Paste yAnaemia is defined as a decrease in the concentration of haemoglobin which transports oxygen in the blood of vertebrates as well as a decrease in concentration of circulating red blood cells which in the circulation of vertebrates gives the blood its characteristic color. Anaemia in pregnancy is therefore defined as a haemoglobin concentration less than 11.0 g/dl in the first trimester or less than 10.5 g/dl in the second half of pregnancy. It has been estimated that the global prevalence of anaemia in pregnancy is 42%. (Oats J, Abraham S 2005). Despite the above definitions, anaemia in pregnancy is not quite as clear-cut as alluded to above, because of the physiological changes that occur, which also involve the hematologic system. Overall, in pregnancy, plasma volume increases to a greater extent than the increase in red cell mass, causing a relative decrease in the haemoglobin and haematocrit (physiologic/ dilutional anaemia). Some authorities maintain that additional variables of altitude, cigarette smoking and ethnicity may alter the definition of anaemia in individuals. Others are of the opinion that altitude should not modify the definition of anaemia in pregnancy and that there is insufficient information to alter the definition of anaemia based on ethnicity. (Macgregor, M. 1963).
Epidemiology
According to a study carried in 2013, it has been estimated that about 39% of pregnant women around the world have anemia. The estimated prevalence of anaemia in pregnancy, according to a 2009 study, differs widely between continents, the highest being in Africa (55.8%) and Asia (41.6 %), and lowest in Europe (18.7%) and North America (6.1%). The prevalence in other regions falls between these limits. Predominantly, the prevalence of anaemia increases as the pregnancy progresses. (Nwizu E. N, Iliyasu S. A and Galadanci H. S 2011) During pregnancy anemia is a major public health and economic issue around the world, which has a major impact on the pregnant female and fetal morbidity and mortality; during pregnancy anaemia can also have profound short-term and far-reaching adverse impact for the infant. Anaemia, during the first trimester, has been associated with untimely pregnancy outcomes (Van Hove et. al, 2000)..Clinical manifestations of anemia in pregnancy include the adverse outcome such as, fetal growth restriction, preterm delivery, low birth weight , impaired lactation, poor maternal/infant behavioral interactions, post-partum depression, and increased fetal and neonatal mortality .Iron deficiency anaemia in particular has been associated with decreased work capability of adults and reduced cognitive function of children that may persist into adulthood; impaired motor development is another manifestation of anemia(Oats J, Abraham S 2005).. All these factors lead to economic losses.
Aetio-pathogenesis
They are multiple interacting levels in which anaemia can be found. There are proximal and distal causes of anaemia that are taken into consideration. The proximal causes of anaemia can be considered to be decreased red blood cell/haemoglobin production or if there is increased loss of red blood cells/haemoglobin such as in profuse bleeding. Causative factors for this includes lack of nutrients in the body, infectious and genetic entities which, in turn, are associated with access to food, health services, education, clean water, sanitation, etc. Ultimately, the political economy is the most distal cause of anaemia as it directly affects the other causes (Raeburn & Rootman, 1998) . In short, multiple interacting factors at different levels operate in the aetiology of anaemia, starting from the political economy
nd culminating in decreased red blood cell/haemoglobin production or increased loss of red blood cells/haemoglobin, and thus anaemia. The aetiology of anaemia in pregnancy must therefore be considered in the broader context of which is depicted diagrammatically by Balarajan and colleagues, in Figure 1.1. Besides the physiologic haemodilution of pregnancy, there are many risk factors for anaemia in pregnancy. On a global scale, some of the important risk factors include deficiency of nutrients such as iron as seen in iron deficiency anaemia (reportedly the most common risk factor), folate and vitamin B12, infections such as human immunodeficiency virus (HIV), malaria and hook worms, and disorders in the structure or production of haemoglobin such as sickle cell disease and the thalassemias(Saks M, Allsop J, 2007) . Other risk factors include teenage pregnancy, in which there is lack of knowledge on nutrients and a good diet socio-economic status, and high parity. Overall, in high income countries compared to low and middle income countries, nutritional, infectious and genetic risk factors for anaemia are less common because of common knowledge on pregnancy, and so anaemia in pregnancy occurs at a lower prevalence in high income countries
FIGURE1.1
Conceptualmodelofthedeterminantsofanaemia,reproducedwithpermissionfromBalarajanetal
There is an impairment in the delivery of oxygen to tissues due to the low hemoglobin level, this seems to be the central mechanism by which anaemia increases the risk of maternal organ (brain, heart, kidney) injury and mortality (Springett, 2001) . The delivery of oxygen to the uterus (and fetus) may therefore be reduced if the woman carrying the fetus has anaemia
Chapter 2: Research focus
2.1 Significance of the study:
Given the serious problems caused by anemia during pregnancy, it is important to continue characterizing and quantifying the birth outcomes and identifying potentially modifiable risk factors associated with anaemia in pregnancy.
