IMPACT OF PHARMACISTS’ HEALTH EDUCATIONAL INTERVENTION ON ANEMIA IN PREGNANCY IN RURAL SETTINGS IN KANO, NIGERIAHTML Full Text
IMPACT OF PHARMACISTS’ HEALTH EDUCATIONAL INTERVENTION ON ANEMIA IN PREGNANCY IN RURAL SETTINGS IN KANO, NIGERIA
D. U. Adje * 1, M. I. Umar 2, M. A. Gadanya 3 and R. A. Rufai 3
Department of Clinical Pharmacy 1, Delta State University, Abraka, Nigeria.
Department of Pharmaceutical Sciences 2, Department of Community Medicine 3, Aminu Kano Teaching Hospital, Kano, Nigeria.
ABSTRACT: The worsening trend of anemia in pregnancy continues to be a cause for concern in many developing countries. There is a need for synergy involving all health care professionals in order to reverse this alarming trend. The objective of this study was to assess the impact of pharmacists initiated health education intervention on anemia in pregnancy in the rural setting, in Kano, Nigeria. A total of 280 pregnant women attending an antenatal clinic, 140 each from the test and control sites, were recruited by a systematic sampling technique after signing a written informed consent form. A pre-tested interviewer-administered questionnaire was used to elicit baseline demographic and obstetric information. Baseline Packed Cell Volume (PCV) was done for each group, using the capillary technique. Health education intervention was administered to the test group only. Baseline and Post-intervention PCV were compared after 8 weeks using Chi-square statistics. A p-value of less than 0.05 was considered significant. The baseline prevalence of anemia was quite high, 31.4% and 39.3% for test and control groups respectively. There was a significant overall decrease in anemia prevalence among pregnant women in the test group from 31.4% to 15.2% compared with 39.3% to 31.4% in the control (p < 0.05). Primi gravidae and grand multiparous clients were less likely to be anaemic than the multiparous clients (χ2 = 25.4, p = 0.003, α = 0.05 and χ2 = 35.7, p = 0.0004, α = 0.05 respectively). Conclusively pharmacist-initiated educational intervention significantly reduced the prevalence of anemia among rural pregnant women.
Anemia, Pharmacists, Pregnancy, Health Education, Nigeria
INTRODUCTION: Anemia in pregnancy is a global public health problem 1-3. The disease burden is highest in sub-Saharan Africa as a result of ignorance, poverty, and high levels of illiteracy 4-5. It is estimated that nearly half of pregnant women in developing countries are anemic 6. Anemia is directly or indirectly responsible for 20 to 30% of all maternal deaths 7-8.
Despite strenuous efforts, the maternal mortality indices for Nigeria is still one of the worst in the world 9-10. Several studies have been conducted in Nigeria on the prevalence and risk factors of anemia in pregnancy 11-16. However, majority of these studies were done in the major urban centers and cities of Nigeria. No recent interventional studies have been reported in the rural areas of Northern Nigeria where there is a high prevalence of illiteracy and poverty.
Interventions to improve maternal health status during pregnancy consists mainly of health education through group talks delivered en masse to pregnant women at antenatal clinics. Usually, the environment is noisy, sitting arrangement is poor and there are many distractions during these sessions. This has the potential to limit the benefits of such educational interventions. Therefore, reinforcing health education messages by the pharmacist as part of the dispensing process could complement efforts by the nursing staff and promote positive behavioral changes. Interventions at the level of the pharmacy provide an opportunity for personal, one on one interaction with a health professional devoid of all the drawbacks of mass education as obtains at the Antenatal clinic setting.
The objectives of this study were to determine baseline prevalence of anemia in control and test groups, to compare anemia prevalence in control and test groups after 8 weeks’ intervention period and determine the impact of pharmacists’ educational intervention on anemia in pregnancy in a rural setting in Kano State, Nigeria.
MATERIALS AND METHODS:
Study Setting: The study was carried out in the primary health care centers of Kumbotso and Babawa towns in Kumbutso and Gezawa Local Government Areas of Kano State, Nigeria. The test group was recruited from Kumbutoso while the control group was selected from clients at booking for ANC in Babawa Health Centre located at Gezawa LGA. Both study sites have similar ANC schedules and are staffed with doctors, pharmacists, pharmacy technicians, nurses, Community Health Extension Workers (CHEWs), records officers and other auxiliary staff members. Patient turnover is an average of 200 to 300 pregnant women per week at each of the two clinics. In this rural setting, there is a cultural preference for high parity with short intervals between pregnancies which may deplete iron stores and predispose women to anemia in subsequent pregnancies. The situation is compounded by skepticism and poor use of effective contraception techniques 13.
