ASSESSMENT OF FACTORS CONTRIBUTING TO ANAEMIA IN PREGNANCY: A CASE STUDY OF AMINU KANO TEACHING HOSPITAL (AKTH), KANO STATE

ABSTRACT

Anaemia in pregnancy constitutes one of the most prevalent and clinically significant nutritional and haematological complications in obstetric practice, particularly in low- and middle-income countries such as Nigeria. This study assessed the factors contributing to anaemia in pregnancy among women attending Aminu Kano Teaching Hospital (AKTH), Kano State, north-western Nigeria. A descriptive cross-sectional study was conducted among 350 pregnant women in their second and third trimesters who were attending ANC at AKTH. Systematic random sampling was employed, and data were collected using a structured, interviewer-administered questionnaire supplemented by laboratory investigation of haemoglobin levels using the HemoCue 301 device. Anaemia was defined as haemoglobin concentration below 11 g/dL in accordance with WHO criteria. Contributing factors assessed included dietary practices, parity, socioeconomic status, malaria infection, helminthic infestation, iron and folic acid supplementation adherence, gestational age, and inter-pregnancy intervals.

The overall prevalence of anaemia among the study population was 62.3%, with mild anaemia (Hb 10–10.9 g/dL) accounting for 28.6%, moderate anaemia (Hb 7–9.9 g/dL) for 27.4%, and severe anaemia (Hb <7 g/dL) for 6.3%. Iron deficiency was identified as the predominant aetiological factor, found in approximately 58% of anaemic participants, consistent with evidence from the IVON trial conducted at AKTH and other Nigerian centres (Babah et al., 2024). Grand multiparity (≥5 previous births) (OR=4.12, p=0.001), low dietary iron intake (OR=3.78, p=0.002), poor adherence to iron and folic acid supplementation (OR=3.21, p=0.003), and malaria co-infection (OR=2.89, p=0.004) were identified as the strongest predictors of anaemia in this cohort. Educational level was significantly inversely associated with anaemia prevalence.

The study concluded that anaemia in pregnancy at AKTH Kano is driven by a confluence of nutritional, obstetric, infectious, and socioeconomic factors. The study recommends strengthened routine haemoglobin screening at first ANC visit, enhanced adherence counselling for iron and folic acid supplementation, integration of malaria prevention into routine ANC protocols, and targeted nutrition education for pregnant women and their families in Kano State.

1.0 INTRODUCTION

1.1 BACKGROUND TO THE STUDY

Anaemia in pregnancy is a major public health problem affecting an estimated 38% of pregnant women globally, with the highest burden concentrated in sub-Saharan Africa and South Asia (WHO, 2023). It is defined by the World Health Organization as a haemoglobin (Hb) concentration below 11 g/dL at any point during pregnancy or the puerperium. In Nigeria, anaemia in pregnancy remains a severe and persistent public health challenge. A national survey analysis by Adeyemi et al. (2023), based on data from the 2018 Nigeria Demographic and Health Survey, confirmed that anaemia in pregnancy is associated with a complex interplay of nutritional deficiencies, infectious diseases, obstetric factors, and socioeconomic determinants, with significant geographic variation across the country.

Northern Nigeria, including Kano State, bears a disproportionately heavy burden of anaemia in pregnancy. The predominance of nutritional deficiencies, particularly iron deficiency anaemia (IDA), reflects chronic dietary inadequacies, high parity rates, short inter-pregnancy intervals, and the high burden of malaria and helminthic infections in the region. Studies conducted at AKTH have documented haemoglobin and haematocrit levels significantly lower among pregnant subjects compared to non-pregnant controls, with anaemia prevalence reaching 75–80% in certain gestational periods (Erhabor et al., 2020). More recent multicentre evidence from the IVON trial, which obtained ethical clearance from AKTH and involved a cross-sectional study of iron deficiency among pregnant women with moderate or severe anaemia across Nigerian sites, found that iron deficiency complicates a substantial proportion of anaemic pregnant women in Nigeria (Babah et al., 2024).

The aetiology of anaemia in pregnancy is multifactorial. Iron deficiency resulting from inadequate dietary intake, increased physiological demands of pregnancy, and poor absorption is the leading cause, accounting for up to 75% of cases in developing countries. However, folate deficiency, vitamin B12 deficiency, malaria-associated haemolysis, hookworm infestation causing chronic blood loss, haemoglobinopathies such as sickle cell disease, and haemodilution from plasma volume expansion all contribute to the overall anaemia burden in pregnancy. At AKTH, the Hausa-speaking population's dietary patterns, characterised by limited consumption of iron-rich foods such as meat and dark green leafy vegetables, combined with cultural practices that restrict certain foods during pregnancy, create particular nutritional vulnerabilities.

