Anaemia is typical of pregnancies: capturing community perception and management of anaemia in pregnancy in Anambra State, Nigeria

Maternal anaemia care in Kano state, Nigeria: an exploratory qualitative study of experiences of uptake and provision

Background

Maternal anaemia (anaemia in pregnancy, childbirth, and the postpartum period) remains a persistent challenge, particularly in Kano State, Nigeria, which has the highest prevalence of maternal anaemia globally, at 72%.

Methods

We conducted a qualitative study in Murtala Muhammad Specialist Hospital in Kano State, Nigeria. We aimed to identify factors constraining uptake and provision of maternal anaemia care, exploring perspectives across different stakeholders. We carried out 10 key informant interviews with policymakers and hospital managers, 28 in-depth interviews with healthcare providers and pregnant women using antenatal services and four focus group discussions with pregnant women's husbands and mothers-in-law. Data were analysed thematically.

Results

Issues with provision include a lack of provider training and guidelines specific to maternal anaemia and blood transfusion, insufficient staff to meet increasing demand, and inadequate resources. Issues with uptake include the inability to afford informal user fees, distrust in health services and the blood transfusion process, and a lack of understanding of the causes, consequences, and treatment for anaemia, resulting in poor uptake of care and adherence to treatment.

Conclusions

This study recommends the implementation of standardized guidelines and training sessions to better support healthcare providers in offering quality services and increasing funding allocated to supporting maternal anaemia care. Education initiatives for service users and the public are also recommended to build public trust in health services and to improve understanding of maternal anaemia.

The Effect of Anemia in Pregnancy on Postpartum Hemorrhage

Eighty percent of maternal deaths are caused by complications during pregnancy and childbirth. Furthermore, twenty-five percent of maternal deaths is affected by postpartum hemorrhage which is estimated 100,000 deaths annually. Indonesia places at the second ranks of the highest maternal deaths country after Laos. The cause of death in Indonesia is 28% by hemorrhage.  The hemorrhage in maternity is due to anemia in pregnancy. It occurs because when the mother gives birth, there will be adequate uterine contractions so that the hemorrhage is inevitable. The objective of the study is to identify the effect of anemia in pregnancy on the incidence of postpartum hemorrhage. The type of research employed is an analytic survey with a retrospective design. The research location was at Juata Tarakan Health Center. The population in this study were all pregnant women who visited the obstetrics and gynecology polyclinic in 2020 which was obtained from secondary data, the patient's medical record book at the Juata Public Health Center with a sample of 271 on June 23 to August 31, 2021. Sampling employed a non-probability sampling technique, total sampling, and the data analysis was administered univariately, and bivariate with chi-square test. The incidence of postpartum hemorrhage in women giving birth in the working area of the Juata Tarakan Health Center is 12.9%. Anemia in pregnancy possesses a significant effect on the risk of postpartum hemorrhage with p value (OR=11,253, 95%CI 5,120-24,732). Meanwhile, parity, age, type of delivery did not possess significant effect on postpartum hemorrhage. Mothers with anemia in pregnancy own a higher risk of postpartum hemorrhage which was 11.253 times greater than mothers who were not anemic in pregnancy. Therefore, it is necessary to perform proper handling of anemia in pregnant women to prevent postpartum hemorrhage.

Exploring Indonesian mothers' perspectives on anemia during pregnancy: A qualitative approach

OBJECTIVE

The study aims to investigate the perceptions of anemia among pregnant women to design culturally relevant interventions in Indonesia.

METHOD

Qualitative study with dates from 24 pregnant women in a province in Indonesia through focus group discussions. Data were analyzed using the inductive content analysis method.

RESULTS

Five themes emerged from the experiences of pregnant women with anemia: (1) anemia during pregnancy is perceived as a woman's destiny; (2) lack of knowledge related to clinical indicators of anemia; (3) the traditional taboo related to anemia; (4) the husband and family provide support related to anemia prevention; and (5) there is a need for cultural and religious-based health counseling.

CONCLUSIONS

Interventions to provide health information about anemia in pregnancy should be designed with consideration of local knowledge, beliefs and values, combined with medical elements. It is likely these interventions can change the perceptions of pregnant women's perceptions about anemia, ensuring that they are able to maintain their pregnancy. The implementation of programs to support these women should involves health workers who can understand their needs and who are adequately trained in cultural competence.

Exploring Indonesian mothers' perspectives on anemia during pregnancy: A qualitative approach

OBJECTIVE

The study aims to investigate the perceptions of anemia among pregnant women to design culturally relevant interventions in Indonesia.

METHOD

Qualitative study with dates from 24 pregnant women in a province in Indonesia through focus group discussions. Data were analyzed using the inductive content analysis method.

RESULTS

Five themes emerged from the experiences of pregnant women with anemia: (1) anemia during pregnancy is perceived as a woman's destiny; (2) lack of knowledge related to clinical indicators of anemia; (3) the traditional taboo related to anemia; (4) the husband and family provide support related to anemia prevention; and (5) there is a need for cultural and religious-based health counseling.

CONCLUSIONS

Interventions to provide health information about anemia in pregnancy should be designed with consideration of local knowledge, beliefs and values, combined with medical elements. It is likely these interventions can change the perceptions of pregnant women's perceptions about anemia, ensuring that they are able to maintain their pregnancy. The implementation of programs to support these women should involves health workers who can understand their needs and who are adequately trained in cultural competence.

Nutrition modification aimed at enhancing dietary iron and folic acid intake: an application of health belief model in practice

Background

The amount of calories and nutrients required for woman increase during pregnancy and Intake adequate amounts of nutrients is essential for the health of mother and foetal. This study was designed to investigate the effect of nutrition education based on the Health Belief Model (HBM) on calories, iron and folic acid intake for pregnant women.

Methods

This quasi-experimental study was performed on 76 pregnant women referring to four urban health centres of Khuzestan at 2015. Two education sessions were held covering items on nutrition during pregnancy. Data were collected through a demographic questionnaire, HBM questionnaire (CVI= 0.89, CVI = 0.83 and Cronbach's alpha = 0.84) and 3-day food record form. Data collection tool was valid and reliable self-administered questionnaire based on the HBM. Data analysis was done applying Chi-squared t -test, Mann-Whitney U -test and Wilcoxon test using SPSS 15.

Results

Before the intervention, there was no significant difference between the mean of calories, iron and folic acid intake in both groups. But after intervention, it was significant ( P <0.05). Before the intervention, there was no significant difference between the two groups in terms of health belief model constructs ( P > 0.05), but the difference was significant after intervention ( P < 0.05).

Conclusions

Educational intervention strategies based on HBM can improve dietary iron and folic acid intake in pregnant women in primary health care setting. Since anaemia is one of the leading indirect causes of maternal mortality and it is easily preventable, our findings have critical public health implications and perhaps might be used in evidence-based decision making by authority bodies.