AFRICA MEDICAL COLLEGE

MASTER OF PUBLIC HEALTH

PREVALENCE OF ANEMIA AND ASSOCIATED FACTORS AMONG

PREGNANT WOMEN IN LIDETA SUBCITY HEALTH CENTERS,
ADDIS ABABA, ETHIOPIA

BY: Melese Belachew

A Research paper submitted to Africa Medical College, Department Master

of Public Health Program in Partial Fulfillment of the Requirements for the
Degree of Master of Public Health

College: Africa Medical College

Program: Master of public Health

January/ 2023
Addis Ababa, Ethiopia
PREVALENCE OF ANEMIA AND ASSOCIATED FACTORS AMONG
PREGNANT WOMENIN IN LIDETA SUBCITY HEALTH CENTERS,
ADDIS ABABA,ETHIOPIA

BY: Melese Belachew

A Research paper submitted to Africa Medical College, Department Master

of Public Health Program in Partial Fulfillment of the Requirements for the
Degree of Master of Public Health

Major Adviser: G/Medhin B/Mariam (Ph.D.)

Co-Adviser: TeklehaimanotMeᴢgebe

January/ 2023
Addis Ababa,Ethiopia
 AFIRICA MEDICAL COLLEGE

MASTER OF PUBLIC HEALTH

APPROVAL SHEET
As thesis research advisor and co-advisor, we hereby certify that we have read and evaluated
this thesis prepared under our guidance by Melese Belachew entitled prevalence of anemia
and associated factors among pregnant women in Lideta sub-city Health centers. We
recommend that it be submitted as fulfilling the thesis requirement.
____________ _____________ _________
Major advisor Signature Date
____________ ________ ________
Co- advisor Signature Date
As members of the Board of Examiners of the MPH thesis open defense examination, We
certify that we have read and evaluated the thesis prepared by Melese Belachew and
examined the candidate. We recommend that the thesis be accepted as fulfilling the thesis
requirements for the degree of Master of Public Health.
________________ ____________ ___________
Chairperson Signature Date
____________ ______________ ____________
Internal Examiner Signature Date

____________ ______________ ____________

External Examiner Signature Date

i
 DEDICATION
I want to dedicate this paper to my beloved wife Tiᴢta Zebene who support material aid
for successful development of this research ,and my father Ato Belachew Desta and mother
Tihune Andualem who up brought me supporting in every aspects to reach to such status.

ii
 STATEMENT OF THE AUTHOR
By my signature below, I declare and affirm that this thesis is my own work; I have followed
all ethical principles of scholarship in the preparation, data collection, data analysis and
completion of this thesis. All scholarly matter that is included in the thesis has been given
recognition through citation. I affirm that I have cited and referenced all sources used in this
document. Every serious effort has been made to avoid any plagiarism in the preparation of
this thesis.
This thesis is summited in partial fulfillment of the requirement for master of public health
degree to Africa Medical College. I would like to declare that this thesis has not been
submitted to any other institution anywhere for the award of any academic degree, diploma or
certificate

Name __________________________Signature______________Date______________

Program : Master of public Health, Africa Medical College

iii
 BIOGRAPHICAL SKETCH
I was born in Addis Ababa, 1992 GC, and I have attended my first degee at higher
education at Jimma university by medical laboratory technology. I have done at Lideta sub-
city woreda 10 for about 1 years by medical laboratory from july /2004 to Nov/2005 E.C,
from jan /2005 to Nov/ 2006 E.C by advisory service at Lideta woreda 1 admnistration ,and
then from Jan/2006 E.C up to now I am now working in Lideta sub city Hidase fire Health
Center as medical laboratory technologist.

iv
 ACKNOWLEDGEMENT

I would like to express my deep gratitude to my major advisor G/medhin B/mariam(PhD)

and co-advisor Teklehayimanot Meᴢgebe for their excellent comments on developing this
research . The last but not the least I would like to give my deep appreciation to my family in
supporting materials.

v
 LIST OF ACRONYM´S AND ABBREVATION

ANC Ante-Natal Care

AOR Adjusted Odds Ratio

aPOR adjusted Prevalence Odds Ratio

CI Confidence Interval

EDHIS Ethiopian Demographic and Health Survey

g/dl Gram per deciliter

Hb/Hgb Hemoglobin

HC Health Center

LBW Low Birth Weight

NB New Born

NTD Neural Tube Defects

SD Standard Deviation

SGA Small-for-Gestational Age

WHO World Health Organizatio

vi
TABLE OF CONTENTS

Contents Page

APPROVAL SHEET...................................................................................................................i
DEDICATION............................................................................................................................ii
STATEMENT OF THE AUTHOR...........................................................................................iii
BIOGRAPHICAL SKETCH.....................................................................................................iv
ACKNOWLEDGEMENT..........................................................................................................v
LIST OF ACRONYM´S AND ABBREVATION.....................................................................vi
LIST OF TABLES......................................................................................................................x
LIST OF FIGURES...................................................................................................................xi
ABSTRACT.............................................................................................................................xii
1 INTRODUCTION...................................................................................................................1
1.1 Background of the study..................................................................................................1
1.2 Statement of the problem.................................................................................................3
1.3 Significance of the study..................................................................................................5
2 LITRATURE REVIEW...........................................................................................................6
2.1 Prevalence of anemia among pregnant women...............................................................6
2.2 Factors of anemia among pregnant women.....................................................................7
3 OBJECTIVES........................................................................................................................10
3.1 General Objectives.........................................................................................................10
3.2 Specific Objectives........................................................................................................10
4 MATERIAL AND METHODS.............................................................................................11
4.1 Study Area and period...................................................................................................11
4.2 Study design...................................................................................................................11
4.3 Population......................................................................................................................11
4.3.1 Target population........................................................................................................11
vii
 4.3.2 Study population.........................................................................................................11
4.4 Exclusion & Inclusion Criteria......................................................................................11
4.4.1 Inclusion criteria.........................................................................................................11
4.4.2 Exclusion criteria........................................................................................................12
5 STUDY VARIABLE.............................................................................................................13
5.1 Dependent variable........................................................................................................13
5.2 Independent variable......................................................................................................13
5.3 Sample size determination.............................................................................................13
5.4 Sampling Technique.....................................................................................................14
5.5 Data collection procedure and instruments....................................................................15
5.6 Data quality control........................................................................................................16
5.7 Data Analysis and Interpretation...................................................................................16
5.8 Operational definition....................................................................................................16
5.9 Ethical consideration......................................................................................................17
5.10 Dissemination of the Result.........................................................................................17
6 RESULTS..............................................................................................................................18
6.1 socio-demographic characteristics of study participants...............................................18
6.2 Magnitude of Anemia among study participants...........................................................20
6.3 Bivariate and multivariate analysis of socio-demographic determinants of anaemia...23
7 DISCUSSION........................................................................................................................28
8 STRENGTHS AND LIMITATIONS OF THE STUDY.....................................................31
8.1 strengths.........................................................................................................................31
8.2 Limitations.....................................................................................................................31
9 CONCLUSSION....................................................................................................................31
10 RECOMMENDATION.......................................................................................................32
REFERENCES.........................................................................................................................33
APPENDIX...............................................................................................................................35
APPENDIX 1............................................................................................................................35
Information sheet......................................................................................................................35
viii
APPENDIX 2............................................................................................................................36
Questionnaire............................................................................................................................36

LIST OF TABLES

ix
Table 1 Frequency distribution of socio-demographic characteristics of pregnant women, lideta, Addis
Ababa , 2022........................................................................................................................................19
Table 2 Frequency distribution of Behavioral Characteristics and Nutritional Status of participants,
lideta, Addis Ababa , 2022...................................................................................................................21
Table 3 Frequency distribution of obstetrics and clinical characteristics of pregnant women, Lideta,
Addis Ababa, 2022...............................................................................................................................22
Table 4 Association of anemia with the socio-demographic characteristics of the study subjects
(Lideta, Addis Ababa, 2022)................................................................................................................24
Table 5 Association of anemia with Behavioral Characteristics and Nutritional Status of p................25
Table 6 Association of anemia with obstetric risk factors of pregnant women , Lideta, Addis
Ababa,2022..........................................................................................................................................27

LIST OF FIGURES
Figure 1 Conceptual frame works...........................................................................................................9

x
Figure 2 :-Sampling technique schemic representation........................................................................15
Figure 3:- proportion of anemia among pregnant women according to age, Lideta ,Addia Ababa,2022.
.............................................................................................................................................................20

xi
 ABSTRACT
Background: According to the World Health Organization, between 35% to 75% (56% on
average) of pregnant women in underdeveloped nations like Ethiopia are anemic, which has
serious effects for both the mother and the fetus.

