BARRIERS TO ANAEMIA PREVENTION AMONG PREGNANT WOMEN IN

EKPOMA, EDO STATE

ABUBAKAR FIRDAUS OSHOS

CMS/FBM/NSG/18/41261

DEPARTMENT OF NURSING SCIENCE, FACULTY OF BASIC MEDICAL

SCIENCES, COLLEGE OF MEDICAL SCIENCES, AMBROSE ALLI
UNIVERSITY, EKPOMA, EDO STATE.

FEBRUARY, 2023
BARRIERS TO ANAEMIA PREVENTION AMONG PREGNANT WOMEN IN
EKPOMA, EDO STATE

ABUBAKAR FIRDAUS OSHOS

CMS/FBM/NSG/18/41261

DEPARTMENT OF NURSING SCIENCE,

FACULTY OF BASIC MEDICAL SCIENCES,
COLLEGE OF MEDICAL SCIENCES,
AMBROSE ALLI UNIVERSITY, EKPOMA, EDO STATE

IN PARTIAL FULFILMENT OF THE REQUIREMENT OF NURSING AND

MIDWIFERY COUNCIL OF NIGERIA FOR THE AWARD OF BACHELOR OF
NURSING SCIENCE (B. N. Sc.) DEGREE

FEBRUARY, 2023
 DECLARATION

This is to declare that this research project titled BARRIERS TO ANAEMIA

PREVENTION AMONG PREGNANT WOMEN IN EKPOMA, EDO STATE was

carried out by ABUBAKAR FIRDAUS OSHOS is solely the result of my work except

where acknowledged as being derived from other person(s) or resources.

Matriculation Number: CMS/FBM/NSG/18/41261

In the DEPARTMENT OF NURSING SCIENCES, FACULTY OF BASIC

MEDICAL SCIENCES, COLLEGE OF MEDICAL SCIENCES, AMBROSE ALLI

UNIVERSITY, EKPOMA, EDO STATE

……………………………………............. ……………...
ABUBAKAR FIRDAUS OSHOS Date
Student

ii
 CERTIFICATION

This is to certify that this project by ABUBAKAR FIRDAUS OSHOS with

matriculation number: CMS/FBM/NSG/18/41261 has been examined and approved for

the award of Bachelor of Nursing Science (B. N. Sc.) Degree.

…………………………………….... ……………
LAWRENCE A. Date
Project Supervisor

…………………………………….... ……………
LAWRENCE A. L. Date
Head of Department

…………………………………….... ……………
Chief Examiner Date

iii
 ABSTRACT

Anaemia during pregnancy is a public health problem especially in developing countries

and is associated with adverse outcomes in pregnancy. The objective of this study is to
identify the barriers to anaemia prevention among pregnant women in Ekpoma, Edo
state. This was a descriptive survey among pregnant women in Ekpoma, attending
antenatal clinic in Ukpenu primary health centre. A sample of 143 pregnant women were
selected to take part in the study using a convenience sampling technique. Data was
collected using a structured questionnaire and analysed using descriptive statistics.
Findings from the study showed that the main barriers to anaemia prevention among
pregnant women include limited access to iron-rich foods (41.9%), lack of awareness
about anaemia prevention methods (36.4%), fear of side effects of iron supplements
(35.7%), lack of knowledge about the consequences of anaemia during pregnancy
(32.9%), financial constraints preventing the purchase of iron supplements (31.5%), and
cultural beliefs discouraging iron supplementation (25.2%). The anaemia prevention
measures among pregnant women in Ekpoma, Edo state regular use of iron tablets
(95.8%), intake of folic acid supplements (95.1%), intermittent and early preventive
treatment of malaria (90.9%), use of insecticide-treated nets (73.4%), early treatment
and control of helminth infestations such as hookworm and guinea worm (60.8%)and
consumption of foods rich in iron, notably liver and snail (94.4%), inclusion of green
leafy vegetables in their diet (90.9%), intake of citrus fruits or fruit juice (83.2%),
consumption of sprouted grains (67.8%), and frequent inclusion of fibre-rich foods
(55.9%). The study concluded that pregnant women are aware of and implement
preventive measures, there remain barriers that require multi-pronged interventions
from the healthcare community.

Keywords: Barriers, Anaemia prevention, Pregnant women

iv
DEDICATION

v
ACKNOWLEDGEMENT

vi
 TABLE OF CONTENTS

TITLE i
DECLARATION ii
CERTIFICATION iii
ABSTRACT iv
DEDICATION v
ACKNOWLEDGEMENT vi
TABLE OF CONTENTS vii
LIST OF TABLES ix
LIST OF FIGURES x
CHAPTER ONE 1
INTRODUCTION 1
1.1 Background to the study 1
1.2 Statement of problem 1
1.3 Objectives of the study 1
1.4 Research questions 1
1.5 Research hypotheses 1
1.6 Significance of the study 1
1.7 Scope of the study 1
1.8 Operational definition of terms 2
CHAPTER TWO 3
LITERATURE REVIEW 3
2.1 Conceptual review 3
2.2 Theoretical review 3
2.3 Empirical review 3
2.4 Summary of literature review 3
CHAPTER THREE 4
METHODOLOGY 4
3.1 Study design 4
3.2 Study settings 4
3.3 Target population 4
3.4 Sample size determination 4

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3.5 Sampling technique 4
3.6 Instruments for data collection 5
3.7 Validity of the instrument 5
3.8 Reliability of instrument 5
3.9 Method of data collection 5
3.10 Method of data analysis 5
3.11 Ethical considerations 5
CHAPTER FOUR 6
RESULTS 6
4.1 Presentation of results 6
4.2 Answering research questions 7
4.3 Test of hypotheses 8
CHAPTER FIVE 9
DISCUSSION OF FINDINGS 9
5.1 Key findings 9
5.2 Discussion 9
5.3 Implications of findings to nursing 9
5.4 Limitations of study 9
5.5 Summary 9
5.6 Conclusion 9
5.7 Recommendations 9
5.8 Suggestions for further studies 10
REFERENCES 11
APPENDIX 12

viii
 LIST OF TABLES

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ix
 LIST OF FIGURES

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x
 CHAPTER ONE

INTRODUCTION

1.1 Background to the study

Anaemia during pregnancy is a public health problem especially in developing countries

and is associated with adverse outcomes in pregnancy (Nonterah, Adomolga & Yidana,

2019). Anaemia is one of the most common nutritional deficiency diseases observed

globally and affects more than a quarter of the world’s population (Wemakor, 2019)

According to the World Health Organization [WHO] (2022), anaemia affects 1.62 billion

people, among which 56 million are pregnant women globally. Anaemia is described as a

situation in which there is a reduction of haemoglobin concentration in the blood of

pregnant women to a level below 11g/dl. Anaemia during pregnancy is considered severe

when haemoglobin concentration is less than 7.0 g/dl, moderate when the haemoglobin

concentration is 7.0 to 9.9 g/dl, and mild when haemoglobin concentration is 10.0 to 10.9

g/dl (Tulu, Atomssa & Mengistu, 2019).

It is estimated that 41.8% of pregnant women worldwide are anaemic (WHO, 2022).

When the prevalence of anaemia among pregnant women is 40.0% or more, it is

considered as a severe public health problem (McLean, Cogswell, Egli, & Benoist,

2018). In developing countries, the prevalence of anaemia during pregnancy is 60.0%

and about 7.0% of the women are severely anaemic (Agan, Efiok, & Mgbekem, 2022).

In Africa 57.1% of pregnant women are anaemic (de Benoist, Cogswell, Egli, &

Wojdyla, 2018). Sub-Saharan Africa is the most affected region, with prevalence of

1
anaemia estimated to be 17.2 million among pregnant women. This constitutes to

approximately 30% of total global cases (WHO, 2022). In Nigeria the prevalence of

anaemia among pregnant women is 54.5% – 56% (Olatunbosun, Abasiattai, Bassey, &

Ibanga, 2021; Esike, Nwokpor, & Umeora, 2021) and constitutes a severe public health

problem.

Nigeria has one of the highest rates of anaemia in pregnancy in the world. The 2018

Nigeria Demographic and Health Survey (NDHS) reported that approximately 44% of

women aged 15-49 in Nigeria are anaemic (National Population Commission, 2019).

Anaemia prevalence is particularly high among pregnant women, with estimates ranging

from 49% to 66%. Despite various efforts to address this issue, the prevalence of

anaemia among pregnant women in Nigeria has remained high, indicating a need for a

more in-depth understanding of the barriers to anaemia prevention and management

(Duko, Tadesse, Gebre, &Teshome, 2022).

