ANEMIA AND ASSOCIATED FACTORS AMONG PREGNANT WOMEN

ATTENDING ANTENATAL CARE CLINIC IN SHENEN GIBE HOSPITAL,

JIMMA ZONE, SOUTHWESTERN ETHIOPIA

BY, ENDALE KASSAYE

A RESEARCH PAPER TO BE SUBMITTED TO THE DEPARTEMENT OF

MEDICAL LABORATORY SCIENCE AND PATHOLOGY, COLEGE OF HEALTH
SCIENCES, JIMMA UNIVERSITY FOR THE PARTIAL FULFILEMENT OFTHE
REQUIREMENT FOR BACHELOR OF SCIENCE DEGREE IN MEDICAL
LABORATORY SCIENCE

MAY, 24 2016GC

JIMMA, ETHIOPIA
JIMMA UNIVERSITY

COLEGE OF HEALTH SCIENCES DEPARTEMENT OF MEDICAL

LABORATORY SCIENCE AND PATHOLOGY

ANEMIA AND ASSOCIATED FACTORS AMONG PREGNANT WOMEN

ATTENDING ANTENATAL CARE CLINIC IN SHENEN GIBE HOSPITAL,
JIMMA ZONE, SOUTHWESTERN ETHIOPIA

BY:

ENDALE KASSAYE

ADVISOR:
Mr. GIRUM TESFAYE (BSC, MSC)

MAY 24, 2016 GC

JIMMA, ETHIOPIA
 ABSTRACT
BACKGROUND: Anemia is a hematological disorder known by the reduction of the
concentration of hemoglobin level in the peripheral blood. It is the major worldwide public
health problem. Anemia associated with pregnancy contributes for high maternal and
prenatal morbidity and mortality. Anemia in pregnancy results from multiple causes. Iron
deficiency, malaria, hook worm, TB and HIV has been identified as risk factors for anemia
in pregnancy.

OBJECTIVE- To determine the prevalence and related risk factors of anemia among
antenatal care clinic attending pregnant women in Shenen Gibe Hospital ,from April 1 to
15, 2016GC.

METHODS – A facility based cross sectional study was conducted to determine the
prevalence of anemia among pregnant women attending antenatal care clinic in Shenen
Gibe Hospital, Southwestern Ethiopia from April 1 to 15, 2016 GC. All pregnant women
attendants during the study period Was involved in the study. Data was collected by
questionnaire and from hospital log book and was analyzed by making use of SPSS version
20 for windows. A P value of less than 0.05 was considered as statistically significant for all
variables.

RESULT: – A total of 145 pregnant women were included in this study and the study
indicated that the overall prevalence of anemia is 10.3%. Out of the investigated pregnant
women, 130(89.7%) were non anemic and 15(10.3%) were anemic. Out of the total study
subjects, 45(31%) found in the age group between 26 to 30 years old and out of those
4(8.8%) were anemic and 41(91.2%) were non anemic. Based on the degree of severity
Mild anemia 9(60%), Moderate anemia 5(33.3%) and Sever anemia 1(6.7%).

CONCLUSION :– The overall prevalence obtained from the study area is 10.3% with
related risk factors like Malaria, monthly income, History of abortion, numbers of ANC Visit
and give berth reptile this indicates that anemia is one of the commonest public health
problem in the study area
Key words: Anemia, pregnant women, associated factors, intestinal parasitic infection

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ACKNOWLEDGEMENT

First of all I would like to thank Jimma University department of medical laboratory
science and pathology for giving me this opportunity for partial fulfillment of bachelor of
degree in Medical Laboratory Technology

Next I would like to express my great full thank to my advisor Mr. GIRUM TESFAYE for his
supportive advice and assistance in the development of this research paper.

Furthermore I would like to appreciate Shenen gibe Hospital staff specially the Laboratory
Technologists for their cooperation during data collection.

Above all I would like to thank the community and pregnant women Hospital attendants of
Shenen gibe who are volunteer to give me the real information and helped me during the
data collection.

Lastly but not the least I would to express my special thanks to all who advice, support and
assist me in the development of this research paper.

Finally my special thanks go to my brother and all my family who supported me during my
education to reach to this stage.

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 TABLE OF CONTENTS
Title Page

TABLE OF CONTENT

ABSTRACT....................................................................................................................................................................................... I
ACKNOWLEDGEMENT.............................................................................................................................................................II
Table of contents....................................................................................................................................................................... III
List of figure and tables........................................................................................................................................................... V
ABBREVIATIONS AND ACRONYMS...................................................................................................................................VI
OPERATIONAL DEFINITIONS............................................................................................................................................VII
CHAPTER ONE............................................................................................................................................................................. 1
INTRODUCTION.......................................................................................................................................................................... 1
BACKGROUND INFORMATION........................................................................................................................................1
1.2 STATEMENT OF THE PROBLEM...............................................................................................................................3
1.3 SIGNIFICANCE OF THE STUDY......................................................................................................................................5
CHAPTER TWO............................................................................................................................................................................ 6
LITERATURE REVIEW.............................................................................................................................................................. 6
CHAPTER THREE........................................................................................................................................................................ 8
objectives....................................................................................................................................................................................... 8
3.1 General objective............................................................................................................................................................ 8
3.2 SPECIFIC OBJECTIVE.................................................................................................................................................... 8
CHAPTER FOUR........................................................................................................................................................................... 9
METHODOLOGY.......................................................................................................................................................................... 9
4.1 Study area and period.................................................................................................................................................. 9
4.2 Study design..................................................................................................................................................................... 9
4.3 Population......................................................................................................................................................................... 9
4.3.1 Source population................................................................................................................................................. 9
4.3.2 Study population....................................................................................................................................................9
4.4 Sample size and sampling technique.....................................................................................................................9

