EVALUATION OF IRON STATUS IN PREGNANT WOMEN WITH IRON DEFICIENCY ANEMIA

EVALUATION OF IRON STATUS IN PREGNANT WOMEN WITH IRON DEFICIENCY ANEMIA AT OWERRI, IMO STATE, NIGERIA
 
CHAPTER ONE
INTRODUCTION
1.1     BACKGROUND OF STUDY 
According to Okafor et al., (2013), Anemia is a global public health problem affecting both developing and developed countries with major consequences for human health as well as social and economic development. It occurs at all stages of the life cycle, but it is prevalent in pregnant women and young children. As noted by World Health Organization (WHO, 2010), the importance of good hemoglobin concentration and good iron store during pregnancy for both the woman and the growing foetus cannot be overemphasized. Being a driving force for oxygen for the mother and foetus, a reduction below acceptable levels can be detrimental to both (Agan et al.,2010). Traditionallyas defined by Bull, (2006), anemia can be define as a decrease in the ability of blood to carry oxygen due to a decrease in the total number of erythrocytes, a diminished concentration of haemoglobin per erythrocyte, or a combination of both. A haemoglobin concentration below 11.0g/dl or a packed cell volume (PCV) of less than 33.0% is regarded as anaemia during pregnancy by the World Health Organization (WHO, 2010).
Iron-deficiency has been noted to accounts for the major cause of  of anaemia especially in pregnancy (WHO, 2010)  and is defined as an anaemia accompanied by a depleted iron stores and a compromised iron delivery to tissues.  In their study, Bursary et al., (2008), stated that iron deficiency is usually caused by nutritional deficiency or low iron stores resulting from previous pregnancy or previous heavy menstrual blood loss. Many researches have demonstrated that thephysiological requirements for iron in pregnancy are three times higher, than in non-pregnant menstruating women and that this requirement for iron increases as pregnancy advances. Iron deficiency anaemia is a serious health problem in the gestation-puerperal period as it is associated with several adverse perinatal outcomes like prematurity, lowbirthwight, maternal and perinatal mortality. It has been noted as one of the most intractable public health problems in developing countries and one of the commonest complications in pregnancy in sub-Saharan Africa and Nigeria as a nation (Bursary et al., 2008).
Epidemiologically, the World Health Organization estimates that anemia affects over half of the pregnant women in developing countries (Omigbodum, 2004). Recent estimates in the developing countries including Nigeria put the prevalence at 60.0% in pregnancy and about 7.0% of these women are said to be severely anemic (Komolafe et al.,2005). In their publication, van den Broek and Letsky,(2000)  stated that the high prevalence and the etiological factors responsible for anaemia in pregnancy are multiple and their relative contributions are said to vary by geographical area and by season.
Anaemia in pregnancy may be relative or absolute.  Relative anaemia is a normal physiological phenomenon that occurs in pregnancy due to larger increase in plasma volume (approximately 45.0% in singleton and 50.0–60.0% in twin gestation) than in red cell mass, resulting in the well-known physiological anaemia of pregnancy. Absolute anaemia involves a true decrease in red cell mass, involving increased red cell destruction as in haemoglobinopathy, malaria, and bacterial infection like urinary tract infection; increased red cell loss as in bleeding; or decreased red cell production as in nutritional deficiency such as iron or folate or in chronic disease (Burkar et al.,2009).
According to Adimma et al.,(2002), the predisposing factors of anaemia in pregnancy in Nigeria include young age, grand multiparity, low socioeconomic status, illiteracy, ignorance, and short interpregnancy intervals. Infection with hookworm and intestinal helminthes causes gastrointestinal blood loss resulting in depletion of the iron stores and consequently impaired erythropoiesis. They also lead to mal-absorption and inhibition of appetite, thereby worsening micronutrients deficiency and maternal anaemia.
Iron supplementation is noted as the primary treatment for iron deficiency anaemia however, the administration route differs according to individual needs and prevalence of adverse effects. Iron-rich foods and iron-fortified foods are also recommended for patients with iron deficiency especially those with major risk factors for the condition (example pregnant women). Short and long-term effects of iron deficiency anaemia on the development of a fetus or an infant are also being studied in conjunction with prophylactic and therapeutic iron supplementation both before and during pregnancy (Bánhidy et al., 2011).
1.2    STATEMENT OF PROBLEM
Iron deficiency affects a significant part, and often a majority of the population in nearly every country in the world. Programmes for the prevention of iron deficiency particularly iron supplementation for pregnant women are under way in most countries of the world as reported by WHO in 1992 however,most ofthese intervention programmes are neither systematically implemented nor wellmonitored or evaluated and this still present a problem in managing anemia due to nutritional deficiency like iron. The situation is still worst at large in developing countries like Nigeria. In Nigeria, anemia specifically iron deficiency anemia is highly prevalent among pregnant women due to many factors and has been noted to contribute to an increase rate of maternal and infant mortality in Nigeria.
1.3    JUSTIFIACATION OF STUDY 
Surveillance of iron deficiency involves an ongoing process of recordingand assessing iron status in an individual or a community. Worldwide,the most common method of screening individuals or populations for irondeficiency involves determining the prevalence of anaemia by measuringblood haemoglobin or haematocrit levels.
A major limitation of each of these two tests however, lies in the fact thatanaemia is not a specific indication of iron deficiency. As noted in most literatureother nutrient deficiencies and most infectious diseases can also result insignificant anaemia.Another limitation of haemoglobin or haematocrit measurements is that levelschange only when they are very low at the outset and when iron deficiency isalready severe. In resource-adequate situations the usual practice involvesthe use of further, specific, and more sensitive tests for individualassessment. These measurement of serum iron level, serum ferritin, transferrin saturation, and others and these reasons informed the rationale to embark on this study.
1.4    AIMS AND OBJECTIVE
The study aims
To determine the prevalence of iron deficiency anaemia among pregnant women attending antenatal clinic at Owerri Imo state.
To determine and identify the possible risk factors of iron deficiency among the subject group.
To evaluate the diagnostic importance of blood film, hematocrit and heamoglobin concentration in the early diagnosis of iron deficiency anaemia as compared to measurement of total serum iron, serum ferritin level. 
1.5    DELIMITATION OF THE STUDY
This research work is targeted at pregnant women at different trimesters of their pregnancy who are at most risk of developing iron deficiency anaemia or post sequels/complications of the disease conditions.
1.6    LIMITATIONS OF THE STUDY
The following challenges may be encountered during the course of this research:
Due to the invasive proceduere involve in blood collection, it is expected that most patient may decline to participate in the study.
Also it is expected that the cost of running the research work will be high as the prices of most reagents in the market has doubled.