Full Project – Awareness and practices in the prevention of iron deficiency anaemia among elderly

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CHAPTER ONE

INTRODUCTION

1.1     Background to the study

Anaemia refers to a case where there is a reduction of haemoglobin concentration in the blood level below 11g/dl. It is one of the most common nutritional deficiency sickness observed internationally and it affects more than a quarter of the entire world’s population (WHO/CDC, 2013). Worldwide, anaemia affects about 1.62 billion people (25%), out of which 56 million are pregnant and advanced women (Balarajan, 2011; WHO/CDC, 2012). While it is reported that 41.8% of pregnant women globally are anaemic, in the majority of anemia cases in the elderly, an etiology can be observed. The most prevalent causes including iron deficiency (with or without blood loss), chronic disease/inflammation, as well as chronic kidney disease. At least half of this anaemia load is attributed to be from iron deficiency. Iron deficiency anaemia (IDA) is the most prevalent nutritional disorder globally, affecting about 2 billion people worldwide with pregnant women and elderly persons particularly at risk (WHO guideline, 2012). In developing countries, the prevalence of anaemia during pregnancy is 60.0% and about 7.0% of the women are severely anaemic (Agan et al., 2010). In Africa 57.1% of pregnant women are anaemic (de Benoist et al., 2012). Sub-Saharan Africa is the most affected region, with prevalence of anaemia estimated to be 17.2 million among pregnant women. This constitutes to approximately 30% of total global cases (WHO, 2012). In Kenya the prevalence of anaemia among pregnant women is 55.1% and among non-pregnant women is 46.4% (Ministry of Health, 2013).

The etiology of IDA is multifaceted and begins with the antenatal period, the iron status of an expectant woman is a major determining factor of the subsequent child’s iron status since iron passes through the placenta from the maternal blood to the foetal blood. Secondly, the natural diet of infants above 6 months does not possess enough iron required by them, iron stores acquired from the mother’s womb are already used up and thus dietary iron is the only other reliable source. Other major etiologies of IDA are; malaria infection, helminthic infestation, sanitation, hereditary haemoglobinopathes, low socio-economic level and micronutrient deficiencies, retinol and iron deficiency as well. The main causing factors of IDA are however summarized as dietary intake of non-heme iron, poor sanitation and low socioeconomic level (Bharati et al., 2013).

Various nutrients and contributing factors are involved in ensuring the normal synthesis of hemoglobin, which is a key constituent of iron. The main nutrients involved here include iron, folic acid, and vitamin B12, however, in terms of public health; iron deficiency is by far the major cause of nutritional anemia globally.  Folic acid deficiency, however, is less vastly spread and it often comes with iron deficiency (WHO, 2013).  Consequences of IDA during childhood years include retardation of growth, decreased school achievement, improper motor and cognitive development, and increased diseases. Specifically, IDA can lead to deficits in memory and behavioral regulation as iron is needed to produce neurotransmitters such as dopamine, epinephrine and serotonin (Beard et al., 2013).  Also, impaired myelination contributes to motor function deficits, some of these abnormalities are perceived to be irreversible if occurrence happens at an early age and the consequences may continue even after treatment procedures, reinforcing the relevance of early detection and prevention (Beard et al., 2013; Lin, 2010).

The form of dietary iron is a key determinant for IDA depending on the level of its bioavailability. This study aims to assess the awareness and practices in the prevention of anaemia among elderly in Owan East LGA, Edo State.

1.2     Statement of problem

It is reported that Iron-deficiency in the first months of life is a contributory factor to permanent psychomotor and cognitive injuries that result in lower quality of life and hence reduced work performance in adulthood (Brunt et al., 2012). Globally, IDA prevalence is estimated at about 25% (Calis, Phiri & Farragher, 2009; UNICEF, 2010) nevertheless, national information on iron levels is lacking and according to (VMNIS, 2011); data available is only restricted to vitamin A, iodine, and anemia prevalence. IDA prevalence has been estimated with the prevalence of anaemia of (69%) which is (34.5%) in Nigeria (UNICEF, 2012). The prevalence of about 34.5%, assumes that almost half of all anaemia cases are related to IDA which not the case is seeing that anemia has various causal factors (Blair & Lynette, 2011). Few studies have been carried out in elderly on IDA. Hence, the paucity of data on anaemia prevalence in Nigeria, specifically, Edo State is the background against which this study was carried out.

