CHAPTER ONE

INTRODUCTION

1.0 Background

The health-conscious world community has come to realize that anaemia, the majority of which is due to iron deficiency, has serious health and functional consequences. And that it is widespread especially among tropical low-income populations and that most of its nutritional component is controllable with a very high benefit/cost ratio. Women of reproductive age and pregnant, lactating as well as their infants and young children are

particularly affected.

In response to the overwhelming evidence to this effect, world authorities have agreed that by the end of this century, anaemia in pregnant women must be reduced by 1/3. The more aggressive groups believe that with new approaches for the control of iron deficiency, a reachable goal is to reduce iron deficiency anaemia to overall levels below 10% in most populations.

It is estimated that about 2.15billion people are iron deficient, and that this deficiency is severe enough to cause anaemia in 1.2 billion people globally.About 90% of all anaemias have iron deficiency components. In the developing world, nearly ½ of the population is iron deficient.

About, 47% of non-pregnant women and 60% of pregnant women have anaemia worldwide. In the developed world as a whole, anaemia prevalence during pregnancy averages 18%, and over 30% of these are iron deficient, with the poor mostly affected. Women in reproductive age and pregnant women are at high risk of incurring negative balance and iron deficiency due to their increased iron needs because of menstruation and demands of pregnancy. The average requirements of absorbed iron are estimated to be

1.36mg/day and 1.73mg/day among adult and teenage menstruating females respectively. However, 15% of adult menstruating women require more than 2.0mg/day, and 5% require as much as 2.84mg/day.  The superimposition of menstrual losses and growth in menstruating teenage girls increase the demands for absorbed iron; 30% need more than 2.0mg/day; 10% as much as 2.65mg/day and 5% 3.2mg/day. These requirements are very difficult to meet even with good quality iron fortified diets.

Iron needs are markedly increased during the second and especially during the third trimesters up to an average of 5.6mg/day (approximate range of 3.54 - 8.80mg/day).This amount of iron needs cannot be met from food iron hence the importance of prepregnancy iron reserves upon which to draw and iron supplementation during pregnancy.

Iron deficiency during lactation is mostly residual from that of pregnancy and delivery and can be partially alleviated because of lactational amenorrhea, but once menstruation returns, if lactation continues, iron requirements become higher. The risk of iron deficiency in pregnancy and lactation begins with inadequate pregnancy iron reserves among women in reproductive age.

Folate deficiency has also been documented in pregnancy, often leading to combined iron-folate deficiency anaemia. This is common among lower socioeconomic groups who consume mostly cereal-based diets (poor in folate) aggravated by prolonged cooking and reheating. Folate requirements double in the second half of pregnancy and are markedly increased by processes that involve haemolysis, such as malaria and haemoglobinopathies.  Malabsorption processes common among tropical, low socioeconomic groups impair folate absorption.

1.1 Problem Statement

Anaemia is one of a wide spread public health problem in the world. WHO estimates the number of anaemia, people worldwide to be a staggering 3.5 billion in the developing countries and that approximately 50% of all anaemia can be attributed to iron

deficiency. The global distribution of the disease burden of Iron deficiency anaemia is heavily concentrated in Africa and WHO regional Southeast Asia-D. These regions bear 71% of the global mortality burden and 65 % of the disability-adjusted life years lost.Although estimates of the prevalence of anaemia vary, it can be assumed that significant proportions of younger children and women of the child bearing age are

anaemic. It is the only nutrient deficiency that is also significantly prevalent in the industrialized countries. Perusal of WHO global database on anaemia depicts that the most affected groups are pregnant women (48%) and 5-14 year old children (46%). Predictably, the prevalence of anaemia in developing countries is three to four times higher than in industrialized countries. The most highly affected population groups in developing countries are pregnant women (56%), school age children (53%), and nonpregnant women (44%). In industrialized countries, the most affected groups are pregnant women (18%) and preschool children (17%), followed by non-pregnant women and older adults, both at 12%. Asia has the highest prevalence of anaemia in the world; followed by Africa. About half of all anaemic women live in the Indian subcontinent where 88% of them develop anaemia during pregnancy.

Available data indicate that up to 60% of pregnant Nigerian women, especially those in the rural areas, are anaemic during pregnancy.This anaemia is mostly due to the nutritional deficiency of folic acid, iron, vitamin and trace elements; hence it is more common among the poor and malnourished women. Nutritional anaemia is a major cause of adverse outcomes of pregnancy in Nigerian women. It is a direct and indirect cause of maternal and perinatal morbidity and mortality. It causes intra-uterine fetal growth retardation, with resulting increase in rates of stillbirth, neonatal and perinatal mortality.

Several Nigerian women have died during pregnancy because of severe anaemia

(Hb<6.0g/l). Despite the high incidence of anaemia as a cause of maternal mortality in Nigeria, very few interventions currently address anaemia as a major safe motherhood issue in Nigeria. To-date, only about 58% of pregnant Nigerian women receive iron supplement during pregnancy.

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