Objective: To assess anemia and associated factors among pregnant women in Lideta Sub
city health centers, Addis Ababa, Ethiopia, 2022.

Methods: An institution-based cross-sectional study was conducted on 394 pregnant women.

A pre-test structured questionnaire was used to gather data, and the results were presented in
text, figures, and tables. Statistical significance was determined by the P-value threshold of
0.05. Epi-data was used for data entry, while SPSS version 25.0 was used for analysis.

Results: A study done on lideta sub city Health Center, anemia was found in 28.4% of the
population, with a 95% confidence interval of 13.4%–43.4%. Multivariate analysis revealed
that age at marriage >30 years (AOR = 13.491, 95% CI 1.986, 91.660, p = 0.008), no iron
supplement (AOR = 9.895, 95% CI 4.271,22.928 , p = 0.000), previous history of
miscarriage (AOR = 7.507, 95% CI 3.284, 17.162, p = 0.000) and History of intestinal parasite
or blood parasite (AOR = 6.547, 95% CI 1.206, 35.538, p = .029) were significantly
associated with anemia in pregnancy.

Conclusion: The prevalence of anemia was 28.4%, and factors that contribute to anemia in
pregnancy include history of miscarriage, age at marriage, using any sort of iron supplement
and history of intestinal parasite or blood parasite.

.
Key words: Anemia, Prevalence, Supplements, Pregnant women, intestinal parasite,
gestational age, hemoglobin.

xii
 1 INTRODUCTION

1.1 Background of the study

One of the most frequent complications related to pregnancy is anemia. There is a Normal
physiologic changes in pregnancy which affect the hemoglobin (Hb),a relative or absolute
reduction in Hb concentration. The most common cause of anemia in pregnant women who
have inadequate diets and who are not receiving prenatal iron and folate supplementsare iron
deficiency anemia (approximately 75%) and foliate deficiency megaloblastic anemia.
Pregnant women with anemia a hemoglobin level less than 6 g/dl will produce series
consequences. An Hb level of 11 g/dl in the late first trimester and 10 g/dl in the second and
third trimesters are suggested to be lower limits for Hb concentration.(1)

Themost common hematologic complication of pregnancy due to anemia will increase rates
of premature birth, low birth weight and perinatal mortality. Iron deficiency and Folic acid
deficiency which is cause of megaloblastic anemia are the most common associated factor
for pregnant women. (2)

Anemia has adverse outcome on both mother and fetal health.Anemia during pregnancy is
highly prevalent in developing countries like India. Depending on degree and type of anemia
all are treated and followed up for maternal and perinatal outcome.(3)

Thecommonest hematological disorder that occurs in pregnancy is anemia, i.elack of iron.

Therecent standard laid down by ‘WHO’, anemia is present when the Hemoglobin (Hb)
concentration in the peripheral blood is 11 g/dl or less. Most of pregnant women who are
anemic are women from low socio-economic groups and teenagers. Iron and folate
supplementation is indicated during pregnancy to prevent the complications.Normally in
pregnancy the hemoglobin concentration becomes diluted according to the increase in the
volume of circulating blood..(4)

1
Level of anemia is varied according to age, sex, and pregnancy status.According toWorld
Health Organization reported that pregnant women are more anemic in developing countries
than developed countries.(5)

A risk factor for pregnancy and can be a cause of anemia in newborns (NB), besides being
related to higher miscarriage rate, intrauterine growth restriction (low birth weight - LBW),
prematurity, fetal death and anemia in the first year of life due to low iron stores is maternal
anemia.(6)

According to World Health Organization (WHO), approximately 40% of pregnant women

are anemic. Anemia is a global health problem in all age groups.(7)

Pregnancy and postpartum anemia occurs worldwide, particularly in developing countries

that accounts for substantial maternal and infant morbidity and mortality (8)

As I have understood from the above researches, anemia among pregnant women is a
global concern and there are associated factors for being anemic. So my study assessed this
on the distribution of anemia and its associated factors among pregnant women in my scope
of study.

2
 1.2 Statement of the problem

Prematurity, spontaneous abortions, low birth weight, and fetal deaths are complications of
severe maternal anemia. A mild to moderate iron deficiency does not appear to cause a
significant effect on fetal hemoglobin concentration (1)
One of the most common medical disorders during pregnancy is anemia. It can cause
serious adverse effects on the mother and the fetus with high risk for maternal
mortality. Anemia in pregnancy could be due to malnutrition, blood loss, infections,
chronic diseases, parasites and chronic hemolysis, and several risk factors have been
recognized as unhealthy lifestyle, multiple pregnancies, alcohol, smoking, and
menstrual disorders. Approximately 5% of the world’s populations are carriers of
inherited hemoglobin disorders.(5).
Anemia of pregnancy, an important risk factor for fetal and maternal morbidity, is
considered a global health problem, affecting almost 50% of pregnant women.The
most common cause of anemia in pregnancy women are iron deficiency, foliate
deficiency and low hemoglobin level ,cobalamin,etc. the consequences of anemia in
pregnant women are preterm birth, low birth weight (LBW), small-for-gestational age
(SGA) newborns ,diminished auditory recognition memory in infants, increased neural
tube defects (NTDs) and others. WHO recommends folate supplementation for
pregnant women, 400 μg per day from early pregnancy to 3 months postpartum, daily
allowance of cobalamin in pregnant women than in non-pregnant women (2.6 vs 2.4
μg per day)to support fetal neurologic development, improves the motor functioning.
(9)
According to 2011 Ethiopian Demographic and Health Survey(EDHIS), 22% of
pregnant women in Ethiopia were reported to be anemic. However, since the
Ethiopian population is diverse with regard to culture, religion and other
characteristics, this evidence may not represent the demography .(10)
But, the problem still exists. However, studies in Ethiopia is vary due to different population
in diverse. Therefore, this study assessed the prevalence and associated factors of anemia
among pregnant women at health centers in Lideta sub city of Addis Ababa town.

3
Even if the problems of anemia among pregnant women are global and there are associated
factors that affect pregnant women, there is no study specifically on prevalence of anemia
and associated factors among pregnant women attending ANC follow up in lideta sub-city
health centers. so i would like to identify the problems that are not addressed before and
determine the prevalence of anemia as well as associated factors among pregnant women
attending ANC follow up in lideta sub-city health centers. I have tried to suggest the possible
solution with recommendation to the identified problems that was found. This study may
support to the concerned body and may be inputs to future action plan concerning on
pregnant and its associated issues. I have tried to identify the problem that was not addressed
till now. The last but not the least I would like to announce the distribution of anemia studied
to the concerned bodies.

4
 1.3 Significance of the study

This study´s findings will be of greater importance to health administrators and other
concerned bodies as well as the community and in priority setting and decision making
based on the finding in sub-city health office accordingly .It is also a greater
importance to Health facility ANC focal to give especial a tension. The study can also
have greater importance to assess the prevalence of anemia and associated factor
among pregnant women attending ANC follow up in Lideta Sub-city health centers to
follow up.
Furthermore, such study will be helpful to filling such gaps design appropriate
intervention strategies to improve the wellbeing of anemic mothers. The study finding
will be used as baseline information for further studies as well as teaching purpose.