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 4.4.1 Sample size............................................................................................................................................................... 9
4.4.2 Sampling technique............................................................................................................................................11
4.5 Variables.......................................................................................................................................................................... 11
4.5.1 Dependent variables..........................................................................................................................................11
4.5.2 Independent variables......................................................................................................................................11
4.6 Materials required.......................................................................................................................................................12
4.7 Data collection process...........................................................................................................................................13
4.8 Data analysis.................................................................................................................................................................. 13
4.9 Quality control.............................................................................................................................................................. 13
4.10 Ethical consideration...............................................................................................................................................13
4.11 Pre-test.......................................................................................................................................................................... 13
4.12 Dissemination of the result.................................................................................................................................. 14
CHAPTER FIVE:-....................................................................................................................................................................... 15
RESULTS...................................................................................................................................................................................... 15
5.1 Socio-demographic and clinical characteristics of study participants.....................................................15
5.2 Prevalence of anemia.................................................................................................................................................15
5.3 Risk factors for anemia............................................................................................................................................. 15
CHAPTER SIX............................................................................................................................................................................. 22
DISCUSSION................................................................................................................................................................................ 22
CHAPTER SEVEN
CONCLUSIONRECOMMENDATION AND LIMITATION............................................................................................24
References................................................................................................................................................................................... 27

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 L.IST OF FIGURE AND TABLES
Table 1.;Age distribution of anemia among pregnant women attending
ANC……………………………………………………………………………………………………………………………16.

Table 2: prevalence of anemia versus educational status among pregnant women

attendants of ANC………………………………………………………………………………………………………17.

Table 3. Distribution of anemia versus gestation period among pregnant women

attending ANC …………………………………………………………………………………………………………18.

Table 4: Degree of severity of anemia based on the hemoglobin level of pregnant

women attendant……………………………………………………………………………………………………...18.

Table 5: History of previous abortion in relation to anemia among ANC attendant pregnant
women………………………………………………………………………………………………………………………19.

Table 6: Prevalence of anemia in relation with history of malaria infection among pregnant
women attending ANC…………………………………………………………………………………………………19.

Table 7: : Distribution of anemia versus monthly family income among pregnant women
ANC attendants…………………………………………………………………………………………………………...20.

Table 8: RBC morphological distribution of anemia based on mcv value among ANC
attendant……………………………………………………………………………………………………………………..21.

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ABBREVIATIONS AND ACRONYMS

ANC --Antenatal care.

Hgb --Hemoglobin.

PCV-- Packed Cell Volume.

MCHC-- Mean Cell Hemoglobin Concentration.

RBC--Red Blood Cell.

RDW--_Red cell distribution width

MCV-- Mean Cell Volume.

CBC --Complete blood count.

Hct -- Hematocrit.

IDA --Iron deficiency anemia.

HIV – Human immunodeficiency virus

TB – Tuberculosis

WHO --World Health Organization

SOP--Standard Operational Procedure.

SRP-- Student Research Project.

SPSS-- Statistical Program for Social Science.

JUSH--Jimma University specialized hospital.

SHGH--Shenen Gibe Hospital.

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OPERATIONAL DEFINITIONS
Anemia– Is defined as the hemoglobin level less than 11g/dl.

Mild anemia– Hemoglobin value in between 10g/dl and 11g/dl.

Moderate anemia –Hemoglobin value in between 8g/dl and 10g/dl.

Severe anemia – Hemoglobin value less than 8g/dl.

Gravidity-all previous, pregnancies-term live birth, still birth, abortion, ectopic

pregnancy or Hydatidiform mole

Parity Pregnancies that have extended beyond fetal viability whether the fetus is
delivered alive or dead

Anemia in pregnancy: is a condition when hemoglobin level is below 11g/dl or HCT

below 33%

Parasitic infection: infection of the parasite including soil transmitted helminthes and
other such as ENT amoeba and Guardia

Pregnancy: is the period during which a woman carries a developing fetus normally in
the uterus.

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CHAPTER ONE
INTRODUCTION

BACKGROUND INFORMATION: Anemia is defined as the reduction in the

concentration of oxygen carrying hemoglobin in the peripheral blood. Anemia results when
hemoglobin level is lower than 11g/dl for pregnant women and children aged 6 –59months
and 12g/dl for n on-pregnant women (1,2)

Anemia status during pregnancy cannot be expected to improve without correct

implementation of guide line by the health center staff. Therefore one effort that should be
made in the prevention and treatment of anemia in pregnancy is determination of
hemoglobin level of pregnant women and WHO has recognized the problem and
recommends screening for anemia of all pregnant women. For some of the common causes
of anemia, there is a good evidence of effectiveness of simple intervention; For instance
iron supplementation, long lasting insecticidal net and intermittent preventive treatment
for malaria(3).There are many causes resulting for anemia, the commonest cause of anemia
is micronutrient or malnutrition which leads to illness and premature death through the
world. Particularly iron deficiency which is the most common form of anemia in pregnant
mothers and during rapid growth of the infant when the needs of iron consumption
increase. Anemia is the major public health problem of developing countries. Anemia also
can be occur due to foliate deficiencies, infections like malaria, hook worm, diarrhea,
tuberculosis and HIV (4, 5)

