Evaluation of the

performance of physicians
working in rural health
care units in Mansours
district when dealing with
anemia in pregnancy
 introduction
Anemia is a global public health problem 

affecting both Developing and developed

countries with major consequences for
human health as well as social and
economic development. It occurs at all
stages of the life cycle, but is more
prevalent in pregnant women and young
(.children. (WHO 2005
Anemia in pregnancy is defined by 

the World Health Organization as a

hemoglobin value below 11 g/dl
(.(WHO 1992; WHO 2001
Nearly half of the pregnant women in 

the world are estimated to be

:anemic
in developing- as compared with 52% 

23% in developed– countries.

Throughout Africa, about 50% of
pregnant and 40% of non-pregnant
(.women is anemic. (WHO 2001
Physiologically During pregnancy, there is an 

increase in both red cell mass and plasma

volume to accommodate the needs of the
growing uterus and fetus. However, plasma
volume increases more than the red cell
mass leading to a fall in the concentration of
hemoglobin in the blood (Letsky 1991).this
so-called physiological anemia of pregnancy.
( (Steven G. et al 2002
Prophylactic iron supplementation in all women 
is recommended to prevent anemia. (Vincenzo
(.Berghella 2007
Evidence suggests that without supplemental 
iron, women can exhaust their serum ferritine
(iron stores) markedly between the 12th and
(.25th week of gestation (Allen 2001
The main causes of anemia are: dietary iron 

deficiency; infectious diseases such as

malaria, hookworm infections and
schistosomiasis; deficiencies of other key
micronutrients including folate, vitamin B12
and vitamin A; or inherited conditions that
affect red blood cells (RBCs), such as
(.thalassaemia. (WHO2004
Iron deficiency with or without 
anemia have important
consequences for human health and
child development: anemic women
and their infants are at greater risk
.of dying during the perintal period
Iron deficiency anemia can cause 
.increased risk for maternal infection
It is also associated with infant and child 

morbidity and mortality from

prematurity .low birth weight, lower infant
.iron reserve, and heavier placentas
In addition, these infants can have 
developmental, cognitive, and growth
( delay. (Jacqueline E. 2008
The four basic approaches to the 
prevention of iron deficiency anemia
are supplementation with medicinal
iron, education and associated
measures to increase dietary iron
intake, the control of infection, and
the fortification of a staple food with
.iron
The success of all technical 
approaches to anemia control
depends on the active participation
of the population. Hence the need for
a public education support strategy
based on careful analysis of the
.behavioral changes required
The major changes in behavior that are 

needed centre on compliance with

supplementation regimens, changes in eating
habits, and measures for infection control,
including better personal hygiene and more
rational feeding of sick children-
responsibilities that in many societies are
.assigned primarily to women
Rational and
justification
 According to WHO 2005 the 

prevalence of anemia in EGYPT in

women was 39.2% in rural areas,
39.7% in urban areas, 36% in lower
Egypt, 42% in upper Egypt and 40%
(.in urban governorates. (WHO 2005
Dietary iron intake can be increased in poor 
communities by enhancing the bioavailability
of the iron ingested, rather than its total
amount, based either on promoting the
intake of iron absorption enhancers, including
haem iron, or on reducing the ingestion of
absorption inhibitors such as tannin and
(phytic acid . (E.M. DeMaeyer et al 1989
Iron absorption can vary from 1% to 
40%, depending on the mix of
enhancers and inhibitors in the meal.
((WHO 2001
Pregnant women are a priority group 

for iron supplementation. Identifying

this group and distributing iron
tablets to each pregnant woman is a
task within the competence of the
.health care members
Supplementation should occur 
primarily during the second half of
pregnancy, when the iron
requirement is greatest. During early
pregnancy, morning sickness will in
any case reduce the effectiveness of
.supplementation
The major obstacle to iron 
supplementation is poor compliance
with treatment. This is often due to
side-effects, but it may also because
women's lack of awareness of the
importance of iron supplementation
.to herself and to her fetus
All of the above reasons lead to the 

need of the presence of the family

physician in the health care unit to
achieve the valuable goal of
preventing anemia among pregnant
.women
Family physicians provide diagnosis and 
treatment, health protection and
promotion, coordination of care and other
community facilities particularly in rural
.areas
They are clinically competent to provide 
the greater part of their care, taking into
account the cultural, socioeconomic and
(psychological background. (WONCA 1991
 Aim of the work

Improve the performance of 

physicians working in a family health
care unit and in a primary health
care unit when dealing with anemia
.in pregnancy
Decrease the high prevalence of 
anemia during pregnancy leading to
decrease of both morbidity and
mortality among pregnant women in
.the perinatal period
 :Objectives

Evaluation of the physicians'- 1 

performance when dealing with
.anemia in pregnancy
Assessment of the prevalence of- 2 

anemia among pregnant women in

both family health centers and
primary health care units in
.MANSOURA district
Subject and method
:Study design- 
.Observational study 

:Population- 
The physicians - 

working in the rural health care units

in Mansoura district will be included
.in the study
: sample size- 
Will be calculated 

:Sample technique- 

Randomly selected 
: Time of schedule- 
One month for 

preparing questionnaire and pilot

.study
And 3 months for data 

.collection and analysis

:Tools of the study
The physicians will be divided into- 1 

two groups according to whether

they work in a family health care unit
or a primary health care unit to
evaluate both systems in dealing
.with anemia in pregnancy
The physicians will be observed- 2 
about their performance on dealing
.with pregnant women
Check list will be recorded for each- 3 

physician including all items required

to be done for each pregnant women
.attending the health care unit
the Check list will include a special- 4 

part about dealing with anemia in

pregnancy ( iron supplementation,
health education and hemoglobin
(assessment
A record for each health care unit will be- 5 
done to include information about the number
of population they serve, average number of
pregnant women attending per month, the
average number of visits to each pregnant
woman attending during her antenatal period
and the prevalence of anemia in the last six
.months
 Pilot study will be done to test the- 6 

check list designed and to detect any

obstacles of the study