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Effect of Community-Based Anaemia Risk Assessment on Anaemia Risk Detection among Pregnant Women in Nigeria

Abstract

Anaemia is a major public health concern among pregnant women in Nigeria and is associated with increased risks of maternal morbidity, poor pregnancy outcomes, preterm birth, low birth weight, and other complications. Pregnancy increases the demand for iron and other essential nutrients, while factors such as inadequate dietary intake, iron deficiency, malaria, parasitic infections, infections, closely spaced pregnancies, and other underlying conditions may increase the risk of anaemia. Anaemia may develop or worsen during pregnancy without obvious symptoms, making routine risk assessment important for early identification and intervention. Community-based anaemia risk assessment provides an opportunity to identify pregnant women with anaemia-related risk factors through community outreach programmes, primary healthcare centres, antenatal outreach services, mobile health initiatives, and other accessible community platforms. Early identification of risk may facilitate haemoglobin assessment, nutritional counselling, appropriate iron and folic acid supplementation, malaria prevention and management, investigation of underlying causes, and timely referral for further care. However, limited access to antenatal and community health services, inadequate screening equipment, shortage of trained healthcare personnel, low awareness, financial constraints, geographical barriers, and weak referral systems may limit the effectiveness of community-based anaemia risk assessment in Nigeria. Against this background, this study investigates the effect of community-based anaemia risk assessment on anaemia risk detection among pregnant women in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and the Health Systems Framework. The Health Belief Model explains how pregnant women's perceptions of susceptibility to anaemia, perceived severity, perceived benefits of risk assessment, perceived barriers, and cues to action may influence participation in community-based anaemia risk assessment. The Social Ecological Model emphasizes the influence of individual, household, community, socioeconomic, nutritional, cultural, and environmental factors on maternal nutrition, anaemia risk, healthcare-seeking behaviour, and access to preventive services. The Health Systems Framework emphasizes service delivery, health workforce, health information, medical products and technologies, financing, laboratory capacity, and accessibility as essential components of effective community-based anaemia risk assessment and prevention programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how community-based anaemia risk assessment may influence anaemia risk detection among pregnant women in Nigeria. The study will adopt a quantitative cross-sectional analytical or quasi-experimental research design. The study population will comprise pregnant women residing in selected communities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, households, primary healthcare centres, and eligible pregnant women. Community-based anaemia risk assessment will be measured using indicators such as availability of risk assessment services, assessment coverage, frequency of community assessment activities, haemoglobin measurement, dietary assessment, assessment of iron and folic acid intake, malaria risk assessment, assessment of parasitic and infectious disease risks, obstetric history, interpregnancy interval, nutritional status, availability of trained healthcare personnel, assessment equipment, maternal health education, and referral arrangements. Anaemia risk detection will be assessed using indicators such as identification of women with anaemia-related risk factors, low haemoglobin levels where testing is conducted, nutritional risk, inadequate iron intake, malaria-related risk, previous history of anaemia, recurrent infection, high-risk pregnancy characteristics, newly identified women requiring further assessment, referrals for confirmatory or clinical evaluation, and linkage to appropriate maternal and nutritional health services. Data will be collected using structured questionnaires, community risk assessment forms, haemoglobin records, antenatal registers, nutritional assessment forms, healthcare facility records, referral registers, and relevant maternal health programme documents. Descriptive statistics will be used to summarize participants' characteristics, obstetric and nutritional factors, risk assessment coverage, and patterns of anaemia risk detection. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the effect of community-based anaemia risk assessment on anaemia risk detection. Where appropriate, anaemia risk detection rates before and after implementation of community-based risk assessment activities may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that community-based anaemia risk assessment has a significant positive effect on anaemia risk detection among pregnant women in Nigeria. Pregnant women who participate in community-based anaemia risk assessment are expected to have a higher likelihood of previously unrecognized anaemia-related risk factors or low haemoglobin levels being identified than women without access to such services. Community-based assessment may facilitate early recognition of nutritional deficiencies, inadequate iron and folic acid intake, malaria-related risks, previous anaemia, recurrent infections, and other factors associated with maternal anaemia. Early identification may provide opportunities for nutritional counselling, appropriate iron and folic acid supplementation, malaria prevention, clinical assessment, treatment of underlying conditions, and timely referral. Bringing risk assessment services closer to pregnant women may reduce geographical, financial, and time-related barriers and encourage greater participation in preventive maternal healthcare. Community-based maternal health education may also improve knowledge of anaemia prevention, dietary practices, supplementation, malaria prevention, and the importance of antenatal care. Conversely, inadequate assessment coverage, limited laboratory capacity, shortage of trained healthcare workers, financial constraints, low community participation, poor access to supplements, and weak referral and follow-up systems may reduce the effectiveness of community-based anaemia risk assessment. The study therefore expects accessible and well-organized community-based anaemia risk assessment to contribute significantly to improved detection and early management of anaemia risk among pregnant women in Nigeria. The study is expected to contribute to the literature on community-based anaemia risk assessment, anaemia risk detection, maternal nutrition, maternal health, pregnancy health, antenatal care, nutritional deficiency prevention, community health services, preventive healthcare, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, primary healthcare centres, antenatal care providers, nurses, midwives, community health workers, nutritionists, maternal health programme managers, development partners, and policymakers regarding strategies for strengthening maternal anaemia prevention. The study will also provide evidence-based recommendations for expanding community-based anaemia risk assessment, improving access to haemoglobin testing and appropriate laboratory services, strengthening maternal nutrition education, promoting adequate iron and folic acid intake, improving malaria prevention and management, increasing availability of trained healthcare personnel and assessment equipment, strengthening referral and follow-up systems, and integrating anaemia risk assessment into comprehensive community-based maternal and antenatal health programmes across Nigeria.

Keywords: Community-based anaemia risk assessment, anaemia risk detection, pregnant women, maternal anaemia, pregnancy, maternal nutrition, haemoglobin assessment, antenatal care, preventive healthcare, community health services, Nigeria, public health.