Anaemia in pregnancy at booking: Prevalence, Risk Factors and Perinatal outcomes among Antenatal Clinic Attendees in a Secondary Healthcare Facility in North Central Nigeria: An Analytical Study

Background: Anaemia during pregnancy is an unacceptable public health problem in most developing countries inclusive of Nigeria where access to adequate nutrition and healthcare services is limited. Objectives : This study aimed to determine the prevalence, severity of anaemia, associated factors (socio-demographics, maternal, medical history, obstetric history, gynaecological history, substance abuse and laboratory findings) at booking and perinatal outcomes among parturient who present for booking at the antenatal clinic of a secondary health facility in north-central Nigeria. Methods : An analytical study that involved 1,141 parturient who presented at the booking clinic between 14 October, 2022 and 14 October, 2023. With the aid of a pre-tested semi-structured interviewer administered questionnaire, data on socio-demographic characteristics, obstetrics and gynaecological history, substance abuse, 24-hour dietary recall and other relevant histories, were collected from consecutive parturient who fulfilled the inclusion criteria and consented to the study. A sample of venous blood was collected using aseptic technique to obtain a packed cell volume by microhaematocrit method. Diagnosis of anaemia at booking was based on the World Health Organization definition of anaemia in pregnancy: haemoglobin concentration less than 11g/dl in the first and third trimester and 10.5g/dl in the second trimester. All parturient who had anaemia were also investigated for the aetiology of the anaemia; full blood count, rapid diagnostic test for malaria, Human Immunodeficiency Virus screening, hepatitis B surface antigen, hepatitis C, urinalysis and stool microscopy. Parturient whose condition was amenable to treatment during pregnancy were treated while others were counselled and referred to appropriate clinics following delivery. All parturient however received haematinics throughout the duration of pregnancy. The results were analysed using SPSS version 24, Chi-square test and logistic regression analysis were used to identify the independent determinants of anaemia at booking Results: Out of 1,141 parturient who participated in this study, 728(63.8%) had anaemia at booking. Majority (56.4.0%) had microcytic hypochromic anaemia. Socio demographic characteristics that were significantly associated with anaemia at booking were: occupation (p<0.001), religion (p<0.001), level of education (p=0.001), social class (p<0.001) and women’s dietary diversity score (p<0.001). Medical, obstetrics and gynaecological history of study participants that showed significant relationship with anaemia at booking were: gravidity (p<0.001), history of miscarriage (p=0.001), number of children alive (p<0.001), history of pre conceptional counselling and care (p<0.001), history of use of herbal medication (p<0.001), history of substance abuse (p=0.001), history of use of insecticide treated net (p<0.001), history of haematinics use (p<0.001). Laboratory parameters showed that hook worm infestation, human immunodeficiency virus infection, hepatitis B & C virus infection, and malaria parasite infection all had significant relationships (p<0.001) with anaemia at booking. There was a significant improvement in the packed cell volume at the end of twelve weeks following treatment (p<0.001). After adjusting for co-founders, variables that were associated with increased risk of anaemia at booking were: presence of ova of hookworm (AOR) of 7.990 (95% CI, 4.004 to 15.946); HIV status (AOR) of 8.367 (95% CI, 2.577 to 27.167); positive malaria parasite test (AOR) of 139.308 (95% CI, 64.819 to 299.068), use of ITN (AOR) of 5.976 (95% CI, 2.718 to 13.137); substance abuse (AOR) of 1.746 (95% CI, 1.249 to 2.441) and WDDS (AOR) of 43.449 (95% CI, 29.911 to 63.114) Conclusion: This study found that malaria infection, hookworm infection, human immunodeficiency virus infection, hepatitis B and C surface antigen virus, urinary tract infection, gravidity, history of miscarriage or abortion among others are factors contributing to anaemia in pregnant women. Therefore a more comprehensive approach that will address the factors associated with anaemia at booking including pre-conceptional counselling and care, early ante natal care booking, routine use of haematinics, eating balanced diet, early screening and treatment of organisms that can cause anaemia, use of ITN, discouragement of use of herbal medication and substance abuse in pregnancy will allow for early diagnosis and prompt treatment of anaemia at booking and this will improve the overall wellbeing of pregnant women, their developing foetus and perinatal outcomes.