Impact of pharmacist-monitored patient education in pregnant women with anemia: a knowledge, attitude and practice study
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20263433Keywords:
Anemia, Anemia Mukt Bharat, Antenatal care, Maternal education, PregnancyAbstract
Background: Anemia during pregnancy, defined as hemoglobin levels below 11 g/dL, affects nearly 37% of pregnant women globally and 52.2% in India. Pharmacists are well positioned to provide education, though evidence for the impact of pharmacist-led interventions on knowledge, attitudes, and practices (KAP) regarding anemia is limited. This study evaluated the impact of pharmacist-monitored patient education on KAP in pregnant women with anemia.
Methods: This six-month prospective interventional study (Jan-2025 to June-2025) was conducted among 130 pregnant women at a tertiary care hospital in Mangaluru, Karnataka. Data were collected during routine antenatal visits using a validated structured questionnaire in English and Kannada. Following initial KAP assessment, participants received pharmacist-led counselling and educational informational leaflet. KAP was reassessed after 1.5 months using the same questionnaire. Data were analysed using SPSS, with one-way ANOVA and paired t-tests. A p value <0.05 was considered statistically significant.
Results: Most participants were aged 26-35 years (65.38%), rural residents (62.30%) with high school education (61.54%) and no prior anemia history (80%); most were unemployed (83.84%), multigravida (59.24%), in their third trimester (63.14%), and continued their usual diet (84.62%). Knowledge (1.92±2.70 to 5.16±3.61) and attitude (14.67±2.53 to 15.91±2.48) scores increased significantly (p<0.00001, p=0.00096), while practice scores changed minimally (2.72±0.59 to 2.76±0.58; p=0.08326) post intervention. Knowledge was associated with education (p=0.0406); attitude with age, residence, and parity (p<0.05); and practice with age (p=0.0199). Anemia Mukt Bharat awareness rose from 10% to 60%.
Conclusions: Pharmacist-monitored education significantly improved knowledge and attitude towards anemia in pregnancy, though practice change was limited. Integrating pharmacist-led counselling into antenatal care may support sustained behavioural change and anemia prevention.
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References
World Health Organization. Anaemia: Fact Sheets, 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/anaemia. Accessed 21 January 2025.
World Health Organization. Anaemia, 2025. Available at: https://www.who.int/news-room/fact-sheets/detail/anaemia. Accessed 11 September 2026.
Kuppusamy P, Prusty RK, Khan SA. Assessing the prevalence and predictors of anemia among pregnant women in India: findings from the India National Family Health Survey 2019-2021. Curr Med Res Opin. 2024;40(1):51-8. DOI: https://doi.org/10.1080/03007995.2023.2276851
Geographic Insights Lab. Anemia Mukt Bharat - Insights from Ranking of Key Performance Indicators, NFHS 2015-16 and NFHS 2019-21. Cambridge (MA): Harvard University; 2022. Available at: https://doi.org/10.7910/DVN/NEMMUL. Accessed 21 January 2025.
Nguyen NT, Chen YC, Nhu NT, Bao HB, Hsu CY, Das A, et al. Global prevalences of erythropoiesis-associated micronutrient deficiencies (iron, folate, and vitamin B12) among pregnant women: a systematic review and meta-analysis. Ann Medi. 2025;57(1):2602960. DOI: https://doi.org/10.1080/07853890.2025.2602960
Gibore NS, Ngowi AF, Munyogwa MJ, Ali MM. Dietary habits associated with anemia in pregnant women attending antenatal care services. Curr Dev Nutr. 2021;5(1):178. DOI: https://doi.org/10.1093/cdn/nzaa178
Hess SY, Owais A, Jefferds ME, Young MF, Cahill A, Rogers LM. Accelerating action to reduce anemia: Review of causes and risk factors and related data needs. Ann N York Acad Sci. 2023;1523(1):11-23. DOI: https://doi.org/10.1111/nyas.14985
Smith C, Teng F, Branch E, Chu S, Joseph KS. Maternal and perinatal morbidity and mortality associated with anemia in pregnancy. Obstet Gynecol. 2019;134(6):1234-44. DOI: https://doi.org/10.1097/AOG.0000000000003557
Patel A, Prakash AA, Das PK, Gupta S, Pusdekar YV, Hibberd PL. Maternal anemia and underweight as determinants of pregnancy outcomes: cohort study in eastern rural Maharashtra, India. BMJ open. 2018;8(8):e021623. DOI: https://doi.org/10.1136/bmjopen-2018-021623
Tandon R, Jain A, Malhotra P. Management of iron deficiency anemia in pregnancy in India. Indian J Hematol Blood Transfus. 2018;34(2):204-15. DOI: https://doi.org/10.1007/s12288-018-0949-6
Ministry of Health and Family Welfare, Government of India. Anemia Mukt Bharat: Intensified National Iron Plus Initiative (I-NIPI): Operational Guidelines for Programme Managers, 2018. Available at: https://www.pib.gov.in/PressReleasePage.aspx?PRID=2297512®=48&lang=2. Accessed 21 January 2025.
