By July 14, 2017 Medical

Anemia in gestation constitutes a major public wellness job in developing states. It is defined as decrease in the O transporting capacity of the blood as a consequence of fewer circulating red blood cells than normal or a lessening in the concentration of Haemoglobin ( Hb ) ( Hoque et al. , 2009 ) . During gestation, there is an addition in sum of Fe required to increase ruddy cell mass, expand plasma volume and to let growing of fetal-placental unit ( Scholl, 2005 ) . The lack occurs through reduced production or an increased loss of ruddy blood cells. Anaemia in pregnant adult females in developing states is by and large presumed to be the consequence of nutritionary lack. In Malaysia, the incidence of anemia among pregnant female parents go toing public prenatal clinics was reported to be 35 % ( Jamaiyah et al. , 2007 ) . Hadipour et Al. ( 2010 ) reported a higher incidence of anemia among Persian pregnant adult females i.e. 51.4 % . Iron lack anemia is the most prevailing nutritionary lack job impacting pregnant adult females. Pregnant adult females are considered to be the most vulnerable group, since the extra demands that are made on maternal shops during this period exposes them to assorted latent lacks that manifest themselves as anemia ( Hoque et al. , 2009 ) . Increased Fe demands, low pre-pregnancy Fe shops and continued unequal dietetic consumptions of Fe exacerbate this physiologic anemia during gestation in many parts of this universe ( Christian et al. , 2003 ) . Brabin et Al. ( 2001 ) reported a strong association between terrible anemia ( OR 3.51, 95 % CI: 2.05-6.00 ) and maternal mortality.

Anaemia may ensue from both nutritionary and nonnutritional factors, specifically besides Fe, lack of micronutrients such as vitamins A, C and B-12 and folic acid may lend to the development of anemia. These foods may impact hemoglobin synthesis either straight or indirectly by impacting soaking up and/or mobilisation ( Ramakrishnan et al. , 2004 ) . Systemic rating of the efficaciousness of prenatal Fe supplementation is known to raise haemoglobin concentration, although it effects are influenced by dosage and conformity degree ( Christian et al. , 2003 ) . Inability to run into the needed degree for Fe and other vitamins either as a consequence of dietary or auxiliary gives rise to anaemia ( Idowu et al. , 2007 ) . Harmonizing to the World Health Organization ( WHO, 1998 ) , anemia should be considered when the haemoglobin degree is below 11 g/dL. Anaemia ranges from mild, chair to terrible and WHO classifies the haemoglobin degree for each of these types of anaemia in gestation at 10.0-10.9 g/dL ( mild anaemia ) , 7-9 g/dL ( moderate anaemia ) and & lt ; 7 g/dL ( terrible anaemia ) .

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The effects of maternal anaemia on the foetus were considerable and include the undermentioned: the prematureness rate among babies of anaemic female parents was 18.1 % , 3 times that of babies born to nonanemic female parents ; the perinatal loss in the anaemic female parent was 13.1 % , twice that of the nonanemic female parent ( 6.8 % ) ; and the stillbirth rate among babies born to anaemic female parents was 91.0/1000 compared with a rate of 15.7/1000 among babies born to nonanemic female parents. The findings indicate the earnestness of terrible anaemia in gestation. Etiological factors are considered since this will be the footing of rational therapy.

Iron lack anaemia may develop for several grounds. There is normally a dietetic lack of Fe, and at that place may besides be a lowered soaking up from the intestine. Besides, there may be inordinate blood loss due to hookworm and menorrhagia, and there are the demands of perennial childbirth. Apart from hookworm infestation, deficient dietetic consumption of Fe was the chief cause of anaemia among the adult females in the survey with Fe lack anaemia. Among the adult females with megatoblastic anaemia folic acid was the premier lack taking to this type of anaemia. The anaemia was aggravated by increasing malnutrition as demonstrated by lessened serum albumen and globulin concentration. The diagnosing of terrible Fe lack anaemia was made by appraisal of the haemoglobin concentration, supplemented in some instances by serum Fe surveies. Megaloblastic anaemia in gestation can merely be diagnosed with truth by a bone marrow vilification. Consideration of the etiology of anaemia in Malaysia led to a standard intervention among the pregnant adult females surveies. The intervention attack is reviewed in item.

In Malaysia, pregnant adult females from a lower social-economic group indicated the prevalence of anemia was 30-40 % . Since so, Malaysia has had enormous economic alterations and is expected to hold alterations in the prevalence of anemia as good. This survey was conducted with the purpose of identifying of hazard factors that lending anemia among prenatal female parents such as sociodemografic informations, antenatal attention and maternal wellness position.


Anaemia still constitutes a public wellness job in the universe, particularly in the development states ( Royston & A ; Armstrong ) ,1989, Abou Zahr & A ; Royston,1992 ) .Nutritional anemia is found more among rural female parents, where hapless dietetic consumption and parasitic infections are more common. Many adult females start their lives with deficient Fe shops, but besides, because of unequal kid spacing, they have small clip to construct up their Fe degrees between gestations ( WHO,1975 ) .