2.2 Problem statement
Studies have shown that anaemia in pregnancy has several risk factors and is associated with adverse maternal and peri-natal outcomes (this is discussed in detail in the literature review). Some of the serious adverse outcomes include maternal and peri-natal death; other adverse outcomes include low birth weight, premature birth, etc.
2.3 Hypothesis (Null and opposing)
The mean post-test knowledge scores of antenatal mothers who have undergone the structured teaching programme regarding Anaemia and its prevention will be significantly higher than there means pre test scores. There will be significant association between the knowledge, of antenatal mothers regarding Anaemia and its prevention with selected socio- demographic variables.
2.4 Aims
This study was done to determine the prevalence of anaemia among pregnant women receiving antenatal care at Job Shimankane Tabane hospital and a traditional birth home in order to obtain a broader prevalence data. Participants were enrolled in the study during their first antenatal visit and were kept under a systematic view through pregnancy for anaemia. Hematocrit was used to determine the level of anemia; Questionnaires were also used to obtain information.
2.5 Objectives
 To calculate the prevalence of anaemia in pregnancy (haemoglobin concentration < 11 g/dL) in a cohort of women participating in the SCOPE study from 2004 to 2011.
 To identify the modifiable risk factors for anaemia in pregnancy in this cohort of women.
 To compare the birth outcomes between women with and without anaemia in early pregnancy, in this cohort.
2.6 Research questions
 To calculate the prevalence of anaemia in pregnancy (haemoglobin concentration < 11 g/dL) in a cohort of women participating in the SCOPE study from 2004 to 2011.
 To identify the modifiable risk factors for anaemia in pregnancy in this cohort of women.
 To compare the birth outcomes between women with and without anaemia in early pregnancy, in this cohort.
Chapter 3: Material and Methods
3.1 Ethics statement
The approval will be obtained from national health laboratory services (NHLS)at job Shimankane Tabane hospital ,the data is going to be kept on our system TRAKCARE. The data is going to be given track numbers instead of actual names to protect the participants.
3.2 Research design
This study is to be carried over a period of 6 months, a descriptive study that is conducted using a structured questionnaire to attain data from pregnant participants who consented to be part of the study.
3.3 Selection of research sites and participants
3.3.1 Study population, (recruitment, who, where and why)
The population of this study consisted of pregnant women getting their anti-natal care at Job Shimankane Tabane Hospital over the period of ( August to November, 2018) regardless of age, gestational period, and number of women that consented to participate in the study.
3.3.2 Inclusion criteria
 Antenatal mothers attending Job shimankane Tabane Hospital in Rustenburg NW
 Antenatal mothers who are willing to participate in the study.
 Antenatal mothers who are present at the time of data collection.
3.3.3 Exclusion criteria
 Antenatal mothers who are not willing to participate in the study.
 Antenatal mothers who are not present at the time of data collection
3.4. Research methods
3.4.1 Sample size calculation
According to a 2013 study, approximately 38% of pregnant women worldwide are anaemic ..To be 95%confident that the survey is within the +/-5% of the true share,the sample size is calculated.
Using the formula:
With z=1.96
p=0.38
q=1-p=1-0.38=0.62
e=0.05
=(1.96)2(0.38*0.62)
(0.05)2
=0.9050
0.0025
=362
[Here you need to show your calculations]
There for this study we require a minimum of 362
3.4.2 Data collection/
 The data of Antenatal mothers is going to be collected from ward 4 (maternity ward)
 Structural interview schedule to assess the knowledge about prevention of Anaemia. Checklist to know the Hb% level of all Antenatal mothers.
3.4.3 Production methods (Identification of data variables/method of analysis)
Xx
3.4.4 Statistical analysis
The collection and storage of results will be done on Microsoft Excel spreadsheet. the statistical analysis will then be done on the program as the results will be imported the raw data is going to be broken done into subclasses , separated into normal groups, ordinal variables. The mean, variance, standard deviation will then be calculated. To compare amongst various groups the chi square will be calculated.
3.5 Proposed work schedule, time frame
# Description Approximate time-frame to complete
QUISTIONNARES 15 AUGUST TO 18 AUGUST 2018
COLLECTION OF DATA 20 AUGUST TO 30 AUGUST 2018
ANALYSIS OF DATA 30 AUGUST TO 30 SEPTEMBER 2018
INTERPRETATION OF DATA 02 OCTOBER TO 15 OCTOBER
CONCLUSION 30 NOVEMBER 2018
3.6 Proposed budget
# Description Approximate amount
TEST TBES FOR BLOOD COLLECTION R800
REAGENTS FOR ADVIA INSTRUMENTS R6000
A4 PAPER R300
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