PREVALENCE OF ANEMIA AMONG PREGNANT

WOMEN ATTENDING ANTENATAL CARE AT JIMMA

HIGHER TWO HEALTH CENTER

By: - ASEFA MITIKU

A RESEARCH PROPOSAL TO BE SUBMITTED TO THE

DEPARTMENT OF NURSING AND MIDWIFERY, JIMMA
UNIVERSITY, IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE DEGREE OF BACHELOR OF
SEIENCE (BSC) IN MIDWIFERY.

JANUARY, 2014

JIMMA,
ETHIOPIA

1
 JIMMA UNIVERSITY

COLLEGE OF PUBLIC HEALTH AND MEDICAL SCIENCE

DEPARTMENT OF NURSING AND MIDWIFERY

PREVALENCE OF ANEMIA AMONG PREGNANT WOMEN

ATTENDING ANTENATAL CARE AT JIMMA HIGHER TWO
HEALTH CENTER

By: ASEFA MITIKU

ADVISOR: - MEKIDA SINEGA (BSc MPH/RH)

JANUARY,
2014

2
 JIMMA,
ETHIOPIA

3
 Acknowledgment

I would like to express my gratitude to my advisor s/r Mekida Sinega for her
precious and constrictive suggestion, comment and guidance from the
begging to the compilation of the research proposal.

And also I am so happy to express the same kind of feeling to those persons
who work in the documentation, journal and internet service room for their
active participation in searching reference for me.

Last but not least I would say my heartfelt to w/o Sosna Tlahun for doing
secretarial work for me.

i
 Proposal Summary

Background:-Anemia is one of world public health problem. This remains a

major problem in nearly all developing countries and in many developed
countries .anemia associated with pregnancy contribution for high maternal
and prenatal morbidity and mortality.

Objective:- the aim of this study would be to determine the prevalence of

anemia and its risk factor among first time ANC attendant pregnant women
at Jimma Higher two Health center.

Method and Materials:- Across sectional study will be conducted to

determine prevalence of Anemia and its risk factor among 160 pregnant
women using simple random sampling technique. This study will be
conducted from March, 21 to 27, 2014. Data will be collected by questioner.
Blood sample will be observed from client’s card for hemoglobin
determination by Hematocrite method and also stool sample will be checked
for intestinal parasite infection.

Data analysis and presentation: - data analysis will be done by computer

method. All collected data will be daily checked for computer and
consistency then coded entered in to a computer and analyzed using SPSS
version 16.0 windows. Frequency tables and figures will be constricted to
display findings tables and figures will be constricted to display finding. The
relation between the dependent and independent variable will be
determined by chi- square tests. A p-value of 0.05 will be as a cut off point
for significance.

Conclusion and recommendation:- after finishing this study conclusion

will be made and recommendation will be forwarded.

ii
 LIST OF ABBREVIATION

ANC-Antenatal care

WHO- World health organization

Hgb- hemoglobin

PCV- Packed cell volume

GA- Gestational age

MCV- Mean cell volume

MCH- Mean cell hemoglobin

MCHC- Mean cell hemoglobin concentration

RBC- Red blood cell

IDA- Iodine deficiency anemia

iii
 List of Dummy Table

Table 1. Prevalence of anemia pregnant mother attending ANC at Jimma

Higher two Health center January, 2014.........................15

Table 2. Percentage of sever and moderate anemia among anemic women

January, 2014 .................................................................15

Table 3.Relationship of anemia with different age group among

pregnant women attending ANC at Jimma Higher two health center

January, 2014....................................................................... 16

Table 4. Association of anemia with sciodemographic among pregnant

women attending ANC at Jimma Higher two Health center

January, 2014..................................................................... 17

Table 5.Distribution of anemia by parity and gestational age among

pregnant women attending ANC at Jimma Higher two Health

center January, 2014......................................................... 18

Table 6.Distribution of anemia by family planning utilization and previous

abortion experiences among pregnant women attending ANC

at Jimma higher two Health center January, 2014 19

Table 7.Parsiticinfectin in relation to anemia among pregnant women

attending ANC at Jimma higher two health center January,

2014................................................................................ 20

iv
 Table of content
Contents Page

Acknowledgment......................................................................... I