5
 2 LITRATURE REVIEW

2.1 Prevalence of anemia among pregnant women

Anemia remains a public health challenge worldwide. A study conducted in the United Arab
Emirates female college students attending the University of Sharjah (UoS),the over all
prevalence of anemia (Hb<11g/dL) was 26.7% and the majority (88.4%) of the 69 anemic
students had mild anemia, whereas 7.2% were moderately anemic and 2.3% Emirate students
were severely anemic (hemoglobin <7g/dL).(11)

A research conducted in Uganda Guluand Hoima Regional Hospitals from July to October
2012, a total of 743 pregnant women took part in the study for a response rate of 91.1 %. A
total of 164 (22.1 %) women were anemic. Greater efforts were required to encourage early
antenatal attendance from women in these at risk groups of anemia. This would allow iron
and folic acid supplementation during pregnancy, which would potentially reduce the
prevalence of anemia.(12)

A study conducted in Arba Minch General Hospital, Arba Minch, and Secha Health Centers
in Arba Minch town in2014/15,the Prevalence of Anemia was About one-third, 109 (32.8%),
of the 332 ANC attendees were anemic (hematocrit < 33%). From those who were anemic,
the majority s57 (52.3%) were mild (hematocrit value ≥ 30% and <33%) and 4 (3.7%) were
severely anemic (hematocrit value < 21%). Eleven (3%) of the pregnant women were found
to be HIV positive. Giardia lamblia, 30 (9%); Entamoebahistolytica5 (1.5%); hookworm 2
(0.6%) were among intestinal parasites detected in the pregnant women.(13)

In Ethiopia, anemia during pregnancy is a major public health problem and affects both the
mother’s and their child’s health. Based on the 2016 Ethiopian Demographic Health Survey
(EDHS) that used a two-stage stratified cluster sampling technique and a cross-sectional study
that was conducted among 3080 pregnant women. The prevalence of anemia among pregnant
women was 41% of which 20% were moderately anemic, 18% mildly anemic and 3%
severely anemic. Anemia increases the risk of maternal and child morbidity and mortality. It
also impairs cognitive and physical development of children and decreases work efficiency in
adults.(14)
6
 2.2 Factors of anemia among pregnant women
A study done in Kenya the prevalence of anemia among pregnant women to be 40.7%
with a significant association of Helminthic infestation and anemia (p =0.003),
Education showed statistically significant relationship with anemia (p =0.001) and
was a strong association between prevalence of anemia and the dietary practices (p
=0.003).(15)
A study done in Adigrat general hospital, the prevalence of Anemia among the
pregnant women attending Adigrat General Hospital was 7.9%. About 62.5% and
37.5% of the anemic women were with mild (Hgb: 10.0–10.9 g/d1) and moderate
(Hgb: 7–9.9 g/dl) type respectively. Factors like, residing in rural areas increases risk
of anemia by 6 times (AOR = 6, 95% CI 1.34, 27.6, p = 0.019), participants having
current blood loss (AOR = 3.4, 95% CI 1.16, 10.2, p = 0.026), having history of recent
abortion (AOR = 7.9, 95% CI 2.23, 28.1, p = 0.001) and gestational age in the third
trimester (AOR = 4.9, 95% CI 1.39, 17.6, p = 0.013) were statistically associated with
anemia. Strong endeavor was needed to control anemia among pregnant women by
assessing different micronutrient deficiencies for further prevention.(16)
A study done in Kenyapumwani maternity hospitalrevealed that the prevalence of
anemia among the pregnant women was 57%. Advanced maternal age (>31 years)
(AOR = 2.71; 95% CI = 1.25 - 5.88; P = 0.012) more than 18 - 24 years,
government/private employed women (AOR = 2.94; 95% CI = 1.47 - 5.88; P = 0.002)
and self-employed women (AOR = 1.91; 95% CI = 1.03 - 3.53; P = 0.039) compared
to housewives, not taking iron/folic acid supplementation (IFAS) (AOR = 2.04; 95%
CI = 1.14 - 3.64; P = 0.016) and mid-upper arm circumference (MUAC) less than 23
cm (AOR = 2.52; 95% CI = 1.36 - 4.67; P = 0.003) were found to be predictors of
anemia.(17)
A study done on antenatal clinic of the Marie Stops in Dhaka ,the mean (±SD) age of
the subjects was 26.4 ± 2.81 years. Sixty-three percent of the subjects had normal level
of hemoglobin, and 37 % were anemic 26 % mild and 11 % moderate. Maternal
anemia was significantly associated with age (p = 0.036), education (p = 0.002),
income (p = 0.001) and living area (p = 0.031).

7
Results of binary logistic regression analysis showed that maternal anemia was also
significantly associated with age (p = 0.006), educational status (primary to 8th grade,
p = 0.004; secondary and above, p = 0.002), living area (P=0.022), and income
(P=0.021).(18)
A study done in pregnant women living in an urban community setting in Hyderabad,
Pakistan,the prevalence of anemia (defined by the World Health Organization as
hemoglobin < 11.0 g/dL) was 90.5% of these 75.0% had mild anemia (hemoglobin
from 9.0 to 10.9 g/dL) and 14.8% had moderate anemia (hemoglobin from 7.0 to 8.9
g/dL). Only 0.7% were severely anemic (hemoglobin < 7.0 g/dL). Nonanemic women
were significantly taller, weighed more, and had a higher body mass index.
Multivariate analysis after adjustment for education, pregnancy history, iron
supplementation, and height showed that drinking more than three cups of tea per day
before pregnancy (adjusted prevalence odds ratio [aPOR], 3.2; 95% confidence
interval [CI], 1.3 to 8.0), consumption of clay or dirt during pregnancy (aPOR, 3.7;
95% CI, 1.1 to 12.3), and never consuming eggs or consuming eggs less than twice a
week during pregnancy (aPOR, 1.7; 95% CI, 1.1 to 2.5) were significantly associated
with anemia. Consumption of red meat less than twice a week prior to pregnancy was
marginally associated with anemia (aPOR, 1.2; 95% CI, 0.8 to 1.8) but was
significantly associated with lower mean hemoglobin concentrations (9.9 vs. 10.0
g/dL, p = .05) during the study period.(19)

A study done in Banke, Nepalmean years of schooling ± SD was 4.77± 4.94 years and age
(23.6 ± 4.77) with 20% under the age of 20. Mean hemoglobin was 11.2+/−1.3 g/dL, and
anemia prevalence was 40%. Bivariate analyses showed significant negative relationships
between serum hemoglobin and age (p=0.0001), use of iron supplements (p=0.003), received
deworming medication (p=0.001), ante natal (ANC) visits (p=0.000) and trimester
(p=0.000)and positive relationships with years of schooling (p=0.0001), access to an
improved water source (p=0.039), first pregnancy (p=0.02), consumption of nuts and seeds
(p=0.0059) and minimum dietary diversity (p=0.0022).

8
Controlling ethnicity and geographic location, women between 30–34 years had significantly
lower hemoglobin levels compared to women under 20 years. Women with secondary school
education had significantly higher hemoglobin (p=0.031). Hemoglobin levels were
significantly lower in the second (p=0.0000) and third trimester (p=0.0000). Consuming any
iron supplement was associated with higher hemoglobin (p=0.043) while attending antenatal
clinic was associated with lower hemoglobin (p=0.005) as was a low MUAC (p=0.005).
Women in households with an improved water source and having achieved minimum dietary
diversity had significantly higher hemoglobin levels (p=0.040 and p=0.003 respectively.(20

-Level hemoglobin(16,20)

-intestinal parasites(14,15)

-HIV positive (14)

-Status of education (15,18,20)

age(1718,20) Determinant factors

-Dietary practices (19,20) Anemia

-demographic(16,18,20)

-blood loss, current abortion(16)

-gestational age (16)

supplementation(17,19,20, income(18)

Figure 1 Conceptual frame works

9
 3 OBJECTIVES

3.1 General Objectives

 The aim of this study is to assess prevalence of anemia and associated factors
among pregnant women attending antenatal care in health centers of Lideta
Sub- city, Addis Ababa, Ethiopia,2022

3.2 Specific Objectives

 To determine the magnitude of anemia among pregnant women attending antenatal

care in health centers of Lideta sub- city, Addis Ababa, Ethiopia.
 To identify factors associated with anemia among pregnant women attending
antenatal care in health centers of Lideta sub- city, Addis Ababa, Ethiopia.

