|Year : 2012 | Volume
| Issue : 1 | Page : 54-57
Prevalence of anemia in the postnatal women at a tertiary care teaching hospital in Mumbai
Pallavi R Shidhaye1, Purushottam A Giri1, Shashikant N Nagaonkar2, Rahul R Shidhaye3
1 Department of Community Medicine (PSM), Rural Medical College and Pravara Rural Hospital of Pravara Institute of Medical Sciences (Deemed University), Ahmednagar, India
2 Department of Community Medicine (PSM), Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
3 Indian Institute of Public Health, Hyderabad, India
|Date of Web Publication||3-Apr-2012|
Pallavi R Shidhaye
Department of Community Medicine (PSM), Rural Medical College and Pravara Rural Hospital of Pravara Institute of Medical Sciences (Deemed University), Loni, Dist., Ahmednagar - 413 736, Maharashtra
Background: Anemia is rampant in India. Around 20% of maternal deaths are due to indirect causes and anemia is the most significant cause. The prevalence of anemia in pregnant women has remained unacceptably high worldwide despite the fact that routine iron supplementation during pregnancy has been almost universally recommended to prevent maternal anemia, especially in developing countries over the past 30 years.
Materials and Methods: A cross-sectional study was carried out in the postnatal ward of Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, during the period of January 2008 to June 2008. A total of 408 women were included and a pre-designed and pre-tested questionnaire was used for the study. Data was analyzed by using Statistical Package of Social Sciences (SPSS) 16.0.
Results: In the present study, 312 (76.5%) women were found anemic. Anemia was classified into mild (30.1%), moderate (59.6%), and severe (10.3%). Only 72 (25.5%) had more than three ANC visits during the pregnancy. About 234 (57.4%) received iron and folic acid (IFA) tablets, while 174 (42.6%) didn't receive.
Conclusion: Most of the women did not receive IFA tablets and out of those very few consumed more than 100 tablets as per the National Nutritional Anemia Prophylaxis Program. There is a need to promote, educate, and increase the awareness regarding the National health programs at the community level.
Keywords: Anemia, National Nutritional Anemia Prophylaxis Program, postnatal women, prevalence
|How to cite this article:|
Shidhaye PR, Giri PA, Nagaonkar SN, Shidhaye RR. Prevalence of anemia in the postnatal women at a tertiary care teaching hospital in Mumbai. J Med Nutr Nutraceut 2012;1:54-7
|How to cite this URL:|
Shidhaye PR, Giri PA, Nagaonkar SN, Shidhaye RR. Prevalence of anemia in the postnatal women at a tertiary care teaching hospital in Mumbai. J Med Nutr Nutraceut [serial online] 2012 [cited 2015 Jan 25];1:54-7. Available from: http://www.jmnn.org/text.asp?2012/1/1/54/94630
| Introduction|| |
Nutritional anemia has been defined by World Health Organization as "a condition in which the hemoglobin content of blood is lower than normal as a result of a deficiency of one or more essential nutrients, regardless of the cause of such deficiency."  Around 80% of maternal deaths are due to direct causes, i.e. obstetric complications of pregnancy, and remaining 20% of maternal deaths are due to indirect causes, i.e. resulting from pre-existing diseases or disease developed during pregnancy and anemia is the most significant indirect cause. Around 47% of maternal deaths in rural India are attributed to excessive bleeding and anemia resulting from poor nutritional practices.  The low statuses of women in the society coupled with their low literacy levels prevent the women from taking antenatal care even if services are available. Thus, good antenatal care, institutional delivery, and proper utilization of health services shall improve the maternal health.  The prevalence of anemia in pregnant women has remained unacceptably high worldwide despite the fact that routine iron supplementation during pregnancy has been almost universally recommended to prevent maternal anemia, especially in developing countries over the past 30 years.  National Nutritional Anemia Prophylaxis Program (NNAPP) was initiated in 1970 during Fourth Five Year Plan with the aim to reduce the prevalence of anemia to 25%.  Under this program, iron and folic acid (IFA) tablets were given to pregnant, lactating mothers, and pre-school children at least 100 days in a year. Hence, the present study was conducted to assess the prevalence of anemia within the framework of National Nutritional Anemia Prophylaxis Program in postnatal women at a tertiary care teaching hospital in Mumbai.
