STUDY OF ANAEMIA IN PREGNANCY AT ANEKAL
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- Title
- STUDY OF ANAEMIA IN PREGNANCY AT ANEKAL
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* * * * * * * * * * * * *
*
*
' STUDY
ANAEMIA
*
*
AT
IN
* * * ★ ★
PREGNANCY
A N E K A L
*
*
OF
IN
RURAL
* *
WOMEN
*
★
*
* * * * * * * * * *
***********************
J Dr. MANJULA T.K.R. *
* Com. MED.
PROJECT *
***********************
r
1
THE
AIM:
STUDY
OF ANEMIA
IN
PREGNANCY
TO DETECT ANEMIA IN RURAL POPULATION IN PREGNANT WOMEN
INTRODUCTION :
Anemia, in pregnancy is a major public health problem
in developing countries.
It is one of the commonest
causes of high maternal mortality rate.
Anemia is
directly responsible for about 20% of maternal deaths
and in about another 20% a predisposing factor.
It is
also responsible for high incidence of premature and
low birth weight babies thus increasing the perinatal
mortality and morbidity. (Reference - Menon 1968).
According to W.H.O. reference Committee on
haematology (1968) a level of hemoglobin below 11.5% gm
during pregnancy has been accepted as indicative of
anaemia.
Majority of women go through pregnancy without
any apparent problems with mild and moderate anaemia.
obvious complications noted when Hb falls below 8.5 g%.
Hb surveys in different parts of count^indicate that
incidence of anaemia during pregnancy varies between
40
70%.
Severe anaemia in pregnancy is seen in about
10% of cases.
The incidence of anaemia increases with
increasing parity.
In rural population, incidence of
anaemia is likely to be of a much higher order due to
poor socio-economic status and associated infestations
and infections.
A seasonal variation in the incidence
of anaemia in pregnancy was observed being highest
(Contd...Page 2)
* 2 *
during summer, perhaps due to non availability of
leafy vegetables during this season. (Reference :
Swaminathan 1966).
MODERATE
SEVERE ANAEMIA
11.5 gm%
16.5 gm %
Normal
8.5 gm%
11.5 gm %
Mild
5.5 gm%
8.5 gm %
Moderate
Less than
5.5 gm %
Severe
CRITERIA
FOR
Hb
METHODS
AND
MILD,
MATERIALS
USED :
This study was conducted in the mobile clinic at
Anekal village.
6 villages were studied.
Total number
of patients - pregnant females included in study were
50.
A thorough clinical examination done to pick up
pallor in conjunctiva, nails, palms, buccal mucosa.
tongue.
Since we did not have any sophisticated
techniques to do Hb estimation. a simple Hb% estimation
done in the field using Sahli’s haemoglobinometer which
gave us accurate value of haemoglobin.
PHYSIOLOGY^. OF ^IRON^ REQUIREMENT ^.IN^PREGNANCY :
Iron is required for the growth of fetus and
placenta to meet daily physiological losses and
requirements of lactation.
500 mg of Iron is
required by bone marrow during pregnancy.
Therefore
for each pregnancy increased iron requirements is
500 mg - 600 mg of Iron.
(Contd...Page 3)
* 3 *
Results of diet surveys in India show that
average Indian diet has adequate iron content
20 - 22 mg/day.
Most of the population in Asian
countries have very poor or negligible stores of Iron.
Thus most women start pregnancy in an Iron deficient
state# due to uncompensated menstrual losses or due
to repeated pregnancies and 60 - 70% have Iron
deficiency anaemia by third trimester.
Government
of India has accepted the recommendations of a
study group on nutritional anaemia that 60 mg of
Elemental Iron with 500 nfg of folic acid should be
given daily as a supplement in last 12 - 16 weeks
of gestation.
DATA
ANAL Y S I S :
All pregnant females who came to mobile clinic
from 6 villages of Anekal viz. Harogade# Hulimangala,
Ingalwadi/ H.P. Colony# Bestamanahal1i, Vanakanahal1i
were examined and Hb% check up was done.
It is found that out of 50 pregnant females
20 patients are anaemic.
