PREVALENCE OF ANEMIA AND ASSOCIATED FACTORS AMONG WOMEN

ATTENDING ANTENATAL CLINIC AT SIGOR HEALTH CENTRE, WEST POKOT.

PHILIPH TOROITICH LOUTA

H151-01-0225/2018

A RESEARCH PROJECT SUBMITTED IN PARTIAL FULFILMENT OF THE

REQUIREMENTS FOR A BACHELOR OF SCIENCE IN NURSING IN THE SCHOOL OF
NURSING DEDAN KIMATHI UNIVERSITY OF TECHNOLOGY

NOVEMBER 2022
DECLARATION
This project is my original work and has not been presented for a degree at this or any other
university.

Signature ………………………. Date………………………………

PHILIPH TOROITICH LOUTA

H151-01-0225/2018

This research project has been submitted with my approval as the appointed university
supervisor:

Signature ………………………. Date……………………………….

PAULINE MAINA MUTHONI

Lecturer

School of nursing

DEDAN KIMATHI UNIVERSITY OF TECHNOLOGY

i
DEDICATION
I dedicate this work to almighty God, my loving father Louta, mother Miriam and the entire

affiliated loving family members for their financial and psychological support to this far.

ii
ACKNOWLEDGEMENT
I acknowledge God wholeheartedly for the guidance and support in enabling me to

develop a research project on the Prevalence of Anemia and associated factors among pregnant

women attending Sigor health center West Pokot. I would like to thank my supervisor Madam

Pauline for her tireless step-by-step analysis, monitoring, correcting and supporting me through

the planning, organizing, directing and controlling my proposal toward the proposal of objectives

and practicability of the research proposal. Thank you for your anonymous knowledge,

motivation and enthusiasm that enabled me to reach this far.

Table of Contents

iii
DECLARATION...............................................................................................................................................i
DEDICATION.................................................................................................................................................ii
ACKNOWLEDGEMENT.................................................................................................................................iii
Table of Contents........................................................................................................................................iv
LIST OF TABLES AND FIGURES.....................................................................................................................vi
LIST OF ABBREVIATIONS............................................................................................................................viii
CONCEPTUAL AND OPERATIONAL DEFINITIONS.........................................................................................ix
ABSTRACT....................................................................................................................................................x
1.0 CHAPTERS ONE....................................................................................................................................1
1.1 Background Study Anemia in Pregnancy...........................................................................................1
1.2 Problem statement............................................................................................................................3
1.3 Justification of the study...............................................................................................................4
1.4 Objectives..........................................................................................................................................5
1.4.1 Board Objective..........................................................................................................................5
1.4.2 Specific objectives.......................................................................................................................5
1.5 Research Questions...........................................................................................................................5
1...............................................................................................................................................................6
1.6 Conceptual framework......................................................................................................................7
2.0 CHAPTER TWO: LITERATURE REVIEW....................................................................................................8
2.1 Introduction.......................................................................................................................................8
2.2 Prevalence of Anemia in pregnancy..................................................................................................8
2.3 Socio-demographic Factors Associated with Anemia in Pregnancy.................................................11
2.4 cultural factors.................................................................................................................................14
2.5 Dietary habits..................................................................................................................................16
3.0 CHAPTER THREE: RESEARCH METHODOLOGY.....................................................................................20
3.1 Introduction.....................................................................................................................................20
3.2 Study Design....................................................................................................................................20
3.3 Study Area.......................................................................................................................................20
3.4 Study population.............................................................................................................................21
3.5 Sample size determination..............................................................................................................21
3.6 Sampling and sampling technique...................................................................................................23
3.7 Inclusion and exclusion criteria........................................................................................................23
3.7.1 Inclusion Criteria.......................................................................................................................23

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 3.7.2 Exclusion criteria.......................................................................................................................23
3.8 Data collection instrument..............................................................................................................23
3.9 Validity and reliability of the study tool...........................................................................................24
3.9.1 Validity......................................................................................................................................24
3.9.2 Reliability..................................................................................................................................25
3.10 Pretesting......................................................................................................................................26
3.11 Data collection, analysis and presentation....................................................................................27
3.11.1 Data collection procedure......................................................................................................27
3.11.2 Data analysis and presentation...............................................................................................28
3.12 Ethical considerations....................................................................................................................28
CHAPTER FOUR : RESULTS.........................................................................................................................30
4.1 Response rate..................................................................................................................................30
4.3 Anemia in pregnancy prevalence.....................................................................................................30
4.2 Social-demographic characteristics of respondents........................................................................31
4.4 Cultural factors................................................................................................................................33
4.5 Dietary habits related factors..........................................................................................................34
4.6 The relationship between socio-demographic factors and anemia in pregnancy............................35
4.7 The relationship between cultural factors with anemia in pregnancy.............................................37
4.8 The relationship between dietary habits factors with pregnancy anemia.......................................39
CHAPTER 5: DISCUSSION, CONCLUSION, AND RECOMMENDATION.........................................................41
5.1 Discussion........................................................................................................................................41
5.1.1 Prevalence of pregnancy anemia..............................................................................................41
5.1.2 Socio-demographic factors associated with anemia in pregnancy...........................................42
5.1.3 Cultural factors associated with anemia in pregnancy.............................................................43
5.1.4 Dietary habits factors associated with anemia in pregnancy....................................................44
5.2 Conclusion.......................................................................................................................................46
5.3 Recommendations...........................................................................................................................47
References.................................................................................................................................................48
APPENDICES..............................................................................................................................................55
Appendix 1: Study Instrument; Questionnaire......................................................................................55
Appendix 2: Informed Consent Form (ICF)...........................................................................................58
Appendix 3: authorization letter............................................................................................................59
Appendix 4: Sigor health center map..................................................................................................61

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LIST OF TABLES AND FIGURES
LIST OF TABLES

Table 1: Socio-demographic characteristics of respondents 24

Table 2: Cultural factors 26

Table 3: dietary habits factors 27

Table 4: The relationship between socio-demographic factors with anemia in pregnancy 29

Table 5: The relationship between cultural factors with pregnancy anemia 31
Table 6: The relationship between dietary habits factors with anemia in pregnancy 33

LIST OF FIGURES
Figure 4.1: The prevalence of pregnancy anemia 25

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LIST OF ABBREVIATIONS

ANC- antenatal clinic

Hb- Hemoglobin

KDHS- Kenya demographic health survey 2014

NIH- National Institute of Health

WHO-World Health Organization

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CONCEPTUAL AND OPERATIONAL DEFINITIONS

Anemia in pregnancy- A condition in which when the hemoglobin (Hb) level in the body is less
than 11 grams per deciliter (WHO, 2001), it decreases the oxygen-carrying capacity of red blood
cells to tissues. In this study it will used to indicate Hb below 11g/dl.

Prevalence-- is the proportion of persons in a population who have a particular disease or

attribute at a specified point in time or over a specified period of time. In this study, prevalence
will be the total value proportion of women with Hb less than 11g/dl in pregnancy

Sociodemographic factors- refer to a combination of social and demographic factors that define
people in a specific group or population. In other words, when we talk about socio-
demographics, we mean different social and demographic features that help us know what
members of a group have in common. (Blog, 2022) In this study, sociodemographic factors will
include aspects like age, parity, marital status, occupation, level of education and level of
income.

cultural factors-cultural is a term which means common traditions, habits, patterns and beliefs
present in a population group. In this study will include aspects like taboos, norms and beliefs.

Dietary factors- are those that are directly related to eating habits. In this study, dietary factors
will include aspects like the use of caffeine and the frequency of meals.

Pregnancy: The state of carrying a developing embryo or fetus within the female body for a
period of 280 days or 40 weeks.

