Anemia is a big public health problem in India affecting all the stage groups particularly the pregnant women. The study was conducted to get an idea about the burden of anemia in pregnancy in one block of central Kashmir.
The study was conducted in one of the clusters of a medical block in central Kashmir. All the pregnant women registered in the facilities of the selected cluster from April 2018 to January 2019 were included. Data regarding the variables were obtained from the hospital records.
Out of the 380 study subjects. Anemia according to WHO criteria was found in 98% of selected study subjects. Moderate anemia being the common type (83% ). About 72%of the females were in the age group of 26 to 35 years.
A high burden of anemia was found in the study area.
Anemia is a major public health problem affecting children, adolescents, women of reproductive age group, and lactating mothers worldwide. As per NFHS-4, the prevalence of anemia in India is 53% in reproductive age group (15-49) [1]. Anemia, which is a condition in which there is insufficient oxygen carrying ability of blood either due to change in Red blood cell morphology or number [2]. According to the definition of World Health Organization (WHO),anemia in women who are pregnant, is defined as a condition in which Hemoglobin concentration is less than 11g/dl.3 WHO further divides anemia in pregnancy into mild(Hb 10 -10.9gm/dl).
(9.9gm/dl), moderate (Hb 7-9.9gm/dl) and severe(Hb <7gm/dl) [3].It is estimated that 52% of pregnant women and 23% of the pregnant women are anemic living in developing and developed countries respectively, as per the WHO report [4]. In developing countries, there are various factors responsible for the anemia particularly in pregnancy as nutritional deficiencies like iron, folate and vitamin B12. Other causes include parasitic infestation, such as malaria and hookworm. Geographical location, season and dietary practice also have an effect on the health of pregnant women. Common causes of anemia in pregnant women in Sub-Saharan Africa is iron and folic acid deficiency. India being the highest in the list accounts for 80% of maternal deaths due to anemia in South Asia. In contrast, only 4-12 % of women of childbearing age in developed countries suffer from anemia [5-8]. Prevalence of anemia is also high in this part of the country particularly in pregnant women besides other non-communicable diseases [9]. There is limited data available regarding the prevalence of anemia in the study area. This study was conducted to provide an overview of the burden of anemia in pregnant women in one of the rural medical blocks of central Kashmir.
The present study was conducted in block khansahib in District Budgam of Kashmir Valley. Block Khansahib is one of the ten blocks of the district Budgam. There are two Community Health Centres (CHC) in the said block. For the purpose of sampling, the block was divided into two clusters based on the catchment area of the Community Health Centres (CHC). One cluster under Community Health Centres (CHC) Krimshore was selected for the study. All the sub centers and Primary Health Centres in the selected cluster were included in the study.
The study is a data-based descriptive cross sectional study. All the pregnant women registered from April 2018 to January 2019 in the selected centres were included. Data regarding the socio-demographic variables (age, residence, etc.) was collected from the records of these centres. The hemoglobin level at the time of registration was taken to avoid repeated measurements. Anemia was classified as per the WHO classification based on the maternal hemoglobin concentration Permission was obtained from the Block Medical Officer Khansahib, Budgam.
Records of 380 pregnant women were taken from the sub-centres and primary health centres of the cluster. The mean age of the study subjects was 30 year with minimum age of 19 years and maximum of 44 years with Standard deviation of 4.5. About 72%of the females were in the age group of 26 to 35 years. (table1). The percentage of primigravida women was 40% followed by gravida 2 which were 33% (table 2). About 14% of the females gave history of previous abortions. (Table3). The mean hemoglobin level was 9.0gm/dl with standard deviation of 0.98 with minimum of 6 gm/dl and maximum of 11.4gm/dl. According to WHO criteria, 98% of the pregnant women were having anemia based on the maternal hemoglobin. The percentage of moderate anemia was 83% followed by mild anemia in 11.4% of pregnant women and severe anemia was found in 13%. (Table1). Most common Blood group found was B type (40%) and 95% were having positive Rh factor. (Table 4 and Table 5)
|
|
|
|
|||
|
|
|
|
|
||
| <20 | 0 | 1 | 0 | 0 | 1 (0.3%) |
| 20-25 | 0 | 42 | 6 | 0 | 48 (12.6%) |
