Beledweyne-Somalia ϝΎ

ϣϮλϝ ΍-ϦϳϭΪ Ϡ
Α

LaboratoryscreeningofIronDeficiencyAnemiaamon
gpregnant women in Hilaal Hospital at
Beledweyne, Hiiraan, Somalia

AResearchThesisSubmittedToTheCollegeOfHealthScience
InPartialFulfillmentOf The Requirement For The Award Of Bachelor
Degree In Medical Laboratory Technician

=========================

PREPAREDBY:

1. Nimco Abdi Mohamed

2. Maryan Mohamed Adan

SUPERVISOR’SNAME:

DR.Suldan Abukar Ali

BELEDWEYNE- HIIRAAN-
SOMALIAJULY, 2024.

I
 DECLARATION

Wecertifythatthisthesis isouroriginalworkproject entitled“LaboratoryscreeningofIron

DeficiencyAnemiaamongpregnantwomeninHilaalHospitalat Beledweyne ,Hiiraan, Somalia”
and has not been presented for a degree in anyother universityor anyother award.

Nameof group: Signature:

1. Nimco Abdi Mohamed .

2. Maryan Mohamed Adan .

II
 APPROVAL

I hereby certify that I have read and evaluated this thesis “Laboratory screening of Iron
DeficiencyAnemiaamongpregnant womeninHilaal Hospitalat Beledweyne, Hiiran,Somalia“with my
approval as the supervisor.
Signed:………………………………..……. Date……………..……………

Dr.Suldan Abukar Ali (SUPERVISOR)

III
 DEDICATION

We dedicate my work to our dear parents who impressed on our early in our youth ofthe great
power inherent in acquiring good education. We also dedicate this thesis to our parents, finally
this are dedicated to all medical students those who are learning medical laboratory students in
order to use reference to our research.

IV
 ACKNOWLEDGEMENT

Firstofallwewould liketothank Allahforgiving usabilitytocompleteandsubmit thisthesis successful on

time.
Wewould liketo expressour deepest and heartfelt gratitudeappreciationto our supervisor Dr. Suldan
Abukar Ali for his constructive guidance, valuable support and tireless encouragement
throughouttheproductionofthisdissertationandtakinghistimeto correctthis manuscript.

A vote of thanks also goes to our family and friends for their moral, spiritual support and encouragement
throughout our period of study. Without their continued support, this may have not been achieved. Our
love for them endures for a life time.

Lastlybut notthe least,WeSpecialthanks forallourlecturersandadministrationalrankofall university offices

for their operation and service
Allahblessesyouall.

V
 TABLEOFCONTENTS

COVERPAGE...............................................................................................................................I
DECLARATION.........................................................................................................................II
APPROVAL...............................................................................................................................III
DEDICATION...........................................................................................................................IV
ACKNOWLEDGMENT.............................................................................................................V
TABLE OFCONTENTS............................................................................................................VI
LISTOFTABLES.....................................................................................................................VIII
LISTOFFIGURES....................................................................................................................IIX
LIST OFABBREVIATIONS......................................................................................................X
ABSTRACT...............................................................................................................................XI
CHAPTERONE..........................................................................................................................1
INTRODUCTION........................................................................................................................1
1.0 Overview...........................................................................................................................................1
1.1 Background ofthe study....................................................................................................................1
1.2 Problemofthestudy............................................................................................................................5
1.3 PurposeofStudy.................................................................................................................................6
1.4 ObjectiveofStudy...............................................................................................................................6
1.5 Researchquestion..............................................................................................................................6
1.6 Scopeofthestudy...............................................................................................................................6
1.7 Significanceofthestudy......................................................................................................................7
1.8 Conceptualframework.......................................................................................................................7
CHAPTERTWO.........................................................................................................................8
Literaturereview.......................................................................................................................................8
2.0 Introduction.......................................................................................................................................8
2.1 PhysicalpredisposingfactorsofIdaonpregnantwomen.....................................................................8
2.2 PathologicalpredisposingfactorsofIdaonpregnantwomen................................................................9
2.3 SocialpredisposingfactorsofIdaonpregnantwomen.......................................................................10
2.4 FunctionofIron.................................................................................................................................. 11
2.5 PhysiologicalofIronTransport.........................................................................................................11
2.6 DietaryfactorseffectingIronStatus13
2.7 BiomarkersofIronStatus..................................................................................................................15

VI
VIII
2.8 CausesofIronDeficiency Anemia...................................................................................................17
2.9 SignsandSymptomsofIron DeficiencyAnemia..................................................................................18
2.10 DiagnosisofIronDeficiencyAnemia................................................................................................18
2.11 PreventionofIronDeficiency Anemia...........................................................................................19
2.12 ManagementofIronDeficiencyAnemia..........................................................................................20
2.13 TreatmentofIronDeficiencyAnemia.............................................................................................20
2.14 ImpactofAnemiaonfetusandMother.............................................................................................21
CHAPTERTHREE...................................................................................................................24
METHODOLOGY.....................................................................................................................24
3.1 Overview.........................................................................................................................................24
3.2 ResearchDesign...............................................................................................................................24
3.3 Targetpopulation.............................................................................................................................24
3.4 Samplesize.......................................................................................................................................24
3.5 Samplingtechniques........................................................................................................................24
3.6 ResearchInstrument........................................................................................................................25
3.7 Dataanalysis....................................................................................................................................25
3.8 ValidityandReliabilityoftheinstrument.............................................................................................25
3.9 EthicalConsiderations......................................................................................................................26
3.10 StudyLimitations............................................................................................................................26
CHAPTERFOUR.....................................................................................................................27
4.0 Results.............................................................................................................................................27
CHAPTERFIVE.......................................................................................................................48
5.1 Introduction.....................................................................................................................................48
5.2 Summaryofthefindings....................................................................................................................48
5.3 Conclusions.....................................................................................................................................49
5.4 Recommendations...........................................................................................................................49
REFERENCES...........................................................................................................................51
APPENDIXA:THETIME FRAME OFTHE STUDY................................................................53
APPENDIXB:BUDGETCOSTS................................................................................................54
APPENDIXC:QUESTIONNAIRE............................................................................................55

VII

VIII
 LISTOFTABLE
Table4.1Age ofthe respondent...................................................................................................28
Table4.2Educationofthe respondent...........................................................................................29
Table4.3 Numberofchildren you have?......................................................................................30
Table 4.4 Typeofpregnancy.................................................................................................................31
Table4.5Hb%ofthe respondent...................................................................................................32
Table4.6LFTsofthe respondent..................................................................................................33
Table 4.7Gestationalmonths....................................................................................................................34
Table4.8Ageoflastchildrenborn..................................................................................................35
Table4.9Typeoffamilyyouhave?.................................................................................................36
Table4.10 Monthlyincome ofthe household?.............................................................................37
Table 4.11Currentstatusoftherespondent?..................................................................................38
Table4.12 Eating habitsoftherespondent?..................................................................................39
Table4.13 Dailyteaintakeofthe respondent?...............................................................................40
Table4.14Howoftenyoueatfreshfruits, vegetablesandmilk?.......................................................41
Table4.15 Areyouusing anysortofironsupplement?....................................................................42
TABLE4.16Areyousuffering fromfrequentnauseaand vomiting?..............................................43
Table4.17Yourdailyeatinghabitsare...........................................................................................44
Table4.18Doyouknowthatpregnantwomenneeddouble diet?.....................................................45
Table4.19Doyouknowaboutcheapalternativesofhealthydiet?....................................................46
Table4.20Doyouhaveprevioushistoryofmiscarriage?.................................................................47

VIII
VIII
 LISTOF FIGURE
Figure 4.1Age oftherespondent..................................................................................................28
Figure4.2Educationofthe respondent..........................................................................................29
Figure4.3Number ofchildrenyouhave?.......................................................................................30
Figure4.4 Typeofpregnancy.......................................................................................................31
Figure 4.5Hb%oftherespondent..................................................................................................32
Figure 4.6LFTsoftherespondent.................................................................................................33
Figure4.7Gestationalmonths......................................................................................................34
Figure4.8Ageoflastchildrenborn................................................................................................35
Figure4.9Typeoffamilyyouhave?...............................................................................................36
Figure 4.10Monthlyincome ofthehousehold?.............................................................................37
Figure 4.11Currentstatusoftherespondent?.................................................................................38
Figure4.12 Eating habitsofthe respondent?................................................................................39
Figure 4.13Dailyteaintakeoftherespondent?...............................................................................40
Figure4.14Howoftenyoueatfreshfruits, vegetablesandmilk?......................................................41
Figure4.15 Areyou usinganysortofironsupplement?..................................................................42
FIGURE4.16Areyousufferingfromfrequentnauseaand vomiting?.............................................43
Figyure4.17Yourdailyeatinghabitsare........................................................................................44
Figure4.18Doyouknowthatpregnantwomenneeddoublediet?.....................................................45
Figure4.19Doyouknowaboutcheapalternativesofhealthydiet?...................................................46
Figure4.20Doyouhaveprevioushistoryofmiscarriage?................................................................47

IX
VIII
 LISTOFABBREVIATIONS

 RBC:Redbloodcells

 HB:Hemoglobin

 HCT: Hematocrit

 WHO:Worldhealthorganization

 PCV:Packedcellvolume

 IDA:Irondeficiencyanemia

 CBC:Completeblood count

 MCV:Meancorpuscularvolume

 MCH:Meancorpuscularhemoglobin

 MCHC:Meancorpuscularhemoglobinconcentration

 UNICEF:unitedNationsinternationalchildrenemergencyfund

 MICS:Multipleindicatorclustersurvey

 TFR:Transferrinreceptor

 CBOs:Communitybased organizations

 NGOs:Nongovernmentalorganizations

 EDTA:Ethylenediamenetetra-aceticacid

 IV:Intravenous

 FPENS:Formalprivateeducationnetwork

 DME:Divalentmodeltransporter

 IRP:Ironregulatoryprotein

X
VIII
VIII
 ABSTRACT

Background: Iron deficiency anaemia is the most common nutritional disorder in the world, affecting
bothdeveloped and developing countries. Globally, the most commoncause ofanemia is iron deficiency,
which is responsible for about halfofanemia cases in pregnancy, it is estimated in developed countries;
about 38% of pregnant women had iron depletion, anemia affects 1.62 billion people with prevalence of
24.8%, out of whom an estimated, 56 million (41.8%) of pregnant women had anemia, where iron
deficiency is thought to be the most commoncauseofanemiawhichaccount for 75%-95%ofcasesbut
majorityofpregnant mothers lack correct perception (WHO, 2014).The Aim of this study was to find out
the study on the laboratory screening of Iron Deficiency Anemia among pregnant women in Hilaal
Hospital at Beledweyne, Somalia. The specific objectives of this studywere to assess the physical,
pathological, and socio-economic predisposing factors of iron deficiency anemia among pregnant
women.

Methods: A cross sectional design involving quantitative method used at Hilaal hospital,
MogadishuduringJune2022.Thetargetpopulationofthisstudyispregnant womenwithiron anemia deficiency
attending ANC clinic at Hilaal hospital. Structured questionnaire is administered to collect data from 60
respondents using random sampling.

Results: The study reveals that 25(41.7%) were 15-20yrs, 18(30.0%) were 21-25yrs, 9(15.0%) were 26-
30yrs, 8(13.3%) were 31-35yrs. Regarding knowledge of The majority of the
respondents30(50.0%)weresingle,11(18.3%)weretwin.11(18.3%)weretriple,8(13.3%)were Quarter
let.The researcher indicates the majority of the respondents were single.

Conclusion: from our findings, pregnant mothers were unaware of the risk factors of iron
anemiadeficiency,sothestudyrecommendseducatingpregnant mothersto consume ironrich local foodslike
meat, grainsand vegetablesduring pregnancy, and fullutilizationofantenatal care services among pregnant
women.

