|Year : 2014 | Volume
| Issue : 1 | Page : 36-39
Anemia and iron deficiency in pregnant women in Zaria, Nigeria
Abdul-Aziz Hassan1, Aisha Indo Mamman1, Sunday Adaji2, Bolanle Musa3, Simon Kene4
1 Department of Haematology, ABUTH, Zaria, Nigeria
2 Department of Obstetrics and Gynaecology, ABUTH, Zaria, Nigeria
3 Department of Medicine, ABUTH, Zaria, Nigeria
4 Department of Community Medicine, ABUTH, Zaria, Nigeria
|Date of Submission||05-Aug-2013|
|Date of Acceptance||24-Sep-2013|
|Date of Web Publication||24-Mar-2014|
Department of Hematology, ABUTH PMB 06 Shika, 810001 Zaria
Introduction: Anemia is common in pregnancy and iron deficiency is a major cause of anemia in pregnant women in Africa. This is due to increased demands of the fetus, growing uterus, placenta, and poor nutritional habits. Objectives: To determine the prevalence of anemia and the role of iron deficiency in causation of anemia in pregnant women attending the antenatal clinic of the Ahmadu Bello University teaching hospital (ABUTH) in Zaria, Nigeria. Materials and Methods: Ninety (90) consenting pregnant women were entered for this study with an equal number of controls. A structured questionnaire was administered to participants. Full blood count, serum ferritin, urine and stool microscopy for parasites were carried out. Results: The mean hematocrit in the pregnant and non-pregnant subjects was 35% (SD ± 3.8; 95 CI = 34.2-35.8) and 39% L/L (SD ± 3.2; 95% CI = 37.3-38.7) with P < 0.001. In the pregnant subjects 11(12.2%) had anemia while none of the controls was anemic. Mean serum ferritin among the pregnant and non-pregnant subjects was 26.0 μg/L (SD ± 35.2; 95% CI = 18.6-33.4) and 70.3 μg/L (SD ± 106.1; 95% CI 48.1-92.5), respectively, with P-value of <0.001. Even though iron deficiency was observed in 68/90 (75.6%) of pregnant women, it was latent in 61/68(89.7%) of the women while it was frank in 7/68 (10.3%). In the non-pregnant subjects, 23/90 (25.6%) had iron deficiency despite a normal hematocrit. Of the 11/90 (12.2%) of pregnant subjects that had anemia 7/11(63.6%) had frank iron deficiency anemia while 4/11 (36.4) had anemia due to other causes. 2/90 (2.2%) of the pregnant subjects had ova of hookworm in their stool samples and both had iron deficiency anemia. Conclusion: Iron deficiency underlies many cases of anemia in pregnancy, thus justifying the use of iron supplementation in pregnancy as is currently practiced. Latent iron deficiency among non-pregnant controls suggests that iron supplementation may benefit non-pregnant women within the reproductive age group could help to improve their iron stores before the contemplation of pregnancy, thereby, reducing the prevalence of pregnancy related anemia in this environment.
Keywords: Anemia, iron deficiency, pregnancy, Zaria
|How to cite this article:|
Hassan AA, Mamman AI, Adaji S, Musa B, Kene S. Anemia and iron deficiency in pregnant women in Zaria, Nigeria. Sub-Saharan Afr J Med 2014;1:36-9
|How to cite this URL:|
Hassan AA, Mamman AI, Adaji S, Musa B, Kene S. Anemia and iron deficiency in pregnant women in Zaria, Nigeria. Sub-Saharan Afr J Med [serial online] 2014 [cited 2019 Jul 23];1:36-9. Available from: http://www.ssajm.org/text.asp?2014/1/1/36/129311
| Introduction|| |
Anemia is a common problem worldwide and poses a great challenge to both health workers and governments due to its attendant consequences on health and socio-economic indices. These indices reflect the quality of life of citizens of a nation.  Anemia in pregnancy poses a great danger to both mother and child. The world health organisation (WHO) estimates in 2003 that about 24 million women in sub Saharan Africa are pregnant at some time during the course of a year. 
Iron is one of the most abundant elements in the earth crust yet iron deficiency anemia is the commonest nutritional disorder world-wide.  This is due to the body's limited capacity to absorb iron, while there is a higher probability of mucosal loss. , Iron is essential for many metabolic processes in the human body, but its function in the production of hemoglobin is the most important. 
