problem. The educational status of the husbands and the women are equally important factors as it makes the couple receptive to the advice given by the health staff. Therefore, there is a need for dietary counseling and nutritional education in antenatal clinics to tackle the issue of anemia in pregnancy with missionary zeal, innovative approach, and evidence-based interventions.
| References|| |
|1.||Government of India (sample registration system). Maternal mortality in India: 1997-2003, Trends, causes and risk factors. Register General India, New Delhi in collaboration with Centre for Global Health Research University of Toranto, Canada. |
|2.||Agarwal DK, Agarwal KN, Roychaudhary S. Targets in national anaemia prophylaxis programme for pregnant women. Indian Pediatr 1988;25:319-22. |
|3.||Nutritional anaemia. National Family Health Survey (NFHS-3) 2005-2006. Volume 1. Ministry of Healthy and Family Welfare, Government of India, New Delhi; 2007. p. 308-9. |
|4.||Baride JP, Kulakrni AP. Text book of community medicine. 3 rd ed. Mumbai, India: Vora Medical Publications; 2006. p. 12-35. |
|5.||Jelilifee DB, The assessment of the nutritional status of the community. Geneva: World Health Organization; 1966. p. 132. |
|6.||Sanyal S. Clinical Pathology: Prep manual for undergraduates. New Delhi: Elsevier India Private limited; 2005. p. 25. |
|7.||Toteja GS, Singh P. Micronutrient profile of Indian population. New Delhi: Indian Council of Medical Research; 2004. |
|8.||Government Medical College. IEC. Meeting circular No: Pharm/200/2007 dated on 09-04-2007. |
|9.||Lwanga SK, Lemshaw S. Sample size determination in health studies: A practical Manual. Geneva: World Health Organization; 1992. |
|10.||Agarwal KN, Agarwal DK. Prevalence of anaemia in pregnant and lactating women in India. Indian J Med Res 2006;124:173-84. |
|11.||Toteja GS, Singh P, Dhillon BS, Saxena BN. Micronutrient deficiency disorders in 16 districts of India -Part 1 Report of ICMR task force study. District Nutrition Project. Ansari nagar, New Delhi: Indian Council of Medical Research; 2001. |
|12.||Desalegn S. Prevalence of anaemia in pregnancy in Jima town, southwestern Ethiopia. Ethiop Med J 1993;31:251-8. |
|13.||Kidanto HL, Morgen I, Lindmark G, Massawe S, Nystrom L. Risk for preterm delivery and low birth weight are independently increased by severity of maternal anaemia. S Afr Med J 2006;99:98-102. |
|14.||Massawe S, Urassa E, Lindmark G, Moller B, Nystrom L. Anaemia in pregnancy: A major health problem with implications for maternal health care. Afr J Health Sci 1996;3:126-32. |
|15.||Adam I, Khamis AH, Elbashir MI. Prevalence and risk factors for anaemia in pregnant women of eastern Sudan. Trans R Soc Trop Med Hyg 2005;99:739-43. |
|16.||Haggaz AD, Radi EA, Adam I. Anaemia and low birth weight in Western Sudan. Trans R Soc Trop Med Hyg 2010;104: 234-6. |
|17.||Uneke CJ, Duhlinska DD, Igbinedion EB. Prevalence and public health significance of HIV infection and anaemia among pregnant women attending antenatal clinics in south eastern Nigeria. J Health Popul Nutr 2007;25:328-35. |
|18.||World Health Organization. The prevalence of anaemia in women: A tabulation of available information. 2 nd ed. Geneva: WHO; 1992. |
|19.||Gautam VP, Bansal Y, Taneja DK, Renuka S. Prevalence of anaemia amongst pregnant women and its socio-demographic associates in rural area of Delhi. Indian J Community Med 2002;27:157-60. |
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]