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Project Topic and Material on Evaluation of the Level of Awareness of the Dangers Associated With Anemia in Pregnancy
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DISCUSSION OF FINDINGS, CONCLUSION AND RECOMMENDATIONS
In this chapter, the researcher discussed the result from the data analysis and relating interpretation to literature review in order to sharpen the focus of discussion using the research question.
5.1 Discussion of Findings
Research Question One: What is the knowledge of anemia in pregnancy amongst pregnant women attending antenatal care in Ilaro community?
The socio-demographic characteristics of the study population revealed that out of the 220 respondents, 169 of them were in the age range of 20-29 years while those that were 40years old and above were the least (0.3%). The minimum age of the respondents was 18years while the maximum age was 46years. The mean age of the respondents was 26.8years. About half of the women were self-employed, 26.8% were fulltime housewives, 13.5% were unemployed, and 4.9% were company workers, while 4.4% were Civil Servants. More than three-quarter of the respondents had one form of formal education or the other, while only a meager 2.2% had no any form of education at all. This certainly must have affected their level of awareness and health-seeking behavior hence, the least prevalence of anemia among those with tertiary education.
The knowledge about anemia and its causes, in this study is low (21.2%), majority of the respondents said they had never heard of anemia. This is in line with a similar study conducted in Raichur, India where knowledge about anemia in pregnancy is very low (6.48%) (Vijaynath et al, 2020). Most women who have heard of anemia were not able to correctly identify the causes. A major hurdle is the fact that anemia is not perceived a major health problem by many even by sufferers who ascribed its consequences to general fatigue. Even where the problem is recognized, there may be a reluctance to invest necessary funds owing to skepticism regarding the effectiveness of interventions for controlling it. Evidence of the independent effect of iron status on function would therefore, help in advocacy. The predisposing factors recognized to be responsible for anemia in pregnant women were parity (14.2%), adoption/miscarriage previously (28.1%), blood transfusion (23%), and being a sickle cell anemia patient (28.3%). This was in contrast to a study by Monif (2014) who revealed that women who had malaria during pregnancy were almost five times more likely to be anaemic. Similarly other studies have found almost the same association, which suggest that women who were anaemic during pregnancy were 3 times more likely to be anaemic (Monif et al., 2014; WHO 2016). This can be controlled by providing pregnant women with insecticide- treated bed nets (ITN) and intermittent preventive treatment (IPT) with anti -malarial medication.
The results of this study also showed that the prevalence of anemia was higher in the multiparous women than the primiparous women (number of times given birth). This is in line with a similar study which showed that high parity pregnancies carry about three times higher risk of developing anemia in pregnancy than low parity pregnancies, and that the risk of anemia in pregnancy increases in a dose-response fashion over increasing levels of parity (WHO, 2019). This may be explained by the increased susceptibility to hemorrhage in women having high parity. High parity is among the factors with etiologic potential in causing anemia in Pregnancy. The WHO defines high parity as five or more pregnancies with gestation periods of ≥ 20 weeks, and low parity as less than 5 pregnancies with gestation periods of ≥ 20 weeks (WHO, 2019). Compared to the non-pregnant state, every pregnancy carries an increased risk of hemorrhage before, during, and after delivery. Therefore, higher parity exposes women more frequently to periods of hemorrhage risk.
Research Question Two: What are the strategies used by the pregnant women for the prevention and management of anemia in Ilaro community?
The highest strategy was that regular medical checkup is necessary during pregnancy (70.4%), adequate treatment is necessary to eradicate hook worm infestation and malaria to prevent anemia (67.3%), and fasting or missing the meals must be avoided during pregnancy (65.3%). It was strongly kicked against the statement that pregnant women should eat last after consumption of all family members whatever is left over, shown by the response of 10.2% of the respondents.
The prevalence of anemia amongst women attending ANC in Ilaro community, Ogun state in this study was found to be 56.4%.This falls within the range 35%-75% from previous reports from a study by Chukwubelu and Obi (2014). It is however higher than 29.1% reported from similar studies conducted in Sagamu, 8.8% reported from Enugu and 29.79% from Lagos (Chukudebelu & Obi, 2014; Ojo, 2015; Olodeoku, 2016). The high prevalence of anemia found among women in this study could be attributed to low educational status, low nutritional and socio-economic status commonly found among residents of urban slums. According to the World Health Organization, a severe public health problem exists if the prevalence of anemia is equal or greater than 40% in any group (De Benoist et al, 2019). This is therefore, an indication that anemia during pregnancy is a major problem in Nigeria.
In other studies, pregnant women who were not eating balanced diet properly at least one time per week compared to those who ate two times had the likelihood of developing anemia. This result is consistent with other studies done in Ethiopia (Argaw, 2015; Bekele, et al, 2016). This significant association might be due to the reason that meat is an important source of heme iron. However, consuming substances like tea immediately after food has a negative association with anemia during pregnancy. The odds of developing anemia among pregnant mothers who were consuming tea/coffee immediately after food were 3.6 times greater than the odds of mothers who did not consume tea/coffee immediately after food during their current pregnancy. This result is in agreement with a study done in Egypt and Ethiopia, which showed significant association between anemia and consumption of tea (Ashiry, 2014). This could be drinking tea/coffee after food intake may affect iron absorption which leads to inadequate dietary iron intake in the pregnant women.
