Prevalence of Maternal Anemia in A Tertiary Care Hospital in Western Nepal

ABSTRACT Introduction: Maternal anemia is a common problem in developing countries like Nepal accounting for around 30-50% of women becoming anemic during pregnancy. The present study aims to find out the prevalence of maternal anemia in a tertiary care hospital in Western Nepal. Methods: A descriptive cross-sectional study was carried out at Devdaha Medical College, Bhaluhi, Rupandehi, Nepal from October 2018 to May 2019 after taking ethical approval from the institutional review committee with the approval number: 012/2018. Three eighty three samples were taken and convenient sampling was done to reach the sample size. Data were collected from the study population after taking consent and entered in a predesigned proforma. It was then entered in an SPSS; point estimate at 95% CI was calculated along with frequency and proportion for binary data. Results: During the study period, out of 383 mothers, 230 (60.2%) mothers were anemic at 95% CI (10.6-10.8%); of which 172 (74.8%) were moderately anemic while 58 (25.2%) were mild anemic. The mean maternal Haemoglobin was 9.5±1.76SD. The mean maternal age was 24.24±3.26 SD; mean gestational age at the time of delivery was 36.08±1.77 SD. Conclusions: The prevalence of maternal anemia in this study is found to be higher than the national data which implies that maternal anemia is still a public health issue which needs to be addressed in spite of safe motherhood program launched by the government of Nepal.


INTRODUCTION
Maternal anemia, in developing countries like Nepal is the most common medical condition accounting for around 30-50% of women becoming anemic during pregnancy. 1 WHO defines anemia as haemoglobin<11 grams% in pregnancy, mild anemia (10-10.9 g/dL), moderate anemia (7-9.9 g/dL) and severe anemia (<7 g/dL). 2,3 Globally, about 38.2% of pregnant mothers are anemic. 4 Nepal Demographic Health Survey (2011) shows the prevalence rate of anemia in pregnancy to be 48%. 5 Maternal anemia is associated with Post-Partum Haemorrhage (PPH), Low Birth Weight (LBW) babies, prematurity, Small for Gestational Age (SGA) babies and perinatal death. This gestational outcome is considered as a major public health concern; it is more prevalent in countries with low financial resources. 6 LBW (weight < 2500 grams) are more prone to infant morbidity and mortality. 7 Free Full Text Articles are Available at www.jnma.com.np The objective of the study was to find the prevalence of maternal anemia in a tertiary care hospital in Western Nepal.

METHODS
This hospital-based descriptive cross-sectional study was conducted from October 2018 to May 2019 at Devdaha Medical College, Bhaluhi, Rupandehi, Nepal after taking ethical approval from the institutional review committee (IRC) of the college. The present study included 383 pregnant mothers>18 years of age with ANC visits done at Devdaha Medical College with a singleton pregnancy using consecutive sampling method. Those pregnant women with multiple pregnancies, history of preterm delivery and with any obstetrical complications or medical illness except anemia were excluded from the study. We took a written consent from the mother to participate in the study for the mothers. A detailed history was taken from the mother during the presentation for delivery and the data of the mothers was entered in the predesigned proforma. The blood of the mothers were collected from the antecubital vein and stored in the EDTA containing vial and then analysed using the automated hematologic analyzer.
Maternal anemia was defined as Hb<11 g/L. All the information including gestational age at the time of delivery, mode of delivery, clinical signs and symptoms, indication for admission in NICU, maternal risk factors, were recorded in the predesigned proforma. The perinatal outcome was defined as the maternal and fetal consequences caused by maternal habits and pregnancy complications during labor and one hour after delivery. The maternal consequences included preterm delivery, prolonged labor and maternal mortality whereas fetal consequences included small for gestational age, low Apgar score, intrauterine growth retardation, and intrauterine death. The fetal outcomes were small for gestational age, congenital anomalies, low birth weight, stillbirth, respiratory distress syndrome, preterm babies, intrauterine growth retardation, low Apgar score less than 5 at 1 min and birth asphyxia. The total sample size calculated was 383. The mothers were followed until discharge or death. In case of death, the cause of mortality was recorded. Data were checked for any errors or inconsistencies, then entered in a Statistical Package for Social Sciences (SPSS), point estimate at 95% CI was calculated along with frequency and proportion for binary data.

RESULTS
The prevalence of maternal anemia was found out to be 60.2% at 95% CI (10.

Admission in NICU
No

Anemia in baby
Yes 25 (6.5) No

(2.9)
Among anemic mothers, anemia was found prevalent at 37 weeks of gestation following second most at 35 and 36 weeks respectively ( Table 2). One hundred and sixty one (42%) mothers with maternal anemia delivered low birth weight babies (Table 3).

DISCUSSION
During the study period, 383 mothers along with their newborns were included, of which 230 (60.2%) proportions of mothers were anemic. The prevalence of maternal anemia was found out to be 60.2% at 95% CI (10.6-10.8%) in our study. This is similar to a study reported from India 9 (60.38%) and 10 (62.3%) while it is in contrast to some studies done in other parts of Nepal which showed a low prevalence rate ranging from 42 to 48%. 11-12 NDHS data set 2016 showed a prevalence rate of 40%. 13 Our study revealed 74.8% of mothers were moderately anemic while 58 (25.2%) were mildly anemic. This indicates that the nutritional significance of nutrition is subordinate and awareness is made to the rectification of anemia in the pre-pregnancy period.
Our study showed mean maternal haemoglobin to be 9.5±1.76 gm/dL which is near to comparable from a study done in Nepal 14 which showed the mean maternal haemoglobin concentration to be 11.14 ± 1.39 gm/dL. Our study showed mothers having preterm delivery were 23.4% and the proportion of low birth weight was high. A study from Karnataka showed the preterm birth was 38%. 22 Perinatal mortality in our study was 44.3 per thousand population which is similar to a study done 42%. 23

CONCLUSIONS
The high prevalence rate of maternal anemia in this study implies that maternal anemia is still a public health issue which needs to be addressed in spite of the safe motherhood program launched by the government of Nepal. Low maternal haemoglobin levels are associated with increased risk of stillbirth and IUD, and LBW babies. The prevalence of low birth weight was found to be significantly high among institutional deliveries of this region of the country.