| Materials and Methods|| |
A cross-sectional study was carried out during the period of January 2008 to June 2008 in the postnatal ward of a Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai. It has its own teaching institute catering to a population coming from all classes of society but predominantly from the middle and lower classes. A total of 408 women who were admitted in the postnatal ward during the study period were selected consecutively for the study. All the women included in the study were informed about the purpose of the study. No one refused to participate in the study. Hence, the total sample size came to 408 women. A pre-designed and pre-tested questionnaire was used to get information regarding socio-demographic factors, the antenatal (ANC) visits, and iron folic acid (IFA) tablets received and consumed during the ANC period. Hemoglobin estimation was done by Sahli's method. Anemia was classified as per WHO criteria.  Informed consent of the participants was taken. All the questions were asked in the participant's language or else the meaning was conveyed properly . Ethical committee of the Lokmanya Tilak Municipal Medical College, Mumbai, had approved the study. Data were entered in MS Excel and analyzed using Statistical Package of Social Sciences (SPSS) 16.0. The statistical significance was set at P ≤0.05.
| Results|| |
It was observed from [Table 1] that out of the total 408 women, 244 (59.8%) women were in the age group of 20 to 30 years while 108 (26.4%) were aged below 20 years. According to modified B.G. Prasad's Classification,  majority 144 (35.3%) belonged to lower middle class followed by 120 (29.4%) belonged to upper middle class, while 100 (24.5%) were from the upper lower class. A majority of women were housewives 267 (65.4%) and 102 (25%) worked as laborers. About 154 (37.7%) had studied up to primary level schooling followed by 132 (32.4%) up to secondary and 57 (14%) were illiterate. The age at marriage for most women 242 (59.3%) was 18 to 24 years.
It was seen from [Table 2] that out of 408 women, 312 (76.5%) were found anemic. 186 (59.6%) had moderate followed by 94 (30.1%) mild anemia. A total of 283 (69.4%) women were registered during antenatal (ANC) period and out of these, 143 (50.7%) were registered in the second trimester followed by 124 (43.6%) in the first trimester. Majority 240 (58.8%) were multigravidas and 151 (37%) were primigravidas. Only 72 (25.5%) had more than three ANC visits during the pregnancy. About 234 (57.4%) women received IFA tablets while 174 (42.6%) didn't receive.
It is evident from [Table 3] that out of the 408 women, 169 (69.3%) received IFA tablets in the age group of 20-30 years. Out of them, only 67 (27.5%) women consumed. Fifty (89.3%) women above 30 years didn't receive tablets (P<0.01). IFA tablets received and consumed was significantly associated with education and occupation (P<0.01). In illiterates, the consumption of IFA tablets was 9 (15.8%), but as education increased, the consumption increased and the women receiving IFA tablets also increased (P<0.01). IFA tablets consumed and received were found statistically significant with the socioeconomic class (P<0.01).
| Discussion|| |
The present study conducted among 408 women revealed the overall prevalence of anemia around 76.5% with mild, moderate, and severe anemia being 30.1%, 59.6%, and 10.3%, respectively. Similarly, Desalegn  and Agarwal et al.  found that 74.3% had moderate, 2.5% had severe anemia and 80% moderate and 3.7% had severe anemia, respectively. By occupation, 65.4% were housewives, 25% were working as laborer, 8.6% were involved in service and only 1% was self-employed. A study by Venkatesh et al.  reported a significant difference in the level of utilization of antenatal services by the housewives compared to the working women (P<0.001). As per socioeconomic status, 144 (35.3%) women belonged to lower middle class followed by 120 (29.4%) belonged to upper middle class, while 100 (24.5%) were from the upper lower class. Similarly, a study by Crape et al.  reviewed that pregnant women taking supplements of iron increased with increasing socioeconomic status.
In the present study, only 69.4% had registered for antenatal care and 30.6% were not registered. Similarly Couillet  found that 23% had not undertaken any ANC consultation during their last pregnancy. It was found that 43.6% women had their first antenatal visit within the first trimester, 50.7% of the women in the second trimester while only 5.7% had registered in the third trimester. Similarly, a study by Mpungu  found that 57.7% visited ANC clinic during second trimester and 33.5% during third trimester.
In the present study, 39.9% women had one to two ANC visits and 34.6% had total three ANC visits and 25.5% had more than three ANC visits during pregnancy. Similarly, according to National Family Health survey (NFHS-3),  total number of mothers who had at least three antenatal care visits for their last birth was 75.3% (Maharashtra) and 90.7% (Mumbai). A study by Singh and Yadav  reported that 89% of the pregnant women had antenatal visits and 62% had more ANC visits and 11% pregnant women had no ANC visits. Similarly, Piammongkoll et al.  found that the number of ANC visits ranged from 0 to 8 with a median of three visits.
