ASSESSMENT OF SICKLE CELL DISEASE

ABSTRACT

This study was carried out on the assessment of sickle cell disease: a case study of Ilaro. The study focused on pregnant women attending antenatal in Ilaro community, Ogun state. The study adopted a descriptive cross-sectional design and a self-designed questionnaire was the research instrument used for data collection. The researcher determined the sample size of 220 respondents for the study using Taro Yamane sample size formula. From the findings, the knowledge about sickle cell disease and its causes, in this study is low (21.2%), majority of the respondents said they had never heard of sickle cell disease. Most pregnant women in Ilaro community have been exposed to secondary education but unfortunately, were not well informed with the condition of sickle cell disease in pregnancy. The predisposing factors recognized to be responsible for sickle cell disease in pregnant women were parity (14.2%), adoption/miscarriage previously (28.1%), blood transfusion (23%), and being a sickle cell disease patient (28.3%). Increasing access to health information and quality services will greatly affect health seeking behavior and utilization of health services. The results indicated that the major challenge was finances with a response rate of 84.1%, followed by time constraint (62.3%), lack of support from family/friends (59.3%), and accessibility to ANC services (56.9%). The most valid strategy for managing sickle cell disease was that regular medical checkup is necessary during pregnancy (70.4%). The prevalence of sickle cell disease amongst the participants was high. The parity, gestational age at booking, educational status and the birth interval are factors that were found to have affected the prevalence of sickle cell disease in this study. Therefore educating women on early antenatal booking and compliance with the use of prescribed medications (Iron Supplements, Folate and Antimalarials) should also be emphasized to reduce the problem of sickle cell disease and its effect on pregnancy outcome in Nigeria.

CHAPTER ONE

INTRODUCTION

1.1 Background to the study

Sickle cell disease is defined as the condition in which there is decreased level of hemoglobin (Hb) or red blood cells than the normal value (Eltayeb et al., 2014). According to the 2008 World Health Organization (WHO) report, sickle cell disease affected 1.62 billion (24.8%) people globally (WHO, 2008). The risk of sickle cell disease is high in women who are premenopausal and/or pregnant. This is mainly due to menstrual blood loss, increased demand to support the fetus, puerperal blood loss, and it is usually exacerbated by nutritional insufficiency that is common in developing countries (Bick et al., 2016).

Sickle cell disease is a major public health problem worldwide, especially for women of childbearing potential in developing countries. In most countries around the world, an estimated 56 million pregnant women are anemic. It is estimated that the overall prevalence of sickle cell disease in pregnancy is approximately 41.8%, which differs from a minimum of 5.7% in the USA, up to 75% in Gambia (Chathuranga, Balasuriya and Perera, 2014). In the US, it was estimated that the sickle cell disease in pregnancy would increase from 1.8% to 27.4% in the first and third trimesters. Some women become anemic before pregnancy, while others become increasingly anemic during pregnancy (Goonewardene et al., 2019).

Sickle cell disease in pregnancy is 61% in developing countries (WHO / FHE / MSM / 93.5) with a high incidence and severity in pregnant women living in malaria areas and Africa accounts for about 20% of maternal deaths due to pregnancy sickle cell disease in fetuses high risk of premature birth, low birth weight, and perinatal mortality as a result of deterioration of placental oxygen (Idowu et al., 2015). Women often become anemic during pregnancy as there is a high demand for iron and other vitamins due to the physiological burden of pregnancy; inability to meet the required level of these substances either as a result of malnutrition or infection, leading to sickle cell disease (Van den Broek, 2016).

An estimated 2.15 billion people are iron deficient and that this deficiency is severe enough to cause sickle cell disease in 1.2 trillion people worldwide (WHO, 2019). Components About 90% of all sickle cell disease types have iron deficiency. In developing countries, almost half of the population suffers from iron deficiency (Viteri, 2019). About 47% of non-pregnant women and 60% of pregnant women suffer from sickle cell disease worldwide. In the developed world as a whole, the prevalence of sickle cell disease during pregnancy averages 18% and over 30% of them are iron deficient, and the poor most affected (Hughes, 2016).

Women of childbearing potential and pregnant women are at high risk for a negative balance and iron deficiency due to their increased iron requirements due to menstrual and pregnancy requirements. The average demand for iron absorption in adult women and in menstruating adolescents is estimated to be 1.36 mg/day and 1.73 mg/day, respectively. However, 15% of adult women who have menses need more than 2.0 mg/day and 5% even 2.84 mg/day. The superposition of menstrual losses and the growth of menstruating adolescents increase the need for absorbed iron; 30% require more than 2.0 mg/day; 10% up to 2.65 mg/day and 5% 3.2 mg/day. These requirements are very difficult to meet, even in diets enriched with good quality iron (WHO, 2019). The iron requirement increases significantly in the second and especially in the third quarter to an average of 5.6 mg/day (approximate range of 3.54 - 8.80 mg/day) food, therefore, the importance of iron stores to extract before pregnancy and iron supplements during the Pregnancy.

Iron deficiency during breastfeeding is mainly due to pregnancy and childbirth and can be alleviated in part by lactating amenorrhea. However, once menstruation recommences, iron needs to increase as breastfeeding continues. The risk of iron deficiency during pregnancy and lactation begins with inadequate iron stores during pregnancy in women of childbearing age. Folate deficiency has also been documented during pregnancy, often leading to iron deficiency sickle cell disease and combined folate. This is common among lower socioeconomic groups, who consume mainly grain-based diets (poor folic acid), which are enhanced by prolonged cooking and reheating. The folate requirement doubles in the second half of pregnancy and increases significantly with hemolytic processes such as malaria and hemoglobinopathies. The malabsorption processes, which are common among tropical and low socioeconomic groups, affect the absorption of folic acid (WHO, 2019).

