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Indian Journal of Community Medicine

Prevelance of Amaemia Amongst Pregnant Women and its Socio-Demographic Associates in a Rural Area of Delhi

Author(s): Virender P. Gautam, Yogesh Bansal, D.K. Taneja, Renuka Saha

Vol. 27, No. 4 (2002-10 - 2002-12)

Deptt. of Community Medicine, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi - 110002

Abstract:

Research question: What is the prevalence of anaemia and its relationship with various socio-demographic variables?

Objectives: 1. To find out the prevalence of anaemia amongst pregnant women. 2. To find out the socio-demographic factors associated with anaemia in pregnancy.

Study design: Cross-sectional study.

Setting: The study was conducted in two villages viz. Pooth Khurd and Alipur, the rural field practice centres (RFPC) under the department of Community Medicine, Maulana Azad Medical College, New Delhi.

Participants: A total of 114 pregnant women with gestational period between 12-20 weeks were registered.

Study variables: Hb level, age, education, religion, caste, income, type of family, age at first pregnancy, gravida, birth interval, number of abortions and history of abnormal bleeding.

Statistical analysis: Proportions, chi-square test, fischer exact test.

Results: A high prevalence (96.5%) of anaemia (Hb <11 gm/dl) was observed. The overall prevalence of anaemia was found to be almost similar in different age groups, family type, income groups, religion, caste, age at first pregnancy, gravida, birth interval and number of abortions. However, the prevalence of severe anaemia was found significantly higher in those with age >25 years, educated till high school or less, nuclear family, no history of abortions and birth interval of >36 months.

Keywords: Pregnant women, Anaemia, Rural area

Introduction:

The importance of anaemia as a major public health problem throughout the world is widely recognized. According to WHO, in developing countries the prevalence of anaemia among pregnant women averages 56%, ranging between 35 to 100% among different regions of the world1. Various studies from different regions of the country (India) have reported the prevalence of anaemia to be between 33 and 100%2,3.

In India, anaemia is the second most common cause of maternal deaths, accounting for 20% of total maternal deaths4. Anaemia affects mainly the women in child bearing age group, young children and adolescent girls. Association of anaemia with adverse maternal outcome such as puerperal sepsis, ante-partum haemorrhage, post-partum haemorrhage and maternal mortality is no longer a debatable subject5. Apart from the risk to the mother, it is also responsible for increased incidence of premature births, low birth weight babies and high perinatal mortality5,6.

National Nutritional Anaemia Prophylaxis Programme (NNAPP) was initiated in 1970 during fourth five year plan with the aim to reduce the prevalence of anaemia to 25 percent7. Subsequent evaluations have shown no change in the situation. Since 1992, the daily dosage of elemental iron for prophylaxis and therapy has been increased to 100 mg and 200 mg, respectively under Child Survival and Safe Motherhood Programme.

In view of the above, present study was carried out to find out the prevalence of anaemia amongst pregnant women and socio-demographic factors associated with anaemia in pregnancy.

Material and Methods:

The present study was conducted in two villages viz. Pooth Khurd and Alipur, the rural field practice centres (RFPC) under the department of Community Medicine, Maulana Azad Medical College, New Delhi. These two villages were selected as these could provide adequate number of cases for the study. All pregnant women from these villages were registered in the antenatal clinic run by the department and were provided free antenatal care.

Based on the knowledge that about 50% of pregnant women in the country are anaemic, it was calculated that a sample size of 100 pregnant women will provide an estimate of prevalence with 10% error within 95% confidence limits. The study was carried out from May to December 2000 and a total of 114 pregnant women with 12-20 weeks of gestation were registered for the study.

The women with multiple pregnancies and bleeding disorders were excluded from the study.

The pregnant women were interviewed using a pre-structured, pre-tested schedule. Haemoglobin estimation was done by Sahli's method. Anaemia was classified as per WHO criteria8. Typing of anaemia was done as per standard peripheral blood smear examination method9.

Modified BG prasad classification was used for income classification10,11. Chi-square and Fischer's exact test were used as applicable.

Results:

Table I: Distribution of degree of anaemia by socio-demographic characteristics.

