KEAMED MEDICAL COLLEDGE

DEPARTMENT OF NURSING

PREVALENCE OF ANEMIA AND ASSOCIATED FACTORS AMONG

PREGNANT WOMEN ATTENDING ANTENATAL CARE AT HIWOT
AMBA HEALTH CENTER SINCE 2016 G.C
BY: YOSEF FIKRE
: SENTAYEHU KITAWE
: ABIYE WENDESEN
: TEFERA DESALEGN
ADVISOR: Getachwe G/Medehen BSc,MPH

A RESEARCH PROPOSAL SUBMITTED TO KEAMED MEDICAL

COLLEDGE, DEPARTMENT OF NURSING FOR PARTIAL
FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF
BACHELOR OF SCIENCE IN NURSING

MAY, 2016 G.C

Addis Ababa Ethiopia

 PREVALENCE OF ANEMIA AND ASSOCIATED FACTORS AMONG
PREGNANT WOMEN ATTENDING ANTENATAL CARE AT HIWOT
AMBA HEALTH CENTER SINCE 2016 G.C

BY:
:
:
:
ADVISOR:

MAY, 2016 G.C

Addis Ababa Ethiopia

Acknowledgements

First, we would like to thanks almighty God for the continuous help in every step of our research
proposal work. God! We have nothing to repay you.
Next, we would like to express our gratitude to keamed medical college mostly Research Office
members for their approving this research title & giving letter of permission for me to conduct
this research project.

we would like to express our deepest gratitude to advisor Getachew G/medhin (Bsc, MPH) for
his unfailing support; guidance and commenting this research and attempt to be one of the best
published researches of the graduate class.
Acrimony
ANC Ante Natal Care

HIV Human Immunodeficiency Virus

MCH Maternal and Child Health

Mg Milligram

WFP World Food Program

WHO World Health Organizational

ETB Ethiopian birr

HAHC Hiwot Amba health center

IDA Iron deficiency anemia

Hb Hemoglobin

SPSS Statistical Package for Social Sciences

MCV mean red cell volume

Table of content
Acknowledgements 3
Acrimony 4
Table of content 5
List of Tables 7
List of figure 8
Summary 9
CHAPTER ONE 10
1 INTRODUCTION..............................................................................................................................10
1.1Backgrounds 10
1.2 Statement of the problem 12
1.3 Significance of the study 14
1.4 Justification 15
CHAPTER TWO 16
2. LITERATURE REVIEW..................................................................................................................16
CHAPTER THREE 21
3 OBJECTIVE.......................................................................................................................................21
3.1 General Objectives 21
3.2. Specific objectives 21
CHARTER FOUR 22
4 METHODOLOGY.............................................................................................................................22
4.1 The study area 22
4.2 Study period 22
4.3 Study design 22
4.4 population 22
4.4.1 Source population 22
4.4.2 Study population 22
4.4.3 Study units 22
4.5. Eligibility criterion 22
4.5.1 Inclusion criterion 22
4.5.2 Exclusion criterion 23
4.5 The sample size Determination and Sampling procedure 23
4.5.1. Sample size Determination 23
 4.5.2. Sampling procedure 23
4.6 Data collection instrument, process and quality assurance 24
4.7. Variables 24
4.7.1. Dependent variables 24
4.7.2. Independent variables 24
4.8. Operational Definition 24
4.9. Data analysis and interpretation 25
4.10. Dissemination plan 25
4.11. Ethical consideration 25
CHAPTER FIVE 26
Work plan 26
CHAPTER SIX 27
Budget Requirement..............................................................................................................................27
CHAPTER SEVEN 28
Reference..............................................................................................................................................28
APPENDIX I 31
QUESTIONNAIRE....................................................................................................................................31
APPENDIX II 33
LABORATORY FORM..............................................................................................................................33
APPENDIX III 34
CONSENT FORM................................................................................................................................34
List of Tables
Work plan --------------------------------------------------------------------------- table 1

Budget requirement -------------------------------------------------------------- table 2

