10. 5005/jp-journals-10006-1177 Judith Angelitta Noronha et al NURSING PRACTICE Anemia in Pregnancy??”consequences and Challenges: A Review of Literature Judith Angelitta Noronha, Esra A1 Khasawneh, Vidya Seshan, Shanthi Ramasubramaniam, Savithri Raman ABSTRACT Anemia during pregnancy is a global public health challenge facing the world today, especially in the developing countries. Anemia in pregnancy is an important contributor to maternal mortality/morbidity as well as to the low birth weight which in turn might contribute to increased percentage for infant mortality.
Many epidemiological studies in the past have reported the problem in high magnitude. This review was conducted to identify the persistence of the problem in the South Asian countries during the last 5 years irrespective of iron supplementation as a measure to tackle this problem. Materials and methods: A review of all published literature related to prevalence of anemia for a period of 5 years (20072011) in South Asian countries was carried out. The online databases MEDLINE, CINAHL, Science Direct, Scopus, and Cochrane were used to identify relevant studies.
Data from studies meeting inclusion/exclusion criteria were abstracted into a standardized form. Results: Eleven studies with a total of 1,93,131 pregnant women were included in the review. The maximum and minimum reported prevalence rates of anemia during pregnancy were 80 and 18% respectively. The maximum and minimum prevalence of severe anemia affecting pregnant women is 20 and 2. 7%. The risk factors that are involved are young age, educational status and socioeconomic status, poor birth spacing and lack of compliance to iron and folic acid supplementation.
Conclusion: Anemia is the most frequent maternal complication of pregnancy. All the 1 1 studies reviewed focused on assessing the prevalence of anemia during various stages of pregnancy. It shows anemia is prevalent from mild to severe degree with substantial variations across trimesters. The outcomes of these suggest prevalence of anemia is due to associated factors and lack of deficiency of vitamin B 12, low BMI, infection with ascariasis, deficient dietary consumption off s fortified with iron, low socioeconomic conditions and high parity. Keywords: Anemia, Southeast Asia, Pregnancy, Prevalence,
Hemoglobin, Mortality, Morbidity. How to cite this article: Noronha JA, A1 Khasawneh E, Seshan V, Ramasubramaniam S, Raman S. Anemia in Pregnancy??” Consequences and Challenges: A Review of Literature. J South Asian Feder Obst Gynae population in the world The highest proportions of individuals affected are in Africa and in Southeast Asia (WHO 2008). Among the South Asian countries, WHO estimate that India has the highest prevalence of anemia in pregnancy. Prevalence of anemia in pregnant Indian women is 49. 7%, against the global prevalence of 41. 8% (WHO 2008).
In Asia, anemia (irrespective of severity) is the second leading cause of maternal death and accounts for 12. 8% of maternal deaths independent of death due to postpartum hemorrhage. 14,23 India contributes to about 80% of the maternal deaths due to anemia in South Asia10 (Table 1). The prevalence of anemia in Bangladesh was 50% reported estimates from nationwide survey. 34 The multicenter, cross-sectional observational study conducted by Hanif et al (2007) in Malaysia reported the overall prevalence to be 35%. The main factors contributed were young age, grand multiparty and ethnicity. In Indonesia, the prevalence of anemia based on scattered surveys was in between 50 and 70%. 9 According to the demographic health survey report of Srilanka (2006/07), the prevalence of anemia was 20. 7% (mild) and moderate to severe was 13. 3%. The overall prevalence was 34%. 8 In Bhutan, the prevalence was found to be 50%. 8 According to the health nutrition and population statistics, the prevalence of anemia among pregnant women ranged from 21. 4% in Iran, 55. 4% in Maldives (2001), 42. 4% in Nepal (2006) and 39. 1% in Pakistan (2001). 8
Iron deficiency anemia is the most common and widespread nutritional deficiency in the world. The studies carried out in South Asian countries have shown that iron deficiency is the major cause of anemia. Recently, identified more than 70% of the pregnant women have vitamin 812 deficiency compared to international guidelines. 32 In India, the prevalence of anemia is high because of fewer intakes of iron, folic acid and food sources that prevent iron absorption, coupled with poor bioavailability of iron is the major factor responsible for prevalence of anemia. 29 More than iron deficiency, zinc,
Table 1: Prevalence of anemia and its contribution to maternal mortality Country Source of support: Nil Conflict of interest: None declared INTRODUCTION South Asian countries representing Quarter of the World’s population with 1. 5 billion people are faced with formidable health challenge of which anemia is still a persistent one. Anemia in pregnancy is one of the most common and widespread public health problems affecting 24. 8% of the Afghanistan Bangladesh Bhutan India Nepal S. Asia region (total) World total Prevalence of anemia in pregnant women (%) Maternal deaths from anemia 74 87 2800