Iron-deficiency anemia in pregnancy: assessment of knowledge, attitudes and practices of pregnant women in Yerevan

Abstract

Iron Deficiency Anemia (IDA) is the most widespread disorder among pregnant women in Armenia. It is associated with adverse pregnancy outcomes (pre-term delivery and low birth weight) as well as increases risk of maternal mortality from hemorrhage in delivery. Since knowledge, attitudes and practices of pregnant women play an important role in IDA prevention, it is necessary to explore them. For this purpose a study in Yerevan was conducted utilizing mixed methodology (qualitative and quantitative methods). The first stage of the study was key informant interviews with pregnant women as well as physicians of Prenatal Consultation Clinics (PCC). In total six pregnant women and six physicians were interviewed. The results of this qualitative phase showed poor knowledge of the pregnant women on IDA risk factors and ways of prevention as well as lack of counseling in the PCCs. The second (quantitative) stage of the study was a telephone survey with a random sample of pregnant women. Sample size was calculated using a formula for single proportion calculation. Sample size (62) was increased 2.5 times, since expected response rate was 40%. Sampling procedures consisted of 3 stages: 1) simple random sampling of PCC; 2) proportionate systematic random sampling of names and telephone numbers of pregnant women from the registration books of the selected clinics; 3) simple random sampling during data collection process. Sixty-two women were interviewed in order to explore their knowledge, attitudes and practices on major risk factors of IDA. Data were entered in EXCEL Microsoft and translated into STATA. A comparison of sociodemographic factors and pregnancy history among different knowledge and attitudes levels, as well as between anemic and non-anemic women was presented in tables and described. A significant difference was found in the frequency of anemia between the strata of PCCs close to the center and far from it. Data were analyzed according to the sum of the score obtained for every correct answer. The scores for knowledge, attitudes and practices were stratified on low, medium and high. The results have shown relatively high levels on attitude scores and low levels on knowledge and practice scores. The weak points and widespread misconceptions in knowledge, attitudes and practices of pregnant women were explored. Recommendations are made to the Ministry of Health to establish certain rules of counseling for all pregnant women independent of their iron status, to develop a brochure on IDA risk factors and prevention and distribute it through PCCs, to give guidelines about administration of iron tablets to the women at high risk of IDA and finally to conduct another study to explore the problem of IDA throughout all regions of Armenia.