Two-third of all pregnant and half of all non-pregnant women in Africa have anemia.  Anemia in pregnancy arises from a variety of factors which include the physiological hemo-dilution of pregnancy, increased demand of the fetus on maternal stores of iron and folic acid, poor nutritional diet, infections and infestation such as malaria and hookworm and some adverse cultural practices. , Iron deficiency anemia accounts for 70-85% of cases of anemia in pregnancy all over the world and more especially in Africa. Anemia in pregnancy is associated with maternal problems such as hemorrhage and increased maternal morbidity and mortality. , Anemia in pregnancy is also associated with adverse fetal outcomes such as intrauterine growth retardation, pre-term delivery, low birth weight and fetal death. ,
Anemia in pregnancy is more common in sub-Saharan Africa due to poor nutrition resulting from poverty and illiteracy,  other factors include maternal depletion syndrome, a high incidence of parasitic infestation, poor access to health care facilities and the absence of a Government policy on prevention of iron deficiency. ,
Anemia in pregnancy in Nigeria is not different from other parts of sub-Saharan Africa. In the neighbouring republic of Niger, Murray, et al., found that about 47% of breast-feeding women were iron deficient.  Harrison, et al., (1989) showed that about 40% of pregnant women are anemic.  Isah, et al., (1985) found a prevalence of anemia of 46% in non-pregnant and 52% of pregnant women respectively in Zaria.  Iron deficiency was found in 54% and 25% of non-pregnant and pregnant women respectively by Isah, et al.  Gwarzo, et al., (1994) in Kano found a prevalence of iron deficiency of 17% among pregnant women in Kano. 
| Materials and Methods|| |
This was a cross-sectional case-controlled hospital-based study carried out on pregnant women attending the ante-natal clinic (ANC) in ABUTH Zaria North West Nigeria. Ninety (90) pregnant women were selected after excluding hamoglobinopathies, malignancies and other medical causes of anemia. Another 90 apparently healthy non-pregnant women were selected by convenient sampling method, after getting an informed consent from each subject. Ethical approval was obtained from the Scientific and Health Research Ethics Committee of ABUTH.
Blood, urine and stool samples were collected from each of the 180 subjects. Full blood count and reticulocyte count were done using automated analyser (Sysmex 2000i), Serum ferritin by ELISA method and stool and urine microscopy was also carried out by manual concentration techniques.
The data obtained were entered into the Statistical Package for the Social Sciences (SPSS) and analysed. Student's t test was used for bi-variate analysis and a p value of 0.05 was considered as statistically significant. Anemia was defined as a hematocrit of less than 30% while serum ferritin of less than 20 μg/L defines iron deficiency. 
| Results|| |
The mean hematocrit in pregnant women and controls were 35 % (SD ± 3.8; 95 CI = 34.2-35.8) and 39 % (SD ± 3.2; 95% CI = 37.3-38.7), respectively (P < 0.001). Eleven (12.2%) of the pregnant women had anemia while none of the controls was anemic. The total white blood cell count and platelet counts were 6.8 and 5.2 and 221 and 253 × 10 9 /L, respectively (P < 0.005). The percentage reticulocyte counts were 1.1 and 1.7%, respectively, in non-pregnant and pregnant women. The red cell indices of MCV, MCH and MCHC were not statistically significantly different in the two groups studied. The mean serum ferritin in the pregnant women was 26.0 μg/L (SD = 35.2; 95% CI = 18.6-33.4) and 70.3 μg/L (SD = 106.1; 95% CI 48.1-92.5) in the non-pregnant controls (P < 0.001 ) see [Table 1]. Iron deficiency was found in 68 (75.6%) of pregnant women and 23 (25.6%) of non-pregnant controls. Of the 11/90 (12.2%) of pregnant subjects that had anemia 7/11(63.6%) had frank iron deficiency anemia while 4/11 (36.4%) had anemia due to other causes see [Figure 1].
|Table 1: Haematological parameters of pregnant and non-pregnant women in Zaria|
Click here to view
Two 2 (2.2%) of the pregnant women had ova of hookworm and both had iron deficiency. Only one (1.1%) of the controls had hookworm in the stool without iron deficiency.
| Discussion|| |
Anemia and iron deficiency related to pregnancy remain a major health problem especially in Africa. The finding of a statistically significant difference in the hematocrit between the pregnant and non-pregnant women is in keeping with the expected physiologic hemodilution of pregnancy and the higher prevalence of anemia in pregnant women than in the non-pregnant women. The prevalence of anemia of 12.2% in pregnant women in this study was significantly lower than the finding of Isah, et al.(1985)  in the same hospital, who reported a prevalence of 37% and 52% in elite and non-elite pregnant women, this may be due to the commercialization of ante-natal service in the present day as opposed to the free services rendered in the past. Thus women of all socio-economic background attended the ANC in the past but now only educated and well to do women attend ANC regularly. Dim, et al., (2007)  reported a 40% prevalence of anemia in pregnant women in Enugu, South east Nigeria though they used a hemoglobin cut-off point of 11 g/dl (PCV of 0.33) for anemia thus having a higher prevalence because if a cut off of 10 g/dl (PCV of 0.30) was used the prevalence might be similar to this study. Monjurul-Hoque (2006)  reported a prevalence of 15.7% in Grey-town South Africa while Bagachi (2004)  reported a prevalence of 14% in the UAE, 26% in Egypt and 45% in Pakistan which are significantly higher than the findings in this study and the varying percentages may reflect the socioeconomic status of the countries.
