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ABSTRACT

Anemia in pregnancy is identified by the WHO, as hemoglobin level less than 11g/dl and is divided into three levels of severity, Mild anemia (Hb level, 9 – 10.9g/dl), Moderate level of anemia (Hb level, 7 – 8.9g/dl) and severe anemia (Hb level 7 – 4.5 g/dl) (Margwe, 2015). Iron deficiency anemia is a global public health problem influencing both developing and developed countries. Iron deficiency anemia a major cause of maternal mortality. This was a quantitative, cross-case study. Data was collected from 131 pregnant women. The result of study showed pregnant women have knowledge about iron deficiency anemia similarly have negative attitude and poor practices. The knowledge of pregnant women towards iron deficiency anemia was better, but negative attitude and low practice found. Women should consume iron rich diet.

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study
Anaemia, a low blood haemoglobin concentration, is a global public health problem affecting both developing and developed countries. Globally, anaemia affects 273.2 million people (42.6%) and Africa represent a largest proportion of 84.5 million people which is 62.3% prevalence1. A total of 32.4 million pregnant women of 15-49 years of age worldwide have anaemia at a prevalence of 38.2% whereas in Africa the prevalence of anaemia in pregnant women is 46.3% and 9.2 million are affected (WHO, 2015).
More than 50% of global anaemia cases are due to iron deficiency. The main contributing factors to iron deficient anaemia include inadequate dietary intake and absorption, increased iron requirements and excessive iron losses, genetic defects, disease affecting blood cells or blood cell producing organs such as malaria, schistosomiasis, hookworm infection and HIV Infection (Pasricha SR, 2013 and Stevens GA, 2013).
Grand-multiparity, too early pregnancies, too many and too frequent pregnancies, spacing of less than one year, low socioeconomic status, illiteracy, and late booking of pregnant women at antenatal care units are among the known risk factor for development of anaemia during pregnancy (Benoist B de, 2008 and Hailu Jufar A., 2013). Anaemia during pregnancy may result into pre-term delivery, prenatal mortality, low birth weight and low mental capacity of children (Pasricha SR, 2013).
In rural areas of developing countries anaemia in pregnancy is generally associated with indicators of infections and nutritional deficiencies (Hinderaker SG, 2002), and these are areas where the intervention strategies focus. Iron supplementation in pregnant women improves birth length and birth weight and reduces neonatal mortalities. Screening for anaemia in pregnant women and universal iron supplementation to meet the iron requirements in pregnancy is recommended. This intervention should be implemented in conjunction with measures to prevent, diagnose and treat malaria, helminthiases and schistosomiasis to improve absorption of iron and alleviate loss of haemoglobin (Pasricha SR, 2013). Anaemia interventions are to be delivered at health care centers but the anticipated outcome is not achieved because the problem seems complex with multiple contributing factors, some of which are not part of the strategy. For example access to appropriate dietary requirement and use infection protective gear like insecticide impregnated bed-nets are some socioeconomic factors which are important in anaemia control
Plan (Hinderaker SG, 2002). Knowledge and attitude of women of child bearing age may have influence on the outcome of anaemia control during pregnancy.
As per World health organization, anemia is a state in which the quantity and quality of RBCS, or the hemoglobin level, falls beneath a built up cut-off esteem (Organization, 2014). Iron deficiency in pregnancy is distinguished by the world health organization (WHO), as hemoglobin level under 11g/dl and is separated into three levels of seriousness, Mild frailty (Hb level, 9 – 10.9g/dl), Moderate pallor (Hb level, 7 – 8.9g/dl) and extreme anemia (Hb level 7 – 4.5 g/dl) (Margwe, 2015). Press insufficiency sickliness commonly comes about when the admission of dietary iron is deficient for hemoglobin combination. The Iron insufficiency paleness comes about because of dietary inadequacy, loss of iron through dying, or expanded requests amid pregnancy in ladies (Camaschella, 2015).
Moreover, deficiency of iron is a worldwide medical issue influencing both developing and developed countries with major consequences for human well-being as well as social and economic improvement. It happens at all phases of the life cycle, however is more predominant in pregnant ladies and youthful kids (Prakash, Yadav, Bhardwaj, & Chaudhary, 2015). Likewise, iron deficiency main cause of anemia and more common in developing countries. Anemia posing additional burden on health care system. Due to physiological reason female and children are at high risk (Mawani, Ali, Bano, & Ali, 2016). Furthermore, World health organization (WHO) major health consequences of iron deficiency anemia in pregnancy consist of poor outcome of pregnancy, physical disability, and cognitive development. Iron Anemia increased risk of morbidity in children and reduced work productivity in pregnant women. Around 20% of maternal deaths lead by iron deficiency anemia. (Organization, 2011).
In a region of Pakistan, a study showed low knowledge and negative states of mind of pregnant ladies towards the routine antenatal examination and government health facilities (Ghaffar, Pongpanich et al. 2012).
Moreover, Regular checkup during pregnancy is essential.
Routine antenatal is a key passage point for pregnant women. Pregnant ladies get a wide scope of wellbeing advancement and preventive wellbeing administrations, including information about healthy practices during pregnancy, nourishing help, and iron deficiency anemia prevention (Ghaffar, Pongpanich et al. 2012).
Othman specified in his article that fitting eating regimen learning is required for pregnant ladies so they can devour balance amount of iron from food and supplement (Othman et al. 2016). Moreover pregnant women attitude and knowledge about iron deficiency anemia and supplements is an important. It includes as a barrier factor or motivation for iron supplements intake (Gowri, Sakthi, & Palanivel, 2017). Balasubramanian emphasis in his article on generating understanding of pregnant women about iron supplementation and health education can grossly reduce the frequency of iron deficiency anemia and thereby prevents anemia related mortality and morbidity (Balasubramanian, Aravazhi, & Sampath, 2016).
Similarly, during antenatal checkup comprehensive nutritional knowledge about iron rich diet and Supplements should be made an integral component. Women should be informed effective nutritional practices and benefits of the iron supplements. In antenatal checkup individual should motivate to increase the consumption of such food those are rich in iron, reduce the consumption of tea and coffee that inhibit iron absorption (Rizvi, 2012). Additionally, a study showed that attitude towards antenatal visits, importance of a healthy diet, and iron and folic acid intake during pregnancy could have a profound influence on their hemoglobin levels (Margwe, 2015). Namazi established in his study that knowledge and practice of pregnant have significance towards iron deficiency anemia (Namazi and Alizadeh 2016). A study concluded by Paula stated that tea consumption should be avoided by pregnant women as it has adverse effect on fetus outcome (e Paula, Shang et al. 2017).