Research Question Three: What are the challenges encountered in the management of Anemia among pregnant women in Ilaro community?
The challenges to effective management and prevention of anemia among pregnant women were analyzed in table 4.4 above. The results indicated that the major challenge was finances with a response rate of 84.1%, followed by time constraint (62.3%), lack of support from family/friends (59.3%), and accessibility to ANC services (56.9%). These factors impede the effective adherence and practice of the pregnant women towards anemia prevention and management. Anemia in pregnancy is related to different socio-demographic factors which in turn have certain limitations and constraints (Jufar, 2018; Karaoglu, 2020). Studies have shown a higher prevalence of anemia in young pregnant mothers, large family size and large number of children ever borne. In different studies, age, family size, parity and economical status were found to be significantly associated with anemia during pregnancy (Jufar, 2018; Karaoglu, 2020) which were consistent with our current study.
In conclusion, the overall prevalence of anemia indicated that it is a moderate public health problem. Intervention strategies should focus on associated factors of anemia among pregnant women. Increase awareness for family planning methods might have a contribution for reducing risk of anemia. Economic and nutritional empowerment should be considered. Large scale longitudinal studies should be done to identify specific etiologies and root causes of anemia among pregnant women by assessing micronutrients (serum iron and folate).
5.2 Implications of findings to Nursing
This study has implication for nursing arising form the results and findings. The study indicated that knowledge about anemia and its causes, in this study is low implying a wide gap in the health education and information space. Health services and facilities should be made accessible for the pregnant women during antenatal care and for mothers during postnatal care to ensure that health linkages are strengthened between these two parties involved (the health beneficiaries and the health agents). This will ensure better health outcomes and safer pregnancies for women. High level of knowledge on anemia, its causes and management strategies should be disseminated and adequately discussed through awareness programmes, training sessions, workshops and sensitization campaigns which will be anchored by health workers, health educators and other healthcare professionals during their antenatal visit to hospital.
The purpose of the study was to determine the lack of awareness on prevention of anemia in pregnancy among pregnant women in Ilaro community, Ogun state. To achieve the purpose of the study, objectives and research questions were formulated. Related literature pertinent to the study was reviewed under conceptual review, theoretical review, and empirical headings.
From the findings, the knowledge about anemia and its causes, in this study is low (21.2%), majority of the respondents said they had never heard of anemia. Most pregnant women in Ilaro community have been exposed to secondary education but unfortunately, were not well informed with the condition of anemia in pregnancy. The predisposing factors recognized to be responsible for anemia in pregnant women were parity (14.2%), adoption/miscarriage previously (28.1%), blood transfusion (23%), and being a sickle cell anemia patient (28.3%). Increasing access to health information and quality services will greatly affect health seeking behavior and utilization of health services.
The prevalence of anemia was high (56.4%) among the pregnant women in this study. Assessment of anemia during pregnancy is important, because it directly or indirectly contributes to the high Maternal and perinatal morbidity and mortality seen in Nigeria. It also affords one the opportunity to institute interventions to prevent complications especially when carried out at booking. Therefore, there is a need to identify the risk factors for anemia. Among other findings, the study showed that the lack of knowledge of anemia was almost universal. Additional finding shows a strong correlation between parity and prevalence of anemia, that the higher the parity, the greater the prevalence of anemia (“pregnancy too many”).
Measures to improve and demonstrate maternal and child health (MCH) effectiveness through built-in evaluation procedures should thus go hand-in-hand with a drive to increase awareness of the need for iron supplements. Such an increased awareness will lead to an increased demand. Ultimately, adherence with iron therapy at the user level is affected by interactions between policy, service system and user factors. As already mentioned, lack of awareness of the prevalence, health impact and economic cost of anemia, and the efficacy of iron supplementation at all three levels (health policy makers, health care providers and among vulnerable groups within communities) are all significant problems.
Based on the findings, the following recommendations were made;
- There is need for public enlightenment campaigns to sensitize the public on what anemia is, its causes, risk factors and complications. Strategies should also be put in place to increase awareness on anemia. These should include dissemination of information via antenatal and under-five clinics, public radio, and community development meetings conducted by extension workers.
- Health education and promotion, especially to encourage all pregnant women to book early for antenatal care and to take appropriate intervention measures. Information, Education and Communication (IEC) efforts should be directed towards increasing levels of awareness and commitment at all levels.
- All pregnant women should be intermittently screened for the presence of anemia during the antenatal care visit, instead of just at booking which is the practice in most health facilities.
5.5 Limitations of the Study
The constraints faced by the researcher include time constraint as the researcher had to combine this study with other academic activities and preparations, inadequate material of the study, stress and financial constraints. Also, this work was limited to Ilaro community and pregnant women attending antenatal care; this implies that a general inference cannot be made for other women and mothers on issues related to motherhood practices.
5.6 Suggestions for Further Studies
Based on the research findings, the researcher suggests the following areas for further studies. There is need for more research to analyze the role of risk factors and perception in management of anemia among pregnant women and mothers as a whole.