List of figure
Fig. 1 --------------------------------------------------------------- conceptual framework schematic
Summary
Anemia is defined as a condition in which there is less than the normal hemoglobin (Hb) level in
the body, which decreases oxygen-carrying capacity of red blood cells to tissues. Anemia is a
global public health problem affecting both developed and developing countries with major
consequences for human health as well as social and economic development. It occurs at all
stages of the life cycle. To determine the prevalence of anemia and associated factors among
pregnant women attending antenatal care (ANC) at hiwot amba health center Addis Ababa
Ethiopia from Jun 12 to July 12 will be our goal and All pregnant women who attend ANC at in
HAHC will be the source population. Convenient sampling technique will be used to select the
pregnant mothers. Data will be collected by face to face interview and laboratory result. After
data collection, all collected data will be analyzed by version 20 SPSS. The results summarized
using tables and graphs, frequencies and other descriptive statistics.
 CHAPTER ONE

1 INTRODUCTION
1.1Backgrounds
Anemia is defined as a condition in which there is less than the normal hemoglobin (Hb) level in
the body, which decreases oxygen-carrying capacity of red blood cells to tissues. Anemia is a
global public health problem affecting both developed and developing countries with major
consequences for human health as well as social and economic development. It occurs at all
stages of the life cycle (3,24).
World Health Organization defines anemia as hemoglobin below 11g/dl as the lower limit
acceptable and 10.5g/dl in the second half of pregnancy. Anemia can further be classified into
mild anemia (10 -10.9g/dl), moderate anemia (7-9.9g/dl) and severe anemia (<7g/dl). An
estimated 58.27 million women worldwide are anemic during pregnancy, 95.7% of whom live in
developing countries. In Africa, the prevalence of anemia in pregnancy is estimated to be
between 35% and 75% as compared to the developed countries where prevalence is at 15% (1-3).
Globally, the most significant contributor to the onset of anemia is iron deficiency so that iron
deficiency anemia (IDA) and anemia are often used interchangeably. It is generally assumed that
50% of the cases of anemia are due to iron deficiency, but the proportion may vary among
population groups(3). The main risk factors for IDA include a low intake of iron, poor absorption
of iron from diets high in phytate or phenolic compounds, and period of life when iron
requirements are especially high (i.e. growth and pregnancy).

Iron is essential for synthesis of haem – a component of hemoglobin (Hb) - the oxygen carrying
pigment of RBC’s where 70% of iron found in body as hemoglobin. Iron is normally obtained
through the food diet and by recycling iron from old red blood cells and in the absence of the
required iron blood concentrations, blood cannot carry oxygen effectively and hence normal
functioning of every cell in the body will be affected (1, 2). Patients with anemia have similar
clinical symptoms irrespective of the cause. Fatigue, breathlessness, dizziness, lethargy, pallor of
the skin and inner eyelid and headache are some of the common complaints (26).

During pregnancy, the average total iron requirement has been estimated to be approximately
1200 mg for an average weight of 55 kg in a pregnant woman. The iron is used mainly for the
increase in maternal erythrocyte mass (450 mg), placenta (90– 100 mg), fetus (250–300 mg)
general losses (200–250 mg) and a blood loss at delivery corresponding to 150 mg iron (300–500
ml blood loss). Around 40% of women begin their pregnancy with low or absent iron stores
(serum ferritin <30 mg/l) and up to 90% have iron stores of <500 mg (serum ferritin <70 mg/l),
which is insufficient to meet the increased iron needs during pregnancy and postpartum. Iron
absorption requirements in the first trimester are around 0.8 mg/day, rising to 7.5 mg/day at third
trimester. (8)

The lowest normal hemoglobin in the healthy non-pregnant woman is defined as 12 g/dl. The
World Health Organization (WHO) recommends that haemoglobin ideally should be maintained
at or above 11.0 g/dl, and should not be allowed to fall below 10.5 g/dl in the second trimester.3
Pregnancy usually induces a slight increase (2–3 fl) in mean red cell volume (MCV),
independent of folate status. This is sometimes enough to mask the microcytosis normally found
in iron deficiency (internate) Fatigue, exhaustion, weakness, ‘less energy’ Cardiovascular
symptoms (e.g., palpitations) Pallor, pale mucous membranes and conjunctivae Tachycardia,
hypotension Cardiac hypertrophy in chronic cases are among major clinical symptoms.(8)