10
 4 MATERIAL AND METHODS

4.1 Study Area and period

Addis Ababa is the capital city of Ethiopia. Administratively, the city is divided in to11 sub
cities and 116 districts with an area of 527 sq. km. According to the 2012 Population census
(CSA) report, the total population of Addis Ababa is 3,686,068. Whereas, 1,527,478 are
Female population. There are13 Hospitals and 98 Health Centers in town. Lideta sub city
has 1 private and 3 governmental Hospitals, 8 health centers ,and a population of 339,597 in
ten woredas. During the 2007 population and housing census of Ethiopia, out of total
population of 201,713 people ,there were 105,441 females. Reproductive Age group is
considered to be from ages 15-45 years. The number of reproductive age groups is 64,920.
The expected average number of pregnant women attending ANC follow -up in Lideta sub-
city is 6115. This study was conducted from September 29-October 30,2022, of the
prevalence of anemia and associated factors among pregnant women at the eight health
centers.

4.2 Study design

Institution based cross sectional study was conducted

4.3 Population

4.3.1 Target population

 All pregnant women who came to health centers of Lideta sub city.

4.3.2 Study population

 All pregnant women who were attending ANC follow up in Lideta Sub city
health centers.

4.4 Exclusion & Inclusion Criteria

4.4.1 Inclusion criteria

 Pregnant women who were voluntary and present during data
collection period

11
 4.4.2 Exclusion criteria
 Mothers who were involuntary and Unconscious and seriously sick mothers.

12
 5 STUDY VARIABLE

5.1 Dependent variable

 anemia in pregnancy

5.2 Independent variable

Age, Marital status, Educational status, Monthly income, Occupational status, supplement
intake, eating habits, frequency of hot drink, frequency of vegetables, fruit and milk intake,
age of first pregnancy, history of miscarriage, history of intestinal /blood parasite, exposure
to worry, stress, nausea & vomiting , level of Hemoglobin and gestational age.

5.3 Sample size determination

As it is known that sample size was determined in two steps
1. Calculate the sample size for infinite population
2. Adjust the sample size to required population.
So, first Calculate the sample size for infinite population as follows
n= (Z@/2)2 p (1-p)
d2
Where z=ᴢ score

d = margin of error

p = population value of a parameter falls within a specified range of values.

I consider 95% confidence level then ᴢ- score is 1.96

Margin of Error is a small amount that is allowed for in case of miscalculation or change of
circumstances. Generally ,I took margin of error as 5% (d=0.05)

proportion(assumed to be 50%=0.5)

ᴢ -score is determined based on confidence level, confidence level :the probability that the

q = 1-p

13
 n= (1.962)2X (0.5 (1-0.5)
(0.05)2
= (1.96)2X (0.25) = 384
(0.05)2
So, the sample size for infinite population is 384
By adding 10%, non-response rate the sample size is 422
Now, it must be adjusted the sample size for the required population. I had the required
population of pregnant women 6115.
Then I used the following formula for adjusted sample size
Adjusted sample size = 422/1+((422-1)/population of pregnant women)
=422/1+((422-1)/6115)=394..39 = 394
So, the required sample size was 394.

5.4 Sampling Technique

A study participant were selected by using systematic technique until required sample size
obtained during the actual data collection period. All health centers in Lideta sub-city except
woreda 4 H/C were selected purposively. Total numbers of pregnant women who have ANC
follow up during data collection were determined from the ANC registration book. The total
sample size were allocated proportionally to each health center based on the total number of
pregnant women. I have determined monthly plan K interval of the facility. Then, the first
mother was randomly selected based on her arrival at the facility and every K the women
was taken into the study until the required number of study participants will be reach.

14
 lideta subcity health
centers
#6115 ANC
registered

Dagim Hidase Fire T/hayimanot H/C

lideta H/C Beletishachew H/c Hdase fire H/c Jagama kelo H/C Abnet H/C
H/C #957ANC
#984ANC registered #877 ANC Registered #685ANC registered #967 ANC Registered #752 ANC registered
#925ANC Registered REGISTERED

probability probability probability probability probability probability probability

proportional to size proportional to size proportional to size proportional to size proportional to size proportional to size proportional to size
#62 #56 #50 #61 #61 #60 #54

394

Figure 2 :-Sampling technique schemic representation

5.5 Data collection procedure and instruments

Data were collected by face to face interview guide using structured and pretested
questionnaire. Four data collectors were involved in the data collection process. Data were
collected from Sep29- Oct30/2022 after one day discussed on interviewing technique, the
objective of the study and the different section of the questionnaire. The participants were
come to ANC and to laboratory. Blood hemoglobin level was taken while the women gave
blood sample in laboratory. The measurement was taken from participant`s blood. The
measurements are done by using haemacue or CBC machine or other hemoglobin measuring
apparatus. Those pregnant women with abnormal findings was checked at least two times and
undergo for another hemoglobin measurement apparatus. This was done in relation with
laboratory technician to do blood test for all pregnant women during data collection.

15
 5.6 Data quality control

Data collectors and supervisor discussed on how to approach the participants and perform
measurements. The performance of the instruments was checked and measurement tools
monitoring had done. Participants were asked to give blood sample while coming to ANC
clinic in case of follow up. Blood hemoglobin level measurement was taken by one staff so
as to avoid the inter-observer bias. The supervisor will check questionnaires on daily basis
for inconsistencies and omissions. The questionnaires were first prepared in English then
would be translated to local language (Amharic) and back to English to maintain conceptual
consistency. The questionnaires were pretested at one of the health centers.

5.7 Data Analysis and Interpretation

First, the data were checked for completeness, coded, entered and analyzed using SPSS
software version 25. Binary logistic regression was used to assess the association between
the dependent variable and independent variables. Then variables with P-value less than or
equal to 0.25 were fitted to multiple logistic regression .Finally, variables with p-value less
than 0.05 will considered as factors associated for anemia. The finding of our study was
interpreted in to a form of appropriate figure, tables, proportions, percentages, frequency and
the result of the study was compared to previously done researches.

5.8 Operational definition

Anemia in pregnancy is as defined by the World Health Organization as hemoglobin level is
<11.0g/dl. On the bases of its severity, anemia is categorized as severe anemia (<7.0g/dl),
moderate anemia (7.0-9.9g/dl) and mild anemia(10.0-10.9g/dl). Premature birth is defined as
a birth that occurs before the 37 th weeks of pregnancy. Maternal anemia is happened more
during the first trimester than second and third trimester.

16
 5.9 Ethical consideration

Ethical clearance was obtained from Africa medical college and Addis Ababa Health bureau
public health research and emergency management directorate. Permission was obtained
from Lideta sub city health office to get access to the data. Only codes were assigned and no
name was put to each checklist. The code was used to facilitate data entry and analysis, no
one can link the identity of the participants with the registration numbers.

5.10 Dissemination of the Result

The finding from this study will be communicated to Addis Ababa regional health bureau,
Addis Ababa public health research and emergency management directorate office and
Africa medical college. Furthermore, the result will be present on appropriate seminars
conferences and workshops and publishing scientific journal will be considered.