Antenatal clinic (ANC): Maternal and Child Health clinic which provides care for expectant
parents; the mother's and baby's health are monitored, maintained and optimized to ensure a
healthy pregnancy, safe delivery, and post-delivery period. Moreover, the clinic provides
nutritional supplements (iron/folate) and dietary information throughout the pregnancy

viii
ABSTRACT

Anemia in pregnancy is defined by a hemoglobin (Hb) content of less than 11 g/dl, according to t
he World Health Organization (WHO). Globally, WHO estimated that one-third of the world's
population has anemia in pregnancy, and the majority (50%) of cases reside in developing
countries like Sub-Saharan Africa and Southeast Asia.
This study was aimed at assessing the Prevalence of Anemia and associated factors among
women attending antenatal Clinic at Sigor Health Centre, West Pokot. A descriptive facility
based cross-sectional study was employed among 97 respondents. Data was collected via
researcher administered questionnaire, cleaned, entered in STATA version 9.10 and analyzed.
The data were analyzed both descriptively and by inferential statistics using a Chi-square at a
confidence interval of 95% with a significance level of < 0.05. The findings from this study
revealed that; socio-demographic factors such as occupation, income and level of education were
significantly associated with pregnancy anemia. Further, cultural factors such as religion and
having a Pokot traditional diet for pregnant women were established to be associated with
pregnancy anemia. Moreover, regarding dietary habits factors, taking beverages such as tea,
coffee and cocoa as well as craving for non-food substances such as stones and soil were the
factors significantly associated with pregnancy anemia. There was a high prevalence of
pregnancy anemia hence the researcher recommends the relevant stakeholders to put up
strategies to clarify religious and traditional beliefs on diet as well as raising awareness against
the use of non-food substances such as foods and stones as these were established in this study to
have a relationship with pregnancy anemia.

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1.0 CHAPTERS ONE
1.1 Background Study Anemia in Pregnancy.

Anemia in pregnancy is defined by a hemoglobin (Hb) content of less than 11 g/dl;according to th

e World Health Organization (WHO), anemia is considered a public health issue or problem when

the Prevalence of Anemia is 5.0 percent or greater in the population research. Anemia,

with a prevalence of 40% in a population, is considered a serious public health issue. (Stephen et

al. 2018). Pregnant women in developing countries are more likely to develop Anemia because of

poor socioeconomic conditions. Anemia is linked to inadequate nutritional intake, recurrent illness

es, frequent pregnancies, cultural factors, and a lack of health-seeking habits. (Gunm et al., 2018)

Low birth weight, preterm birth, and perinatal and neonatal mortality are all increased by anemia

during pregnancy. Furthermore, severe anemia is linked to a higher likelihood of maternal death.

Over half a billion women of reproductive age suffer from anemia worldwide. It is estimated that

32.4 million pregnant women in the world are affected. (Yadav et al., 2021). Iron deficiency

causes about 75% of all anemia cases during pregnancy. Anemia has serious health, social, and

economic consequences in pregnant women, increasing the risk of low physical activity,

maternal morbidity, and mortality. (Osman et al., 2020) Preeclampsia, antepartum hemorrhage,

puerperal infection, and thromboembolic problems in the mother might result in uterine sub

involution, lactation failure, and delayed wound healing(Odhiambo et al., 2020)

Pregnant women in underdeveloped nations, particularly in SubSaharan Africa (57%) and South-

East Asia (48%), were found to have the highest frequency of anemia, whereas pregnant women

in South America had the lowest prevalence (24.1%). (Gudeta et al., 2019). Maternal and

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perinatal mortality is linked to anemia. It increases the risk of maternal death by two-fold and is

responsible for 20% of all maternal deaths (Tirore et al., 2020).

In Kenya, according to the Ministry of Health, the Prevalence of Anemia among pregnant

women is 55.1 %.( Okube et al., 2016). In Kenya, the etiological diversity of maternal anemia is

hampered by a scarcity of resources, resulting in avoidable morbidity and mortality at the sub-

county level. National policy guidelines and efforts on combined iron and folic acid supplements

for pregnant women have aimed to improve both newborn and maternal outcomes in order to

alleviate this load. (Odhiambo et al., 2020) The goal-oriented and women-centered focused

Prenatal Care (FANC) program, which advises at least four scheduled comprehensive antenatal

visits to promote the health of pregnant women and their infants, has been implemented to

achieve this. (Odhiambo et al., 2020). In the era of diminishing resources, understanding

maternal anemia trends at the county level at which services are planned, organized, and

delivered will assist local policymakers in deploying tailored, equity-oriented, and availing

nutrition-specific interventions to women in high-risk areas. This will enable the county to

monitor progress towards attainment of both national and global targets, for instance, reducing

by 50% the Prevalence of Anemia among pregnant women by 2025.

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1.2 Problem statement

Globally, WHO estimated that one-third of the world's population has anemia during pregnancy,

and the majority (50%) of cases reside in developing (Getaneh et al., 2018)

There is high prevalence of anemia in sub-Sahara Africa, which is linked to socioeconomic

factors, inadequate food intake, cultural (Kotonto et al., 2021)

In Kenya, the Prevalence of Anemia among pregnant women was reported at 40.3 % (World

Bank, 2019). Maternal deaths are approximately 14% among women of reproductive age, and

about 1 in 67 women is likely to die during pregnancy (KDHS, 2014).

West pokot with majority of population living in rural settlement. Most of the high-risk groups,

including pregnant women, live in rural areas. (Odhiambo & Sartorius, 2020)

Sigor, being one of the areas where cultural is dominant, and most settler practices

transhumanism and the area does not support the growth of leafy vegetables, which are

alternative sources of iron. This is major challenge to dietary intake and types of dietary as per

cultural practices. It's taboo for a pregnant woman to consume meat during pregnancy which is

the main source of iron and vitamin B12. To add the weight and magnitude of problem, they

constantly migrate from one place to another place looking for green pasture which makes

pregnant mothers to miss their antennal clinic or late visiting to ANC hence and early detection

of problem which could be solved through health care directives and thus low birth weight,

premature birth. (Rian et al., 2017). It is necessary to understand underlying unaddressed factors

and reasons behind it to improve the knowledge of anemia in pregnancy accounting 40% of

attendance in Sigor. This study will, therefore, brings linear understanding of factors that are

associated with anemia in pregnancy is Sigor community

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 1.3 Justification of the study

Anemia is a significant maternal problem during pregnancy, associated with a negative outcome

for both the woman and the newborn. For this reason, which adopted reducing maternal mortality

is one of the three health-related millennium development goals.

Epidemiology of Anemia during pregnancy is important for deciding on control strategies. Data

on prevalence and associated factors of anemia remain important indicators of public health

since anemia is related to morbidity and mortality in the population, especially pregnant women.

The management and control of anemia in pregnancy are therefore enhanced by the availability

of local prevalence statistics, which are, however, not adequately provided in Kenya. In view of

the problems caused by anemia, more research is required to identify the prevalence and

associated prevalence and associated factors so as to come up with appropriate strategies that

will ensure its reduction. Therefore, this study aims at determining the Prevalence of Anemia and

associated factors among pregnant women attending antenatal care services at Sigor Health

Centre, West Pokot.

4
1.4 Objectives
1.4.1 Board Objective
To determine the Prevalence of Anemia and associated factors among women attending antenatal
Clinic at Sigor Health Centre, West Pokot.

1.4.2 Specific objectives

1) To determine the prevalence of anemia among women attending antenatal Clinic at Sigor
Health Centre, West Pokot.
2) To identify sociodemographic factors associated with anemia among women attending
antenatal Clinic at Sigor Health Centre, West Pokot.
3) To determine cultural factors associated with anemia among women attending antenatal
Clinic at Sigor Health Centre, West Pokot.
4) To determine the dietary habits associated with anemia among women attending
antenatal Clinic at Sigor Health Centre, West Pokot

1.5 Research Questions

1) What is the Prevalence of Anemia among women attending antenatal Clinics at Sigor
Health Centre, West Pokot?
2) What are the demographic factors associated with anemia among women attending
antenatal Clinic at Sigor Health Centre, West Pokot?
3) What are the cultural factors associated with anemia among women attending antenatal
Clinic at Sigor Health Centre, West Pokot?
4) What are the dietary habits associated with anemia among women attending antenatal
Clinic at Sigor Health Centre, West Pokot?