Anemia prevention among pregnant women faces numerous barriers that hinder effective

interventions and contribute to the persistently high rates of anemia in this population

(Akinwaare, Ogueze, & Aluko, 2019; Haidar, 2022). These barriers, rooted in various

factors including individual, cultural, socioeconomic, and healthcare system aspects,

collectively pose significant challenges to addressing anemia during pregnancy (Duko,

Tadesse, Gebre & Teshome, 2022). Individual factors play a crucial role in impeding

anemia prevention efforts such as limited awareness about anemia, its causes, and

preventive measures, non-compliance with recommended iron and folic acid

supplementation and fear of side effects, or a lack of understanding regarding the

2
significance of these supplements may contribute to low adherence rates (Akinwaare,

Ogueze, & Aluko, 2019).

Cultural factors also significantly influence anemia prevention in pregnant women

(Haidar, 2022). Traditional beliefs and practices surrounding pregnancy can restrict the

consumption of iron-rich foods or interfere with the uptake of iron supplements (Ugwu,

& Uneke, 2020). Cultural norms and customs may impose dietary restrictions or taboos,

limiting pregnant women's access to essential nutrients (Tolentino & Friedman, 2022).

Moreover, gender norms and power dynamics within households may hinder women's

autonomy and decision-making regarding their own health, making it challenging to

prioritize anemia prevention (Tulu, Atomssa, & Mengist, 2019). Socioeconomic factors

contribute to the barriers faced by pregnant women in anemia prevention (Olatunbosun,

Abasiattai, Bassey, & Ibanga, 2021). Poverty and food insecurity are pervasive issues

that limit access to a nutritious diet. Pregnant women from poor backgrounds may

struggle to afford or access iron-rich foods (Wemakor, 2019). The high cost of iron

supplements and transportation to healthcare facilities for antenatal care can further deter

women from seeking appropriate interventions.

The healthcare system itself presents barriers to anemia prevention (Tulu, Atomssa, &

Mengist, 2019). Inadequate antenatal care services, characterized by a shortage of skilled

healthcare providers and long waiting times, can impede timely prevention and

management of anemia (Wemakor, 2019). Limited screening for anemia during antenatal

visits contributes to missed opportunities for early detection and intervention.

Additionally, the inconsistent availability of iron supplements in healthcare facilities

further hampers pregnant women's access to these essential resources (Duko et al., 2022;

3
Lumor, Dzabeng, & Adanu, 2019). Addressing the barriers to anemia prevention requires

a comprehensive approach that tackles each of these factors (Akhtar & Hassan, 2022).

Therefore, this study aims to identify the barriers to anaemia prevention among pregnant

women in Nigeria, focusing on the Ekpoma region of Edo State. Understanding these

barriers is crucial to developing effective strategies and interventions to address anaemia

in pregnancy and improve maternal and child health outcomes in Nigeria.

1.2 Statement of problem

Anaemia in pregnancy is a worldwide public health problem affecting both developing

and developed countries with significant impact on the health of mothers and foetus.

Anaemia is an indicator of nutritional deficiencies that significantly contribute to birth

defects, preterm labour and low birth weight, hence it causes global public health

problem (Lumor, Dzabeng, & Adanu, 2019). More so, anaemia is a leading cause of

maternal morbidity and mortality, prenatal and perinatal infant loss; physical and

cognitive losses thus in developing countries stall social and economic development

(Friedrisch & Cançado; Gafter-Gvili et al., 2019). Despite the national health policy of

routine iron supplementation and intermittent preventive treatment for malaria with anti-

malarial drugs, maternal anaemia continues to be a common cause of morbidity and

mortality.

In addition, the researcher during his clinical posting at the Primary Health Centre

Ukpenu observed that some women despite attending regular antenatal care at the centre

often come down with anaemia during delivery. If strategies for preventing maternal

anemia are not adhered to, the condition will persist and result in numerous negative

4
outcomes for pregnant women. These outcomes include the development of anemia,

which in turn can lead to birth defects, preterm labor, and low birth weight.

Consequently, this poses a significant public health problem at the national level.

Therefore, this study is aimed at eliciting information on the barriers to anaemia

prevention among pregnant women in Ekpoma, Edo state.

1.3 Objectives of the study

Broad objective

The objective of this study is to identify the barriers to anaemia prevention among

pregnant women in Ekpoma, Edo state.

Specific objectives

The specific objectives of the study are as follows:

1. To identify the barriers to anaemia prevention among pregnant women in

Ekpoma, Edo state.

2. To assess the anaemia prevention measures among pregnant women in Ekpoma,

Edo state.

1.4 Research questions

1. What are the barriers to anaemia prevention among pregnant women in Ekpoma,

Edo state?

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 2. What is the anaemia prevention measures among pregnant women in Ekpoma,

Edo state?

1.5 Significance of the study

This study will be beneficial to pregnant women, health workers and policy makers. This

study is basically for pregnant women and expectant mothers. Hence the study hopefully

is significant to the extent that the above specify persons should be able; to know what to

do to prevent anaemia in pregnancy, to understand the importance of complying with

anaemia preventive measures. It is believed that the proposition from this study will help

the pregnant women have more knowledge on what anaemia is all about and how to

prevent it by complying with preventive regimen. The health workers will make use of

this study in updating their knowledge about preventive measures for anaemia in

pregnancy, so as to be able to make proper assessment, diagnosis, planning and

implementation of modalities geared towards competent management of cases in order to

reduce the incidence of anaemia among pregnant women. Findings from this study will

hopefully be useful to policy makers in providing appropriate preventive measures to

reduce the maternal mortality of which anaemia is one of the leading causes.

1.6 Scope of the study

The study will be delimited to pregnant women residing in Ekpoma, Edo State. The

scope of the research will focus specifically on identifying the various factors that hinder

anemia prevention in this population.

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1.7 Operational definition of terms

Barriers: Factors that hinder or prevent pregnant women from taking actions to prevent

anaemia during pregnancy.

Anaemia: A medical condition characterized by low levels of red blood cells or

haemoglobin in the blood, which can lead to fatigue, weakness, and other health

complications.

Prevention: Actions taken by pregnant women to avoid or reduce the risk of anaemia

during pregnancy. This may include taking iron and folic acid supplements, consuming a

balanced and nutritious diet, and seeking antenatal care.

Pregnant women: Women who are currently pregnant or have been pregnant in the past

year. This includes women of all ages, socioeconomic backgrounds, and health statuses

who are residing in Ekpoma, Edo state.

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 CHAPTER TWO

LITERATURE REVIEW

This chapter presents all the reviewed literature used in the current study. The chapter

was discussed under the following headings: Conceptual review, Theoretical review and

Empirical review.

2.1 Conceptual review

Anaemia in pregnancy

Anaemia is a global public health problem affecting both developing and developed

countries and its prevalence in pregnant women has been estimated to be 51% (Melku et

al., 2018). Sub-Saharan Africa is the most affected region with an estimated anaemia

prevalence of 57% pregnant women which corresponds to about 17.2 million affected

women with severe consequences for human health as well as social and economic

development. Anaemia occurs at all stages of the life cycle but is more prevalent among

pregnant women (Abriha et al., 2018).

Anaemia occurring in pregnancy is defined as a condition where there is less than 11g/dl

of hemoglobin (Hb) concentration in the blood of pregnant women, which decreases

oxygen-carrying capacity of the blood to the body tissues. The importance of good

hemoglobin concentration during pregnancy for both the woman and the growing foetus

cannot be overemphasized. Being a driving force for oxygen for the mother and foetus, a

reduction below acceptable levels can be detrimental to both (Agan et al., 2022).

8
Anaemia affects 1.62 billion (24.8%) people globally (WHO, 2022). Globally, almost

half of all preschool children (47.4%) and pregnant women (41.8%) and close to one-

third of non-pregnant women (30.2%) are anaemic (De Benoist et al., 2018; Badham et

al., 2022).

WHO has categorized and emphasized on the significant health consequences based on

the prevalence of the anaemia (USAID, 2021). If the prevalence of anaemia is 4.9% or

less, it is considered as no public health problem for that country. Prevalence of anaemia

between 5.0% and 19.9% indicates a mild public health problem. Moderate public health

problem is been considered when the prevalence is between 20.0% and 39.9%. If the

prevalence is 40.0% or more, it is considered as a severe public health problem (McLean

et al., 2018).