The consequence of anemia in gestation has been shown to be associated with an addition hazard of maternal and foetal morbility ( Tasker,1958 ; Llewellen-,1965 ; Lourdeadin,1969 ; Baker,1978 ) . However, hazard factors such as anemia in gestation can be controlled and monitored by good antenatal attention and appropriate action, including referral, in conformity to the degree of badness of the anemia.

In Malaysia, 30 to 40 % of pregnant adult females and 25 % of adult females from rural communities suffer from Fe lack anemia. The most common haematologic complication of gestation and is associated with increased rates of premature birth, low birth weight and perinatal mortality. Harmonizing to Jamaiyah et Al. ( 2007 ) , found that the prevalence of anemia during gestation is 35 % and largely of the mild type and more prevalent in the Indian and Malays.

WHO estimates that more than half of pregnant adult females in the universe have a haemoglobin degree declarative mood of anemia. ( & lt ; 11.Ogldl ) , the prevalence may nevertheless be every bit high as 56 or 61 % in developing states. Women frequently become anemic during gestation because the demand for Fe and other vitamins in addition due to physiological load of gestation. The inability to run into the needed degree for these substances either as a consequence of dietetic lacks or infection give rise to anemia. It was supported by Van Den Broek N ( 1998 ) .

Base on the many beliing determination of this similar survey, therefore the purpose of this survey is to find the factors that lending anemia during gestation among female parents admitted at prenatal ward, Hospital Jeli, Kelantan.

1.2 Aims

1.2.1 General aims

To find factors associated with anemia during gestation among female parents admitted at Antenatal Ward, Hospital Jeli, Kelantan.

1.2.2 Specific aims

1. To find the hemoglobin degree for female parents who admitted at prenatal ward, Hospital Jeli, Kelantan

2. To find factors associated with anemia female parents.

1.3 Benefit of survey

Knowledge on factors associated anemia during gestation among female parents such as factors societal demographic, antenatal attention of maternal position and maternal nutrition of the female parents.

To forestall and cut down the prevalence of low birth weight among babies and to forestall maternal and antenatal mortality.

1.4 Conception frame work

Figure 1: factors that lending with anemia

Anemia in gestation constitutes a major public wellness job in developing states. ( Brabin et al.2001 ) . This conceptual model describe those maternal factors that may act upon anemia among prenatal female parents.

The of import factors are the socio demographic informations such as the age of female parent, race, para, instruction degree of female parents, Occupation of female parents, Occupation of male parent and figure of dependant.

Perinatal attention variables that were studied were entree to antenatal engagement, figure of visit to antenatal clinic, para, Period of Gestation ( POG ) , vitamin and Fe addendums, household planning and eating tabu.

Maternal wellness factors such as past medical history, Big babe, APH, placenta praevia, hyperemesis, Hb degree, Multiple gestation and others were included in this survey to find the factors that lending anemia female parents.

Chapter 2


2.1 Definition of anemia in gestation

In gestation, anaemia has a important impact on the wellness of the foetus every bit good as that of the female parent. The physiologic enlargement of the plasma volume is detactable every bit early as 6 to 8 hebdomads gestationan ( Wood & A ; Ronneberg, 2006 ) . The universe wellness organisation ( WHO ) defines anaemia in gestation as haemoglobin concentration of less than 11.0g/dl. WHO estimates that more than half of pregnant adult females in the universe have a haemoglobin degree declarative mood of anaemia ( & lt ; 11.ogldl ) , the prevalence may nevertheless be every bit high as 56 or 61 % in developing states ( WHO, 1994 ) .

Iron is indispensable for multiple metabolic procedures, including O conveyance, DNA synthesis, and electron conveyance. Iron equilibrium in the organic structure is regulated carefully to guarantee that sufficient Fe is absorbed in order to counterbalance for organic structure losingss of Fe. While organic structure loss Fe quantitavely is every bit of import as soaking up in footings of keeping Fe equilibrium, it is a more inactive procedure than soaking up. Consistent mistakes in keeping this equilibrium lead to either Fe lack or Fe overload.

Iron balance is achieved mostly by ordinance of Fe soaking up in the proximal little interstine. Either diminished absorbable dietetic Fe or inordinate loss of organic structure Fe can do Fe lack. Decrease soaking up normally is due to an deficient consumption of dietetic Fe is an absorbable signifier. It si support by Ladewig et Al. ( 2006 ) , found that the common anaemia of gestation are due to either to deficient hemoglobin production related to nutritionary lack in Fe or folic acid during gestation. Anemia is the most common haematologic complication of gestation and is associated with increased rates of premature birth, loe birth weight and perinatal mortality.

Harmonizing to Allen ( 2000 ) , iron lack anaemia is a factor that can do preterm birth and low birth weight and can consequence the neonatal wellness position. Haemoglobin values bead during the 2nd trimester of gestation because of the dilution of the blood caused by plasma additions and this physiologic anaemia is normal. During the 3rd trimester, hemoglobin degrees by and large return to pre gestation degrees because of increased soaking up of Fe from the GI piece of land. Generally, a adult females is considered anemia if her hemoglobin is less than 11 g/dl during the first and 3rd trimester or less than 10.5 g/dl during the 2nd trimester ( Cunningham et al. , 2001 ) .