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1.6 Conceptual framework

INDEPENDENT VARIABLES DEPENDENT VARIABLE

Socio-demographic factors

 Age
 Parity
 Marital status
 Income level
 Education level
 Occupation

ANEMIA IN PREGNACY
cultural factors
OUTCOMES
 Taboos practiced
 Norms 1. Anemic
 Cultural beliefs 2. Non-anemic

Dietary habits and health status

 Frequency of the meal

 Consuming tea and coffee
 Cravings of non-food substances

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7
2.0 CHAPTER TWO: LITERATURE REVIEW
2.1 Introduction

Anemia during pregnancy in impoverished nations is caused by a variety of factors, including

micronutrient deficiencies in iron, folate, and vitamins A and B12, as well as parasite illnesses

like Malaria and hookworm, as well as chronic infections like tuberculosis and HIV.

Geographical location, dietary behavior, and season all influence the contribution of each of the

elements that cause anemia during pregnancy.

2.2 Prevalence of Anemia in pregnancy

Studies on prevalence and factors associated with anemia in women of reproductive age in

Bangladesh, Maldives and Nepal revealed that the prevalence was 41.8 percent in Bangladesh,

58.5 percent in the Maldives, and 40.6 percent in Nepal. Previous research has found that women

in Bangladesh, the Maldives, and Nepal have a significant frequency of anemia. The Prevalence

of Anemia in this study, however, is higher than the global Prevalence of Anemia, which was

32.8 percent in 2016. (Rahman et al., 2021)

A study on magnitude and factors associated with anemia among pregnant women attending

antenatal care in public health centers in the central zone of the Tigray region, northern Ethiopia,

revealed that 107 (16.88 percent) of the 634 pregnant women in the study were found to be

anemic, with a 95 percent confidence interval of 13.95 to 19.8 percent, which is lower than

studies conducted in Woldia (39.1 percent), Gode town (56.8 percent), Butajira (27.6 percent),

Nekemt (52 percent), Mizan Tepi (23.5 percent), Dera (30.5 percent)

8
Although the overall size of anemia in pregnant women is currently reducing as a result of multi-

sectorial initiatives such as improving health access and the country's economy over time, it

remains a public health issue. (Grum et al., 2018)

A study on prevalence and factors associated with anemia among pregnant women attending

antenatal clinic at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia,

revealed that the prevalence was 11.6 percent of the participants in this study (95 percent

confidence interval: 7.8 percent-14.8 percent). This prevalence was nearly identical to that found

in research conducted in Awassa (15.1%), Gondar (16.6%), Debre Berhan (9.7%), Sudan (10%),

Iran (13.6%), and Nakhon Sawan, Thailand (14.1%). However, our findings are significantly

lower than those of research conducted in Pakistan (90.5%), India (87.2%), Malaysia (57.4%),

Benin (68.3%), Nigeria (54.5%), Somali Region (56.8%), Walayita Sodo (40%), West Arsi zone

(36.6%), and Tigray's northwestern zone (36.1%). In addition, our result is lower than those

reported from Uganda (22.1%), Southern Ethiopia (29%), Southeast Ethiopia (27.9%), Mekelle

(19.7%), and Addis Ababa (19.7%). (21.3 percent). (Gebreweld et al., 2018)

A study on anemia and its associated factors among pregnant women attending antenatal clinic

at Mbagathi County Hospital, Nairobi County, Kenya, showed that the prevalence to be at 40.7%

is a sign that anemia during pregnancy is still a major challenge in Kenya despite efforts being

put in place to mitigate anemia prevalence in pregnancy. The results of this study provide more

evidence of the confluence of well-established underlying factors among all population groups,

given the locality of the study. This study is in line with a study done in northwestern Ethiopia

by Melku and others, which showed anemia prevalence to be 36.1%. (Melku et al., 2015). More

than one-third of antenatal mothers were found to be anemic.

9
This prevalence is higher than that reported elsewhere (Caroline 2013, Nairobi) and (Khadija

2006, Kakamega) at 36.2% (95% CI of 31.4-41.3%) and 25.7% (95% CI of 20.7-31.2%)

respectively. The Prevalence of Anemia in our study was lower than the average (57.1%)

reported for the African region (Klemm R et al., 2011) but consistent and slightly lower than the

41.6% reported by the Kenyan Demographic and Health Survey of 2014. (Nyabuti et al., 2020)

According to the study on prevalence and determinants of anemia among pregnant women in

East Africa, 41.82 percent of pregnant women (95 percent confidence interval: 40.78, 42.87)

were anemic, indicating that anemia among pregnant women is a substantial public health issue

in East Africa. This result matched that of a Nigerian study. This study's prevalence is higher

than those found in Saudi Arabia, Ethiopia, and Uganda. This conclusion, however, is lower than

that of Mali, India, Sudan, and Pakistan. Differences in food preferences and cultural attitudes

regarding nutritional consumption during pregnancy, the incidence of infectious diseases, and the

availability of healthcare facilities could all contribute to such geographical variances in anemia.

Furthermore, the current study's greater Prevalence of Anemia could be attributable to recent

resurgences of Malaria in East Africa as a result of climate change. (Liyew et al., 2021)

In Saharan Africa, a lack of iron-rich foods is the major cause of anemia among pregnant

women.

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2.3 Socio-demographic Factors Associated with Anemia in Pregnancy

Many studies have been done to show the relationship between anemia among pregnant women

and sociodemographic factors. According to a study conducted in china on the Prevalence of

Anemia and sociodemographic characteristics among pregnant and non-pregnant, Hemoglobin

concentration was negatively associated with parity. Because of the limited recovery time, every

pregnancy carries an increased risk of bleeding before, during, and after delivery when compared

to the non-pregnant condition. (Wu et al., 2020) This is especially true during short pregnancy

intervals. As a result, increasing parity exposes women to more bleeding risk periods. Women

with a history of delivery had a higher prevalence of anemia than women without a history of

childbirth, according to a similar study in Mexico (OR: 1.5–1.8). (Wu et al., 2020) another study

in India revealed that anemia was linked to gravida, pregnant women's education, and negative

obstetric history. In a study, women's education was found to be strongly linked to anemia during

pregnancy; this study revealed a p-value of 0.003(Suryanarayana et al., 2017)

A study conducted on the size of the family was also found to be a major factor in anemia in the

current study. Family size (joint) had a 1.59 times higher risk of anemia than nuclear family size

[AOR (95 percent CI) = 1.59 (1.03 - 2.45), P = 0.03]. A study conducted at Tikur Anbessa

Hospital in Ethiopia, JigJiga in Eastern Ethiopia, and Southern Ethiopia found comparable

results. Anemia in pregnant women is linked to increased family size, which could be

attributable to food insecurity. Anemia is known to be influenced by clinical and maternal

factors.

11
In sub-Africa, many studies have been done to show sociodemographic factors; according to

(Girma et al. 2020), the size of the household is another factor. The majority of pregnant women

in the research region came from the pastoralist group, and they had big families because they

did not use family planning services. Many families may face food insecurity as a result of their

big family size. As a result, pregnant women with a large family size were nearly twice as likely

to develop anemia as pregnant women with smaller family sizes (AOR=2.1, 95 percent CI

1.132–3.77). (Girma et al., 2020) According to a current study carried out in East Africa,

unmarried women had a higher prevalence of anemia than married women, and Unmarried

pregnant women had greater rates of illness, low mental well-being, stress, and depression; when

compared to married women, they are less likely to report being happy and healthier. (Liyew et

al., 2021)In addition, pregnant teenagers had a higher rate of anemia than older women,

according to the study. Early marriage has been linked to a low economic position, school

dropout, risk of sexually transmitted illnesses (such as HIV/AIDS), greater rates of multiple bad

social and physical outcomes, pregnancy difficulties (such as anemia), and a high rate of divorce,

according to several studies. As a result of the cumulative influence of these factors, teenage

pregnancy may be associated with an increased risk of anemia. (Liyew et al., 2021)

In a study done in Ethiopia on Anemia among Pregnant Women Attending Ante Natal Care

Clinic in Adare General Hospital, Only family income and not having attended formal education

showed statistically significant associations with anemia in this study, indicating a higher

prevalence of anemia in pregnant women with low monthly family income and not having

attended formal education. (Kare&Gujo et al., 2021).

