Anemia affects almost two-thirds of pregnant women in developing countries and

contributes to maternal mortality and low birthweight.[1,2] The World Health Organization
(WHO) defines anemia as a condition in which the hemoglobin concentration of a woman
during pregnancy is <11 gm/dl Nutritional anemia as iron deficiency anemia (IDA) is the
most common cause of anemia during pregnancy, globally affecting about 32 million
women[3,4] and at least half of all the pregnant women in middle and low-income countries.
[5] In these countries, the risk of anemia is higher due to a wide range of factors such as
inadequate diet, hemoglobinopathies, and infections such as HIV, malaria, and parasitic
infestation.[5,6] The prevalence of anemia is estimated to be higher in India when compared
to all other developing countries.[7] Also, it is the second leading cause of maternal deaths in
the country.[8]

Numerous national health programs related to the prevention and control of anemia
have been in existence. Initially launched as the National Nutritional Anemia Prophylaxis
Programme (NNAPP) in the year 1973, iron–folic acid supplementation was later on
integrated into the Reproductive and Child Health Programme as a part of which pregnant
women are administered 100 mg of elemental iron along with 0.5 mg of folic acid.[9]
According to the recent data of National Family Health Survey (NFHS-4), the prevalence of
anemia is estimated to be 50.3%, with an overall burden of 45.4% in Karnataka.[10]
Although there has been a reduction in the prevalence of anemia from 58.3 (NFHS-3) to
50.3% (NFHS-4), there is not much difference in the prevalence of anemia reported in
NFHS-2 (49.7%) and NFHS-4 (50.3%).[10].

Anemia is a condition defined with less hemoglobin (Hgb) level than the normal
range in the body, which decreases oxygen-carrying capacity of red blood cells to tissues [1].
World Health Organization (WHO) and Center of Disease Control and Prevention (CDC)
definitions for anemia differ with age, sex and pregnancy status. The classification is as
follows: children 6 months to 5 years anemia is defined as a Hgb level < 11 g/dl, children 5–
11 years Hgb < 11.5 g/dl, adult males Hgb < 13 g/dl; non-pregnant women Hgb < 12 g/dl and
pregnant women Hgb < 11 g/dl [2, 3].

Globally, Anemia is one of the public health concerns, which affects 32.4 million
(38.2%) pregnant women around the world. Particularly, common in South East Asia (48.7%)
[4, 5]. Worldwide, it has been reported that nearly 510,000 maternal deaths occur per year
associated with childbirth or early post-partum. Approximately 20% of maternal death is
caused by anemia; with majority of deaths occurred in developing countries [6].

Anemia is the main cause of morbidity and mortality among pregnant women in
developing countries with maternal and fetal consequences [7], which leads to premature
births [8], low birth weight [9], fetal cognitive impairment, and death [10, 11].

According to the WHO report of 2008, in Africa, 57.1% of the pregnant women were
anemic [12]. Moreover, anemia among pregnant women is having a severe public health
problem in Ethiopia with an overall prevalence of 62.7%. Seventeen percent of Ethiopian
women in the reproductive age group are anemic and 22% of them women were pregnant
[13,14,15,16].The reason of anemia during pregnancy in developing countries includes
nutritional deficiencies of iron, folate, and vitamin B12 and parasitic diseases, such as malaria
and hookworm. The relative contribution of each of these factors to anemia varies greatly by
geographical location, season, and dietary practices [7]

Globally, anaemia affects 1.62 billion people (95% CI: 1.50–1.74 billion), which
corresponds to 24.8% of the population (95% CI: 22.9–26.7%). The highest prevalence is in
preschool-age children (47.4%, 95% CI: 45.7–49.1), and the lowest prevalence is in men
(12.7%, 95% CI: 8.6–16.9%). However, the population group with the greatest number of
individuals affected is non-pregnant women (468.4 million, 95% CI: 446.2–490.6).

