Knowledge and Practice of Anemia Prevention Among Pregnant Women Attending Antenatal Clinic in Yola, Nigeria: A Hospital Based Cross-sectional Study

INTRODUCTION

Pregnancy-associated anemia is a community health problem of great concern. According to recent global estimates, 37% of women who are pregnant are battling with anemia and anemia-related conditions to a serious degree.^[1] A qualitative and/or quantitative decline in the body's circulating red blood cells (RBCs) is known as anemia, and it can have detrimental effects on mothers and newborns.^[2] Anemia is defined by the World Health Organization (WHO) as a health disorder in which the body's physiological needs are not sufficiently met by the quantity of RBCs or their ability to transport oxygen. A hemoglobin level of less than 11 g/dl is utilized to diagnose this condition during pregnancy.^[3] Women who are pregnant and children under the age of six are disproportionately affected by anemia, a severe worldwide public health concern.^[4,5] The most prevalent nutritional deficiency disorder affecting pregnant women is termed iron deficiency anemia (IDA) and is the most prevalent blood disorder that hinders the organ system's ability to operate normally by lowering the quantity of oxygen that circulates through the blood to various tissues and organs.^[6] Research indicates that acute blood loss, parasite illnesses like hookworm and malaria, and dietary deficiencies including folate, iron, and vitamin B12 have been shown to increase the incidence of anemia during pregnancy.^[7]

Numerous maternal adaptations, such as an increase in red blood cell count and a greater need for a micronutrient (iron) by the growing and developing fetus, result in a higher demand for iron during pregnancy.^[9] Pregnancy-related anemia is most prevalent in lower and middle-income countries, where it greatly increases maternal morbidity and mortality.^[10] Iron deficiency is responsible for 50% of anemia cases among women and is the leading cause of pregnancy-related anemia globally. Pregnant women who have IDA may experience cognitive deterioration, a higher incidence of underweight offspring, and a high risk of early neonatal and child death.^[11] The aim of this study was to assess the knowledge and practice of anemia prevention among pregnant women who visit the antenatal clinic at the specialist hospital in Yola, Nigeria.

MATERIALS AND METHODS

RESULTS

Table 1 provides a detailed distribution of the socio-demographic characteristics of study participants on knowledge and practice of anemia prevention among pregnant women.

Table 2 presents a detailed analysis of the knowledge of anemia during pregnancy among the 318 participants visiting the antenatal services at the Specialist Hospital, Yola.

Table 3 outlines the practices related to anemia prevention during pregnancy, as reported by the participants, and provides insight into their attitudes and behaviors regarding various preventive measures.

Educational level showed a significant association with both knowledge (Pearson's χ² = 14.094, df = 3, P = 0.003) and practice (Pearson's χ² = 3.957, df = 1, P = 0.047) of anemia prevention. In contrast, age was not significantly associated with either knowledge (Pearson's χ² = 12.615, df = 9, P = 0.181) or practice (Pearson's χ² = 2.382, df = 3, P = 0.497) of anemia prevention. These findings indicate that educational attainment, rather than maternal age, was an important determinant of knowledge and preventive practices among the study participants.

DISCUSSION

The response rate was exceptionally high, with 318 of the 320 questionnaires returned (99.38%). Most of the women (72.6%) were aged 21-30 years, with fewer participants from older age groups. This is significant because it aligns with the common reproductive age group, which reflects typical attendance at antenatal clinics. The relatively small number of women over 40 years (0.3%) suggests that pregnancies among older women are less common in this setting, which may be attributed to cultural, biological, or socio-economic factors that limit childbearing at later ages.^[17,18] A large majority of respondents (85.8%) were married, which is typical in most societies where marriage correlates with childbearing. One of the critical findings is the high level of knowledge of anemia prevention during pregnancy (90.6%). The relatively high levels of knowledge and anemia prevention practices observed in this study may reflect the impact of routine antenatal health education delivered at the study facility. Furthermore, the provision of educational pamphlets on maternal and child health may have complemented these health talks by reinforcing information on anemia prevention among pregnant women.