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1.2 Statement of the Study
The prevalence of anemia in Nigeria has been variously studied with no reliable statistics by region though estimates exist. In Lagos specifically, there are no documented studies on prevalence.
However, pregnant women attending antenatal clinics are routinely put on iron supplementation in their second through to third trimester of pregnancy but the burden of disease remains high as determined by anemia related fetal and maternal mortality and morbidity. This study will seek to determine the prevalence of anemia in Lagos as well as its associated etiological factors. The results of this study as well as its recommendations will help put in place policies to effectively investigate and manage anemia in pregnancy and therefore reduce the burden of disease.

1.3 Aim and Objective of the Study
The main aim and objective of this study was to determine the knowledge and attitude of pregnant women towards anaemia prevention and control measures so that the findings can be used in intervention strategies to control of maternal anaemia and reduce anaemia related health problems in Nigeria and similar rural settings of developing countries. Other objective are:
1. To examining the cause of anemia in pregnant woman.
2. To analyze the solutions and prevention of anemia.
3. To analyze knowledge on anemia that can help in the prevention in pregnancy woman.
4. To analyze attitude on anemia that can help in the prevention in pregnancy woman.
5. To analyze practice on anemia that can help in the prevention in pregnancy woman.

1.4 Research Questions
The research question for this study are stated below:
1. What are the cause of anemia in pregnant woman?
2. What are the solutions and prevention of anemia in pregnant woman?
3. Can knowledge on anemia can help in the prevention in pregnancy woman?
4. Can attitude on anemia can help in the prevention in pregnancy woman?
5. 4. Can practice on anemia can help in the prevention in pregnancy woman?

1.5 Significance of the Study
This study will enhanced the knowledge, attitude and practice among pregnant women towards iron deficiency anemia. A health education session conducted for pregnant women living in rural area. Moreover, this study has a great significance being a nurse I have identify the ratio of knowledge, attitude and practice of pregnant women towards iron deficiency anemia. Through this study, to create a good insight for the policy makers, Non-governmental organizations and other governmental service provider shows directions to concerned bodies on how to implement the service in order to overcome the problem.

1.6 Scope of the Study
The scope of this study is centered on the knowledge and attitude on the prevention of aneamia in pregnancy of woman in wammako area of sokoto.

1.7 Limitation of the Study
The research work is limited to Knowledge and Attitude on the Prevention of aneamia in pregnancy of woman in wammako area of sokoto. The main constraint of the research is divided into the following parts.
a) Time constraints- due to the short time given for the study, the researcher could not get all the required information needed for the study.
b) Finance- as a result of money constraint the researcher had not enough money to carry out the study beyond the level. The researcher could not visit places where necessary information relevant to the study could be obtained.
c) Attitude of respondents – some of the respondents were unwilling to cooperate with the researcher because they felt, they have nothing to benefit from the study both financially and otherwise. Besides they were afraid of losing their jobs, if all information needed are released to the researcher.
1.9 Definition of Term
Anemia: is a condition that develops when your blood lacks enough healthy red blood cells or hemoglobin. Hemoglobin is a main part of red blood cells and binds oxygen. If you have too few or abnorma
Pregnancy: also known as gestation, is the time during which one or more offspring develops inside a woman. A multiple pregnancy involves more than one offspring, such as with twins.
Knowledge: is a familiarity, awareness, or understanding of someone or something, such as facts, information, descriptions, or skills, which is acquired through experience or education by perceiving, discovering, or learning.
Attitude: is a psychological construct, a mental and emotional entity that inheres in, or characterizes a person. They are complex and an acquired state through experiences. It is an individual’s predisposed state of mind regarding a value and it is precipitated through a responsive expression towards a person, place, thing, or event (the attitude object) which in turn influences the individual’s thought and action.
Prevention: measures to prevent diseases or injuries rather than curing them or treating their symptoms

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