Proposal summery......................................................................... II

Acronyms ......................................................................III

List of Dummy table .................................................................IV

List of content .......................................................................V

Chapter one

1.1 Introduction ........................................................................1

1.2 Statement of the problem ......................................................2
1.3 Significance of the study........................................................4

Chapter Two

2.1 Literature review ...................................................................5

Chapter Three

3. Objective ........................................................................7
3.1 General Objective ............................................................7
3.2. Specific Objective........................................................... 7

Chapter Four

4. Method and Material ..............................................................8

4.1 Study Area and period ....................................................8
4.2 Study design ..................................................................8
4.3 Population ......................................................................8
4.31 source population..........................................................8
4.3.2 study population...........................................................9
4.3.3 Inclusion and exclusion criteria....................................9
4.4 Samples size determination ...........................................9
4.5 Study variable.................................................................9
4.6 Data collection process ................................................10
4.7 Data processing and analyzing ....................................10
4.8 Ethical consideration ....................................................11

v
 4.9 Data quality control measures .....................................11
4.10 Dissemination of results .............................................11
4.11 Operational Definition.................................................12

Chapter five

5. Work plan ......................................................................13

Chapter Six

6. Budget ......................................................................14

Annex

Annex I. Demy Table ..................................................................15

AnnexII.Measurement.................................................................21

Reference ......................................................................22

Questionnaire ......................................................................24

vi
 Chapter one

Introduction
1.1 Background

Anemia is defined as decreased hemoglobin level, or circulating red blood

cell and it is the most common hematological disorder during pregnancy.
Inadequate intake or absorption of iron in conjunction with blood loss during
pregnancy could be associated with sever complication like increased risks of
maternal mortality and morbidity, premature delivery, and low birth with.
Thus, routine screening tests for anemia are recommended in pregnant
women (1, 2).

More than half of the pregnant women in the world have hemoglobin level of
indicative of anemia. (3) Although only 15% of pregnant women are anemic
in developed countries, (4). The prevalence of anemia in developing
countries is relatively high (33% to 75%). (5) the most common cause of
Anemia in pregnancy worldwide is iron deficiency (6). The predisposing
factors include grand multiparty low socio economic status malaria
infestation, HIV infection and inadequate child spacing among others (6).

According to WHO estimate the global prevalence of anemia in pregnant

women is 68%. In Africa its prevalence is estimated to be 66.8% (7). In the
developing world, pregnant women and their children are frequently exposed
to parasitic infection like malaria and intestinal helminthes, which co-exist
widely with micronutrients deficiencies and contribute to IDA (8).

In Ethiopia, anemia is the sever problem affecting 63.7% of pregnant

mothers and 52.3% non pregnant women (19) according to EDHS report of
2011, the prevalence of anemia in pregnant women was 17% at the country
level and in Oromia regional state (10).

1
 1.2 Statement of the Problem

Anemia is the reduction in the concentration of hemoglobin in the peripheral

blood. It is the most common nutritional problem worldwide with its highest
prevalence among Children and pregnant mothers in individuals with
parasitic infection. (11)

The most common worldwide cause of Anemia during pregnancy is iron

deficiency due to poor bioavailability of dietary iron in most developing
countries and with intestinal parasite especially hookworm infection are
reported to be a major causes other causes include malaria and congenital
hemolytic disease. (12)

Anemia during pregnancy has many causes possible causes include folic acid
deficiency, loss of blood from bleeding, hemorrhoid or gastro intestinal
bleeding and also the unborn child consumes some of iron of folic acid
normally available to the mother’s body. (14)

Anemia in tropical Africa is of associated with many factors with the different
causes interactions with various cycle notional deficiencies are regarded as
the most cause of anemia is sub-sharan Africa – Malaria is the predominant
causes of anemia in pregnant women. HIV disuse also contributes to anemia
and its common manifestation even in asymptomatic individuals. Recurrent
abortion and multiple pregnancies also cause one anemia. Having many
children is a potential risk factor for anemia in pregnancy. (5)