The diagnosis of anemia is made by clinically and laboratory methods. The most reliable
one is laboratory method because laboratory test can detect anemia before the onset of
symptoms. Determination of hemoglobin and PCV determination using complete blood
count (CBC) machine are the most common laboratory methods for the diagnosis of anemia
as a reference. In addition examination of red cells morphology to study the etiologic
causes of anemia, cyan met hemoglobin, hematocrit, Sahel method and ox hemoglobin
methods are the most practical and commonly used laboratory measurements for the

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purpose of screening Laboratory diagnosis of anemia based Hct measurement and
Hgbestimation are reliable than clinical diagnosis. For classification of anemia
morphologically, RBC morphology examination is useful for instance micro cystic norm
chromic RBCs can give evidence for iron deficiency anemia, macro cystic norm chromic
RBC is caused by vitamin B12 or folic acid deficiency and normocytic norm chromic is an
indicator of hemolytic anemia- Anemia due top proliferation disorder and blood loss
anemia (6).

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1.2 STATEMENT OF THE PROBLEM
Worldwide anemia is the commonest red cell disorder. It occurs when the concentration of
hemoglobin level falls below normal for person age, gender and geographical location
resulting in oxygen carrying capacity of the blood being reduced(8).

Anemia in pregnancy is an important public health problem worldwide. WHO estimates

that more than half of pregnant women in the world have a hemoglobin level indicative of
anemia (<11.0g/dl) the prevalence may how ever be as high as 56 or 61% in developing
countries. Women often become anemic during pregnancy because the demand for iron
and other vitamins increased due to physiological burden of pregnancy. The inability to
meet the required level for these substances either as a result of dietary deficiencies or
infection gives rise to anemia (9).

Given the high fertility rate nutritional status and poor hygiene condition predominate in
the developing countries. Hook worm infection during pregnancy contribute significantly
to the degree of anemia in pregnant women. Iron deficiency anemia in pregnant women
jeopardizes the health status of the mother and fetus. It causes intrauterine growth
retardation, fetal death, low birth weight and subsequent death during or following child
birth (8, 10).

Iron deficiency anemia is the most common in pregnant women in tropical Africa. Iron and
fociate deficiency increased during high volume of RBCs, especially in the last two
trimesters where it needs 80% of blood from the mother. Approximately 50% of all
anemias are estimated to be due to iron deficiency, a condition of deteriorating iron
reserves in the body caused by low dietary intake of iron or blood loss which leads to loss
of iron. Iron deficiency anemia is the most common sever form of anemia and results when
the body’s iron supply cannot support production of hemoglobin (11,12,13).

Since iron requirement is increased in pregnancy, dietary intakes are low and iron stores
are low or absent in the great majority of pregnant women in Ethiopia and other
developing countries. The major cause of anemia in pregnancy in these countries is dietary
iron deficiency which is thought to be responsible for 20% maternal death. In addition to

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iron deficiency the other significant cause that leads to iron deficiency anemia is hook
worm infection (14,15, 16).

Anemia prevalence is highest among pregnant women, infants and young children due to
high iron demands of growth and pregnancy. An average of 45% pregnant women and 49%
of children under five years of old are anemic in developing countries. Anemia in pregnant
women reduce women’s ability to survive bleeding during and after child birth(i.e. post
partum hemorrhage) and result in premature death or lower birth weight babies with a
higher risk of death(12).

In West Africa anemia in pregnancy results from multiple causes including iron deficiency,
malaria, hook worm, TB and HIV has been identified as risk factors for anemia in pregnancy
(17).

Therefore anemia is one of common public health problem and contributes significant
proportion of maternal death in the developing countries. So this study will attempt to
determine the prevalence of anemia and related risk factors among ANC attendant
pregnant women in Shenen Gibe Hospital.

The prevalence of anemia in pregnant women in Jimma zone, Jimma town, Shenen Gibe
Hospital not well assessed and documented. Therefore this study aimed at determining the
prevalence of anemia and associated factors among pregnant women of this study area.

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 1.3 SIGNIFICANCE OF THE STUDY
High prevalence of anemia particularly among pregnant women is the most common
public health problem and the major contributing factor for maternal and prenatal
mortality and morbidity in the world especially in developing countries.

Knowing the magnitude of the problem is helpful in early detection of both moderate and
sever anemia to prevent complications. Moderate anemia causes impaired growth and
mental retardation. Severe anemia can result in death. On the other hand morphological
classification of anemia is essential because it is suggestive for possible etiology.

This study Was attempt to measure Hgb level of pregnant women to assess the prevalence
of anemia and to give attention for health care workers and concerned body for early
detection of anemia so as to prevent further complication and death.

In addition, this study was provide valuable information to address the prevalence of
anemia and its associated risk factors like maternal and fetal mortality and morbidity. This
paper was also provide valuable information on :

•The burden of anemia and its related risk factors to the pregnant women and community.
•The relationship between anemia and its associated risk factors to antenatal health care
givers towards early detection and promote the management of anemia in pregnancy.
•Providing information for laboratory personnel on the identification and detection of
anemia based on RBC morphological classification, hemoglobin determination to the
laboratory personnel.

