Original Article

Anaemia in Pregnancy: Prevalence and Socio demographic determinants

Sunanda Pramanick*, Suprakas Hazra**, Dipak Pal***,Debashis Dutt**** and G.K. Pandey*****,

* Student M.Sc. Applied Nutrition. All India Institute of Hygiene & Public Health, Kolkata.

** Faculty, Department of Epidemiology, All India Institute of Hygiene & Public Health, Kolkata.

*** Professor, Department of Epidemiology , All India institute of Hygiene & Public Health, Kolkata.

**** Director Professor, Department of Epidemiology , All India institute of Hygiene & Public Health, Kolkata.

*****Director Professor, Department of Epidemiology , All India institute of Hygiene & Public Health, Kolkata.

Corresponding author:Suprakas Hazra,
Email: hazrasuprakas@yahoo.com,
Mobile : 9433215913

Abstract

Background and Objective:Anaemia is a commonly prevalent nutritional deficiency disorder. Its prevalence and severity is known to increase during pregnancy. Multitude of factors like dietary habits, poverty, ignorance, poor sanitation, poor access to health care and religious practices etc. have been found to be associated with anaemia. The aims of this study were to estimate the prevalence of anemia and its associated factors among pregnant women attending health facilities in a district of West Bengal. . Methods :A Cross sectional study was conducted among 174 pregnant women in three PHCs and one Hospital selected randomly. Data were collected by observation and interview of the antenatal mothers.

Results:Prevalence of anaemia was 66.1%. It was higher among women from minority community (90.2%), women who were illiterate (83.3%), who worked as labourers (84.4%), had fewer ANC visits (84.4%), consumed less than 100 IFA tablets(81.4%), whose husbands worked as labourers (73.0%), and with BMI less than 18.5(88.3%). Conclusion Anaemia during pregnancy continues to remains a challenge to public health. Women from minority community, lower educational levels, belonging to laboring class of occupation, poorly utilizing MCH services, husbands being labourers and women with lower BMI have greater predisposition towards anaemia. Recommendation: Persisting inequities call for addressing the social determinants.

Key words: Anaemia, Pregnancy, Minority Community, Antenatal Care (ANC), Body Mass Index (BMI), Iron and Folic Acid (IFA) tablet, Underweight, Primary Health Centre (PHC)

Introduction

Anaemia is the term used to describe the condition in which there is a reduction in the concentration of haemoglobin in the blood stream to a level below 11gm/dl for pregnant women.1Anaemia is a commonly prevalent nutritional deficiency disorder. Its prevalence and severity is known to increase during pregnancy.WHO has estimated that prevalence of anaemia in pregnant women in India is 65-75 per cent2. Anaemia is also known to adversely affect the outcome of pregnancy, both to the mother and foetus.3

Multitude of factors like dietary habits, poverty, ignorance, poor sanitation, poor access to health care and religious practices etc. have been found to be associated with anaemia4.

The present investigation was conducted to find out the prevalence of anaemia among pregnant women attending health care facilities for ante-natal care in selected health facilities of Burdwan district in West Bengal.

Materials and Methods

Study was carried out in Burdwan district of West Bengal located nearly a hundred kilometres from Kolkata. It had a population of 77,23,663, census 20115.Religious minorities constituted over one fifth of its population.

Expectant mothers who were registered for antenatal care in the health facilities constituted the subjects of study. The study was conducted between November 2014 to April 2015 in primary and secondary care health facilities located in the district.

Considering the prevalence of anaemia among pregnant woman as 65%1, estimated sample size was 87,with a confidence level of 95% and absolute allowable error of 10%. As the mothers were not selected by simple random sampling, a design effect of size 2 was considered giving the revised sample size as 87 x 2=174.

The health facilities of the district were grouped in two strata namely PHCs and Hospitals. From the first stratum three PHCs and from the second, one hospital was chosen by simple random sampling.

The data were collected two days in a week .In each day 5 patients were interviewed. From past data it was observed that the average attendance of patients in the Hospital and PHC’s were 75 and 32 respectively. From the Hospital every 15th and from PHC’c every 6th mother was selected by systematic random sampling .In this way 45 mothers from the Hospital and 43 mothers from each PHC’s were taken ,so as to make the total sample size 174. Data were collected using a pretested questionnaire by interview, direct observation and scrutiny of antenatal records. Anemia was estimated by Cyanomet Haemoglobin method using WHO criteria.6 To categorize socio- economic `status modified Prasad’s scale was used 7. Anthropometric rod and spring balance, were used for measuring height and weight respectively.

Expectant mothers who were ill, who came for delivery, and whose ante natal records were not available were excluded.

Data were analyzed in M S Office Excel and online Vassar Stats. Odds ratios, p value, and 95% confidence interval were computed.

Ethical clearance was obtained from the ethical committee of All India institute of Hygiene & Public Health, Kolkata. Verbal consent was obtained from the participants.