Prevalence of anaemia Population affected

Population group Number
Percent 95% CI 95% CI
(millions)
Preschool-age children 47.4 45.7-49.1 293 283-303
School-age children 25.4 19.9-30.9 305 238-371
Pregnant women 41.8 39.9-43.8 56 54-59
Non-pregnant women 30.2 28.7-31.6 468 446-491
Men 12.7 8.6-16.9 260 175-345
Elderly 23.9 18.3-29.4 164 126-202
Total population 24.8 22.9-26.7 1620 1500-1740
 Anemia is a significant public health problem during pregnancy and its prevalence
varies in different cohorts. Correct identification of this problem in a given population is
important for implementation of various health schemes. This study was carried out at a
tertiary care hospital in Haryana. The prevalence of anemia in females at the time
pregnancy diagnosis during first trimester was studied. The study period was January 2018
to June 2019. Severity of anemia was categorized as mild (hemoglobin 10–10.9 gm/dl),
moderate (hemoglobin 7–9.9 gm/dl) and severe (hemoglobin < 7 gm/dl) as per the WHO
definition. Relevant review of literature on prevalence of anemia in pregnancy in different
Indian states was done. The median age of 388 females with diagnosis of pregnancy during
first trimester was 27 years. Mean hemoglobin concentration was 10.47 gm/dl. 264 (68%)
females had anemia. Out of these 191 (72.3%) had mild anemia, 65 (24.6%) had moderate
anemia and eight had severe anemia. Out of the total study population, 270 (69.58%) were
from rural and 118 (30.41%) were from urban background. Among the anemic pregnant
females, 179 (67.8%) belonged to rural areas and 85 (32.20%) belonged to urban areas. Out
of 264 patients with anemia, 87 (32.95%) patients were primigravida and 177 (67.04%)
were multiparous females. The results of literature review showed a high prevalence of
anemia in the other Indian states also. There is high prevalence of anemia in females at the
time of diagnosis of pregnancy. Rates of anemia are higher in females with higher parity.

In 2005, globally, 1.62 billion people were estimated to be affected by anemia [2].
Similarly, as per the 2011 estimates, the global prevalence of anemia among pregnant women
is about 38% (32.4 million pregnant women), and non-pregnant women is about 29% (496.3
million non-pregnant women)), and for all women of reproductive age is about 29% (528.7
million women of reproductive age) [3]. The prevalence of anemia among non-pregnant and
pregnant women is relatively low in high-income countries compared with low-and-middle-
income countries.

Anemia is a condition in which the hemoglobin level is below normal and insufficient
to meet physiologic needs.[1] The World Health Organization (WHO) estimates anemia as a
major public health problem with almost 2 billion people having anemia below normal
values.[2] One of the most common causes of anemia is due to inadequate supply of
nutrients.[3]

Poor eating habits play a major role in the development of iron deficiency anemia that
is an important indicator of poor health status.[3] Children and adolescent are at increased
risk of developing iron deficiency anemia because of their increased demand for iron during
growth and puberty.[4]

India continues to be one of the countries with very high prevalence. National Family
Health Survey (NFHS-3) reveals the prevalence of any anemia to be 55.3%.[5] The NFHS-3
also estimates the prevalence of any type of anemia in Karnataka to be 51.5%, putting half of
the population at risk of acquiring anemia.[5]

There are 50 major tribes with 109 subtribes in Karnataka state (as of March 2005),
according to the notified schedule under Article 342 of the Constitution of India.[6] Among
these tribes, Koraga and Marati Naik tribes dwell in the tribal locales of Udupi Taluk, Udupi
district. Previous studies conducted by Jai Prabhakar and Gangadhar[7] in 2009, reports
prevalence of anemia in children of Jenukuruba tribe of Karnataka to be 77.1%. De et al.,[8]
in 2006 reported incidence of anemia among the tribal people of Assam as 59.82%, in
Arunachal Pradesh 53.77% and Tripura 57.45%. The objective of the study is to estimate the
prevalence of anemia among tribal women (aged 15-49 years).

Anemia in pregnancy is one of the most common preventable causes of maternal

morbidity and poor prenatal outcome [1]. Anemia is defined as a decrease in the
concentration of circulating red blood cells or in the hemoglobin concentration and a
concomitant impaired capacity to transport oxygen because of low level of circulating
erythrocyte than the normal [1, 2]. World Health Organization has accepted up to 11 gm
percent as the normal hemoglobin level in pregnancy. Therefore any hemoglobin level below
11 gm in pregnancy should be considered as anemia [3].

Anemia is a global public health problem affecting both developing and developed
countries with major consequences for human health as well as economic development [2].
According to WHO report about 56 million pregnant women are affected by anemia
worldwide. Among those 17.2 million pregnant mothers are from Africa [4].

