Prevalence of Anemia Among Women Receiving Antenatal Care at Boditii Health Center, Southern Ethiopia
Dereje Lelissa1, Matiyas Yilma1, Weldesenbet Shewalem1, Amanuel Abraha2, Mesfin Worku1, Henock Ambachew1, Misganaw Birhaneselassie1,
1Hawassa University College of Medicine and Health Sciences, Department of Medical Laboratory; Hawassa, Ethiopia
2Orebro University School of Health and Medical Sciences, Department of Clinical Medicine, Örebro, Sweden
To cite this article:
Dereje Lelissa, Matiyas Yilma, Weldesenbet Shewalem, Amanuel Abraha, Mesfin Worku, Henock Ambachew, Misganaw Birhaneselassie. Prevalence of Anemia Among Women Receiving Antenatal Care at Boditii Health Center, Southern Ethiopia. Clinical Medicine Research. Vol. 4, No. 3, 2015, pp. 79-86. doi: 10.11648/j.cmr.20150403.14
Abstract: Background: Anemia is regarded as a major risk factor for unfavorable outcome of pregnancy both for the mother and the fetus. Methodology: A heath center based cross-sectional study was conducted in Boditii Health Centers from April 12 to June 23, 2012. Data was collected using pretested questionnaire, which contains socioeconomic, demographic and clinical characteristics of pregnant women shown to have association with anemia. A total of 125 pregnant women were enrolled in this study. HGB was measured using the Sahli-Hellinge method of HGB determination. Data was entered and statistical analysis was performed using SPSS version 16, software. Association between variables was done using chi square, and statistical significance was considered at P value < 0.05. Result: The prevalence of anemia obtained in this study was 77/125 (61.6%), based on the WHO criterion for the diagnosis of anemia in pregnancy, i.e. hemoglobin <11.0 g/dl (PCV <33%). In terms of severity, mild anemia was present in 41(53.2%) of women, moderate anemia was present in 36 (46.8%), and there were no cases of severe anemia. The prevalence of anemia in this study was 58.4% and 41.5% for primigravida and multigravida, respectively (P<0.05). Anemia was also found to increase as the gestational age increases, showing the highest prevalence in the third trimester (46.7%) than second (45.4%) and first trimester (7.8%), (P<0.001). Conclusion and Recommendation: From our results, we can conclude that anemia in pregnant women was highly prevalent in Boditti town. Our study revealed that the prevalence of anemia is higher in primigravidea than multigravidea. Anemia also increased as the gestational age increases. Intervention including health education about causes of anemia and its risk factors and antenatal care (ANC) follow up should be improved.
Keywords: Anemia, Antenatal Care, Pregnant Women
Anemia is a global public health problem. It affects approximately 2 billion people of the world wide (1). It occurs as a result of deficiencies of essential nutrients, heavy blood loss, parasitic infections or increased requirements including those seen in pregnancy (1, 2).
Fifty six percent of pregnant women and 43% of non-pregnant women in developing countries are anemic while only 18% of women in developed countries are believed to be anemic (3,4). Prevalence of anemia during pregnancy in developing countries is relatively high (33% - 75%) (5, 6), while 15% of pregnant women are anemic in developed countries (3-7).
Anemia is the most common nutritional deficiency disorder in the world (8) and the most common cause worldwide is iron deficiency (6). The predisposing factors include grand multiparity, low socioeconomic status, maternal infection, late prenatal care, HIV infection and inadequate spacing of children (9).
Anemia is regarded as a major risk factor for unfavorable outcomes of pregnancy (10) both for the mother and the fetus. Studies have shown that the adverse consequences of maternal anemia may affect not only the neonate but also increase the risk of non-communicable disease as the neonate grows into an adult and may contribute to the risk of low birth weight in the next generation (11). Anemia has been associated with premature labour and low birth weight (10) and maternal and prenatal l mortality (12). Fetal mortality has consistently been associated with maternal mortality (13).
Antenatal care services, although not as strong in health institutions in Ethiopia as in the developed world, these services are the main mechanism for safe motherhood interventions and are believed to reduce maternal and perinatal mortality. In Ethiopia, 66% of pregnant women attend the ANC clinic once per pregnancy (4, 14).
Intervention measures are planned and improved based on available information regarding the magnitude and severity of anemia, and associated risk factors in the geographic area. Therefore, the objective of this study was to assess the prevalence of anemia among pregnant women attending ANC at Boditti Health Center, southern Ethiopia and to identify factors that contribute to the presence and severity of anemia.