Anemia status during pregnancy cannot be expected to improve without the

current implementation of the guideline by health center staff. Therefore one
of the essential comforts that should be made in the prevention of
hemoglobin level of pregnancy for which supervision and treatment could be
followed. (6)

Hookworm infection is one of principal causes of iron deficiency anemia in

developing countries. About one fourth of the world population has
hookworm

2
infection. In Ethiopia hookworm is wide spread in the 800 – 1200 altitude
Zone humid western lowland of every lower elevation. Adult hookworm in
duodenum and jejunum where it attaches to intestinal mucosa from which
they suck blood coursing blood loss. (17)

Screening program based on hemoglobin determination during pregnancies

advisable in operational clinical and economical term. The WHO has
recognized this problem and is recommended screening for anemia of all
pregnant women (18)

Generally this study will attempt to give emphasis on the association

between prevalence of anemia and its predisposing tractors among pregnant
women at Jimma Higher two health Center. And from the results obtained
prevention will be given through Health education and treatment of the
disease to improve material and health care.

3
 1.3 Significance of study

This study will attempt to show the prevalence and risk factor of anemia
in the first time ante natal care attendant pregnant women in Jimma
Higher two Health center. After analyzing the data, the finding will be
forwards to health planner, researcher’s mothers and other concerned
bodies so that they may be beneficiary from this study.

In addition it will indicate the major problem exists so that method of

prevention and modification of the antenatal care service delivery
systems will be planned by Jimma Higher two health centers for the
future.

4
 Chapter Two

2 Literature review

Anemia in pregnancy is a public Health Problem worldwide WHO estimates

that more than half of pregnant women in the world have hemoglobin level
indicative of anemia < 11.0g/dl the prevalence may however be as high as
56% or 61% in developing countries ( 18).

In Indonesia national survey has showed that prevalence among pregnant

women and under five children to be 64% and 56% respectively similar study
conducted in South Africa showed that 41.3% of pregnant women were
anemia. Mild, mode rate and severe anemia was present in 25 .2%. 15% and
0.4% pregnant women. (19.20).

Many studies in Africa reported high prevalence anemia and showed

common association in women < 20 years in their trimester of pregnancy
and among rural residents. But generally it is considered to be multi-causal
like nutrients, medical problem, poverty, grand multi-parity, recurrent
abortion, multiple pregnancies and under Utilization of family planning being
the major contributing factors. (21)

West Africa is highly affected region in Africa with the prevalence rate of
56% for pregnant women and 47% for non pregnant women where as the
remaining region of Africa have a fairly uniform prevalence of 41 - 54% for
non – pregnant and 41 – 43% for pregnant women (21).

A study conducted in Nigeria. Abeukuta about anemia in pregnancy showed

that from a total of 477 pregnant women anemia was diagnosed 366 (76.5%)
of the women in the first trimester of pregnancy but severe anemia was
diagnosed 7 (1. 9%) and moderate anemia was predominant (15).

5
In Ethiopia there were studies conducted in different part of country. A study
conducted in 2006 among pregnant mothers in Jimma from total of 168
pregnant women who came from for their first attendant care visit. The

Prevalence of anemia was 64 (38.2%) and the mean hemoglobin level was
11.3mg/dl. Another study conducted in nine administrative region of Ethiopia
on the prevalence of iron deficiency anemia of reproductive age showed the
prevalence of rate of anemia to be 30.4% moderate 49.7% And iron
deficiency anemia 17?% are common while sever is rare 0.9% with the
distinct regional variations. (14, 12)

A study conducted min Jimma Specialized Hospital Showed that a high

prevalence rate of anemia 28.1 among 312 ( 88.6%) selected or first time
attendants of pregnant mothers in which the rate being 54.8% and 20.9 for
rural and urban respectively by using saline method to measure hemoglobin
value. The majority 58.7% had mild anemia and 41.3% had moderate and
non cases had severe anemia (22).

The other was prospective study carried in Jimma town the overall
prevalence of anemia was 41.9% the rate going 56.8% and 35.9% for rural
and urban resident respectively. The majority ( 74.3) has moderate anemia,
2.5% had severe anemia the rate of anemia is higher among the literates
and in those who do not practice family planning and in those who do not
practice family planning and in the third trimester and increase with party.
(23).