The study was a controlled prospective interventional study on anemia in pregnancy with patients attending Kumbotso Health Centre, as intervention group while the control population comprised of pregnant women attending Babawa Health Centre. The primary considerations for matching were not specific patient and clinical characteristics. Matching was done on the basis of proximity of the study sites, the similarity in demographics as well as medical resources available to both communities.
Inclusion Criteria / Exclusion Criteria: Patients who were not likely to deliver during the study period (at least 12 weeks) and who signed an informed consent form were recruited for the study while patients who were recently transfused or transfused for any reason during the study period and who had antepartum hemorrhage or any other cause of blood loss, as well as those who reported non adherence to routine medications, were excluded from the study. Adherence was determined by self- report. Also excluded were those with communication difficulties.
Sample Size Determination / Sampling Procedure: The formula for sample size for a comparison of two proportions was used 17. This formula computes the minimum sample size required to demonstrate significant effect at a power of 0.80. The formula is:
N = 2 × [(1.96 x 0.704) + (0.84 × 0.7)]2 / 0.01 = 774.6
Adjusting for population less than 10000 using the formula
nf = N/ [1+ (P/N)]
Where, P = total population from which sample will be taken = average of 200 patients per week per center = 800 + 800 = 1600
nf = 775[1+ (1600/755)] = 253 plus 10% allowance for possible attrition.18 = 280 Approx.
Therefore, the total sample size for the two groups is 280, which brings the sample size to 140 per group. A systematic sampling technique was used to recruit consenting pregnant women as they registered at the booking clinic. Sampling was conducted for a period of 4 weeks. Since the sample size determined for the study was 140 for each group, 35 patients were recruited for the study each week in cases and controls. With an estimated 150 eligible clients seen every week, every 4th eligible patient (i.e., 150/35) was selected to participate in the study. The first patient is the one whose serial number was randomly selected from a random number table. Subsequent patients were obtained by adding the sampling interval to the previous patient’s serial number.
Data Collection: A pre-tested structured interviewer-administered questionnaire was adapted from a previous study 12 and translated into local language (Hausa). The questionnaire was divided into three parts; the first section contained questions pertaining to patient demographics, the second part elicited information about the previous obstetric history and the third section inquired about the history of the current pregnancy. Gestational age was estimated by the Last Menstrual Period (LMP) due to a lack of facilities like Ultrasound scan in the rural setting.
Determination of Packed Cell Volume (PCV): Finger prick blood samples of 25 microliters were collected from consenting patients using the heparinized capillary technique. Samples were centrifuged at 3000 rpm for 5 min. PCV was measured using a Hewkley microhematocrit reader 21. For the purpose of this study, anemia in pregnancy was defined as a haematocrit of less than 30% 19-20. The severity of anemia was classified as follows, mild (PCV 27% - 29%) moderate (PCV 21% - 26%) and severe (PCV below 21%).
The procedure was repeated post-intervention to determine the impact, if any, of the intervention.
Intervention: Pharmacists at both sites dispensed routine medications to pregnant women which included iron tablets and multivitamins. Only the usual care was provided to the control group. At the intervention site, a 2-day training on the delivery of health education messages was conducted for pharmacists. Training was facilitated by the lead researcher in conjunction with the midwives who were quite experienced in talking with pregnant women at the antenatal clinic.
The educational intervention was done using a written leaflet in English and translated verbatim into the local Hausa language. The leaflet covered four main areas, namely; the need to adhere to scheduled antenatal appointments and prescribed routine drugs, healthy eating habits, personal hygiene and environmental sanitation, and encouraging the use of Long Lasting Insecticide-treated Nets (LLIN). Leaflet based messages were reinforced by verbal reminders given at bi-weekly appointments for anemic patients in the intervention group. Reminders were provided by the pharmacist on duty as part of the dispensing process. Only subjects in the intervention group were given the prescribed health education.
Data Analysis: Completed questionnaires were scrutinized for errors, incompleteness or misclassification of data obtained during the interviews. All data were entered by two data entry clerks into separate Microsoft Excel Spreadsheets, and the two separate entries were compared to detect entry errors. The Statistical Package for Social Sciences (SPSS) version 16 was used for the data analysis 22. Chi-square test was used for qualitative statistical analysis of proportions and t-tests for quantitative analysis of quantitative variables. A probability level of less than 0.05 was considered significant for all statistical calculations.