2.1. Study Setting
A heath center based cross-sectional study was conducted in Boditii Health Center from April 12 to June 23, 2012. Boditti is a town located in SNNPR of Ethiopia, with a distance of 770 km from the capital city of Ethiopia (Addis Ababa), 140 km from the regional state university (Hawassa) and 16 km from zonal center Wolayta. The source population was all pregnant women in Damot Gale woreda, Wolaita zone, Boditii town. The study population included all pregnant women attending the antenatal care (ANC) clinic at Boditii Health Center. Pregnant women who came for ANC during the study period were included as study participants.
2.2. Data Collection
Data was collected using a pretested questionnaire, which contains socioeconomic, demographic and clinical characteristics of pregnant women shown to have association with anemia. The questionnaire was developed by the CBE (Community Based Education) office of Hawassa University College of Medicine and Health Sciences, adopted and modified for the purpose of this study. Data was collected by practicing laboratory technologists under the supervision of senior staff. A total of 125 pregnant women were enrolled in this study.
Blood samples were collected from all study participants. The HGB value was determined and the severity of anemia was noted based on the HGB value according to the WHO definition as mild, moderate and severe anemia (15). HGB was measured using the Sahli - Hellinge method of HGB determination. In this study, anemia in pregnancy was defined as HGB < 11 g/dl. Mild, moderate and severe anemia was defined as HGB measurements between 10-10.9 g/dl, 7-9.9g/dl and less than 7 g/dl, respectively (16). Anemic pregnant women were immediately referred to the attending health professionals at the ANC clinic of the health center for treatment and follow up.
2.3. Data Analysis
Data was entered and statistical analysis was performed using SPSS version 16, software. Association between variables was done using chi square, and statistical significance was considered at P value < 0.05.
2.4. Ethical Consideration
Ethical approval was obtained from the Institution Review Board (IRB) of Hawassa University College of Medicine and Health Sciences, and the solicitation to participate letter was submitted to the administration of the health center from the department of medical laboratory sciences. The consent of the study participants was ensured and confidentiality was maintained.
The study involved a total of 125 pregnant women who attended ante natal care (ANC) at Boditii Health Center, southern Ethiopia. The mean ± SD age of the women was 23.8 ± 4.0 with a range of 17-34 years. Half of the participants were home makers and 56 (49%) of them were educated at the elementary education level. Most of the women included in this study were from the rural areas and earned lower level incomes per month (Table 1).
|Monthly income ( Eth birr)|
Among all pregnant women, 52.8% of them were multigravida and 47.2% were primigravida. A majority of the women (81.8%) had birth spacing of more than two years. A majority of the women had no chronic disease in previous pregnancies and had no diseases on admission to the clinic, 88% and 92% respectively. Over half of the pregnant women 64(51%) were in their second trimester of pregnancy, and 70% of them used supplementary drugs such as iron supplements in their pregnancy (Table 2).
The overall prevalence of anemia in this study was 77/125 (61.6%). In terms of severity, mild anemia was 41(53.2%), moderate anemia was 36 (46.8%), and there was no severe anemia identified (Fig 1). The severity of anemia was distributed among respondents’ characteristics; moderate anemia was more common in women of multigravida (23.3%), in women of ≥ 2 years of birth spacing (50%), and in women who do not take supplement drugs (16.9%) (Fig 2) (Table 3). Mild anemia was more common in primigravida (35.1%), in first (6.5%) and second (23.3%) trimester of pregnancy, and in women taking supplement drugs (41.5%) (Fig 2) (Table 3).
|> 2 years||54||81.8|
|Chronic disease in previous pregnancy|
|Hemoglobin level ( g/dl)||P - value|
|Non anemic (n=48)||Anemic (n=77)|
|Age||Above 11||Mild (10-11)||Moderate (7-9.9)||Total anemic N (%)||P > 0.05|
|15-19||5(10.4%)||11(14.3%)||9(11.6%)||20 ( 25.9)|
|20 -24||19(39.6%)||14(18.2%)||11(14.3%)||25 ( 32.5)|
|Gov employee||10(20.8%)||4(5.2%)||3(3.8%)||7 (9)||P > 0.05|
|House wife||27(56.2%)||18(23.3%)||17(22.1%)||35 (45.4)|
|Illiterate||5(10.4%)||3(3.8%)||4(5.2%)||7(9.1)||P > 0.05|
|< 150||3(6.3%)||6(7.7%)||2(2.6%)||8(10. 3%)||P < 0.05|
|Primigravida||14(29.2%)||27 (35.1%)||18(23.3%)||45 (58.4)|
|<2 years||8(16.7%)||2(6.2%)||2(6.2%)||4(12.5)||P > 0.05|
|≥ 2 years||26(54.2%)||12 (37.5%)||16(50%)||28(87.5)|
|Chronic disease in previous pregnancy|
|Yes||3 (6.2%)||1(3.1%)||4(12.5%)||5 (15.6)||P > 0.05|
|Current disease||P > 0.05|
|Trimester||P < 0.001|
|Supplement taking||P > 0.05|
Approximately 26%, 32.4%, 32.4% and 9% of the pregnant women who were in age range of 15-19, 20-24, 25-29 and 30-34 years were anemic, respectively. Nearly half of the women with anemia were home makers, and had been educated at the elementary (Table 3).