6
 Chapter Three

3.1 Objective

3.2 General Objective

To determine the prevalence of Anemia and risk factor among first time
ANC attendant pregnant women at Jimma health center from.

3.3 Specific Objective

- To determine the prevalence of anemia by measuring or observing

Hemoglobin level.

- To determine the prevalence of intestinal parasite and its association

With anemia

- To verify the factor which are the contributing for the occurrence of

Anemia.

- To verify association between anemia and selected risk factors.

7
 Chapter four

Methods and materials

4.1 study area and period

The study will be conducted in Jimma higher two health center. Which is
located in Jimma town, 346km away from Addis Ababa, Oromia region south
western Ethiopia. it gives a comprehensive health care service in emergency
case team, adult OPD case team, MCH case team, labor case team with a
collaborate laboratory and pharmacy.

According to 2003 population and house census the Jimma town has 13
kebele and Jimma higher two health center found in H/Merkato Keble.
H/Merkato Keble has a total population of 7972 and out of this 3406 Are
male and 4566 are female. The climatic condition of the area was
woinadega. The study will be conducted from March 21 to March 27, 2014.

4.2 study design

A cross sectional study will be conducted in to determine the prevalence of

anemia and its associated risk factors among 160 first time ANC attending
pregnant women.

4.3 populations

4.3.1 Source population

The source population will be all pregnant mothers who attended ante
natal clinic of Jimma Higher two health centers from September 7, 2011 to
September 7, 2013.

8
4.3.2 Study Population

The study population will be all pregnant women who attended antenatal
clinic of Jimma higher two health center from September 7, 2011 to
September 7, 2013.

4.3.3 Inclusion and exclusion criteria

Inclusion criteria

All pregnant mothers who attended antenatal clinic of jimma

higher two health center with full antenatal care follow up data.

Exclusion criteria

Antenatal care follow up data that had not full information in the
registered book.

4.4 Sample size determination

n=z2p(1-p)

d2

n = (1.96)2 0.17(1-0.17) ......................(24)

(0.05)2

=217

Where:- n= required sample size

9
 z= confidence level at 95%

p= estimated prevalence

d= margin error of 5%

Since the total number of ANC attendant women in this health center is 620, that is less than
10,000. So we use correction formula.

nf =n/1+n/N where nf=the final sample size

=217/1+217/620 n=predetermined sample size

=160 N=number of ANC attendants in

average

With 10% non-response rate the final sample size will be 176

4.5 Study Variable

4.5.1. Dependent variable

- Hgb level of pregnant women

- ANC follows up

4.5.2. Independent Variable

- Educational status

- Durational of pregnancy

- Utilization of family planning

- Age

10
4.6 Date collection process

Data collection will be under taken from March 21 to march 27, 2014. Data
will be collected through pregnant women’s antenatal care follow-up data
using a prepared standard check-List in antenatal care clinic. The content of
check list Include socio – demography, co morbidity, past objectives history,
history of present pregnancy, physical examination and laboratory
examinations. In order to assure the quality of the data the following
measures will be undertaken:-

 5% Pre-test will be done before 3 day of the research conduct in JUSH

MCH ward.
 Data will be collected by trained health workers (nurses) workers in the
center.
 Principal investigation will strictly supervise data collector daily and
review all filled format.

4.7 Data processing and analyzing

Data will be checked for its completeness every day. To be edited, cleaned
and analyzed, the collected data will be entered in to SPSS version 16
windows soft ware. The relation between variables will be determined by chi-
square and p value will be as cutoff point significance.

4.8 Ethical Consideration

11
Prior to data collection official letter will be written from Jimma University
students research programmed to Higher two Health center. After getting
permission, data collection will be started and patient confidentiality will be
kept throughout the study.

4.9 Data quality control measures

In this study the method to be used will be hematocrit method which is

recommended by WHO an efficient means of technique for the determination
of hemoglobin level and also stool examination result will be checked for
intestinal parasitoids.