12
Regarding family income, the current study found that pregnant women with a lower monthly

income have a higher risk of anemia. This means that empowering women in terms of money

and decision-making authority are critical methods for reducing anemia risk and improving the

health of pregnant mothers and their babies. In terms of educational attainment, this high

frequency of anemia among pregnant women who did not have formal education could be

attributed to a lack of understanding of the causes that cause anemia and how to avoid the risk

factors. (Kare et al., 2021)

The mother's occupation (farmer) was found to be strongly linked with anemia during pregnancy

in this study. A farmer was the occupation of 42 percent of pregnant women in cases and 53

percent of pregnant women in controls. This could be due to a lack of knowledge about excellent

and acceptable nutritional practices during pregnancy, as well as economic factors,

inaccessibility, and underuse of healthcare facilities. (Berhe et al., 2019).

2.4 cultural factors

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 Food taboos have been recognized as one of the variables contributing to maternal anemia

during pregnancy, particularly among women in Sub-Saharan Africa. Cultural norms, taboos,

and beliefs are among the contextual elements listed as one of the basic causes of malnutrition in

the UNICEF Food-Care Health conceptual framework. This is due to the fact that poor

nutritional habits, particularly during pregnancy and early childhood, can have a significant

impact on children's growth and development. Pregnant women in many communities are

required to adhere to certain cultural taboos and practices, which have an impact on the food they

consume, making them more vulnerable to micronutrient deficiencies, particularly vitamin A,

folate, iodine, iron, calcium, zinc, all of which are essential during pregnancy. (Chakona et al.,

2019)

A study conducted in the Maasai community in Northern Tanzania showed that women preferred

to follow traditional pregnancy practices since they were encouraged by other women and were

cared for in a traditional manner (by elders and traditional birth attendants) (Lennox et al., 2017)

According to a study on Food Taboos and Cultural Beliefs Influence Food Choice and Dietary

Preferences among Pregnant Women in the Eastern Cape, South Africa has shown a substantial

overlap between non-preferred foods and taboo foods, as most of the foods mentioned as non-

preferred were also listed as taboo foods. For example, chicken, red meat, wild animals, potatoes,

beans, butternut/pumpkin, fruits, fish and eggs, which were the top taboo foods, also appeared as

the top foods that the majority of women did not like to consume during pregnancy. (Chakona et

al., 2019)

According to a study on Traditional food taboos and practices during pregnancy, postpartum

recovery, and infant care of Zulu women in South Africa, some of the traditional Zulu food

taboos mentioned in our study are healthy and should be reinforced. Sweets, sugarcane

14
(Saccharum officinarum L.), commercial juice, sweet food, and honey, for example, were

considered prohibited during pregnancy because they could create a drooling newborn with

excessive saliva and dermatitis. Sugarcane was forbidden in Laos' People the Democratic

Republic because it would result in a chubby baby and, consequently a difficult birth.

(Ramulondi et al., 2021) According to a study conducted in Eastern Cape Town in South Africa

showed that Most of the foods that were reported as taboo foods are rich sources of essential iron

micronutrients (beans, eggs, offal, all fruits, pumpkin, and butternut), protein (bush meat, fish,

eggs, chicken, waste, and beans) and carbohydrates (potatoes and amateur), which are crucial for

maternal health and child development. (Chakona et al., 2019)

A study conducted in the Maasai community in Ngorongoro, Tanzania, revealed that during

pregnancy, food intake is highly associated with cultural restrictions and the unavailability of

fruits and vegetables (Mshanga et al., 2020). A study in Ghana revealed that cultural beliefs

prevent pregnant women from eating certain food types. Typical food sources their beliefs and

religion forbid are eggs, snails, and beans (cowpea) with ripe plantain. Quite significant women

(57%) claim their beliefs instill food restrictions. Though this is far less common compared to

about 66% of women in Pakistan who practice food restrictions during pregnancy because of

their beliefs, our finding shows an equally worrying situation. For instance, it is worrying that

half of the women do not take eggs during pregnancy; meanwhile, an egg is known to be a

source of high biologic quality protein.

Also, African snails have high values of iron, magnesium, calcium, phosphorus, potassium and

sodium as minerals and serve as good animal protein sources [28]. The staple food cowpea with

ripe plantain is a well-balanced diet with protein and energy; meanwhile, it is not taken by many

women (60%) because of their cultural beliefs. (Nelofar et al., 2018)

15
A study conducted in Isiolo county on the influence of taboos and beliefs on anemia among

pregnant women showed that there is a significant association between taboos and beliefs and

with Prevalence of Anemia since the vital part of a balanced diet was restricted during

pregnancy, thus impacted the Prevalence of Anemia (Agustino et al. 2020).

2.5 Dietary habits

Studies done in Tanzania showed that pregnant women's excessive consumption of tea and

coffee at mealtimes reduced the bioavailability of iron from the meals they ate. Tea consumption

with a meal has been demonstrated to reduce iron absorption by 50%, potentially increasing the

risk of iron deficiency. (Gibore et al., 2020)

Studies done in Tanzania showed that women who ate fewer than three meals every day were

more likely to be anemic. This finding could imply that while nutrient demand rises during

pregnancy, increasing daily meal frequency improves nutrient sufficiency. This study supports

recent research from Southern Sudan and Kenya, which found that pregnant women who ate

three meals per day had a lower risk of anemia during pregnancy. However, this discovery could

simply mean that eating three meals per day is a sign of food poverty, which raises the risk of

anemia. In many situations, food poverty increases the risk of anemia, and a pregnant woman's

ability to obtain adequate nutrition is hampered by her household's economic state. (Gibore et al.,

2020) .

According to studies done in Ethiopia, meal frequency of three times or less per day was

associated with anemia. This study is consistent with Studies conducted in Mekelle town and in

Northwest of Tigray. This implies that increased meal frequency during pregnancy needs to

fulfill the nutrients demand of pregnant women. (Grum et al., 2018)

16
According to study on prevalence and factors associated with anemia among pregnant women

attending antenatal clinics in the second and third trimesters at Pumwani Maternity Hospital,

Kenya, showed that during pregnancy, eating soil is a risk factor for the development of anemia.

(Okube et al., 2016)

A study conducted in a Southwest rural community in Ethiopia showed that dairy products,

including beef, milk, cheese, and yogurt, as well as fruits like bananas, avocados, eggs, and

vegetables like cabbage, pumpkin, Taro, and sugarcane, were the foods most commonly avoided

during pregnancy. The majority of the banned foods are high in vital micronutrients, which are

important for maternal health as well as child growth and development. The present study's

findings back up previous research, which indicated that diets during pregnancy are more

elaborate, nutritionally relevant, and differ only in the type of food avoided and the reasons for it

(Tsegaye D. et al. 2021). In this study, consumption of eggs during pregnancy is discouraged

since it is thought to make the fetus larger, making delivery more difficult. This discovery is

backed up by findings from a study conducted in Ghana and Kenya, which found that eating

eggs makes the fetus grow larger. This conclusion is backed up by a study from Nigeria, where

egg eating is forbidden during pregnancy due to concerns that the children will develop negative

habits after birth. (Tsegaye D., et al 2021).

Theoretical frameworks

This study adopted The Health Belief Model (HBM), which was developed in the early 1950s by

social scientists at the U.S. Public Health Service in order to understand the failure of people to

adopt disease prevention strategies or screening tests for the early detection of disease. The HBM

suggests that a person's belief in a personal threat of an illness or disease, together with a
17
person's belief in the effectiveness of the recommended health behavior or action, will predict the

likelihood the person will adopt the behavior.