XI
VIII
 CHAPTER ONE

INTRODUCTION

1.0 Overview
This chapte rhighlightsbackgroundofthestudy,problemstatement,purposeofthestudy,studyobjectives, research
questions, scope of the study, significance of the study and finallyconceptualframeworkofthestudy.
1.1 Background of the study
Iron deficiency ananemia is the most common nutritional disorder in the world, affecting
bothdeveloped and developing countries.
Globally, the most common cause of anemia is irondeficiency, which is responsible for about half of anemia
cases in pregnancy, it is estimated indeveloped countries, about 38% of pregnant women had iron depletion
(Jack F, et al., 2014).Globally, anemia affects 1.62 billion people with prevalence of 24.8%, out of whom
anestimated, 56 million (41.8%) of pregnant women had anemia, where iron deficiency is thoughtto be the
most common cause of anemia which account for 75%-95% of cases but majority ofpregnant mothers lack
correct perception (WHO, 2014). As of the WHO recommendations toachieve the sustainable development
goals, as one of the strategic objective awareness raisinghas got a great deal especially with invisible forms
of malnutrition like anemia. In 2018, anestimated 264 millionwomenofreproductive ageare affected byiron-
deficiencyan anemia.Withthe current global effort to eliminate the current global malnutrition by 2025, Iron
Hematocrit: This test measures the in aSerum ferritin: Ferritin is a protein that stores iron in the body sample
of blood. A low hematocrit level is another indicator of anemia percentage of red blood cells Serum ferritin:
Ferritin is a protein that stores iron in the body Low ferritin levels are an indicator of iron deficiency. these
tests can be performed using relatively The study of iron deficiency globally has a rich history, motivated by
its widespread prevalence and significant health consequences. Here's a glimpse into the key developments:
Early Recognition (Pre-20th Century): Iron deficiency was recognized in various cultures for centuries, often
associated with fatigue, pale skin, and weakness. However, the understanding of its causes and full impact
remained limited.20th Century: Increased Focus and Scientific Advancements Early 1900s: Development of
better diagnostic tools like blood tests allowed for identification of anemia, a major consequence of iron
deficiency.Mid-20th Century:Iron deficiency became recognized as the leading cause of anemia
worldwide.Research efforts intensified, focusing on:Global burden of iron deficiencyDietary patterns and
iron intake across different regionsFactors influencing iron absorption (e.g., parasitic infections)Late 20th
Century and Beyond: Refining the Picture

1
Global efforts like the World Health Organization (WHO) brought focus to iron deficiency as a major public
health concern.Studies explored the social and economic determinants of iron deficiency:Poverty and limited
access to iron-rich foodsLack of sanitation and hygiene contributing to parasitic infections that hinder iron
absorptionResearch delved deeper into the consequences of iron deficiency:Reduced work capacity and
productivityIncreased risk of maternal and child mortalityCognitive development issues in children21st
Century and Ongoing EffortsDevelopment of strategies to address iron deficiency:Food fortification programs
to increase iron content in staple foodsDietary diversification efforts to promote iron-rich plant and animal
sourcesPublic health education campaigns on iron deficiency and its preventionExploring new
interventions:Investigating the effectiveness of iron supplements with improved bioavailabilityDeveloping
targeted interventions for high-risk groups (pregnant women, children)Challenges and Future
DirectionsDespite progress, iron deficiency remains a significant global health issue.Addressing social and
economic inequalities that contribute to iron deficiency is crucial.Research continues to explore:Long-term
health effects of iron deficiency across the lifespanThe complex interplay between iron deficiency and other
nutritional deficienciesDeveloping sustainable and cost-effective solutions for iron deficiency prevention and
controlThe study of iron deficiency globally is an ongoing battle. By understanding its causes, consequences,
and effective interventions, researchers and public health professionals strive to make a significant impact on
the lives of millions around the world.Screening for IDA during pregnancy is an important part of ensuring the
health of both mothers and babies. Early diagnosis and treatment of IDA can help to improve maternal and
child health outcomes. Iron deficiency anemia is one of the serious health problems among pregnant women

In Africa.The study of iron deficiency in Africa has a long and complex history, shaped by the continent's high
burden of the condition and its distinct contributing factors. Here's a closer look: Early Observations (Pre-Mid-
20th Century):Similar to other regions, early observations in Africa noted connections between:Poor
dietFatiguePale skinThese were seen in some populations, but the understanding of the cause (iron deficiency)
remained limited.Colonial healthcare systems often focused on specific diseases rather than widespread
nutritional deficiencies Mid-20th Century: Increased Recognition and ResearchPost-independence, research
efforts identified iron deficiency anemia as a major public health concern.Studies focused on:Prevalence of
iron deficiency anemia in various regions and populations (pregnant women, children) Dietary patterns and
limitations in iron intake (reliance on staple crops low in bioavailable iron).The role of infectious diseases,
particularly malaria, in hindering iron absorption Late 20th Century and Beyond: A Multifaceted
ApproachRecognition emerged of the complex interplay between factors contributing to iron deficiency in
Africa:Dietary factors:Low intake of animal-source foods rich in heme iron (easily absorbed).Reliance on
plant-based sources with lower bioavailability (iron less readily absorbed).Phytates in certain staple foods

2
further inhibit iron absorption.Infectious diseases: Malaria and other parasitic infections remain a significant
public health challenge impacting iron absorption and utilization.Socioeconomic factors: Poverty, limited
access to clean water and sanitation, and inadequate healthcare infrastructure all contribute to the prevalence of
iron deficiency.Current Research TrendsDeveloping Culturally Appropriate and Sustainable
Interventions:Food fortification: Fortifying staple foods like maize flour with iron can significantly increase
iron intake.Dietary diversification: Promoting consumption of iron-rich plant sources alongside bio-
fortification strategies.Improved sanitation and hygiene: Reducing parasitic infections can enhance iron
absorption.Targeted interventions: Tailoring iron supplementation programs for pregnant women and
children.Addressing Challenges. Monitoring and evaluation of implemented interventions.Ensuring long-term
sustainability and affordability of programs.Addressing micronutrient interactions, as iron deficiency often co-
exists with other deficiencies.Unique Considerations in AfricaResearch is exploring:Specific genetic variations
in some African populations that might influence iron absorption or utilization.The impact of sickle cell
disease, a prevalent genetic condition in Africa, on iron status.The role of traditional African diets and
potential iron-rich indigenous foods.ConclusionThe study of iron deficiency in Africa is crucial for public
health. By understanding the unique context and addressing the complex contributing factors, researchers can
develop effective strategies to combat this widespread nutritional deficiency and improve the health and well-
being of millions of Africans. Recognition emerged of the complex interplay between factors contributing to
iron deficiency in Africa: Dietary factors: Low intake of animal-source foods rich in heme iron (easily
absorbed), reliance on plant-based sources with lower bioavailability, and phytates in certain staple foods
further inhibiting iron absorption.Infectious diseases: Malaria and other parasitic infections remain a
significant public health challenge, impacting iron absorption and utilization.Socioeconomic factors: Poverty,
limited access to clean water and sanitation, and inadequate healthcare infrastructure all contribute to the
prevalence of iron deficiency.Current Research Trends:Developing culturally appropriate and sustainable
interventions for iron deficiency prevention and control:Food fortification: Fortifying staple foods like maize
flour with iron can significantly increase iron intake.Dietary diversification: Promoting consumption of iron-
rich plant sources alongside bio-fortification strategies.Improved sanitation and hygiene: Reducing parasitic
infections can enhance iron absorption.Targeted interventions: Tailoring iron supplementation programs for
pregnant women and children.Addressing challenges:Monitoring and evaluation of implemented
interventions.Ensuring long-term sustainability and affordability of programs.Addressing micronutrient
interactions, as iron deficiency often co-exists with other deficiencies.Unique Considerations in
Africa:Research is exploring the specific genetic variations in some African populations that might influence
iron absorption or utilization.The impact of sickle cell disease, a prevalent genetic condition in Africa, on iron
status is being investigated.The role of traditional African diets and potential iron-rich indigenous foods is
3
being re-evaluated.The Future of Iron Deficiency Research in Africa, The study of iron deficiency in Africa is
crucial for improving public health. By understanding the unique context and addressing the complex
contributing factors, researchers can develop effective strategies to combat this widespread nutritional
deficiency. This will ultimately lead to improved health and well-being for millions of Africans.

InSomalia, A prevalence rate of anemia is believed to be higher in the general

population,especiallyinpregnantwomenandinthechildren.
Higherratesabove50%havealsobeenreportedinpregnantwomen(WorldBank,2004). Iron is essential for many
biochemical processes including electron transfer reactions,
generegulation,regulationofcellgrowthanddifferentiation, andoxygentransport. oxygen is boundto
hemoglobinwithintheredbloodcellsorasfacilitatorofoxygendiffusionintissue.Iron becomes deficient in the body
when there is prolonged negative iron balance due to inadequatedietary iron intake or absorption, increased
need for iron during pregnancy or growth periods,increased iron loss as a result of menstruation, chronic
illnesses and infections (WHO 2001). Inshort, iron deficiency is a state in which there are no available iron
stores due to disturbance ofthe normally stable cycle of iron metabolism. Iron deficiency is the most common
nutrientdeficiency in the world. Symptoms of iron deficiency are: subtle, nonspecific and often onlybecome
apparent with severe anemia. The pallor of anemia was associated with weakness
andtirednesslongbeforeitscausewasknown.Now,itisrecognizedthatevenwithoutanemia,mildto moderate iron
deficiency has adverse functional consequences on health (Oppenheimer,2001). Iron deficiency is considered
to be the most common nutritional disorder worldwide, withchildren and pregnant women most at risk (Beard
2001, WHO 2001). There are different factorsrelated with nutritional deficiencies. Eating diets which are poor
in iron is the most commonpractice (Ababiya and Gabriel 2014.) The other factor related to nutritional iron
deficiency ispoor absorption of iron that is aggravated by dietary contents. Iron deficiency can result
fromblood loss due to different reasons. Once iron stores are depleted, dietary and recyclederythrocyte iron are
not usually sufficient to compensate for acute blood loss. In all cases of irondeficiency anemia (IDA), blood
loss should be considered. Hemorrhage itself is by far the mostcommon mechanism for acute iron loss and
anemia. Hemorrhage decreases the host’s red cellmass,decreasesthesupplyofiron
forerythropoiesis,andincreasestheirondemandforerythropoiesis.
Chronicbloodlossfrommenstruationhasthegreatestimpactworldwide.
statusshouldnotbebasedsolelyonredbloodcellcharacteristicsas hematopoiesis
isoftenunaffectedintheearlystagesofdeficiency.