Outcome Variables: Primary outcome measures were pre- and post-intervention PCV values.
Ethical Consideration: Ethical approval for the study was obtained from the Ethical Committee of Aminu Kano Teaching Hospital, Nigeria (Approval no. NHREC/21/08/2008/AKTH/EC/1181) and Kano State Primary Health Care Board (Permit no PHCMB/ADM/13/12). Informed consent was obtained from prospective respondents prior to the commencement of the interviews.
RESULTS: Two subjects were transfused in the test group after the commencement of the study while one was transfused in the control group. In addition, two subjects were lost to follow up in the control group. Therefore, the number of subjects post-intervention was 138 and 137 for test and control groups respectively.
Patient Demographics: The age range of the 140 respondents from the test group was 14 to 45 years with a mean age of 24.97 ± 6.025. The majority of the subjects were Hausa-Fulani (n = 131, 93.6%) and all of them being of the Islamic faith. Almost all the subjects were married (n = 138, 98.6%) with one subject divorced and the other separated. Chi-Squared tests did not show any significant difference in demographic variables between the two groups. The socio-demographic characteristic of study participants is summarized in Table 1.
TABLE 1: SOCIO-DEMOGRAPHIC CHARACTERISTICS OF TEST AND CONTROL GROUPS. N=140
|Variable||Test (n=140) n (%)||Control (n=140) n (%)||χ2||p-value|
|Age group (years)|
|14 – 25||89 (63.6)||75 (53.6)|
|26 – 37||45 (32.1)||55 (39.3)||3.2||0.2|
|38 – 49||6 (4.3)||10 (7.1)|
|Hausa-Fulani||131 (93.6)||134 (95.7)||0.6||0.4|
|Others||9 (6.4)||6 (4.3)|
|House wife||64 (45.7)||118 (84.3)||72||<0.0001|
|Petty trading||76 (54.3)||22 (15.7)|
|Up to secondary||99 (70.7)||87 (62.1)|
|Tertiary||12 (8.6)||4 (2.9)||9.9||0.007|
|Non Formal||29 (20.7)||49 (35.0)|
Maternal Characteristics: The mean parity among pregnant women in the intervention group was 2.5 ± 1.982 with a mean birth interval of 2.13 ± 1.263 years compared with 2.9 ± 1.454 and 2.4 ± 0.849 years respectively for the control group. Details of maternal characteristics and utilization of antenatal services are shown in Table 2.
TABLE 2: BASELINE MATERNAL CHARACTERISTICS AND UTILIZATION OF ANTENATAL SERVICES. N=140
|Variable||Test (n=140)||Control (n=140)||χ2||p-value|
|Primi||27 (19.3)||6 (4.3)|
|1-2||47 (33.6)||55 (39.3)||19.2||0.0002|
|3-4||37 (26.4)||57 (40.7)|
|5 and above||29(20.7)||22 (15.7)|
|4||37 (26.4)||75 (53.6)|
|5||54 (38.6)||52 (37.1)||72.0||<0.00003|
|6||39 (27.9)||12 (8.6)|
|Interval between births|
|Primi||27 (19.3)||6 (4.3)|
|<1 year||14 (10.0)||15 (10.7)|
|1 <2years||15 (10.7)||35 (25.0)||25.1||<0.00004|
|2-4 years||78 (55.7)||83 (59.3)|
|>4 years||6 (4.3)||1 (0.7)|
|Previous antenatal history|
|Attended||103 (73.6)||87 (62.1)|
|Not attended||37 (26.4)||53 (37.9)||4.2||0.04|
|Mode of last child delivery|
|Home||51 (36.4)||79 (56.4)|
|Problems encountered during last delivery|
|No problems||96 (68.6)||90 (64.3)|
|Still birth||15 (10.7)||8(5.7)|
|Use of Long -lasting insecticide treated nets|
|Yes||100 (71.4)||91 (65.0)|
|Episode of fever|
|Use of IPT|
LLIN=Long -lasting insecticide-treated nets; IPT= Intermittent Preventive Therapy
The prevalence of anemia among pregnant women stratified by maternal characteristics is shown in Table 3.
