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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 30  |  Issue : 3  |  Page : 784-788

Anemia among pregnant women attending the family health center in Kafr Al-Sheikh city, Egypt (an intervention study)


1 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Family Medicine Ministry of Health, Kafr Al-Sheikh Governorate, Kafr El Sheikh, Egypt

Date of Submission02-Mar-2016
Date of Acceptance10-Jul-2016
Date of Web Publication15-Nov-2017

Correspondence Address:
Rasha F Abd-Elhaleem
Kafr El-Sheikh, 33511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.218248

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  Abstract 

Objective
The aim of this study was to assess the prevalence of anemia among pregnant women and estimate the effect of iron supplementation on hemoglobin concentration among the anemic participants.
Background
Anemia in pregnancy is a major health problem. It is the most common cause of maternal mortality. Severe anemia is associated with preterm birth, low birth weights, and a fetus small for gestational age. Most of the complications are preventable through increased awareness and improving health status of pregnant women.
Participants and methods
This was a cross-sectional study conducted in the family health center of Kafr Al-Sheikh city. The study included 200 pregnant women attending the selected family health center during the period of data collection. The studied group was assessed regarding their socioeconomic characteristics, obstetric history, and dietary history. Then, the hemoglobin level was estimated for the diagnosis of anemia. The anemic group received iron supplementation according to the recommendations in National Practice Guidelines for Family Physicians. The hemoglobin level was re-estimated after 4 weeks of taking iron.
Results
The study results revealed that the prevalence of anemia among the studied group was 32%. The majority of anemic women had mild anemia (92.2%). The most significant risk factor for anemia among the studied groups was a histtory of anemia [P = 0.000, odds ratio (OR)=18.18], followed by a low socioeconomic standard (P = 0.089, OR = 17.4), and then a long duration of menstruation (P = 0.000, OR = 14.16). There was a significant improvement in hemoglobin concentration after intervention (4.04 ± 1.68%).
Conclusion
There was a significant improvement in the hemoglobin level among anemic pregnant women after 4 weeks of oral iron supplementation according to National Practice Guidelines for Family Physicians.

Keywords: anemia, antenatal, iron supplement, national guidelines


How to cite this article:
El-Moselhy HM, Khalil NA, Abd-Elhaleem RF. Anemia among pregnant women attending the family health center in Kafr Al-Sheikh city, Egypt (an intervention study). Menoufia Med J 2017;30:784-8

How to cite this URL:
El-Moselhy HM, Khalil NA, Abd-Elhaleem RF. Anemia among pregnant women attending the family health center in Kafr Al-Sheikh city, Egypt (an intervention study). Menoufia Med J [serial online] 2017 [cited 2019 Nov 22];30:784-8. Available from: http://www.mmj.eg.net/text.asp?2017/30/3/784/218248


  Introduction Top


In Egypt, anemia is considered as a severe public health problem as it affects more than 40% of the pregnant women [1]. Hemoglobin estimation is a measure for anemia. Anemia is diagnosed in pregnant mothers if the level of hemoglobin is less than 11 g/dl [2]. Iron-deficiency anemia (IDA) is a decrease in the total hemoglobin (Hb) levels caused by iron deficiency. It is the most common cause of anemia worldwide [3]. During pregnancy, women need three to six times more iron than nonpregnant women to support fetal and placental growth. This increased iron demand often results in maternal IDA [4]. Severe anemia is associated with preterm birth, low birth weights, and a fetus small for gestational age [5].

All pregnant mothers should receive routine iron and folic acid supplementation after the first 3 months of pregnancy. The dose is 200 mg ferrous fumarate or sulfate and 300 μg folic acid, which should be given once per day [2]. The hemoglobin should increase within 2 weeks, otherwise further tests are required [6]. A high-iron diet should be recommended, including red meats (if possible), fortified cereals, and drinks [7].

Intravenous iron should be used only in severe cases of iron deficiency, if the woman is unresponsive to oral iron treatment, or when rapid repletion of iron is required [8].

Rationale of the study

Anemia in pregnancy continues to be a common problem; the impact of anemia in women ranges from increased fatigue, decreased cognitive ability, decreased work productivity, and consequent economic costs of increased morbidity and mortality.

Hence, this work was designed to focus on the most important risk factors predisposing one to the development of anemia during pregnancy to improve the health status of pregnant women and overcome this problem.


  Participants and Methods Top


The study consisted of two phases: the first phase was a cross-sectional study and the second phase was an interventional prospective study. This study was conducted in the family health center (FHC) of Kafr Al-Sheikh city.

The study included 200 pregnant women who attended the selected FHC in the period from 1 September 2014 till the end of March 2015. Pregnant women in the first trimester were excluded from the study.

The study was conducted in three phases

Basal evaluation of the studied group

The semistructured validated questionnaire used included the following: socioeconomic data according to the El-Gilany socioeconomic scoring system [9], the relevant obstetric, dietary, menstrual history, history of anemia, and conditions precipitating anemia, in addition to assessment of the hemoglobin level in the first visit.

