A CLINICAL STUDY OF KNOWLEDGE

AND PRACTICE OF ANEMIA AMONG

PREGNANT WOMEN ATTENDING
ANTENATAL CLINIC AT TERTIARY
HOSPITAL
 INTRODUCTION
• Anemia is one of the most common medical disorders encountered
in pregnancy.
• Anemia in pregnant women has severe consequences on health,
social and economic development.1
• Prevalence of anemia depends on multiple factors such as
geography, ethnicity, socio-economic level, nutrition, pre-existing
iron status, prenatal iron supplementation.2
• The cause of anemia is multifactorial.Nutritional deficiency is the
most common form.
• It affects people of all age groups but its prevalence is more
common in pregnant women.
• World Health Organisation (WHO) defined anemia in pregnancy as
hemoglobin concentration less than 11gm/dl.3
• WHO statistics data shows that 40.1% of pregnant
women worldwide were anemic in 2016.
• The prevalence is more common in developing
countries than in developing countries. The condition is
more prominent in South East Asian countries where
about half of all global maternal deaths were due to
anemia.4
• India is included in the list of countries with high
prevalence of anemia in pregnant women. There is a
marginal decrease in prevalence of anemia in pregnant
women in India from 58% in NFHS-3 ( National Family
Health Survey- 2005-06) to 50% in NFHS-4 survey.
• Ministry of Health and Family Welfare, Government of
India has given emphasis to prevent anemia under
RMNCH+A services.
• National Nutrition Mission has been set up under the
oversight of Ministry of Women and Child Development
with aim to reduce anemia among young children,
adolescent girls, women of reproductive age group by one-
third of NFHS-4 levels by 2022.

• Despite of all these anemia still continues to be a common

cause of mortality and morbidity among pregnant women

• This study will be helpful to formulate a policy regarding

the vulnerable group in the society. Hence this study was
conducted to assess the knowledge and prevalence of
anemia among the pregnant women attending antenatal
clinics at Government General Hospital, Kakinada.
 MATERIALS AND METHODS
• A cross-sectional observational study was conducted at Antenatal
Outpatient Clinic at Department of Obstetrics and Gynaecology,
Government General Hospital, Kakinada.

• 100 pregnant women attending the Antenatal Outpatient Clinic

were randomly selected and included in the study. Pregnant
women admitted in the antenatal wards, high risk pregnancies were
excluded from the study.

• A structured interview schedule was used to collect the required

information. Ethical clearence was obtained from the Institutional
Ethics Committee. A formal permission from the was obtained from
the hospital authorities and consent was taken from the study
subjects.
 RESULTS
• Out of the 100 pregnant women, majority of the women (63%)
were in the age group of 20-24 years, with mean age of 22 years,
28% in the age group of 25-39 years, 9% in the age group of 15-19
years.
• 59% of the women registered in first trimester, 21% in the second
trimester and 21% in the third trimester.
• 52% were primigravida,38% were second gravida and 10% were
third and fourth gravida.
• 48% studied upto secondary level, 24% completed their graduation,
11% completed their primary education, 9% are illiterates 8%
completed their higher secondary education.
• Out of the 100 respondents 51% live in joint family,49% in nuclear
family.
• Majority of them (93%) are housewife, 4% are doing labour, 3% are
doing other jobs.
• 60% of them have income between 5000-10000, 25%
between 10000-15000, 8% between 15000-20000 and 7%
greater than 20000.
• Majority of the respondents are non-vegetarians (96%),
only 4% are vegetarians.
• The study found that there is a significant association
between women’s education and knowledge regarding
causes of anemia and knowledge regarding prevention and
treatment of anemia. The study showed that knowledge
regarding signs and symptoms of anemia, proper diet to
prevent anemia, knowledge regarding prevention and
treatment of anemia, knowledge regarding preventive
practices of anemia is good. Knowledge regarding cause of
anemia is poor.
 DISCUSSION
• In the present study, out of 100 respondents majority of the women
(63%) were in the age group of 20-24 years, with mean age of 22 years,
followed by 28% in the age group of 25-39 years, 9% in the age group
of 15-19 years. A study conducted in Nepal showed that 87.81%
women were less than 30 years.5

• Majority of the women (59%) registered in first trimester followed

21% in the second trimester and 21% in the third trimester. In the
study conducted at Nigeria 14.24% had registered their pregnancy in
first trimester, 54.75% in seccond trimester and 9.52% in third
trimester.6