Ministry of Health and Family Welfare, Government of India. Anemia Mukt Bharat. Available at: https://ambabhiyaan.mohfw.gov.in/. Accessed 11 September 2026.
Godara S, Hooda R, Nanda S, Mann S. To study compliance of antenatal women in relation to iron supplementation in routine ante-natal clinic at a tertiary health care centre. JDDT. 2013;3(3):71-5. DOI: https://doi.org/10.22270/jddt.v3i3.520
Ghimire N, Pandey N. Knowledge and practice of mothers regarding the prevention of anemia during pregnancy, in teaching hospital, Kathmandu. J Chitwan Med Coll. 2013;3(3):14-17. DOI: https://doi.org/10.3126/jcmc.v3i3.8631
Nimbalkar PB, Patel JN, Thakor N, Patni M. Impact of educational intervention regarding anaemia and its preventive measures among pregnant women: an interventional study. Int J Reprod Contracept Obstet Gynecol. 2017;6(12):5317-21. DOI: https://doi.org/10.18203/2320-1770.ijrcog20175137
Titaley CR, Rahayu E, Damayanti R, Dachlia D, Sartika RA, Ismail A, Sanjaya A, Karyadi E. Association between knowledge and compliance of taking iron/folic acid supplements during pregnancy. Asian J Pharm Clin Res. 2017;10(5):176-82. DOI: https://doi.org/10.22159/ajpcr.2017.v10s5.23126
Nasir BB, Fentie AM, Adisu MK. Adherence to iron and folic acid supplementation and prevalence of anemia among pregnant women attending antenatal care clinic at Tikur Anbessa Specialized Hospital, Ethiopia. PLoS One. 2020;15(5):e0232625. DOI: https://doi.org/10.1371/journal.pone.0232625
Habib F, Habib Zein Alabdin E, Alenazy M, Nooh R. Compliance to iron supplementation during pregnancy. J Obstet Gynaecol. 2009;29(6):487-92. DOI: https://doi.org/10.1080/01443610902984961
Nivedita K, Shanthini F. Knowledge, attitude and practices of pregnant women regarding anemia, iron rich diet and iron supplements and its impact on their hemoglobin levels. Int J Reprod Contracept Obstet Gynecol. 2016;5(2):425-31. DOI: https://doi.org/10.18203/2320-1770.ijrcog20160383
Begum N, Fatima M, Farheen M, Fatima T, Sultana A. Knowledge, Attitudes and Practices regarding anemia among pregnant women. IJSRD. 2017;5(4): 949-52.
Sunuwar DR, Sangroula RK, Shakya NS, Yadav R, Chaudhary NK, Pradhan PM. Effect of nutrition education on hemoglobin level in pregnant women: A quasiexperimental study. PloS One. 2019;14(3):e0213982. DOI: https://doi.org/10.1371/journal.pone.0213982
Ahmed ME N, Mohamed Elsayed A, Ragab H, Salem Mohamed N. Effect of health promotion instructions regarding iron deficiency anemia on young pregnant women's knowledge and practice: A pre and post study. Egypt. J. Health Care. 2021;12(3):48-63. DOI: https://doi.org/10.21608/ejhc.2021.183803
Nahrisah P, Somrongthong R, Viriyautsahakul N, Viwattanakulvanid P, Plianbangchang S. Effect of integrated pictorial handbook education and counseling on improving anemia status, knowledge, food intake, and iron tablet compliance among anemic pregnant women in Indonesia: a quasi-experimental study. J Multidiscip Healthc. 2020:43-52. DOI: https://doi.org/10.2147/JMDH.S213550
Jalambo MO, Sharif R, Naser IA, Karim NA. Improvement in knowledge, attitude and practice of iron deficiency anaemia among iron-deficient female adolescents after nutritional educational intervention. Glob. J. Health Sci. 2017;9(7):15-23. DOI: https://doi.org/10.5539/gjhs.v9n7p15
Gomes F, King SE, Dallmann D, Golan J, da Silva AC, Hurley KM, et al. Interventions to increase adherence to micronutrient supplementation during pregnancy: a systematic review. Ann N Y Acad Sci. 2021;1493(1):41-58. DOI: https://doi.org/10.1111/nyas.14545
Totade M, Gaidhane A, Sahu P. Interventions in maternal anaemia to reduce maternal mortality rate across India. Cureus. 2023;15(10):e46617. DOI: https://doi.org/10.7759/cureus.46617
Dutta RR, Chhabra P, Kumar T, Joshi A. Tackling anemia in pregnant women in India: reviewing the obstacles and charting a path forward. Cureus. 2023;15(8):e43123. DOI: https://doi.org/10.7759/cureus.43123
Jufar AH, Zewde T. Prevalence of anemia among pregnant women attending antenatal care at tikur anbessa specialized hospital, Addis Ababa Ethiopia. J Hematol Thromboembolic Dis. 2014;2(1):125.