In Malaysia, ion lacks ever happen in Malay and Indians pregnant adult females because their peculiar eating wonts of different races. It support study done by mohanambal et Al. ( 2002 ) , found that Fe lack was sees in Malays and Indians, no Fe deficienciency was seen among the Chinese.

2.2 Factors associated with anaemia

2.2.1 socio- demographic factors

Malayan baby mortality diffentials, because socioeconomic development has really clearly had a diffential impact by cultural group. The Chinese rates of infant mortality are significantly lower than the Malay or Intdian rates. Low socioeconomic degree was the most of import hazard factor for anemia among prenatal female parents. And was independent of other factors, including those related to production and nutrition, wellness service and prinatal attention. It is support by Sohl & A ; Moore ( 2000 ) , reported that there are clear familial and constituonal influences that act on fetal growing, it is estimated that 40 % of birth weight is due to heredity and the staying 60 % to environmental factors.

Harmonizing to kennedy et Al. ( 1998 ) and Ecob and Smith ( 1999 ) , among the socio-economic factors are income, instruction, business, family leading and gender differences related to functions within the household. It support the findings surveies by Tuntiserance et Al. ( 1999 ) , studied a cohort of 1797 pregnant adult females sing prenatal clinics, they found that significantly factors between socio-economic indexs and gestation results. The indexs were household socio-economic position, maternal instruction, maternal business, household income and work exposures, while the gestation results were base on anemia female parents.

Age of female parent

Maternal age is an of import and dependent hazard factor for inauspicious gestation result ( Delbaere et al.,2007 ) . Epidemiologic surveies suggest that there is a tendency in developing states to detain the age of the first gestation. Maternal age & gt ; 35 old ages for first gestation is associated with low birth weight, intra uterine growing deceleration and prematureness. It is supports the determination survey by Ann et Al. ( 2007 ) that have same decision that increasing maternal age to be associated with low birth weight and anemia during bringing.

Educational degree of female parent

Educational degree of female parent are linked to certain antenatal hazard factors such as anemia and to turn out damaging to deliver outcomes. this can assist intercession workers to place the at hazard female parent. Early designation can ensue in focussed plans administered straight to the persons most likely to profit ( Wasser, 1995 ) . Harmonizing to Currie and moretti ( 2003 ) started that the consequence of maternal instruction on birth weight I the US with a policy increasing the supply of colleges when the female parent was adolescent. The principle is that the gap of a college reduces the cost of higher instruction in a manner that is uncorrelated with the unobservable term correlating both instruction and wellness.

Family income

Family income is by and large considered a primary step of a state ‘s fiscal prosperity. Income or poorness position had a statistically important consequence on anemia female parents and both low birth weight and the mortality rate. Harmonizing to Duncan and Brooks-Gunn ( 1997 ) , found the effects of income or poorness position and a figure of pregnancy-related wellness services on birth results for white and black adult females besides found that for Whites but non for blaks.

Prenatal attention of female parents

Antenatal attention is the clinical appraisal of female parent and foetus during gestation, for the intent of obtaining the best possible result for the female parent and kid. Antenatal attention traditionally involves a figure of ‘routine ‘ visits for appraisal, to a assortment of health care professionals, on a regular footing throughout the gestation.

Number of kids ( para )

Parity was determined to all the figure of old gestations ensuing in either unrecorded birth or still births after 22 hebdomads of gestational age. Maternal para and age were significantly positively associated with anemia female parents.

Womans frequently become anemic during gestation because the demand for Fe and other vitamins is increased. The female parent must increase her production of ruddy blood cells and, in add-on, the foetus and placenta need their ain supply of Fe, which can merely be obtained from the female parent.

In order to hold plenty ruddy blood cells for the foetus, the organic structure starts to bring forth more ruddy blood cells and plasma. It has been calculated that the blood volume increases about 50 per cent during the gestation, although the plasma sum is disproportionately greater. This causes a dilution of the blood, doing the hemoglobin concentration autumn. This is a normal procedure, with the hemoglobin concentration at its lowest between hebdomads 25 and 30. The pregnant adult female may necessitate extra Fe supplementation, and a blood trial called serum ferritin is the best manner of monitoring this.

Many adult females are anemic during gestation. A recent survey by the Anaemia Working Group found that about tierce of pregnant Malayan adult females are anemic. ( Dr. Milton Lum, 2009 ) .Anaemia occurs because there is increased demand for Fe and vitamins in gestation. The female parent has to bring forth more ruddy blood cells for herself and the fetus. More plasma is besides produced.The blood volume additions by about 50 % during gestation with a disproportional addition in plasma. This leads to a dilution of the blood with the hemoglobin falling. The hemoglobin is at its lowest degree between 24 and 30 hebdomads of gestation.

Poor diet: If the diet is low in Fe and vitamins, particularly folic acid, there is a hazard of anemia as these are the natural stuffs needed to bring forth sufficient Numberss of ruddy blood cells. Vegetarians who have a rigorous diet may non acquire adequate Fe or vitamin B12 in their nutrient.