The implementation of iron therapy can be initiated based on several different guidelinesdepending on
etiology. The European consensus on the diagnosis and management of
4
irondeficiencyandanemiaininflammatoryboweldisease(ECCO)suggestsironsupplementationforpatients with
ferritin under 30 ng/mL or less than 100 ng/mL if transferrin saturation is below20% for those with iron
deficiency due to inflammatory bowel disease. Similarly, the KidneyDisease: Improving Global Outcomes
(KDIGO) guidelines use serum ferritin below 100 ng/mLand transferrin saturation under 20% to indicate
therapy in patients with renal disease. TheEuropean Society of Cardiology uses ferritin less than 100 ng/mL or
100 to 299 ng/mL withtransferrinsaturationbelow 20%inpatientswithheartfailure.
Most oral iron formulations are considered to be dietary supplements. As such, they are
notsubjecttothesamesetofregulationsused bytheU.S.Foodand DrugAdministration(FDA) toevaluate traditional
drug products. Parenteral, i.e., intravenous iron therapy is approved by theFDA to treat iron deficiency anemia
for patients who are intolerant to oral iron or havedemonstrated an inadequate response and for patients with
chronic kidney disease. It should benoted that further guidelines and restrictions vary by individual brand of
parenteral iron. Thegoal of this study is therefore to determine the laboratory screening of Iron Deficiency
Anemia amongpregnantwomeninHilaalHospitalatBeledweyne, Hiiraan, Somalia.
1.2 Problem of the study

The laboratory screening of Iron with hemoglobin concentration during pregnancy for both thewoman and the
growing foetus cannot be overemphasized. Being a driving force for oxygen forthe mother and foetus, a
reduction below acceptable levels can be detrimental to both (Agan, etal.,
2010).However,IronDeficiencyAnemiainpregnancyisaworldwidepublichealthproblemaffecting both
developing and developed countries with significant impact on the health ofmothers and foetus (Siamak,
2014). Iron Deficiency Anemia is an indicator of nutritionaldeficiencies that significantly contribute to birth
defects, preterm labour and low birth weight,hence it causes global public health problem. However, iron
deficiency anaemia is a leadingcause of maternal morbidity and mortality, prenatal and perinatal infant loss;
physical andcognitive losses thus in developing countries stall social and economic development. In sub-
Saharancountries,includingSomalia, themagnitudeofIronDeficiencyAnemiainpregnancyisquitealarming,
wherebyitsprevalenceiswidelycontributedbypoorironintakeandabsorption,parasitic infestations, chronic
infections, illiteracy, and short pregnancy intervals (Agan, et
al.,2010).Consequently,ifthisconditioncontinuouswithoutbeendevelopedinterventionsoftreatingandpreventing
maternal iron deficiency for many pregnant women will develop anemia that latercauses birth defects, preterm
labour and low birth weight, hence it causes national public healthproblem. Therefore, the aim of the study on
which this dissertation is based is to determine thelaboratory screening of Iron Deficiency Anemia among
pregnant women in Hilaal Hospital atBeledweyne, Hiiraan,Somalia. Iron deficiency, though widely
recognized, presents challenges in studying it effectively. Here are some of the key problems researchers
face:Differentiation from other causes of anemia: Iron deficiency anemia (IDA) is the most common form of
5
anemia, but other factors like vitamin deficiencies or chronic diseases can also cause anemia. Teasing out iron
deficiency specifically can require additional tests and make it difficult to isolate the exact cause of a patient's
symptoms.Hidden iron deficiency: Iron deficiency can exist without causing anemia initially. Iron stores can
be depleted before red blood cell production is affected. This makes it harder to diagnose early on, potentially
delaying intervention.Dietary assessment challenges: Accurately measuring dietary iron intake can be difficult.
People's recollection of their diet may not be entirely accurate, and iron absorption is influenced by other
dietary factors like vitamin C and phytates.Variations in iron absorption: Iron absorption is affected by several
factors, including a person's age, health status, interventions or definitively link dietary intake to iron stores.

1.3 Purpose of the study

The purpose of this research was to find out the study on the laboratory screening of IronDeficiencyAnemia
amongpregnantwomenin Hilaal HospitalatBeledweyne, Hiiraan, Somalia.

1.4 Objective of the study

1.4.1 General objectives

Theobjective of this research is to describe study on the laboratory screening of

IronDeficiencyAnemiaamongpregnantwomeninHilaal Hospital atBeledweyne, Hiiraan, Somalia.

1.4.2 Specific objectives

1. Toidentifyphysical,pathological,andsocio-
economicpredisposingfactorsofirondeficiencyanemiaamongpregnantwomeninHilaal
HospitalatBeledweyne, Hiiraan, Somalia.

2. ToassesstheimpactofirondeficiencyanemiaamongpregnantwomeninHilaal HospitalatBeledweyne,
Hiiraan,Somalia.

3. ToexplorethepreventionandtreatmentofirondeficiencyanemiaamongpregnantwomaninHilaal
HospitalatBeledweyne, Hiiraan,Somalia

1.5 Research questions

1. Whatarethephysical,pathological,andsocio-economicpredisposingfactorsofirondeficiencyanemia
amongpregnantwomeninHilaal Hospital?

2. WhataretheimpactsofirondeficiencyanemiaamongpregnantwomaninHilaal Hospital?

3. How topreventandtreatiron deficiency anemiaamongpregnantwomenin Hilaal Hospital?

1.6 scope of the study

6
There arethree dimensionsofscope whichare time,geographyandcontentofscope.

1.6.1. Timeofscope:thisstudyhasbeendonefromFebruary2024-upto July2024

1.6.2. Geographicalscope:the areaofthisstudywasHilaal hospitalin Beledweyne-Hiiraan-Somalia

1.6.3. Content of the scope: the content of the research is to the study on the

laboratoryscreeningofIronDeficiencyAnemiaamongpregnantwomeninHilaal HospitalatBeledweyne, Hiiraan,

Somalia.

1.7 Significance of the study

This study will be help full in providing evidence to create laboratory screening test for irondeficiency for
every pregnant woman who come to hospital for early caring and treatment, andconsidering supplementation
for those deficient patients and to decrease the consequence whichcome relating with it. Studying iron
deficiency deepens our understanding of iron absorption, storage, and utilization in the body. This knowledge
can be applied to develop more effective treatments for various iron-related disorders. In conclusion, the study
of iron deficiency is not just about addressing a single nutritional issue. It has far-reaching implications for
public health, maternal and child health, cognitive function, chronic disease prevention, and overall well-being.
By continuing research efforts, we can develop strategies to combat this widespread problem and improve the
lives of millions of people around the world. The study will serve as guidance for the local national
community,international community CBOs, NGOs, operating in Somalia. Moreover, the researcher
hopesthat,thisstudymayhelpforother researchesasaspringboardtoworkmoreonitandtoconductfurtherstudies.

1.8 Conceptual framework

IronDeficiencyAnemia
PregnantWomen

IV D

PhysicalFactors

Pathological Factors PregnantWomen

Socio economic Factors

7
 CHAPTER TWO

LITERARURE REVIEW

2.0 Overview

Iron deficiency anemia is the most frequent nutritional deficiency in pregnancy, with an impacton
maternal and fetal morbidity and mortality. It is regarded as the most important preventablecause of
prenatal complications, such as premature delivery, intrauterine growth retardation
andneonatalandprenataldeath.AnumberofStudieshaveindicatedthatIDAduring pregnancymaybe
associated with an increased Case of prematurity and prenatal mortality.However, how ID inpregnant
Women affect the iron metabolism and iron status of their fetus’s remains to
beestablished.PrevalenceofIDAcouldbeaffectedbyseveralfactorswhichincludesocioeconomic conditions,
lifestyle, and health-seeking behaviors across different Communities.IDAisstilla
commonproblemthatdeservestobe studied extensively.(Ironstatusof2004)
The difficulty in establishing a precise diagnosis of the iron status of pregnant women representsa
complicating factor in the understanding of the relationship between Maternal and fetal
ironstatus.Thephysiologicchange,concerningincreased plasmaVolumeandincreasederythropoiesis has a
significant impact on both the available Hematological and biochemicalparameters that are used to assess
iron status, which provides a clinical challenge. Reducedamounts of HB accompany an overall reduction
in body iron in IDA, since HB contains thelargest amount of iron. To assess IDA, Accompanied with
reduced amounts of HB, serumferritin, serum iron, serum TfR assay, TIBC, % saturation, HB and RBC
indices can
beperformed.ItisstillnotclearwhetherIDinpregnantwomenmightleadtoadeficientironstatusoftheirnewborns.
(Ironstatus,2004).
2.1 PhysicalpredisposingfactorsofIdaonpregnantwoman

Substantialamountsofironaredepositedintheplacentaandfetusduringpregnancy.Thisresultsinanincreasedne
edofabout700-850mginbodyironoverthepregnancy.
Overall, iron absorption is increased during pregnancy, when menstruations stop.
Pregnantwomenstilldonotabsorbsufficientadditionaliron,
however,andtheriskofirondeficiencyincreases(AmericanAssociationofBloodBanks,2014).

2.1.1 ClinicalManifestations

8
Fatigue, pallor, light-headedness, tachycardia, dyspnea, poor exercise tolerance, and
suboptimalworkperformancehaveallbeenreportedinpregnantor postpartumwomenwithirondeficiency,

as have postpartum depression, poor maternal behavioural interactions, impaired lactation,

lowbirthweight,prematuredelivery,intrauterinegrowthretardation,andincreasedfetalandneonatal mortality.
The pallor of anemia was associated with weakness and tiredness long
beforeitscausewasknown.Nowitisrecognized thatevenwithoutanemia,mild tomoderateirondeficiency has
adverse functional consequences.Iron deficiency adversely affects the cognitiveperformance, behaviour,
and physical growth of infants, preschool and school-aged children,
theimmunestatusandmorbidityfrominfectionsofallage groups;andTheuse
ofenergysourcesbymusclesandthusthephysical
capacityandworkperformanceofadolescentsandadultsofallage groups. Specifically, iron deficiency
anemia during pregnancy Increases prenatal risks
formothersandneonatesandincreasesoverallinfantmortality.(AmaniWaleedMahmoud 2007).
2.1.2 CognitiveDevelopment

Inexperimentalanimals,ironhasbeenshowntoplayakeyrolein brainfunction.Severalareasof the brain

contain iron, sometimes in large quantities. Iron-deficient animals show
alterationsbothinneurotransmittersand behaviorthatdoesnot usuallyrespond to ironreplenishment.
Thereisstrongevidencethatfindingsfromanimalstudiesalsoapplytohumans.

For example, iron deficiency anemia has been conclusively seen to delay psychomotordevelopment and
impair cognitive performance of infants Adolescent girls whose diet wassupplemented with iron felt less
fatigued; their ability to concentrate in school increased andtheir mood improved. Neurological
malfunction in young children, adolescents, and adults
asdeterminedbyelectrophysiologicalmeasurementshasalsobeendocumentedasbeingassociatedwithirondefi
ciency.(AmaniWaleedMahmoud2007)
2.2 PathologicalPredisposingFactorsofIdaonPregnantWomen

Commoninfections,especiallythosewhicharechronicandrecurrent, mayimpairhematopoiesisand
consequently cause anemia. Malaria by hemolysis and some parasitic infections, e.g.hookworm,
trichuriasis, amoebiasis, and schistosomiasis (both vesical and intestinal forms),cause blood loss directly.
This blood loss contributes to iron deficiency. (Amani WaleedMahmoud2007).
2.2.1 ResistancetoInfection

9
Morbidity from infectious disease is increased in iron-deficient populations because of
theadverseeffect ofirondeficiencyontheimmunesystem. Inthesesituations,leukocytes havea

replicate when stimulated by a mutagen. Also in such cases, there occurs a lowered concentrationof cells
responsible for cell-mediated immunity and a depressed skin-test response to commonantigens. Iron
supplementation and milk or cereal fortification among deficient children has beenreported to reduce
morbidity from infectious disease (American Association of Blood Banks,2014).
2.3. SocialPredisposingFactorsofIdaonPregnant Women

Iron deficiency is most common among groups of low socioeconomic status. (Allman, 1998).Women
of reproductive age lose iron during menses and have a substantially higher need
forironduringpregnancy, becauseoftheincreaseinredcellvolumeofthemother, placentalandfetalgrowth.
This substantially increases their risk of iron deficiency anemia. if there is too little iron in thediet, the
iron consumed is poorly bioavailable or if the overall meal contents interact to curtailavailability beyond
the range of the body’s ability to up regulate absorption to meet iron needs,stored iron will be used up
and iron deficiency will occur. The World Health Organizationestimates that 52% of all pregnant
women are anemic For women, the consequences of anemiainclude reduced energy and capacity for
work, poor pregnancy and birth outcomes including:Premature delivery, low birth weight, and increased
prenatal mortality and increased risk ofdeathduring deliveryandpostpartum.Itisestimated
thatasmanyas20% ofmaternaldeathsarecausedbyanemia(WHO,2000).
2.3.1 EconomicImplicationsofIronDeficiencyAnemia