4.10 Dissemination of results

After analyzing the data collected and writing the result will be distributed to
concerned bodies that are to Jimma health center CBE coordinating office to
college of public health and medical science and to my Advisor.

4.11 Operational Definition

Anemia – decreased in number of RBC or less than normal quality of Hgb in

the blood. It can include decreased oxygen binding ability of each Hgb
molecule due to deformities or lack in numeral development as in some
other type of Hgb deficiency.

ANC – A preventive, primitive and medical care given to women during their
pregnancy.

Abortion – the process of expulsion fetal tissue before viability.

Hemoglobin – the all ostrich protean in the blood that is responsible for the
transport of oxygen, carbon dioxide and maintenance of PH.

12
Parity – state of giving birth to on infant alive or dead when the length of
gestation is 24 or more weeks

Prevalence- is astatically concept referring to the number of cares of

advisees that are present in a particular population at a given time.

CHAPTER FIVE

RESULTS

A total of 160 mother's check lists were seen during the study period with
hundred present response rates. Regarding age 54(33.75%) of the study
population were in the age group of 21-25 of which 13(25%) of them were
anemic. Thirty eight (23.75%) of study population were in the age group of
26-30 while 22(13.75%) and 20(12.5%) of the study population were in the
age group of <20 and > 35 respectively. One hundred twelve (70.4%) of the
study population were living in the urban of which 33(63.47%) have anemia.
The rest 48(29.6%) of the study population were living in rural area out of
which 19(36.53%) were anemic.

One hundred twenty two (76.25.2%) of the study population were literate
and out of which 36(69.23%) were anemic, while 38(23.75%) of the study
population were illiterate of which 16(30.77%) were anemic

One hundred twenty nine (61%) of the study population were Oromo of
which 28(23%) were anemic followed by amhara 60(29.1%) and Tigre
7(3.4%). Based on religion, 54.2%were found to be orthodox Christian, out of
which 25% were anemic while 30% were Muslim out of which 26% were
anemic. 15% were protestant out of which 26% were anemic.

13
Table 1. The relationship of anemia with age, residence and literacy status
among antenatal care attendants in jimma higher two health center.

Variable Anemic Non- total X2 p

ane
mic

NO. % No. % No. % valu valu

e e

Age <20 9 17. 13 12.0 22 13.7

31 3 5

21-25 20 38. 51 47.2 71 44.3

46 2 7

26-30 11 21. 27 25.0 38 23.7

15 1 5

31-35 10 19. 16 14.8 26 16.2

24 2 5

>35 2 3.8 1 0.92 3 1.87

4

Residenc Urban 33 63. 79 73.1 112 70

e 47 5

14
 Rural 19 36. 29 26.8 48 30
53 5

Literary literat 36 69. 86 79.6 122 76.2

status e 23 2 5

illitera 16 30. 22 20.3 38 23.3

te 77 8 5

Ethnicity Orom 21 40. 41 37.9 62 38.7

o 38 9 5

Amha 14 26. 32 29.6 46 28.7

ra 92 2 5

Tigre 7 13. 19 17.5 26 16.2

46 9 5

gurag 6 11. 8 7.40 14 8.75

e 55

other 4 7.6 8 7.40 12 7.5

s 9

Religion Musli 21 40. 40 37.1 61 38.1

m 38 3 2

Ortho 19 36. 30 27.7 49 30.6

dox 54 8 3

Prote 7 13. 19 36.5 26 16.2

stant 46 2 5

Catho 5 9.6 11 10.1 16 10

lic 2 7

other 0 - 8 7.40 8 5
s

15
Among the study population 23.2% had anemia with a mean hemoglobin
level of 10.6gm/dl and 9.6gm/dl for the total and anemic mother
respectively. Out of the anemic mother 22(40%) were found to have
moderate anemia and 5(9%) had sever anemia. The rate of anemia was
13.1. and 3.3% for the rural and urban respectively.