Family history: Some adult females whose household members have anaemia because of familial cistrons are at increased hazard. Chronic conditions like kidney or liver failure, and malignant neoplastic disease increases the hazard. Chronic blood loss from some parts of the organic structure due to ulcers, hemorrhoids, etc, may take to press lack anemia.

2.3 Regulation of Fe transportation to the foetus

Transportation of Fe from the female parent to the foetus is supported by a significant addition in maternal Fe soaking up during gestation and is regulated by the placenta.Serum ferritin normally falls markedly between 12 and 25 wk of gestation, likely as a consequence of Fe use for enlargement of the maternal ruddy blood cell mass. Most Fe transportation to the foetus occurs after hebdomad 30 of gestation, which corresponds to the clip of peak efficiency of maternal Fe soaking up. Serum beta globulin carries Fe from the maternal circulation to transferrin receptors located on the apical surface of the placental syncytiotrophoblast, holotransferrin is endocytosed, Fe is released, and apotransferrin is returned to the maternal circulation. The free Fe so binds to ferritin in placental cells where it is transferred to apotransferrin, which enters from the foetal side of the placenta and issues as holotransferrin into the foetal circulation. This placental Fe transportation system regulates iron conveyance to the foetus. When maternal Fe position is hapless, the figure of placental beta globulin receptors increases so that more Fe is taken up by the placenta. Excessive Fe conveyance to the foetus may be prevented by the placental synthesis of ferritin.

2.4 Effect of anaemia on maternal mortality and morbidity

The major concern about the inauspicious effects of anaemia on pregnant adult females is the belief that this population is at greater hazard of perinatal mortality and morbidity. Maternal mortality in selected development states ranges from 27 ( India ) to 194 ( Pakistan ) deceases per 100000 unrecorded births. Some information show an association between a higher hazard of maternal mortality and terrible anaemia, although such informations were preponderantly retrospective observations of an association between maternal haemoglobin concentrations at, or near to, bringing and subsequent mortality. Such informations do non turn out that maternal anaemia causes higher mortality because both the anaemia and subsequent mortality could be caused by some other status. For illustration, in a big Indonesian survey, the maternal mortality rate for adult females with a haemoglobin concentration & lt ; 100 g/L was 70.0/10000 bringings compared with 19.7/10000 bringings for nonanemic adult females.

2.5 Maternal anaemia and birth weight

The relation between maternal anaemia and birth weight has been reviewed more extensively elsewhere in this issue. In several surveies, a U-shaped association was observed between maternal haemoglobin concentrations and birth weight. Abnormally high haemoglobin concentrations normally indicate hapless plasma volume enlargement, which is besides a hazard for low birth weight. Lower birth weights in anaemic adult females have been reported in several surveies. In a multivariate arrested development analysis of informations from 691 adult females in rural Nepal, adjusted decreases in neonatal weight of 38, 91, 187, and 153 g were associated with hemoglobin concentrations a‰?20, 90-109, 70-89 and & lt ; 70 g/L, severally. The odds for low birth weight were increased across the scope of anaemia, increasing with lower haemoglobin in an about dose-related mode ( 1.69, 2.75, and 3.56 for hemoglobin concentrations of 90-109, 70-89, and 110-119 g/L, severally ) . Tests that included big Numberss of iron-deficient adult females showed that Fe supplementation improved birth weight.

2.6 Maternal Fe lack anaemia and continuance of gestation

There is a significant sum of grounds demoing that maternal Fe lack anemia early in gestation can ensue in low birth weight subsequent to preterm bringing. For illustration, Welsh adult females who were foremost diagnosed with anaemia ( hemoglobin & lt ; 104 g/L ) at 13-24 wk of gestation had a 1.18-1.75-fold higher comparative hazard of preterm birth, low birth weight, and antenatal mortality. After commanding for many other variables in a big Californian survey, Klebanoff et Al showed a twofold hazard of preterm bringing with anaemia during the 2nd trimester but non during the 3rd trimester. In Alabama, low haematocrit concentrations in the first half of gestation but higher haematocrit concentrations in the 3rd trimester were associated with a significantly increased hazard of preterm bringing. When legion potentially confusing factors were taken into consideration, analysis of informations from low-income, preponderantly immature black adult females in the United States showed a hazard of premature bringing ( & lt ; 37 wk ) and later of holding a low-birth-weight baby that was 3 times higher in female parents with Fe lack anaemia on entry to care.

2.7 Maternal anaemia and infant wellness

An association between maternal anaemia and lower baby Apgar tonss was reported in some surveies. In 102 Indian adult females in the first phase of labour, higher maternal haemoglobin concentrations were correlated with better Apgar tonss and with a lower hazard of birth asphyxia. When pregnant adult females were treated with Fe or a placebo in Niger, Apgar tonss were significantly higher in those babies whose female parents received Fe. A higher hazard of premature birth is an extra concern related to the consequence of maternal Fe lack on infant wellness ; preterm babies are likely to hold more perinatal complications, to be growth-stunted, and to hold low shops of Fe and other foods. In the Jamaican Perinatal Mortality Survey of & gt ; 10000 babies in 1986, there was an a‰?50 % greater opportunity of mortality in the first twelvemonth of life for those babies whose female parents had non been given iron addendums during gestation, although the Fe position of these babies and their female parents was non assessed. Apart from this study, there is small known refering the effects of maternal Fe position during gestation on the subsequent wellness and development of the baby.