Intervention phase

All participants received health education message about adequate diet, avoiding excessive salt, and the importance of compliance to nutrient supplementation. According to National Practice Guidelines for Family Physicians [2], anemic pregnant women diagnosed with mild and moderate anemia (Hb = 8–11 g/dl) received curative doses of ferrous fumarate (200 mg three times daily for 4 weeks) and patients with severe anemia (Hb <8 g/dl) received a higher level. They were instructed to attend the center with follow-up appointment after 4 weeks. Nonanemic pregnant women (Hb >11 g/dl) received a preventive dose of ferrous fumarate (200 mg once per day).

Reassessment and follow-up visit

Hemoglobin assessment was repeated 4 weeks after iron supplementation to estimate the improvement in the hemoglobin percent in the anemic group. There was a drop out of six cases in the post-intervention phase.

Statistical analysis

Analysis was carried out using SPSS version 20.0 (IBM SPSS Statistics for Mac, Released 2011; IBM Corp., Armonk, New York, USA; SPSS Inc., Chicago, Illinois, USA).

Two types of statistics were performed: Descriptive statistics [e.g., percentage (%), mean and SD] and analytic statistics, which included the following tests: χ2-test to compare two or more qualitative groups, Odds ratio (OR) to determine significant risk factors, and stepwise regression test to test the association between variables and to detect of risk factors.

P value of less than 0.05 was considered statistically significant.

Ethical consideration

The Menoufia Faculty of Medicine committee for medical research ethics formally approved the study. A written consent form was obtained from all participants, after simple and clear explanation of the research object, procedure, and the liberty to drop out.


  Results Top


This study revealed that 32% of the studied pregnant women were diagnosed with anemia at Hb level below 11 g/dl. About 92% of the anemic pregnant women had mild and moderate anemia (Hb = 8–11 g/dl), and two participants with hemoglobin level < 8 g/dl were referred to a higher level of care [Figure 1].
Figure 1: Prevalence of anemia among the studied pregnant women.

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Anemia was significantly higher among pregnant women with secondary education, and a low socioeconomic standard (40.6 and 73.4%, respectively) [Table 1].
Table 1: Comparison between anemic and nonanemic pregnant women regarding the sociodemographic characteristics

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This study revealed that the most significant risk factors for anemia among the studied pregnant women were a history of anemia (P = 0.000, OR = 18.18), followed by a low socioeconomic level (P = 0.089, OR = 17.4), and then a long duration of menstruation (P = 0.000, OR = 14.16) [Table 2].
Table 2: Logistic regression for predicting different variables related to the presence of anemia among the studied groups (total=200)

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There was obvious improvement in participants' level of hemoglobin concentration after the supplementation (P = 0.000) in comparison with that before the supplementation. The mean hemoglobin level was statistically higher after the supplementation (P = 0.000) [Table 3].
Table 3: Effect of oral iron treatment on the hemoglobin level in the studied anemic group (total=62)

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Improvement in hemoglobin concentration is significantly affected by the educational level, being higher among those with higher education (P = 0.003) [Table 4].
Table 4: Relation between the presence of hemoglobin level improvement and education level in anemic patients (total no=56)

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  Discussion Top


Anaemia during pregnancy is common and has both maternal and fetal consequences; the most common cause is IDA, and other causes include folate and vitamin B12 deficiency [10].

In this study, the prevalence of anemia among the studied pregnant women in the selected center was 32%. This is in parallel to the results of the study by Abdel-Raouf et al. [11], which was carried out on 206 pregnant women in El Sahel Teaching Hospital, Cairo, Egypt, and found that the prevalence of anemia was 30%. Also, a study conducted by Okeke [12] in Japan on pregnant women attending the antenatal clinic of Porto Novo hospital found that the prevalence of anemia was 30.8% in their studied group.

There was no statistically significant difference between the anemic and nonanemic groups regarding maternal age; this result was similar to the result obtained by Zama et al. [13]. A case–control study investigating 403 women attending ANC in Sokoto, Nigeria, found no statistically significant difference between the anemic group and the nonanemic group regarding maternal age.

In the current study, anemia during pregnancy were more prevalent among housewives (65.6%) than among working women.

This is in consistent with a result of a study conducted by Melku et al. [14], which found that the risk of anemia was 2.42 times higher among housewives as compared with government employees.

Regarding the socioeconomic level, the present study showed that the percentage of anemic pregnant women (73.4%) was significantly higher in the low socioeconomic strata.

This finding is in line with Nwizu et al. [15] who found that the risk of anemia was 4.2 times higher among women from the low socioeconomic class as compared with women from the high socioeconomic class in a study conducted in Kano, Northern Nigeria.

This study showed a highly significant improvement in Hb% after treatment of anemia with therapeutic iron supplementation: with 200 mg three times daily of ferrous fumarate for 1 month, 49 out of 64 patients had an increase in Hb level (76.5%) (P = 0.000).

