الفهرس 
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Abstract
According to Khalid (2011) iron deficiency is still the world’s most common nutritional deficiency, and generally, iron deficiency anemia is the most prevalent form of anemia. The major risk groups for iron deficiency include women of childbearing age, pregnant women, and lactating postpartum women.The present study was carried out with the aim of studying the effect of nutritional program combined with weekly oral iron supplementation regimen on improving iron deficiency anemia among pregnant women. The study was conducted at the outpatient clinic of the Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University Hospital. This study was a quazi experimental design. A random sample of 120 pregnant women was recruited into the study. Inclusion criteria of the studied women were: (i) Primigravida patients, (ii) Singleton pregnancy, (iii) Gestational age between 13 and 24 weeks, (iv) No prior intake of iron during current pregnancy, (v) Women with hemoglobin level between 7 and 11g/dl (≥ 7 and < 11 g/dl) in the late first trimester or second trimester. They were randomly divided into 3 study groups, with
40 women in each study group. Group allocation was computer-driven. Group 1: Anemic pregnant women receiving daily oral iron supplementation for three months. Group 2: Anemic pregnant women receiving weekly oral iron supplementation for three months. Group 3: Anemic pregnant women receiving nutritional program combined with weekly oral iron supplementation for three months. - 95 - SUMMARY The tools used in data collection were: 1. Pre and post knowledge questionnaire regarding iron deficiency anemia. 2. Laboratory investigation which included blood analysis to assess hemoglobin level, serum ferritin and blood film. Also, stool analysis to exclude parasitic infection particularly hookworm. 3. Structured interview questionnaire which was designed by the investigator and included the following sections: sociodemographic data, past medical and surgical history, family history, menstrual history, present pregnancy and nutritional habits. All women recruited in this study were informed that participation was voluntary and were ensured about privacy and confidentiality. Data collection for this study extended from January 2013 to June 2013. The study was conducted 5 days per week on a regular basis. At first, the researcher informed each woman alone about the study in simple terms then explained the tool content and filled the form by herself for each woman. The researcher interviewed about 2 – 3 women per day. Each
interview was completed in a period of 25 – 30 minutes. During this time, the researcher did the following: 1. Collect data about sociodemographic characteristics, past medical and surgical history, family history, menstrual history and data about present pregnancy. 2. Venous blood samples (3cc) were drawn in standard tubes, one of them containing ethylene diamine tetraacetic acid (EDTA) as anticoagulant for hemoglobin measurement. A blood film was also made for each patient by spreading a blood DROP between 2 slides. 3. Stool sample was also obtained from each patient. - 96 - SUMMARY 4. The blood samples, blood films, and stool samples were transformed to the laboratory for investigation. Hemoglobin level was estimated, blood films were examined for microcytosis and hypochromia of RBCs, and stool samples were examined to exclude any parasitic infection. 5. Distributed the pre- test questionnaire to Group 3 only to assess their knowledge regarding iron deficiency anemia. The educated women filled the tool by themselves and the researcher filled the tool of uneducated women. Then, the researcher gave all of them a nutritional educational session using booklet containing colored pictures about iron rich foods, iron enhancers and iron inhibitors. The aim of this session was to correct wrong knowledge, increase the awareness of pregnant women about iron deficiency anemia and encouraging them to adopt dietary behaviors to improve iron intake and its absorption. 6. Immediate post test was done for each woman after educational session for assessing their acquisition of knowledge. 7. A copy of educational booklet was given to each woman in Group 3. The content of this booklet included definition of anemia, signs and symptoms, causes, complications, importance of healthy balanced diet to the pregnant women, dietary sources of iron, iron enhancers and iron inhibitors. 8. Distribute iron tablets: All patients received the same elemental iron brand in the form of ferrous fumarate tablets equivalent to 27 mg iron with different doses given to the three groups as follows: Group 1: Daily for three months Group 2: Three times per week for three months Group 3: Three times per week for three months.