2.8 Benefits of Fe supplementation on maternal Fe position

There is small uncertainty that Fe supplementation improves maternal Fe position. Even in industrialised states, Fe addendums have been reported to increase haemoglobin, serum ferritin, average cell volume, serum Fe, and transferrin impregnation. These betterments are seen in late gestation, even in adult females who enter gestation with equal Fe position. When compared with unsupplemented pregnant adult females, differences in Fe position due to supplementation normally occur within a‰?3 minute of the clip supplementation begins. Supplement can cut down the extent of Fe depletion in the 3rd trimester. However, for adult females who enter gestation with low Fe shops, Fe addendums frequently fail to forestall Fe lack.

The benefits of Fe supplementation on maternal Fe position during gestation go even more evident postpartum. This is illustrated by a Swedish survey in which all pregnant adult females who did non take Fe addendums had less than “ sufficient ” Fe shops in late gestation compared with 43 % of supplemented ( 200 mg Fe/d ) adult females.

Use of nutritionary addendums

Intake of Fe addendums during gestation was besides found to hold a protective consequence with anemia in gestation. This is consistent with the findings of some other surveies on Fe supplementation and gestation result ( Hesss et al.,2001 ) . Iron supplementation during gestation protects a adult females from going anemic because the needed sums may non be supplied from dietetic consumption during this period. Controlled tests of Fe supplementation during gestation have systematically demonstrated positive effects on maternal Fe position at bringing.

The prevalence of low haemoglobin or hematocrict is reduced: serum ferritin, serum Fe and about every other step of maternal Fe position, including bone marrow Fe, are increased in comparing with controls ( Mohamed, 1998 ) . Malaysia has gone a long manner towards bettering the nutritionary position of the population. Malnutrition has been defined as a “ pathological province ensuing from a comparative or a absolute lack or surplus of one or more indispensable foods, ” it can consist four forms-under-nutrition, over-nutrition, instability and specific lack ( Park, 20000.

Prenatal engagement

Prenatal engagement is a an appraisal of the physical, societal, psychological and emosional province of the pregnant adult females. The chief intent of the booking visit to obtain a comprehensive history, set up the gestational age and place maternal and ftal hazard factors. Baseline probes are performed. Harmonizing to Adesina et Al. ( 2003 ) , stated that early prenatal engagement and good control in gestation are strongly advocated as agencies of accomplishing good gestation result. It support by Tayie and Lartey ( 2008 ) , found that early prenatal attention was associated with gestation results.

Number of visits to prenatal clinics

Antenatal clinic ( ANC ) , refer to gestation related services provided between construct and bringing consisting of supervising wellness position female parent and her gestation. ANC was expected to ontain of female parent to acquire anaemia and preterm bringing plexus, a higher mean birth weight and reduced neonatal mortality. Harmonizing to Kost et Al. ( 1998 ) , prenatal clinic ( ANC ) visits could perchance be seen as index of the female parent ‘s sense of duty to her unborn babe. Visit to ANC services could besides hold a positive influence on the attitude of the female parent, will impact on birth-outcomes. Entire Numberss of ANC visits for the current gestation were categorized as & gt ; 4 visit and & lt ; 4 visit, based on the World Health Organization ( WHO ) and UNUCEF standards that adult females should hold & gt ; 4 ANC visits with an appropriate wellness attention provided ( World wellness organization,2004 )

ANC visits as portion of primary wellness attention to early sensing and intervention of likely job countries, and contribute to the quality of the birth result. ANC has been associated with improved maternal and perinatal result, but there is no understanding on the most effecting timing of visit prenatal female parent. In Malaysia, the frequence of ANC visit depends on the gestational such as 0-28 hebdomad every one mont, 28-36 hebdomad every 2 hebdomad and 36-4- hebdomad every 1 hebdomads.

Antepartum bleeding ( APH )

vagina hemorrhage is an of import factor forecaster of inauspicious effects anemia female parents. About 50 % of adult females who shed blooding in last half of gestation have placenta praevia or abruptio placenta. When of all time the hemorrhage occurs at the beginning of gestation, nevertheless the cause is frequently unknown ( Valero de Bernabe et al.,2004 ) .

Chapter 3


3.1 Study Location

This survey were carried out at the prenatal ward, Hospital Jeli, Kelantan.

3.2 Study Design

A cross-sectional survey design were done in prenatal ward, Hospital Jeli, Kelantan from period of January until March 2011.

3.3 Sampling

3.3.1 Sampling population

All female parents who admitted to antenatal ward, Hospital Jeli, Kelantan during the period of January until March 2011 were included in the survey.

3.3.2 Sampling frame

A list of all prenatal female parents who are admitted at prenatal ward Hospital Jeli, Kelantan during the period of January – March 2011 were obtained.