This result is in agreement with a study conducted by Meier et al. [16] on women who developed IDA during the second trimester and received therapeutic supplementation with 180 mg of elemental iron daily and found that the IDA had resolved in 75% of the patients by the end of their pregnancies.

It is important to note that some of the participants reported noncompliance due to various observed side effects of iron tablets due to high dose such as heart burn, vomiting, and constipation.

Hemoglobin level improvement was significantly higher among women with secondary and higher level of education (44.7 and 34%, respectively).

This is in agreement with Kohan et al. [17], who stated that highly educated women have a greater access to finance and they are more likely to live a high-quality life than less educated and poorly remunerated women and have greater access to information and are more likely to make more evidenced-based and informed decisions concerning their nutrition, health, and well-being.


  Conclusion Top


Although anemia is a common preventable problem, the prevalence of anemia in pregnant women attending Kafr Al-Sheikh FHC was 32%; there was an obvious improvement in hemoglobin concentration in anemic pregnant women after supplementation of iron for 4 weeks by the dose recommended by Egyptian practice guidelines for family physicians.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
World Health Organization (WHO). Worldwide prevalence of anaemia: aglobaldatabase on anaemia (2005). Available at: http://www.who.int/publications/. [Last accessed 2014 May].  Back to cited text no. 1
    
2.
Egyptian practice guidelines for family physicians. The pregnant mother and antenatal care. Ministry of health and population, Egypt 2010;(3):21–29. Available from: http://www.egyfellow.mohealth.gov.eg. [Last accessed 2014 May].  Back to cited text no. 2
    
3.
Abdel-Rasoul GM, El Bahnasy RE, El Shazly HM, Gabr HM, Abdel-Aaty NB. Epidemiology of iron-deficiency anemia among primary school children (6–11 years). Menoufia Med J 2015; 28:663–669.  Back to cited text no. 3
    
4.
Beard JL. Effectiveness and strategies of iron supplementation during pregnancy. Am J Clin Nutr 2000; 71:1288S–1294S.  Back to cited text no. 4
    
5.
Milman N. Prepartum anaemia: prevention and treatment. Ann Hematol 2008; 87:949–959.  Back to cited text no. 5
    
6.
Pavord S, Myers B, Robinson B, Allard S, Strong J, Oppenheimer C. UK. Guidelines on the management of iron deficiency in pregnancy. Br J Haematol 2012; 156:588–600.  Back to cited text no. 6
    
7.
South Australian Perinatal Practice Guidelines. Anaemia in pregnancy [chapter 60]. South Australia [updated 22 May 2012].  Back to cited text no. 7
    
8.
Bryant C, Larsen S. Anaemia in pregnancy. Aust N Z J Obstet Gynaecol 2009; 11:17–18.  Back to cited text no. 8
    
9.
El- Gilany A, El wehady A, El-Wasify M. Updating and validation of the socioeconomic status scale for health research in Egypt. East Mediterr Health J 2012; 18:962–968.  Back to cited text no. 9
    
10.
Breymann C, Bian X, Blanco-Capito LR. Expert recommendations for the diagnosis and treatment of iron-deficiency anemia during pregnancy and the postpartum period in the Asia-Pacific region. J Perinat Med 2010; 38:1–8.  Back to cited text no. 10
    
11.
Abdel-Raouf AR, Ali DK, Talkhan HM. Pregnancy outcome and the effect of maternal nutritional status. J Egypt Soc Parasitol 2013; 43:125–132.  Back to cited text no. 11
    
12.
Okeke PU. Anaemia in pregnancy – is it a persisting public health problem in Port Novo – Cape Verde. Res J Med Sci 2011; 5:193–199.  Back to cited text no. 12
    
13.
Zama I, Argungu IB, Yakubu A, Taylor JR, Osaro E, Suzette U. Socio-demographic and obstetric factors associated with anaemia among pregnant women in Sokoto, no Western Nigeria. Health Sci Res 2014; 1:119–126.  Back to cited text no. 13
    
14.
Melku M, Addis Z, Alem M, Enawgaw B. Prevalence and predictors of maternal anemia during pregnancy in Gondar, Northwest Ethiopia: an institutional based cross-sectional study Anemia 2014; 2014:108593.  Back to cited text no. 14
    
15.
Nwizu EN, Iliyasu Z, Ibrahim SA, Galadanci HS. Sociodemographic and maternal factors in anaemia in pregnancy at booking in Kano, Northern Nigeria. Afr J Reprod Health 2011; 15:33–41.  Back to cited text no. 15
    
16.
Meier PR, Nickerson HJ, Olson KA, Berg RL, Meyer JA. Prevention of Iron deficiency anemia in adolescent and adult pregnancies. Clin Med Res 2003;1:1–29.  Back to cited text no. 16
    
17.
Kohan S, Ghasemi S, Dodangeh M. Associations between maternal health literacy and prenatal care and pregnancy outcome. Iran J Nurs Midwifery Res Autumn 2007; 12.  Back to cited text no. 17
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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