17
 6 RESULTS

6.1 socio-demographic characteristics of study participants

Almost half of the pregnant women were between the ages of 25 and 30, with an average
age of 26.41, and the majority of them (348, or 88.3%) were married. None of the pregnant
women are housewives. About 1% of pregnant women are not able to read or write. The
majority of the pregnant women in the study, 141 (35.6%), earned between 3001 and 5000
birr. Above half of the pregnant women's occupations were government (250, 63.5%), and
other occupations were 3 (0.8%). It is summarized in (table1, fig 3).

18
 Table 1 Frequency distribution of socio-demographic characteristics of pregnant
women, lideta, Addis Ababa , 2022

Variables/characteristics Frequency Percent

age of respondent 17-24 144 36.5%
25-30 183 46.4%
31-35 55 14.0%
36-40 12 3.0%
age at the time of less or equal to 15 18 4.6%
marriage 16-20 92 23.4%
21-25 202 51.3%
26-30 70 17.8%
above 30 12 3.0%
level of education not able to read and write 3 0.8%
able to read and write 26 6.6%
1-8 61 15.5%
9-12 134 34.0%
higher education 170 43.1%
marital status Single 33 8.4%
Married 348 88.3%
Widowed 10 2.5%
Divorced 3 0.8%
Occupation Government 250 63.5%
Private 141 35.8%
house wife 0 0.0%
Other 3 0.8%
average monthly 1600-3000 75 19.0%
income 3001-5000 141 35.8%
5001-7000 116 29.4%
7001-10000 52 13.2%
10001-10500 10 2.5%

19
 6.2 Magnitude of Anemia among study participants
A total of 394 pregnant women were studied. In the study, the prevalence of anemia was
28.4% (95% CI (13.4%). The hemoglobin values ranged from 9.0g/dl to 16.0g/dl with mean
±SD level was 12.3±1.52. According to WHO category the study was most likely mild.

Figure 3:- proportion of anemia among pregnant women according to age, Lideta ,Addia
Ababa,2022.
From the total participants on behavioral characteristics and nutritional status studied in
lideta sub-city health centers most of eating habits of the pregnant women were, three times a
day 346(87.8%) the least were more frequently 12(3.0%). Mostly hot drinking habits of the
respondents were once a day 251(63.7%). eating fresh fruits and other vegetables of
participants daily were rare 30(7.6%). Using any sort of iron supplement of study
participants were 357(90.6%). The socio-demographic information of the participants is
summarized in (table1, fig 3).

20
 Table 2 Frequency distribution of Behavioral Characteristics and Nutritional Status of
participants, lideta, Addis Ababa , 2022

Characteristics Frequency Percent

eating habit of two times a day 18 4.6%
respondent three times of a 346 87.8%
day
4 times of a day 18 4.6%
more frequently 12 3.0%
hot drink (tea, milk, once a day 251 63.7%
coffee, others)intake twice a day 98 24.9%
three times a 30 7.6%
day
more frequently 15 3.8%
how often you have Daily 30 7.6%
eaten fresh fruits, two times a 146 37.1%
vegetables week
Weekly 90 22.8%
very rare 128 32.5%
are you using any Yes 357 90.6%
sort of iron No 37 9.4%
supplement

The Behavioral Characteristics and Nutritional Status of participants is summarized in table 2

above

21
 Table 3 Frequency distribution of obstetrics and clinical characteristics of pregnant women,
Lideta, Addis Ababa, 2022

Characteristics Frequency Percent

gestational month 1-3 month 116 29.4%
4-5 month 182 46.2%
6-7 month 63 16.0%
8-9 month 33 8.4%
age at first pregnancy less or equal to 21 5.3%
(in years) 18
18-30 352 89.3%
greater or equal 21 5.3%
to 30
previous history of Yes 42 10.7%
miscarriage No 352 89.3%
history of intestinal E.histolytica 9 2.3%
parasite or blood G.lambilia 16 4.1%
parasite hook worm 2 0.5%
Malaria 4 1.0%
no history of 363 92.1%
parasite
other,specify 0 0.0%
are you suffering Yes 198 50.3%
from any sort of No 196 49.7%
worry, stress, nausea
and vomiting

Nearly half of the study participants of gestational months were between 4-5 months
182(46.2%). The age at the time of marriage of the participants were high between age 18-
30,352(89.3%) but the least were age of less or equal to 18 and greater or equal to
30,21(5.3%). While we were investigating the history of intestinal parasite or blood parasites
, the study participants had no history were 363(92.1%) but those who had history of
intestinal parasite or blood parasites mostly were G.lambilia 16(4.1%). Being or not be
suffered from any sort of worry, stress, nausea and vomiting were almost on equal status.
Frequency distribution of obstetrics and clinical characteristics of pregnant women is
summarized in table 3 above.
22
6.3 Bivariate and multivariate analysis of socio-demographic determinants of
anaemia

The presence of anemia was assessed based on the socio-demographic characteristics of the
study subjects, Age, age at time of marriage in years, level of education, marital status,
occupation, and average income of the pregnant were taken as study variables to see the
outcome of of dependent variable. However, there was no statistically significant difference
between all socio-demographic variables and anemia except age at the time of marriage. The
presence of anemia was assessed based on different variables. These are the age of pregnant
women, age at time of marriage, level of education, marital status, occupation, and average
income of the family of pregnant women taken as study variables to see the outcome of the
dependent variable as shown on table 4. Logistic regression was performed to determine how
socio-demographic variables affect pregnant women's probability of getting anemia. A total of
394 pregnant women were used in the analysis. The model explained 15.8% of the variation
in hemoglobin level and correctly classified 76.1% of cases. Each additional unit increases the
age at marriage by 30 years. 9 (2.3%) was associated with a 13.49 (11.986, 91.660) increase
in the odds of a pregnant woman developing anemia when compared to her age at marriage
(15 years of pregnancy).

.
.

23
 Table 4 Association of anemia with the socio-demographic characteristics of the study
subjects (Lideta, Addis Ababa, 2022)

Characteristics Anemia(<11. Not COR AOR (95% C.I.)

0g/dl) anemia(>11 (95% C.I.)
.0g/dl)
age at the less or equal to 15 3(0.8%) 15(3.8%) 1 1
time of 16-20 30(7.6%) 62(15.7%) 2.419(0.650,9.002) 1.967 (.515, 7.519)
marriage 21-25 47(11.9%) 155(39.3%) 1.516(0.421,5.463) 1.400(.383,5.118)
26-30 23(5.8%) 47(11.9%) 2.447(.643,9.309) 2.920( .750,11.362)
Above 30 9(2.3%) 3(0.8%) 15.000(2.477,90.843) 13.49(11.986,91.660)

64(16.2%) 186(47.2%) 1 1
Government
45(11.4%) 96(24.4%) 1.362 (0.865,2.145) 1.437(.855,2.415)
Occupation Private 46949737762
3(0.8%) 0(0%)
House wife

17(4.3%) 58(14.7%) 1 1
1600-3000
47(11.9%) 94(23.9%) 1.706 (0.896,3.248) 1.996(0.996,4.000)
average 3001-5000 1.415(0.722,2.771) 1.739(0.824,3.669)
34(8.6%) 82(20.8%)
monthly 5001-7000 1.257(0.555,2.846) 1.175(0.473,2.921)
14(3.6%) 38(9.6%)
income 7001-10000 10(2.5%) 0(0%)
10001-10500

N.B: significant at p <0.05, and italic indicates statistically significant association with
multivariate analysis.