In a meta-analysis of several observational and intervention trials, (4) concluded that

approximately 20% of the maternal mortality seen in sub-Saharan Africa and South Asia is
attributable to anemia that is primarily the result of iron deficiency. Severe anemia has been
associated with an increased risk of stillbirth and infant mortality (5, 6). Based on several
observational studies there is an increased risk of delivering a preterm and/or low-birth-weight
infant for women who are anemic compared to those who are not Routine supplementation with
iron and folic acid is recommended by the WHO for all pregnant women, especially in
developing country including Ethiopia settings where the prevalence of anemia and iron
deficiency is high (2).
1.2 Statement of the problem
The global anemia prevalence among pregnant mothers was 41.8% (39.9%- 43.8%) ranging
from in number from 54 million to 59 million. (12) Anemia in pregnancy remains one of the
most intractable public health problems in developing countries. Globally, anemia contributes to
20% of all maternal deaths. Although not always shown to have a causal link, severe anemia
contributes to maternal morbidity and mortality. (South)

WHO classifies the public health significance of anemia based on national anemia prevalence
estimates and, as evidenced by the prevalence rates in anemia in pregnant women and children is
a severe public health problem (anemia prevalence ≥ 40%) in regions such as Africa, the Eastern
Mediterranean, and South-East Asia (3). In sub-Saharan Africa the prevalence rate for pregnant
women is 50% while that for non-pregnant women is 40%(7). Using anemia as an indicator and
data collected from multiple countries, the World Health Organization (WHO) estimates that half
of children and women and up to a quarter of men are iron-deficient in developing countries
(12).

In (2006) micro nutrient initiative (MI) of Ethiopia estimated 27.0% & 30.6% prevalence of
anemia among women of reproductive age and pregnant women respectively (13). A study
conducted by Jamal in Ethiopia showed that iron deficiency anemia was 18.1%. According to the
current Ethiopian demographic and health survey seventeen percent of Ethiopian women age 15-
49 are anemic, with 13 percent having mild anemia, 3 percent having moderate anemia, and 1
percent having severe anemia. A higher proportion of pregnant women are anemic (22 percent)
than women who are breastfeeding (19 percent) and women who are neither pregnant nor
breastfeeding (15 percent) (14).

High menstrual blood loss, Vegetarians or adults with special diets, Athletes, Chronic blood loss
e.g., intestinal disease, Acute blood loss, e.g., surgery, Chronic diseases and Parasitic diseases
are the major risk factors that contributes to iron deficiency anemia (8).
Anemia in pregnancy may also lead to premature births, low birth weight, fetal impairment and
infant deaths (11). Apart from maternity-related complications, anemia has major consequences
on human health and social and economic development. It adversely affects physical and
cognitive development in children (12) and is associated with increased frailty risk in
community-dwelling older adults (13).
Iron deficiency in childbearing women increases maternal mortality, prenatal and perinatal infant
loss, and prematurity. forty percent of all maternal perinatal deaths are linked to anemia.
favorable pregnancy outcomes occur 30-45% less often in anemic mothers, and their infants have
less than one-half of normal iron reserves. such infants require more iron than is supplied by
breast milk, at an earlier age, than do infants of normal birth weight. moreover, if pregnancy-
induced iron deficiency is not corrected, women and their infants suffer all the consequences
described above. The aim of this study is, therefore, to determine the prevalence of iron
deficiency anemia and associated factors among pregnant women attending antenatal care
(ANC) at hiwot amba health center.
1.3 Significance of the study
Anemia is a significant public health problem in Ethiopia. According to the 2012 Ethiopian
Central Statistical Agency report, nationally, 44% of children aged 6-59 months were anemic,
with 21%, 20% and 3% having mild, moderate and severe anemia. Moreover, 17% of women
aged 15-49 were anemic; of which 13% had mild anemia, 3% were moderately anemic, and less
than 1% were severely anemic. Iron deficiency anemia was ranked as one of the significant
micronutrient deficiency problems in Ethiopia [19,20].
Epidemiological studies done on prevalence of anemia in pregnant women in Ethiopia have
reported varying magnitude of anemia and identified several factors associated with anemia [21-
23]. Determination of the magnitude of anemia among pregnant women helps to monitor health
of the pregnant women, contributing to reduction in maternal morbidity and mortality. Also,
assessment of factors predisposing to anemia in a local area enables to take targeted intervention
activities. Therefore, this study is aimed at determining prevalence of anemia and assessing
associated risk factors among pregnant women attending antenatal care (ANC) at Hiwot Amba
health center Addis Ababa Ethiopia.
1.4 Justification
Iron Deficiency Anemia (IDA) is one of the most common nutritional disorders and it has public
health importance in developing countries like Ethiopia. It is the most common cause of
nutritional anemia in adolescents and women of reproductive age. About 2 billion people are iron
deficient, with half of them manifesting clinical signs of anemia. The economic and social
consequences of iron deficiency anemia, as yet un-quantified, are thought to be enormous
including a significant drain on health care, education resources and labour productivity, and
reduced physical and mental capacity of large segments of the population. Although the most
important determinant factor of iron deficiency anemia is poor bioavailability of dietary iron in
most developing countries, intestinal parasites, especially hookworm infestation are reported to
be a major cause - other causes include malaria and congenital hemolytic diseases.
Although the magnitude of IDA in Ethiopia has not yet been well documented nationwide,
limited data is available on the prevalence rate of IDA among pregnant and lactating women in
the rural communities, which showed a prevalence rate of 18.7%. In a more recent study
conducted in urban slum communities of Addis Ababa administrative region, a prevalence rate of
22.3% was reported in lactating women suggesting that iron deficiency anemia is of moderate
public health problem in the country which is in conformity with one of the earlier study reported
by Hofvander (27).
 CHAPTER TWO