Sixty eight (75.6%) of pregnant women were found to be iron deficient with serum ferritin of less than 20 μg/L. The control group had 25.6% prevalence of iron deficiency this is remarkably higher than the report by Isah, et al., about 20 years ago who obtained an iron deficiency incidence of 45%, 30% and 25% in non-pregnant elite, pregnant elite and pregnant non-elite women, respectively. This finding may be a reflection of the economic downturn as evidenced by a reduction in the GDP of Nigeria from 88 billion dollars in 1985 to 44 billion dollars in 2002.  This reduction in GDP translates to decreased income to the populace which might adversely affect the nutritional status of women in Nigeria. Valberg et al., (1979)  reported an iron deficiency incidence of 60% among Canadian women which was lower than this study probably due to better socioeconomic status in Canada compared to Nigeria.
| Conclusions|| |
This study has shown that anemia in pregnancy is not uncommon in Zaria and iron deficiency accounts for a larger proportion. This further confirms the justification for iron supplementation in pregnancy as is currently practiced in Nigeria. The finding of over a quarter of non-pregnant women with latent iron deficiency should raise the need for iron supplementation in all women of child-bearing age through fortification of food and also the need for prenatal assessment of women of child-bearing age when they contemplate becoming pregnant.
| References|| |
|1.||Battling iron deficiency anemia. Turning the Tide of Malnutrition Responding to the challenges of the 21 st Century. WHO/NHD/00.7 2000. |
|2.||Pallister C. Nutritional requirements for Hemopoiesis. In: Blood Physiology and pathophysiology. London: Butterworth-Heinemann; 1994. p. 33-52. |
|3.||Hoffbrand AV, Petit JE, Moss PA. Hypochromic anaemia's and iron overload. In: Essential Haematology. 4 th ed. Massachusetts: Blackwell Science; 2000. p. 28-42. |
|4.||Iron deficiency anaemia Assessment, Prevention and Control. A guide for programme managers. WHO/NDH/01.3 2001. p. 15-20. |
|5.||Merchant T, Schellenberg JA, Nathan R, Abdulla S, Mukasa O, Mshinda H, et al. Anaemia in Pregnancy and infant mortality in Tanzania. Ann Trop Med Parasitol 2002;96:477-87. |
|6.||Isah HS, Fleming AF, Ujah IA, Ekwempu CC. Anaemia and iron status of pregnant and non-pregnant women in the guinea savannah of Nigeria. Ann Trop Med Parasitol 1985;79:485-9. |
|7.||Murray MJ, Murray AB, Murray NJ, Murray MB. The effect of iron status of Nigerièn mothers on that of their infants at birth and 6 months, and on the concentration of iron in breast milk. Br J Nutr 1978;39:627-31. |
|8.||Harrison KA. Anaemia in pregnancy in Maternity care in developing countries. London: Royal College of Obstetrics and Gynaecology Press; 2001. p. 112-214. |
|9.||Gwarzo MY, Sen KK, Atiku MK. Diet and serum iron status in pregnant and lactating Hausa women in Kano State Nigeria. Ann Trop Med Parasitol 1994;88:673-6. |
|10.||Isah HS. Diagnosis of iron deficiency: Challenges in tropical Africa. Biochem Clin 1991;15:799-805. |
|11.||Prevention and Control of Iron Deficiency Anaemia in women and children. Report of the UNICEF/WHO regional consultation. Geneva Switzerland. As stated 1999. p. 16-30. |
|12.||Dim CC, Onah HE. The prevalence of anaemia among pregnant Women at Booking in Enugu, South Eastern Nigeria. MedGenMed 2007;9:11. |
|13.||Monjurul-Hoque AK, Kader SB, Hoque E, Mugero C. Prevalence of anaemia in pregnancy at Greytown, South Africa. Trop J Obstet Gynaecol 2006;79:3-7. |
|14.||Bagachi K. Iron deficiency an old enemy. East Mediterr Health J 2004;10:754-60. |
|15.||Country info on Nigeria by UNICEF. Also Available from: http://www.unicef.org/infobycountry/nigeria.html.[Last accessed on 15-06-2012]. |
|16.||Valberg LS, Sorbie J, Ludwig J, Pelletier O. Serum ferritin and iron status of Canadians. Can Med Assoc J 1976; 114:417-21. |