The HBM derives from psychological and behavioral theory with the foundation that the two

components of health-related behavior are 1) the desire to avoid illness or, conversely, get well if

already ill; and 2) the belief that a specific health action will prevent or cure illness. Ultimately,

an individual's course of action often depends on the person's perceptions of the benefits and

barriers related to health behavior. There are six constructs of the HBM. The first four constructs

were developed as the original tenets of the HBM.

Perceived susceptibility - This refers to a person's subjective perception of the risk of acquiring

an illness or disease. There is wide variation in a person's feelings of personal vulnerability to an

illness or disease. For example, women's perception of getting anemia

Perceived severity - This refers to a person's feelings on the seriousness of contracting an illness

or disease (or leaving the illness or disease untreated). There is wide variation in a person's

feelings of severity, and often a person considers the medical consequences (e.g., death,

disability) and social consequences (e.g., family life, social relationships) when evaluating the

severity. For example, the consequences of not treating anemia

Perceived benefits - This refers to a person's perception of the effectiveness of various actions

available to reduce the threat of illness or disease (or to cure illness or disease). The course of

action a person takes in preventing (or curing) illness or disease relies on consideration and

evaluation of both perceived susceptibility and perceived benefit, such that the person would

accept the recommended health action if it was perceived as beneficial. For example, pregnant

women understand the benefits of nutritional intake.

18
Perceived barriers - This refers to a person's feelings about the obstacles to performing a

recommended health action. There is wide variation in a person's feelings of barriers, or

impediments, which leads to a cost/benefit analysis. The person weighs the effectiveness of the

actions against the perceptions that they may be expensive and dangerous, for example, taboos

and beliefs regarding the intake of food.

19
3.0 CHAPTER THREE: RESEARCH METHODOLOGY

3.1 Introduction

This chapter gives details of the methods of data collection, analysis and presentation that was

used in this study. It focuses on research design, target population, sampling procedure, methods

of data collection, the validity of the instruments used, reliability of the research findings and

data analysis techniques used in the study.

3.2 Study Design

This research adopted a descriptive cross-sectional study design. This is a study design where

data is collected from a population at a specific. This design is selected because data can be used

to determine regional variance and temporal changes in illness prevalence. This may aid in

generating hypotheses about the disease's causation (Aggarwal et al., 2019). Researchers collect

data but do not interfere with the subjects or intervene in any way.

3.3 Study Area

West Pokot County is situated in the northwest part of Kenya, along the border with Uganda.

The county borders Turkana County to the North and Northeast, Trans-Nzoia County to the

South, Elgeyo-Marakwet County, and Baringo County to the Southeast and East. It also borders

Up in the West and Sebei district in Uganda in the Southwest. The county has the following sub-

counties: West Pokot (Kapenguria, Sook, and Kongelai); South Pokot (Lelan, Chepareria, and

Tapach); Pokot Central (Sigor and Chesegon) and North Pokot (Kacheliba, Alale, Kasei,

Kiwawa, Konyao). The study will be conducted at Sigor sublocation in Sigor ward.

20
3.4 Study population

The study's target population was all pregnant mothers attending antenatal clinics at Sigor Health

Centre, West Pokot. According to Sigor health center records, approximately 130 women

participate in antenatal clinics monthly (MOH, 2021).

3.5 Sample size determination

The sample size was calculated using the formula below (Fisher et al., 1998)

Since the data was unavailable on antenatal exercise among pregnant women in the area, 40.3 %
of the population proportion was considered to determine the sample size based on a single
population proportion, and the level of precision (d) is (0.05).

2
z p ( q)
n=
d2

Where,

n =minimum sample size of the study subject

z =standard normal distribution curve /value for the 95% confidence interval (1.96)

p = proportion of the population (40.3%) Kenya prevalence of anemia among pregnant women
as per World Bank report, 2019

d = the margin of error taken (0.05)

Calculation.

n= Sample Size (n) = (0.403 x (1-0.403)) / ((0.403/1.96) Squared)

Sample Size = 0.92425/ 0.05Squared)

Sample Size = 0.92425 / 0.0025

Sample Size = 370 participants

21
Since the source population is <10,000, population correction formulas are employed with the
following formula:

nf = __n__

1+ (n/N)

Where

nf= The desired sample size for population <10,000

n= the calculated sample size

N= the total population (130); this is the estimated number of pregnant women attending
antenatal clinic at Sigor health center as per Sigor antenatal health records monthly

Hence

sample Size (n) = 370/ 1+ 370/130

True Sample = 370/3.846

True Sample (n) = 96.204, which was 97

Some of the respondents may fail to show up or partake in the study even after being selected;
hence the sample size was adjusted upwards to cater to the non-response rate, which is estimated
at 10%

The following formulae were used;

n=1/ (1-anticipated non response rate) *n

n=1/ (1-0.10) *97= 101.111

Therefore, 102 pregnant women selected conveniently

22
3.6 Sampling and sampling technique

A convenient sampling technique was used in this study to obtain women of interest. The
pregnant women in the ANC queue who meets inclusion criteria were selected to participate in
the study after consenting. The procedure was carried till 102 participants was obtained.

3.7 Inclusion and exclusion criteria

3.7.1 Inclusion Criteria

The study included all woman attending ANC clinic in Sigor health centre, willing to participate,

signed a consent form, and present during the time of study

3.7.2 Exclusion criteria

Those pregnant women attending high-risk clinics.

3.8 Data collection instrument

A well-formulated and pretested questionnaire comprising of both closed and open-ended

questions written in English was utilized in this study since the utilization of a questionnaire as a
research tool provides the respondents with enough time to give their well-thought responses to
the questionnaire items and allow big samples to be covered within a limited time (Ayanaw
Habitu et al., 2018). A questionnaire involved questions arranged in series, and sections was used
to elicit key information from participants.

The study questionnaire was designed in four sections, socio-demographic, anemia prevalence,
socio-cultural, dietary habits associated with anemia among pregnant women. The dependent
variable was measured using the WHO anemia scale

23
3.9 Validity and reliability of the study tool
3.9.1 Validity

Validity refers to the degree to which a research instrument measures the truth of what it is

required to measure (Mugenda & Mugenda, 2008; Haber & LoBiondo-Wood, 2006). It is also an

indicator of the extent to which study findings can be accurately interpreted and generalized to

other populations and also measures the truth and accuracy of an argument (Burns & Grove

2009). To assess the research instrument for validity, the questionnaire was given to my

supervisor to evaluate each element of the questionnaire in relation to the objectives and assess if

the instrument is answering the research questions. The advice from the supervisor was taken

into consideration for further corrections to ensure that the instrument would measure what it is

intended to.

24
3.9.2 Reliability

Reliability refers to the degree to which study findings are considered consistent and replicable
after repeated trials (Mugenda & Mugenda, 2003). Reliability was used to measure the
consistency, exactness, accuracy, strength, comparability, and homogeneity of the study.

Steps that were taken to ensure the reliability of the study is maintained include.

 The aim of the study was explained to all participants, and their informed consent and
cooperation to participate in the research was obtained.
 A pretest study was conducted to ensure that the research instrument is accurate in terms
of collecting relevant data and information required in the study.

 The researcher was available during information collection sessions and explained any
unclear questions and aspects to the respondents.

 Medical terminologies were avoided so that the participants could comprehend the
questions with easy and respond appropriately

25
3.10 Pretesting

Pretesting research tools assist the researcher in identifying and correcting any deficiencies in the

research tools and interviewing skills so that quality and sufficient information is obtained. It

was carried out to help the researcher determine the practicability of the study by identifying

study design problems, the efficiency of sampling techniques, and refining data collection and

analysis techniques used in the study (F. Fathalla, 2004). To test the validity and reliability of the

questionnaire, a pretest was conducted. The pilot study of this research was conducted in Lelan

Health Centre, West Pokot County. The sample size was approximately 10% of the total

population (10 participants). The results were not used in the final report

26
3.11 Data collection, analysis and presentation
3.11.1 Data collection procedure

After the approval of the research proposal by Dedan Kimathi University, a letter of

authorization was given then taken to the administration of Sigor Health Centre. Permission for

data collection was obtained. The researcher agreed with the hospital's administration on

collecting data. On the agreed date, the researcher presented himself in the hospital and identified

the respondents in the antenatal clinic all the clients in the que were given numbers according to

their line in the que, the consent was explained to the first woman in numerical and upon given

consent data was collected progressively in the line until the que is complete. This was done until

the required sample size was achieved. Data was collected through researcher-administered

questionnaires that the respondents answer all questions asked as researcher fills the

questionnaires. To take part, the researcher interviewed participants for 5 to 10min. The data

collected was recorded, checked, cleaned, and coded. The data collection and analysis process

took 3 week.

