WOLLO UNIVERSITY

ANEMIA AND ASSOCIATED FACTORS AMONG PREGNANT WOMEN

ATTENDING ANTENATAL CARE CLINIC IN DESSIE
REFERRAL HOSPITAL, NORTH CENTRAL ETHIOPIA

BY, GROUP FIVE STUDENTS

NAME ID

1. Samuel Mogos------------------------------3493/10
2. Mebrhatu Berhe---------------------------2463/09
3. Minassie Demsie--------------------------2475/09
4. Eisa Eyayu-----------------------------------2309/09
5. Tilahun Beletew----------------------------2337/09

A RESEARCH PROPOSAL PAPER TO BE SUBMITTED TO THE DEPARTEMENT OF MEDICAL

LABORATORY SCIENCE, COLEGE OF MEDICINE AND HEALTH SCIENCES, WOLLO
UNIVERSITY

DECEMBER, 17, 2019GC

DESSIE, ETHIOPIA

WOLLO UNIVERSITY
COLEGE OF MEDICINE AND HEALTH SCIENCES DEPARTEMENT OF
MEDICAL LABORATORY SCIENCE

ANEMIA AND ASSOCIATED FACTORS AMONG PREGNANT WOMEN

ATTENDING ANTENATAL CARE CLINIC IN DESSIE REFERRAL HOSPITAL,
SOUTH WOLLO ZONE, NORTH EASTERN ETHIOPIA

BY:

GROUP FIVE STUDENTS

ADVISOR:
Mr. Wodosen

DECEMBER 17, 2018GC

DESSIE, ETHIOPIA
ACKNOWLEDGEMENT

First of all we would like to thank Wollo University department of medical laboratory
science for giving us this opportunity for providing of the research proposal paper in
Medical Laboratory Technology

Next we would like to express our great full thank to our advisor [Link] for his

supportive advice and assistance in the development of this research proposal paper.

I
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.

II
Table of contents

Title page Page

Table of Contents

ACKNOWLEDGEMENT ............................................................................................................................................................. I
ABBREVIATIONS AND ACRONYMS ...................................................................................................................................II
Table of contents....................................................................................................................................................................... III
List of figure and tables........................................................................................................................................................... V
SUMMARY.................................................................................................................................................................................... VI
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
METHOD......................................................................................................................................................................................... 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
4.4.1 Sample size............................................................................................................................................................... 9

II
I
 4.4.2 Sampling technique............................................................................................................................................11
4.5 Variables.......................................................................................................................................................................... 11
4.5.1 Dependent variables..........................................................................................................................................11
4.5.2 Independent variables......................................................................................................................................11
4.5.3 Operational definitions.....................................................................................................................................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

WORK PLAN…………………………………………………………………………………….……………..………………………15

CHAPTER SIX……………………………………………………………………………………………………………………………16

BUDGET……………………………………………………………………………………………..……………………………………16

REFERENCES……………………………………………………………………………..………….………………………………….17

I
V
LIST OF FIGURES AND TABLES
Table 1: Work Plan………………………………………………………………………………………………15

Table 2: Budget…………………………………………………………………………………………………16

V
SUMMARY
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 Dessie Referral Hospital, from
December 17 to JUNE, 2019GC.

METHODS – A facility based cross sectional study will be conducted to determine the
prevalence of anemia among pregnant women attending antenatal care clinic in Dessie
Referral Hospital, North Eastern Ethiopia from December 17 to JUNE, 2019GC. All pregnant
women attendants during the study period will be involved in the study. Data will be
collected by questionnaire and from hospital log book and will be analyzed by making use
of SPSS version 20 for windows. A P value of less than 0.05 will be considered as
statistically significant for all variables.

Budget:- to accomplish this research 6400 Ethiopian birr is needed

V
I
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

1
purpose of screening Laboratory diagnosis of anemia based Hct measurement and Hgb
estimation 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).

2
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
foliate 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
anemia’s 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

3
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 Dessie Referral Hospital.

The prevalence of anemia in pregnant women in South Wollo zone, Dessie town, Dessie
Referral 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.

4
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
severe 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 will 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 will provide valuable information to address the prevalence of
anemia and its associated risk factors like maternal and fetal mortality and morbidity. This
paper will 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 will be used as a base line data for further studies on anemia and
its related risk factors pregnant women on the study area.

5
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).

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).

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).

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).

A cross sectional study conducted from two villages of Tanzania showed that the
prevalence of 28% and the risk of anemia were 3rd 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)
According to the 2011 Ethiopian Demographic Health Survey (EDHS) result, there exist 22%

6
Anemia burden among pregnant women in Ethiopia that indicative of moderate public health
problem in the country(21)

A study 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].

7
CHAPTER THREE

OBJECTIVES

3.1 GENERAL OBJECTIVE

To determine the prevalence of anemia and related risk factors among antenatal care clinic
attendant pregnant women in Dessie Referral Hospital.

3.2 SPECIFIC OBJECTIVE

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

•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.

