WOLKITE UNIVERSITY
COLLEGE OF MEDICINE AND HEALTH SCIENCE
DEPARTMENT OF MIDWIFERY
PREVALENCE OF ANEMIA AND ITS ASSOCIATED FACTOR
AMONG PREGNANT WOMEN IN WOLKITE HEALTH CENTER,
SNNPR, ETHIOPIA, 2019.
BY
1. AZIZA MIFTA
2. MIHRET TAYE
3. TINSAE H/MICHAEL
ADVISOR Mr. SOLOMON S.
Mr. JONE
A RESEARCH PROPOSAL to be SUBMITTED TO WOLKITE UNIVERSITY
COLLEGE OF MEDICINE AND HEALTH SCIENCE DEPARTMENT OF
MIDWIFERY IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR
BACHLER OF SCIENCE DEGREE IN MIDWIFERY
AUGEST 14/2021 G.C
SUMMARY
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BACKGROUND: Anemia is a significant public health problem in developing countries,
particularly in pregnant women. It may complicate pregnancy, sometimes resulting in tragic
outcomes. Anemia impairs cognitive development, reduces physical work capacity, preterm
delivery and in severe cases increases risk of mortality particularly during prenatal period.
Anemia is a global health problem affecting both developing and developed countries with
major adverse effects on human health as well as social and economic development. According
to WHO (2008) report 57% (17 million) of pregnant women in Africa and 48% (18 million)
pregnant women in south East Asia suffer from anemia.
OBJECTIVE: The aim of this study is to assess the prevalence and associated factors of anemia
among pregnant women in wolkite health center on age 15-49 in 2013EC.
Method: An institutional based Cross sectional study will be conducted among pregnant women
in wolkite health center and SRS type of sampling technique will be used to recruit study
subjects. The hemoglobin value will be determined using hem-cue method. A total of 304
pregnant women will be enrolled during the study period.
Work plan and budget: A research team with three members will conduct the research within 1 months’
period and total of 5700 ETB will be required to carry out this research.
Key words: prevalence of anemia, Hemoglobin, Hematocrit.
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1. Introduction
1.1Background
Anemia refers to a condition in which the hemoglobin content of the blood is lower than normal
for person’s age gender and environment, resulting in the oxygen carrying capacity of blood
being reduced. It is also a condition that develops when our blood lacks enough healthy red
blood cells (RBC) both in quality and quantity or hemoglobin in circulation to carry adequate
oxygen to tissue (1, 2).
Anemia in pregnant women is an important public health problem worldwide. Anemia is major
health problem affecting all ages of the population with its highest prevalence among children
under five year and pregnant women (3, 4). WHO estimates that more than half pregnant women
in the world have hemoglobin level indicative of anemia (<11g/dl), the prevalence may be
however as high as 56 or 61% in developing countries (5).
Anemia prevalence during pregnancy differed from 18% in developed countries to75% in south
east Asia (6). The prevalence of anemia can be as high as 61% in developing countries with high
incidence and severity occurring among prim gravida living in malaria endemic areas (7)
Anemia ranges from mild, moderate to severe and 10-10.9 g/dl mild anemia 7-9.9g/dl (moderate
anemia) and <7g/dl (severe anemia) (8). Several types of anemia can develop during pregnancy.
This include iron deficiency anemia, folic acid deficiency anemia and vitamin B12 deficiency (9)
In sub-Saharan Africa, iron and folate deficiencies are the most common cause of anemia in
pregnant women (1), however iron deficiency anemia (IDA) is the cause of 75% of anemia
cases.
Vitamin B12 deficiencies may be an unrecognized contributor to anemia in this region of the
world due to reliance of the population on grains as dietary staples and low consumption of foods
of animal origin which are primary source of dietary vitamin B12.
Ethiopia is among countries where there is a high level of anemia among women of reproductive
age (15-49 Years) and pregnant women. A higher proportion of pregnant women are anemic (22
%) than women who are breastfeeding (19 percent) and women who are neither pregnant nor
breastfeeding (15%) (10). Therefore, the objective of this study will be to determine assess the
prevalence and associated factors of anemia among pregnant in wolkite Wolkite town, SNNP,
Ethiopia.
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1.2. Statement of the problem
Anemia is wide spread public health problem associated with increased risk of morbidity and
when sever mortality especially in pregnant women and young children with estimated global
prevalence of 51% and 43% respectively (1).
In pregnancy, anemia has significant impact on the health of fetus as well as that of mother. 20%
of maternal death in Africa has been attributed to anemia (11). Fetus is at risk of low birth weight
(LBW), morbidity and prenatal mortality due to impairment of oxygen delivery to placenta and
fetus (12, 13).