The present study revealed a very high knowledge of anemia prevention among the respondents, which is consistent with the research reported by Ademuyiwa et al.^[19] This suggests that the majority of the respondents are actively practicing the various ways of anemia prevention during pregnancy.^[20,21] This research also revealed an association between the level of education and anemia prevention among pregnant women attending antenatal services in the study area. This finding corresponds with the findings reported by Adeyemi et al.^[22] There was no association between the factor of age and anemia prevention among expectant mothers seeking antenatal care in the research area. Anemia prevention among expectant mothers was also found not to differ significantly between younger and older pregnant women.^[22]

The study revealed that expectant mothers with a good level of education know about anemia prevention. Engidaw et al. found that women who attended antenatal classes were more likely to understand and adopt anemia prevention practices, including dietary changes and iron supplementation.^[23] Similarly, Adeyemi et al. highlighted that knowledge gaps about anemia were most prevalent among women who did not receive formal education.^[22] This discovery corresponds with the research conducted by Ademuyiwa et al., which indicates a notable linear connection between one's level of education and their understanding of anemia.^[19]

There is no significant correlation between age and the understanding of anemia prevention. This finding agrees with Hajizadeh et al., who argued that age is a less critical factor compared to education or socioeconomic status in determining health knowledge.^[24] They also found that knowledge about anemia prevention tends to be uniform across different age groups, likely because interventions are often designed to targ et all pregnant women, regardless of age.^[24] In contrast, Mankelkl and Kinfe found a slight variation in health-seeking behavior based on age, where older pregnant women (above 30 years) were more proactive about their knowledge of preventive care than younger women.^[25] However, their findings indicated that age alone was not sufficient to explain these differences; factors such as experience from previous pregnancies, education, and access to healthcare played a more substantial role .

This study identified a significant association between education and the effectiveness of anemia prevention practices. Abujilban et al. discovered that women who possess higher levels of education tend to be more inclined to adopt preventive health behaviors, largely due to increased health literacy, which improves their understanding of the causes, symptoms, and preventive strategies for conditions like anemia.^[26] Adekanle et al. reported a significant association between educational attainment and knowledge of maternal health interventions, supporting the idea that higher education levels equip women with the skills to access and comprehend healthcare information.^[27] Another study by Abiodun-Ojo et al. emphasized that antenatal programs targeting educated women had a higher impact on reducing anemia prevalence due to better retention of health information and greater adherence to preventive measures such as iron supplementation.^[28]

The study revealed an insignificant correlation between age and anemia prevention behaviors among pregnant women. Related research also suggests that age does not significantly impact the practice of anemia prevention.^[20] Adeyemi et al. noted similar results in their study, where anemia prevention practices did not differ significantly between younger and older women.^[22]

However, they suggested that other factors, such as household income and educational attainment, might play a larger role in determining health practices. In contrast, studies reported by Appiah et al. found that older women (particularly those in their late 30s and 40s) were more inclined to follow precautionary actions, possibly due to increased awareness from previous pregnancies.^[29] However, this effect was not observed universally and varied widely depending on the women's education level and access to healthcare.There is more stacking of references in the discussion and can be reduced if needed. In addition to strengthening routine antenatal health education, improving access to iron-folic acid supplementation and providing tailored dietary counseling should be prioritized to enhance anemia prevention among pregnant women.^[30] Furthermore, addressing health-system barriers, such as ensuring consistent availability of supplements and adequate staffing for antenatal services, may improve the effectiveness and uptake of these interventions.

The study's single-center, hospital-based cross-sectional design limits the generalizability of its findings to the broader population. While a systematic method was employed in the clinic, the selection process might have introduced selection and recall bias and may not have adequately represented all pregnant women in the community. Furthermore, Likert-scale responses were treated as quantitative data, which may not fully reflect their ordinal nature. Insufficient adjustment for key confounders, especially socioeconomic status, also reduces the clarity of the identified associations.

CONCLUSION

The findings from this study indicated that pregnant women attending antenatal care in the study area generally demonstrate good knowledge of anemia prevention and actively practice anemia prevention strategies, suggesting effective health education within antenatal services. Educational status was a significant predictor of knowledge and practice related to anemia prevention, with higher educational attainment associated with better knowledge and preventive practices. Maternal age, however, showed no significant association with anemia prevention. These results highlight the critical role of maternal education and continued antenatal health education in strengthening anemia prevention efforts and improving maternal health outcomes.