Knowledge, attitude and practices of pregnant women regarding anemia, iron rich diet and iron supplements and its impact on their hemoglobin levels

Background: Anemia in pregnancy has detrimental effects on maternal and child health and prevalence of anemia during pregnancy is alarmingly high, inspite of the implementation of the national nutritional anemia prophylaxis programme which provides iron and folic acid which are the essential nutrients lacking in their diet. The purpose of this study was to assess the knowledge, attitude and practices of pregnant women regarding anemia, Iron rich food and iron supplements and also to assess the impact of these factors and other socio demographic variables on the hemoglobin levels of these vulnerable groups of women. Methods: This is a cross sectional, descriptive institution based study conducted at Sri Manakula Vinayagar medical college hospital, Puducherry, India. Sample size was calculated using formula for single proportion with 5% marginal error and 95% CI and a non-response rate of 10% and was found to be 316. Data collection was carried out using a predesigned, self-administered questionnaire in local language in the antenatal clinic at the time of routine antenatal checkup, from pregnant women who consented to participate in the study. At the same sitting, 1 ml of blood was collected for hemoglobin estimation, analyzed and the result was recorded and disclosed to the patient. The data was entered in SPSS and analyzed using descriptive and inferential statistics (Chi square test). A p value of <0.05 was considered to be statistically significant. Results: Assessment of knowledge revealed that only 39.87% of the participants were aware of and understood the term anemia. 53.8% of the participants accepted that pregnant women were more vulnerable to anemia and 66.1% responded correctly that the fetus will be affected by severe anemia. Only 32.6% gave the correct response that pregnant women should take iron supplementation in spite of taking a healthy diet. Only 44.62% of the participants were aware of their hemoglobin level in the current pregnancy. Knowledge about food rich in iron was poor among the participants. At least 1/5 th of the participants have not received educational information regarding anemia from any source. The overall attitude towards antenatal checkup, healthy diet and the benefits of iron supplementation was generally good among the participants 49.36% of the participants were taking only the usual diet during their pregnancy. 74.36% claimed to have taken iron supplementation regularly whereas 9.8% had not taken iron supplementation. On hemoglobin estimation it was found that 62.97% of the participants were anemic taking 11 grams as the cut off for anemia. The only significant determinants of hemoglobin levels were regular intake of iron supplements (p value 0.006) and timing of iron consumption (p value 0.0262). Conclusions: The present study indicated the lack of knowledge regarding anemia, iron rich foods and the importance of iron supplementation during pregnancy. Targeted estimation of hemoglobin levels in adolescent girls and women in reproductive age group, intensive counseling and motivation of pregnant women to consume Iron and folic acid and ensuring adequate supply to them, intensive de-worming, provision of toilet facilities to all households would help in reducing the incidence of anemia in pregnant women.