Results:

The study population consisted of 174 ante-natal women. Almost 71% of the women were Hindus. More than two third of them (67.8%) belonged to joint family. Nearly one third (33.7%) were from general caste and 31.6% from scheduled tribe. More than half (53.5%) of women were between 20-24 years. As per modified Prasad scale, 38.5% and 28.7% belonged to social class IV and III respectively. More than one third mothers had education upto middle class (37.9%) and 21.8% had studied upto higher secondary level. Housewife (59.2%) was the most common occupation of mothers. Majority (69%) of the pregnant women got married between 15 and 19 years and age at first pregnancy was maximum (56.3%) in the same age group. (Table 1)

The prevalence of anaemia was 66.1% among pregnant women. 31.6% had mild anaemia (Hb 10 to 10.99 gm/dl), 28.7% had moderate anaemia (Hb 7 to 9.9 gm/dl) and 5.8% had severe anaemia(Hb<7gm/dl).

Further, the prevalence of anaemia was analysed in terms of demographic and biological, variables. The prevalence of anaemia was 90.2 % among Muslim women. Higher prevalence of anaemia was seen among women who were illiterate (83.3%), who worked as labourers (84.4%). Women who had less than 4 ante-natal visits had higher prevalence (84.4 %). Mothers who consumed less than 100 IFA tablets showed higher prevalence (81.4%) in comparison to women who consumed 100 or more IFA tablets (37.7%).Women whose husbands worked as labourers had higher prevalence (73.0%) than the women whose husbands were engaged in other occupations (52.5%).Antenatal women with BMI less than 18.5 had greater disposition to anaemia (88.3%) than mothers having BMI 18.5 or above. No significant difference in prevalence of anaemia was found with regard to age, caste, type of family, age at the time of marriage, age at first pregnancy, parity, level of education of husband, socioeconomic class (Table2).

Discussion:

Anaemia continues to remain a major public health problem in ante-natal period. Overall prevalence of anaemia, in the present study was found to be 66.1% which corresponds with the findings of a community based study in rural Bengal by Bisoi et al8. Another study in the same district by Agarwal et al9 in 1999 had found 80% of pregnant women to be anaemic. In rural Maharashtra also a prevalence of 92.4 % has been reported by Wadgave10. Relatively lower proportion of anaemic mothers in the present study could partly be attributed to IFA supplementation, and better MCH services.

High proportion (90%) of anaemia observed in women from minority community in present study corroborates with the findings of Bisoi et al8 who found 80.6% anaemia in Muslim women. On the contrary Gautam et al11 and Dutta et al12 found higher proportion of Hindu women to be anaemic. These differences point out to persisting inequities in health and call for addressing the social determinants of health.

The type of family i.e. joint or nuclear had no relation to anaemia in the present study. But Bisoi et al8, Gautam11 and Bhattacharyya et al13found higher prevalence of anaemia in mothers from joint familes.

In the present study no variation in the prevalence of anaemia was found in different socioeconomic groups, although Gautam11 & Judith et al14 have reported higher prevalence in women from lower socio economic strata.

Age of the mother during pregnancy did not affect the prevalence of anaemia in the present study, which corresponds with the findings of S. Bisoi et al8 and Judith14 et al. However Bhattacharyya et al13noted higher prevalence in mothers below the age of 20 years. Greater awareness in the younger mothers because of improved educational status and sustained efforts of health system possibly had contributed to this change.

Occurrence of first pregnancy in younger women (below20years) did not affect the prevalence of anaemia in the present study, which is similar to the findings of Bisoi et al8.
Inverse relationship was found between literacy status of mothers and anaemia in the present study which was similar to Bisoi et al8. Gautam11 found higher proportion of women to be anaemic in the just literate group.

It was observed that there was a direct relationship between consumption of IFA tablets and prevalence of anaemia. Similar findings were noted by Bisoi et al8 who also found lower prevalence of anaemia in mothers who consumed greater quantities of IFA.

All the pregnant women who had less than 3 years gap between last two consecutive births suffered from anaemia (100%) compared to those who had spacing of at least 3 years (60.3%). The study conducted by Judith 14et al also made similar observations where higher prevalence was recorded in women with short pregnancy intervals. Bisoi et al8found lack of spacing between successive pregnancies as an important predictor of anaemia. Women who had less than two year gap between pregnancies were reported to have higher prevalence of (88.9%) in comparison to rest of the women (65.3%).

The prevalence of anaemia among underweight pregnant women was higher (88.3%) than the women who were normal or overweight (54.4%). Better nutritional status is known to have inverse relationship with anaemia and this study is no exception.

Conclusion:

Anaemia during pregnancy continues to remain a challenge to public health. Women from minority community, lower educational levels, labourers, utilizing less MCH services, low BMI have greater predisposition to anaemia. Persisting inequities call for addressing the social determinants.