24
 Table 5 Association of anemia with Behavioral Characteristics and Nutritional Status of
pregnant women , Lideta, Addis Ababa,2022

Characteristics Anemia(<1 Not COR(95% C.I) AOR(95% C.I)

1.0g/dl) anemic(>11
.0g/dl)
eating habit of Two Times a day 12(3%) 6(1.5%) 1 1
respondent Three times a day 91(22.1%) 255(64.7%) 0.178(.065,.489) .209(.072,.608)
Four times a day 6(1.5%) 12(3%) 0.250(.063,1.000) .506(.103,2.490)
More frequently 9(2.3%) 3(0.8%) 0.167(.033,.853) .153(.024,.964)

hot drink (tea, Once a day 79 (20.1%)

milk, coffee, Twice a day 12(3.0%) 172(43.7%) 1 1
others)intake Three times a day 12(3.0%) 86(21.8%) 0.304(.157,.588) .293(.136,.631)
More frequently 9(2.3%) 18(4.6%) 1.451(.667,3.158) 1.383(.571,3.350)
3.266(1.124,9.491)
6(1.5%) 1.918(.500,7.348)
how often you Daily 15(3.8%)
have eaten Two times a week 33(8.4%) 15(3.8%) 1 1
fresh fruits, Weekly 17(4.3%) 113(28.7%) 0.292(.129,.659) .266(.090,.788)
vegetables? Very rare 47(11.9%) 73(18.5%) 0.233(.096,.567) .280(.084,.939)
81(20.6%) 0.580(.261,1.292) .406(.129,1.282)

Are you using yes 85(21.6%)

any sort of No 27(6.9%) 272(69.0%) 1 1
iron 10(2.5%) 8.640(4.019,18.574) 9.895(4.271,22.928)
supplement?
N.B: significant at p<0.05, and Italic indicates statistically significant association with
multivariate analysis.

25
As shown in Table 5, the presence of anemia was assessed based on the behavioral
characteristics and nutritional status of pregnant women. These are eating habits, hot drink
(tea, milk, coffee, etc.) intake, the habit of eating fresh fruits, and using any sort of iron
supplement. Women were taken as study variables to see the outcome of the dependent
variable. Logistic regression was performed to determine how behavioral characteristics and
nutritional variables affect pregnant women's probability of getting anemia. A total of 394
pregnant women were used in the analysis. The model explained 25.9% of the variation in
hemoglobin level and correctly classified 77.4% of cases. Each additional unit increase in not
using any sort of iron supplement (27, 6.9%) was associated with an increase of 9.895 (4.271,
22.928) in the odds of pregnant women getting anemia as compared to using any sort of iron
supplement.

As shown in Table 6, the presence of anemia was assessed based on obstetric risk factors in
pregnant women. These are gestational age, age at first pregnancy, previous history of
miscarriage, suffering from any sort of worry or stress, nausea and vomiting, and history of
intestinal parasites or blood parasites. These were taken as study variables to see the outcome
of the dependent variable. Logistic regression was performed to determine how obstetric risk
factors affect pregnant women's probability of getting anemia. A total of 394 pregnant women
were used in the analysis. The model explained 20.8% of the variation in hemoglobin level
and correctly classified 77.4% of cases. Each additional unit increase in previous history of
miscarriage of 85 (21.6%) was associated with an increase of 7.507 (3.284, 17.162) in the
odds of a pregnant woman getting anemia as compared to no history of miscarriage. Each
additional unit increase in the history of intestinal parasites or blood parasites (E. histolytica 6
[1.5%]) was associated with an increase of 6.547 (1.206, 35.538) in the odds of a pregnant
woman getting anemia as compared to no history of intestinal parasites or blood parasites.

26
 Table 6 Association of anemia with obstetric risk factors in pregnant women, Lideta, Addis
Ababa, 2022

Characteristics Anemia Not COR(95% C.I) AOR(95% C.I)

(<11.0g/dl) anemic(>11.
g/dl)
gestational month 1-3 months 46(11.7%) 70(17.8%) 1 1
4-5 months 33(8.4%) 149(37.8% ) 0.337(.198,.572) .265(.147,.477)
24(6.1%) 39(9.9%) 0.936(.499,1.758)
6-7 months .692(.337,1.420)
0.571(.244,1.337)
8-9 months 9(2.3%) 24(6.1%) .164(.054,.493)

age at first ≤ 18yrs 12(3.1%) 9(2.3%) 1 1

91(23.1%) 261(66.2%) .432(.159,1.171)
pregnancy (in years) 18-30yrs 0.261(.107,.641)
0.563(.166,1.910) 1.274( .308,5.275)
≥30yrs 112(28.4%) 282(71.6%

previous history of
yes 85(21.6%)
miscarriage 267(67.8%) 5.654(2.874,11.124)
No 27(6.9%) 7.507(3.284,17.162)
15(3.8%) 1
1

are you suffering

yes 63(16.0%) 135(34.3%) 1.40(.901,2.175) 1.393(.834,2.326)
from any sort of 49(12.4%)
No 147(37.3%) 1 1
worry, stress,
nausea and
vomiting
E.histolytic 6(1.5%) 6.547(1.206,35.538)
3(0.8%) 5.485(1.345,22.358)
a 9(2.3%) 3.526(1.278,9.726) 2.567(.774,8.513)
History of intestinal 7(1.8%)
G.lambilia 0(0%) 2(0.5%)
parasite or blood 0(0%)
Hook warm 4(1.0%)
parasite
Malaria
No history 97(24.6%)
of parasite 266(67.5%) 1 1

N.B: significant at p<0.05, and Italic indicates statistically significant association with
multivariate analysis.

27
 7 DISCUSSION

The study has shown that, of 394 pregnant women, 28.4% had anemia. This shows that
there are a considerable number of anemic problems among pregnant women. Globally, in
different countries, different studies were done with different results. In a study of female
college students at the University of Sharjah (UoS) in the United Arab Emirates, the overall
prevalence of anemia (Hb 11 g/dL) was 26.7%, with the majority (88.4%) of the 69 anemic
students having mild anemia, 7.2% moderately anemic, and 2.3% severely anemic
(hemoglobin 7 g/dL). (11). A total of 743 pregnant women took part in the study in Uganda's
Gulu and Hoima Regional Hospitals, for a response rate of 91.1 percent. A total of 164
(22.1%) women were anemic. (12). A study conducted in our country at Arba Minch General
Hospital, Arba Minch, and Secha Health Centers in Arba Minch town in 2014/15 found the
prevalence of anemia to was About one-third (109, 32.8%). Eleven (3%) of the pregnant
women were found to be HIV positive. Giardia lamblia, 30 (9%); Entamoeba histolytica, 5
(1.5%); and hookworm, 2 (0.6%), were among the intestinal parasites detected in the pregnant
women (13). Based on the 2016 Ethiopian Demographic Health Survey (EDHS), which used
a two-stage stratified cluster sampling technique and a cross-sectional study that was
conducted among 3080 pregnant women, the prevalence of anemia among pregnant women
was 41% (14).

In our study, we classified the independent variables that affect the dependent variables into
different categories. These are socio-demographic characteristics, behavioral characteristics,
nutritional status, and obstetric risk factors.

The study we conducted on socio-demographic characteristics found that age at time of

marriage of pregnant women was associated with one of the dependent variables of the
respondents: anemia

Nine (2.3%) of the 394 respondents in the study who were over 30 at the time of marriage
were anemic. The prevalence of anemia in Lideta sub-city health centers was 28.4%, which
was higher than the prevalence of 26.7% found in a study on female college students at the

28
University of Sharjah (UoS); a response rate of 91.1 percent from a total of 164 (22.1 percent)
in a study in Uganda's Gulu and Hoima regional hospitals; and a prevalence of 7.9% in an
Adigrat general hospital. (16) However, our study of anemia prevalence was lower than that
of Arba Minch General Hospital and Secha Health Centers in Arba Minch town in 2014/15:
109 (32.8%). (13) , studied conducted based on the 2016 Ethiopian Demographic Health
Survey (EDHS) that used a two-stage stratified cluster sampling technique and a cross-
sectional study that was conducted among 3080 pregnant women, the prevalence of anemia
among pregnant women was 41% (14), and in A study done in pregnant women living in an
urban community setting in Hyderabad, Pakistan, the prevalence of anemia (defined by the
World Health Organization as hemoglobin 11.0 g/dL) in these subjects was 90.5% (19).