Prevalence of anaemia during pregnancy

The prevalence of anaemia in pregnancy in developing countries is reportedly still high

and nearly half of pregnant women worldwide are estimated to be anaemic, with 52% in

sub–Saharan Africa compared to 23% in industrialized countries (WHO, 2021). Recent

world health organization data shows that approximately 10.8million in African

countries, 9.7million in the western pacific are anaemic (Alemu, 2021). Prevalence of

anaemia among pregnant women is around 24.1% in the Americas, 48.2% in South East

Asia, 25.1% in Europe, 44.2% in East Mediterranean, 30.7% in West Pacific and highest

in Africa at 57.1% (de Benoist et al., 2018). Studies in Africa have shown a high

prevalence of anaemia in pregnancy ranging from a low of 41% to a high of 83% in

different settings (Haggaz et al., 2022; Kidanto et al., 2022). Sub-Saharan Africa is the

9
most affected region, with anaemia prevalence estimated to be 17.2 million pregnant

women, which corresponds to approximately 30% of total global cases (WHO, 2022).

In Nigeria the prevalence of anaemia among pregnant women is 54.5%-56%

(Olatunbosun, Abasiattai, Bassey, & Ibanga, 2021; Esike, Anozie, Onoh, Sunday,

Nwokpor & Umeora, 2021) and constitutes a severe public health problem. Anaemia

during pregnancy is a major risk factor for low birth weight, preterm birth and

intrauterine growth restriction and can result in serious neural tube defect, heart defects

and cleft lips, limb defects, and urinary tract anomalies (Bottalico et al., 2019; Dai et al.,

2019; Friedrisch & Cançado; Gafter-Gvili et al., 2019).

A cross-sectional study conducted in northern Tanzania revealed that the prevalence of

anaemia among pregnant women was 47.4% (Sia et al., 2018). A study which was

conducted in the University of Uyo Teaching Hospital, Uyo, Nigeria revealed that the

prevalence of anaemia among pregnant women was 54.5% and majority (61.0%) of the

anaemic women had mild anaemia, 38.5% had moderate anaemia, while 0.5% had severe

anaemia (Olujimi et al., 2018). A study which was conducted in 2018 to determine the

prevalence of anaemia in pregnancy in an urban area of eastern Ethiopia found that

56.8% of pregnant women were anaemic. 1.2% of them were severely anaemic, 26.7%

were moderately anaemic, and 28.9% were mildly anaemic (Kefyalew and Abdulahi,

2018).

Causes of Anaemia in Pregnancy

Globally, the most common cause of anaemia is iron deficiency, which is responsible for

about half of anaemia cases in pregnancy, and it is estimated that in developed countries

10
38% of pregnant women have iron depletion (Jack et al., 2018). In sub-Saharan Africa,

there are multiple causes of anaemia in pregnancy, which Others include inadequate diet,

folate and vitamin B12 deficiencies, impaired micronutrient absorption, blood loss

resulting from haemorrhage, and helminth infestation (Olubukola et al., 2021).

A research done by Buseri et al. (2022) revealed that, in developing countries, the major

causes of anaemia in pregnancy are nutritional deficiencies, parasitic infestations, HIV

infection, haemorrhage and some chronic medical disorders like renal and hepatic

diseases. However, infectious diseases have been reported to cause a high prevalence of

anaemia in sub-Saharan Africa (Alem et al., 2018). Malaria is considered to be the

principal cause of severe anaemia in malaria-endemic areas in Africa (Imelda et al.,

2021). In each year more than 30 million African women in malaria-endemic areas are at

a high risk and it is estimated that malaria contributes for 3 to 5% of maternal anaemia, 8

to 14% of low birth weight and 3 to 8% of infant mortality (Akinleye et al., 2022). The

other non-nutritional causes of anaemia include thalassemia, malaria and genetic blood

disorders such as sickle cell diseases (Adam et al., 2021).

Anaemia in pregnancy is a major public health problem in developing countries. In sub

Saharan Africa, such anaemia is generally accepted as resulting from nutritional

deficiency, particularly iron deficiency (Buseri et al. 2022). Women often become

anaemic during pregnancy because the demand for iron and other vitamins is increased

due to physiological burden of pregnancy. The inability to meet the required levels of

these substances either as a result of dietary deficiencies or infections gives rise to

anaemia. The mother must increase her production of red blood cells and, in addition, the

11
foetus and placenta need their own supply of iron, which can only be obtained from the

mother.

Consequences and burden of anaemia in pregnancy

Anaemia has significant adverse health consequences, as well as adverse impacts on

social and economic development (WHO, 2019). It is one of the most intractable public

health problems in developing countries and the commonest complication in pregnancy

in sub-Saharan Africa (Buseri et al., 2018). In developing countries, anaemia in

pregnancy is a major cause of maternal and foetal morbidity and mortality (Akhtar and

Hassan, 2022). It is estimated that anaemia causes more than 115,000 maternal and

591,000 perinatal deaths globally per year (Salhan et al., 2022). Anaemia during

pregnancy contributes to 20% of all maternal deaths (WHO, 2019). Anaemia increases

risk of maternal morbidity and mortality, abortion, poor intrauterine growth, preterm

birth and low birth weight. These effects in turn result in higher perinatal morbidity and

mortality and higher infant mortality rate (Bodeau et al., 2021).

Anaemia in pregnancy causes low birth weight (Banhidy et al., 2021), fetal impairment

and infant deaths (Kalaivani, 2022). It also causes preterm birth, low APGAR score,

intrauterine growth restriction (Adam et al., 2022; Haggaz et al., 2022; Kidanto et al.,

2022). Deficiency in folic acid during pregnancy can result in a serious neural tube

defect (severe abnormalities of the central nervous system) that develop in embryos

during the first few weeks of pregnancy leading to malformations of the spine, skull, and

brain (Wolff et al., 2022), heart defects and cleft lips (Wilcox et al., 2022), limb defects,

and urinary tract anomalies (Goh and Koren, 2018). When the pregnant women are

12
anaemic, the odds for fetal growth restriction and low birth weight are tripled. The odds

for preterm delivery are more than doubled. Even a moderate hemorrhage in an anaemic

pregnant woman can be fatal (Olujimi et al., 2018).

A basic principle of fetal/neonatal iron biology is that iron is prioritized to red blood cells

at the expense of other tissues, including brain. When iron supply does not meet iron

demand, the fetal brain may be at risk even if the infant is not anaemic. Anaemia

adversely affects cognitive performance, behavior and physical growth of infants,

preschool and school-aged children. Anaemia depresses the immune status and increases

the morbidity from infections in all age groups.

Prevention of anaemia in pregnancy

It is advisable to build up iron store before a woman marries and becomes pregnant. This

can be achieved by: Routine screening for anaemia for adolescent girls from school days;

Encouraging iron rich foods; Fortification of widely consumed foods with iron;

Providing iron supplementation from school days; and Annual screening for those with

risk factors (Dwumfour, 2018).

If all pregnant women receive routine iron and folic acid, it is possible to prevent

nutritional anaemia in pregnant women (Dwumfour, 2018). National Nutritional

Anaemia Prophylaxis Program recommends 60milligram elemental iron and 500

micrograms of folic acid daily for 100 days to all pregnant women. However it is

suggested that 100milligram of elemental iron and 1 milligram folic acid are the

optimum daily doses needed to prevent pregnancy anaemia. Higher dose is required in

13
women from developing countries as they start pregnancy with low or absent iron stores

due to poor nutrition and frequent infections like hook worm and malaria.

WHO recommends that all pregnant women in areas where anaemia is prevalent should

receive supplements of iron and folic acid (WHO, 2022). In spite of the WHO

recommendations, the use of IFAS among pregnant women is still low in Kenya. The

KDHS (2018-09) showed that 54% of women reported taking iron tablets or syrup for

less than 60 days during the pregnancy (MoH, Republic of Kenya, 2018). Daily oral iron

(60 mg) and folic acid (400 μg) should be commenced as soon as a woman becomes

pregnant, and continued up to 6 months' postpartum.

Pregnant women need iron to cover their basic losses, increased RBC mass and demand

from fetoplacental unit. It is recommended to take iron with orange juice to enhance its

absorption. Parenteral iron can be administered intramuscular (IM) or intravenous (IV).

Studies have shown that low or moderate dose of iron/folate supplementation in early

pregnancy has a positive effect on foetal growth in women with both adequate and

deficient iron status (Rodriguez-Bernal, Rebagliato and Ballester, 2022).