Table 2: Prevalence of anemia among antenatal care attendants in jimma

higher two health center, 2014

Hemoglobin level Frequency %

10-10.9 31 59.63

7-9.9 16 30.76

<7 5 9.61

16
The prevalence of anemia increase with previous history intestinal parasites
compared with those have no intestinal parasite infestation. Out of 30
mothers who had intestinal parasite attack in the past 1 year, 18(27%) were
anemic while out of 130 mothers who didn't have previous parasite
infestation only 35(12.5%) were anemic.(p=0.002). Stool examination
revealed 0.5% positive for hook worm out of which all are anemic. One
hundred six (99.5%)

Table 3. Prevalence of anemia in relation to parasitic infection among

antenatal care attendants in jimma higher two health center, 2014.

Intestinal NO. of anemic

parasite mother

No. % No. %

Hook worm 6

Trichuris 13
trichiura

Entamoeba 11
histolytica

Ascaris
lumbricoides

Total

The occurrence of of anemia increase with parity. Ninety five percent of

grand multiparas in the study population were anemic while 45(23%) of

17
mothers who were from para 1-4 were anemic and 35%of primigravida were
anemic. 53% of mothers were primigravida.

Table 4. Distribution of antenatal care attendants by parity in relation to

anemia among pregnant mothers in jimma higher two health center, 2014

Parity Anemic Non-anemic Total X2 P

No. % No. % No % valu value

. e

2-4

>5

Ninety point eight percent of mothers visited antenatal clinic in the second
and third trimester of their pregnancy and only 16(7%) visited in their first
trimester. The prevalence of anemia was 18.4% and 25% in the second and
third trimester, respectively. 3(21%) of those in the first trimester were
anemic.(table 5)

Table 5. Prevalence of anemia in relation to gestational age among antenatal

care attendants in jimma higher two health center, 2014

Gestational anemic Non anemic total X2 P

18
age(in week) No. % No. % No. %

1st trimester

2nd trimester

3rd trimester

The prevalence increases with previous abortion experience. Out of 13

mothers who had previous abortion experience which account 31.5 were
anemic while from 147 mothers with no abortion. But the prevalence' was
less with family planning utilization.(table 6)

Table 6. The relationship of anemia with previous abortion and family

planning utilization among pregnant mothers attending antenatal care in
jimma higher two health center, 2014

Utilization No. of mother anemic Non anemic

of family
planning

Yes

No

Total

19
Previous
abortion
experienc
e

Yes

No

Total

DISCUSSION

It has been estimated that approximately 68% of the population worldwide

and more than half of pregnant women are anemic according to WHO.(3) the
burden of this problem is higher in some countries such as west Africa (56%),
Indonesia (64%). Many studies in Africa reported high prevalence of anemia
and show common associations with women age less than 20 years in their
third trimester of pregnancy and among rural residents. (21) This study also
showed the prevalence of anemia in pregnancy to be 32.5% among the 160
attendant mothers. The prevalence was comparable with 35.9% study done
in jimma town except 3.4% (23). The prevalence was lower than 38.2%
prevalence of previous study done in jimma town (14, 12). The reason may
be in this study convenient sampling technique was used to select the
attendants and they were tested at different visit. So some of them might
have taken the prophylactic or therapeutic iron or folic acid and this with the
health education given at each visit may increase the hemoglobin level. But
in the previous study, only mothers those in their first visit were tested

20
before they took any medication or health education in the antenatal clinic.
Also, socioeconomic and geographic difference of the study population and
improvement in the quality of service delivery play role.

The prevalence of anemia in this study is higher than study done in Nigeria
(28.1%). This difference may be attributed to advancements in the quality of
ANC and living conditions in Nigeria. When we see the degree of anemia
59.63% were found to have mild anemia, 30.76% were found to have
moderate

anemia and the rest 9.61% had severe anemia. Most mothers who had
severe anemia were primigravida, grand multiparas with birth intervals less
than 2 years and those in their third trimester of pregnancy with previous
positive for hookworm and from rural. This is because high parity (grand
multiparas) exposes women more frequently to periods of hemorrhage risks
which deplete body stores of iron that leads to extra requirement of iron than
usual. High parity increase the risk of hemorrhage through intermediates
such as increased venous drainage to the lower part of uterus, hyalinization
of the blood vessels and decreased elasticity of the uterine wall. (14) When
this iron reserves are already low due to malnutrition, frequent pregnancies,
malarial attack and hook worm, the severity of anemia is marked. High rates
of anemia in pregnancy among primipara’s pregnancies are commonly found
to be associated with adolescence and HIV disuse. (5)