The study looked at pregnant women's behavioral characteristics and nutritional status,
as well as their eating habits, habits of drinking hot drinks (coffee, tea, and others), eating
habits of fresh fruits and vegetables, and use of iron supplements. Three times a day (346,
87.8%), once a day intake of hot drinks (tea, milk, coffee, etc.) 251, 63.7%, eating fresh
fruits and vegetables twice a week (146, 37.1%), and use of any type of iron supplement
(357, 90.6%) were the most common eating habits

The study conducted on obstetric risk factors for pregnant women assessed different factors.
These were gestational months, age at first pregnancy (in years), previous histories of
miscarriage, history of intestinal or blood parasites, and suffering from any sort of worry,
stress, nausea, or vomiting. The most gestational months attended ANC follow-up studies
were 4-5 month 182 (46.2%) and the least were 8-9 month 33 (8.4%). Age at first pregnancy
(in years): mostly they were 18–30, 352 (89.3%), and the least was less than or equal to 18,
and greater than or equal to 30 was 21 (5.3%). While we were conducting research on the
history of intestinal parasites or blood parasites, we discovered that the majority of pregnant
women (92.1%) had no history of intestinal parasites but who had intestinal parasites. G.
lambilia was the most important factor (16.9%). In a study on the previous history of
miscarriage of pregnant women who were attending ANC follow-up, 352 (89.3%) had no
history of miscarriage. According to a study conducted at Lideta health centers, people who

29
were suffering and those who were not suffering from any type of worry, stress, nausea, or
vomiting had nearly equal status.

A study conducted in Lideta sub-city health centers on the association of socio-

demographic, behavioral, nutritional, and obstetric characteristics of pregnant women with
anemia was done. The prevalence of anemia among the pregnant women attending ANC
follow-up at Lideta health centers was 28.4%. Factors such as age at marriage >30 years
increase the risk of anemia by 13.491 times (AOR = 13.491, 95% CI 1.986, 91.660, p =
0.008), and not using any sort of iron supplement increases the risk of anemia by 9.895 times
(AOR = 9.895, 95% CI 4.271, 22.928, p = 0.000), which is more significant than a study
done in Kenya's Pumwani maternity hospital The history of previous histories of miscarriage
increase risk of anemia by 7.507 times (AOR = 7.507, 95% CI 3.284, 17.162, p = 0.000),
which is more significant than a study done in According to a study conducted at Adigrat
General Hospital, a previous history of miscarriage increased the risk of anemia by 0.129
times (AOR = 0.129, 95% CI 0.059, 0.283) (13).

In a study conducted in Lideta sub-city health centers, binary logistic regression analysis
revealed that age at marriage >30 years (p = 0.008) was less significantly associated with age
at the Marie Stopes antenatal clinic in Dhaka (p = 0.006) (18).

In a study conducted in Lideta sub-city health centers, the hemoglobin values

ranged from 9.0 g/dl to 16.0 g/dl with a mean SD level of 12.3 1.52 and a prevalence
of anemia of 28.4%, which was less than a study done in Banke, Nepal. The mean
hemoglobin was 11.2+/1.3 g/dL, and anemia prevalence was 40% (20)

30
 8 STRENGTHS AND LIMITATIONS OF THE STUDY

8.1 strengths

 The use of health personnel in data collection, so that measurement error was
minimized.

 The use of pretesting, CBC, and hemacue for hemoglobin determination

8.2 Limitations

 The study design was cross-sectional, which measures exposure and outcome at the
same time and cannot establish a cause-and-effect relationship.
 Self-response bias occurred while conducting data collection, which will affect and
challenge the research result

9 CONCLUSSION

Pregnant women who were attending ANC follow-up at Lideta sub-city health centers had
anemia rates of 28.4% of the total 394 pregnant women investigated.

Age in years at the time of marriage, such as >30, not using an iron supplement, a history of
intestinal parasites or blood parasites, as well as a previous history of miscarriage, were
shown to be associated with anemia among pregnant women.

31
 10 RECOMMENDATION

1. Pregnant women who were being monitored in ANC follow- up of the health centers
of Lideta sub-city have significant anemia. It is necessary to support, and monitoring
should be continued and strengthened.
2. Preventive as well as promotion activities should be began to increase pregnant
women's awareness of anemia and effort is needed to increase through health education
at all health centers and at community level.
3. Attention should be paid to the obstetric factor.
4. Communicating the effects of anemia on pregnant women with the government,
society, and stakeholders.
5. More research should be done in different areas to expand the collected data, which is
useful for improving the health of pregnant women.

32
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 APPENDIX
AFRICA MEDICAL COLLAGE

RESEARCH AND PUBLICATION

APPENDIX 1

Information sheet

Hello, this is …...........................and I am studying in Africa Medical College. I am here to

enroll and take interview from eligible study participants like you and fill in the
questionnaire forms prepared by the study group. I am glad to inform you that you are one of
the chosen study participants to participate in the study. The purpose of which is to assess
the prevalence of anemia and associated factors among pregnant women in Lideta health
centers Addis Ababa, Ethiopia.
The information in this questionnaire will be kept strictly confidential, will not be
disclosed to any one and only I will have access to the information you gave but your
name and address will not be recorded or identified even by the researcher.
However, it is your right to terminate your participation at any time (from the very
beginning or you can answer some questions you like to do so).I will appreciate and
respect what so ever your decision will be.

Thus, this questionnaire will be filled only if you agree to take part in the study and we
sincerely ask you to give your genuine and true responses to the question provided you
would agree to participate in the study.
So, would you like to participate in the study?
Yes/ agree……………….
No/disagree…………...
Thank you!
Date…………………………
(………………………………………………………………………………………)
Signature of the interviewer/data collector to
Certify the informed consent verbally
35
 APPENDIX 2

Questionnaire
Africa Medical College

School of Public Health

A questionnaire for the assessment of prevalence of anemia and associated factors

among pregnant women in Lideta sub city health centers, Addis Ababa region,
Ethiopia.
Preliminary drafts to English version Questionnaire
Section1: socio-demographic information of study participants
N0 Questions Options Skip to
101 Age __________ _______years
102 Age at the time of 1)≤15 2) 16-20 3) 21-25 4) 26-30
marriage 5) Above 30
103 Level of education 1. Not able to write and read
2. Able to write and read
3. 1-8
4. 9-12 5. Higher education
104 Marital status 1. Single 3. Window
2. Married 4.Divorced
105 Occupation 1. Government 3. House wife
2. Private 4. Other
106 What is the
average monthly ____________birr
income of the
family?

36
Section 2: Behavioral Characteristics and Nutritional Status of participants
N0 Questions Options Skip to
201 Eating habits of 1. Two times of a day 3. 4 times of a day
respondents 2. Three times of a day 4. More frequently
202 Hot beverage use 1 once a day 2. Twice a day
(tea,milk,coffee,others) 3.Three times a day 4. More
intake of the respondents frequently
203 How often you have eat 1. Daily 2. Two times a week
fresh fruits, vegetables 3. Weekly 4. Very rare
and milk?
204 Are you using any sort of 1. Yes 2. NO
iron supplement?