National socioeconomic development, as well as personal health and self-fulfillment, areimpaired by iron
deficiency. The negative impact on national development can be estimatedfrom:thenumber
ofindividualsaffectedinvariousageandgender categoriestheseverityofthedeficiency, the duration and
consequences of the condition (American Association of BloodBanks,2014).
TheEconomicImplicationsOfSuchConditionsInclude:

The costs incurred by the public and private sectors in therapeutic measures for the prevalentlevel of
anemia, the societal consequences of increased maternal mortality and resultantrestraints on
productivity, the long term projected negative consequences of impaired mentaldevelopment on human
capital formation. This vicious circle impairs individual, family, andcommunity,
aswellasoverallsocioeconomicdevelopment. Consequently, estimatesofonlythe

economic cost of iron deficiency are conservative understatements of the true handicap imposedon
society. Costs of interventions specifically directed at nutrition and health education,
dietarydiversification, and other public health interventions that also result in improvements in
10
ironnutrition, are not considered here. There is a general scarcity of information both on the actualcost of
programs for the control of iron deficiency, and on the benefits obtained by its
correction.Variousprogrambudgetaryconsiderationsincludethecostsof:Iron compoundsrequiredtotreat
anemia and control iron deficiency; Provision of iron fortification programs;
Facilities,personneltime,logisticssupport;andprogrammonitoringandevaluation.
(AmericanAssociationofBloodBanks,2014).
2.4 FunctionofIron

Iron is required in almost all forms of life and plays a prominent role in human physiology as thekey
component of the heme group which plays a critical role in energy generation and plays arole in the
brains dopamine system. Iron can also be potentially toxic. Its ability to donate
andacceptelectronsmeansthatifiron
isfreewithinthecell,itcancatalyzetheconversionofhydrogenperoxideintofreeradicals.Freeradicals
cancausedamagetoawidevarietyofcellularstructures,andultimatelykillthecell.Topreventthatkindofdamage,
alllifeformsthatuseironbind the iron atoms to proteins that allow the cells to use the benefits of iron, but
also limit itsability to do harm. Iron has the capacity to accept and donate electrons readily, inter
convertingbetween ferric (Fe3+) and ferrous (Fe2+) forms. This capability makes it a useful component
ofcytochromes, oxygen-binding molecules (i.e., HB and myoglobin), and many enzymes. Inresponse to
bacterial infection, the body can down-regulate its level of iron (since bacteriarequire iron from the host),
thus in a sense lower iron levels can provide some protection againstbacterial infection. Iron is a binding
site for oxygen in heme containing proteins, such as HB inRBCs and myoglobin in muscle. Heme
consists of a ferrous (Fe2+) iron complex withinprotoporphyrin IX. Porphyrins are a cyclic
macromolecule that binds divalent and trivalentmetals like iron to form complexes. Thus, HB and
myoglobin perform the important function ofoxygen transport in human body. Iron protoporphyrin
(heme) and iron–sulfur clusters serve asenzyme cofactors.(Ironstatus,2004)

2.5 PhysiologyofIronTransport

2.5 .1DistributionofBodyIron

Adult men normally have 35 to 45 mg of iron per kilogram of body weight. Premenopausalwomen have
lower iron stores as a result of their recurrent blood loss through menstruation.More than two thirds of
the body’s iron content is incorporated into HB in developing erythroidprecursors and mature red cells.
Uptake of erythroid iron is highly dependent on receptor-mediated endocytosis of di-ferric Tf bound to
TfR (the transferrin cycle, each erythrocytecontainsa
billionatomsofiron;atnormalratesofturnover,thisconcentrationcorrespondstotheincorporation of 2×1020
11
atoms of iron per day Consequently, anemia is the cardinal sign of ID.Most of the remaining body iron is
found in hepatocytes and reticuloendothelial macrophages,which serve as storage depots. The liver has
first-pass access to dietary nutrients and can readilytakeupanamountofcirculatingironthatexceedsthe
bindingcapacityofplasma Tf.
Reticuloendothelial macrophages. Ingest senescent red cells, catabolize HB to scavenge iron, andload the
iron on to Tf for reuse. This process is indispensable; the erythron alone has a dailyrequirement of about
20 mg of iron, but only 1 to 2 mg of iron normally enters the body each daythroughtheintestine.
(Ironstatus,2004).
2.5.2 RegulationofIronAbsorption

Theamountofironextractedfromthedietissmall,theregulationoftheintestinalabsorptionofironiscriticalbeca
usehumanshavenophysiologicpathwayforexcretion.Duodenalcryptcellssense the iron requirements of
the body and are programmed by that information as they maturein to absorptive enterocytes.
Enterocytes lining the absorptive villi close to the gastro duodenaljunction are responsible for all iron
absorption. Iron must pass from the gut lumen through theapical and basolateral membranes of the
entrecote to reach the plasma. Iron obtained from foodis not bound to Tf, and there is no role for Tf
within the lumen of the intestine. Instead, the lowpH of gastric effluent helps dissolve ingested iron and
provides a proton-rich milieu. Thisfacilitates enzymatic reduction of ferric iron to its ferrous form by a
brush border ferricreductase.Divalent metal transporter 1 (DMT1) is a protein that transfers iron across
the apical membraneandintothecellthroughaproton-coupledprocess. DMT1is
notspecifictoiron;itcantransporta wide variety of divalent metal ions, including manganese, cobalt,
copper, zinc, cadmium, andlead.(Ironstatus,2004).

Heme iron is taken up by a separate process that is not well characterized. Inside the
absorptiveenterocyte,ironhastwopossiblefates:itmaybestoredasferritin,oritmaybetransferredacrossthe
basolateral membrane to reach the plasma. These are Not mutually exclusive, and thedetermining factor
is probably an iron absorption “set Point” that was established when theenterocyte developed from a
crypt cell. Iron that remains in the form of ferritin as the enterocytecompletes its limited life cycle will be
sloughed with the senescent cell and will leave the bodythrough the gastrointestinal Tract. This process
represents an important mechanism of iron loss.The basolateral enterocyte iron transporter has not been
definitively identified, but a recentlydescribed protein, Ireg1, is a likely candidate. Genetic studies in
mice have shown that thebasolateraltransporterrequiresanaccessoryprotein,amulticopper
proteincalledhephaestin.
Hephaestin is similar to plasma ceruloplasmin and is presumed to function as a

12
ferroxidase.Ceruloplasminalsohasanimportantrole
inironmetabolism.Theabsorptionofintestinalironisregulated in several ways First; it can be modulated by
the amount of iron recently consumed inthe diet,amechanismreferredtoasthedietaryregulator.
(Ironstatus,2004).
For several days after a dietary iron bolus, absorptive enterocytes are resistant to acquiringadditional
iron. This phenomenon has previously been called “mucosal block”. This blockingaction probably
results from the accumulation of intracellular iron, leading the enterocyte tobelieve that its set-point
requirements have been met. It may occur even in the presence ofsystemic ID. A second regulatory
mechanism also senses iron levels but responds to total bodyiron,ratherthandietaryiron.
Thismechanismhas beentermedthestoresregulator;itiscapableof changing the amount of iron absorbed to
a limited extent: iron absorption is modulated by
afactorofonlytwotothreeinirondeficientstatesascomparedwithiron-replete states.
Althoughthemolecular detailsofthestoresregulatorarenotknown,itprobablyactsatthelevelof crypt-cell
programming, in response to the saturation of plasma Tf with iron. Experiments inanimals suggest that
the levels of the apical transporter, DMT1, are altered in response tochanges in body iron stores. The
third regulatory mechanism, know n as the erythropoieticregulator, does not respond to iron levels at all.
It modulates iron absorption in response to therequirements for erythropoiesis. The erythropoietic
regulator has a greater capacity to increaseiron absorption than the stores regulator. It is logical that the
erythron should have someinfluence on the rate of intestinal iron absorption, since most of the body iron
is used forerythropoiesis.

2.5.3 IronStorageandRecycledIron

Ferritin andhemosiderin aretheprimary storageformsofiron.Thesecompoundsareabsorbedin the liver,

spleen, bone marrow, and skeletal muscle. Ferritin can be measured in plasma, whilehemosiderin is more
often identified in the urine or stained through the bone marrow. Iron storesin men are generally 1.0 to
1.4 g of body iron, and for women, 0.2 to 0.4 g.Iron absorptionrequirement is on average 1 mg/day; it is
easy to understand why in adults with iron-poor dietsanemiamaytakeyearstodevelop.Specifically,body
storesinmenof1g.wouldlast3to4years before iron depletion takes place]. Indeed, most cases of ID are
directly related to
externalbloodloss,especiallymenorrhagiaorslowgastrointestinalbleed.Bloodlostoutsidethebodyhasno
chance of being recycled into the usable by product of heme and globin. The recycling of ironfrom heme
and amino acids from globin following the lysis of aged red cells is a very efficientprocess. Heme is
returned to the bone marrow, and the amino acids of the globin chain arereturned to the amino acid pool.

13
Each of these products will later be recruited for HB formationand red cell production. In the adult,
approximately 95% of recycled iron is used for red cellproduction,
whereasintheinfant,only70%isusedforthispurpose.Becauseofthisrelationship,it is easy to understand the
significance of adequate iron sources in the early years ofdevelopment.(Ironstatus,2004).
2.6 DietaryFactorsEffectingIronStatus

2.6.1 IronIntake

Heme and non-heme iron are two forms of iron available from animal and plant Foods. Hemeiron is
derived from HB and myoglobin present in animal tissues, such as Meat, sea food andpoultry. Non-heme
iron is also found in animal sources, including egg yolk and milk, as well asin plant sources, including
fortified grains and cereals, Leafy green vegetables, nuts, oilseeds andlegumes. Previous study assessed
non-heme iron absorption from a lacto vegetarian dietcompared to heme iron absorption. The
bioavailability of heme iron (3.8%) was found to be 70%higher than that of non-heme iron (1.1%) [32].
this greater bioavailability is likely related to thestructure of heme (Hb) 3, which facilitates absorption
and is unaffected by dietary inhibitingfactors that influence absorption of non-heme iron. These studies
indicate that heme iron intakeenhances the bioavailability of iron. While this suggests that greater heme
iron intake shouldimproveiron

14
we’re not associated with iron. These observations suggest that, along with dietary iron
intake,othernutritionalandnon-nutritionalfactorsalsoinfluenceironabsorptionandironstatus.
(Ironstatus,2004).
2.6.2 AbsorptionofNon-HemeIron

Non-hemeironabsorptionisacomplexprocessthatinvolvesanumber ofothernutrientsanddietary
components that can be broadly classified as enhancers of or Inhibitors of ironabsorption.
2.6.3 EnhancersofIronAbsorption

Orangejuice,VitaminC, Pickels, VinegarandSoysauce.