1.2 Statement of problem

Sickle cell disease is one of the most prevalent public health problems in the world. The WHO estimates that the number of sickle cell disease that affects people around the world is 3.5 trillion in developing countries and that about 50% of all sickle cell disease can be attributed to iron deficiency (WHO/UNICEF, 2014). The worldwide distribution of disease burden of iron deficiency sickle cell disease focuses mainly on Africa and the Southeast Asia-D region. These regions account for 71% of the global mortality rate and 65% of disability adjusted life years. While estimates of the prevalence of sickle cell disease may vary, a significant proportion of young children and women of childbearing age may be adopt anemic (WHO, 2019). It is the only nutrient deficiency that is also significant in industrialized countries. The study of the global database on sickle cell disease WHO shows that the most affected groups are pregnant women (48%) and children 5 to 14 years (46%). As expected, the prevalence of sickle cell disease in developing countries is three to four times higher than in industrialized countries. The most affected populations in developing countries are pregnant women (56%), school-age children (53%) and non-pregnant women (44%). In developed countries, the most affected groups are pregnant women (18%) and preschoolers (17%), followed by non-pregnant women and seniors, both at 12%. Asia has the world's highest prevalence of sickle cell disease. followed by Africa (WHO, 2019). Almost half of all anemic women live in the Indian subcontinent, where 88% of them develop sickle cell disease during pregnancy.

Available data show that up to 60% of pregnant women in Niger, especially those who live in rural areas, are anemic during pregnancy (WHO, UNICEF, UNFPA and World Bank, 2015). This sickle cell disease is mainly due to the deficiency of folic acid, iron, vitamins and trace elements. Therefore, it is more common in poor and malnourished women. Diet-related sickle cell disease is a major cause of unwanted pregnancy outcomes in Nigerian women. It is a direct and indirect cause of maternal and perinatal morbidity and mortality. It leads to a delay in intrauterine fetal growth and thus to an increase in mortality rates, neonatal and perinatal mortality. Several Nigerian women have died from severe sickle cell disease during pregnancy (Hb <6.0 g / L) (WHO, 2019). Despite the high incidence of sickle cell disease as the cause of maternal mortality in Nigeria, very few interventions currently address sickle cell disease as a major problem of safe maternity in Nigeria. So far, only 58% of pregnant Nigerian women receive iron supplements during pregnancy (WHO, 2019). It is therefore imperative to study not just the prevalence of this concept, but the management and control measures, hence, this study on the assessment of level of awareness of sickle cell disease: a case study of Ilaro community, Ogun state.

1.3 Objectives of the study

The general objective of this is to evaluate the level of awareness of sickle cell disease: a case study of Ilaro. Specifically, the study seeks to;

1. Determine the level of awareness of sickle cell disease in pregnancy amongst pregnant women attending antenatal care in Ilaro community.

2. Assess the strategies used by the pregnant women for the prevention and management of sickle cell disease in Ilaro community

3. Determine the challenges encountered in the management of Sickle cell disease among pregnant women in Ilaro community

1.4 Research questions

The following questions were formulated based on the research problem and objectives;

1. What is the level of awareness of sickle cell disease in pregnancy amongst pregnant women attending antenatal care in Ilaro community?

2. What are the strategies used by the pregnant women for the prevention and management of sickle cell disease in Ilaro community?

3. What are the challenges encountered in the management of Sickle cell disease among pregnant women in Ilaro community?

1.5 Significance of the study

Findings from the study would generate data on how pregnant women in Ilaro community seek routine healthcare during pregnancy for management of sickle cell disease, and the eventual outcome. This information could serve as a basis for nurses, midwives, and other health workers to improve maternal health and reduce maternal morbidity and mortality. This could be done through improved maternal health care services and encouraged use through evidence based health education programmes. Also, findings will help the health care profession to create more awareness on maternal health and antenatal care services utilization targeted at mothers, because maternal health services when adopted will help maintain optimal health during pregnancy as well as timely management of problems like sickle cell disease, should they arise.

This study would also serve as a point of reference and information based on the results that would be derived from the analysis and interpretation for policy implication by major stakeholders and health authorities. It is desirable to have information on management, prevention and control of sickle cell disease among pregnant women to help bridge any identified gaps and enable them better understand the benefits of early detection, prevention and utilization of antenatal care. Lastly, this study will contribute to the existing body of literature and serve as a reference for future research in related fields.

1.6 Scope of study

This study is delimited to assessing the assessment of level of awareness of sickle cell disease: a case study of Ilaro. The variables covered in this study include the knowledge on sickle cell disease amongst pregnant women, prevalence of sickle cell disease in pregnancy among pregnant women, predisposing factors to sickle cell disease in pregnancy amongst pregnant women, and strategies used by the pregnant women for the prevention and management of sickle cell disease in Ilaro community.

1.7 Operational definition of terms

Sickle cell disease: is a condition in which the number of red blood cells or their oxygen-carrying capacity is insufficient to meet physiologic needs, which vary by age, sex, altitude, smoking, and pregnancy status. Sickle cell disease in pregnancy refers to a hemoglobin concentration of less than 110 g/L (less than 11 g/dL) in venous blood implying a reduction in the oxygen carrying capacity of the blood.

Management: refers to a system of coordinated healthcare interventions and communications for people with conditions/diseases in which patient self-care efforts are significantly required.

Pregnant Women: this refers to women who are in their first to third semester of pregnancy; which is the time during which one or more offspring develops inside a woman.