In one study done in university of Nigeria teaching hospital to determine the

prevalence and risk factors for maternal anemia and the effect of HIV
infection on severity of maternal anemia, the prevalence of overall anemia
during pregnancy was 40.4%. The majority 90.7% of these anemic women
were mild anemic (Hgb9-10 g/dl) whereas 9.3% moderately anemic (Hgb7-
8.9g/dl). The HIV status of 530 cases was done and 27 of the cases were

21
positive for HIV infection out of which 20 (74%) of mothers were anemic.(19)
in this study, even though the serostatus screening was not done, on
historical background, 5 out of 207 mothers were positive for HIV. Out of
these positive for HIV, 60% were anemic. This relativerelative risk of
seroposetivity increased with severity of anemia, thus significant association
was found between degree of anemia and HIV serostatus among the study
women with anemia.

Anemia had significant association (p<0.05) with literary status, hook worm
infestation, chronic illness, malarial attack, parity and number of abortion.
This is because most illiterate mothers are less likely to use family planning
thus will have more blood loss during delivery and there will be no time to
restore already depleted iron stores and hence anemia results. Also malaria
causes by destroying RBCs at a rate faster than body can replace them.
There was no statistically significant association (p> 0.005) between anemia
and age, religion, ethnicity, marital status, gestation, birth interval,
contraception and family income.

22
Conclusion and recommendation

Result of this study showed that the occurrence if anemia in pregnancy has
been present in large proportion of pregnant women. The rate of anemia
being higher among grand multiparas, in third trimester of pregnancy, short
intervals between pregnancies and in mothers who had parasitic infection.

For pregnant women anemia can result in severe morbidity and reduce the
resistance if blood loss with the result that death may result from the blood
loss associated with normal delivery. Hence there should be proper health
education about importance of : early booking during pregnancy, Family
planning, hook worm infection is something that can be easily prevented yet
it causes serious complications, provision of adequate and balance diet
which can be prepared from locally available food items at its minimum cost
so that to minimize the additive effect of malnutrition and other factors to
cause anemia and iron should be supplemented for the high-risk group.

23
 Chaptere five

WORK PLAN

S.No 2013 /2014 Time table in month

Activety Sep. Dece Jan. Feb. Mar. Apr. May. Jun.

.

1 Topic
selection

2 Desioning
questione

3 Proposal
preparation

4 Proposal
aproval

5 Preparation of
data collection

6 Data
collaction

7 Data analysis

8 Report
writting

9 Presentation
of finding to
advisor

10 Report to
depertment
and

24
 symposium

Chapter Six

Budget

1. Stationary material

Unit price Total Price

S.N List of time
Unit Quantit Birr Cent Birr Cent
o
y

1 Paper 01 105 .00 105 .00

2 Pen Each 5 3.5 .00 17 .00

3 Pencil Each 04 1 .00 4 .00

4 Comrat disc Each 01 30 .00 30 .00

5 Data Per 04 50 .00 200 .00

collector perso
n

6 Printer Pice 02 140 .00 280 .00

7 Secretary Per 01 150 .00 150 .00

work perso
n

8 Quesionair Piece 02 180 .00 180 .00

Dupilcation

25
 Total 966 .00

Contigencey 96.6 .00

(10%)

Grand Total 1,062 .60

Annex I
Dummy Table
Table. 1 prevalence of anemia among pregnant women attending ANC
Jimma Higher two Health center,January, 2014.

Pregnant women
Hgb in g/dl
Frequency %

Hgb < 11.0 ( anemia)

Hgb > 11.0 ( non anemia

Total

Table. 2 Presentage of sever, moderate and mild anemia among anemic

pregnant women, January,2014.

Anemic women
Hgb level
Frquency %

26
< 7 g/dl

7 – 10g/dl

10-11g/dl

Total

Table. 3 Relation ship of anemia with different age group among

pregnant women attending ANC at Jimma Higer two Health center,
January,2014.