27
3.11.2 Data analysis and presentation

Data collected through the interviewer-administered questionnaire was entered in STATA, a

software version 9.10. Data cleaning was done on the do-file by checking for outliers, duplicate

IDS, and missing data. The cleaned data was then saved and analyzed. The data that has been

collected was then analyzed through STATA, a software version 9.10, a descriptive statistic for

the independent variables. The Chi-square test was then applied to explore any association

between the different independent variables, which include socio-demographic factors, cultural

factors, and dietary habits, with the primary dependent variables (Anemia in pregnancy) to

determine the factors associated with anemia in pregnancy.

Descriptive statistics was used quantitatively to analyze data. Any value with a p-value of less

than 0.05 was regarded as statistically significant. The final results were presented in graphs and

pie charts

3.12 Ethical considerations

Before the study was conducted, the researcher requested permission from the administration of

Sigor Heath Centre, West Pokot County, by providing a letter of introduction from the nursing

department at Kimathi University. The respondents were explained how to go about the study

and its purpose. Participation in the study was voluntary. The respondents were given the

freedom to seek clarification concerning the study and were free to withdraw from the study at

any time during the interview. Privacy and confidentiality were assured to all the respondents

throughout the study by not entering the name of the respondent in the questionnaire but instead,

code numbers were used. Data collected from the participants was secured in a software form,

28
and password-encrypted information to be collected from the participants. Justice was ensured

by making sure that all the participants were approached and treated equally and fairly regardless

of social class. The respondent voluntarily signed a consent form before allowing the participants

to participate in giving responses.

29
CHAPTER FOUR : RESULTS
4.1 Response rate

The study had a target sample size of 97 respondents out of whom 97 respondents had

their questionnaires completely answered and submitted on time and analyzed hence the

response rate was 100%.

4.3 Anemia in pregnancy prevalence

The finding revealed that 40.21%, (n=39) of the respondents had anemia in pregnancy as

shown in figure 4.1 below.

Prevalence of anemia in pregnancy

Yes; 40.21%

No; 59.79%

Figure 4.1: The prevalence of pregnancy anemia

30
4.2 Social-demographic characteristics of respondents

Regarding the socio-demographic characteristics of respondents, the study established

that, more than a third of the respondents, 44.33% (n=43), were aged between 26-30 years. Less

than a quarter of the respondents, 19.59% (n=19) had college/university level education. Further,

majority of the respondents, 55.67% (n=54) were married. Almost half of the respondents,

48.45% (n=47) had a monthly income of less than Kshs. 10,000. Majority of the respondents,

52.58% (n=51) were self employed as shown in table1 below.

Table 1: Socio-demographic characteristics of respondents

CHARACTERISTIC CATEGORY FREQUENCY (N) PERCENTAGE (%)

Age in years 18-25 20 20.62

26-30 43 44.33

31-45 23 23.71

>45 11 11.34

Marital status Married 54 55.67

Single 24 24.74

divorced 11 11.34

Widowed 8 8.25

Level of education non-formal 24 24.74

Primary 28 28.87

Secondary 26 26.8

college/university 19 19.59

31
Occupation unemployed 30 30.93

self-employed 51 52.58

formally employed 16 16.49

Monthly income <10,000 47 48.45

10,000-40,000 41 42.27

>40,000 9 9.28

32
4.4 Cultural factors

Regarding cultural factors, the study findings revealed that, majority of the respondents,

76.29% (n=74) resided in the village, while remaining n =26 resides in small shopping centre.

Majority of the respondents, 53.61% (n=52) had a family size of more than 4. Further, Majority

of the respondents, 51.55% (n=50) were affiliated to christianity religion. 57.73% (n=56) of the

respondents reported having a pokot traditional food for pregnant women as illustrated in table 2

below.

Table 2: Cultural factors

CHARACTERISTIC CATEGORY FREQUENCY (N) PERCENTAGE (%)

Residence rural 74 76.29

urban 23 23.71

Family size 1 to 2 29 29.9

3 to 4 16 16.49

>4 52 53.61

Avoids some foods before or during pregnancy Yes 53 54.64

No 44 45.36

Religion Christian 50 51.55

Muslim 15 15.46

pagan 19 19.59

others 13 13.4

33
Is pokot traditional diet for pregnant women? Yes 56 57.73

No 41 42.27

4.5 Dietary habits related factors

Regarding dietary habits factors, the study findings established that, majority of the
respondents, 83.51% (n=81) reported taking tea, cocoa or coffee. Almost a quarter of the
respondents, 18.56% (n=18) reported craving for non-food substances such as stones and soils.
Further, 23.71% (n=23) of the respondents reported smoking cigarettes while 18.56% (n=18)
reported using alcohol as shown in table 3 below.

Table 3: dietary habits factors

CHARACTERISTIC CATEGORY FREQUENCY (N) PERCENTAGE (%)

Takes tea, cocoa or coffee Yes 81 83.51

No 16 16.49

Non-food substances cravings stones/soils 18 18.56

Charcoal 6 6.19

burnt matches 3 3.09

toothpaste 3 3.09

Others 8 8.25

None 59 60.82

Smokes cigarettes Yes 23 23.71

No 74 76.29

Takes alcohol Yes 18 18.56

No 79 81.44

34
Frequency of meals per day Once 10 10.31
Twice 50 51.55
thrice 20 20.62
More than 3 17 15.31

Further, inferential statics using Chi-square was done to test the relationship between the

independent variables and the primary dependent variable which in this case was pregnancy

anemia and the results were as follows:

4.6 The relationship between socio-demographic factors and anemia in

pregnancy

The findings established that, level of education, p=0.001, income, p=0.038 and

occupation, p=0.000 were statistically significant with anemia in pregnancy while age, p=0.208

and marital status, p=0.906, were not statistically significant with anemia in pregnancy as shown

in table 4 below.

35
Table 4: The relationship between socio-demographic factors with anemia in pregnancy
FREQUENCY PERCENTAGE PREGNANCY CHI-
CHARACTERISTIC CATEGORY (N) (%) ANEMIA SQUARE(Χ2)

Yes No

Age in years 18-25 20 20.62 11 9 χ2 =4.5518

26-30 43 44.33 13 30 df = 3

31-45 23 23.71 9 14 p = 0.208

>45 11 11.34 6 5

Marital status Married 54 55.67 21 33 χ2 =0.5573

Single 24 24.74 9 15 df = 3

divorced 11 11.34 5 6 p = 0.906

Widowed 8 8.25 4 4

Level of
education non-formal 24 24.74 13 11 χ2 = 16.8497

Primary 28 28.87 15 13 df = 3

Secondary 26 26.8 11 15 p = 0.001*

college/university 19 19.59 0 19

Occupation unemployed 30 30.93 21 9 χ2 = 22.3475

self-employed 51 52.58 18 33 df = 2
formally
employed 16 16.49 0 16 p = 0.000*

36
Monthly income <10,000 47 48.45 25 22 χ2 = 6.5476

10,000-40,000 41 42.27 12 29 df = 2

>40,000 9 9.28 2 7 p = 0.038*

4.7 The relationship between cultural factors with anemia in pregnancy

The findings revealed that, religion, p=0.033 and having a pokot traditional food such as

maize,millet, sorghum and trees leaves(sokoria) which dries depending with periods considered

as local vegetables used by for pregnant women, p=0.007 were statistically significant with

anemia in pregnancy since eating meat is prohibited by the cultural norms so they have to

depend on rare vegetable which take little during supper time, while family size p=0.929 and

having well established food plans on budget were found to have p=0.125 were not statistically

significant with pregnancy anemia as shown in table 5 below.