Characteristic Anaemia Normal n p value
Mild Moderate Severe Total No (%)
Age (in years)
<20 7 (31.8) 12 (54.6) 3 (13.6) 22 (100.0) - (0.0) 22 <0.05
20-24 14 (21.9) 36 (56.2) 11 917.2) 61 (95.3) 3 (4.7) 64
25-29 5 (20.8) 8 (33.3) 10 (41.7) 23 (95.8) 1 (4.2) 24
>30 - (0.0) 2 (50.0) 2 (50.0) 4 (100.0) - (0.0) 4
All 26 (22.8) 58 (50.9) 26 (22.8) 110 (96.5) 4 (3.5) 114
Type of family
Nuclear 5 (14.7) 15 (4.1) 14 (41.2) 34 (100.0) - (0.0) 34 <0.05
Joint 21 (26.2) 43 (53.8) 12 (15.0) 76 (95.0) 4 (5.0) 80
All 26 (22.8) 58 (50.9) 26 (22.8) 110 (96.5) 4 (3.5) 114
Educational status
Illiterate 3 (15.8) 8   7   18 (94.7) 1 (5.3) 19 <0.05
Just literate - (0.0) 4 (66.7)   (33.3) 6 (100.0) - (0.0) 6
Primary 4 (23.5) 10 (58.8) 3 (17.7) 17 (100.0) - (0.0) 17
Middle 2 (8.7) 13 (56.5) 8 (34.8) 23 (100.0) - (0.0) 23
High School 11 (34.4) 16 (50.0) 3 (9.4) 30 (93.7) 2 (6.2) 32
Sr. Secondary 4 (33.3) 6 (50.0) 2 (16.7) 12 (100.0) - (0.0) 12
Graduation 2 (50.0) 1 (25.0) 1 (25.0) 4 (100.0) - (0.0) 4
Post Graduate - (0.0) - (0.0) - (0.0) - (0.0) 1 (100.0) 1
All 26 (22.8) 58 (50.9) 26 (22.8) 110 (96.5) 4 (3.5) 114

A total of 114 pregnant women were studied. Most of the pregnant women were between 20 and 24 years of age (56.1%), followed by 25-29 years (21.1%), while less than 20 years accounted for 19.3% and only 3.5% were 30 years and above. Majority of pregnant women were Hindus (91.2%), followed by Muslims (6.1%) and Sikhs (2.6%). A high prevalence of anaemia (96.5%) among pregnant women was observed. Majority (50.9%) had moderate anaemia (Table I). Normocytic hypochromic and microcytic hypochromic type of blood picture, a characteristic of iron deficiency anaemia were commonly observed types of anaemia.

Table II: distribution of degree of anaemia by no. of abortions and birth interval.

Characteristic Anaemia Normal n p value
Mild Moderate Severe Total No (%)
No. of abortions
0 23 (24.2) 44 (46.3) 25 (26.3) 92 (96.8) 3 (3.2) 95 <0.05
1 2 (12.5) 12 (75.0) 1 (6.3) 15 (93.7) 1 (6.3) 16
2 1 (33.3) 2 (66.7) - (0.0) 3 (100.0) - (0.0) 3
All 26 (22.8) 58 (50.9) 26 (22.8) 110 (96.5) 4 (3.5) 114
Birth interval (in months)
<18 2 (8.7) 17 (73.9) 3   22 (95.7) 1 (4.4) 23 <0.05
18-35 7 (26.9)   (53.9)   (19.2) 26 (100.0) 15 (93.7) 26
>36 3 (18.8) 6 (37.5) 6 (37.5) 15 (93.7) 1 (6.2) 16
All 12 (18.5) 37 (56.9) 14 (21.5) 63 (96.9) 2 (3.1) 65

*49 women were primigravida

The prevalence of anaemia was not significantly related with age, type of family, income, religion, caste, birth interval and number of abortions (Table I and II).

However, severity of anaemia was significantly higher in those aged >25 years, from nuclear family, educated till high school or less, birth interval >36 months and with no history of abortions.

There was a trend of lower severity of anaemia with higher per capita income.