2.6.4 InhibitorsofIronAbsorption

Tea,Milk,CoffeeandOregano

2.6.5 BasalIron Loses

Iron is not actively excreted from the body in urine or in the intestine. Iron is only lost with cellsfromthe
skinand theinteriorsurfacesofthe bodyintestines,urinarytract,andairways.The totalamount lost is estimated
at 14 mg/kg body weight per day. In children, it is probably morecorrect to relate these losses to body
surface. A non-menstruating 55-kg woman loses about 0.8mg of iron per day and a 70-kg man loses
about 1mg per day. The range of individual variationhasbeenestimatedtobe±15%(Ironstatus,2004).
2.7 BiomarkersofIron Status

Ironstatusmaybeassessedinvariousways.ThesensitivityandspecificityoftheseParametershave been studied

to identify the most accurate and reliable biomarkers of iron status. If irondepletion is diagnosed at an
early stage, preventive measures of iron Supplementation can beimplementedtoimproveironstatus.
(Ironstatus,2004).
2.7.1 BoneMarrowExamination

Ironfromthestoragesiteistakenupbytheerythroblastspresentinbonemarrow. Bonemarrowexamination
includes histological assessment of iron stores. Although it is considered the mostdefinitive measurement
of iron status, it is not used for screening of ID in major populationsbecause of its invasiveness. It is
mainly used to assess iron status in hospitalized patients.

15
 2.7.2 Hemoglobin

Hemoglobin is iron bound to a protein in circulating erythrocytes. HB is used for screening

ofanemia in large populations. However, it is not a reliable measure because there are
differenttypesofnutritionalanemiawhichcanresultinto falseestimationofID. ThenormalHBlevelscan
vary according to different populations as well as age, sex and hydration status. However,the cut-
off level as per WHO standard is 13 g/dL for adult men, 12 g/dL for
non-pregnantwomenand11g/dlforpregnantwomen.(Ironstatus,2004).
2.7.3 FreeErythrocyteProtoporphyrin

The heme molecule consists of protoporphyrin IX and iron. In the later stages of ID, FEP
levelsincreaseasamanifestationofreducedhemesynthesis. This isnotthemostSensitiveindicatorofID,
since it is a late stage of iron depletion leading to iron deficient erythropoiesis. The cut-offvalue for
free erythrocyte protoporphyrin is 70 μg/dl. Increased levels of free
erythrocyteprotoporphyrinindicateIDA.(Ironstatus,2004).
2.7.4 MeanCorpuscularVolume

Mean corpuscular volume is not sensitive to depletion of iron stores, but iron deficienterythropoiesis
and IDA are associated with microcytosis (small cell volume), so
MCVMeasurementsareusefulindeterminingthetypeofanemia. However,
MCVcanalsodecreaseininfection or chronic disease, leading to a false assessment of IDA. Therefore,
MCV alone is notconsideredareliablemeasureofID. Thenormalvaluefor MCVis80fl.(Ironstatus,2004).
2.7.5 TransferrinSaturation

Transferrin Saturation measures how much iron is bound to Tf. % Saturation <16% reflects
ID.Similartootheriron-related measures,suchasHB,MCVandFEP,%Saturationmeasurementsare not
sensitive to early-stage depletion of iron body stores. Also, it can be a false indicator
ofID,sinceitcanvaryincaseofclinicaldisorders.(Ironstatus,2004).
2.7.6 SerumFerritin

Iron is stored in the body in the form of ferritin. Serum ferritin concentration was shown toreflect
body iron stores in normal individuals, as well as in persons with ID or iron overloaddisorders; 1
ng/ml of serum ferritin reflects 8 mg of body iron stores. In case of dietary ID, ironstores are utilized
to supply iron metabolic needs. Therefore, Low serum ferritin concentrationsreflect

16
is elevated above normal. Measurement of serum ferritin is the most sensitive indicator of bodyiron
stores in a normal healthy adult. Although cut-off values for serum ferritin have beendefined by
different population groups, the normal range of serum ferritin falls within 20-200μg/L, with <12
μg/L indicative of depleted iron stores. However, because ferritin protein is
anacutephasereactantthatincreasesinresponsetoinflammationorchronicdisease.
Serumferritinconcentration can lead to a false indication of the extent of body iron stores in persons
withconcomitantinfectionorinflammation.(Ironstatus,2004).
2.7.7 SerumTransferrinReceptor

A soluble truncated form of the TfR can be detected in serum samples. ID gives rise to upregulation
of cell surface expression of TfR that are reflected in an increase concentration ofcirculating soluble
TfR Similar to ferritin, the synthesis of TfRItis also controlled by a post-transcriptional mechanism.
When free iron is low in the cytoplasm, as in iron depletion, TfRsynthesis is up regulated as a result
of iron regulatory protein (IRP) binding with TfR mRNA.Because ferritin is an acute-phase reactant,
its usability is compromised to some extent in casesof inflammation, liver disease and chronic
disease. To distinguish IDA from the anemia
ofchronicdisease,serumTfRmeasurementsareahelpfulindicatorofID, sinceitsconcentrationisstable in
inflammatory conditions. However, when used alone, serum TfR gives no informationabout body
iron stores, and it is also affected by other conditions that influence the rate oferythropoiesis.
(Ironstatus,2004).
2.8 CausesofIronDeficiencyAnemia

There are many populations that are vulnerable to IDA. Infants and pregnant women may sufferfrom
nutritional deficiency, young children may develop IDA when their growth anddevelopment rate
outstrip their iron intake, and young women who have increased iron need dueto menstruation or
pregnancy may develop IDA. But the primary cause of ID in the westernworld is gastrointestinal
bleeding, bleeding for males and excessive menses for females. In bothofthesecases, bloodis
lostfromthebody.Externalbloodlosspresentsasignificantchallengetothe body because millions of shed
red cells can never be used for recycling new red cells. Slowgastro-intestinal bleeding, bleeds and
dysfunctional uterine bleeding over time will lead to adepletion of iron stores and IDA will
commence. Storage iron, represented by ferritin, representsa primary reservoir of iron that can be
used as other iron sources are depleted. Barring any otherexternallossofblood,irondeficiencysolelydue
to lack ofdietarysourceswould developoveraprotracted period of time of dietary sources would
develop over a protracted period of time. (Ironstatus,2004).

17
 2.8.1 TheMostCommonCausesofIronDeficiencyAnemiaareFallowing:

 Relatedtoincreasedirondemands

 Growthspurtsin infantsand children

 Pregnancyandnursing

 Relatedtolackofironintake

 Poordiet

 Conditionsthatdiminishabsorption

 Relatedtobloodloss

 Menorrhagia

 Gastrointestinalbleeding(GIbleed)

 Hemolysis

2.9 SignsandSymptomsofIronDeficiencyAnemia

 Pallorofthe mucous membranes

 Fatigue

 Generalweakness

 Decreasedappetite

 Dizziness

 Fainting

 Headache

 Shortnessofbreath

 Increasedheartrate(tachycardia)andpalpitation.

2.10 DiagnosesofIronDeficiencyAnemia

DiagnosisofIDAduringpregnancyisdifficultduetothefactthatmorphologicalchangesoccurat a later
stage, MCV increases slightly during the first and second trimester and serum irondrops and TIBC
increases during pregnancy even in women who are not iron deficient. Irondeficiency anemia is
usually discovered during a complete medical history and physicalexamination through routine blood
18
test, which includes a complete blood count (CBC).A lowhemoglobin concentration only indicates
anemia is present; it does not reveal the cause ofanemia.Lack ofiron inthetissuecanbedemonstrated
bymeasuringtheserumferritinisthe

body's main iron storage protein. Serum ferritin levels fall in proportion to the decrease in
ironstoresandwillshowchangesbeforethelevelofhemoglobinfalls. Serumferritinisconsideredasone of
the best laboratory tests for evaluation of iron deficiency as measurement of serum ferritindirectly
related to iron storage. However, inflammation is major problem seems to be associatedwith this test;
a problem must be taken in consideration when thinking of use of this test. Toavoid such problem one
can use C-reactive proteins to exclude elevated ferritin caused by acutephase reactions.
(Irondeficiencyanemia,2007).
A more reliable test in pregnancy may be to assess cellular iron status by measuring
serumtransferring receptor(TFR)concentrations.The serum transferringreceptor(TFR)concentrations
remain normal in pregnancy unless tissue iron deficiency is present. The
WHOrecommendationforthelowerlimitofthenormalrangeofhemoglobinconcentration(Hb)is11g/dL7.
The Centers for Disease Control and Prevention specifies anemia as an Hb<11.0 g/dL orhematocrit
<0.33 for the first and third trimesters and Hb<10.5 g/dL or hematocrit <0.32 for thesecond
trimester.8 Table 1.1 represents the criteria for anemia in pregnancy (maximumhemoglobin
andhematocritvaluesforanemia.(Irondeficiency,2007).
2.10.1 CriteriaforCutoffValueforHb andHct forAnemiain Pregnancy:

Stageofpregnancy Hb levelg/dl loweraverage Hct(%)

Fist 11.0 33.0
Second 10.5 32.0
Third 11.0 33.0
2.11 PreventionofIronDeficiencyAnemia

Dietary
modificationFood
fortificationIrons
upplementation
2.11.1 DietandNutrition Education

Eatmorefruitsandvegetable
19
 sNocoffeeorteawithmeals
Programsshouldbetargetedtoatriskgroups

Reducephyticcontentofcerealsandlegumesbyfermentation

2.11.2 FoodFortification

Freelywatersoluble,ferroussulphate,gluconate,andlactate,andferricammoniumcitrate

Poorly water soluble, ferrous fumarate succinate, saccharate, Water in soluble, ferric
pyrophosphate,ferricorthophosphate,andelementaliron.Experimental,sodium-ironEDTA,andbovine
HB concentrate,(Irondeficiencyanemia,2007).
2.11.3 IronSupplementation

Poorly water soluble, ferrous fumarate succinate, saccharate, Water in soluble, ferric pyro

Phosphate,ferricorthophosphate,andelementaliron.Experimental,sodium-ironEDTA,and
2.12 ManagementofIronDeficiencyAnemia

All pregnant women should be screened for anemia at their first antenatal care visit and re-screened
during the third trimester (at 28-36 weeks). The present policy provides one screeningat 30 weeks
and one at 36 weeks, in addition to screening in the first week postpartum. Womenwho were anemic
during pregnancy or had multiple deliveries screened for anemia at 4-6 weekspostpartum.
Themainwaysofcontrollingtheirondeficiencyanemiaamongpregnantwomenare:

o Bloodtransfusioniftheheartfailureiseminent.

o IVorIMiron inpregnantwoman

o Treatunderlyingcauses

o Dietaryeducation.

2.13 TreatmentofIronDeficiencyAnemia

Treatmentofanemicwomenwhoarestableisusuallycarried outintheprimaryhealthcenterormaternity
home with very close follow-up that include the following procedure Assessment
ofmedicalandobstetrichistoryandfoodintake.
Bloodtestforhemoglobinlevels(CBC).

Complete physical examination at the first antenatal visit orPostpartum,

initiate iron and folate treatment: 120mg iron +
20
800μg.FolicaciddailyforthreemonthsandprovidecounselingtoimproveContin
uance and

compliance ofiron/folate therapy.

Referthewomento
anappropriatecommunityhealthworkerforOngoingnutritionassessmentandsu
pport.
Evaluate women health one week after starting iron/folate
treatment.Providefollow-upoftreatedcasesofsevereanemiaandifawoman's

conditionworsened,refer immediately,butifstableorimprovingReview
counselingandnutrition.
Becertainthatshehasenough ironandfolatetabletstocontinuetoTakethe
appropriatedose forsevereanemia.
One monthafterinitiating iron/folatetherapy,reviewthequestionsinrapid initialassessmentofsevere
anemia:
Ifawoman'sconditionisnobetter,referimmediately.