2. LITERATURE REVIEW
CONCEPTUAL FRAMEWORK
NARRATIVE
Anemia in pregnancy is a major Public Health concern and more so in Sub-Saharan Africa.
Poverty is an important contributing factor. People afflicted by poverty live in unsanitary
conditions leading to parasitic infestations such as malaria and soil transmitted helminthes. This
leads to secondary iron deficiency anemia. These pregnant women cannot afford adequate and
well balanced diets and hence end up with micronutrient deficiency. Increasing parity also
aggravates the poverty which causes depletion of the iron stores in the pregnant woman. This
leads to anemia in the pregnant woman.
Without any interventions, anemia in pregnancy leads to maternal and fetal morbidity and
mortality such as puerperal infections, preterm labor, poor weight gain, postpartum hemorrhage,
prematurity, low birth weight, fetal cognitive impairment and poor APGAR scores and even
infant deaths.
This grave situation can be improved by carrying out studies on the anemic pregnant women to
determine the actual prevalence, etiologic type and socio-demographic factors predisposing the
pregnant women to anemia and thus estimate burden of disease. From the study, policies and
interventions will be formulated for corrective action in terms of either treatment of anemia or
prophylaxis for every pregnant woman.
CONCEPTUAL FRAMEWORK SCHEMATIC: Fig. 1

Parasitic Fetal complications

Prematurity, low birth
Infestation
weight, Poor APGAR
(Malaria/ Undiagnosed scores, fetal impairment
Helmint impairment

Maternal complications
PPH/APH
Micronutrient Infections, preterm labor,
deficiency ANEMIC poor weight gain
(Iron/Folate) PREGNANT weight gain
WOMAN

diagnosed

inves TREATED
Increasing tigati
parity ons

TREATED
ESTIMATE
Inadequate BURDEN
resources

HEALTHY
MOTHER
Further Increase Prophylaxis Treatment AND
research awareness BABY