•Furthermore, this study was used as a base line data for further studies on anemia and its
related risk factors pregnant women on the study area.

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 CHAPTER TWO
LITERATURE REVIEW
Pregnant women are the most affected groups with anemia with an estimated global
prevalence of 51%. A high proportion of mothers become during pregnancy estimate from
WHO report shows that from 35.75% of pregnant women in developing countries and
18%of pregnant women from developed countries are anemic(18,19).

Africa is the continent where anemia affected majority of its pregnant women population. In
2012 from a cross-sectional study conducted on 300 pregnant women in Niger delta area of
Nigeria, the prevalence of anemia was found 66.7% from which 55.7% had mild anemia and
44.3% had moderate anemia (20).According to the 2011 Ethiopian Demographic Health Survey
(EDHS) result, there exist 22% Anemia burden among pregnant women in Ethiopia that
indicative of moderate public health problem in the country(21)

Anemia is the most known public health problem throughout the world and it is known to
have multiple etiologies. Globally the most important cause of anemia is iron deficiency
which causes 50% of anemia attributable to death. But the burden of anemia is higher in
south Asia, which causes 71% of total mortality and morbidity, where as in north America,
the total mortality and morbidity due to anemia is 1.4%(22).

Anemia in pregnant women is often caused by iron deficiency, which is the most common
nutrient deficiency in the world. It has been estimated that, in developing countries, half of the
population (mainly children and women of reproductive age) is affected by anemia (23).

In Africa as a whole one half of all pregnant women are anemic, and as over 40% of are non
pregnant women. Western Africa is the highly affected region in Africa with the prevalence
rate of 50% for pregnant women and 47% for non pregnant women where as the
remaining regions of Africa have fairly uniform prevalence of between 41% and 54% for
pregnant women and 41% and 43% for non pregnant women (18, 24).

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A cross sectional study conducted from two villages of Tanzania showed that the
prevalence of 28% and the risk of anemia were 3 rd up to 4th months of gestation when
compared to 1st up to 8th months of ‘’gestation”. Similarly a report from regional survey in
Mali estimated that the prevalence of anemia among pregnant women and 59 %( 25, 26)
Astudy carried in Jimma health center showed that the overall prevalence of anemia was
41.9% and the rate being 56.8% and 35.9% for rural and urban residents. Majority (74.3%)
had moderate anemia, 2.5% had sever anemia. The rate of anemia was high among
illiterates and in those who did not practice family planning and in the third trimester (27)
The most clinically relevant classification of anemia are hemolytic anemia, megaloblastic
anemia, Iron Deficiency anemia (IDA), sideroblastic anemia [31].Anemia also could be
caused due to increased hemolytic, diminished erytherocytosis and blood loss [32].

Another study done by Jamal H. and Rebecca S. Pobocikamong women of reproductive ages
in Ethiopia found the overall prevalence rate of iron deficiency anemia was 18.0%.
Prevalence of anemia, especially iron deficiency anemia was highest among those 31-49
years old. In addition, intake of vegetables less than once a day and meat less than once a
week was common and was associated with increased anemia. Although the prevalence of
anemia was slightly higher among women with parasitic infestation the difference was not
significant [33].

The recent study conducted in the Gondar Town among384 pregnant women also found
21.6% prevalence of anemia. The majority of anemic cases 49 %were of the mild type
Hb10.0–10.9g/d1) followed by 46% cases of moderate anemia (7–9.9g/dl) and 5% severe
anemia Hb< 7g/ dl). Pregnant women with age>34, rural residence, history of malaria
attack, hookworm infection and absence of iron supplements are significantly associated
with increased risk of anemia [34].

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CHAPTER THREE
OBJECTIVES

3.1 GENERAL OBJECTIVE

To determine the prevalence of anemia and related risk factors among antenatal care clinic
attendant pregnant women inShenen Gibe Hospital.

3.2 SPECIFIC OBJECTIVE

• To determine the prevalence of anemia among pregnant women attending ANC in SHGH.

•To determine the severity of anemia among pregnant women.

•To determine the morphologic types of anemia among pregnant women.

• To identify the risk factors for anemia among pregnant women.

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CHAPTER FOUR

4.1 METHODOLOGY
Study area and period The study was conducted in Shenen gibe hospital, which is found in
Jimma town. The town is located in south western part of Ethiopia, 345km away from the
capital city of Ethiopia high land climate condition, heavy rain fall, warm temperature and
long wet period –Based on the 2007 census conducted, by the CSA, the total population of
the zone is 2, 486,155 of whom 1, 250, 527 are men and 1,235, 628 are women (43). The
study was conducted in Shenen Gibe Hospital from April 1-15, 2016GC.

4.2 STUDY DESIGN

Across sectional study was conducted to determine the prevalence of anemia in pregnant
women who attending ANC in Shenen gibe hospital.

4.3 POPULATION
4.3.1 SOURCE POPULATION
All pregnant women who will visit ANC in SHGH

4.3.2 STUDY POPULATION

All pregnant women who will attend ANC in SHGH during the study period.

