CHAPTER ONE
INTRODUCTION
1.1 Background of study
Anemia 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, anemia affected 1.62 billion (24.8%) people globally (WHO, 2008). Approximately 51% of pregnant women were expected to be anaemic in 2001(G.C.). The prevalence in developing countries was 56% and 18% in developed countries (Bick et al., 2006). The most recent global estimates suggest that the prevalence of anemia is 41.8% among pregnant women and 30.2% among non-pregnant women (WHO, 2008; Bhutta et al., 2012). In Africa, 57.1% of the pregnant women were anaemic. According to Ethiopian Demographic Health Survey (EDHS) report of 2011, the numbers are stated to be lower putting the prevalence of anemia in pregnant women at 22% at the country level and 24.9% in Oromia Regional State encompassing the study area (CSA, 2011). The risk of anemia 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., 2006). Anemia contributes to almost 120,000 maternal deaths globally and indirectly to almost a fifth (18%) of the burden of maternal mortality. In addition to maternal deaths, there are several adverse health outcomes associated with anemia including preterm delivery, intrauterine fetal death, stillbirths, neonatal mortality, low birth weight (LBW) and poor cognitive development in the offspring (Bhutta et al., 2012; Melku et al., 2014). In developing countries, maternal anemia during pregnancy is a product of many factors, such as maternal malaria, intestinal parasitic infection, recurrent infection, reduced dietary intakes, parity and micronutrient deficiencies just to name but few (Bhutta et al., 2012; Ugwuja, et al., 2011; Haidar, 2010). Among the micronutrient deficiencies the most common encountered are iron deficiency anemia (IDA) and folate deficiency 2 megaloblastic anemia. Of all anemia diagnosed during pregnancy, 75% are due to iron deficiency. Iron deficiency (ID) alone affects nearly 20% of the world’s population (Bick et al., 2006). The odds for developing anemia were 60% more likely in the iron-deficient and 40% more likely in the folic acid deficient. One in every three women had anemia and deficiency of folic acid while one in every two had iron deficiency, suggesting that deficiencies of both folic acid and iron constitute the major micronutrient deficiencies in Ethiopian women (Haidar, 2010). Apart from iron and folate deficiency cobalamin (Vit B12) deficiency has been shown to account for some cases of anemia (Morris et al., 2007; Khan et al., 2010). Studies show that iron intake in Ethiopia is adequate (Gibson et al., 2008), however anemia is still a health concern affecting 22% of pregnant women (WHO, 2008) leading to devastating outcomes of pregnancy and delivery necessitating studies to be conducted on other micronutrients which could play an important role on the occurrence of anemia. In the present study the socio-demographic and obstetric characters and plasma levels of iron, folate and cobalamin, was evaluated in anaemic (case) and non-anaemic (control) pregnant women to ascertain the impact these factors have on maternal anemia and the possible interactions among them.