CHAPTER ONE
INTRODUCTION
1.1       Background of the study
Pregnancy is almost certainly the greatest physiological stress and the most common major change of the normal biological process to which the woman is subjected during her life. Anemia is the most common nutritional problem among women and is on the wholerampant among pregnant women (Admad, Saeid, & Leila, 2008).However, anaemia is defined as a shortened amount of haemoglobin (Hb) in the blood. It is a shortage in the size or number of red blood cells (RBCs) or the quantity of Hb they contain (Mahan, Escott-Stump & Raymond 2012). Haemoglobin is a substance in the blood that carries oxygen from the lungs to all parts of the body. The most common type of anaemia, iron deficiency anaemia, is more often than not caused by low iron intake or absorption and/or excessive iron loss (Thomas & Bishop, 2007).
Iron forms an indispensableconstituent of the Hb molecule and nutritional anaemiafallout fromnot enough intake of iron, protein, vitamin B12, folic acid, pyridoxine, ascorbic acid, and copper(Mahan, Escott-Stump & Raymond, 2012).Anaemia is classified based on Hb content as hypochromic (pale colour from deficiency of Hb) and normochromic (normal colour),depicted according to cell size as macrocytic (larger than normal), normocytic (normal), and microcytic (small).Haemoglobin levels differ with age, sex, pregnancy, and lifestyle. Different levels of Hb are considered typically for different categories of people, under which an individual can be classified as anaemic. For example, the normal Hb level of pregnant women at sea level is 11g/dl or 110g/L. A pregnant woman that hasHb level below 11g/dl or 110g/L is said to be anaemic (WHO, 2008).
According to Ghana Health Service (2004), pregnant woman with anaemia will present with any of the following: angular stomatitis, pallor, glossitis spoon shaped nails, dizziness, fatigue and shortness of breath.Reducing this anaemia burden in pregnant women has improved minimally, especially in African countries and Nigeria is no exemption.The episode of anemia as a major public health problem all over the world isextensively recognized. In developing countries, the occurrence of anemia among pregnant women the averages is 56%, ranging between 35-100% among different regions of the world (GHS Annual Report 2004).
World Health Organization in 2008 estimation, approximately 500 million women in the world are iron deficient and in addition anemia affects so many women in the developing world, including two thirds of pregnant women (WHO, 2008).Anaemia is asignificant public health problem worldwide and the most susceptible group, are pregnant women and children.The causes of anaemiaconsist of genetic factors, nutritional deficiencies, and infectious agents. Of the nutritional causes of anaemia, iron deficiency is perhaps the most common and important because the physiological changes associated with pregnancy put fortha demand for additional iron needed for transfer to the foetus(Webster-Gandy, Madden&Holdsworth, 2012). Infections, together with malaria, worm infestations are as well involved in the pathogenesis of anaemia in pregnancy.