When first pregnancy was delayed upto 18 years or later, the pregnant women were more often normal or had mild anaemia. Women with gravida >2 more often had severe anaemia. However, these trends were statistically not significant. All the pregnant women with past history of abnormal bleeding (11.4%) were anaemic and 76.93% had moderate or severe anaemia.

Discussion:

The observed very high prevalence of anaemia and its severity in the current study although is similar to earlier studies2,3, but what is revealing is the fact that such a high prevalence has been observed in a rural area of the national capital. Since haemoglobin estimation was done at 12-20 weeks of gestation, e.g., before maximum haemodilution, the observed status reflects pre-pregnant levels, which calls for widening the scope of programme for prevention and control of anaemia, so as to cover adolescent girls also.

The findings that, normocytic hypochromic and microcytic hypochromic type of anaemia were predominant is consistent with other studies except lower prevalence of dimorphic blood picture12.

Higher prevalence of severe anaemia among those aged >25 years, birth interval >36 months and with no history of abortions remains unexplained and is at variance with known facts.

As in other studies, severity of anaemia was inversely related to educational status13 and income14. Similar to earlier studies13,15 severe anaemia was more often seen when first pregnancy occurred before 18 years of age or gravidity more than two. These factors are amenable to education of girls and delaying the age at marriage.

Conclusion:

A very high prevalence of anaemia (96.5%) early in pregnancy i.e. 12-20 weeks of gestation is indicative of the status of pre-pregnant levels. It calls for studies on anaemia among adolescent girls and a strategic shift in a programme focussed on pregnant women alone to broaden the coverage so as to include adolescent girls also for control of anaemia.

As normocytic hypochromic and microcytic hypochromic blood pictures were predominant, it indicates deficient iron intake/absorption irrespective of age, type of family, caste, religion or number of children as the prevalence was equally high in all these groups in this population.

References:

  1. World Health Organization. The prevalence of anaemia in women: a tabulation of available information, 2nd Ed., Geneva: WHO, 1992.
  2. Luwang NC, Gupta VM, Khanna S. Anaemia in pregnancy in a rural community of Varanasi, Ind J Prev Soc Med 1980; 11: 83-8.
  3. Agrawal V, Tejwani S. Prevalence of iron deficiency anaemia in Indian antenatal women especially in rural areas. Ind Med Gaz, Sept 1999; 300-3.
  4. Govt. of India. Health information of India, 1995, DGHS, Nirmal Bhawan, New Delhi.
  5. Roy S, Chakravorty PS. Maternal and perinatal outcome in severe anaemia. J Obstet Gynae Ind, 1992; 42: 743-50.
  6. Rangnekar AG, Darbari R. Foetal outcome in anaemia during pregnancy. J Obstet Gynae Ind, 1993; 43: 172-6.
  7. Agarwal DK, Agarwal KN, Roychaudhary S. Targets in National Anaemia Prophylaxis Programme for pregnant women. Indian Paediatr 1988; 25: 319-22.
  8. Preventing and controlling iron deficiency anaemia through primary health care, WHO, Geneva, 1989.
  9. Firkin F, Chesterman C, Penington D, Rush B. deGruchy's Clinical Haematology in Medical Practice, Oxford University Press, 5th edition 1990, P31.
  10. Kumar P. Social classification - need for constant updating. Ind J Com Med 1993; XVIII(2): 60-1.
  11. Economic Survey 2000-2001. Govt. of India, Ministry of Finance, Economic Division, Table 1.
  12. Dass A, Bhatt I, Dhaliwal B. Megaloblastic anaemia in pregnancy (In Delhi). J Obstet Gynae Ind 1967; 17: 37-43.
  13. Thangaleela T, Vijayalakshmi P. Prevalence of anaemia in pregnancy. Ind J Nutr Dietet 1994; 31: 26-9.
  14. Shah SNA, Baksh Ali, Rauf A, Ahmad M et al. Incidence of iron deficiency anaemia in rural population of Kashmir. IJPH 1982; 26(3): 144-54.
  15. Koen MC, Lemson MS, Sampath Kumar V, Abel R. Prevalence of anaemia among pregnant mothers in a rural south indian population. J Obstet Gynae Ind, 1992; 42(6): 283-7.
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