| 26-30 | 9 | 123 | 24 | 4 | 160 (42.0%) |
| 31-35 | 3 | 99 | 7 | 4 | 113 (30.0%) |
| 36-40 | 1 | 47 | 7 | 0 | 55 (14.4%) |
| >40 | 0 | 3 | 0 | 0 | 3 (0.7%) |
| TotalPercentage | 13(3.4%) | 315(83%) | 44(11.6%) | 8(2.6%) | 380 (100%) |
|
|
|
|
| Primigravida | 151 | 40 |
| Gravid 2 | 125 | 33 |
| Gravid 3 | 72 | 19 |
| Gravid 4 | 23 | 6 |
| More than 4Total | 9 380 | 2100 |
|
|
|
|
| None | 327 | 86.1 |
| One | 43 | 11.3 |
| Two | 7 | 1.8 |
| Three | 3 | 0.8 |
| Total | 380 | 100 |
|
|
|
|
| A | 78 | 20.5 |
| B | 151 | 39.7 |
| AB | 21 | 5.5 |
| O | 130 | 34.2 |
| Total | 380 | 100.0 |
|
|
|
|
| NEGATIVE | 18 | 4.7 |
| POSITIVE | 362 | 95.3 |
| Total | 380 | 100.0 |
Our study demonstrates that anemia is highly prevalent among pregnant women of rural population of central Kashmir region, with the prevalence rate of 90% among the registered pregnanciess. The prevalence rate is same as that estimated by Mehbooba Rasool et.al (2017) [10]and Kaul et.al 2013 [11]who found a prevalence rate of 90.4 %and 91% respectively in their studies. It is observed that majority of pregnant women (42% )were in age group of 26-30 years. The similar study was conducted in a rural block (Hajin) of Kashmir valley, by Kaulet.al, and it was found that maximum subjects were above 25 years of age.10Some other studies have also shown a high prevalence of anemia in age groups above 25 years.12,13,13 14. In our study 84% of the patients suffered with moderate anemia, 11.4% patients with mild anemia, and 2.6% women had severe anemia. Our results were comparable with Mehbooba et.al who showed a %age of 75.4%, 13.6% of moderate and severe anemia respectively. Kaul et.al reported 51.4% moderate anemia, and 22.8% severe anemia [9].Local dietary habits, lack of knowledge and awareness about importance the nutrition in pregnancy may be the cause for such huge burden.
The limitations of the study are that we took the maternal hemoglobin level based on the secondary data from the hospital records. The actual reason for such high burden could not be found out as the study was conducted to have an idea about the burden of anemia in pregnancy.
The study found high burden of anemia in pregnancy in the area. Further studies are advocated to find out the cause of such burden. The stakeholders of the various national programmes concerned with the issue should address the various factors associated with this burden of anemia.
Our special thanks goes to Block Medical Officer Khansahib for her support.
NFHS-4, National Family Health Survey India 2015-2016. 2016, 1-8.
World Health Organization Essential Nutrition actions improving maternal, newborn, infant and young child health and nutrition. WHO, Geneva 2014.
Rajaratnam J, Abel R, Ganes C, Aseelan S. Maternal anemia: a persistent problem in rural Tamil Nadu. National Medical j India 13(5), 2000, 242-5.
Lama Al-Mehaisen, Yousef Khader, Oqba Al-Kuran, Fayrouz Abu Issa, and Zouhair Amarin, “Maternal Anemia in Rural Jordan: Room for Improvement,” Anemia, 2011, Article ID 381812, 7 pages, 2011. https://doi.org/10.1155/2011/381812.
WHO Sixth Report on the World Health situation (1973-1977). Geneva World health Organization.1980.
Tiwari B K, Kundu A K, Bansal RD. National iodine deficiency disorders control programme in India. Indian J public health 39(4), 1995, 48-51.
World Health Organization in Preventive Medicine. The major deficiency syndromes, Epidemiology and approaches to control. WHO Monograph series No 62 Geneva, Switzerland: World Health Organization.
J. Baker and E.M. DeMaeyer, “Nutritional anemia: Its understanding and control with special reference to the work of World Health Organization”, American Journal of clinical Nutrition, 32(2), 368-417,1979.
Hamid A, Rouf A, Saleem SM. JMSCR || March Morbidity Pattern of Non-Communicable Diseases among Pregnant Women. 6(3), 2018, 291-295.
Rasool M, Ayub T, Khan SMS. Prevalence of Anemia among Pregnant Women in Block Hazratbal of Srinagar District Prevalence of Anemia among Pregnant Women in Block Hazratbal of Srinagar District. 2017.
Shoib S, ahmad a, ashraf m, ahmad r. Research article anaemia in pregnant women in a rural block of kashmir valley : its prevalence and socio- demographic associates. 2(4), 2013.
Gebremedhin S, Enquseiassie F. ‘correlates of anemia among women of reproductive age in Ethopia. Evidence from Ethopian DHS 2005- Ethop J Health Dev-2011, 25=22-30
Nazia Aram M Khan, Venkat Rama K Sonkar Vijay K Domple, Ismail A Inamdar ‘study of anemia and its associated risk factors among pregnant women in a rural field practice area of medical college.National Journal of community Medicine. 8(7), 2017
Juditha A. Noranha, Aparna Bhaduri and H Vinod Bhat, prevelence of anemia among pregnant women: A community based study in UDPI District.