4.4 SAMPLE SIZE AND SAMPLING TECHNIQUE

4.4.1 SAMPLE SIZE
Among all pregnant women who visiting ANC in SHGH at the period of data collection a
total of 145 will be included in the study.
Sample size calculation using single population proportion formula by taking:
p = 50%, d = 5%, q = 1 - p

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 Ni = (Zα/2)2P(q)

d2

where,

n=sample size required for the study

p= the assumed population proportion of anemia in Jimma town = 50%

zα/2= z value at(α=0.05)=1.96 corresponding to 95% confident level

d=the margin of error= 0.05

ni=(1.96)2 0.5(1 – 0.5)

(0.05)2

ni=(3.8416) (0.25)

0.0025

αni= 384

We use this correction formula as follows to reduce the sample size:

nf = ni

¿
1+ N

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4.4.2 SAMPLING TECHNIQUE
The convenient sampling technique was used and all pregnant women was included during
the study period.

4.5 VARIABLES
4.5.1 DEPENDENT VARIABLES
•prevalence of anemia

4.5.2 INDEPENDENT VARIABLES

• Age

•Residence

•Gestation period

•History of abortion

•Educational status

•Family income

•parity

 gravidity

•Body mass index

•Intestinal parasitic infection

•History of malaria

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4.6 MATERIALS REQUIRED
∎Microscope

∎Microscopic slide

∎Wright stain solution

∎Lancet

∎Immersion oil

∎70% alcohol

∎Cotton

∎Glove

∎Gown

∎sealant

∎Marker

∎Test tube

∎Test tube rack

∎Gauze

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4.7 DATA COLLECTION PROCESS
Data was collected by questionnaires and Hgb values will be measured by CBC automated
analyzers specifically CELL DYN 1800.

4.8 DATA ANALYSIS

Data was analyzed using SPPS version 16 for windows. Descriptive statistics such as
frequency and mean was performed. A bivariate and multivariate analysis was carried out
to checkout the association of predictors and outcome variables. A p value of less than 0.05
was considered as statistically significant.

4.9 Quality control

Questionnaires were checked and revised and necessary instruments and reagents was
checked for their proper function before any test was performed. The patient`s blood
sample was collected, prepared and tested according to SOP to get reliable result from the
study. In each and every step the three quality assurance phases was followed and
maintained. At the end the results was checked and registered on the laboratory record
format before delivery to the patients.

4.10 ETHICAL CONSIDERATION

An official letter was written from the department and SRP which describing the aim of
study to the concerned body. During collection of the data, it is necessary to explain aim of
the study to the study subjects and they was asked verbally for permission to collect data
from them.

4.11 PRE-TEST
Pre-test was done in another alternative area before data collection and the actual study
was performed to check acceptability of the questionnaire whether it contains the
necessary information or not and if unnecessary, to make possible corrections. The

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necessary laboratory equipments to be employed was checked for their appropriate
functioning.

4.12 DISSEMINATION OF THE RESULT

Based on the result that was obtained from the study, possible recommendation and
intervention on the prevalence of anemia and its related risk factors among pregnant
women was given and final result of the study was submitted in hard copies to the
department of Medical laboratory science and pathology.

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CHAPTER FIVE:-
RESULTS
5.1 SOCIO-DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF STUDY
PARTICIPANTS .
From the total of 145 pregnant women attendants, the majority of pregnant women
attendants 96(62.2%) were from urban area and the rest 49(33.8%) were from rural area.
Depending on their age 45(31%) were found in the age between 26 to 30 years old.. The
highest prevalence 56(16.2%) was laid on the age ranges between 26 – 30 years followed
by 33(9.5%) with the age ranges of 31 – 35 years with p-value >0.05 which indicates there
is no statistically significant association between age and the prevalence of anemia in
pregnant women. With regard to educational status 115(79.3%) were literate and
30(20.5%) were illiterate.

5.2 PREVALENCE OF ANEMIA

From the total study participants 15(10.3%) were anemic and 130(89.7%) were non
anemic based on their hemoglobin level, in this case the prevalence rate of anemia in the
study area is 10.3%. Based on the degree of severity of anemia, Mild anemia 5(33.3%),
Moderate anemia 9(60%) and sever anemia 1(6.7%). From all pregnant women
attendants 25(17.2%) do have lower MCV and 6(4.1%) of them are anemic and this is
indicative of iron deficiency anemia or Microcytic anemia. 9(6.2%) of anemic pregnant
women has normal MCV, most probably this is normocytic anemia.

5.3 RISK FACTORS FOR ANEMIA

.Risk factors which contributing for high prevalence of anemia in this study area were
Malaria, Numbers of ANC visit, monthly income

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.The parasitic infection, , residence, occupation, place of delivery, use of contraceptive
water source and walking bare foot have significant association in this study.

Table 1: Age distribution of anemia among pregnant women attending ANC in SHGH from
April 1 – 15 , 2016GC.

Anemic Non anemic Total

Age distribution
N0 % N0 % N0 % X2 p-value

<20 4 2.8 18 12.4 22 15.2 7.87 >0.05

20-25 3 2.1 24 16.5 27 18.6

26 – 30 4 2.8 41 28.3 45 31
31 – 35 4 2.8 27 18.6 31 21.4
36 – 40 0 0 17 11.7 17 11.7
>40 0 0 3 2.06 3 2.1
Total 15 10.34 130 89.6 145 100

There is no statistically significant association between Age distribution and anemia with
p> 0.05

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Table 2: prevalence of anemia versus educational status among pregnant women
attendants of ANC in SHGH from April 1- 15, 2016GC.