3.3.3 Sampling Method

Simple random Sampling, where all prenatal female parents who fulfil inclusion standards were selected.

3.3.4 Sample Size

The minimal sample size required in this survey was 30. Datas were collected by utilizing close and unfastened – ended questionnaires and recode reappraisal of admittance registered at prenatal ward, Hospital Jeli, Kelantan. In this survey, all prenatal female parents who admitted were taking by Universal trying.

3.3.5 Inclusion Criteria

Mothers who are willing to take part survey

All The citizen female parents

3.3.6 Exclusion standards

Mothers who ‘s garbage to take part in this survey

Non citizen female parents

Mothers who non understand Malay and English linguistic communication.

3.4 Research Instrument

An interviewer – administered questionnaire was developed with two subdivisions:

Section A ( demographic informations )

Factors socio demographic ( Maternal age, races, instruction degree, household income, employment position, employment position of hubby, Hb degree and figure of dependants.

Section B ( antenatal attention of female parents )

Time period of gesational, prenatal engagement, prenatal clinics, para, nutritionary addendums, .

Section C ( Maternal Health Status )

Factors of maternal wellness position ( past medical history, large babe, infection during gestation, Ante partum bleeding and hyperemesis during gestation.

3.5 Definition of survey variables

The dependent variable:

Antenatal female parent

The independent variables

socio demographic factors



Educational degree

Primary school

Secondary school

Third degree

Occupational of female parents



Non professional

Occupational of hubby


Non professional

Agriculture & A ; forestry

Montly household income. It is divided to 3 classs ;

& lt ; 1000


& gt ; 2500

Hb degree of female parent during admittance

Mild anaemia ( 10.0 – 10.9 g/dL )

Moderate anaemia ( 7.0 – 9 g/dL )

Severe anaemia ( & lt ; 7.0 g/dL )

Number of dependants

two. Prenatal attention of female parents

Number of kids ( para ) all the Numberss of old gestations ensuing in either unrecorded births or still births after 22 hebdomads of gestational age.

Number of visits to antenatal clinics that divided to 3 classs

0-4 visit

5-7 visit

Above 8 visit

Gestational age of female parent – Time measured from the first twenty-four hours of the adult females ‘s last catamenial rhythm to the current day of the month.

Use of nutritionary addendums such as Fe, folic acid, multivitamin and others

three. Maternal Health position

Past medical history -Gestational Diabetic Mellitus ( GDM )

-Pregnancy Induced Hypertension ( PIH )



Ante Partum Haemorrhage

-Placenta praevia

-Placenta abruptio


3.6 Definition of footings

1. Anemia: Anaemia is a deficiency of ruddy blood cells, which can take to a deficiency of O – carrying ability, doing unusual fatigue.

The lack occurs either through the seduced production or an increase loss of ruddy blood cells. These cells are manufactured in the bone marrow and hold a life anticipation of about four months.

The World Health Organization defines a non-pregnant adult females with a hemoglobin of less than 12 g/dl at sea degree as likely to be anaemia.

2.Pregnancy: The province of transporting a developing embryo or foetus within the female organic structure. This status can be indicated by positive consequences on an nonprescription urine trial, and confirmed through a blood trial, ultrasound, sensing of foetal pulse, or an X-ray. Pregnancy lasts for approximately nine months, measured from the day of the month of the adult female ‘s last catamenial period ( LMP ) . It is conventionally divided into three trimesters, each approximately three months long.

3. Parity: Determined to all the figure of old gestations ensuing in either unrecorded births or still births after 22 hebdomads of gestational age.

4.Maternal mortality: Maternal deceases are those for which the certifying doctor has designated a maternal status as the underlying cause of decease. The maternal complications are those assigned to bringings and complications of gestation, childbearing and the puerperium.

5.Prenatal mortality: A antenatal decease is defined as a foetal decease of 20 hebdomads or more

gestation and infant deceases under 28 yearss of life.

6.Gestational age: Gestational age is the clip measured from the first twenty-four hours of the adult females ‘s last catamenial rhythm to the current day of the month.

7.Morbidity: the extent of unwellness, hurt or disablement in a defined population, expressed as general or specific rates of incidence or prevalence. Sometimes used to mention to any episode of disease.

3.7 Data aggregation processs

Data was collected by utilizing close and open-ended questionnaires and recode reappraisal of admittance registered at prenatal ward, Hospital Jeli, Kelantan. This cross sectional survey design was conducted from the month of January until March 2011. In this survey, all prenatal female parents who have anemia were taking by Universal trying.

Pilot Study

A pilot survey was conducted with 5-8 patient at prenatal ward, Hospital Jeli before the survey commented to revise and formalize the questionnaire. The pilot survey was carried on each class of questionnaires to prove for the dependability. Any job was identified and correct.

Datas analysis

All informations analyzed utilizing statistical Package for Social Sciences ( SPSS ) version 18 for Windowss. First, in order to find the distribution of respondents, descriptive statistics were performed on sociodemographic informations ( age, ethnicity, educational degree, occupational, household income and figure of dependants, antenatal feature ( gestational age, prenatal engagement, figure of visit, para and nutritionary addendums. Maternal wellness position ( past medical history, infection, prenatal bleeding and hyperemesis.