TABLE 3: PREVALENCE OF ANEMIA IN PREGNANCY BY MATERNAL CHARACTERISTICS FOR TEST AND CONTROL GROUPS AT BASELINE. N=140
|Characteristic||Test (n=140) n (%)||Control (n=140) n (%)||χ2||p-value|
|Age Group (Years)|
|14 – 29||79(72.5)||30(27.5)||68(61.8)||42(38.2)|
|30 – 45||17(54.8)||14(45.2)||17(56.7)||13(43.3)||3.8||0.300|
|1 – 2||35(74.5)||12(25.5)||37(67.3)||18(32.7)|
|3 – 4||22(59.5)||15(40.5)||32(56.1)||25(43.9)|
|5 and above||18(62.1)||11(37.9)||12(54.5)||10(45.5)||25.4||0.003|
|Interval between births|
|Previous antenatal history|
|Problems encountered during last delivery|
|Use of LLIN|
|Episode of fever|
|Use of IPT|
LLIN=Long -lasting insecticide-treated nets; IPT= Intermittent Preventive Therapy.
FIG. 1: DEGREE OF ANEMIA FOR TEST AND CONTROL GROUPS AT BASELINE
Degree of Anemia at Baseline among Clients in Test and Control Groups: At baseline, 96% of the test subjects had normal PCV while 12.9%, 15.0% and 3.6% had mild, moderate and severe anemia respectively. For the control group, 85% had normal PCV and 20.7%, 15.7% and 2.9% had mild, moderate and severe anemia respectively, Fig. 1.
Outcome of Pharmacist’ Intervention: Prevalence of anemia (PCV<30%) at baseline was 44/140 (31.4%) and 55/140 (39.3%) for intervention and control groups respectively while PCV values at baseline were 31.1 ± 5.10 and 30.3 ± 4.30 for test and control groups respectively.
Following educational intervention, prevalence of anemia was significantly reduced in intervention compared to control group, 21/138 (15.2%) and 43/137 (31.4%) χ2 = 10.07, p = 0.002, α = 0.05. while PCV values were increased and ranged from 26% to 39% (mean 34.2% ± 3.50) and 23% to 40% (32.8 ± 4.50) for test and control groups respectively, Table 4.
TABLE 4: DIFFERENCE BETWEEN PCVs OF TEST AND CONTROL GROUPS AT BASELINE AND POST INTERVENTION
N = 140
N = 140
|Difference between test and control groups||Test gp
N = 138
N = 137
|Difference between test and control groups|
|Not Anaemic||96 (68.6)||85 (60.7)||11||117 (84.8)||94 (68.0)||23|
|Anaemic||44 (31.4)||55(39.3)||-9||21 (15.2)||43 (31.4)||-22|
Anemia = PCV<30%, * χ2 = 10.07, p = 0.002, α = 0.05
Socio-demographic Characteristics: The study population in both groups were mostly younger women as compared to other studies reported in Ibadan 5 Lagos 12 Benin City 23 and Kaduna 11. Also, almost all the subjects for the study were married. This is not surprising as there is a cultural preference for early marriage in northern Nigeria. Nwizu and his colleagues found a predominance of married persons in a similar study carried out in Kano 13, perhaps because married women are more likely to be encouraged to attend antenatal care.
Prevalence and Degree Anemia: Even though the WHO recommends anemia with a cut-off of PCV <33%, this study used a more pragmatic cut-off of PCV <30% since it has been argued that pregnant women in this setting can tolerate lower levels of anemia and still remain quite stable 19-20. This gave a baseline prevalence rate of 31.4% and 39.3% for the test and control group respectively. Prevalence and the degree of anemia observed in this study were comparable with those found in similar previous studies conducted in Nigeria. For example, prevalence rates of 17% have been reported in Kano by Nwizu and colleagues in 2011 13, 35.3% in Lagos 12 20.7% in Benin 23, 32.8% in Oyo 24 and 40.4% in Enugu 25. However, rates higher than those obtained in this study were observed in studies conducted in Ilorin 26, Port Harcourt, Rivers State 27 Kenya 28 and Libya 29 (using WHO cut-off). These findings are understandable as the World Health Organization estimates that about 57.1% of pregnant women in the tropics of Africa and almost 60% in Nigeria are anemic at booking 30, 31.