Anemic Non anemic Total

Mother`s
educational status N0 % N0 % N0 % X2 p-value

Illiterate 5 3.4 25 17.2 30 15.2 1.8565 0.762

Read and Wright 2 1.4 22 15.17 24 18.6

Elementary school 2 1.4 26 17.9 28 31.0

(Grade 1 to 8)
Secondary school 2 1.4 23 15.9 25 21.4
(Grade 9 to 12)
College /University 4 2.8 34 23.4 38 11.7

Total 15 10.3 130 89.7 145 100

There is no statistically significant association between educational statu and anemia with
p> 0.05

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Table 3: Distribution of anemia versus gestation period among pregnant women
attending ANC in SHGH from April 1-15, 2016GC.

Anemic Non anemic Total X2

Gestation period p-value

N0 % N0 % No0 %
X2=4.308
p-value=0.116
First trimester 1 0.7 35 24.1 36 24.8

Second trimester 6 4.14 55 37.9 561 42.1

Third trimester 8 5.5 40 27.6 48 33.1

Total 15 10.3 130 89.7 145 100

There is no statistically significant association between gestational period and anemia with
p> 0.05

Table 4: Degree of severity of anemia based on the hemoglobin level of pregnant women
attendant in SHGH from April 1-15, 2016GC.

Degree of severity Hemoglobin N0 %

level in g/dl
B/n 10 and 11 5 33.3
Mild anemia
9 60
Moderate anemia B/n 8 and 10
Less than 8 1 6.7
Sever anemia
15 100
Total

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Table 5: History of previous abortion in relation to anemia among ANC attendant
pregnant women in SHGH from April 1-15, 2016GC.

Anemic Non anemic Total

History of abortion
N0 % N0 % N0 % X2 p-value

Yes 2 1.83 29 26.6 31 28.44 0.385 0.535

No 8 7.3 70 64.2 78 71.6
Total 10 9.2 99 90.8 109 100

There is no statistically significant association between history of previous abortion and

anemia with p> 0.05

Table 6: Prevalence of anemia in relation with history of malaria infection among pregnant
women attending ANC at SHGH from April 1-15 , 2016GC.

History of Anemic Non anemic Total

malaria N0 % N0 % N0 % X2 p-value
4 2.8 64 44.13 68 46.83 2.749 0.0975
Yes
11 7.6 66 45.5 77 53.07
No
15 10.3 130 89.7 145 100
Total

There is no statistically significant association between with history of malaria infection

and anemia with p> 0.05

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Table 7: Distribution of anemia versus monthly family income among pregnant women
ANC attendants in SHGH from April 1 -15, 2016GC.

Monthly family Anemic Non anemic Total

income N0 % N0 % N0 % X2 p-value
3 3.5 8 9.4 11 12.9 5.575 0.233
<500birr
3 3.5 18 21.2 21 24.7
500 to 1000 birr
2 2.4 19 22.3 21 24.7
1100 to 1500 birr
0 0 9 10.6 9 10.6
1600 to2000 birr
>2000 1 1.2 22 25.9 23 27.1
Total 9 10.6 76 89.4 85 100
Total

There is no statistically significant association between monthly family income and anemia
with p> 0.0

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Table 8: RBC morphological distribution of anemia based on mcv value among ANC
attendant pregnant women in SHGH From April 1-15 , 2016 GC.

RBC Prevalence of morphological anemia

morphology
classification No %
NCNC 9 60

MICCHC 6 40

MACCNC 0 0

TOTAL 15 100

NCNC= Normocytic norm chromic

MICHC= Microcytic hypo chromic

MACNC=Macrocytic norm chromic

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CHAPTER SIX
DISCUSSION
The overall prevalence of anemia obtained in this study among pregnant women in Shenen
Gibe Hospital is 10.3%. There is no similar study carried out in this study area for
comparison. But similar study which was carried out in Jimma health center obtained a
prevalence of 41.9% which is higher than the above 10.3% finding.

From the total of 15 anemic pregnant women 4(2.8%) found in the age of < 20 years,
3(2.1%) of them found in the 20 – 25year 4(2.8%) were found in 26 - 30 years
4(2.8%)of them found 31_35.
The degree of severity of anemia among the study subjects was also assessed and
categorized into mild anemia 5(33.3%), moderate anemia 9(60%) and sever anemia
1(6.7%) based on their Hgb level.
From the total pregnant women the largest number 61(42.1%) of them were found in
the second trimester, out of this 6(4.4%) were anemic and also from 48(33.1%)
pregnant women attendant which are found in the third trimester, 8(5.5%) of them are
anemic and only 1(0.7%) were anemic in the first trimester in general the higher
prevalence rate of anemia occurs during the second and third trimesters.

Among 30(20.7%) pregnant women who were illiterate, 5(3.4%) were anemic the left
2(1.4%), 2(1.4%), 2(1.4%) and 4(2.8%) were read and Wright, elementary school,
secondary school and college or university levels respectively were considered as
literate and are anemic. Research conducted in rural Ethiopia among pregnant women
showed that illiteracy increases the risk of anemia in relation to Hook worm infection
by 4 (2.8%).in this study there is no pregnant women who has Hook worm infection at
all, this might be due to good sanitary and shoe wearing habit. The result obtained
from this study shows there is no statistically significant association between the level
of education and prevalence of anemia. Even though illiteracy is a factor to increase the
prevalence of anemia, the difference in geographical area, climatic condition and
nutritional habit my result in variation of the prevalence of anemia.