Ifissymptomaticallyimproving,
testherhemoglobinorhematocritIftherehasbeennoimprovementinherhemoglobin,referforfurtherevalu
ation.
2.14 Impact ofAnemia on FetusandMother

According to the WHO, around 18% of women in industrialized countries are anemic; in
thedeveloping world, this rises to 56% and is a contributory factor to women developing
healthproblems and dying during pregnancy and childbirth. Such situation renders both mother
andfetalneonatalrisks.Womenwithirondeficiencyanemiamaybeasymptomatic, howeveris
moresusceptible toinfection.
2.14.1 Impact ofIronDeficiency Anemiaon themother

o Increasedchanceofpreeclampsiaandpostpartumhemorrhage

o Toleratespoorlyevenminimalbloodlossduringbirth

o Healing ofanepisiotomyoranincision

o Cardiacfailure,Fatigueanddyspnea

o DecreasedworkcapacityandIncreasedrisk ofpregnancycomplications

21
o Decreasedmaximumaerobiccapacity

2.14.2 ImpactofIronDeficiencyAnemiaontheFetus

 Low-birthweightininfantsandneonataldeathininfants

 Impairedcognitivefunctioningandmemory

 Decreasedschoolperformance

 DecreasedPrematurity

 Fetalgrowthretardation

 Sterilityandosteoporosis

 Depressedimmunefunction

2.15 Summary

Iron deficiency anemia (IDA) is a major concern for pregnant women globally, affecting around 40% according
to estimates. It's the most common type of anemia during pregnancy.

Here's a quick summary:

 Cause: Iron deficiency due to increased iron needs during pregnancy and inadequate intake.
 Risk factors: Low socioeconomic status, poor diet, frequent pregnancies, and skipping prenatal
vitamins.
 Complications: Increased risk of preterm birth, low birth weight, and health problems for both mother
and baby.
 Prevention: Prenatal vitamins with iron and a balanced diet rich in iron sources.

Pregnant women are routinely screened for anemia to ensure early detection and treatment. This often involves
blood tests to measure hemoglobin levels and iron stores.

2.16 Conclusion

Anemia is a common disease during pregnancy because the blood volume increase during pregnancy is
mainly an increase of plasma, resulting in a limited count of red blood cells and diluted blood.
However, the fetus needs iron during its development, so ID and IDA are commonly seen during
22
 pregnancy. In this study the incidences of ID and IDA in pregnant women were 59.78% and 8.62%,
respectively, which are similar to 48.2% and 13.9% from a survey in 2018 in China.

This study further analyzed the potential risk factors for ID and IDA. We found that the risk factors for ID were
age ≥35 years, number of pregnancies ≥2, number of childbirths >1, number of abortions ≥3 and drinking of
strong tea or coffee, while the protective factors against ID were regular prenatal cares, iron supplementation
and nutrition guidance during pregnancy.

23
 CHAPTER THREE
METHODOLOGY

3.0 Overview

Thischaptercontainsresearchdesign, researchpopulation, samplesize,

samplingprocedure,research instruments, validity and reliability, data gathering and data
analysis, and ethicalconsiderationsofthestudy.

3.1 Research design

This was a descriptive cross-sectional study that utilized quantitative research methods of
datacollection and analysis for a specific point in time. This design allowed for collection
ofextensive data within a short time on issues based on the relationship between the
variablesunderstudy.

3.2 Target population

Thestudypopulationcomprisedof70 pregnantwomenofreproductiveagebetween15-49yearson their

first Antenatal visit at Hilaal Hospital during their current pregnancy. The choice ofthis population
was suitable because the antenatal women haven’t received any
supplementationandtheyconstitutedtheurbanpoorpopulation.

3.3 Sample size

Thedatawillcollectfromthe selected sampleof60 respondents,the studywilluseSlovene’s

N
formulawhichis n=
1+(Nxe 2)

Wheren=samplesize,

N= population size,
70
ande=marginoferror
of0.05

N
n=
1+(Nxe 2)

70
n=
1+(70 x 0.0025)
= 60

24
3.4 Sampling techniques

The sample technique which will use for the study was the sample random sampling.
Samplerandom sampling was selected to collect data without bias from accessible patients, and
from themanageable population of patients of the target population, this ensured that correct and
reliableinformation will get from the relevant patients. This study used systemic sampling
techniquemethodtorecruitandconsentparticipants.Systematicsamplingisatypeofprobabilitysampli
ng method in which sample members from a larger population are selected according to a
randomstartingpointandafixed.

3.5 Research instrument

The study instrument was structured questionnaire which were administered to the
studyparticipants who fulfill eligibility criteria. The hemoglobin level was measured to identify
theirondeficiencyanemia.HemoglobinconcentrationwasmeasuredusingportableHEMOCUEB-Hb
photometer. One drop of capillary blood via finger prick was used to
estimatehemoglobinlevel.Theprocedurefortaking blood andmeasuring Hbwasasfollows.
Participant’s fingertip was warmed, cleaned with alcohol, and punctured with a lancet. The first
two drop of blood was discarded; the micro-cuvette then was filled with a single drop of
blood.The filled micro-cuvette was placed into the HemoCue micro-cuvette holder within one to
threeminutesoftakingthesample,andareadingwasobtainedwithin45sec.Thehemoglobinvaluethat
appeared on the display was recorded in the questionnaire. Based on WHO guideline, Hblevelless
than11g/dlduringpregnancywas consideredasanemia.

3.6 Data analysis

DatacollectedwascompiledandanalyzedusingtheappropriateStatisticalanalysisespeciallyStatistica
lPackageforSocialScience(SPSS)andthequantitativeanalysiswascarried out.
Thereafter,theresearchermadeaninterpretationofthefrequencytablesandfiguresandaccordinglyma
de a summaryoffindings,conclusionsandrecommendations.

3.7 Validity and reliability

3.7.1 Validity

Validity assesses the degree to which the instrument will be actually suitable, and to check
howtherespondentsfilledthequestionnairestoavoidbias(Rässler&Riphahn, 2006). Validityofthestudy
was assured by randomly sampling the households, use of questions adapted fromstandardized
questionnaires of the research instruments and use of appropriate data analysismethods.

3.7.2 Reliability

25
Reliabilityistheproportionofvarianceattributabletothetruemeasurementofavariableandestimates
the consistency of such measurement over time (Mugenda, 2011). The method wasused to test
the consistency of the questionnaire in producing the same results. The
samequestionnairewasusedforallmothers/ caregiversto maintainreliabilityoftheresult.

3.8 Limitations

One of the limitations of this study is the nature of the study design, being as a cross-
sectionalstudydesign,itdoesnotshow whichprecededanemia orthe riskfactors.
Second, due to constraint of resource (money), it was not possible to classify the types ofanemia
basedonredbloodcellmorphology.Morphologicclassificationwouldgiveusclearpicture on the
types of anemia and therefore we could determine the magnitude of
irondeficiencyanemiasimultaneously.
Every research has its limitations. There are two major limitations in this study that could
beaddressedin futureresearch.

1. the study or research paper involve some hospitals and people in the
research,andsometimesyoumaygetproblemswithaccesstothesehospitalstosharetheirinformation
Duetothis, you needto redesignandrewriteyour study
2. some respondent’s cultural backgrounds or perspectives of certain phenomena, andthis can
affect a study’ With respect to the information received, some relevantinformation was not
provided by respondents due to the sensitive nature of the topic.However,theselimitations
didnot affect the findings of theresearch.

3.9 Ethical
consideration
In a research situation researcher should ensure that they are ethical social researchers
areboundtoethicalconsiderationsintheirstudies”.Thus,thewishesoftheindividualrespondents
within the organizations were respected. Every respondent’s
identityandinformationthatisprivilegedandconfidentialwasprotectedbythe

researcher.Thus,theresearcherobservedtherightsofallrespondentsandtheinformation
shared by respondents was kept confidential. The respondents were also made fully aware of
whatthestudywas about, such that the informationtheyprovidedwould beused
fortheresearchpurposeonly.

Ethical clearance for this research has been sought from administration of Hilaal Hospital
andResearch committee of Plasma University and individuals who were fill questionnaire
data byfirst explaining the purpose of the study. Pregnant women and all participants were
26
educated ontherelevanceofthestudyandincludedintheresearchbased ontheirconsent
toparticipate.

27
 CHAPTERFOUR
DATAPRESENTATION, ANALYSISANDINTERPRETATION
4.0 Overview
This chapter provides presentation, interpretation and analysis of data. Presentation and analysis of the
collected data was computed using percentages.In order to show the distribution of the respondents on
the various question items.Tables, pie charts and graphs were used in the presentation of data. This
chapter presented the analysis of the data and its interpretation. Frequency tables and charts were used to
show study results.
Table4.1 Ageofthe respondent.

Age oftherespondent
Frequency Percent ValidPercent CumulativePercent

15-20yrs 25 41.7 41.7 41.7

21-25yrs 18 30.0 30.0 71.7
Valid26-30yrs 9 15.0 15.0 86.7
31-35yrs 8 13.3 13.3 100.0
Total 60 100.0 100.0
Accordingtotable4.1,themajorityoftherespondents25(41.7%)were15-20yrs,18(30.0%) were 21-25yrs,
9(15.0%) were 26-30yrs, 8(13.3%) were 31-35yrs.
Theresearcherindicatesthemajorityoftherespondentswere15-20yrs

28
Figure 4.1 Ageofthe respondent.

29
 Table4.2Educationofthe respondent
Educationoftherespondent

Frequency Percent ValidPercent CumulativePercent

primary 28 46.7 46.7 46.7

Middle 15 25.0 25.0 71.7
Matric 11 18.3 18.3 90.0
Valid
Intermediate
6 10.0 10.0 100.0

Total 60 100.0 100.0

Accordingtotable4.2,the majorityoftherespondents28(46.7%) were primary, 15(25.0%) were middle,
11(18.3%) were Matric, 6(18.3%) were Intermediate.
Theresearcherindicatesthemajorityoftherespondentswereprimary.
Figure4.2 Educationoftherespondent.

30
 Table4.3 Numberofchildren you have
Numberofchildren youhave
Frequency Percent Valid CumulativePercent
Percent
1-3 35 58.3 58.3 58.3
4-7 16 26.7 26.7 85.0
Valid
above7 9 15.0 15.0 100.0
Total 60 100.0 100.0
Accordingtotable4.3,themajorityoftherespondents 35(58.3%)were1-3,16(26.7%)were4-7.
9(15.0%)wereabove7.
Figure4.3 Numberofchildren you have

31
 Table4.4 Typeof pregnancy
Typeofpregnancy

Frequency Percent Valid CumulativePercent

Percent
Single 30 50.0 50.0 50.0
Twin 11 18.3 18.3 68.3
Triple 11 18.3 18.3 86.7
Valid
Quarter
8 13.3 13.3 100.0
let.
Total 60 100.0 100.0
According to table 4.4, the majority of the respondents 30(50.0%) were single, 11(18.3%) were twin.
11(18.3%) were triple, 8(13.3%) were Quarter let.
Theresearcherindicatesthemajorityoftherespondentsweresingle.
Figure 4.4Type ofpregnancy

32
 Table 4.5HB%oftherespondent
HB%of therespondent

Frequency Percent Valid CumulativePercent

Percent
3-4g/dl 28 46.7 46.7 46.7
5-6g/dl 15 25.0 25.0 71.7
7-10g/dl 12 20.0 20.0 91.7
Valid
above10
5 8.3 8.3 100.0
g/dl
Total 60 100.0 100.0
Accordingtotable4.5,themajorityoftherespondents28(46.7%)were3-4g/dl,15(25.0%)
Were5-6g/dl.12(20.0%)were7-10g/dl,5(8.3%)wereabove10g/dl. The researcher
indicates the majorityofthe respondents were 3 - 4 g/dl. Figure 4.5 HB% of the
respondent

33
 Table4.6LFTsofthe respondent
LFTsoftherespondent

Frequency Percent Valid CumulativePercent

Percent
<Normal 29 48.3 48.3 48.3
Normal 19 31.7 31.7 80.0
ValidMorethan
12 20.0 20.0 100.0
normal
Total 60 100.0 100.0
Accordingtotable4.6,themajority of therespondents29(48.3%)were< Normal,19(31.7%) were Normal,
12(20.0%) were More than normal.
Theresearcherindicatesthemajorityoftherespondentswere<Normal.
Figure4.6LFTsofthe respondent.