Anemic Non anemic Total

Age
Frequenc % Frequenc %
y y

< 20

21 -25

26 -30

31 – 35

> 35

Total

27
Table. 4 Association of anemia with scio demographic among pregnant
women
attending ANC at Jimma igher two Health center, January,2014.

Anemic Non
Residence Anemic

Frequency % Frequency %

Rular P2=
X2
Urban
=

Total

Religon P2=
X2
Muslim
=

Ortodox

Protestant

Others

Total

Ethnicity P2=

28
 Ormo X2
=
Amhara

Gurage

Kulli

Tigray

Others

Total

Education P2=

status X2
=
Iliterate

Literate

Total

Table.5. Distribution of anemia by parity and gestational age among

pregnant
women atending ANC at Jimma Higher two Health center,
January,2014.

Variable Anemic Non Anemic Total

Frequenc % Frequency %
Parity y

2-4

>=5

Total

Gestational
age ( week )

< 12

29
 13 -28

> 28

Total

Table.6 Distrbution of anemia by family planing utilzation and previous

abortion experiences among pregnant women attending ANC st
Jimma Higher two Health centers, January,2014.

Anemic Non Anemic Total

Utilization of
Frequenc % Frequenc %
family planning y y

Yes

No

Total

Previous
abortion
experience

Yes

30
No

Total

Table 7. Parasitic infection and HIV status relation to anemia among

pregnant

women attending ANC at Jimma Higher two Health center,

January,2014.

Anemic Non Anemic Total

Paracite Frequency % Frequency %

Hook worm

Entamoeba
histolytica

Ascaris
lumbricoide
s

31
Total

HIV Status

Reactive

Non
reactive

Total

Annex II

Measurements

Referennce value for hemoglobin

According to WHO

 Men – 13 – 18 g/dl
 Women – 12 - 16g/dl
 Pregnant women - > 11g/dl
 Hgb value between s10 and 11 g/dl – mild anemia
 Hgb Value between 7 and 10 g/dl – moderate anemia
 Hgb value less than 7 g/dl - sever anemia

32
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Questionaire

This questionar is designed to determine the prevalence of anemia among pregnant

mother who attended antenatal care at Jimma Higher two health center from.....

I. Identification
1. Age

II. Socio demographic factor

2.1. Marital Status

A. Married B. Single

35
 C, Divorced D. Widowed

2.2. Residence

A. Urban B. Rural

2.3. Relgion

A. Orthodox B. Muslin

C. Protestant D. Catholic

2.4. Ethnicity

A. Oromo D. Tigre

B. Amhara E. Keffa

C. Gurage F. other

2.5. Educational status

A. Literate C. Read and write

B. Illitrate

III. Situtional related to pregnancy

1. Past obsteric history

A. Gravida _________________ B. Para __________________

C. Abortion _______________ D . Number of Children

__________

2. Gestation age ( in week )

A. < 12 wks ________________ B. 13 -28 wks __________________

C. > 28 wk __________________

3. Have you encountered abortion previously

36
 A. Yes B. No

4. If yes to the question above how many time

A. 1 B. 2 C. 3 D. >3

5. Anemic and non anemic mother by their hemoglobin level

A. Hgb ≤11( Anemic ) B. Hgb >11 Non Anemic

6. Value of Hgb level

A. < 7g/dl B. 7-10g/dl C. 10-11g/dl

7. Age group which anemia mostly encontered

A. < 20 D. 31 – 35

B. 21 – 25 E. > 35

C. 26 -30

8.prevalence of anemia by their parity

A. 1 ____ B.2-4______ C.>=5______

9.Prevalence of anemia by their trimister

A.first B.second C.third

10.prevalence of anemiain association with parasitic infection

1.trichuris trichiura__________

2.hook worm___________

3.entamoeba histolytica__________

4.ascaris lumbricoides___________

37
11.Nutritional entake

A.meat and egg C. Firut

B.vigetables D. Others

12. HIV status of pregnant women

A. Reactive

B. Non-reactive

13. Do you use contraceptive methed

A. YES

B. NO

38