Published rates of the prevalence of anemia during pregnancy in developing countries range
from 53 to 61% for Africa, from 44 to 53% for South-East Asia and from 17 to 31% for Europe
and North America. It is assumed that iron and folate deficiency are the most common
etiological factors responsible for this situation. Anemia of pregnancy is not merely common in
these countries; it is also frequently severe. It is estimated that 20% of pregnant women have Hb
of less than 8 g/dl, and that between 2 and 7% have a value of less than 7 g/dl. The situation is
aggravated during the postpartum period because of blood loss during labor and in the
puerperium. Even in modern obstetrics, peripartum blood losses of more than 500 ml are not
uncommon. A variety of the interventions used in obstetrics today, the technique by which labor
is induced, the use of regional analgesia and factors such as assuming an upright position while
giving birth, can all lead to heavier bleeding during labor and delivery (8).
A prospective study on severe anemia in pregnancy was done in Kisumu District and it studied
prevalence and risk factors. Of the respondents who developed obstetric complications, 22%
were found to be anemic. Poor pregnancy care, illness during pregnancy, socioeconomic
conditions of the mother and the sanitary conditions of the household among other things also
significantly increased prevalence of anemia in their subjects.(32)A study done in Kilifi District,
10% of women booked for antenatal care had severe anemia (Hb<7g/dl) with 76% having
Hb ,11g/dl and the main causes for the anemia were reported as iron deficiency often
exacerbated by hookworm infestation, malaria, folate deficiency and HIV infection.(17)
The etiology of anemia varies from region to region and is thought to be environmentally
determined. World Health Organization reports the commonest cause to be nutritional. Iron
deficiency is the most common and widespread nutritional disorder in the world. [19]As well as
affecting a large number of children and women in developing countries, it is the only nutrient
deficiency which is also significantly prevalent in industrialized countries. The numbers are
staggering: 2 billion people – over 30% of the world’s population – are anemic, many due to iron
deficiency, and in resource-poor areas, this is frequently exacerbated by infectious diseases.
Malaria, HIV/AIDS, hookworm infestation, schistosomiasis, and other infections such as
tuberculosis are particularly important factors contributing to the high prevalence of anemia. Iron
deficiency affects more people than any other condition, constituting a public health condition of
epidemic proportions. More subtle in its manifestations than, for example, protein-energy
malnutrition, iron deficiency exerts its heaviest overall toll in terms of ill-health, premature death
and lost earnings. (19,36)

Iron deficiency and anemia reduce the work capacity of individuals and entire populations,
bringing serious economic consequences and obstacles to national development There is
documented loss of cognitive function. (37,38) Other micronutrients like Vitamin B-12, Folic
acid and Zinc deficiencies have also been associated with anemia in pregnancy(31,33,34) leading
to a combination of both microcytic and megaloblastic Anemia Factors that put women at risk of
acquiring anemia in pregnancy include twin or multiple pregnancy, spacing between two
pregnancies is short and heavy menstrual flow before pregnancy due to either fibroids or
abnormal uterine bleeding. Other risk factors for anemia included older maternal age, education
below junior high school, farming occupation, mild pregnancy-induced hypertension (PIH) and
severe PIH . Also rate of anemia was higher among those who do not practice any form of family
planning and those with increased parity. (30,18) Adolescent prime gravidas also have a higher
risk of anemia in pregnancy due to their age and more often than not poor nutritional status. (29)

A cross-sectional community-based study with analytic component was conducted during June-
July 2005 in nine of the 11 regions of Ethiopia by Jemal Haidar shows that The overall
prevalence of anaemia, iron deficiency, iron-deficiency anaemia, deficiency of folic acid, and
parasitic infestations was 30.4%, 50.1%, 18.1%, 31.3%, and 13.7% respectively. Women who
had more children aged less than five years but above two years, open-field toilet habits, chronic
illnesses, and having intestinal parasites were positively associated with anaemia. Women who
had no formal education and who did not use contraceptives were negatively associated with
anaemia. The major determinants identified for anaemia were chronic illnesses [adjusted odds
ratio (AOR)=1.1, 95% confidence interval (CI) 1.15-1.55), deficiency of iron (AOR=0.4, 95% CI
0.35-0.64), and deficiency of folic acid (AOR=0.5, 95% CI 0.50-0.90) (25).

