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Effect of Preconception Anaemia Screening on Anaemia Detection among Women of Reproductive Age in Nigeria

Abstract

Anaemia is an important public health concern among women of reproductive age and may have significant implications for maternal health and pregnancy outcomes when it remains undiagnosed and untreated before conception. Women with undetected anaemia may enter pregnancy without appropriate assessment, nutritional counselling, treatment, or follow-up, potentially increasing the risk of adverse maternal and fetal outcomes. Preconception anaemia screening provides an opportunity to identify women with previously undiagnosed anaemia before pregnancy and facilitates timely evaluation, treatment, nutritional intervention, and appropriate referral. In Nigeria, however, preconception anaemia screening may be limited by inadequate awareness, financial constraints, geographical barriers, limited laboratory capacity, shortage of trained healthcare personnel, and inadequate integration of anaemia screening into reproductive health services. Against this background, this study investigates the effect of preconception anaemia screening on anaemia detection among women of reproductive age in Nigeria. The study will be anchored on the Health Belief Model, Andersen's Behavioral Model of Health Services Use, and the Health Promotion Model. The Health Belief Model explains how women's perceptions of their susceptibility to anaemia, perceived severity of anaemia-related complications, perceived benefits of screening, perceived barriers, and cues to action may influence participation in preconception screening. Andersen's Behavioral Model explains how predisposing characteristics, enabling resources, and healthcare needs influence women's utilization of preconception and preventive health services. The Health Promotion Model emphasizes individual experiences, perceived benefits and barriers, interpersonal influences, and behavioural factors that influence participation in preventive healthcare activities. Collectively, these theoretical perspectives provide a suitable framework for explaining how preconception anaemia screening may influence anaemia detection among women of reproductive age in Nigeria. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise women of reproductive age who are planning pregnancy or accessing reproductive, family planning, preconception, and primary healthcare services in selected healthcare facilities and communities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, clinics, and eligible women. Preconception anaemia screening will be assessed using indicators such as availability of screening services, screening participation, haemoglobin assessment, appropriate laboratory testing, screening procedures, availability of trained healthcare personnel, laboratory capacity, anaemia risk assessment, counselling, documentation, referral arrangements, and follow-up of women with abnormal results. Anaemia detection will be assessed using indicators such as newly identified anaemia cases, haemoglobin levels below the applicable diagnostic threshold, identification of previously undiagnosed anaemia, classification of anaemia severity where appropriate, referral for further clinical assessment, identification of possible underlying causes, and linkage to appropriate treatment and follow-up services. Data will be collected using structured questionnaires, laboratory screening records, preconception clinic registers, medical records, referral registers, and relevant maternal health and reproductive health programme documents. Descriptive statistics will be used to summarize participants' characteristics, screening coverage, laboratory findings, and anaemia detection patterns. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of preconception anaemia screening on anaemia detection. Where a quasi-experimental design is adopted, anaemia detection outcomes before and after implementation of structured preconception screening may be compared, while relevant demographic, socioeconomic, nutritional, reproductive, and healthcare-access factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that preconception anaemia screening has a significant positive effect on anaemia detection among women of reproductive age in Nigeria. Women who participate in preconception anaemia screening are expected to have a higher likelihood of previously undiagnosed anaemia being identified than women without access to routine screening. Early detection may provide opportunities for further clinical assessment, nutritional counselling, iron and other appropriate treatment, investigation of underlying causes, and follow-up before pregnancy occurs. Integrating anaemia screening into preconception, family planning, and primary healthcare services may improve access to preventive screening and identify women who may not otherwise seek assessment for anaemia. However, limited awareness, the cost of laboratory investigations, inadequate equipment, shortage of trained healthcare personnel, geographical barriers, and weak referral and follow-up systems may reduce screening coverage and the benefits of early detection. The study therefore expects accessible, affordable, reliable, and well-integrated preconception anaemia screening services to contribute significantly to improved anaemia detection among women of reproductive age in Nigeria. The study is expected to contribute to the literature on preconception anaemia screening, anaemia detection, preconception care, reproductive health, maternal health, nutritional health, non-communicable and nutrition-related health conditions, 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, hospitals, primary healthcare centres, family planning clinics, healthcare professionals, maternal health programmes, nutrition programmes, development partners, and policymakers regarding strategies for strengthening preconception healthcare. The study will also provide evidence-based recommendations for integrating anaemia screening into routine preconception and reproductive health services, improving access to affordable laboratory testing, strengthening healthcare-worker capacity, increasing awareness of preconception anaemia screening, establishing effective referral and follow-up systems, and linking women with appropriate treatment, nutritional support, and preconception care across Nigeria.

Keywords: Preconception anaemia screening, anaemia detection, women of reproductive age, preconception care, haemoglobin screening, reproductive health, maternal health, nutritional health, preventive healthcare, Nigeria, public health.