Intervention: Pharmacist initiated educational intervention resulted in a statistically significant reduction in the prevalence of anemia among pregnant women in the test group compared to the control. 15.2% vs. 31.4%, χ2 = 10.07, p = 0.002. A similar controlled interventional study in two antenatal centers in Tanzania involving malaria chemoprophylaxis, free hematinic and community health education achieved a reduction in anemia prevalence among the cases from 60% at booking to 47% 32. Another interventional study in rural Ghana which consisted of comprehensive treatment for severely anemic women, found that the mean PCV in the severely anemic group decreased by 9.6% 33. In a 6-month retrospective, longitudinal cohort study involving 101 anemic patients with chronic kidney disease, significantly higher levels of adherence to guidelines for hemoglobin monitoring (32.3% vs. 14.3%, P = 0.049) and iron monitoring (61.3% vs. 30.0%, P = 0.005) as well as lower medication utilization rates were observed in test group compared to patients receiving usual care 34.
Another prospective cross-sectional interventional study designed to assess adherence to oral iron supplements among pregnant women showed that the mean adherence rate and hemoglobin levels were significantly higher in the intervention group at the fourth visit following the pharmacist's intervention. The intervention consisted of free iron supplements along with routine counseling 35. Pharmacists could also complement the activities of physicians and other health care providers in the management of anemia by carrying out interventions among pregnant women designed to optimize the absorption of iron. This would include identifying and reducing drug interactions with oral iron, identifying medications that can exacerbate the anemia and making dietary recommendations to pregnant women 36.
Factors Associated with Anemia in Pregnancy: Predictors of anemia in pregnancy include age, parity, birth interval and post-natal complications. In this study, increasing age was found to be associated with anemia in pregnancy. Even though we could not demonstrate a statistically significant association (χ2 = 3.8, p = 0.3), the prevalence of anemia was highest in the 30-45 years age group. This trend agrees with the findings in Kano 11 and Benin 23 but differs from the findings of a study conducted in Lagos 12.
Prim gravid and grand multiparous clients in this study were less likely to have anemia compared to clients that are multiparous (para 1 to 4). (χ2 = 25.4, p = 0.003, and χ2 = 35.7, p = 0.0004, respectively). This could be explained by the fact that the latter group’s situation could be confounded by short birth interval, leading to depleted iron stores or maternal depletion syndrome and agrees with other reported findings 37-38. Other workers however, found the highest anemia prevalence among prim gravid clients 12.
Episodes of febrile illness among pregnant women in this study were shown to be associated with anemia in pregnancy (χ2 = 72, p = <0.00008), Similar findings have been reported by other workers 12, 39. Although lack of use of Long Lasting Insecticide-treated Nets (LLIN) and Intermittent Preventive Therapy (IPT) for malaria was not shown to be associated with anemia in this study (χ2 = 1.4, p = 0.71, α = 0.05 and χ2 = 18.3, p = 0.0004, respectively), they have been reported to be strongly associated with anemia in pregnancy in malaria-endemic areas 12, 40.
This study had several limitations. Being a facility-based study, the effects of selection bias could limit the generalization of the findings to the whole populace as most rural pregnant women do not attend formal health care facilities. Also even though both sites had similar characteristics, subjects in the test and control groups were not matched on the basis of individual clinical characteristics. Other possible causes of anemia such as parasitemia and hookworm infestation were not excluded. Another limitation was that gestational age was restricted to the second trimester only. Also self- reported adherence to routine medications was determined by self- report. A validated instrument would have been more reliable.
CONCLUSION: Prevalence of anemia in pregnancy among rural pregnant women attending antenatal care at primary health centers in Kano, Nigeria was high. Anemia in pregnancy was found to be significantly associated with parity (especially multiparous women but not prim gravidae and grand multiparous women), the interval between births, previous postnatal complications, episodes of febrile illness and the utilization of malaria Intermittent Preventive Therapy (IPT). Pharmacist initiated educational intervention at the point of dispensing routine medication significantly reduced the prevalence of anemia among rural pregnant women
ACKNOWLEDGEMENT: Our thanks to the matrons and staff of Kumbotso and Babawa health centers for their cooperation and support.
CONFLICTS OF INTEREST: We declare no conflict of interest as our work was self- sponsored
- WHO (2015) The global prevalence of anemia in 2011 available at www.who.int/nutrition/publications/micro-nutrients/global_prevalence_anemia.../en/
- Messenger H and Lim B: The prevalence of Anemia in pregnancy in a developed country – how well understood is it? J Preg Child Health 2016; 3: 231.