A facility based cross-sectional study was employed 714 pregnant women who were attending
antenatal clinics in health facilities found in the study area from April to May 2014 shows that
The overall prevalence of anemia (hemoglobin < 11 g/dL) among the pregnant women was
36.1% (95% CI = 32.7%–39.7%) of which 58.5% were mildly, 35.7% moderately, and 5.8%
severely anemic. In pregnant women, rural residence (AOR = 1.75, 95% CI = 1.01–3.04), no
education/being illiterate (AOR = 1.56, 95% CI = 1.03–2.37), absence of iron supplementation
during pregnancy (AOR = 2.76, 95% CI = 1.92–5.37), and meal frequency of less than two times
per day (AOR = 2.28, 95% CI = 1.06–4.91) were the independent predictors for increased
anemia among the pregnant women. Conclusions. Anemia was found to be moderate public
health problem in the study area. Residence, educational status, iron supplementation during
pregnancy, and meal frequency per day were statistically associated with anemia among the
pregnant women. Awareness creation and nutrition education on the importance of taking iron
supplementation and nutritional counseling on consumption of extra meal and iron-rich foods
during pregnancy are recommended to prevent anemia in the pregnant women .( 28)
 CHAPTER THREE

3 OBJECTIVE
3.1 General Objectives
 To determine the prevalence of iron deficiency anemia and associated factors among
pregnant women attending antenatal care (ANC) at hiwot amba health center Addis
Ababa Ethiopia from Jun 12 to July 12.
3.2. Specific objectives
 To determine the prevalence of iron deficiency anemia among pregnant women’s
 To assess factors associated with iron deficiency anemia in among the study group
 To Determine the prevalence of anemia in relation to reproductive and sociodemographic
characteristics among pregnant women
 CHARTER FOUR

4 METHODOLOGY
4.1 The study area
Addis Ababa the capital city of Ethiopia has a total 10 sub cities and 96 health centers. Among
them Kirkos sub city is found at heart land the city and is the seat of many international
organizations including Africa and European unions. The sub city has 6 health centers and one
hospital and non-government clinic. Hiwot Amba health center is one of the new health centers
established in 2004 E.c found in woreda 6 with a catchment population of 14273 among them
reproductive age group women accounts for 2500.

4.2 Study period

The study will be conducted from Jun12 to July12 G.C

4.3 Study design

Institutional based cross sectional study will be implemented.

4.4 population
4.4.1 Source population
All pregnant women found in Addis Ababa.

4.4.2 Study population

All pregnant women who attending ANC at HAHC during the time of data collection period.

4.4.3 Study units

Individual pregnant mothers who visited ANC at HAHC, will be selected for the study during the
time of data collection period.

4.5. Eligibility criterion

4.5.1 Inclusion criterion
All pregnant mothers who came to HAHC for ANC follow up during the time of data collection
period.
4.5.2 Exclusion criterion
Pregnant mothers who is mentally ill and physically not capable to communicate and listen.
Pregnant mothers who is not volunteer to participate.

4.5 The sample size Determination and Sampling procedure

4.5.1. Sample size Determination
For purposes of this study, we takin P value of 0.223 from the prevalence of anemia in
pregnancy was taken as In a more recent study conducted Jemal Haidar2, Tsegaye Demissie1
Iron Deficiency Anemia among Women of Reproductive Age in Nine Administrative Regions of
Ethiopia Addis Ababa administrative region, a prevalence rate is 22.3%
Fisher’s formula for estimating means and proportions was used to determine the sample size.
n =minimum sample size
= 1.962x p (1-p)/d2

p = proportion in target population estimated to have certain characteristics in this case

overall prevalence of anemia

=22.3%
d =precision/reliability to determine p=5%
Therefore; sample size of ANC mothers
n=1.962(0.223(1-0.223)/ (0.05)2
Thus n=136
A sample of 136 antenatal women will be selected.

4.5.2. Sampling procedure

The study units all pregnant mothers who visited ANC at HAHC during the time of data
collection period and full filled the inclusion criterion will be selected for the study through
convenience sampling technique and included in the sample until the required sample size
becomes achieved.
4.6 Data collection instrument, process and quality assurance

The data will be collected by face to face interview by willing health professionals. A
questionnaire will be adopted from other relevant questionnaire. For verifying the consistency
questionnaire will be prepared by English and translated in to Amharic then back to English.
Pretest will be done on 5% of the study population in the area which have similar characteristics
with the study area, but not supervisors in the field concerning validity of the questionnaire
prepared. The data will be collected by a trained up to 4 years experienced health professionals
who took one days training on the data collection technique.
The questionnaire had the following sections:
1. Socio-demographic and economic data
2. Reproductive history including the index pregnancy
3. Clinical examination findings
4. Laboratory investigation results