Sivapriya SM, Parida L. A study to assess the knowledge and practices regarding prevention of anemia among antenatal women attending a tertiary level hospital in Pune. IJSR. 2015;4(3):1210-4.
Noronha JA, Bhaduri A, Bhat HV, Kamath A. Interventional study to strengthen the health promoting behaviours of pregnant women to prevent anaemia in southern India. Midwifery. 2013;29(7):35-41. DOI: https://doi.org/10.1016/j.midw.2012.07.014
Azhar BS, Islam MS, Karim MR. Prevalence of anemia and associated risk factors among pregnant women attending antenatal care in Bangladesh: a cross-sectional study. Prim health care res dev. 2021;22:e61. DOI: https://doi.org/10.1017/S146342362100061X
Singh G, Ranjitha R, Baskaran P, Goel AD, Gupta MK, Dileepan S, Choudhary Y, et al. Family-centered health education intervention for improving iron− folic acid adherence and anemia reduction among antenatal mothers in rural Jodhpur: a quasi-experimental study. Ind J Publ Heal. 2024;68(4):495-501. DOI: https://doi.org/10.4103/ijph.ijph_844_23
Balcha WF, Eteffa T, Tesfu AA, Alemayehu BA, Chekole FA, Ayenew AA, et al. Factors associated with anemia among pregnant women attended antenatal care: a health facility-based cross-sectional study. Ann Med Surg. 2023;85(5):1712-21. DOI: https://doi.org/10.1097/MS9.0000000000000608
Sinha A, Adhikary M, Phukan JP, Kedia S, Sinha T. A study on anemia and its risk factors among pregnant women attending antenatal clinic of a rural medical college of West Bengal. JFMPC. 2021;10(3):1327-31. DOI: https://doi.org/10.4103/jfmpc.jfmpc_1588_20
Latha K, Shruthi MN, Mahesh V. Anemia in pregnant mothers attending antenatal clinic at primary health center, Devarayasamudra, Kolar, Karnataka, India. Int J Comm Med Publ Heal. 2016:2397-402. DOI: https://doi.org/10.18203/2394-6040.ijcmph20162874
Stephen G, Mgongo M, Hussein Hashim T, Katanga J, Stray-Pedersen B, Msuya SE. Anaemia in pregnancy: prevalence, risk factors, and adverse perinatal outcomes in Northern Tanzania. Anemia. 2018;2018(1):1846280. DOI: https://doi.org/10.1155/2018/1846280
Mengistu T, Lencha B, Mekonnen A, Degno S, Yohannis D, Beressa G. Compliance to iron folic acid supplementation and its associated factors among pregnant women attending Antenatal clinic in Wondo district: a cross-sectional study. Sci Rep. 2023;13(1):17468. DOI: https://doi.org/10.1038/s41598-023-44577-7
Yadav RK, Swamy M, Banjade B. Knowledge and Practice of Anemia among pregnant women attending antenatal clinic in Dr. Prabhakar Kore hospital, Karnataka-A Cross sectional study. Literacy. 2014;30(34):74-80. DOI: https://doi.org/10.9790/0853-13477480
Suryanarayana R, Chandrappa M, Santhuram AN, Prathima S, Sheela SR. Prospective study on prevalence of anemia of pregnant women and its outcome: A community based study. J Family Med Prim Care. 2017;6(4):739-43. DOI: https://doi.org/10.4103/jfmpc.jfmpc_33_17
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