The independent t-test was usage to find the important difference between mean of variables such as age of female parent. Statistically important informations were considered to be those had a p-value & lt ; 0.05. .

Study moralss

Ethical blessing was obtained from the Ministry of Health and Medical Research Eethics Committes of Faculty Medicine and Health scientific disciplines. Before carring out this research undertaking, an blessing missive was sent to the Hospital jeli disposal to acquire the consent.


The patient was informed about the survey and the intent of this survey. Merely participants that hold given their written consent were included in this research.

3.12 Confidentiality

All the information given by the engagement is confidential. The information was used purely for this research. The individuality of the participants will non be reveal.

3.13 right the patient

The participants have the right to inquire anything if they do non understand about the questionnaire.

Chapter 4


4.1 Socio demographic feature of the respondents

A sum of 30 respondaents were participated in this survey giving a response rate of 100 % . Table 1 showed the descriptive socio demographic feature of the survey population ( n=300. The age of the respondents ranged from 19 – 39 old ages old and the mean was 29.62 old ages. The bulk of respondaents belonged to the age group of 20 – 35 old ages with 33.3 % . the cultural composing of the survey population was Malays 24 ( 80 % ) , followed by others ( orang asli ) 6 ( 20 % ) . Most of the respondents belonged had secondary instruction was 19 ( 63.3 % ) , primary instruction was 6 ( 20.0 % ) and third degree was 5 ( 16.7 % ) . Most of the respondents were house married woman 22 ( 73.3 % ) , working as non professional and professional are 4 ( 13.3 % ) . The business position of hubby was categorize into 3 groups: professional, non professional and agribusiness and forestry. Majority of hubby businesss were from agribusiness and forestry that made up 16 ( 53.3 % ) compared to professional group 10 ( 33.3 % ) and non professional 4 ( 13.3 % ) . A household income was divided into three classs. Most of the respondents have household income & lt ; RM1000 about 16 ( 53.3 % ) , between RM1000- RM2500 were 10 ( 33.3 % ) and above RM2500 were 4 ( 13.3 % ) . A sum of respondents had mild anaemias were 18 ( 60.0 % ) while the remainder moderate anaemia and terrible anaemia were 6 ( 20.0 % ) . The mean of figure of dependants was 5.29A±1.13. Most of the respondents have the figure of dependants between 5-7 were 21 ( 70.0 % ) , while 6 dependants ( 20.0 % ) were on figure of dependants 2-4 and 3 ( 10.0 % ) were more than 8 Numberss of dependants.

Table 1: distribution of respondents harmonizing to socio demographic factors ( n=30 )





Age ( old ages )

& lt ; 20






& gt ; 36


























Occupation ( female parent )




Non professional



House married woman



Occupation ( hubby )




Non professional



Agribusiness and forestry



Appraisal of household income

& lt ; RM1000



RM1000 – RM2500



& gt ; RM2500



Hb degree

Mild anaemia ( 10.0 – 10.9 g/dL )



Moderate anaemia

7.0 – 9.0 g/dL )



Severe anaemia ( & lt ; 7.0 g/dL )



Family size








& gt ; 8



I“ Pongo pygmaeus asli

4.2 antenatal attention feature of the female parents

Table 11 showed the descriptive prenatal attention feature of the survey population ( n=30 ) . It showed the distribution of female parent ‘s gestational age during admitted at prenatal ward, which formed into three trimesters. 1st trimester ( & lt ; 12 hebdomads ) were 2 ( 6.7 ) , 2nd trimester ( 12-28 hebdomads ) were 10 ( 33.7 ) and 3rd trimester ( & gt ; 28 hebdomads ) were 18 ( 60.0 % ) . Most of the female parents foremost booking at the 1st trimester were 24 ( 80.0 % ) , 2nd trimester were 5 ( 16.7 ) and the 3rd trimester were 1 ( 3.3 ) . Number of visit prenatal clinic were above 8 were 15 ( 50.0 % ) , 5-7 visit were 9 ( 30.0 % ) and visit 0-4 visit 6 ( 20.0 % ) .The distributions of respondents by the regularly everyday antenatal look into up was signifiers into three: yes were 24 ( 80 % ) , no were 5 ( 16.7 % ) and non certain merely 1 ( 3.3 % ) . The overall mean of para female parents was 3.526. By utilizing the WHO categorization, the para was divided into three classs: gravida I ( 1 ) were 9 ( 30.0 % ) , multipara ( 1-4 ) were 17 ( 56.7 % ) and grandmultipara ( above 5 ) were 4 ( 13.4 % ) . Most of the respondents taken the nutritionary addendums such as Fe, folic acid and multivitamin 0-1 times per hebdomads were 11 ( 36.7 % ) , taken 2-3 times per hebdomads 9 ( 30.0 % ) and taken daily merely 10 ( 33.3 % ) .