The consequence of anemia in pregnancy includes; still birth, low birth weight, reduced work
capacity, decreased mental performance, low tolerance to infections, and death from anemic
heart failure and maternal deaths due to uncontrolled bleeding (14).
Iron deficiency anemia during pregnancy is associated with higher rates of premature birth and
low birth weight.
In the developing world, pregnant women and their child are frequently exposed to parasitic
infections like malaria and intestinal helminthes, which co-exist widely with micronutrient
deficiencies and contribute to iron deficiency anemia and anemia also related to different sociodemographic, dietary and economic factors (15).
Associated factors include, low socio-economic status, illiteracy, ignorance, Infection with Hook
worm and intestinal helminthes causes gastro-intestinal blood loss resulting in depletion of iron
stores and consequently impaired erythropoietin. They also lead to mal-absorption and inhibition
of appetite, there by worsening micronutrient deficiency and maternal anemia (16). Add a
paragraph before this sentence which expresses situation of anemia on pregnant women in
Ethiopia at large and your specific study area So our aim will be to improvement mother and
child health during pregnancy related to anemia and its associated factor, community of
participants in the study and society
1.3. Justification of study
The research has great role in creating awareness on associated factors, prevention, treatment and
implications of anemia in pregnant women in catchment area of wolkite town, SNNP, Ethiopia.
The result of this study is significant for improvement of mother and child health during
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pregnancy related to anemia and its associated factor, community of participants in the study and
society at large.
2. Literature review
2.1. Prevalence of anemia
According to the study conducted at wolkite health center, wolkite town, southern Ethiopia, 384
pregnant women were participated in the study. Out of them 21.6% was anemic. In this study
49% were mild, 46% moderate and 5% were severely anemic (17).
Crosse sectional study conducted at TikurAnbessa Specialized hospital indicate that a total of
395 study subjects were participated. Among these participants, the overall prevalence of anemia
was 21.3%(18). Out of all pregnant women about 80.95% were mildly anemic,17.86% were
moderately anemic and 1.19% were severely anemic (18).
A cross sectional based study design was conducted Thailand Chula Longhorns University,
department of obstetrics and Gynecology revealed that a total 1,304 pregnant women were
recruited. The prevalence of anemia was 19.2 percent (251 cases) classified in each trimester, the
prevalence was 14.8 percent, 20.5 percent and 38.6 percent in the first second and third trimester
respectively (19).
According to the cohort study conducted on Municipality, the capital city of Kilimanjaro region
of Northern Tanzania, shows that 2654 pregnant women participated in the study and the overall
prevalence of anemia was 47.4%(95% CI ;45.5%-49.3%), of these 35.3%,9.9% and 2.1% had
mild, moderate and severe anemia respectively (20).
A cross sectional study conducted in university of Uyo teaching hospital in AkwaIbom state in
south-south geopolital zone of Nigeria revealed that 400 pregnant women were recruitedand
54.5% pregnant women were anemic. Among these majority (61%) had mild, 38.5% had
moderate and 0.5% had severe anemia (21).
According to cross sectional study conducted in New Halfa Teaching hospital eastern Sudan, 744
pregnant women who were attending ANC were studied, of these participants 466(62.6%)had
anemia(Hgb<11g/dl), of these 52.4%had mild anemia, 8.1% had moderate anemia and 2.2%have
severe anemia (22).
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A cross sectional study done in SidiBel Abbes region west of Algeria in 2011, indicate that out of
242 pregnant women attending ANC, the overall prevalence of anemia was 40.08%, based the
severity of anemia 36.08% had mild,49.48% moderate and 14.43% have severe anemia (25).
According to World Health Organization- World Health Statistics 2013 the average prevalence of
anemia in the world is 41.8%. Many studies show that anemia in pregnancy is globally common
but Africa and Asia bear the greatest burden (12). In Africa and Southeast Asia, the prevalence is
estimated at 57.1% and 48.2% respectively. This is twice as common as in America and Europe
where prevalence is estimated at 24.1% and 25.1% respectively (12,13).
Sub Saharan Africa bears the major burden of disease. Prevalence of anemia in pregnancy in
Nigeria is between 30-40%. In Ethiopia, overall prevalence of anemia was found to be 41.9%.
With urban areas having prevalence of 35.9% compared to the rural population at 56.8%(14,15).
2.2 Associated factors of anemia
According to the study conducted at wolkite health center, wolkite town, southern Ethiopia, 384
pregnant women’s were participated in the study. Pregnant women with age >34 rural residences,
history of malaria attack, hook worm infection and absence of iron supplementation are
significantly associated with increased risk of anemia. The most prevalent intestinal parasite
among pregnant women’s in the study is hook worm (4.7%) (17).