• In this study, 52% were primigravida, 38% were second gravida and
10% were third gravida. In a study conducted at Karnataka 48.50%
were primigravida, 33.20% were second gravida and 16% were third
gravida and 2.30% were fourth gravida.7
• Majority of the women(48%) studied had secondary level
education, followed by graduation(24%), 11% completed their
primary education, 9% are illiterates 8% completed their higher
secondary education. A study in Orissa showed that 16.91% were
illiterate, 40.83% were having primary education,24.16% were
having secondary education and 7.08% were having higher
secondary education.8

• Out of the 100 respondents 51% live in joint family,49% in nuclear

family. A study conducted in Karnataka showed that 55.23% were
living in joint family and and 44.76% were living in nuclear family.9

• Majority of the respondents are non-vegetarians (96%), only 4% are

vegetarians.73.33% were non- vegetarians and 26.66% were
vegetarians in a study conducted at Karnataka. 9
• In this study majority of them (93%) are housewife, 4%
are doing labour, 3% are doing other jobs. In a study
done at Kalyobia 58% were housewife and 42% were
doing other jobs.10

• 60% of the women have income between 5000-10000

per month, 25% between 10000-15000, 8% between
15000-20000 and 7% greater than 20000. In a study
conducted at Karnataka 34.80% had income between
5000-10000 per month, 30.50% had income less than
5000,20.80% had 10000-15000,9.20% between 15000-
20000 and 3.80% between 20000-25000.7
• Majority of the illiterate women have not given
correct answers regarding causes of anemia.
Most of the correct answers were given by
women who are educated.
• Knowledge regarding signs and symptoms of
anemia, prevention and treatment of anemia is
good in women who are educated.
• Knowledge regarding proper diet to prevent
anemia, preventive practices regarding anemia is
good in all women.
 CONCLUSION
• The study concluded that although many women have
knowledge regarding proper diet to prevent anemia,
knowledge regarding prevention and treatment of anemia,
knowledge regarding preventive practices but many of
them are not practicing them due to various reasons like
socioeconomic status, nausea and vomittings in pregnancy.

• Adolescent health checkups, early registration during

pregnancy and improving the literacy rate, health
education, proper iron supplementation can reduce the
prevalence of nutritional iron deficiency anemia.
 REFERENCES
1. Benoist B, McLean E, Cogswell M, Egli I, Wojdyla D, World wide prevalence of
anemia, WHO Vitamin and Mineral Nutrition Information System, 1993-2005.
Public Health Nutr, Geneva 2008;12(4): 444-454
2. Williams Obstetrics 25th Edition;Pg No:1075
3. World Health Organisation(WHO), The prevalence of Anemia in women: a
tabulation of available information, Geneva, Switzerland: WHO;1992
(WHO\MCH\MSM\92.2). Assessed on 20/10/2012
4. Vijayanath K, Patil R, Jitendra, Patel A. Prevalence of Anemia in prevalence of
Anemia in pregnancy. Indian Journal of Applied Basic medical sciences 2010
July;12B(15);45-50
5. Ghimere N, Pandey N. Knowledge and Practice of Mothers regarding the Prevention
of Anemia during Pregnancy, in teaching hospital, Kathmandu. Journal of Chitwan
Medical College 2013; 3(5):14-17
6. Buseri FI, Uko EK, Jeremiah ZA, Usanga EA. Prevalence and Risk factors of Anmia
Among Pregnant Women in Nigeria. The Open Hematology Journal 2008; 2: 14-19
7. Yadav RK, Swamy MK, Banjade B. Knowledge and practice of anemia in among
pregnant women attending antenatal clinic in Dr. Prabhakar Khore hospital,
Karnataka, IOSR Journal of Dental and Medical Sciences 2014 April; 13(4); 74-80
8. Panigragi A, Sahoo BP. Nutritional Anemia and its Epidemiological
Correlates among Women of Reproductive Age in Urban Slum of
Bhubaneswar, Orissa. Indian Journal of Public Health, 2011;55(4)
9. Anitha M. A study to assess the knowledge and practices regarding
prevention of registered pregnant mothers attending antenatal clinics in
selected hospital Belgaum, Rajiv Gandhi University of Health Sciences,
Karnataka, Bangalore 2005
10. ElHameed HSA, Mohammed AI, Hameed LTAE. Effect of Nutritional
Educational Guuideline among Pregnant Women with Iron Deficiency
Anemia at Rural Areas in Kalyoboa Governorate. Life Sci J 2012; 9(2): 1212-
17
 VARIABLES NUMBER PERCENTAGE