- Gebreweld A and Tsegaye A: Prevalence and factors associated with anemia among pregnant women attending antenatal clinic at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Advances in Hematology 2018; 1-8.
- Balarajan Y, Ramakrishnan U, Ozaltin, E, Shankar AH and Subramanian SV: Anemia in low-income and middle-income countries The Lancet 2011; 378(9809): 2123-35.
- Owolabi MO, Owolabi AO and Olaolorun DA: Sociodemographic factors in anemia in pregnancy in south western Nigeria. S Afr Fam Pract 2012; 54(3): 222-27.
- Ojengbede OA: Anemia in pregnancy in: safe motherhood at the local govt. level in Nigeria. The proceedings of the workshop on strategies for the reduction of high maternal mortality. Akuse J T Ed 1999; 130-34.
- Prasanth R: Prevalence of anemia in both Developing and Developed countries around the world. World J Anemia 2017; 1(2): 40-43
- Stephen G, Mgongo M, Hashim TH, Katanga J, Stray-Pedersen B and Msuya SE: Anemia in pregnancy: prevalence, risk factors, and adverse perinatal outcomes in Northern Tanzania. Anemia 2018; 1-9.
- WHO, UNICEF, UNFPA and the World Bank Estimates Trends in Maternal Mortality: 1990 to 2010. 2011; 22.
- Esike CO, Anozie OB, Onoh RC, Sunday UC, Nwokpor OS and Umeora OU: The prevalence of anemia in pregnancy at booking in Abakaliki, Nigeria. Trop J Obstet Gynaecol 2016; 33: 332-6.
- Onwuhafua PI, Ozed-Williams IC, Kolawole AO, Zayyan MS and Adze J: Prevalence of anemia in the antenatal booking population at Ahmadu Bello University teaching hospital, Kaduna, Nigeria. Port Harcourt Med J 2018; 12: 23-7.
- Anorlu RI, Oluwole AA and Abudu OO: Sociodemographic factors in anemia in pregnancy at booking in Lagos, Nigeria. J Obstet Gynaecol 2006; 26(8): 773-76.
- Nwizu EN, Iliyasu Z, Ibrahim SA and Galadanchi HS: Socio-Demographic and Maternal Factors in Anemia in Pregnancy at Booking in Kano, Northern Nigeria. Afri J Reprod Health 2011; 15(4): 1-41.
- Bassi AP, Idoko L, Dibigbo-Ibeaji NM, Adeniyi OG, Ramyil MS, Ogundeko TO and Pisagih JK: Prevalence of anemia in pregnancy among women visiting antenatal clinic in Bingham University Teaching Hospital Jos, Nigeria. Clinical Medicine Research 2016; 5(3): 52-62.
- Buhari H, Imoru M and Erhabor O: Anemia in pregnant women of sokoto residents in North Western Nigeria. J Blood Disord Transfus 2016; 7: 366.
- Adewara EO, Omokanye LO, Olatinwo AW, Durowade KA, Panti AA and Salaudeen AG: Prevalence of anemia at booking in a semi-urban community in North-central Nigeria. Niger Postgrad Med J 2014; 21: 327-30.
- Chow C, Shao J and Wang H: Sample size calculation in clinical New York: Marcel Dekker 2003.
- Singha P: Introductory text on biostatistics. 3rd Yahaya Road (Kaduna): Dabco Investment Limited, 2002.
- Harrison KA: Anemia in pregnancy In: Maternity Care in Developing Countries. (Eds) Lawson J B, Harrison K A and Bergstrom S. RCOG Press. 2001; Chp 8; 112-28.
- Agboola A: Anemia in pregnancy. In Agboola A. Textbook of Obstetrics and Gynaecology for medical students, Ibadan, Hainnemann Publishers Ltd, 2006; 376.
- Ochei J and Kolkhtar A: Bacteriology: Medical Laboratory Science, theory and practice. In: Bulakh P.M. and Deshmukh S. (Eds). Tata McGraw-Hill Publishing Company Limited. New Delhi 2000: 525-52.
- SPSS for Windows, Rel. 16.0.1 (2008). Chicago SPSS Inc.
- Chukwudebelu WO and Obi GO: Anemia in pregnancy in Nigerians. Nig Med J 1979; 9: 221-23.
