Maternal mortality continues to be a major health problem in the developing world. Nearly 600,000 women die each year as a result of complications of pregnancy and childbirth; most of these deaths could be prevented with attainable resources and skills(WHO 2003). (1,2,4).

The most common direct causes for maternal mortality include hemorrhage(25%), hypertensive disorders of pregnancy(12%), complications from unsafe abortion(13%), sepsis(15%), obstructed labor(8%), indirect causes include viral hepatitis ,malaria, anemia, HIV/AIDS & cardiovascular disease. 20% cases of maternal mortality are due to anemia (preventable cause) (1,2,3).

It causes direct and indirect deaths from cardiac failure, haemorrhage, infection and preeclampsia (1,2,3). Anemia also increases perinatal morbidity and mortality rates due to an increase in preterm births and IUGR, which also been found to cause low iron stores, iron deficiency anemia and cognitive and behavioural dysfunction in infants. Therefore, according to the UN declaration of 1997, anemia is a major public health problem that needs total elimination.

The risk of Maternal mortality decreases by about 20% for each 1 g/dl increase in haemoglobin. The two most common causes of anemia during pregnancy and immediate puerperium are IDA and Acute Blood Loss (1). The body does not have enough healthy red blood cells to bring oxygen to body tissues and hence the various complications.

SYMPTOMS AND SIGNS OF ANEMIA

SYMPTOMS: It includes the feeling of weakness, lassitude, indigestion, loss of appetite, poor work performance, palpitations, dyspnoea, giddiness, enema, breathlessness

SIGNS: pallor, glossitis, stomatitis, oedema, tachycardia, soft systolic murmur and rarely generalised anasarca and even CCF.

• To define geographical areas around Chandrapur from where the cases of anemia are referred.
• To co-relate variables like Maternal age, Gestational age, Parity, the time elapsed between last childbirth and current pregnancy

Table-1: Taluka wise and Age-wise distribution of severe anemia.

Table-2: Age Distribution

Maximum patients were observed in 21-30 years age group.

In the study conducted by Rukuni R et al (13), APH cases in anemia patients were 14.14% and PPH cases in anemia patients were 21.78%, maternal deaths were 0.01%. In our study, there was no case of abruption or PPH.

In our study around 60% of severe anemia cases were multipara similar to the study by Ravishankar Suryanarayan et al [5], Obese et al [14] and Hashim N et al. [8] In our study around 78% of cases of severe anemia were between the age group of 21 to 30 years similar to the study by Hashim et al (8). Around 68% of cases of severe anemia had gestational age more than 28 weeks similar to the study by Hashim N et al (8).

Strength of our study which adds to existing knowledge. We could identify the talukas in Chandrapur district where the prevalence of severe anemia in pregnant and postpartum women is high which needs to be addressed at different levels.

• The short duration of the study
• Long term effects of anaemia, i.e. secondary haemorrhage, subinvolution, sepsis in mother and prognosis of preterm or IUGR babies in the late neonatal period or infancy could not be assessed.

Peripheral preventive services must be strengthened on a priority basis in Chandrapur, Ballarpur, Rajura and Korpana talukas which belong to south Chandrapur where the tribal area is predominant. Probable problems in these areas might be related to culture, ignorance, dietary habits & availability of Medical Staff which need to be addressed.

Effective counselling regarding early registration restriction of parity contraception for spacing births diet and iron and folic acid supplementation is essential for preventing anemia.

Dr. Deepti V Shrirame: Concept, study design

Dr. M.R. Waikar: Manuscript preparation