Daily IFA supplementation is recommended in women of childbearing age and

adolescent girls where anaemia prevalence is 40% or higher (WHO 2021). The

intermittent IFA supplements are recommended among the non-pregnant population

where anaemia prevalence is less than 20% (WHO 2021)

WHO has endorsed daily oral IFA supplements for pregnant women. The dose of daily

oral IFA supplements is 30 to 60 mg of elemental iron and 0.4 mg of folic acid. 30 to 60

mg of elemental iron is equivalent to 300 mg of ferrous sulfate heptahydrate, 180 mg

14
ferrous fumarate or 500 mg of ferrous gluconate (Goonewardene et al., 2022). This daily

recommended oral IFA supplements must be started as early as possible preferably prior

to impregnation for the prevention of NTD’s (WHO 2012). According to WHO the

recommended dose of intermittent IFA supplements is 60 mg of elemental iron and 2.8

mg of folic acid where the prevalence of anaemia is higher than 20% among the non-

pregnant women. The frequency of intermittent IFA supplement is once a week among

all menstruating girls and adult women (WHO 2021).

Besides increased intake, treatment of underlying conditions and deworming (anti-

helminthic therapy) are important preventive measures. These vitamins play an important

role in embryogenesis and hence any relative deficiencies may result in congenital

abnormalities. Finding the underlying cause is crucial to the management of these

deficiencies. From a neonatal perspective, delayed clamping of the umbilical cord at

delivery (by 1–2 min) is important step in prevention of neonatal anaemia (Olujimi et al.,

2018).

Barriers to anaemia prevention among pregnant women

Despite efforts to improve access to healthcare and nutrition education in Nigeria, many

pregnant women still face significant barriers to preventing anaemia. These barriers can

be categorized into several key areas:

One of the primary barriers to anaemia prevention among pregnant women in Nigeria is

a lack of access to healthcare services (Ekwere and Ekanem, 2019). Many women in

Nigeria live in rural areas where there are few or no health facilities (Ugwu & Uneke,

2020). This makes it difficult for pregnant women to access antenatal care and obtain

15
iron and folic acid supplements, which are essential for preventing anaemia during

pregnancy. Even in urban areas where health facilities are more widely available, some

pregnant women may face financial barriers to accessing healthcare due to the high cost

of medical services (Boti et al., 2018).

In addition to a lack of access to healthcare, cultural and traditional beliefs can also act as

barriers to anaemia prevention among pregnant women in Nigeria (Yesufu et al., 2018).

Some cultural beliefs discourage pregnant women from consuming certain foods or

taking medication during pregnancy. For example, in some communities, pregnant

women are not allowed to eat meat or eggs, which are important sources of iron. In other

cases, traditional healers may discourage pregnant women from seeking medical care,

instead promoting the use of traditional remedies that may not be effective in preventing

or treating anaemia.

Poor nutrition is another significant barrier to anaemia prevention among pregnant

women in Nigeria. Many pregnant women in Nigeria do not have access to a balanced

and nutritious diet due to poverty and food insecurity. This makes it difficult for them to

obtain the necessary vitamins and minerals needed to prevent anaemia. In addition, some

cultural practices such as early marriage and teenage pregnancy may also contribute to

poor nutrition among pregnant women in Nigeria.

Lack of awareness and education about anaemia and its prevention is another barrier

faced by pregnant women in Nigeria. Many pregnant women are unaware of the

importance of taking iron and folic acid supplements or consuming a balanced and

nutritious diet during pregnancy. This lack of awareness may be due to a lack of

16
education and information about anaemia and its prevention, as well as a lack of health

education and promotion programs targeted at pregnant women.

Finally, social and gender norms can also act as barriers to anaemia prevention among

pregnant women in Nigeria. In many communities, women are expected to prioritize the

needs of their families over their own health, which may lead them to neglect their own

health needs during pregnancy. In addition, women may face gender-based

discrimination and inequality, which may limit their access to healthcare and other

resources needed to prevent anaemia.

2.2 Theoretical review

The Health Belief Model

The Health Belief Model (HBM) was developed in the 1950s by a group of social

psychologists in the United States Public Health Service (Rosenstock 1974). The model

attempts to explain and predict an individual’s given health-related behavior from their

beliefs about the behavior and the health problems that the behavior was intended to

prevent or control using a value expectancy approach. It assumes that behavior depends

upon the expected outcomes of an action and the value an individual places on those

outcomes. Six constructs shape the HBM: perceived susceptibility, perceived severity,

perceived barriers, perceived benefits, self-efficacy, and cues to action.

Perceived susceptibility measures an individual’s perception of his or her risk for a

health condition or disease while perceived severity measures feelings surrounding the

seriousness of the condition and the effects of leaving it untreated. The combination of

17
perceived susceptibility and perceived severity is considered a threat or, more broadly,

fear of a disease or health condition.

Perceived barriers include the perceived negative consequences of adopting a behavior

while perceived benefits are the perceived positive consequences of adopting a behavior.

Though these barriers and benefits can be health related, often they are not. Instead, they

might be associated to a greater degree to one’senvironment, lifestyle, or social

surroundings.

Self-efficacy is characterized as the overall confidence in one’s own ability to adopt and

successfully perform a behavior. Having a strong sense of selfefficacy is of great

importance. People with high confidence in their capabilities approach difficult tasks as

challenges to be mastered rather than as threats to be avoided. Conversely, people who

doubt their capabilities shy away from difficult tasks which they view as personal

threats. Thus, lack of self-efficacy can be viewed as a barrier to behavior. Finally, cues to

action refer to “cues such as bodily events and environmental events that instigate

action”. They are the reminders in our everyday lives that signal us to act in one way or

another.

Application of the HBM to the study

The Health Belief Model (HBM) is a theoretical framework that aims to explain and

predict health behaviors by considering individual beliefs, attitudes, and perceptions.

This model can be applied to the topic of barriers to anaemia prevention among pregnant

women in Nigeria.

18
Perceived susceptibility is a key component of the HBM. Pregnant women who perceive

themselves to be at risk of developing anaemia are more likely to take steps to prevent it.

In the context of anaemia prevention, women who understand that anaemia is a common

problem among pregnant women and that they are at risk of developing it may be more

likely to take steps to prevent it.

Perceived severity is another component of the HBM. Pregnant women who understand

the negative consequences of anaemia, such as preterm birth, low birth weight, and

maternal mortality, may be more likely to take steps to prevent it.

Perceived benefits are also important in the HBM. Pregnant women who believe that

taking iron and folic acid supplements and consuming a nutritious diet will prevent

anaemia may be more likely to engage in these behaviors.

Perceived barriers are a significant component of the HBM. Barriers to anaemia

prevention, such as the cost of supplements, lack of access to healthcare facilities, and

cultural beliefs, can discourage pregnant women from taking steps to prevent anaemia.

Cues to action are also essential in the HBM. Healthcare providers can serve as cues to

action by providing information and resources to pregnant women about anaemia

prevention. Antenatal care visits, health education programs, and community outreach

initiatives can also serve as cues to action for pregnant women.

Self-efficacy is a crucial element of the HBM. Pregnant women who feel confident in

their ability to take steps to prevent anaemia, such as taking supplements and consuming

a nutritious diet, are more likely to engage in these behaviors.

19
In conclusion, the Health Belief Model can be applied to the topic of barriers to anaemia

prevention among pregnant women in Nigeria. By considering individual beliefs,

attitudes, and perceptions, the HBM can provide insights into the factors that influence

pregnant women's decisions to prevent anaemia. Interventions that address perceived

susceptibility, severity, benefits, and barriers and provide cues to action and build self-

efficacy can be effective in promoting anaemia prevention among pregnant women in

Nigeria.

2.3 Empirical review

Silubonde et al. (2022) assessed the barriers and facilitators of anaemia prevention

measures among women of reproductive age in Johannesburg, South Africa. This was a

qualitative study among 6 women selected using purposive sampling. Findings revealed

that the barriers to compliance with anaemia prevention measures included the lack of

family support, the link of supplements to antenatal care, and the perceived lack of

benefits of the anaemia prevention measures. Participants reported negative associations

of supplements with medication, individual and societal stigma around medication and

challenges around the supplementation schedule.

Mishra et al. (2021) conducted a cross-sectional questionnaire-based study, including

210 anemic women in a tertiary care center in Delhi, India. In-depth interviews were

conducted with 50 participants. The aim of the study was to evaluate the barriers in the

prevention of anemia and to evaluate the perceptions and practices of anemic women

towards their condition. Findings from the study revealed that ignorance to anemia

symptoms and the importance of consistent intake of the oral iron supplements was seen

20
in 35.2%. 74.8% women accepted that healthcare provider had informed them about

iron-rich and high protein diet, but only 47.1% made dietary modifications. Only 9.5% of

women were consistent in iron intake. Side effects of iron were reported by 30% (n=64)

of women, and 15% were intolerant to oral iron. Non-availability, change of residence,

and forgetfulness were the main reasons behind non-compliance to oral iron.