A cross sectional study conducted in Shallaworeda, west Arsi zone, Oromia region, Ethiopia,
total of 374 pregnant women were participant. According to this finding, family size of five or
more were found to be significantly associated with the occurrence of anemia in pregnancy and
intake of vegetables and fruits less than ones per day, intake of tea always after meal and
recurrence of illness during pregnancy were additional factor associated with anemia (18).
Based on the study conducted on Gilgel Gibe dam, in south western Ethiopia a cross sectional
study done on the total of 388 pregnant women. Pregnant women’s who were rural residents
(AOR=1.62,95% CI;1,02-2.62, P=0.042), not using ITNs during the study period
(AOR=2.84,95% CI;1.33-6.05, P=0.007), those who were plasmodium malaria infected
(AOR=11.19,95% CI;3.31-37.7, P=0.01) and those with STH infections (AOR=1.82,95%
CI;1.16-2.87, P=0.001) had higher odds of being anemic than those who were urban residents
using ITNs free of plasmodium malaria and STH infection respectively. There was a significant
correlation between increasing Hook worm parasite load (r=-0.110, p<0.001), Ascaris
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lumbricoides (r=-.122, p<0.001) and Tricuiristrichiura(r=-.025, P<0.001) and decreasing
hematocrit value(24).
A community based cross sectional study conducted on Gode town Eastern Ethiopia, the total of
577 pregnant women was participants. Among these more than half of (76.8%) of the anemic
study participants were from large families (>5 family members), and most of them are
multiparous (>2) and multigravidas (>3) (21).
According to cross sectional study conducted in New Halfa Teaching hospital eastern Sudan, 744
pregnant women who were attending ANC were studied, the prevalence of anemia was
significantly high in grandmulti gravidae. Malaria (OR=4.5,95% CI 2.5-8.1; P<0.0001) and pica
(OR=1.6,95% CI 1.05-2.6;P=0.03) were the risk factor for anemia(22).
A facility based cross-sectional study involving 258 pregnant women,were conducted from
March to June 2013 , on the prevalence of anemia and associated factors among pregnant women
attending antenatal care(ANC) at Bisidimo Hospital in southeast Ethiopia,residence in rular
area(AOR=3.3,95% CI:1.5-7.4),intestinal parasitic infection(AOR=2.5,95%CI:1.3-4.8) and
history of heavy menstrual cycle(> 5 days of menses)(AOR=2.7,95%CI:1.3-1.7) were the
pridisposing factors of anemia among the pregnant women(23).
3. OBJECTIVES
3.1 General objectives
 To determine assess prevalence of anemia and its associated factor among pregnant
women in wolkite Wolkite health center SNNPR, Ethiopia 2021.
3.2 Specific Objectives
 To determine the prevalence of anemia in pregnant women
 To assess identify the associated risk factors of anemia during pregnancy
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. Methods and Materials
Put your study area background here
4.1 Study Period and Study DesignStudy design and period
Institutional based Cross-sectional study will be conducted among pregnant women in wolkite
health center, SNNPR, Ethiopia, 2021.
4.2 Study Area
The study will be conducted in Wolkite town which is the capital city of Gurage zone. found in
SNNPR and 158KM far from Addis Ababa capital city of Ethiopia in south-west direction and
429km away from Hawassa which is, the capital city of the Region. wolkite town is located
between latitude of 8 17 ̸ N 37 47 E
̸ and longitude of 8.283 N 37.783 E with an elevation of
1,910 and 1,935 meters above sea level The structural plane of wolkite town is set up from 6
kebeles and 3 sub-towns. The 3 sub-towns are Bekure, Addis Brihan and gubreye plus the
corresponding 6 kebeles are selamber, Edigetchora and Menahiria in Addis Brihan sub-city,
Addis hiwot and EdigetBer in Bekure sub-city and 01 kebele in Gubrye sub-city. According to
wolkite town statically agency report, Wolkite town has a total population of 70,796 peoples of
these 53% are males, 47% are females. (2007 census)
4.3. Source population and Study population
Source populations will be all pregnant women attending wolkite health center for ANC
follow up purpose from June 14 to july 11, 2021GC.
Study population will be all pregnant women who will be selected by Systematic Random
sampling method from source population.
Study population will be selecte pregnant women who visit for ANC in wolkite health center. Those
pregnant that fulfill the inclusion criteria was enroll in the study .
. 4.4 Eligibility criteria
4.3.1 Inclusion criteria
Pregnant women, volunteer for interview and to provide blood sample, who had no early
bleeding will be included.
4.3.2 Exclusion criteria
Pregnant women who are severely ill, who had iron supplementation will be excluded from the
study.