34
 Table4.7 Gestationalmonths
Gestationalmonths.

Frequency Percent Valid CumulativePercent

Percent
1 -3month 33 55.0 55.0 55.0
4–5
11 18.3 18.3 73.3
Month
6–7
Valid 12 20.0 20.0 93.3
Month
8–9
4 6.7 6.7 100.0
Month
Total 60 100.0 100.0
According to table 4.7, the majority of the respondents 33(55.0%) were1 - 3month, 12(20.0%) were 6 - 7
month. 11(18.3%) were 4 - 5 month, 4(6.7%) were 8 - 9 months.
Theresearcherindicatesthemajorityoftherespondentswere1 -3month.
Figure 4.7Gestationalmonths.

35
 Table4.8Ageoflast childrenborn
Ageoflastchildrenborn

Frequency Percent Valid CumulativePercent

Percent
.<1year 26 43.3 43.3 43.3
1year 14 23.3 23.3 66.7
2year 12 20.0 20.0 86.7
Valid
Above2
8 13.3 13.3 100.0
Year
Total 60 100.0 100.0
Accordingtotable4.8,themajorityoftherespondents26(43.3%)were.<1year,14(23.3%) were 1 year,
12(20.0%) were 2 year, 8(13.3%) were above 2 year.
Theresearcherindicatesthemajorityoftherespondentswere<1 year.
Figure4.8Ageoflast children born

36
 Table4.9Typeoffamilyyou have

Typeoffamilyyou have

Frequency Perce Valid CumulativePercent

nt Percen
t
Nuclear 23 38.3 38.3 38.3
Joint 20 33.3 33.3 71.7
ValidExtended 11 18.3 18.3 90.0
anyother 6 10.0 10.0 100.0
Total 60 100.0 100.0
According to table 4.9, the majorityofthe respondents 23(38.3%) were Nuclear 20(33.3%) were Joint,
11(18.3%) were Extended, 6(10.0%) were any other.
TheresearcherindicatesthemajorityoftherespondentswereNuclear.
Figure4.9 Typeoffamilyyou have

37
 Table4.10 Monthly incomeofthehousehold

Monthlyincomeofthehousehold

Frequency Percen Valid CumulativePercent

t Percen
t
<$100 29 48.3 48.3 48.3
$100-
14 23.3 23.3 71.7
$200
$200- 11 18.3 18.3 90.0
Valid $300
Above
6 10.0 10.0 100.0
$300
Total 60 100.0 100.0
Accordingtotable4.10,themajorityoftherespondents29(48.3%)were<$100,14(23.3%)were
$100-$200,11(18.3%)were$200-$300,6(10.0%)wereAbove$300. The researcher
indicates the majority of the respondents were <$100.
Figure4.10Monthly incomeofthe household

38
 Table4.11 Currentstatusoftherespondent
Current statusoftherespondent

Frequency Percent Valid CumulativePercent

Percent
House wife 36 60.0 60.0 60.0
Doing job 14 23.3 23.3 83.3
ValidBothAand
10 16.7 16.7 100.0
B
Total 60 100.0 100.0
According to table 4.11, the majorityofthe respondents 36(60.0%) were House wife ,14(23.3%) were
Doing job, 10(16.7%) were Both A and B.
Theresearcherindicatesthemajorityoftherespondentsweremarried.
Figure4.11 Currentstatusoftherespondent

39
 Table4.12Eating habitsoftherespondent
Eating habitsoftherespondent

Frequency Percent ValidPercent CumulativePercent

2timesaday 31 51.7 51.7 51.7

3timesaday 12 20.0 20.0 71.7
4timesaday 10 16.7 16.7 88.3
Valid
More
7 11.7 11.7 100.0
frequently
Total 60 100.0 100.0
Accordingtotable4.12,themajorityoftherespondents31(51.7%)were2timesaday, 12(20.0%) were 3times a
day, 10(16.7%) were 4 times a day, 7(11.7%) were More frequently.
Theresearcherindicatesthemajorityoftherespondentswere2timesaday
Figure 4.12Eatinghabitsoftherespondent

40
 Table4.13 Dailytea intake oftherespondent
Dailytea intake oftherespondent

Frequency Perce Valid CumulativePercent

nt Percen
t
Onceaday 34 56.7 56.7 56.7
Twiceaday 12 20.0 20.0 76.7
Thriceaday 8 13.3 13.3 90.0
Valid
More
6 10.0 10.0 100.0
frequent
Total 60 100.0 100.0
According to table 4.13, the majority of the respondents 34(56.7%) were Once a day, 12(20.0%) were
Twice a day, 8(13.3%) were Thrice a day. 6(10.0%) were More frequent.
TheresearcherindicatesthemajorityoftherespondentswereOnceaday.
Figure4.13 Dailyteaintake oftherespondent

41
 Table4.14Howoftenyoueatfreshfruits, vegetablesandmilk?
Howoftenyoueatfreshfruits, vegetablesandmilk?

Frequenc Percent Valid CumulativePercent

y Percen
t
Daily 28 46.7 46.7 46.7
2times
15 25.0 25.0 71.7
week
Valid
Weekly 10 16.7 16.7 88.3
Very rare 7 11.7 11.7 100.0
Total 60 100.0 100.0
According to table 4.14, the majorityof the respondents 28(46.7%) were Daily, 15(25.0%) were 2 times
week, 10(16.7%) were Weekly, 7(11.7%) were Very rare.
TheresearcherindicatesthemajorityoftherespondentswereDaily
Figure4.14Howoftenyoueatfreshfruits,vegetablesandmilk?

42
 Table4.15Areyouusinganysort ofironsupplement?
Areyouusinganysort ofironsupplement?

Frequency Percent Valid CumulativePercent

Percent
Yes 38 63.3 63.3 63.3
ValidNo 22 36.7 36.7 100.0
Total 60 100.0 100.0
Accordingto table 4.15,themajority of the respondents 38(63.3%)wereyes,22(36.7%)were NO. The
researcher indicates the majority of the respondents were YES.
Figure4.15areyouusinganysort ofironsupplement?

43
 TABLE4.16Areyousufferingfromfrequentnauseaandvomiting?

Areyousufferingfromfrequentnauseaandvomiting?

Frequency Perce Valid CumulativePercent

nt Percen
t
Yes 43 71.7 71.7 71.7
ValidNo 17 28.3 28.3 100.0
Total 60 100.0 100.0
According to table 4.16, the majority of the respondents 43(71.7%) wereYES,17(28.3%) were NO. The
researcher indicates the majority of the respondents were YES.
FIGURE4.16areyousufferingfromfrequentnauseaandvomiting?

44
 Table4.17yourdailyeatinghabitsare:
Yourdailyeatinghabits are:

Frequency Percent Valid CumulativePercent

Percent
Justlikeprevious 33 55.0 55.0 55.0
Doublethen
21 35.0 35.0 90.0
Validprevious
Lessthanprevious 6 10.0 10.0 100.0
Total 60 100.0 100.0
Accordingtotable4.17,themajorityoftherespondents33(55.0%)wereJustlikeprevious, 21(35.0%) were
Double then previous, 6(10.0%) were Less than previous.
Theresearcherindicatesthemajorityoftherespondentswerejustlikeprevious,
Figure4.17yourdaily eatinghabitsare:

45
 Table4.18Doyou knowthat pregnantwomenneeddoublediet?
Doyou knowthat pregnantwomenneeddoublediet?

Frequency Percent Valid CumulativePercent

Perce
nt

Yes 40 66.7 66.7 66.7

ValidNo 20 33.3 33.3 100.0
Total 60 100.0 100.0
Accordingtotable4.18,themajorityoftherespondents40(66.7%)wereyes,20(33.3%) were NO.
TheresearcherindicatesthemajorityoftherespondentswereYES.
Figure4.18Doyouknowthatpregnant womenneeddoublediet?

46
 Table4.19Doyouknowabout cheapalternativesofhealthydiet?
Doyouknowabout cheapalternativesofhealthydiet?

Frequency Percent Valid CumulativePercent

Percent
Yes 40 66.7 66.7 66.7
ValidNo 20 33.3 33.3 100.0
Total 60 100.0 100.0
Accordingtotable4.19,themajorityoftherespondents40(66.7%)wereyes,20(33.3%) were NO. The
researcher indicates the majority of the respondents were YES.
Figure4.19Doyou knowabout cheapalternativesofhealthy diet

47
 Table4.20 Doyouhaveprevioushistory ofmiscarriage?
Doyouhaveprevioushistory ofmiscarriage?

Frequency Percent Valid CumulativePercent

Percent
YES 42 70.0 70.0 70.0
ValidNO 18 30.0 30.0 100.0
Total 60 100.0 100.0
Accordingtotable4.20,themajorityoftherespondents42(70.0%)wereyes,18(30.0%) were NO. The researcher
indicates the majority of the respondents were married.
Figure4.20 Doyou haveprevioushistory ofmiscarriage?

48
 CHAPTERFIVE
SUMMARY,CONCLUSION AND RECOMMENDATION
5.0 Overview
This chapter specifically portrays a summary of the results of the study based on the findings presented
in chapter four. The summary relates to the objectives of the study to the findings aforementioned. The
conclusions are drawn and the recommendations are also given.
5.1 SummaryoftheFindings
The majorityofthe respondents 25(41.7%) were 15-20yrs, 18(30.0%) were 21-25yrs, 9(15.0%) were26-
30yrs, 8(13.3%)were31-35yrs.Theresearcher indicatesthemajorityoftherespondents were15-20yrs,the
majorityoftherespondents28(46.7%)were primary,15(25.0%)weremiddle, 11(18.3%)wereMatric,
6(18.3%)wereIntermediate.Theresearcher indicatesthemajorityofthe respondentswere primary.The
majorityofthe respondents35(58.3%) were 1-3,16(26.7%)were 4-7. 9(15.0%) were above 7.The
majorityofthe respondents 30(50.0%) were single, 11(18.3%) were twin. 11(18.3%) were triple,
8(13.3%) were Quarter let.The researcher indicates the majority of the respondents were single.
The majorityoftherespondents28(46.7%)were 3- 4g/dl, 15(25.0%) were 5- 6g/dl. 12(20.0%) were 7 - 10
g/dl, 5(8.3%) were above 10 g/dl.The researcher indicates the majority of the respondents were 3 - 4 g/dl.
The majority of the respondents 29(48.3%) were < Normal, 19(31.7%) were Normal, 12(20.0%) were
More than normal.The researcher indicates the majority of the respondents were < Normal.
Themajorityoftherespondents33(55.0%)were1-3month,12(20.0%)were6-7month.
11(18.3%) were4 - 5 month, 4(6.7%) were8 - 9 months.The researcher indicatesthe majorityof the
respondents were 1 - 3month.
The majority of the respondents 26(43.3%) were. <1 year, 14(23.3%) were 1 year, 12(20.0%)were 2 year,
8(13.3%) were above 2 year.The researcher indicates the majority of therespondents were <1 year. The
majority of the respondents 23(38.3%) were Nuclear 20(33.3%) were Joint, 11(18.3%) were Extended,
6(10.0%) were any other.The researcher indicates the
majorityoftherespondentswereNuclear.Themajorityoftherespondents29(48.3%)were
<$100, 14(23.3%) were $100 - $200, 11(18.3%) were $200 - $300, 6(10.0%) were above $300.
Theresearcherindicatesthemajorityoftherespondentswere<$100themajorityofthe
respondents36(60.0%)wereHousewife,14(23.3%)wereDoingjob,10(16.7%)wereBothA And B.
Theresearcher indicatesthe majorityofthe respondentswere married. The majorityofthe
respondents 31(51.7%) were 2 times a day, 12(20.0%) were 3 times a day, 10(16.7%) were 4 times a day,

49
7(11.7%) were More frequently.The researcher indicates the majority of the respondents were 2 times a
day,the majority of the respondents 34(56.7%) were Once a day, 12(20.0%) were Twice a day, 8(13.3%)
were Thrice a day. 6(10.0%) were More frequent.
TheresearcherindicatesthemajorityoftherespondentswereOnceaday.