Results:

Table1: Socio-demographic characteristics of Antenatal Mothers (n=174)


Variables

Number

%

Religion
Hindu
Muslim
Others

 

123
50
1

 

70.7
28.7
0.6

Type of family
Nuclear
Joint

 

56
118

 

32.2
67.8

 Caste
General
SC
ST
OBC

 

59
17
54
44

 

33.7
9.8
31.0
25.5

Age (yrs)
15-19
20-24
25-29
≥30

 

33
93
36
12

 

19.0
53.5
20.6
6.9

Socio Economic Class
( per capita income, in Rs)

< 773-( Class V)
773-1546( Class IV)
1547-2577( Class III)

    1. lass II )

≥ 5156 ( Class I)

 

30
67
50
21
6

 

17.2
38.5
28.7
12.1
3.5

Level of Education
Illiterate
Below Primary
Primary
Middle
Secondary
Higher Secondary
Graduate and above

 

30
6
18
66
38
11
5

 

17.2
3.5
10.3
37.9
21.8
6.3
3.0

Occupation
Unemployed
Unskilled Labour
Skilled Labour
House wife
Teachers
Office Staff
Business

 

24
31
1
103
8
1
6

 

13.8
17.8
0.6
59.2
4.6
0.6
3.4

Age at marriage (yrs)
< 15
15-19
20-24
25-29

 

9
120
42
3

 

5.2
69.0
24.1
1.7

Age at first pregnancy (yrs)
< 15
15-19
20-24
25-29


1
98
72
3


0.6
56.3
41.4
1.7

Parity
1st
2nd
3rd
4th and above


60
85
25
4


34.5
48.9
14.4
2.3

BMI (kg/m2)

< 18.5
18.5-22.9
23-24.9

 

60
102
12

 

34.4
58.6
6.9

 

Level of Education of Husband
Illiterate
Below Primary
Primary
Middle
Secondary
Higher Secondary
Graduate and above


8
13
31
61
34
12
15


4.6
7.5
17.8
35.1
19.5
6.9
8.6

 Occupation of Husband
Unemployed
Unskilled Labor
Skilled Labor
Teachers
Office Staff
Business


1
97
18
8
9
41


0.6
55.8
10.3
4.6
5.2
23.5



Table –2 :Level of haemoglobin according to different variables

Variables

Hemoglobin
level
(gm/dl)

O.R.(95% C.I.)

p Value

<11

≥11

Religion
Muslim
Hindu

46(90.2)
70(56.9)

5(9.8)
53(43.1)

6.97(2.6- 18.7)

< 0.0001

Caste
Other caste
General

79(68.7))
36(61.0

36(31.3)
23(38.1)

1.40(0.7-2.7)

0.310159

Type of family
Nuclear
Joint

37(66.1))
78(66.1)

19(33.9)
40(33.9)

-

-

Age (yrs)
<20
≥20

24(72.7)
91(64.5)

9(27.3)
50(35.5)

1.47(0.6-3.4)

0.371093

Level of Education
Illiterate
Illiterate

25((83.3)
90(62.5)

5(16.7)
54(37.5)

3.0(1.1-8.3)

0.028295

Occupation
Labor
Others

27(84.4)
88(62.0)

5(15.6)
54(38.0)

3.31(1.2-9.1)

0.015577

Age at marriage (yrs)
<15
≥15

7(77.8)
108(65.5)

2(22.2)
57(34.5)

1.9(0.4-9.2)

0.35807

Age at first pregnancy (yrs)
<20
≥20

71(71.7)
44(58.7)

28(28.3)
31(41.3)

1.8(1.0-3.4)

0.071861

Number of ANC visits
< 4
≥ 4

76(84.4)
39(46.5)

14(15.6)
45(53.6)

6.3(3.1-12.8)

<0.0001

 Number of IFA tablets consumed
<100
≥ 100

92 (81.4)
23(37.7)

21 (18.6)
38(62.3)

7.2(3.6-14.6)

<0.0001

 Parity  
< 3
≥ 3

86(59.3)
29(100.0)

59(40.0)
0(0)

-

-

Education
of Husband
Illiterate
Illiterate

7(87.5)
108(70.1)

1(12.5)
58(39.9)

3.8(0.5-31.3)

0.1794

Occupation of Husband
Labor
Others

84(73.0)
31(52.5)

31(27.0)
28(47.5)

2.5(1.3-4.7)

0.006857

BMI of pregnant woman(kg/m2)
< 18.5
≥ 18.5

53(88.3)
62(54.4)

7(11.7)
52(45.6)

6.4(2.7-15.2)

<0.0001

 Socio economic Status
Category IV & V
Category IV & V

70(72.2)
45(58.4)

27(27.8)
32(41.6)

1.8(1.0-3.5)

0.057433

Interval between last two consecutive Births (yrs)
< 3
≥ 3
Not applicable

36(100)
47(60.3)
32(53.3)

0
31(39.7)
28(46.7)

-

-



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