AFJOG

African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 2 | 2025 | 15 ORIGINAL RESEARCH African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 3 | 2025 | A cross-sectional study of the prevalence of iron deficiency anaemia in pregnant patients presenting for antenatal care at a secondary level institution, Mowbray Maternity Hospital according to protocol as part of their ante-natal care. All data was collected and interviews conducted during the ante-natal clinic visit. Data Management The patient anonymity was ensured by deidentifying data. Statistical analysis The information was captured on a computer database using Microsoft Excel software and imported on SPSS (Statistical Package for the Social Sciences, version 28, Chicago, IL, USA) for analysis. A p-value of <0.05 is considered statistically significant. Categorical variables were described as proportions and compared using chi-square tests. Continuous variables were described as mean and standard deviation if normally distributed or median and inter-quartile range (IQR) if not normally distributed. Comparisons of continuous variables between groups were performed using t-tests, one-way ANOVA (Analysis of Variance) or equivalent non-parametric tests as appropriate. These were presented as graphs and tables. RESULTS: The study flow diagram is depicted in Figure1. The participants were pregnant women with a mean age of 29.74 years (standard deviation [SD]+/-6.63). The mean gestational age was 32.45 weeks (SD+/-6.75). The majority of patients had experienced two or three pregnancies, and had at least one living child, while nearly 20% had suffered a miscarriage. The women enrolled in this study had the following comorbidities, 22% presented with HIV, 8.3% had hypertension, 6.9% had chronic obstructive pulmonary disease (COPD)/Asthma, 3% had diabetes mellitus, and 12.1% were smokers. Baseline demographic data for the anaemic and non-anaemic groups is shown in Table 1. All patients had a booking Hb level recorded at the first antenatal visit, which was a mean of 11.07 (SD +/- 1.44). Over 90% of these patients received oral iron supplementation with ferrous sulphate tablets, as part of their treatment, and at least 75% were compliant with taking the prescribed supplements. Supplements were not dependent on their booking Hb, and patients were routinely prescribed iron supplementation from the date of the booking appointment. Patients in the study cohort had a median screening Hb (finger prick Haemocue®) of 9.95g/dl (IQR 9.40-10.50). Patients who were anaemic on screening Hb had formal FBC done. 38% of patients found anaemic on screening were excluded (81/213) due to refusal (39), being underage (9), being missed (6) and other reasons (27). Anaemia in those patients who had formal FBC was 57.6% (76 132). According to the WHO classification, 28.8% of these cases presented with mild anaemia, another 28.8% had moderate anaemia, while none were classified as having severe anaemia (Hb below 7g/dl). 89.5% (68/76) of the patients with anaemia had iron deficiency. The odds for iron deficiency in patients with anaemia were calculated to be 2.66 (95% confidence interval [CI] 1.01-6.95). Furthermore, in patients with anaemia, it was found that 73.7% (56/76) had absolute IDA. This observation was statistically significant (p<0.001), with odds for absolute iron deficiency being 3.80 (95% CI, 2.61-5.54) times higher in anaemic patients than in patients without anaemia. Additionally15.8% (12/76) of the anaemic patients had functional iron deficiency, in keeping with iron restriction. Transferrin saturation testing was missed in one patient with a ferritin level of 30ug/L. Patients were asked about specific symptoms of anaemia. The most prevalent symptoms in anaemic patients were mental fatigue (22%), physical fatigue (57%), and headaches (30%). Other common symptoms and signs included breathlessness (15%), cravings (23%), infections (15%), and pallor reported by patients (14%). Less common symptoms included restless legs (10%), hair loss (9%), brittle nails (6%), cold intolerance (3%) and mouth ulcers. DISCUSSION: In this cross-sectional prospective study the prevalence anaemia on FBC among pregnant women, was 57.6%. This prevalence is substantially higher than the global average [5] and indicates a significant health challenge within the studied population. Furthermore, a considerable proportion of the anaemic patients (89.5%) exhibited IDA, highlighting the role of iron deficiency as a contributing factor to anaemia during pregnancy. An interesting observation in this study was that half the patients identified as anaemic on point-of-care testing by Haemocue® testing were found not to be anaemic on FBC analysis, i.e. there was a high false positive rate. This incongruity also suggests the possibility of missed anaemia cases due to Haemocue's high readings i.e. false negatives. Research in various contexts, from pregnant women in Sudan [26] and Brazil, [27] blood donors in the USA [28] and Laotian children, [29] has confirmed the inconsistency between point-of- care and standard blood test results. Iron supplementation is a common intervention prescribed during pregnancy; however, this study revealed that despite the majority of patients receiving iron supplementation, a substantial proportion still experienced anaemia. Even with oral iron supplementation, some women may have poor absorption, or the prescribed dose might be inadequate to meet the increased demands, especially if the deficiency is severe. Nutritional deficiencies and compliance issues, often due to gastrointestinal side effects also play a significant role. Persistent iron deficiency in pregnancy, despite supplementation, requires careful evaluation of potential underlying causes, adjustments in treatment strategies, and close monitoring to ensure maternal and fetal health. A combination of optimised oral therapy, consideration of intravenous iron, and addressing any contributing factors will be essential in managing this complex condition effectively. [42] This glaring issue highlights the necessity for a more in-depth examination of the type of iron supplement used. Research findings indicated that despite a lower dosage, daily intake of iron bisglycinate was notably more efficient compared to ferrous sulphate supplementation. [30-32] Additionally, the chelate form was associated with fewer adverse effects according to the studies. [33]