Ademuyiwa et al. (2020) in a descriptive cross-sectional study among 182 pregnant

women, assessed the level of awareness and prevention of anemia among pregnant

women attending the antenatal clinic at Lagos University Teaching Hospital (LUTH),

Lagos, Nigeria. Simple random sampling technique was used to select the pregnant

women that participated in the study. Findings on demographic variables revealed that

33.3% of the respondents were within the range of 26–30 years of age and the mean age

was 28.16 ± 0.84 years. Furthermore, it was revealed that most of the respondents

sometimes boil their water before drinking 40.6%. Most of the respondents also

sometimes eat a diet rich in iron such as liver, snail, and vegetables. Furthermore, most

of the pregnant women visit the antenatal clinic often visits the antenatal clinic 43.3%

and most of them sometimes put into practice what was taught at the antenatal clinic.

5.6% of the women mentioned that culture and belief affect their prevention of anemia.

A study was done by Akinwaare et al. (2019) to find out the preventive measures and

knowledge of anemia in pregnancy among pregnant women attending antenatal clinic in

Adeoyo Maternity Teaching Hospital, Ibadan. This study used a non-experimental cross-

sectional type of descriptive survey and a convenient sampling technique to select 384

participants. Majority of respondents (69.8%) reported that use of insecticides treated net

can prevents anemia in pregnancy, also majority (63.0%) reported that iron supplements

21
and folic acid can prevent anemia in pregnancy. Many reported that avoidance of

culturally forbidden foods during pregnancy prevents anemia in pregnancy. They also

reported that personal, environmental and food hygiene is important in prevention of

anemia (74.7%). A large number (72.4) reported that its necessary to take supplements

during pregnancy, 67.7% reported that attending antenatal clinic prevents anemia in

pregnancy. Majority reported that smoking and drinking of alcohol during pregnancy can

lead to anemia in pregnancy and that is why they avoid taking them now that they are

pregnant.

Lumor et al. (2019) carried out a cross-sectional study among pregnant women in the

Kintampo North Municipality. This study was conducted to estimate the proportion of

pregnant women using anemia preventing interventions and determine the factors

influencing the use of these interventions. A total of 171 pregnant women attending

ANC in the Kintampo North Municipality were recruited to participate in the study using

purposively sampling. Findings from the study showed that proportion of respondents

who had all four anemia preventing interventions was 29.8%, the remaining 70.2% had

less than the four interventions. Uptake of SP1 was 36.8% while SP2 was 26.3%. Uptake

of SP3 was 17.5%, SP4 and SP5 was 9.9% and 9.4% respectively. All the respondents

were on iron supplements which they took daily. Majority of the respondents, 94.2%

owned an ITN of which about 81.9% obtained it free of charge from the health facility.

2.4 Summary of literature review

This chapter discussed related literature on anaemia occurring in pregnancy and the

barriers to anaemia prevention among pregnant women. Anaemia prevention among

22
pregnant women in Nigeria remains a significant challenge due to a range of social,

cultural, economic, and individual factors. Addressing these barriers will require a

multifaceted approach that includes improving access to healthcare services, promoting

education and awareness about anaemia and its prevention, and addressing cultural and

gender norms that may limit women's access to healthcare and other resources. By

addressing these barriers, we can help to ensure that pregnant women in Nigeria receive

the care and support they need to maintain their health and the health of their babies.

23
 CHAPTER THREE

METHODOLOGY

This chapter deals with the methodology employed by the researcher during the course

of the study. Discussed in this chapter include research design, research settings, target

population, sample size and sampling technique, instrument of data collection, validity

and reliability of research instrument, method of data collection, method of data analysis

and ethical considerations.

1.1 Study design

The study adopted a descriptive survey design to identify the barriers to anaemia

prevention among pregnant women in Ekpoma, Edo state

1.2 Study setting

The study was carried out in a selected health centre in Ekpoma. Ekpoma a semi-urban

settlement located in Esan West Local Government Area of Edo State. Ekpoma is the

administrative headquarters of Esan West Local Government Area of Edo state. Ekpoma

is a university town where most young people in school including tertiary, secondary and

primary institutions reside. Geographically, Ekpoma occupies a total area of 483.29km 2

and located on coordinates. 6°45′N 6°08′E. The people are mainly of Esan tribe and are

predominantly academic and non-academic staffs of Ambrose Alli University, owners of

small-scale medium enterprises (SME’s), subsistence farmers and others which include

civil service, trading, transportation and students of Ambrose Alli University.

24
1.3 Target population

The target population were all pregnant women who attended antenatal clinic in Ukpenu

primary health centre. There were 192 women registered for ANC at Ukpenu primary

health centre based on the previous six months i.e., September 2022 to March 2023.

1.4 Sample size determination

The sample size was calculated using formula for Taro Yamane Formula:

N
n=
1+ N ( e 2 )

Where n = sample size

N = Total population

e = constant (0.05)

Hence,

192
n=
1+192 ( 0.052 )

n=129.7

Therefore,

n ≅ 130

Considering a 10% (13) non-response, the sample size was increased to 143.

25
1.5 Sampling technique

A Convenience sampling technique was used to select the participants for the study.

Inclusion criteria

 Women who consented to participate in the study.

 Women registered at the antenatal clinic.

Exclusion criteria

Women who do not consent to the study.

1.6 Instruments for data collection

The instrument of data collection was a structured questionnaire. The questionnaire was

divided into 3 sections. Section A contained items to elicit the sociodemographic

characteristics of the respondents; Section B contained items to identify the barriers to

anaemia prevention; and section C contained items to assess anaemia prevention

measures.

1.7 Validity of the instrument

Face and content validity technique was used to ascertain the validity of the research

instrument. Copies of the questionnaire was submitted to experts in the field of maternal

and child health to rephrase and restructure questions in line with the reviewed literatures

and objectives of the study.

26
1.8 Reliability of instrument

The test-retest method was used to establish the reliability of the questionnaire. A trial

testing will be carried out on 13 women who were not part of the sample as participants

drawn from the health centre outside the study area. The instrument was administered on

the subjects twice at two weeks interval. The scores from the two administrations were

correlated using Pearson Product Moment Correlation analysis to achieve an index of

reliability at 0.84 which was accepted as reliable.

1.9 Method of data collection

The researcher was assisted by the research assistants to administer the questionnaires to

the mothers at the health facilities. The research assistants were trained by the principal

researcher on the study objectives, purpose and interviewing techniques based on the

research instrument. Before the questionnaires are distributed, eligible mothers were

given explanations concerning the study and how the questionnaire is to be filled by the

respondents, and upon verbal consent to participate. The participants were informed of

the voluntariness of participating in the study, and their confidentiality were assured by

the absence of identifiers on the questionnaire. The questionnaires were filled and

collected immediately on the spot.

1.10 Method of data analysis

Data was analyzed using descriptive statistics (frequencies, means and standard

deviations) and illustrated using frequency tables.

27
1.11 Ethical considerations

Ethical approval was obtained from the Primary Health Coordinator, Esan West Local

Government Area of Edo state. After approval of the proposal, permission to collect data

was obtained from the Matron at the health centre. Nature and purpose of the study were

explained to the participants. Respondents were informed of their right to ask questions

for clarification. An informed consent was obtained from the study participants after

thorough explanation of the benefits of the study and any concerns clarified. Only

women who indicated that they understood the nature of the study and are where willing

to participate were allowed to sign the consent and then interviewed. The women were

informed of the voluntariness of participating in the study. Participants were informed

about the purpose of the study, the data protection rights, and the right to refuse

participation in the study or to terminate the participation without reasoning or penalty.

Confidentiality was assured. Anonymity was maintained, as respondents were not asked

for any identifiers such as their names, surnames, or addresses.

28
 CHAPTER FOUR

RESULTS

This chapter presents the analysis and interpretation of results. A total of 143

questionnaires were distributed and 143 were included for analysis.