37
Table 5: The relationship between cultural factors with pregnancy anemia
CHI-
CATEGOR FREQUENC PERCENTAG PREGNANC SQUARE(Χ2
CHARACTERISTIC Y Y (N) E (%) Y ANEMIA )

Yes No

Residence Rural 74 76.29 35 39 χ2 = 6.5276

Urban 23 23.71 4 19 df = 1

p = 0.011*

Family size 1 to 2 29 29.9 11 18 χ2 =0.1467

3 to 4 16 16.49 7 9 df = 2

>4 52 53.61 21 31 p=0.929

Avoids some foods before

or during pregnancy Yes 53 54.64 25 28 χ2 =2.3568

No 44 45.36 14 30 df = 1

p=0.125

Religion Christian 50 51.55 14 36 χ2 = 8.7039

Muslim 15 15.46 10 5 df = 3

38
 Pagan 19 19.59 10 9 p = 0.033*

Others 13 13.4 5 8

Has pokot traditional diet

for pregnant women Yes 56 57.73 29 27 χ2 = 7.3894

No 41 42.27 10 31 df = 1

p = 0.007*

4.8 The relationship between dietary habits factors with pregnancy anemia

The findings revealed that, taking beverages such as tea, cocoa or coffee, p=0.013, and

having cravings for non food substances, p=0.030 were statistically significant with anemia in

pregnancy while smoking cigarettes, p=0.180 and taking alcohol, p=0.684 were not statistically

significant with anemia in pregnancy as shown in table 6 below.

Table 6: The relationship between dietary habits factors with anemia in pregnancy

FREQUENCY PERCENTAGE PREGNANC CHI-

CHARACTERISTIC CATEGORY (N) (%) Y ANEMIA SQUARE(Χ2)

Yes No
Takes tea, cocoa or
coffee Yes 81 83.51 37 44 χ2 = 6.1180

No 16 16.49 2 14 df = 1

p = 0.013*

Non-food substances χ2 =
cravings stones/soils 18 18.56 10 8 10.5790

charcoal 6 6.19 2 4 df = 5

39
 burnt
matches 3 3.09 2 1 p = 0.030*

toothpaste 3 3.09 0 3

others 8 8.25 2 6

none 59 60.82 23 36

Smokes cigarettes yes 23 23.71 12 11 χ2 =1.7961

no 74 76.29 27 47 df = 1

p=0.180

Takes alcohol yes 18 18.56 8 10 χ2 =0.1651

no 79 81.44 31 48 df = 1

p=0.684
Once 20 10.31 10 10
twice 50 51.55 7 50 χ2=1.02
Frequency of the meal thrice 10 20.62 0 97 df=5
per day More thrice 17 15.31 0 97 P=0.004

40
CHAPTER 5: DISCUSSION, CONCLUSION, AND RECOMMENDATION

5.1 Discussion
5.1.1 Prevalence of pregnancy anemia

This study established a high prevalence of pregnancy anemia among the women attending ANC

clinic at the facility. This study concurs with a study on anemia and its associated factors among

pregnant women attending antenatal clinic at Mbagathi County Hospital, Nairobi County, Kenya,

which showed that the prevalence of pregnancy anemia to be at 40.7% hence an indication that

anemia during pregnancy is still a major challenge in Kenya despite efforts being put in place to

mitigate anemia prevalence in pregnancy.

This study is however not in agreement with a study done in northwestern Ethiopia by Melku

and others, which found a lower prevalence of anemia to be 36.1%. (Melku et al., 2015). The

Prevalence of Anemia in this study was lower than the average (57.1%) reported for the African

region (Klemm R et al., 2011) but consistent and slightly lower than the 41.6% reported by the

Kenyan Demographic and Health Survey of 2014. (Nyabuti et al., 2020). This result matched

that of a Nigerian study. This study's prevalence is higher than those found in Saudi Arabia,

Ethiopia, and Uganda. This conclusion, however, is lower than that of Mali, India, Sudan, and

Pakistan (Liyew et al., 2021).

The respondents ha little knowledge on prevention of anemia in pregnancy due as indicated by

research done in Kenya showing high illiteracy levels in most or rural areas in Kenya (Grum et

al., 2018) .This could be attributed to the fact that the study area being in a villages setting, the

respondents might be knowledge on prevention of anemia in pregnancy due to high illiteracy

41
5.1.2 Socio-demographic factors associated with anemia in pregnancy

Respondents’ income and occupation were found to be a key factor associated with pregnancy

anemia. These findings concur with findings from a study in Ethiopia which established those

pregnant women with a lower monthly income have a higher risk of anemia (Kare et al., 2021).

This findings is explained by the research conducted in tanzania indicating the reason behind the

occupation as linked directly to income level and family organization (Kare&Gujo et al., 2021).

This means that empowering women in terms of fiscal with help in decision-making authority

are critical methods for reducing anemia. since will get the services necessary for prevention of

anemia in pregnancy and hence improving the health of pregnant mothers and their babies

From this study it is then concluded that attributed factors of anemia in pregnancy is lower

levels of income could probably limit one form getting balanced diets which has been proven to

predispose one to dietary anemia.

The respondents’ level of education was found to have a significant association with pregnancy

anemia. These findings were in support of other findings from a study conducted in Ethiopia on

Anemia among Pregnant Women Attending Ante Natal Care Clinic in Adare General Hospital

which found out that only family income and not having attended formal education showed

statistically significant associations with anemia in this study, indicating a higher prevalence of

anemia in pregnant women with low monthly family income and not having attended formal

education. (Kare&Gujo et al., 2021). It is expanded my findings agree in same explanation with

the research conducted by Kare 2021 in Ethiopia which explain that, having knowledge have

positively add up to the health care during pregnancy including total care and deity intake. in

42
accordance with my finds there is general total link between income and the level of education.

Since majority of whom have anemia have informal education

This could be attributed to the lack of understanding and gaining knowledge on changes during

pregnancy and the causes of anemia and how to avoid the risk factors.

5.1.3 Cultural factors associated with anemia in pregnancy

The respondents’ having a traditional food such as surghum, millet,and rarely stoke of maize of

preference was also found to be a significant factor associated with pregnancy anemia. These

findings are consistent with findings from a study conducted in Isiolo County on the influence of

taboos and beliefs on anemia among pregnant women which showed that there is a significant

association between taboos and beliefs and with Prevalence of Anemia. My finding also agree

with explanation by research conducted in Ethiopia that the vital part of a balanced diet was

restricted during pregnancy, thus impacted the Prevalence of Anemia and hence no formation of

sufficient Hb (Agustino et al. 2020). This finding can be farther explained by the study

conducted among Somali women that poor nutritional habits, particularly during pregnancy and

early childhood, can have a significant impact on children's growth and development (Chakona

et al., 2020). Which also agrees with study conducted to correlate factors associated with

maternal death in Pregnant women in Masai community in Tanzania, they concluded that it

requires to avoid adherence to certain cultural taboos and practices, which have an impact on the

food they consume, making them more vulnerable to micronutrient deficiencies, particularly

vitamin A, folate, iodine, iron, calcium, zinc, all of which are essential during pregnancy

(Nelofar et al., 2018)

43
This is attributed to the fact that the belief and practices directly become risk factor to anemia in

pregnancy towards a certain diet could even discourage women from taking certain meals which

could probably have nutrients that prevent anemia. Since they consider taboo and no such

pregnant woman should take under a given magnitude and traditional norms of belief. The

restricted food which is source of the Hb formation is prohibited and considered immoral.

The respondents’ religious beliefs and affiliation was also established to be significantly

associated with pregnancy anemia. These findings concur with findings from a study conducted

in Eastern Cape Town in South Africa which showed that Most of the foods that were reported

as taboo foods are rich sources. (Chakona et al., 2020) this essential iron micronutrients (beans,

eggs, offal, all fruits, pumpkin, and butternut), protein (bush meat, fish, eggs, chicken, waste, and

beans) and carbohydrates (potatoes and amateur), which are crucial for maternal health and child

development (Chaconne et al., 2019).