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4.4 Sample size and sampling technique
4.4.1 SAMPLE SIZE
304 pregnant women will be selected by SRS method. Total sample size to be taken will be
determined by using single population proportion formula with 95% confident interval and
marginal error (d) of 5%. Best sampling techniques will be used to get the required sample size
during study period. Study on prevalence of anemia in mizan-tepi university teaching hospital
was (23.5%).
n=z2x p(1-p)
d2
Where
n=desired sample size of the population valid only when the population is more than 10000
z= standard deviate usually 1.96 which corresponds with 95% confident interval
p=proportion of target population to have the particular characteristics under study
d=degree of accuracy usually 0.05
1.96 2 xo .235 x 0.432
0. o 5 2
= 276.2+(10%of 276.2) =304
Non-response rate 10%=28
The total number will be 304304+28
4.4.2 Sampling technique
Considering 95% confidence interval, 5% margin of error and 23.5% proportion 304 patients
was included in the study. Those women who self-reported to the health center were included
until the required sample size was obtained. The samples were emulsified in a 10% formalin
solution. Stool examinations were done using formal ether concentration technique, which is
considered the most sensitive for most intestinal helminthes.
The hemoglobin concentration in a fresh capillary or ant coagulated blood sample will
determined photo metrically using a dry reagent system. The red cells will be lysed and
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hemoglobin will be converted to azidemethemoglobin by sodium nitrite and sodium azide. This
method of HGB measurement is a widely used point-of-care test.
Blood sample will be processed by collecting whole blood from the study subject and by filling
specimen cuvette with whole blood in a continuous process without bubbles; the specimen
cuvette will be filled with blood immediately as much as possible to prevent clotting.
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44.5 Study variable
4.5.1 Dependent variable
 Anemia
4.5.2 Independent variable
 Age
 Sex
 Education status
 Intake of vegetables and fruits
 Family planning utilization history
 Family size
 Parasitic infection
 Socio-economic status
4.6 OPERATIONAL DEFINITONS
Anaemia- Anaemia during pregnancy is considered when haemoglobin concentration is <11g/dl.
Severe anemia– a condition in which hemoglobin concentrations less than 7g /dl in the Blood
of individual
Mild hemoglobin – Hemoglobin concentrations 10- 10.9g/dl in the blood of the individual
Moderate hemoglobin – Hemoglobin concentrations 7.1-9.9g /dl in the blood of the individuals.
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4.7 Data collection procedure
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5. Ethical consideration
The study will be conducted after getting ethical clearance from Wolkite University, College of
Medicine and Health Science department of midwifery.
Administrators of the study population- (wolkite health center administrator) will be
communicated through formal letter written by Wolkite University college Medicine and Health
Science department of midwifery. The respondents will be notified verbally about the objective
of the study. The study participants will be informed that they can quit whenever they wanted to
and also will be assured that their confidentiality will be maintained. We mustn’t be angry and
aggressive.
6. Dissemination of result
After completion, The final result paper will be submitted to Wolkite University College of
medicine and Health Science department midwifery, and even an effort will be made to
published it to be accessible for every one online.
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7. Work Plan and budget
Table 1 Work plan for Prevalence of anemia and associated factor among pregnant women in wolkite
SNNP, Ethiopia
Activities
April
W
k1
W
k2
Time Period 2021
June
July
May
W
k
3
wk
4
wk
1
W
k2
W
k3
W
k4
W
k1
Wk
2
W
k
3
W
K
4
Wk
1
August
WK
2
Wk
3
Wk
4
Wk
1
Wk
2
Submission and approval of
research title
Writing of the first draft
proposal
Submission first draft
proposal for advisors
Submission of final
proposal and secure ethical
clearance
Duplication of
questionnaire
Data collection and data
checking for compilation
Data analysis and
interpretation
Submission first draft
research for advisors
Submission of the final
research paper
Defense and
Presentation
Dissemination of the result
8. Cost of the project
The cost listed below will be required to carry out this research. The costs are calculated
according to current price and it didn’t consider changes in the future. The items listed are
considered to be essential to carry out this research and we have tried to exclude all items that are
considered to be non-essential.
Table 2 List of budget items and their respective cost
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Wk
3
Wk
4
no
Item
Amount
Measurement
Single
Total
price
price
Birr
Cent
Birr
Cent
1
Paper
2
Pack
250
00
500
00
2
Pen
15
Pisces
150
00
150
00
3
Pencil
5
Pisces
50
00
50
00
4
Writing, print ,copy
-
-
2000
00
6
Transport
-
Person
1000
00
7
Other expense
-
-
1000
00
Total
22
-
5700
00
450
Where is your questioner?
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-