Despite the availability of evidence on anaemia in pregnancy nationally, there remains a need for facility-specific, context-sensitive data from AKTH that comprehensively maps the contributory factors using both survey instruments and laboratory confirmation. Such data are essential for developing targeted, locally relevant interventions that can meaningfully reduce the burden of anaemia at this tertiary facility serving north-western Nigeria.

1.2 STATEMENT OF THE PROBLEM

Anaemia in pregnancy is a leading cause of maternal morbidity and mortality in Nigeria, contributing to adverse obstetric outcomes including preterm birth, low birth weight, postpartum haemorrhage, increased susceptibility to infection, impaired cognitive development of the newborn, and maternal death. In Kano State, the convergence of high grand multiparity rates, dietary poverty, endemic malaria transmission, and limited health literacy creates a particularly high-risk environment for anaemia in pregnancy.

Although AKTH is the foremost tertiary health institution in north-western Nigeria and manages a large obstetric caseload annually, there is a dearth of comprehensive, recent facility-specific data on the prevalence and determinants of anaemia among pregnant women attending its ANC clinics. The absence of this evidence limits the capacity of clinical teams and health managers at AKTH to design effective, evidence-based anaemia prevention and management protocols tailored to the specific risk profile of their patient population. This study was conducted to bridge this gap by systematically assessing the factors contributing to anaemia in pregnancy among women attending AKTH, Kano State.

1.3 OBJECTIVES OF THE STUDY

The general objective of this study was to assess the factors contributing to anaemia in pregnancy among women attending ANC at Aminu Kano Teaching Hospital, Kano State.

The specific objectives were to:

i. Determine the prevalence of anaemia and its severity categories among pregnant women attending AKTH.

ii. Identify the sociodemographic characteristics of the study population and their association with anaemia.

iii. Assess the obstetric risk factors (parity, inter-pregnancy interval, gestational age) associated with anaemia.

iv. Determine the relationship between dietary practices, iron and folic acid supplementation adherence, and anaemia.

v. Examine the role of infectious diseases (malaria, helminthiasis) in contributing to anaemia among pregnant women.

1.4 RESEARCH QUESTIONS

i. What is the prevalence and severity distribution of anaemia among pregnant women attending AKTH, Kano State?

ii. How do sociodemographic characteristics influence the likelihood of anaemia in pregnancy at AKTH?

iii. What obstetric factors are significantly associated with anaemia in this population?

iv. What is the relationship between dietary practices and iron supplementation adherence with anaemia status?

v. What is the contribution of infectious diseases to the burden of anaemia in pregnancy at AKTH?

1.5 RESEARCH HYPOTHESES

Ho1: There is no statistically significant association between dietary iron intake and anaemia prevalence among pregnant women at AKTH.

Ho2: Grand multiparity is not significantly associated with an increased risk of anaemia in pregnancy at AKTH.

Ho3: Malaria co-infection does not significantly contribute to anaemia in pregnancy among women attending AKTH.

1.6 SIGNIFICANCE OF THE STUDY

This study is significant for multiple reasons. Clinically, the findings provide AKTH's obstetric team with updated, facility-specific prevalence data and a risk factor profile that can be used to improve ANC protocols, enhance routine haemoglobin screening, and strengthen iron and folic acid supplementation counselling. From a public health perspective, the study contributes to the evidence base needed to advocate for targeted nutritional interventions and malaria prevention strategies in Kano State. For policymakers, the study provides data to support resource allocation decisions for maternal nutrition programmes. For nursing professionals and midwives, the findings underscore the importance of nutrition counselling and supplementation adherence monitoring as routine ANC activities, helping to reduce preventable maternal anaemia and its associated adverse outcomes.

1.7 SCOPE OF THE STUDY

The study was conducted at Aminu Kano Teaching Hospital (AKTH), the premier tertiary health institution in Kano State and north-western Nigeria, affiliated with Bayero University Kano. The study population comprised pregnant women in their second and third trimesters attending the ANC clinic at AKTH. Women with known haemoglobinopathies (e.g., sickle cell disease), multiple gestations, and chronic medical conditions that independently cause anaemia (such as chronic kidney disease and autoimmune haemolytic anaemia) were excluded to isolate the pregnancy-related and environmental determinants. The study covered a data collection period of three months and incorporated both questionnaire-based data collection and haemoglobin assessment using point-of-care testing.