1.12 Sociodemographic characteristics

Table 1. Sociodemographic characteristics of the respondents

Variable Frequency Percentage (%)

Age (in years)
20-29 72 50
30-39 57 39.8
40-49 14 10.2
Religion
Christian 138 96.5
Muslim 5 3.5
Traditional 0 0
Marital status
Single 26 18.2
Married 115 80.4
Divorced 0 0
Widowed 0 0
Separated 2 1.4
Level of education
No formal education 4 2.8
Primary 25 17.5
Secondary 66 46.2
Tertiary 48 33.6
Occupation
Housewife 7 4.9
Farmer 12 8.4
Trader 81 56.6
Civil servant 35 24.5
Artisan 8 5.6
Parity
1-2 88 61.5
3-4 33 23.1
5 or more 22 15.4

29
Table 1 presents the sociodemographic characteristics of the respondents. The data

includes information on age, religion, marital status, level of education, occupation, and

parity.

Age distribution indicates that the majority of the respondents (50%) fall within the age

group of 20-29 years, with 39.8% in the 30-39 age group, and 10.2% in the 40-49 age

group.

Regarding religion, 96.5% of the respondents identify as Christians, while 3.5% are

Muslims, and none follow traditional religions.

In terms of marital status, the majority (80.4%) are married, 18.2% are single, and there

are smaller percentages for separated (1.4%) and widowed (0%) individuals.

Education levels vary, with 33.6% having tertiary education, 46.2% having secondary

education, 17.5% having primary education, and 2.8% having no formal education.

Occupation-wise, the largest group of respondents (56.6%) are traders, followed by civil

servants (24.5%), artisans (5.6%), housewives (4.9%), and farmers (8.4%).

Parity data reveals that 61.5% of respondents have 1-2 children, 23.1% have 3-4

children, and 15.4% have 5 or more children.

30
1.13 Barriers to anaemia prevention

Table 2. Barriers to anaemia prevention among the respondents

Variable Frequency Percentage (%)

Lack of awareness about anaemia prevention methods
Yes 52 36.4
No 91 63.6
Limited access to iron-rich foods
Yes 60 41.9
No 83 58.1
Cultural beliefs and practices that discourage iron
supplementation
Yes 36 25.2
No 107 74.8
Inadequate antenatal care services
Yes 34 23.8
No 109 76.2
Lack of transportation to health facilities
Yes 39 27.3
No 104 72.7
Financial constraints preventing the purchase of iron
supplements
Yes 45 31.5
No 98 68.5
Fear of side effects of iron supplements
Yes 51 35.7
No 92 64.3
Lack of support from family for anaemia prevention measures
Yes 32 22.4
No 111 77.6
Lack of motivation to prioritize anaemia prevention during
pregnancy
Yes 34 23.8
No 109 76.2
Lack of knowledge about the consequences of anaemia during
pregnancy
Yes 47 32.9
No 96 67.1

Table 2 presents the barriers to anaemia prevention among the respondents. Among the

participants, 52 (36.4%) reported a lack of awareness about anaemia prevention methods

as a significant barrier. Similarly, 60 (41.9%) individuals cited limited access to iron-rich

31
foods as a challenge. Additionally, 36 (25.2%) respondents expressed that cultural

beliefs and practices that discourage iron supplementation impeded anaemia prevention

efforts.

Furthermore, 34 (23.8%) participants highlighted inadequate antenatal care services as a

barrier, while 39 (27.3%) reported a lack of transportation to health facilities. Moreover,

financial constraints preventing the purchase of iron supplements were identified by 45

(31.5%) respondents, and 51 (35.7%) individuals expressed concerns about the side

effects of iron supplements. Additionally, 32 (22.4%) respondents reported a lack of

support from their family for anaemia prevention measures.

Moreover, 34 (23.8%) participants indicated a lack of motivation to prioritize anaemia

prevention during pregnancy, and 47 (32.9%) individuals cited a lack of knowledge

about the consequences of anaemia during pregnancy as a barrier.

32
1.14 Anaemia prevention measures

Table 3. Anaemia preventive measures used by the respondents

Variable Frequency Percentage (%)

Take foods rich in iron for example, liver, and snail
Yes 135 94.4
No 8 5.6
Include green leafy vegetable in your diet
Yes 130 90.9
No 13 9.1
Take citrus fruits or drinking fruit juice during pregnancy
Yes 119 83.2
No 24 16.8
Include sprouted grains in diet
Yes 97 67.8
No 46 32.2
Include fibre rich food frequently in diet
Yes 80 55.9
No 63 44.1
Use regular iron tablets during your current pregnancy
Yes 137 95.8
No 6 4.2
Take folic acid supplements in current pregnancy
Yes 136 95.1
No 7 4.9
Use insecticide treated nets during pregnancy
Yes 105 73.4
No 38 26.6
Take intermittent and early preventive treatment of malaria
Yes 130 90.9
No 13 9.1
Take early treatment and control of helminths infestations
Yes 87 60.8
No 56 39.2

Table 3 reveals the anaemia preventive measures adopted by the respondents. The

majority, 135 (94.4%), reported taking foods rich in iron, such as liver and snails, as part

of their dietary habits. Additionally, 130 (90.9%) participants indicated that they

included green leafy vegetables in their diet during pregnancy. Furthermore, 119 (83.2%)

33
respondents reported consuming citrus fruits or drinking fruit juice as part of their

anaemia prevention practices.

Moreover, 97 (67.8%) individuals mentioned including sprouted grains in their diet,

while 80 (55.9%) reported the inclusion of fiber-rich foods frequently. In terms of

supplementation, 137 (95.8%) respondents used regular iron tablets during their current

pregnancy, and 136 (95.1%) took folic acid supplements.

Regarding malaria prevention, 105 (73.4%) participants used insecticide-treated nets

during pregnancy, and 130 (90.9%) reported taking intermittent and early preventive

treatment for malaria. Additionally, 87 (60.8%) respondents mentioned taking early

treatment and control measures for helminth infestations, such as hookworm and guinea

worm, during pregnancy.

34
1.15 Answering research questions

What are the barriers to anaemia prevention among pregnant women in Ekpoma,

Edo state?

The main barriers to anaemia prevention among pregnant women in Ekpoma, Edo state

include limited access to iron-rich foods (41.9%), lack of awareness about anaemia

prevention methods (36.4%), fear of side effects of iron supplements (35.7%), lack of

knowledge about the consequences of anaemia during pregnancy (32.9%), financial

constraints preventing the purchase of iron supplements (31.5%), and cultural beliefs

discouraging iron supplementation (25.2%). Others were lack of transportation to health

facilities (27.3%), inadequate antenatal care services (23.8%), lack of motivation to

prioritize anaemia prevention during pregnancy (23.8%), and lack of support from family

for anaemia prevention measures (22.4%).

What is the anaemia prevention measures among pregnant women in Ekpoma, Edo

state?

The anaemia prevention measures among pregnant women in Ekpoma, Edo state include

consumption of foods rich in iron, notably liver and snail (94.4%), inclusion of green

leafy vegetables in their diet (90.9%), intake of citrus fruits or fruit juice (83.2%),

consumption of sprouted grains (67.8%), frequent inclusion of fiber-rich foods (55.9%),

regular use of iron tablets (95.8%), intake of folic acid supplements (95.1%), use of

insecticide-treated nets (73.4%), intermittent and early preventive treatment of malaria

35
(90.9%), and early treatment and control of helminth infestations such as hookworm and

guinea worm (60.8%).

36
 CHAPTER FIVE

DISCUSSION OF FINDINGS

1.16 Key findings

 The main barriers to anaemia prevention among pregnant women in Ekpoma,

Edo state include limited access to iron-rich foods (41.9%), lack of awareness

about anaemia prevention methods (36.4%), fear of side effects of iron

supplements (35.7%), lack of knowledge about the consequences of anaemia

during pregnancy (32.9%), financial constraints preventing the purchase of iron

supplements (31.5%), and cultural beliefs discouraging iron supplementation

(25.2%). Others were lack of transportation to health facilities (27.3%),

inadequate antenatal care services (23.8%), lack of motivation to prioritize

anaemia prevention during pregnancy (23.8%), and lack of support from family

for anaemia prevention measures (22.4%).

 The anaemia prevention measures among pregnant women in Ekpoma, Edo state

include consumption of foods rich in iron, notably liver and snail (94.4%),

inclusion of green leafy vegetables in their diet (90.9%), intake of citrus fruits or

fruit juice (83.2%), consumption of sprouted grains (67.8%), frequent inclusion

of fiber-rich foods (55.9%), regular use of iron tablets (95.8%), intake of folic

acid supplements (95.1%), use of insecticide-treated nets (73.4%), intermittent

and early preventive treatment of malaria (90.9%), and early treatment and

control of helminth infestations such as hookworm and guinea worm (60.8%).

