STUDY OF ANAEMIA IN PREGNANCY AT ANEKAL

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Title
STUDY OF ANAEMIA IN PREGNANCY AT ANEKAL
extracted text
* * * * * * * * * * * * *
*
*

' 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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