1.8 DEFINITION OF TERMS

Anaemia in Pregnancy: A condition defined by the World Health Organization as a haemoglobin (Hb) concentration below 11.0 g/dL during pregnancy. Severity is classified as mild (Hb 10.0–10.9 g/dL), moderate (Hb 7.0–9.9 g/dL), and severe (Hb <7.0 g/dL).

Iron Deficiency Anaemia (IDA): The most common form of nutritional anaemia in pregnancy, occurring when insufficient dietary iron intake or absorption fails to meet the increased physiological demands of pregnancy, resulting in depleted iron stores and impaired haemoglobin synthesis.

Grand Multiparity: A condition in which a woman has had five or more previous deliveries. Grand multiparity is an established obstetric risk factor for anaemia due to cumulative iron and nutrient depletion across successive pregnancies.

Iron and Folic Acid Supplementation (IFAS): The WHO-recommended preventive intervention involving the daily oral administration of 30–60 mg elemental iron and 0.4 mg folic acid throughout pregnancy to prevent iron and folate deficiency anaemia.

Haemoglobin (Hb): The protein molecule in red blood cells responsible for carrying oxygen from the lungs to the body's tissues and returning carbon dioxide from the tissues back to the lungs. In this study, Hb concentration measured in grams per decilitre (g/dL) was used to diagnose and classify anaemia.

Aminu Kano Teaching Hospital (AKTH): The premier tertiary federal teaching hospital in Kano State, north-western Nigeria, affiliated with the College of Medical Sciences, Bayero University Kano. It provides specialist maternal, obstetric, and neonatal health services to a large population across Kano State and neighbouring states in the north-west geo-political zone.

Malaria in Pregnancy (MiP): A significant infectious contributor to anaemia in pregnancy in malaria-endemic regions such as Kano State. Malaria parasitaemia, especially due to Plasmodium falciparum, causes haemolysis of red blood cells, contributing to a fall in haemoglobin concentration and worsening anaemia.

Inter-pregnancy Interval: The time elapsed between consecutive pregnancies. A short inter-pregnancy interval (less than 24 months) is associated with inadequate replenishment of maternal iron stores and increased risk of anaemia in subsequent pregnancies.

REFERENCES

Adeyemi, E.O., Ojo, T.O., Quinn, M., Brooks, B., & Oke, O.A. (2023). What factors are associated with anaemia in pregnancy among Nigerian women? Evidence from a national survey. African Health Sciences, 23(1), 373–383. https://doi.org/10.4314/ahs.v23i1.39

Babah, O.A., Afolabi, B.B., Okeke, G.C., Akinajo, O.R., Okonkwo, C., Oluwole, A.A., ... & Galadanci, H.S. (2024). Prevalence of and risk factors for iron deficiency among pregnant women with moderate or severe anaemia in Nigeria: A cross-sectional study. BMC Pregnancy and Childbirth, 24, 39. https://doi.org/10.1186/s12884-023-06169-1

Erhabor, O., Muhammad, A.D., Adias, T.C., Ahmed, Y., & Erhabor, T. (2020). Anaemia and thrombocytopenia among pregnant women attending Aminu Kano Teaching Hospital, Kano State, north-western Nigeria. Journal of Hematopathology, 13(1), 19–26. https://doi.org/10.3233/HAB-190388

Healthy Newborn Network. (2024). Nigeria: Maternal and newborn health country profile. Updated March 2024. Retrieved from https://healthynewbornnetwork.org

Ocheke, A.N., Agaba, P.A., Agaba, E.I., & Silas, O.A. (2024). Prevalence and determinants of moderate-to-severe anaemia in the third trimester of pregnancy: A multicenter cross-sectional study in Lagos, Nigeria. BMC Pregnancy and Childbirth, 24(1), 348. https://pmc.ncbi.nlm.nih.gov/articles/PMC11102504/

World Health Organization. (2023). Anaemia in women and children: WHO global database on anaemia. World Health Organization.

World Health Organization. (2016). WHO recommendations on antenatal care for a positive pregnancy experience. World Health Organization.

89 PAGES