The prevalence of anemia in this study was 58.4% and 41.5% for primigravida and multigravida, respectively (P<0.05). Anemia was also found to increase as the gestational age increases, showing the highest prevalence in the third trimester (46.7%) then the second trimester (45.4%) and first trimester (7.8%), (P<0.001). Women with birth interval of greater than or equal to two years showed more prevalence of anemia (87.5%) than those with an interval of less than two years (12.5%). On the other hand, anemia was reported more commonly in women who didn’t have chronic disease in a previous pregnancy (84.3%) and in women who didn’t have current disease during pregnancy (90.9%), and in women taking supplementary drugs (71.4%) (Table 3).
Among the primigravida (N=59) mothers, 27(45.8%) were home makers, and 28(47.5%) were educated at the elementary level. Among 66 (52.8%) multigravida, 54(81.8%) had child spacing greater than 2 years and 12(18.2%) had birth spacing of less than two years. Of all the multigravida, 32(48.5%) had received ANC services during their previous pregnancies and 34 (51.5 %) did not receive ANC services during their previous pregnancies (data not shown).
Among 34(51.5%) pregnant women who did not receive ANC services during their previous pregnancies, 22(64.7%) respondents identified their reason for this as they were not informed about it, 7(20.6%) reported the absence of a health institution, 3(8.8%) said because they were not willing to receive ANC services and 2(5.9%) cited financial reasons. In the multigravidae, only 8(12.1%) had chronic disease in their previous pregnancies, and among them 6 had hypertension and 2 had diabetes mellitus. However, of all the pregnant women, only 10 had current disease of which 6 had malaria, 3 had typhoid fever and 1 mother had another disease (data not shown).
The prevalence of anemia obtained in this study was (61.6%), based on WHO criterion for the diagnosis of anemia in pregnancy, i.e. hemoglobin <11.0 g/dl (PCV <33%) (15). This finding is high but comparable with other local studies carried out in different parts of Ethiopia. In a study undertaken in the Gilgel Gibe dam area, (53.9%) of pregnant woman were anemic in Asendabo (62.7%), and in Jimma (57%) anemia prevalence was reported in pregnant women attending ANC clinics (17-19). Similar findings were also reported in eastern Sudan (62.6%) and China (70%); India also reported a higher result than this study (92.39%) (20-22).
However, the prevalence of anemia reported in pregnant women showed variability both locally and in other countries. A study conducted in south East Ethiopia (Harar) showed prevalence of anemia as 27.9%, and in Gondar (23.2%) anemia prevalence which were much lower findings from the report obtained in this study (23-24). Other countries, also reported a similarly low prevalence of anemia in pregnant women, Nigeria (23.2%), Thailand (14%), unlike this study (25-26).
Globally, many studies reported different socioeconomic, demographic and clinical characteristics of pregnant woman that may affect the magnitude of anemia (27). Anemia was associated with aspects of lower socioeconomic class such as low level of education, rural residence, not working or manual worker, low reported income. Other clinical characteristics such as gravidity, regular ingestion of iron supplements, trimester of pregnancy, and other factors are shown to be risk factors for anemia (27-31).
In addition, the accuracy of the HGB measurement used should be taken in to account. In this study, the HGB value of the pregnant woman was done by the old comparative Sahli -Hellinge method, which is subjected to biases in dilution and reading of results. Nevertheless, the result obtained in this study was consistent with the characteristics of the study population, and findings from other regional and international reports. The majority of the study subjects involved in this study were rural residents from different catchment areas of Boditii town. Studies conducted to identify risk factors of anemia in pregnant women have found strong association of rural residence with anemia. In ANC services, pregnant women who were from rural areas were more than three times more likely to be anemic than their urban counterparts (23, 24).