37
1.17 Aligning findings with previous studies

The findings from the study conducted in Ekpoma, Edo state, align with previous studies

conducted in different geographical locations, providing a comprehensive understanding

of the barriers and preventive measures related to anemia among pregnant women. The

identified barriers in the Ekpoma study, such as limited access to iron-rich foods, lack of

awareness about anemia prevention methods, fear of side effects of iron supplements,

and lack of knowledge about the consequences of anemia during pregnancy, reflect

common themes found in studies by Silubonde et al. (2022), Mishra et al. (2021),

Ademuyiwa et al. (2020), Akinwaare et al. (2019), and Lumor et al. (2019).

The issue of limited access to iron-rich foods was similarly highlighted by Silubonde et

al. (2022) and Akinwaare et al. (2019), indicating that this challenge is prevalent across

different settings. Additionally, the Ekpoma study emphasized the lack of awareness

about anemia prevention methods, which resonates with the findings from Ademuyiwa et

al. (2020) and Akinwaare et al. (2019). The fear of side effects associated with iron

supplements, as observed in the Ekpoma study, was also a concern raised in the study by

Mishra et al. (2021), further emphasizing the impact of this barrier on anemia prevention

measures.

Moreover, the findings from Ekpoma demonstrate that the lack of knowledge about the

consequences of anemia during pregnancy is a significant barrier, which is consistent

with the results presented by Silubonde et al. (2022). Furthermore, the cultural beliefs

discouraging iron supplementation, inadequate antenatal care services, lack of

transportation to health facilities, lack of motivation to prioritize anemia prevention

38
during pregnancy, and lack of support from family for anemia prevention measures are

key factors identified in the Ekpoma study that have also been acknowledged in other

studies, suggesting the universality of these barriers in diverse populations.

The findings from the study on anaemia prevention measures among pregnant women in

Ekpoma, Edo state, align with and contribute to a growing body of literature examining

the practices and challenges associated with anaemia prevention in various contexts. The

high reported rates of dietary measures for anaemia prevention, such as consumption of

iron-rich foods (94.4%), green leafy vegetables (90.9%), and citrus fruits (83.2%), as

well as the use of iron (95.8%) and folic acid supplements (95.1%), suggest a strong

awareness and adoption of recommended anaemia prevention practices among the

participants in Ekpoma. This contrasts with findings from Mishra et al. (2021) in India,

where a much lower percentage of women made dietary modifications even after being

informed by healthcare providers, and a small fraction consistently took iron

supplements. The contrast could indicate a higher level of health education and possibly

better implementation of health recommendations among pregnant women in Ekpoma.

The utilization of antenatal services and malaria prevention strategies, such as the use of

insecticide-treated nets (73.4%) and preventive malaria treatment (90.9%), also indicates

a broad adherence to preventive health measures, reflecting awareness of the

multifactorial nature of anaemia beyond iron deficiency. This is in line with the findings

of Akinwaare et al. (2019), who found a recognition of the role of insecticide-treated nets

in anaemia prevention among the respondents in Ibadan, Nigeria. However, the

adherence to preventive measures in Ekpoma appears to be higher than in the Kintampo

North Municipality study by Lumor et al. (2019), which could be attributed to

39
differences in program implementation and access to health services. The preventive

measures for helminth infestations reported by 60.8% of respondents in Ekpoma also

resonate with the broader understanding that tackling parasitic infections is critical for

anaemia prevention, as indicated by the practices reported by Lumor et al. (2019), where

all respondents were on iron supplements, and a majority had insecticide-treated nets.

1.18 Implication of the findings with literature support

The findings from the study on barriers to anaemia prevention among pregnant women in

Ekpoma, Edo state, indicate a multifaceted landscape of challenges that resonate with

previous research on anaemia prevention measures among women of reproductive age in

different regions. The identified barriers align with key themes identified in the

literature, shedding light on the complex interplay between individual, cultural, and

systemic factors that shape anaemia prevention practices.

Limited access to iron-rich foods, a prominent barrier reported by 41.9% of the

respondents, corresponds to Mishra et al.'s (2021) findings that a lack of dietary

modifications was prevalent among anemic women. Similarly, Ademuyiwa et al. (2020)

highlighted the influence of cultural beliefs on dietary practices, indicating that cultural

preferences and beliefs can significantly affect the adoption of iron-rich diets. The

findings suggest a need for targeted nutritional interventions, emphasizing the

importance of culturally appropriate dietary education and access to affordable nutrient-

rich foods in Ekpoma, Edo state.

The lack of awareness about anaemia prevention methods, cited by 36.4% of the

respondents, echoes findings from Silubonde et al. (2022), underscoring the significance

40
of education and awareness campaigns in promoting anaemia prevention measures. The

reported fear of side effects of iron supplements (35.7%) and financial constraints

preventing the purchase of iron supplements (31.5%) resonate with the challenges

identified by Mishra et al. (2021), where side effects and accessibility were highlighted

as major factors affecting the compliance and adherence to iron supplementation. These

findings suggest the importance of providing comprehensive information about the

benefits and potential side effects of iron supplementation and addressing financial

barriers to ensure access to affordable supplements for pregnant women in Ekpoma.

The lack of knowledge about the consequences of anaemia during pregnancy (32.9%)

underscores the need for targeted health education interventions, emphasizing the

potential risks associated with untreated anaemia during pregnancy. The reported lack of

transportation to health facilities (27.3%) and inadequate antenatal care services (23.8%)

highlight systemic barriers to accessing healthcare, aligning with Lumor et al.'s (2019)

findings on the importance of healthcare infrastructure and service availability in

promoting anaemia prevention practices. These findings emphasize the need for

improved healthcare infrastructure and accessibility to antenatal care services in

Ekpoma, Edo state, to facilitate early detection and management of anaemia among

pregnant women.

Furthermore, the reported lack of motivation to prioritize anaemia prevention during

pregnancy (23.8%) and the lack of support from family for anaemia prevention measures

(22.4%) emphasize the critical role of social support and motivation in promoting

healthy behaviors during pregnancy. Akinwaare et al. (2019) highlighted the significance

of family and social support in promoting anaemia prevention measures, suggesting the

41
need for community-based interventions that involve families and encourage social

support for pregnant women in Ekpoma.

The findings from the anaemia prevention measures among pregnant women in Ekpoma,

Edo state, highlight several noteworthy aspects, reflecting both the adherence to

recommended measures and the potential challenges that might be encountered in the

implementation of such measures. The high reported rates of consumption of iron-rich

foods such as liver and snails (94.4%), along with the inclusion of green leafy vegetables

(90.9%) and citrus fruits (83.2%) in their diet, reflect a commendable level of awareness

and adherence to dietary modifications to combat anaemia. This aligns with the findings

of Akinwaare et al. (2019), who observed that pregnant women recognized the

significance of iron supplements and iron-rich diets in preventing anaemia. However, the

comparatively lower reported rates of consuming fiber-rich foods (55.9%) and sprouted

grains (67.8%) suggest potential gaps in the knowledge and practice of a comprehensive

diet for anaemia prevention.

The high reported usage of iron tablets (95.8%) and folic acid supplements (95.1%) in

Ekpoma signifies a strong emphasis on pharmacological interventions, likely indicative

of effective antenatal care services. However, the study by Mishra et al. (2021)

highlights the challenges related to iron intake, including side effects and inconsistencies

in supplementation. While this study did not directly examine side effects or compliance,

the high reported usage suggests that the pregnant women in Ekpoma might have found

effective ways to manage or mitigate potential side effects, leading to better compliance

rates.

42
The significant utilization of preventive measures for malaria, such as the use of

insecticide-treated nets (73.4%) and intermittent early preventive treatment for malaria

(90.9%), underscores the multifaceted approach adopted by the participants, considering

that malaria is one of the leading causes of anaemia in many tropical regions. This

finding is consistent with the study by Lumor et al. (2019), which emphasizes the

importance of preventive interventions in reducing the burden of anaemia. Additionally,

the reported early treatment and control of helminth infestations (60.8%) reflect an

awareness of the role of parasitic infections in contributing to anaemia, suggesting a

comprehensive approach to anaemia prevention among the pregnant women in Ekpoma.

However, the findings from Silubonde et al. (2022) indicate the potential influence of

perceived benefits and societal stigma on compliance with anaemia prevention measures.