5.2 CONCLUSIONS.
Our findings, pregnant mothers were unaware of the risk factors of iron anemia deficiency, sothe
studyrecommends educating pregnant mothers to consume iron rich local foods like meat, grains and
vegetables during pregnancy, and full utilization of antenatal care services among pregnant women. Iron
deficiencyanaemia is the most common nutritionaldisorder in the world, affecting both developed and
developing countries. The main objective of this research is to describestudyonthe
laboratoryscreeningofIronDeficiencyAnemiaamongpregnant womenin Hilaal Hospitalat
Beledweyne,Somalia.Specific objective1)To identifyphysical,pathological, and socio-economic
predisposing factors of iron deficiency anemia among pregnant women in Hilaal Hospital at
Beledweyne, Somalia. 2) To assess the impact of iron deficiency anemia among pregnant women in
Hilaal Hospital at Beledweyne Somalia. The majorityof the respondents 25(41.7%) were 15-20yrs,
18(30.0%) were 21-25yrs, 9(15.0%) were 26-30yrs, 8(13.3%) were 31-35yrs.The researcher indicates the
majority of the respondents were 15- 20yrs,the majority of the respondents 28(46.7%) were primary,
15(25.0%) were middle, 11(18.3%) were Matric, 6(18.3%) wereIntermediate. The researcher
indicatesthe majorityofthe respondents were primary. The majorityofthe respondents 35(58.3%) were 1-
3, 16(26.7%) were 4-7. 9(15.0%) were above 7.The majorityof the respondents 30(50.0%) were single,
11(18.3%) were twin. 11(18.3%) were triple, 8(13.3%) were Quarter let. The researcher indicates the
majority of the respondents were single.

5.3 Recommendations

 Establishinganewstrategyfor ensuringthatmotherstakeironsupplementation.
 regularlyandestablishingnutritionaleducationprogramstoimprovethe dietary
 Intakeofpregnantmothers.
 Regular investigationsofpregnant mothersforHBandotherbloodindicesaswellas
ferritin.

 Awarenessprograms formedicalstaffconcerninganemiaof pregnancy.

 Otherresearchstudiesareneededto establishthe normalvaluesofanemia indicesIn
normal pregnant women and their babies.
50
 Administrationofregularironsupplementationduringpregnancyandbetween
 Pregnanciesinhighparitywomen.
 Administrationofironfor newbornsofIDmothersafterdelivery

 Anotherapproachisrequirement toimprovethe ironstatusofyoung infant isto delaythe

clamping of the umbilical cord after birth.
 Othernutritionaldeficiencieshavealsobeenproposedtohaveanimpacton
 Maternalandfetaloutcome,e.g.niacinandzincdeficiencywhichneeded.
 EvaluationandencouragementofdifferentcontrolmethodsforIDAcontrol.
 Startoral,low-dose(30mg/day) supplementsofironatthefirstprenatalvisit.
 Encouragepregnantwomentoeatiron-richfoodsandfoodsthatenhanceironabsorption.
 Pregnant women whose diets are low in iron are at additional risk for iron-deficiency
anemia;guidethesewomeninoptimizingtheirdietaryironintake.SecondaryPrevention
Screening

 Screenforanemiaat thefirst prenatalcare visit.Usetheanemiacriteria forthespecific

stage of pregnancy
 Confirmapositiveanemiascreeningresult byperformingarepeat HbconcentrationoHct test.
If the pregnant woman is not ill, a presumptive diagnosis of iron deficiency anemia can
be made and treatment begun.

51
APPENDIX A:
REFERENCES

1. BeardJ.L.(2000).Effectivenessandstrategiesofironsupplementationduring
pregnancy.American Journal of Clinical Nutrition 71:1288s-1294s.
2. Ironstatusofpregnant womenandtheir new borns inGaza, 2editions, 2005, byMeadgeneral
published in Gaza, Palestine.
3. AmericanAssociationofBloodBanks, 2014, in9thedition, by AmericanJournalofClinical
Nutrition. Vol. 72 No. 1, P: 212-240.

4. WHO: serum ferritin concentrations for the assessment of iron status andiron deficiency
inpopulations 2011.
5. UNICEFF. Population estimation in different districts of Banadir region, 2014
Xiongs,X., etal.(2000).Anemiaduringpregnancyandbirthoutcome: Ameta-analysis.
American Journal of Perinatology, 17(3), 137-146.
6. CarriagaMT, SkikneBS, FinleyB etal.,(1991).Serumtranferrinreceptorforthedetection of iron
deficiency in pregnancy.AmericanJournal of Clinical Nutrition 54:1077-1081.
7. WHO(1992).Theprevalenceofanemiainwomen:atabulationofavailableinformation.
8. AtamnaH., WalterP.B.andAmesB.N., 2002 -TheRoleofHemeandIronSulfurCluster.
InMitochondrialBiogenesis,Maintenance,andDecaywithAge. ArchiveofBiochemistryand
Biophysics. Vol. 397 No. 2, P: 345-353.
9. McCannJ. andAmesB.N., 2007-AnOverviewofEvidenceforA causalRelationbetweenIron
Deficiency during Development and Deficits inCognitive or Behavioral function.American
Journal of Clinical Nutrition. Vol.85 No. 4, P: 931-945.
10. WorldHealthOrganization.2000 -BattlingIDA.Geneva: WorldHealthOrganization. [5]
Rush D., 2000 - Nutrition and Maternal Mortality in Developing World.American Journalof
Clinical Nutrition. Vol. 72 No. 1, P: 212-240.
11. DarulShifaHospitalwebpageinadvertisementandforfindingthehospitalinformation2014.
12. Bothwell,T.H.(2000).Ironrequirementsinpregnancyandstrategiestomeetthem.
AmericanJournalofClinicalNutrition,72(Sup.),257-264.
13. Salzburg,H.S.(2002).Nutritioninpregnancy.InJ.JSciarra(Ed.), Gynecologyand
obstetrics. Philadelphia: Lippincott Williams &Wilkins.

52
14. Dawood HS, Parakash P, Shubber K.M.R (1990). Iron deficiency anemia among
pregnantArabwomeninKuwait. TheJournaloftheKuwaitMedicalAssociation;24(2): 167-
72.
15. DeMaeyerEM.Preventingandcontrollingirondeficiencyanemiathroughprimary
health care. Technical Report.WorldHealthOrganization. Geneva. 1989; 7-8.
16. HalperSL,MastersonBL,LarkD. QuickReferencetoClinicalNutrition.2ndEd.
Philadelphia .J.B Lipincott Co. 1987; 33-42.
17. PassmoreR,EastwoodM.A.DavidsonandPassmore's. HumanutritionandDietetics. 8th
Ed. Edinburgh, 1986. 462
18. JacksonRT,LanthamMC(1982).AnemiasofpregnancyinLiberia. American
Journal of Clinical Nutrition; 35:710-14
19. Johnson AA, Lantham MC, Roe DA (1982). The prevalence and etiology of
nutritionalanemiainGuyana.AmericanJournalofClinicalNutrition;35:309318
20. SimmonW.K,JustunP.J,FoxK. etal.(1982).Asurveyoftheanemiastatusamong
preschool age children and pregnant lactating women inJamaica. American Journal of
Clinical Nutrition; 35:309-318.
21. AmaniWaleedMahmoud(2007);“IronDeficiencyAnemiaamongPregnant
Women”.

53
 APPENDIX B:
QUESTIONNAIRE

Dear respondent we are students who’s running a bachelor degree from plasma University
College of health science, department of medical Lab technician. This questionnaire has
been prepared for data collection concerning the he laboratory screening of Iron Deficiency
Anemia among pregnant women in Hilaal Hospital at Beledweyne, Somalia.

INSTRUCTIONSTORESPONDENT
1:Donotwriteyournameinthe questionnaires.
2:Theresearchisforacademicpurposeandnotformoney.
3: All information will be private.

4:Pleasefillinthespaceprovidedtothebest ofyour knowledge.

5: You are free to choose not to fill it. .

SECTIONA:SOCIALDEMOGRAPHICFACTOR
1 Ageofthe respondent
a. 15–20

b. 21–25

c. 26-30

d. 31-35

e. Above35

2 Educationofthe respondent

b. Primary

c. Middle

d. Matric

54
e. Intermediate

3 Numberofchildrenyouhave?

a.1-3

b.4-7
c.above7

55
4 Typeofpregnancy

a. Single

b. Twin

c. Triple

d. Quarterlet.

SECTIONB:IMPACTOFIRONDEFICIENCYANEMIA

5 Hb%oftherespondent

a. 3-4g/dl

b. 5-6g/dl

c. 7-10g/dl

d. above10g/dl

6 LFTsoftherespondent

a. <Normal

b. Normal

c. Morethannormal

7 Gestationalmonths.

a.1-3month

b. 4-5month

c. 6-7month

d. 8-9month

8 Ageoflastchildren born

56
a. <1year

b. 1year

c. 2year

d. Above2year

9 Typeoffamilyyouhave?

a. Nuclear

b. Joint

c. Extended

d. anyother

10 Monthly incomeofthehousehold?

a. <$100

b. $100-$200

c. $200-$300

d. Above$300

11 Currentstatusoftherespondent?

a. Housewife

b. Doingjob

c. BothAandB

12 Eatinghabitsoftherespondent?

a. 2timesaday

b. 3timesa day

c. 4timesaday

57
d. Morefrequently

13 Dailyteaintakeoftherespondent?

a. Onceaday

b. Twiceaday

c. Thriceaday

d. Morefrequent

SECTIONC:PREVENT&TREATMENTIRONDEFICIENCYANEMIA

14 Howoftenyoueatfreshfruits,vegetablesand milk?

a. Daily

b. 2timesweek

c. Weekly

d. Veryrare

15 Areyouusinganysortofironsupplement?

a. Yes

b. No

16 Areyousufferingfromfrequentnauseaandvomiting?

a. Yes

b. No

17 Yourdailyeatinghabitsare:

a. Justlikeprevious

b. Doublethenprevious

c. Lessthanprevious

58
18 Doyouknowthatpregnantwomenneeddouble diet?

a. Yes

b. No

19 Doyouknow aboutcheapalternativesofhealthydiet?

a. Yes

b. No

20 Doyouhaveprevioushistoryofmiscarriage?

a. Yes
b. No

59
APENDIX C:

TIME FRAME

Theworkplanofourstudyshows youthespecifictimetowhichspecifictasksaretobe completed or

(time framework)

WeeksAnd 25 Aprilup to 20 May up to

10 February upto 25Juneupto July
20 M ay 10 June
Activity 25 April 2024 2024
2024 2024

Proposalwriting

DataCollection

DataAnalysis

Print

APENDIX C:
60
RESEARCH BUDGET

# Item Costdollar($)

1 Computerandinternet services
-Downloadingandcopying
$20
-Printingtheproposalreportandbook
-Photocopyingquestionnaire $25

$50

2 Stationery

- Duplicationpapers $25
- Pens $5
3 Travellingexpenses

- Tosupplyingquestionnaires $30

- Tocollectquestionnaires $25

4 Total cost $180

61
APPENDIX D:
MAP OF SOMALIA

62
APPENDIX E
MAP OF REGION

63
APPENDIX F
MAP OF DISTRICT

64
APPENDIX G
IMAGE OF TOPIC

65