Anemia in pregnancy is a condition with effects that may be deleterious to mothers

and fetuses and it is a known risk factor for many maternal and fetal complications [2]. It
significantly increases fetal and maternal mortality and morbidity due to maternal
vulnerability for infection and hemorrhage [5]. The nutritional status of women in Ethiopia is
low and their daily workload is often enormous because of reproducing and ensuring the
survival of their children. Due to these facts, in Ethiopia, iron deficiency anemia is the
commonest problem affecting pregnant women, women of reproductive age, and children [6–
8]. The Federal Ministry of Health develops a national nutrition program strategy to improve
the micronutrient deficiency among pregnant women by increasing the system to give
comprehensive and routine nutritional assessment intervention as well as routine iron and
folic acid supplementation and deworming during pregnancy [9].

Anemia is a public health problem in both developed and developing countries.

It affects 1.62 billion people globally, which corresponds to
24.8% of the world population. Global prevalence of anemia in pregnant women is
41.8% and the highest proportions of pregnant women affected are in Africa (57.1%).

[National Institute of Informatics Reports] Anaemia during pregnancy is one of

the important factors associated with a number of maternal and foetal complications. It
decreases the woman’s reserve to tolerate bleeding either during or after child birth and
makes prone to infections. Anaemia during pregnancy also has been associated with
increased risk of intra uterine growth restriction, premature delivery, low birth weight (LBW)
and maternal and child mortality.

World Health Organization (WHO)/World Health Statistics data shows that 40.1% of
pregnant women worldwide were anemic in 2016.  The condition is prominent in Southeast
Asian countries where about half of all global maternal deaths are due to anemia and India
contributes to about 80% of the maternal death due to anaemia in South Asia. There is
marginally decrease in prevalence of anemia in pregnant women in India from 58% in NFHS-
3 (National Family Health Survey-2005-06) to 50 % in NFHS-4 survey (2015-16).

Anemia is a major public health problem affecting both the developed as well as the
developing countries. According to World Health Organization, prevalence of anaemia
among pregnant women in developed countries is about14%, whereas it is still as high as
51% in the developing world.1 The condition is even worse in Southeast Asia. About half of
all global maternal deaths due to anemia occur in South Asian countries, out of which India
contributes to 80%.

In India the prevalence of anaemia among pregnant women is about 65-75%.1

Anaemia has been known to be responsible for a number of maternal and foetal
complications. Apart from decreasing the woman’s reserve to tolerate bleeding either during
or after child birth, it has been known to be associated with low birth weight, premature
delivery, intra uterine growth retardation and thus increased perinatal mortality.3-6 Anaemia
has also been found to be associated with increased risk of birth asphyxia and low. Apgar
score at birth. 7 A recent meta-analysis showed that the risk of maternal mortality decreases
by 20% for every 1 g/dl increase in the hemoglobin concentration. This decline is continuous
between Hb levels between 5 and 12mg/dl but not linear. 8 Thus treating anaemia has major
health implications in pregnancy and would go a long way in improving maternal and foetal
outcome. Despite the existing programs on prevention and control of anemia, such as Iron
and folic acid supplementation and free supply of parenteral iron preparations, reports from
multiple large national surveys indicate that there has been no significant decline in the
prevalence of anemia or adverse consequences attributed to it. 9-13 Often programs and
projects aiming to prevent and control anemia are constrained by the erroneous data
regarding socio economic profile of the target group and/or causative factors responsible for
the same. So, the main objective of the present study was to understand the health profile and
the sociodemographic factors of the country’s rural pregnant women and to estimate the exact
prevalence of anemia and other associated factors among pregnant women at term based on
the level of hemoglobin.

For determining anemia the outcome variable, each of the pregnant women enrolled
in the study was advised to undergo hemoglobin estimation in the laboratory of the general
hospital. Out of the study population a total of 23 women refused to undergo hemoglobin
estimation and so were dropped from the study. Thus a total of 850 estimates of hemoglobin
were obtained. Hemoglobin estimation was done by acid haematin method. All the
hemoglobin estimations were performed by a single observer so as to eliminate inter observer
variation. A Haemoglobin level of more than or equal to 11 mg/dl was considered as normal.
Any women with a Hb level of less than 11mg/dl was considered anemic. The levels of
hemoglobin used for classification of anemia in pregnant women as mild, moderate and
severe anaemia were those recommended by the Indian Council of Medical Research
(ICMR). 15 Mild, moderate and severe anemia was defined as follows:  Mild anemia: Hb
10.0mg/dl-10.9 mg/dl.  Moderate anemia: Hb 7.0mg/dl-10.0 mg/dl.  Severe anemia: Hb
less than 7mg/dl.  Very severe anemia: Hb less than 4mg/dl.