Section 3: obstetric and clinical characteristics of participants

N0 Questions Options Skip to
301 Gestational month 1. 1-3 month 3. 6-7 month
2. 4-5 month 4. 8-9 month
302 Age at first pregnancy (in 1. ≤18 3. ≥30
years) 2. 18-30
303 Do you have previous 1. yes 2. No
history of miscarriage?
304 History of intestinal 1. E.histolytica 3.hook worm
parasite/blood parasite 2. G.lamiblia 4.malaria 5.No history of
parasite 6.others, specify___________
305 Are you suffering from 1. Yes 2. No
any sort of worry, stress,
nausea and vomiting.
306 Hemoglobin level ____g/dl(11.0-14.0g/dl)

37
 የአማርኛ ቋንቋ መጠይቅ
መጠይቅ:
የአፍሪካ ሜዲካል ኮሌጅ
የህብረተሰብ ጤና ሳይንስ ትምህርት

ርዕስ:-በእርግዝና ወቅት ለሚከሰት የደም ማነስ ስርጭትና ተያያዥ ምክንያቶቸን መገምገም

ጤና ይስጥልኝ!
ዛሬ
እዚህየተገኘሁትየአፍሪካሜዲካልኮሌጅየህብረተሰብጤናሳይንስትምህርትተማሪየሆንኩትመለሰበላቸዉስሆንጥናቱምየማስተርስዲግ
ሬየንለማገኘትየሚጠቅምሆኖበእርግዝናወቅትለሚከሰትየደምማነስእናተጋላጭየሆኑምክንያቶችበሚልርዕስየሚሰራነው፡፡
የአፍሪካሜዲካልኮሌጅየህብረተሰብጤናሳይንስትምህርትእንዲሁምከአዲስአበባጤናቢሮአስፈላጊውንፈቃድአግኝቻለሁ፡፡
ጥናቱየሚሰጠውጥቅም
የዚህጥናትጥቅምበእርግዝናወቅትለሚከሰትየደምማነስእናተጋላጭየሆኑምክንያቶችእናመንስኤዎችንበመለየትእናበመተንተንየጥናቱ
ንውጤቱንለባለድርሻአካላትመጠቆምይሆናል፡፡
ጥናቱየሚያስከትለውጉዳት
በጥናቱላይመሳተፍምንምአይነትጉዳትአያስከትልም፡፡
የተጠያቂውመብቶች
በዚህጥናትላይየመሳተፍእንዲሁምያለመሳተፍመብትዎየተጠበቀነው፡፡
በጥናቱውስጥለሚጠየቋቸውጥያቄዎችበሙሉመመለስወይምለመመለስፈቃደኛያለመሆናቸውንመተውየሚችሉሲሆንበቃለመጠይ
ቁመሃልበማንኛውምሰዓትማቋረጥይችላሉ፡፡

ሚስጢራዊነት

በዚህጥናትሂደትየሚሰበሰበውመረጃሚስጢራዊነቱየሚጠበቅሲሆንእረሰዎስምባለመፃፍሚስጢራዊነቱንለመጠበቅለመጠይቁየቁጥ
ርኮድየምንጠቀምይሆናል፡፡መረጃዎችበጥናትአድራጊውሃላፊነትውስጥየሚቆይናመረጃውከተቀመረበኋላየሚወገድይሆናል፡፡

38
ስምምነት

ሌላውልነግረዎትየምፈልገውየእርሰዎእውነተኛመልሶችለሚደረገውጥናትበጣምጠቃሚእንደሆነእንዲሁምጥያቄዎቹንመልሶ
ለማጠናቀቅከ 5-15 ደቂቃ ሊፈጅ እንደሚችል ነው፡፡
የተሰጠዎትንመረጃተረድተውበጥናቱለመሳተፍፈቃደኛቢሆኑልንበቅድሚያእናመሰግናለን፡፡

ከላይ ያለውን በሙሉ በማውቀው ቋንቋ ተነቦልኝ ተረድቼ ገብቶኛል ካሉ፡፡

በጥናቱለመሳተፍፈቃደኛነዎት?

አዎ (ቃለ መጠይቁን እንቀጥል) ---------- አይደለሁም (አመሰግናለሁ) --------------

ለሚኖርዎት ጥያቄ የሚጠቀሙት አድራሻ እና የጥናት አድራጊ መረጃ

የጥናት አድራጊ ስም፡መለስ በላቸዉ

የህብረተሰብ ጤና አጠባበቅ ት/ቤት ስልክ፡---------

የጤና ተቋሙ ስም -----------------------የመጠየቁ መለያ ቁጥር --------------------

የጠያቂው ስም እና ፊርማ ------------ የጠየቀበት ቀን (በኢትዮጵያአቆጣጠር) -----/----/-----
የቃለ መጠይቁ ውጤት 1.ተጠናቋል 2.መጠየቅ አልፈለጉም 3.ተጠያቂው አልተገኘም 4.በከፊል የተጠናቀቀ

በሱፐርቫይዘር ተረጋግጧል ስም--------------------- ፊርማ---------- ቀን -------------

39
 ክፍል 1፡በጥናቱየሚሳተፉእርጉዝእናቶችስነ-ህዝብእናማህበራዊሁኔታዎች

ይህመጠይቅየእርጉዝእናቶችንስነ-
ህዝባዊናማህበራዊሁኔታዎችንየሚገልፅሲሆንግልፅካልሆነጥያቄመጠየቅየሚችሉመሆኑንእየገለፅኩወደመጠይቄዎቹአመራ
ለሁ፡፡
መጠየቁቁ ጥያቄ መልስ ዝለል
101 እድሜዎት ስንት ነዉ? ---------ዓመት -----ወር
102 የጋብቻ ዕድሜ 1)≤15 2) 16-20 3) 21-25 4) 26-30
5) Above 30
103 የትምህርት ሁኔታ 1.
2.
3.
4.
5.
104 የጋቢቻ ሁኔታ 1. ያላገባ/ች
2. ያገባ/ች
3. የፈታ/ች
105 የስራ ሁኔታ 1.
2.
106 ወርሀዊ የቤተሰብ ገቢዎት ስንት ነዉ ---------------- ብር

ክፍል 2፡የእናቶችባህሪያትናአመጋገብሁኔታ

በመቀጠልየእናቶችባህሪያትናአመጋገብሁኔታጥያቄዎችአመራለሁ፡፡

መጠ. ጥያቄ መልስ ዝለል

ቁ
201 የአመጋገብልማድ 1.
2.
3.
4.
202 ትኩስመጠት(ሻይ፣ቡና፣ወተትእናሌሎች)በየስንትጊዜይጠጣሉ 1.በቀንአንድጊዜ
2.በቀን 2 ጊዜ
3.በቀን 3 ጊዜ
4.ተደጋጋሚ
203 ምንያህልጊዜፍራፍሬዎችን፣የጓሮአትክልቶችንእናወተትንይጠቀማሉ; 1.
2.
3. በየሳምንቱ
4.በጣምአልፎአልፎ
204 ማንኛዉንምዓይነትየብረትማሟያዎችናሎሎችንእየተጠቀሙነዉ; 1.

40
 ክፍል 3፡የሴቶችየወሊድእናክሊኒካዊባህሪያት

በመቀጠልበእርጉዝእናቶችየወሊድእናክሊኒካዊባህሪያትሁኔታንእጠይቃለሁ፡፡

መጠ. ጥያቄ መልስ ዝለል

ቁ
301 1.1-3 ወር
የእርግዝናወራት
2.4-5 ወር
3. 6-7 ወር
4.8-9 ወር
302 1.≤ 18 3.
የመጀመሪያየእርግዝናዕድሜ
≥30
2. 18-30

303 ከዚህቀደምየፅንስመጨንገፍታሪክአለዎት 1. አወ
2.አይ
304 1. አሜባ
የአንጀትተዉሳክ/የደምጥገኛታሪክአለዎት;አወከሆነ 2. ጃርዲያ
3.መንጠቆት
ል 4. ወባ
5.የለኝም 6.
ሌላካለጥቀ
ሱ
305 በማንኛዉምዓይነትጭንቀት፣ዉጥረት፣ማቅለሽለሽእናማስታወክእየተሰቃዩነዉ፡፡ 1. አወ 2.
አይ

306 የሄሞግሎቢንመጠን -----ግ/

ዴል(11.0-
14.0 ግ/ዴል)

41
42