This may be attributed to the fact that certain religious beliefs prohibit the use of certain foods

which therefore limits access to balanced diets.

5.1.4 Dietary habits factors associated with anemia in pregnancy

Having cravings for non-food substances such as stones and soil was also established to be

significantly associated with pregnancy anemia. These findings were analogous to findings from

44
a study on prevalence and factors associated with anemia among pregnant women attending

antenatal clinics in the second and third trimesters at Pumwani Maternity Hospital, Kenya, which

established that during pregnancy, eating soil is a risk factor for the development of anemia.

(Okube et al., 2016). This could probably be attributed to the fact that such substances could

deplete the blood HB levels hence predisposing one to pregnancy anemia.

The respondents taking beverages such as tea, coffee and cocoa was established in this study to

be significantly associated with pregnancy anemia. This was in support of findings from a study

done in Tanzania which established that pregnant women's excessive consumption of tea and

coffee at mealtimes reduced the bioavailability of iron from the meals they ate. This can be

attributed to the fact that taking such beverages could probably limit one from having balanced

diet which in return may lead to pregnancy anemia. pregnant woman from the findings don’t take

meat which are source of vitamin B12 necessary for Hb formation. Upon traditional combat

belief hinders the pregnancy period.

Tea consumption with a meal has been demonstrated to reduce iron absorption by 50%,

potentially increasing the risk of iron deficiency. (Gibore et al., 2020).

The respondents taking one and two meal per day, was established from these statistics to be

significantly associated with pregnancy anemia. These findings agree with study done in

Ethiopia and Mekelle town and in Northwest of Tigray, meal frequency of three times or less per

day was associated with anemia. (Grum et al., 2018)

In my findings it is attributed to magnitude that taking frequent meals per day and variety

(balanced diet) increases level of Hb. Which agrees with findings conducted in Mombasa

45
demonstrated anemia in pregnancy has significant weight to frequency of diet per day (Okube et

al., 2016).

5.2 Conclusion

The findings established a high prevalence of anemia in pregnancy among women attending the

facility of study. The study further revealed that, socio-demographic factors associated with

pregnancy anemia include occupation, income and level of education. Regarding cultural factors,

respondents’ religious affiliations as well as having a pokot traditional food for pregnant women

were established to be associated with anemia in pregnancy. Moreover, taking beverages such as

tea and coffee as well as craving for non-food substances such as soil were the dietary habits

factors associated with pregnancy anemia.

46
5.3 Recommendations

The researcher recommends that:

1. Campaign should conduct in various religious affiliation to change beliefs and practices
that limit use of certain foods that help prevent anemia in pregnancy. should be clarified
as this was established to be associated with pregnancy anemia
2. Public health campaign should be done to correct negative traditional beliefs on diet
should be established to be associated with pregnancy induced anemia.
3. There is need to raise awareness against the use of non-food substances such as stones as
this was similarly established to be associated with pregnancy induced anemia.
4. The researcher recommends further studies to be conducted to explore the use of non-
food substances and the associated factors among pregnant women as this study
established the use of such substances to be prevalent in the area of study.

47
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APPENDICES

Appendix 1: Study Instrument; Questionnaire

PREVALENCE OF ANEMIA AND THE ASSOCIATED FACTORS AMONG WOMEN

ATTENDING ANTENATAL CLINIC AT SIGOR HEALTH CENTRE WEST POKOT
COUNTY

You are requested to participate in the above-mentioned study. If you agree to participate you
will be asked questions about yourself, and questions about people around you .The interview
will take approximately 20 minutes to complete. The interviewer will explain to you all the
questions and everything discussed with you will remain confidential and will help the
leadership of the area to provide better health services to pregnant women and help reduce
pregnancy anemia.

Participant serial number -------- Date of interview -------- Name of interviewer--------

A) SOCIO-DEMOGRAPHIC DATA – (tick appropriately)

NO QUESTION CODE RESPONSE

1 What is your age? 1 [ ]18-25yrs
2 [ ] 26-30yrs
3 [ ] 31-45yrs
[ ] above 45yrs
2 What is your marital status? 1 [ ] Single
2 [ ] married
3 [ ] divorced
4 [ ] widowed
3 What is your family's monthly income? 1 [ ] <10,000
2 [ ] 10,000-40,000
3 [ ] above 40,000
4 What is your occupation status? 1 [ ] unemployed
2 [ ] self-employed
3 [ ] formally employed
5 What is your highest education level [ ] No formal education
achieved? [ ] Primary
[ ] Secondary
[ ] College/ University

55
B) PREVALENCE OF ANEMIA INFORMATION – (Tick appropriately)

1. What is your current hemoglobin (Hb) level in grams per deciliter? ( confirm from the
booklet)…………………………………..g/dl

2. To be filled by the interviewer (Tick appropriately

ANEMIA STATUS

Yes (anemic) No (non-anemic)

C) CULTURAL FACTORS

NO QUESTION CODE RESPONSE

1 Where is your residence 1 [ ] Rural
2 [ ] Urban

2 What is your family size 1 [ ] 1 to 2

2 [ ] 3 to 4
3 [ ] above 4
3 Do you have foods you avoid before and 1 [ ] Yes
during pregnancy? 2 [ ] No
If yes specify….
4 What is your religion? 1 [ ] Christian
2 [ ] Muslim
3 [ ] Pagan
4 [ ] Others specify

5 Do you have a cultural belief about diet [ ] Yes

that a pregnant women should not take? [ ]No
If yes specify….

56
D) DIETARY HABITS FACTORS

NO QUESTION CODE RESPONSE

1 Do you take tea, cocoa, or coffee? 1 [ ] Yes
2 [ ] No

2 Do you crave or eat any non-food 1 [ ] Yes

substances? 2 [ ] No

2b If yes, which ones? 1 [ ] Stones/soil

2 [ ] Charcoal.
3 [ ] Burnt matches
4 [ ] Toothpaste
5 [ ]Other (specify)
3 Do you smoke cigarettes? 1 [ ] Yes
2 [ ] No
4 Do you take alcohol? 1 [ ] Yes
2 [ ] No

57
Appendix 2: Informed Consent Form (ICF)

This informed consent is for respondents who will participate in a research study on
ASSESSMENT OF THE PREVALENCE OF ANEMIA AND ASSOCIATED FACTORS
AMONG WOMEN ATTENDING ANTENATAL CLINIC AT SIGOR HEALTH CENTRE,
WEST POKOT.
INTRODUCTION
I am PHILIPH TOROITICH LOUTA, a student at Dedan Kimathi University conducting
research on the above named topic. I am going to give you information and invite you to be part
of this research. Before you decide you can talk to anyone you feel comfortable with about the
research.
PURPOSE OF THE RESEARCH
The study is carried out for academic purposes and also for findings that will help in the
improvement of health care services delivery among pregnant women.
VOLUNTARY PARTICIPATION
Your participation in this study is entirely voluntary. It is your right to participate or not. You
may decide to terminate your participation at any stage of the research process.
DESCRIPTION OF THE PROCESS
You will be given a questionnaire which you’ll be required to fill the questions honestly and
complete all the sections in it under the guidance of the researcher or research assistant. Then the
data collected will be aggregated and analyzed.
RISKS
There are no expected risks in this study as it will not involve any manipulation of the sample
population in term of behavior or functioning.
BENEFITS
There will be no benefits directly for you but your responses will help us answer the research
questions which will help on the improvement of health care services among pregnant women.
CONFIDENTIALITY
The questionnaire to be used in data collection will be coded and the respondent will not be
required to indicate his name or other identification credentials. The information collected will
only be subjected to the relevant research team.
I have read the foregoing information and had the opportunity to ask questions about it and any
questions that I have asked have been answered to my satisfaction. I consent voluntarily to
participate as a participant in this research.

58
Signature of the participant…………………………….
Date……………………………………………………
Appendix 3: authorization letter

59
60
Appendix 4: Sigor health center map

61