- Dairo MD and Lawoyin TO: Socio-demographic determinants of anemia in pregnancy at primary care level: a study in urban and rural Oyo State, Nigeria. Afr J Med Sci 2004; 33(3): 213-17.
- Dim CC and Onah HE: The prevalence of anemia among pregnant women at booking in Enugu, South Eastern Nigeria. Med Gen Med 2007; 9(3): 11.
- Babatunde AS, Olawumi HO , Durotoye IA, Shittu AO, Adesina KT and Sani MA: prevalence of anemia among pregnant women at antenatal care booking in Ilorin, North Central Nigeria Tropical Journal of Health Sciences –2017; 24(4): 48-53.
- Okoh DA, Iyalla C, Omunakwe H, Iwo-Amah RS and Nwabuko C: A retrospective study of the prevalence of anemia in pregnancy at booking in Niger Delta, Nigeria, Journal of Obstetrics and Gynaecology 2016. DOI: 10.3109/01443615.2015.1116500
- Okube O, Mirie W, Odhiambo E, Sabina W and Habtu M: Prevalence and factors associated with anemia among pregnant women attending antenatal clinic in the second and third trimesters at Pumwani Maternity Hospital, Kenya. Open Journal of Obstetrics and Gynecology 2016; 6: 16-27.
- Elzahaf RA and Omar M: Prevalence of anemia among pregnant women in Derna city, Libya. Int J Community Med Public Health 2016; 3: 1915-20.
- Lebso M, Anato A and Loha E: Prevalence of anemia and associated factors among pregnant women in Southern Ethiopia: A community based cross-sectional study. PLoS ONE 2017; 12(12): e0188783.
- World Health Organization, Global Health Observatory Data Repository/World Health Statistics Nigeria NG: Prevalence of Anemia among Pregnant Women: % Available at (http://apps.who.int/gho/data/node.main. 1? lang=en).
- Massawe SN, Urassa EN, NystrÖm L and Lindmark G: Effectiveness of primary level antenatal care in decreasing anemia at term in Tanzania. Acta Obstet Gynecol Scand 2003; 78(7): 573-9.
- Geelhoed D, Agadzi F, Visser L, Ablordeppey E, Asare K and O’Rourke P: Severe anemia in pregnancy in rural Ghana: a case-control study of causes and management. Obstet Gynecol Scand 2006; 85(10): 1165-71.
- Debenito JM, Billups SJ, Tran TS and Price LC: Impact of a clinical pharmacy anemia management service on adherence to monitoring guidelines, clinical outcomes, and medication utilization. J Manag Care Pharm 2014; 20(7): 715-20.
- Panda BK, Taralekar VS, Mishra A and Srivastava P: Anemia in pregnancy: improving adherence with interventions. Biopharm Journal 2015; 1(1): 33‐40.
- Kucera A, Smith B and Tsu LV: Anemia and the Role of the Pharmacist. Arizona Journal of Pharmacy 2014; 31-35.
- Gajida AU, Iliyasu Z and Zoakah AI: Malaria among antenatal clients attending primary health care facilities in Kano state, Nigeria. Ann Afr Med 2010; 9(3): 188-93.
- Majok F, NystrÖm L, Munjaja SP, Maso E and Lindmark G: Relation of parity to pregnancy outcome in a rural community in Zimbabwe. Afr J Reprod Health 2004; 8(3): 198-06.
- Jackson RJ, Klee EB and Green SD: Severe anemia in pregnancy: a problem of prim gravidae in rural Zaire. Trans R Soc Trop Med Hyg 1991; 85: 825-32.
- Fleming AF, Ghatoura GBS, Harrison KA, Briggs ND and Dunn DT: The prevention of anemia in pregnancy in prim gravidae in guinea savannah of Nigeria. Ann Trop Med Parasitol 1986; 80: 211-33.
How to cite this article:
Adje DU, Umar MI, Gadanya MA and Rufai RA: Impact of pharmacists’ health educational intervention on anemia in pregnancy in rural settings in Kano, Nigeria. Int J Pharm Sci & Res 2020; 11(5): 2403-10. doi: 10.13040/IJPSR.0975-8232.11(5).2403-10.
All © 2013 are reserved by the International Journal of Pharmaceutical Sciences and Research. This Journal licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.
D. U. Adje *, M. I. Umar, M. A. Gadanya and R. A. Rufai
Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, Delta State University, Abraka, Nigeria.
03 July 2019
21 December 2019
08 February 2020
01 May 2020