8
CHAPTER FOUR
METHOD
4.1 Study area and period
The study will be conducted in Dessie Referral hospital, which is found in Dessie town. The
town is located in North central part of Ethiopia. It sits at a latitude and longitude of 1108’ N
39038’E /11.1330N 39.6330E , with an elevation between 2,470 and 2,570 meters above sea
level(28). It has subtropical highland climate. More to the east, there is a hot semi-arid
climate. Based on the 2007 national census conducted by central statistical agency of
Ethiopia, Dessie woreda has a total population of 151,174 of whom 72,932 are men and
78,242 women; 120,095 or 79.44% are urban inhabitants living in the town of Dessie the
rest of the population is living at rural kebeles around Dessie. The majority of the
inhabitants are Muslim, with 58.62%, while 39.92% are orthodox Christian and 1.15% is
Protestants. The study will be conducted in Dessie referral hospital from December 17 to
June 2019GC(7).

4.2 STUDY DESIGN

Across sectional study will be conducted to determine the prevalence of anemia in
pregnant women who attending ANC in Dessie Referral Hospital.

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

4.3.2 STUDY POPULATION

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

4.4 SAMPLE SIZE AND SAMPLING TECHNIQUE

4.4.1 SAMPLE SIZE

9
Among all pregnant women who visiting ANC in DRH during 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

Ni = (Zα/2)2P (q)

d2

Where,

n=sample size required for the study

p= the assumed population proportion of anemia in Dessie 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 + 10 % of non-respondents

nf = ni + 10*384 =412

100

1
0
 4.4.2 Sampling technique
The convenient sampling technique will be used and all pregnant women will be 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

4.5.3 OPERATIONAL DEFINITIONS

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

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

1
1
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 Hydatid form 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 Entamoeba and Guardia

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

4.6 Materials required

∎Microscope

∎Microscopic slide

∎Wright stain solution

∎Lancet

∎Immersion oil

∎70% alcohol

∎Cotton

∎Glove

∎Gown

∎sealant

1
2
 ∎Marker

∎Test tube

∎Test tube rack

∎Gauze

4.7 DATA COLLECTION PROCESS

Data will be collected by questionnaires and Hgb values will be measured by CBC
automated analyzers specifically CELL DYN 1800.

4.8 Data analysis

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

4.9 Quality control

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

4.10 ETHICAL CONSIDERATION

An official letter will be 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 will be asked verbally for permission to collect
data from them.

4.11 PRE-TEST

1
3
Pre-test will be done in another alternative area before data collection and the actual study
performed to check acceptability of the questionnaire whether it contains the necessary
information or not and if unnecessary, to make possible corrections. The necessary laboratory
equipment’s to be employed will be checked for their appropriate functioning.

4.12 DISSEMINATION OF THE RESULT

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

1
4
 CHAPTER FIVE WORK PLAN
Table 1; Project work plan

Responsibl Dec Jan Feb M a r A p r May Jun

1 Title Selection P i
2 Proposal submission P i

3 Proposal presentation P i
4 Obtain Ethical Permission P i
5 Preparation of study tool P i
6 Data Collection P i
7 Sample processing P i
8 D a t a e n t r y P i
9 Data analysis and process P i
10 Writing result P i
11 First draft submission P i
12 Final report submission P i

Pi=principal investigator

1
5
CHAPTER SIX BUDGET
Table 2; Budget
S/no M a t e r i a l s U n i t Quantity Unit price Total price Over all cost

1 Staining Solution B o t t l e 4

2 Microscope slid e P a c k 4

L a n c e t P a c k 3
3

4 G l o v e P a c k 1 2

5 S e a l a n t B o t t l e 2

6 T e s t t u b e P a c k 4

7 C o t t o n P a c k 3

8 M a r k e r P a c k 1

9 G a u z e p a c k 2

1 0 G o w n 7

1 1 70% Alcohol B o t t l e 3

1 2 Test tube rack 2

1 3 Immersion oil B o t t l e 3

TOTAL COST - -

1
6
REFERENCES

1. Fauci, Braunwald, Kasper, Hauser, Longo, Jameson... Ioscalzo Harrison’s principle of

internal medicine. 19th edition. New york: McGraw-Hill Education; 2015. 3940p.
2. Ma AG,Schouten E ,Wang Y , Li Y, Sun YY, Wang QZ. Anemia prevalence among
pregnant women and birth weight in five areas in [Link]; 2009;
18:368-372.
3. WHO. Maternal health and save motherhood program prevalence of anemia in women.
Geneva, 2nd ed. 2002;(1 – 100).
4. Black R. Micro nutrition deficiency an underlying cause of morbidity and mortality: WHO
2003; 81(2): 79.
5. Food nutrition bulletin. Prevalence of anemia among pregnant women Dec, 2006; 27(4):
(311- 315).
6. Bain Bj and Bales. Basic hematological technique practical hematology 9 th edition.
Churchlivingstone : 2006.
7. Census 2007 Tables; Amhara Region Table 2.1, 2.4, 2.5, 3.1, 3.2, and 3.4.
8. Cheesbrough M. District laboratory practice in tropical countries. India 1998; part 2: (274-
285)
9. Lamina, MA Sorunm. To prevalence of anemia in pregnant women attending ANC in
Nigeria University teaching hospital. Nigerian medpract 2003; vol 44: 39-42
10. Egwangega A., Asayej D. Plasmodium species and intestinal helminthes co-infection among
pregnant women, Nigerian pregnant women c. [Link] Nov,2001; 96(8)(1055-1059)
11. WHO. Prevention and management of sever anemia in pregnancy report of technical working
group. Geneva: 2001
12. Anemia at global level [Link] anemia2006;pdf.
13. .Witrobe MM. clinical hematology. 9th edition volum2
[Link] FE: Iron supplementation for the control of iron deficiency in population on risk.
NutritionReview; 1997, 55:165-209.