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In another hand economical back ground of pregnant women has its own impact on the
prevalence of anemia. According to the final finding collected from the study subjects,
11 (13.9%) out of the total do have monthly family income <500 birr. In this matter
they might be exposed to malnutrition which leads to anemia. Out of 15(10.3%)
pregnant women which are anemic 3(20%) has family income <500 birr per month and
from this 1(6.67%) had >2000 birr income per month.

From the data 68(46.8%) out of the total pregnant women has history of malaria
infection and 4(2.75%) of them were both anemic and has history of malaria. In
addition to this the chi-test square result indicates 2.749 with p > 0.05, this shows
there is no statistically significant association between anemia and history of malaria.

On the other hand presence of any clinical illness during pregnancy may have a big role
on the prevalence of anemia. Out of 15 anemic pregnant women 1(6.67%) were
infected with A.lumbricoid and 1(6.67 %) were infected with T.trichuries.

The laboratory test results are the primary sources of all the necessary information
and final findings in the estimation and identification of the actual test results of the
pregnant women. Among all the laboratory tests hemoglobin determination played a
vital role by indicating the current status of the pregnant women. From the total of 145
pregnant women attendants 15(10.3%) has Hgb value less than 11 g/dl which are
considered as anemic and out of these 5(33.3%) had mild anemia, 9(60.6%)of them
found to be moderately anemic and 1(6.7%) were severely anemic which has Hgb value
<8 g/dl.
In addition to this other hematological parameters were performed to support and
strengthen the finding of this study. Namely Red Cell Indices (i.e. MCV, MCH, MCHC and
RDW) were assessed to give suggestion on the identification of possible etiology.

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CHAPTER SEVEN
CONCLUSION RECOMMENDATION AND LIMITATION
CONCLUSION
Based on the finding it was concluded that the determination of the prevalence of anemia
and its associated risk factors among pregnant women was 10.3%, out of this given birth
10(66.7%), Number of ANC Visit less than first trimesters 8(53.33%), NO monthly income
9(60%) and infected Malaria 4(26.6%). In general it is possible to conclude that there is
relatively high prevalence of anemia among pregnant women it the study area. According
to the study increased prevalence of anemia is due to poor economic background and
repeated exposure to different clinical illnesses.

To reduce the prevalence, there is a need to give awareness to women about the negative
effect of home delivery so that it encourage them to attend ANC in near clinic and
strengthen health care seeking behavior of women to ensure early diagnosis and
management of parasitic infection, anemia, and other medical conditions.
A large community based study needs to be done to determine the prevalence and
predictors of anemia in the general population of pregnant women. In addition to this, all
pregnant women attending antenatal care should be screened for soil transmitted parasites
at each visit.

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Recommendation

Absolutely this study may provide a base line data for future studies. Therefore the
following recommendations are fore warded to improve the life status of pregnant women
in Shenen Gibe Hospital.

 The health professionals at Shenen Gibe Hospital should consider early detection,
treatment and prevention of anemia among pregnant women is better to know the
prevalence and the risk factors related to anemia and to reduce complications and
death due to anemia.
 To reduce the prevalence, there is a need to give awareness to women about the
negative effect of home delivery so that it encourage them to attend ANC in near
clinic and strengthen health care seeking behavior of women to ensure early diagno-
sis and management of parasitic infection, anemia, and other medical conditions.
 Further studies should be conducted to assess the risk factors that contribute for
high prevalence of anemia among pregnant women.
 Encouraging the pregnant women to take Antenatal Care.

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 Limitation
 One of the limitation of this study is the nature of the study design its self, being as a
cross-sectional study design, it does not show which preceded anemia or risk
factors.
 Due to constraint of time and resource, stool concentration technique and
parasite density were not done so I could not assess the impact of parasite load on
the severity of anemia.
 The other limitation is that this study was conducted only at Shenen Gibe Hospital
not included heath center due to shortage of laboratory test equipment.
 Shortage of time, money and recourses. For instance, if this research is supported by
the investigation of Red Blood Cell morphology, it may give further and clear
information about the severity and types of anemia.

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3. WHO. Maternal health and save motherhood program prevalence of anemia in women.
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4. Black R. Micro nutrition deficiency an underlying cause of morbidity and mortality: WHO
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9. Lamina, MA Sorunm. To prevalence of anemia in pregnant women attending ANC in
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14.Viteri FE: Iron supplementation for the control of iron deficiency in population on risk.
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18. WHO. The prevalence of anemia in women.A tabulation of available information 2 nd
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24. Belay G. unpublished research on anemia at JUSH 2003

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Mali. Food and nutrition bulletin 2006; 27: 3-10

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Jun,2007

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34. Meseret A, BamlakuE, AschalewG, TigistK, Mohammed S, YadessaO. Prevalence of
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Histopathology; 2013; 1(3): 137-144.