Remaining 30 are healthy#
normal.
The following table shows
(1)
Total No. of patients studied
50
(2)
No. of Villages
6
(3)
No. of Anaemic pregnant Women
20
(40%)
(4)
No. of normal pregnant women
30
(60%)
(Contd...Page 4)
♦ 4 *
Name of Villa
ges
No. of
Preg.
patient
Normal
preg.
Women
Anemics
Percentage
of Anaemia
A)
HAROGADE
7
3
4
57.14%
B)
HULIMANGALA
8
4
4
50%
C)
INGALWADI
13
9
4
30.76%
D)
H.P.COLONY
NO
ANC
CASES
E)
BESTAMANAHALLI
15
11
4
26.66%
F)
VANAKANAHALLI
7
3
4
57.14%
The above data is depicted in the Graph 1 and 2.
The 2 parameters taken into consideration for
detecting anaemia in pregnancy are
Clinical Examination for Pallor, Koilonychia,
(a)
Edema,Dyspnoea.
(b)
Haemoglobin Estimation
Clinically out of 50 patients, 20 were Pallor positive.
Based on Hb% they were grouped as mild, moderate. severe.
Out of 20 anemics - 16 were mildly anemic and 4 moderately
anemic.
No severe anemic cases found.
Regarding spacing of pregnancies in the 20 anemic
patients showed most of the pregnancies had a gap of
minimum of 2 years - 3 years.
Only 3 cases had a gap
of 1 - 1% years.
The following tabular column shows number of
(Contd•..Page 5)
* 5 *
of patients in all 3 trimesters and anaemia in all
3 trimesters^
TRIMESTERS
Name of the
Village
No. of
pregnant
women
I
II
III
HAROGADE
7
1
2
4
HULIMANGALA
8
3
2
3
INGALWADI
13
0
4
9
H.P.COLONY
0
0
0
0
B E STAMANAHALLI
15
2
5
8
VANKANAHALLI
7
1
3
3
Name of the
Village
SIo. of
pregnant
vomen
No. of Anemic in all
Trimesters
I
II
III
HAROGADE
7
0
2
2
HULIMANGALA
8
1
0
3
INGALWADI
13
0
1
3
H.P. COLONY
0
0
0
0
BESTAMANAHALLI
15
0
1
3
VANKANAHALLI
7
0
2
2
The above data shows most of the patients who came
were in 3rd trimester
23 cases and 16 cases in 2nd
trimester and 7 in the first trimester.
No. ofpatients found to be anaemic were in the
(Contd...Page 6)
* 6 *
3rd trimester#
Then 6 cases in 2nd trimester, only 1
case in first trimester.
INTERPRETATION:
Anaemia in pregnancy is one of the causes of maternal
morbidity and mortality.
Government of India has taken
step to prevent anaemia occuring in pregnant women.
They
have recommended regular intake of Iron and folic acid
tablets from 2nd trimester onwards in addition to
dietary intake.
Most of pregnant women under study have regularly
taken Iron and folic acid given to then by LHV, ANM,
Doctors.
Some of them have not received any Iron and
folic acid.
The above results when taken as percentage shows
73% normal pregnant female in Bestamanahalli, 70% in
Ingalwadi, 50% in Hulimangala, 42% at Solur, Harogade.
57.14% Anaemia detected in Harogade and Vankanahalli.
In Bestamanahalli Village only 26.66% anaemia cases
in pregnancy seen.
This particular village/ pregnant
women underwent regular checkups, received regular Iron
and folic acid tablets.
health.
They were vie 11 aware of their
Anaemia in pregnancy was mostly seen in
3rd trimester.
DISCUSSION:
Anaemia is the condition in which there is a reduction
(Contd....Page 7)
* 7 ♦
in Haemoglobin concentration in blood stream to a level
below 11.5 gm%.
Iron, folic acid, vitamins. trace elements ane
required for formation of Hb which takes place in bone
marrow.
These substances are ingested from food, green
vegetables, cereals.
meat.
Normally excess Iron
ingested is stored in bone marrow
so that during
periods of stress it can be used for formation of Hb.