As per IFA tablets supply and received, 57.6% had received IFA tablets and 42.4% didn't receive any IFA tablets, even though they were registered for antenatal care. Similarly, Singh et al. found that the odds of anemia for a woman not on therapy was about 11 times that of her counterpart on prophylactic iron therapy (95% CI 8.76-14.13). Out of 408 women, 127 (31.1%) received full dose of more than 100 tablets, only 111 (27.2%) women actually had consumed more than 100 IFA tablets. Similarly, Nigam et al.  in their study revealed that only 2.3% received the full dosage of IFA tablets and Malagi et al.  found that only 59% women consumed all IFA tablets given to them. About 16% received 60 tablets, while 38% did not receive any tablets from the functionaries. According to National Family Health Survey (NFHS-3),  mothers who consumed IFA tablets for 90 days or more when they were pregnant was 30.5% (Maharashtra) and 27.5% (Mumbai).
| Conclusion|| |
Coverage of pregnant women with IFA tablets is 100% as per our national goal. For these, program should be effective, three major components need to be present: the recommended number of iron tablets need to reach pregnant women; tablets need to be delivered to women where they are working and living; and the behavioral barriers that keep women from taking the iron tablets need to be addressed.
| Acknowledgment|| |
We express our deep sense of gratitude to the Dr. Daksha Pandit, Professor and Head, Dept of Community Medicine, Lokmanya Tilak Municipal Medical College, Mumbai. We also acknowledge the help and support of Dept. of Obstetrics and Gynaecology, Lokmanya Tilak Municipal Medical College, Mumbai.
| References|| |
|1.||Kumar A. National nutritional anemia control programme in India. Indian J Public Health 1999; 43:3-5, 16. |
|2.||Kapil U, Saxena N, Nayar D. Evaluation of national programme for prevention of nutritional blindness and national nutritional anemia prophylaxis programme in selected states of India. Health Population: Perspectives and Issues 1996; 19:19-28. |
|3.||Park K. Park's Textbook of Preventive and Social Medicine. 21 st ed.Jabalpur, India: M/s Banarsidas Bhanot Publishers; 2011. p. 515-6. |
|4.||Müngen E. Iron supplementation in pregnancy. J Perinat Med 2003; 31:420-6. |
|5.||Agarwal DK, Agarwal KN, Roychaudhary S. Targets in national anemia prophylaxis programme for pregnant women. Indian Paediatr 1988; 25:319-22. |
|6.||World Health Organization. Nutritional Anaemia, Report of WHO group of experts; WHO TRS 503, Geneva; 1972. p. 1-29. |
|7.||Rao TB. Sociology in Medicine. 1 st ed.Guntur: Sree Graphics; 2002. p. 76. |
|8.||Desalegn S. Prevalence of anemia in pregnancy in Jima town, southwestern Ethiopia. Ethiop Med J 1993; 31:251-8. |
|9.||Agarwal AK, Sen AK, Kalra NK, Gupta N. Prevalence of anemia during pregnancy in district Burdwan, West Bengal. Indian J Public Health 1999; 43:26-31. |
|10.||Venkatesh RR, Umakantha AG, Yuvaraj J. Safe motherhood status in the urban slums of Davangere city. Indian J Community Med 2005; 30:6. |
|11.||Crape BL, Kenefick E, Cavalli-Sforza T, Busch-Hallen J, Milani S, Kanal K.Positive impact of a weekly iron-folic acid supplement delivered with social marketing to Cambodian women: Compliance, participation, and hemoglobin levels increase with higher socioeconomic status. Nutr Rev 2005; 63:134-8. |
|12.||Couillet M, Serhier Z, Tachfouti N, Elrhazi K, Nejjari C, Perez F. The use of antenatal services in health centres of Fès, Morocco. J Obstet Gynaecol 2007; 27:688-94. |
|13.||Kiwuwa MS, Mufubenga P. Use of antenatal care, maternity services, intermittent presumptive treatment by pregnant women in Luwero district, Uganda. Malar J 2008; 7:44. |
|14.||National Family Health Survey-3, 2005-2006, International Institute of Population Sciences (IIPS), Mumbai. |
|15.||Singh P, Yadav RJ. Antenatal care of pregnant women in India. Indian J Community Med 2000; 25:112-7. |
|16.||Piammongko S, Chongsuvivatwong V, Williams G, Pornpatkul M. The prevalence and determinants of iron deficiency anaemia in rural Thai-Muslim pregnant women in Pattani Province. Southeast Asian J Trop Med Public Health 2006; 37:553-8. |
|17.||Singh K, Fong YF, Arulkumaran S. Anaemia in pregnancy--A cross-sectional study in Singapore. Eur J Clin Nutr 1998; 52:65-70. |
|18.||Nigam A. Nutritional status of women and children in Uttar Pradesh. Institute of Applied Strategies and Development Studies, Uttar Pradesh 1996. |
|19.||Malagi U, Reddy M, Naik R. Evaluation of national nutritional control programme in Dharwad, Karnataka. J Hum Ecol 2006; 20:279-88. |
[Table 1], [Table 2], [Table 3]