Anemia should not be accepted as an inevitable consequence of aging. A cause is found in approximately 80 percent of elderly patients. The most common causes of anemia in the elderly are chronic disease and iron deficiency. Anemia is common in the elderly and its prevalence increases with age (WHO, 2013). Using World Health Organization criteria for anemia (hemoglobin of less than 12 g per dL [120 g per L] in women and less than 13 g per dL [130 g per L] in men), the prevalence of anemia in the elderly has been found to range from 8 to 44 percent, with the highest prevalence in men 85 years and older. The increased incidence of anemia with aging has led to speculation that lower hemoglobin levels may be a normal consequence of aging, especially with low health concerns and behaviours in developing countries. However, there are at least two reasons for considering anemia in the elderly as a sign of disease. First, older people maintain a normal red cell count, hemoglobin and hematocrit. Second, in most elderly patients an underlying cause of anemia is found for hemoglobin levels of less than 12 g per dL. This prompted the researcher to carry pout a study on the awareness and practice levels of elderly in rural community of Owan East LGA on Iron Deficiency Anemia.

1.3     Objectives of the study

The study has the general aim of assessing the awareness and practices in the prevention of iron deficiency anaemia among elderly in Owan East LGA, Edo State. Specifically, the study seeks to;

1. To determine if the elderly people of Owan East LGA know about iron deficiency anemia
2. To determine if the elderly people of Owan East LGA aware of the causes of iron deficiency anemia relationship between IDA and sanitation of households with the elderly in Owan East LGA
3. To assess the preventive measures towards IDA status in the elderly of Owan East LGA as related to their health status as influenced by malaria, immunization, and helminthic infestation

1.4     Research questions

The following research questions were formulated to guide this research;

1. Do the elderly people of Owan East LGA know about iron deficiency anemia?
2. Are the elderly people of Owan East LGA aware of the causes of iron deficiency anemia?
3. Is there any preventive measure that can be adopted to reduce or prevent IDA among the elderly people of Owan East LGA?

1.5     Significance of the study

The results and findings of this study will fill the knowledge gap as a means of information to patients, healthcare professionals and providers, individuals and the society at large. The study shows the awareness and practice in the prevention of anaemia (IDA) among elderly in Owan East LGA of Edo state. Management and Regulatory Authorities could use the findings from this study as a basis for identifying strategies for community participation, collective action and the equipping of health providers with the aim of implementing effective prevention strategies for anaemia.

The study will generate information that would be useful to the Ministry of Health and other related agencies for the development and implementation of related programmes. The information will also be useful in designing appropriate interventions strategies to enhance complementary feeding and intake of iron rich foods thus militating against IDA in the elderly. Finally, the study will also contribute to knowledge of research efforts on the awareness, prevalence and preventive measures of anaemia among the elderly.

1.6     Scope of study

This study was carried out to assess the awareness and practices in the prevention of anaemia among elderly in Owan East LGA, Edo State. Owan East was chosen as the study area while the elderly people in the community will be chosen as the respondents. The variables covered include knowledge of elderly people of iron deficiency anemia, its causes and preventive measure that can be adopted to reduce or prevent IDA.

1.7     Operational definition of terms

Anaemia is a condition in which when the haemoglobin (Hb) level in the body is less than 11 gram per decilitre, which decreases oxygen-carrying capacity of red blood cells to tissues.

Iron Deficiency Anemia: is a common type of anemia characterized by a condition in which blood lacks adequate healthy red blood cells.

Haemoglobin (Hb) refers to iron-containing oxygen-transport metallo-protein in the red blood cells which is composed of globin and heme that gives red blood cells their characteristic colour.

Iron deficiency anaemia is an advanced stage of iron depletion defined as iron deficiency and low haemoglobin resulting in the condition of anaemia.

Elderly refers to mature adults usually from the age of 50 and above

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Full Project – Awareness and practices in the prevention of iron deficiency anaemia among elderly