Table 11: distribution of respondents harmonizing to antenatal attention characteristic ( n=230 )



( % )


Gestational age during admitted

1sttrimester ( & lt ; 12 hebdomads )

2ndtrimester ( 12-28 hebdomads )

3rdtrimester ( & gt ; 28 hebdomads )







Gestational age of the first engagement )

1sttrimester ( & lt ; 12 hebdomads )

2ndtrimester ( 12-28 hebdomads )

3rdtrimester ( & gt ; 28 hebdomads )







Number of visit


0-4 visit



5-7 visit



Above 8 visit



Regular attended everyday antenatal cheque up










1 ( gravida I )



2-4 ( multipara )



Above 5 ( grandmultipara )



Nutritional addendum

0-1 times per hebdomads taken 2-3 times



2-3 per hebdomads






4.3 Maternal Health Status

Table 111 showed the distribution of respondents on maternal wellness position. Consequence showed that merely 3 ( 10.0 % ) of respondents had history of thalassaemia and 27 ( 90.0 % ) non had. One of them had on intervention of blood transfusion. There were 8 ( 26.7 ) maternal with infection during gestation such as prolong febrility 5 ( 16.7 % ) , Urinary piece of land Infection 3 ( 10.0 % ) , non infection was 19 ( 63.3 ) and 3 ( 10.0 ) non certain about it. There were 6 ( 26.7 % ) maternal were has antepartum bleeding ( APH ) , 4 ( 13.4 % ) of them had placenta previa and 2 ( 6.7 % ) had history of shed blooding per vagina, non APH were 22 ( 73.3 % ) . Maternal had hyperemesis were 10 ( 33.3 % ) and 20 ( 66.9 % ) non had.

Table 111: distribution of respondents by maternal wellness position


Yes ( % )

Any intervention ( % )

No ( % )

Not certain ( % )

Past medical history


3 ( 10 % )

3.3 % ( 1 )

90 % ( 27 )

Infection during gestation

Prolong febrility

Urinary Tract Infection

5 ( 16.7 % )

3 ( 10 % )

63.3 % ( 19 )

10.0 % ( 3 )

Ante partum bleeding

73.3 % ( 22 )

Placenta previa

4 ( 13.4 % )

Shed blooding per vagina

2 ( 6.7 % )

Hyperemesis during gestation

10 ( 33.3 % )

20 ( 66.7 % )

Chapter 5


This survey aims to place the factors that lending anaemia among prenatal female parents. Anemia is a major wellness hazard in gestation. The prevalence of anaemia in surveies done in Singapore was 15.3 % and showed that the highest prevalence of anaemia was among Malays. ( Singh and Fong. 1998 ) harmonizing to a WHO study ( 1992 ) , the prevalence of nutritionary lack in pregnant adult females in Southeast Asia was 63 % . In Malaysia, the incidence of anaemia among pregnant female parents go toing public prenatal clinics was reported to be 35 % ( Jamaiyah et al. , 2007 ) .. Harmonizing to the universe Health organisation ( WHO, 1998 ) , anaemia should be considered when the haemoglobin degree is below 11 g/dL. Anemia ranges from mild, chair to terrible and WHO classifies the haemoglobin degree for each of these types of anaemia in gestation at 10.0 – 10.9 g/dL ( mild anaemia ) , 7 – 9 g/dL ( moderate anaemia ) and & lt ; 7 g/dL ( terrible anaemia ) . In this survey the figure of pregnant adult females was 18 ( 60.0 % ) holding mild anaemia, 6 ( 20.0 % ) was moderate and terrible anaemia. The bulk of these female parents were multiparous. This survey showed most of the respondents from the lower socio-economic position. Based on the determination in this survey, most of the respondent ‘s household income is & lt ; RM1000 was 16 ( 53.3 % ) . Some of the female parents were homemakers and their hubbies was rubber tapper and husbandman. The determination describe that low income had relationship with household size, because large household size and low family income, may do the maternal hapless nutritionary consumption because of poorness. Therefore, the household size was consequence the haemoglobin degree of the female parents. It support by Tee et Al ( 1994 ) found a 30-40 % prevalence of anaemia in gestation in Malay female parents from the lower socio-economic position. Previous survey showed that low educational position and socioeconomic position were associated with anaemia during gestation ( Okwu and Ukoha, 2008 ) .

Consequence showed that about 20 ( 66.7 % ) from the 30 respondents did non follow with the supplementations.. In Malaysia, Fe and folic acid supplementation is routinely prescribed in gestation. It is anticipated that good conformity to the prescribed Fe addendum prevent anaemia during gestation. Normaly, four types of tablets are given to pregnant female parents in Malaysia, for illustration, Fe, folic acid, vitamin B comples and vitamin hundred tablets. Iron supplementation during gestation protects a adult females from going anemic because the needed sums may non be supplied from dietetic consumption during this period. A old survey showed that conformity and average hemoglobin can be increased by giving a individual day-to-day dosage ( Sivalingam & A ; Parman, 1988 ) . This determination provides futher support that conformity with supplementation during gestation. Zulkifli et Al. ( 1997 ) found that merely 50 % of those female parents who were anemic during their last visit in malice of everyday contraceptive unwritten Fe supplementation for all pregnant adult females. The writers speculated that hapless betterment in hemoglobin degrees could be due to hapless conformity among the topics.


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