AGE IN YEARS 15-19 9 9

20-24 63 63
25-30 28 28
30-34 - -
LITERACY Illiterate 9 9

Primary 11 11
Secondary 48 48
Higher Secondary 8 8
Graduate 24 24
TYPE OF FAMILY Nuclear 49 49
Joint 51 51
OCCUPATION Housewife 93 93
Labour 4 4
Others 3 3
DIET Vegetarian 4 4
Non- vegetarian 96 96
MONTHLY INCOME 5000-10000 59 59
10000-15000 25 25
15000-20000 8 8
>20000 7 7
REGISTERED DURING 1st Trimester 59 59
2st Trimester 21 21
3rd Trimester 20 20
 WOMEN'S EDUCATION CORRECT % INCORRECT % TOTAL %

Pregnancy creates large Illiterate 3 33.33 6 66.67 9 100

demand of iron
Primary 8 72.73 3 27.27 11 100

Secondary 37 77.08 11 22.92 48 100

Higher Secondary 8 100 0 0 8 100

Graduate 24 100 0 0 24 100

Increase of Hb% is known as Illiterate 3 33.33 6 66.67 9 100
anemia
Primary 2 18.18 9 81.82 11 100

Secondary 8 16.67 40 83.33 48 100

Higher Secondary 0 0 8 100 8 100

Graduate 3 12.5 21 87.5 24 100

Most cases of anemia are Illiterate 9 0 0 0 9 100
due to nutritional Primary 11 100 0 0 11 100
deficiency Secondary 43 89.58 5 10.42 48 100

Higher Secondary 8 100 0 0 8 100

Graduate 22 91.67 2 8.33 24 100

Iron is an important Illiterate 3 33.33 6 66.67 9 100

element required for Hb%
in pregnancy Primary 9 81.82 21 18.18 11 100

Secondary 41 85.42 7 14.58 48 100

Higher Secondary 8 100 0 0 8 100

Graduate 23 95.83 1 4.17 24 100

Repeat pregnancy at short Illiterate 1 11.11 8 88.89 9 100
intervals <2 years is the cause
of anemia Primary 5 45.45 6 54.55 11 100

Secondary 32 66.67 16 33.33 48 100

Higher Secondary 5 62.5 3 37.5 8 100

Graduate 21 87.5 3 12.5 24 100

Twin pregnancy need extra Illiterate 1 11.11 8 88.89 9 100
iron suppleme-ntation
Primary 8 72.73 3 27.27 11 100

Secondary 28 58.33 20 41.67 48 100

Higher Secondary 6 75 2 25 8 100

Graduate 19 79.17 5 20.83 24 100

Stool and urine examinati-on Illiterate 5 55.56 4 44.44 9 100

are important during
pregnancy Primary 6 54.55 5 45.45 11 100

Secondary 37 77.08 11 22.92 48 100

Higher Secondary 6 75 2 25 8 100

Graduate 21 87.5 3 12.5 24 100

Malaria causes anemia Illiterate 2 22.22 7 77.78 9 100

Primary 5 45.45 6 54.55 11 100

Secondary 27 56.25 21 43.75 48 100

Higher Secondary 4 50 4 50 8 100

Graduate 18 75 6 25 24 100
 WOMEN'S EDUCATION CORRECT % INCORRECT % TOTAL %

Tiredness and weakness Illiterate 7 77.78 2 22.22 9 100

are symptoms of anemia Primary 9 81.82 2 18.18 11 100
Secondary 37 77.08 11 22.92 48 100
Higher Secondary 8 100 0 0 8 100

Graduate 20 83.33 4 16.67 24 100

Pallor of face is a sign of Illiterate 7 77.78 2 22.22 9 100
anemia Primary 8 72.73 3 27.27 11 100
Secondary 34 70.83 14 29.17 48 100
Higher Secondary 8 100 0 0 8 100

Graduate 21 87.5 3 12.5 24 100

Pallor of tongue is a sign Illiterate 6 66.67 3 33.33 9 100
of anemia Primary 6 54.55 5 45.45 11 100
Secondary 35 72.92 13 27.08 48 100
Higher Secondary 8 100 0 0 8 100

Graduate 19 79.17 5 20.83 24 100

Palpitations and Illiterate 3 33.33 6 66.67 9 100
breathing difficulty are Primary 5 45.45 6 54.55 11 100
symptoms of anemia
Secondary 27 56.25 21 43.75 48 100
Higher Secondary 6 75 2 25 8 100

Graduate 17 70.83 7 29.17 24 100

 WOMEN'S EDUCATION CORRECT % INCORRECT % TOTAL %

Well balanced diet during Illiterate 9 100 0 0 9 100

pregnancy prevents anemia Primary 11 100 0 0 11 100
Secondary 42 87.5 6 12.5 48 100
Higher Secondary 7 87.5 1 12.5 8 100