One such physical stress is pregnancy.
During pregnancy, growth of fetus,uterus needs
Most of our Indian Women start pregnancy
extra iron.
with low iron in body.
In the study, I found that most of the anaemia in
pregnancy in villages was due to nutritional deficiency.
A pregnant women requires in addition to normal an extra
20 - 24 mg of Iron per day.
Apart from nutritional cause.
socio-economic factors play an important role.
Hardships,
imposed by poor nutrition, water shortage, food taboos.
inadequacies in food production and storage, absence of
effective systems of social security results in anaemia
in pregnancy.
The study showed out of 20 anaemic pregnant women - 4
had moderate anaemia. 16 mild anaemia.
These women did
not have any symptoms of dyspnoea^tiredness. dizziness.
headaches.
No case of severe anaemia found in study.
Some of the multiple pregnancies did not give any history
(Contd...Page 8)
* 8 *
of anaemia in previous pregnancies.
No infant deaths.
No complicated previous pregnancy - delivered at home
or PHC.
WHO study showed that anemia is a cause of
maternal death in India and also in other developing
countries.
To treat severe cases of anaemia blood transfusions.
hospitalisation needed.
Mild and moderate cases can be
treated by Iron, Folic Acid.
COMMENTS
(1)
Some women didnot receive Iron and folic acid
tablets because no ANM visited gave them tablets.
(2)
Some women because of social obligation did not
go for health check up to PHC / any other medical
facility.
(3)
Means of transport for some women from
interior village to PHC was difficult therefore
they did not go for prenatal check up.
(4)
Iriadequate supply or inferior quality of
medicines.
ROLE
OF
HEALTH
SERVICES
IN
PREVENTING
ANAEMIA
IN PREGNANCY :
(1)
Health Care before oregnancy
Build up nutritional status of women right from
childhood.
(2)
Health Education :
In schools. Community level should be done as two
way exchange of ideas which will prevent people’s
registance for health promotion.
(Contd...Page 9)
★ 9 *
(3)
Health Care during pregnancy :
(a)
Prenatal care is the most important - whose main
function is promotion of health during pregnancy
through advice and education activities.
Screening, identification and referal of
pregnant women if anaemia is suspected —
mobile clinics, PHC
ANNS.
Regular follow up and monitoring is necessary.
If effective prenatal care is taken it will prevent
all the complications of anaemia in pregnancy.
(b)
Post natal care -
Should also be good.
The same
women will be pregnant again, we should be able to
prevent future complication by taking care in
present pregnancy itself.
(c)
During Post natal period, a suggestion of
spacing of pregnancy becomes important.
regarding contraception can be done.
Advice
By good
spacing of pregnancy - blood loss during delivery.
low iron intake, will replenish and be ready for
future pregnancy.
SUGGESTIONS :
(1)
LHV, ANM and other health personnel should do house
to house check up regularly.
(2)
If any pregnant women identified should be subjected
to thorough clinical examination and simple fieLd
test Hb% estimation by Sahli’s method.
This test
can be learnt by health worker and by small pin prick
(Contd...Page 10)
* 10 *
you can save pregnant women going through many
complications.
(3)
All ANM’s during their training period can be
taught to estimate Hb.
Each ANM can be provided
with Haemoglobinometer.
(4)
In some villages ANMs were working for namesake.
They did not bother to see ANCs or give
Iron and folic acid tablets.
CON C L U S I 0 N
It is found that Incidence of anaemia in
pregnancy is 40% — Much can be done to reduce the
incidence of anaemia if all pregnant women have
healthy nutrition and also regular supplementation
of 60 mg of Elemental Iron and 500 mg of folic acid.
The provision of good quality of maternal health
services is needed not only to prevent anaemia in
pregnancy but also other causes of maternal deaths.
REFERENCES :
1968
(1)
Menon
(2)
WHO reference committee on Haematology
(3)
Study of seasonal variation and nutritional
deficiency -
(4)
1968.
Swaminathan 1966.
Methods of preventing maternal deaths WHO ~ Geneva - 1989.
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