[Link] A., Rebecra S. pobocick anemia among women of reproductive age in Ethiopia.
Bmc blood disorders 2009; (7):

16. Haidar J, Nekatibeb H, Urga K. Iron Deficiency Anemia in Pregnant and Lactating Mothers
in Rural Ethiopia. East African Medical Journal; 1999; 76(11):618-22.

17. Van den. Broen N. The etiology of anemia in pregnancy in west Africa. Trop; Oct, 2005;
(26) 5-7

18. WHO. The prevalence of anemia in women.A tabulation of available information 2nd
edition. Geneva. 2002

1
7
19. WHO. Maternal health and safe motherhood program.

20. Isa AI, Kemebradikumo P, Dennis A. The Burden of Anemia among Pregnant Women at
Booking in the Niger Delta of [Link] Journal of Medicine and Medical Science
Research. 2012;1(5):91–5.

21. Ethiopia Central Statistical Agency and ICF International. 2011 Ethiopia Demographic and
Health Survey: Key Findings. Calverton, Maryland, USA: CSA and ICF International. 2012 p. 9–10

22. Muriel C, Nadire F, Michel C. prevalence of anemia and associated risk factors in
young children, Southern Cameroon. American journal of tropical medicine and hygiene
2008; 58(5): 606-611

23. Hercberg S, Galan P, Nutritional anemias. Bailers Clinical Hematology; 1992; 5: 143–168.
24. Belay G. unpublished research on anemia at JUSH 2003

25. Mohamed A, agoyo G, Stoggetal T. determination of anemia among pregnant women in

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

26. Giorop A. etai critical evaluation of the clinical diagnosis of anemia amj. 2006; (124):
656-665

27. [Link] of anemia among pregnant women attending ANC at JUSH.

Jun,2007

28. Climate; Dessie Climate Graph, temperature graph, Climate Table. Climate data
organization Retrieved 25 September 2016.
29. Solomon D. prevalence of anemia in pregnant women in Jimma town south west
Ethiopia.EMJ2002;(2): 3-5

[Link] HEALTH ORGANIZATION. WORLDWIDE PREVALENCE OF ANEMIA. 1993-2005; 49-84.

[Link] website http//www. WHO it/classification/icd/ed/access:[Link] 2012.

32. The world health report 2002: Reducing risks, Promoting healthy life. WHO, Geneva,
2002

[Link],Haidar and Rebecca S Pobocik. Iron deficiency anemia is not a rare problem
amongwomen of reproductive ages in Ethiopia: a community based cross sectionalstudy.
Bio-Medical center Blood Disorders; 2009, 9:7

[Link] A, BamlakuE, AschalewG, TigistK, Mohammed S, YadessaO. Prevalence of

anemia and associated risk factors among pregnant women attending antenatal care in
Azezo Health Center Gondar town, Northwest Ethiopia. Journal of Interdisciplinary
Histopathology; 2013; 1(3): 137-144.

1
8
QUESTIONNAIRE

WOLLO UNIVERSITY COLLEGE OF HEALTH SCIENCES, DEPARTMENT OF MEDICAL

LABORATORY SCIENCE

Data collection format for the determination of prevalence of anemia among pregnant women
attending ANC in DRH North Central Ethiopia. December 17 – June, 2019G.C.
Title of the study: PREVALENCE OF ANEMIA AND ASSOCIATED FACTORS AMONG
PREGNANT WOMEN ATTENDING ANTENATAL CARE CLINIC IN DESSIE REFERRAL
HOSPITAL

1
9
Introduction to the study:
This study Aimed 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 old

2. What is your occupation? Specify__________________

3. Do you have any income? Yes____ No____

4. If the answer is yes for Q. no 3, 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_____
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

2
0
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

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

2
1
 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

Laboratory Request and Report Format

WOLLO UNIVERSITY COLLEGE OF MEDICINEAND HEALTH SCIENCES DEPARTMENT OF

MEDICAL LABORATORY SCIENCE

2
2
Parasitological investigation and Hgb determination among pregnant women in
Dessie Referral Hospital December 17-June2019G.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 _______________________________
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

2
3
 Lymphocyt

Neutrophil

Platelets
Parameter

MCHC

RDW
WBC

MCH
MCV
RBC
s

Mid

Hct
Hb
R e s u l
t

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.

2
4
2
5