Graduate 20 83.33 4 16.67 24 100

Green leafy vegetables and Illiterate 9 100 0 0 9 100
sprouted grains are rich in iron Primary 9 81.82 2 18.18 11 100
Secondary 46 95.83 2 4.17 48 100
Higher Secondary 7 87.5 1 12.5 8 100

Graduate 23 95.83 1 4.17 24 100

Ragi and jaggery should be Illiterate 4 44.44 5 55.56 9 100
avoided in pregnancy Primary 7 63.67 4 36.36 11 100
Secondary 22 45.83 26 54.17 48 100
Higher Secondary 2 25 6 75 8 100

Graduate 10 41.67 14 58.33 24 100

Meat is rich source of iron Illiterate 7 77.78 2 22.22 9 100
Primary 8 72.73 3 27.27 11 100
Secondary 38 79.17 10 20.83 48 100
Higher Secondary 5 62.5 3 37.5 8 100

Graduate 24 100 0 0 24 100

Liver is rich source of iron Illiterate 5 55.56 4 44.44 9 100
Primary 5 45.45 6 54.55 11 100
Secondary 34 70.83 14 29.17 48 100
Higher Secondary 5 62.5 3 37.5 8 100

Graduate 23 95.83 1 4.17 24 100

Citrus fruits promote absorption Illiterate 0 0 9 100 9 100
of iron Primary 4 36.36 7 63.6 11 100
Secondary 26 54.17 22 45.83 48 100
Higher Secondary 4 50 4 50 8 100

Graduate 14 58.33 10 41.67 24 100

 WOMEN'S EDUCATION YES % NO % TOTAL %

Anemia in adolescence Illiterate 5 55.56 4 44.44 9 100

should be corrected Primary 7 63.64 4 36.36 11 100
Secondary 34 70.83 14 29.17 48 100
Higher Secondary 7 87.5 1 12.5 8 100
Graduate 16 66.67 18 33.33 24 100
Regular medical checkup is Illiterate 8 88.89 1 11.11 9 100
necessary during Primary 11 100 0 0 11 100
pregnancy Secondary 48 100 0 0 48 100
Higher Secondary 8 100 0 0 8 100
Graduate 23 95.83 1 4.17 24 100
Daily intake of iron and Illiterate 8 88.89 1 11.11 9 100
folic acid is necessary Primary 10 90.9 1 9.09 11 100
Secondary 45 93.75 3 6.25 48 100
Higher Secondary 8 100 0 0 8 100
Graduate 24 100 0 0 24 100
Adequate treatment is Illiterate 4 44.44 5 55.56 9 100
necessary to treat worm Primary 5 45.45 6 54.55 11 100
infestation Secondary 18 37.5 30 62.5 48 100
Higher Secondary 5 62.5 3 37.5 8 100
Graduate 12 50 12 50 24 100
Do you know free iron Illiterate 9 100 0 0 9 100
tablet is given during Primary 10 90.91 1 9.09 11 100
pregnancy Secondary 46 95.83 2 4.17 48 100
Higher Secondary 7 87.5 1 12.5 8 100
Graduate 23 95.83 1 4.17 24 100
Do you need to take iron Illiterate 3 33.33 6 66.67 9 100
after delivery Primary 3 27.27 8 72.73 11 100
Secondary 18 37.5 30 62.5 48 100
Higher Secondary 6 75 2 25 8 100
Graduate 16 66.67 8 33.33 24 100
 WOMEN'S EDUCATION YES % NO % TOTAL %

Have you changed your Illiterate 6 66.67 3 33.33 9 100

normal dietary pattern
Primary 18 72.73 3 27.27 11 100
during pregnancy
Secondary 34 70.83 14 29.17 48 100
Higher Secondary 6 75 2 25 8 100

Graduate 19 79.17 5 20.83 24 100

Do you include green leafy Illiterate 6 66.67 3 33.33 9 100
vegetables in your diet
Primary 5 45.45 6 54.55 11 100

Secondary 29 60.42 19 39.58 48 100

Higher Secondary 5 62.5 3 37.5 8 100

Graduate 14 58.33 10 41.67 24 100

Do you include sprouted Illiterate 2 22.22 7 77.78 9 100
grains in your diet
Primary 0 0 11 100 11 100
Secondary 14 29.17 34 70.83 48 100
Higher Secondary 4 50 4 50 8 100

Graduate 10 41.67 14 58.33 24 100

Do you include jaggery in Illiterate 9 100 0 0 9 100
your food
Primary 7 63.64 4 36.36 11 100
Secondary 36 75 10 25 48 100
Higher Secondary 5 62.5 3 37.5 8 100

Graduate 21 87.5 0 12.5 24 100