According to the WHO classification, 41(53.2%) of anemic pregnant women had mild anemia (HGB 10-11g/dl) and nearly half of the anemic women had moderate anemia (HGB 7-9.9 g/dl), in this study. Other studies in Ethiopia, reported a mild anemia ranging from 23% to 81%, and moderate anemia from 17.9% to 74.3%. This finding is comparable with studies in other countries, (19,33,34). The study reported in this paper, however, differs in that it didn’t identify any cases of severe anemia.
The present study and other studies in Ethiopia indicated that moderate anemia constitutes a significant portion of anemia in pregnant women attending ANC clinics. In fact, moderate anemia causes considerable consequences such as loss of energy and function for these women. Activities such as child care and household management as well as job performance are affected. They are more vulnerable to infections and improvement from infections may be prolonged. The anemia can also result in risks to the mother and newborn (22, 35,36). Therefore, increased health education on risk factors and interventions to prevent the prevalence and severity of anemia among pregnant women should be a priority for mothers attending ANC.
In this study it was identified that anemia was significantly higher in the primigravidae and third trimester of pregnancy. This is consistent with other studies conducted in sub Saharan Africa. This study reported a statistically significant association between anemia and primigravida women, where the prevalence of anemia in primigravida was higher (35.1%) than in multigravida (18.2%), (P<0.05). Similar reports have also been found in other studies (15, 37, 38).
This study also reported, an association of gestational age with anemia statistically significant for the third trimester, (P<0.001). Anemia was shown to increase from first (7.8%) to second (45.4%) and to third (46.7%) trimester of pregnancy. This report is consistent with the work of others in Ethiopia and Nigeria (33, 34, 39). Overall, this study demonstrated a high prevalence of anemia and described its severity among groups. The study also identified at risk groups of pregnant women for targeted intervention. For example, more focus must be given for primigravida women than multigravida and for women in the third trimester of pregnancy in ANC follow up.
5. Conclusion and Recommendation
From our result we can conclude that anemia is highly prevalent in Boditti town. Our study revealed that the prevalence of anemia is higher in primigravidea than multigravidea women. The severity of anemia also increased as the gestational age increased. Intervention including health education about causes of anemia and its risk factors and ANC follow-up should be given top priority.
The study had limited sample size in relation to other studies and the method used to measure hemoglobin level was Sahli Tube method which can result in personal bias during comparing with the standard.
We heartedly acknowledge the staff and administration of Boditii Health Center for their cooperation and permission to use the laboratory for the study. Our sincere thanks also go to Linda Fell for reviewing the manuscript.
Hawassa University College of Medicine and Health Science
Medical Laboratory Sciences Department
Prevalence of Anemia Among Women Attending Ante Natal Care at Health Center
|1. Code No________, Age___________|
|2. Address : Region ____ Zone______ Woreda ____ Kebele ____|
|¨ Government employee ¨. Merchant ¨ Maid ¨ Student|
|¨ House wife ¨ Bartender ¨ Others specify|
|4. Educational level|
|¨ Illiterate ¨ Literacy campaign ¨ Elementary School|
|¨ Secondary school ¨ Higher level|
|5. What is your monthly income (in average) in birr?|
|¨ Below 150 ¨ 151 -500 ¨ 501 -850 ¨ 851 -1200 ¨ Above 1201|
|6. Is this your first pregnancy? ¨ Yes ¨ No|
|7. If no to No 7, how many times have you been pregnant?|
|¨ 1 ¨2 ¨ 3 ¨ 4 ¨ Above 5|
|8. What is the duration of time you waited between pregnancies?|
|¨ Less than two years ¨ Greater than two years.|
|9. Did you follow ANC during your previous pregnancies?|
|¨ Yes ¨ No|
|10. If no to No 10 why?|
|¨ You were not informed about it ¨ Absence of health institution near your house.|
|¨ You were not willing ¨ Financial problem ¨ Others (specify)|
|11. Was there any chronic disease in the previous pregnancies?|
|¨ Yes ¨ No|
|12. If yes to No 11 what was the disease? Specify.|
|13. Do you have any disease now?|
|¨ Yes ¨ No|
|14. If yes to No 14 specify|
|15. Do you know about anemia?|
|¨ Yes ¨ No|
|16. If yes to No 16, how do you think it’s caused? Specify|
|17. Do you take supplements during your pregnancies?|
|¨ Yes ¨ No|
|18. Hemoglobin level of the respondent|