While the present study did not directly examine the participants' perceptions or attitudes

toward the preventive measures, the high reported adherence rates may suggest a

relatively favorable perception of the benefits of these measures among the pregnant

women in Ekpoma. Additionally, the reported cultural influence on anaemia prevention,

highlighted by Ademuyiwa et al. (2020), was not specifically addressed in the current

study. Still, the findings indicate a general willingness to incorporate health

recommendations provided during antenatal care visits, suggesting a positive impact of

healthcare education and support in overcoming cultural barriers.

43
1.19 Implications of findings to nursing

The findings from Ekpoma provide crucial insights for the nursing profession,

particularly those engaged in maternal and child health. Here are some of the

implications of these findings:

1. Tailored Patient Education: The data underscores the importance of patient

education. Nurses, often being the primary point of contact in antenatal clinics,

should ensure that pregnant women understand the benefits of consuming iron-rich

foods and the potential side effects of iron supplements. By providing clear,

personalized instructions, nurses can help increase adherence to anaemia prevention

regimens.

2. Cultural Sensitivity in Care: The findings highlight the impact of cultural beliefs on

the acceptance and adherence to anaemia prevention measures. As such, nurses

should be trained to offer culturally sensitive care, ensuring that traditional beliefs are

respected while ensuring evidence-based health education.

3. Assessment of Barriers: With various barriers identified, such as lack of

transportation, financial constraints, and lack of awareness, nurses should assess

individual patients to determine specific challenges they might face in adhering to

anaemia prevention methods. This can help in devising personalized strategies or

interventions to mitigate these barriers.

4. Collaboration with Extended Healthcare Teams: The multidimensional nature of

anaemia prevention suggests that nurses should collaborate closely with nutritionists,

social workers, community health workers, and pharmacists. This integrated

44
 approach can offer comprehensive care to pregnant women, from dietary advice to

ensuring consistent intake of iron supplements.

5. Advocacy and Community Outreach: Given the reported lack of awareness and

motivation in some pregnant women, nurses, as trusted health professionals, have a

role in community education and advocacy. Through workshops, community

meetings, or partnership with local leaders, nurses can promote the importance of

anaemia prevention during pregnancy.

6. Feedback Mechanisms: Implementing feedback mechanisms in antenatal clinics can

be valuable. Nurses can gather data on patient experiences, challenges faced in

adherence, and any side effects from medications. This feedback can be instrumental

in refining interventions and providing better care.

7. Resource Allocation: Recognizing the barriers such as financial constraints and lack

of transportation, nursing administrators and policymakers can advocate for better

resource allocation, be it in the form of subsidized supplements, transportation

assistance, or even mobile clinics.

8. Emphasizing the Role of Family Support: Given that lack of family or spousal

support was a barrier, nurses should involve family members in antenatal

consultations and education sessions. By engaging the family, there's a greater

likelihood of creating a supportive environment for the pregnant woman.

1.20 Limitations of study

In carrying out the research, the researcher encountered the following challenges: finance

in printing the questionnaires, uncooperativeness of some of the respondents, and limited

time to carry out the research

45
1.21 Summary

The study aimed to uncover the barriers hindering anaemia prevention among pregnant

women in Ekpoma, Edo state. Conducted at the Ukpenu primary health centre, this

descriptive survey enlisted 143 pregnant women attending antenatal clinics, with

participants selected via a convenience sampling technique. The research tool was a

structured questionnaire, and data interpretation relied on descriptive statistics. Key

findings identified several barriers to anaemia prevention including limited access to

iron-rich foods (41.9%), lack of awareness about anaemia prevention methods (36.4%),

fear of side effects of iron supplements (35.7%), lack of knowledge about the

consequences of anaemia during pregnancy (32.9%), financial constraints preventing the

purchase of iron supplements (31.5%), and cultural beliefs discouraging iron

supplementation (25.2%). The anaemia prevention measures among pregnant women in

Ekpoma, Edo state regular use of iron tablets (95.8%), intake of folic acid supplements

(95.1%), intermittent and early preventive treatment of malaria (90.9%), use of

insecticide-treated nets (73.4%), early treatment and control of helminth infestations

such as hookworm and guinea worm (60.8%)and consumption of foods rich in iron,

notably liver and snail (94.4%), inclusion of green leafy vegetables in their diet (90.9%),

intake of citrus fruits or fruit juice (83.2%), consumption of sprouted grains (67.8%), and

frequent inclusion of fibre-rich foods (55.9%).

1.22 Conclusion

In conclusion, the research conducted in Ekpoma, Edo state, offers pivotal insights into

the anaemia prevention measures among pregnant women. It underscores the

46
significance of dietary practices, the utilization of supplements, and the impact of

sociocultural factors on prevention efforts. The data emphasizes the need for a

comprehensive, culturally-sensitive, and patient-centered approach to improve adherence

and ultimately ensure better maternal health outcomes. It is evident that while many

pregnant women are aware of and implement preventive measures, there remain barriers

that require multi-pronged interventions from the healthcare community. This research

sets the foundation for tailored interventions and policies that can cater to the unique

needs of this demographic.

1.23 Recommendations

Based on the findings of this study the following were recommended:

 Promoting the benefits of early and frequent ANC through community-based

sensitization programmes and mass media campaigns.

 Enhancing the quality of ANC counselling and promoting the knowledge of

women on anaemia are essential elements for improving the awareness of

anaemia.

 Incorporating health extension workers and social workers in order to improve

strong involvement in the dissemination of health information.

 It is recommended that health promotion and disease prevention campaigns on

anaemia be organised at places of contact with pregnant women and women of

the reproductive age group.

 Public enlightenment campaigns should be embarked upon to sensitize the public

on what anaemia is, its causes, risk factors and complications.

47
  Health education and promotion efforts should be directed towards encouraging

pregnant women to book early for antenatal care and to take appropriate

intervention measures.

1.24 Suggestions for further studies

Further research needs to be conducted to find the inhibiting and promoting factors

regarding IFA supplementation, with a potential input in designing and implementing

effective interventions by governmental public health institutions.

48
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 RESEARCH QUESTIONNAIRE

RESEARCH QUESTIONNAIRE

DEPARTMENT OF NURSING SCIENCES, AMBROSE ALLI UNIVERSITY,

EKPOMA EDO SATE

Dear Respondent,

I am a student of the above institution conducting research on “Barriers to anaemia

prevention among pregnant women in Ekpoma, Edo state”.

I humbly request your participation in this study. Kindly and freely express your view

and opinion by answering the questions that follow. Any information provided will be

treated with utmost confidentiality and used for academic purpose only.

Thanks for your anticipated cooperation.

Instruction: Tick of fill in the appropriate response as it applies to you

Section A: Sociodemographic Data

1. Age (in years): a. 20-29 [] b. 30-39 [] c. 40-49 []

2. Religion: a. Christian [] b. Muslim [] c. Traditional []

3. Marital status: a. Single [] b. Married [] c. Divorced [] d. Widowed [] e.

Separated []

4. Level of education: a. Primary [] b. Secondary [] c. Tertiary [] d. No formal

education []

52
 5. Occupation: a. Housewife [] b. Farmer [] c. Trader [] d. Civil servant [] d. Artisan

[]

6. How many times have you given birth? ………………………………

Section B: Barriers to anaemia prevention

Barriers Yes No

7. Lack of awareness about anaemia prevention methods

8. Limited access to iron-rich foods

9. Cultural beliefs and practices that discourage iron

supplementation

10. Inadequate antenatal care services

11. Lack of transportation to health facilities

12. Financial constraints preventing the purchase of iron supplements

13. Fear of side effects of iron supplements

14. Lack of support from family for anaemia prevention measures

15. Lack of motivation to prioritize anaemia prevention during

pregnancy

16. Lack of knowledge about the consequences of anaemia during

pregnancy

Section C: Anaemia prevention measures

17. Do you take foods rich in iron for example, liver, and snail? a. Yes [] b. No []

18. Do you include green leafy vegetable in your diet? a. Yes [] b. No []

53
19. Do you take citrus fruits or drinking fruit juice during pregnancy? a. Yes [] b. No

[]

20. Do you include sprouted grains in your diet? a. Yes [] b. No []

21. Do you include fibre rich food frequently? a. Yes [] b. No []

22. Have you used regular iron tablets during your current pregnancy? a. Yes [] b. No

[]

23. Have you taken folic acid supplements in current pregnancy? a. Yes [] b. No []

24. Do you use insecticide treated nets during pregnancy? a. Yes [] b. No []

25. Do you take intermittent and early preventive treatment of malaria during

pregnancy?

26. Do you take early treatment for worm infestations like hookworm, and guinea

worm during pregnancy? a. Yes [] b. No []

54