QUESTIONNAIRE

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JIMMA UNIVERSITY COLLEGE OF HEALTH SCIENCES, DEPARTMENT OF MEDICAL
LABORATORY SCIENCE AND PATHOLOGY

Data collection format for the determination of prevalence of anemia among pregnant
women attending ANC in LGH, south western Ethiopia April – 15, 2016G.C.

Title of the study: PREVALENCE OF ANEMIA AND ASSOCIATED FACTORS AMONG

PREGNANT WOMEN ATTENDING IN SHENEN GIBE HOSPITAL

Introduction to the study:

This study paned to identify prevalence of anemia and associated risk factors among
pregnant women the study area which is the major cause of morbidity and morbidly, and
provide recommendation possible prevention and controlling level on the problem and
help them for effective intervention plan in the future.

The involvement in the study is based on your voluntary and you have the right to refuse to
participate in the study, and the confidentiality of the information gathered will be kept
and only used for this study. The result of the laboratory find will be communicated to your
physician.

Direction:-Please encircle the letter of your answer or correctly fill in the black space
provided for open ended questioners.

Data collector’s name________________ Code No_______________

Part I: Socio-demographic and economic data

1. How old are you? ______Years

2. What is your occupation? Specify__________________

3. Do you have any income? Yes____ No____

4. If the answer is yes for Q. no I04, what is your monthly income? ___________________
5. What is your educational status?
Didn’t attend any education_____Read and write_____Primary level (1-8)___
Secondary level (9-12) ____ College and above_____

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 6. What is your marital status? Married_______ Unmarried_______

Widowed_____ Divorced _______

7. If your answer is married for Q. no 6, are you living with your husband?
Yes_____ No________

8. Residence
Urban Rural

Part II: Obstetric and reproduction related data

1. What is your gestational age? Probe and write in weeks ____
2. Have you ever given birth? Yes No
If the answer is yes for Q. No2:
3. How many children do you have? ____
4. Where did you deliver your baby/ies? Health institution Home
5. What is the average time interval between successive births? __________ Years
6. Did you follow ANC service in your previous pregnancy?Yes No
7. Was there any blood loss during your current pregnancy? Yes No
8. Did you have any unusually heavy menstrual bleeding prior to the current
pregnancy?
Yes No

9. Did you have any abortion? Yes No

Part III: Parasitic infection related data

1. Do you have latrine? Yes No

2. If you say yes for Q.No1, how often you use it?
Always Sometimes Not at all

3. Do you have shoes? Yes No

4. If you say yes for Q. No 3, how often do you wear?
Always Sometimes Not at all

5. Did you become infected with malaria? Yes No

6. Do you have a bed net? Yes No
7. If you say yes for Q. No 6, how often you use it?
Always Sometimes Not at all

8. Where is your source of water? ___

Part IV: Nutrition and dietary habit related data

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 1. Do you eat meat? Yes No
2. If the answer is yes for Q. No1, how often do you eat?
Every day Every other day Once a week

Once a month Others, specify____________________

3. Do you eat green leafy vegetables? Yes No

4. If the answer is yes for Q. No3, how often do you eat?
Every day Every other day Once a week

Once a month Others specify _______________

5. Do you eat fruits? Yes No

6. If the answer is yes for Q. No5, how often do you eat?
Every day Every other day Once a week

Once a month Others specify ________________

7. What is your staple diet?

Injera maize

Wheat Other, specify ____________

8. Do you drink tea? Yes No

9. Do you drink tea immediately after meal? Yes No
10. If the answer is yes for Q. No 9, how often do you drink?
After every meal Once a day
Every other day Occasionally
11. Do you drink coffee? Yes No
12. Do you drink coffee immediately after meal? Yes No
13. If the answer is yes for Q. No 12, how often do you drink?
After every meal Once a day
Every other day Occasionally
14. BMI measurement __________
Part V: Health service Utilization related data

1. Number of ANC visit; (observe the ANC card) ____

2. Have you taken iron/folate supplement during the current pregnancy ? Ye No

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Laboratory Request and Report Format

JIMMA UNIVERSITY COLLEGE OF HEALTH SCIENCES DEPARTMENT OF MEDICAL

LABORATORY SCIENCE AND PATHOLOGY
Parasitological investigation and Hb determination among pregnant women in
Shenen Gibe Hospital April 1-15, 2016G.C).
1. Personal data
1.1. Code no.__________________
1.2. Age________
1.3. Address __________________
1.4. Date of sample collection ________________
2. Laboratory data
2.1. Parasitological data
2.1.1. Stool examination
A. Physical examination
Consistency of stool
Formed Watery Semi-formed
Appearance/Color
Normal Blood stained Pale yellow
Mucoid
B. Microscopic examination
Direct wet mount technique
Species and stage of parasite seen _______________________________
No ova/parasite
Concentration technique
Species and stage of parasite seen _______________________________

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 No ova/parasite

2.1. 2. Blood film examination result

A. Species and stage of haemoparasite seen _____________
B. Load of haemoparasite seen _____________
2.2. Complete blood count result
Lymphocyt

Neutrophil

Platelets
Parameter

MCHC

RDW
WBC

MCH
MCV
s
RBC
Mid

Hct
Result Hb

Name of investigator: ___________________________________

Signature: _______________ Date: _____________
Note;
This format is developed for this particular research purpose, and should only be applied
for this study to record laboratory investigation results of pregnant women involved in this
study. The laboratory personnel who analyzed the specimen should complete it
appropriately.

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