4.7. Variables
4.7.1. Dependent variables

 Prevalence

 Iron deficiency anemia and associated factor

4.7.2. Independent variables
 Socio-demographic and economic characteristics: Age, marital status, occupation,
educational status, ethnicity, religion, average monthly income, source of information
and, family size.
 Health service related factors: attendance of antenatal care services, number of
antenatal visits taken and provision of advice on anemia by healthcare staff.
 Obstetrics: gestational age, mode of delivery, Birth interval, parity birth order

4.8. Operational Definition

 Prevalence: is the proportion of a population who have (or had) a specific characteristic
in a given time period -in medicine, typically un illness, a condition, or a risk factor such
as depression of smoking
  anemia:

 Iron deficiency anemia and

 associated factor
4.9. Data analysis and interpretation
The data collected will be checked for its internal consistency and accuracy. The analysis of data
will be performed by SPSS version 20 after training was taken from advisor. The analyzed data
will be compiled and summarized by using tables and pie-chart in the respective variable and
objective.

4.10. Dissemination plan

After final presentation, the result will be submitted to keamed medical college department of
nursing in hard and soft copy.

4.11. Ethical consideration

Ethical clearance will be obtained from Keamed medical college. Then following that request
will be send to HAHC from Keamed medical college and a written permission will be secured by
the ethical commit of HAHC. The information collected will be not described in related to
individual names.
 CHAPTER FIVE

Work plan
Activities Months Responsible
person
May June July

Weeks 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

Investigator

topic selection

Writing Investigator
introduction

Writing Investigator
statement of the
problem

Writing Investigator
literature
review

Writing Investigator
objectives

Writing Investigator
methodology

Finalizing Investigator
proposal

Data collection Investigator

Analyzing data Investigator

Supervision Advisor

Submission of
research thesis

Work plan -------------------------------------------------------------------- table 1

 CHAPTER SIX

Budget Requirement

Activity unite of Required qty Unit cost in Total cost

measurement birr

Stationary
A4 size p Pack 1
Pen Pieces 4
Pencil Pieces 1
Ruler Pieces 1
Rubber Pieces 1
CD Pieces 1

Human power
Secretary Per page 40
Advisor
Investigator Per day 10

Miscellaneous cost
Transport Per week 8
Photo copy Per page 40
Print 300
Per page

Total

10%contingency

Ground total

Budget requirement --------------------------------------------------------------- table 2

 CHAPTER SEVEN

Reference
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3. World Health Organization/United Nations University/UNICEF: Iron Deficiency Anemia,

Assessment, Prevention and Control: A Guide for Programme Managers. Geneva: WHO; 2001.
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working notes series no. 3. Academy for Education Development, Washington D.C.

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MICRONUTRIENT DEFICIENCIES

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APPENDIX I

QUESTIONNAIRE
ANC
No…………………………………………………………………………………………………
………………………………………………………………….
CONTACT MOBILE NUMBER/ ID NUMBER...……………………………….......................
1. General Information
1. Age ……………………………..
a. 15-20yr
b. 21-30yr
c. 30-40yr
d. >41yr
2. Parity……………………………..
a. Primigravida ………….
b. Para 1 ……………………..
c. Para 2 ……………………..
d. >Para 3 ………………
3. Ages of the children……………….
4. Education level
a. Primary…………………….
b. Secondary………………….
c. College/university…………
d. None ……………………….
5. Marital status………………………
a. Married ……………..
b. Single ……………..
c. Separated/divorced………..
6. Occupation
a. Employed………………….
b. Not employed………………
7. Husband’s Occupation
a. Employed…………………
b. Not employed……………..
Physical examination
(Yes/No)
1. Pallor …………………
2. Jaundice ………………….
3. Edema ………………….
4. Splenomegaly ………………….
5. Temperature ………………….
6. Fundal height ………………….
APPENDIX II

LABORATORY FORM
ANC NO.
STUDY NO.
1. FULL HEMOGRAM
a. Hemoglobin concentration g/dl
i. 10-10.9g/dl …………………………
ii. 7-9.9g/dl ……………………………
iii. <7g/dl ……
2. Peripheral Blood Film Picture
a. Malaria parasite present ………………
b. Malaria parasite absent ………………..
3. Stool for ova and cyst (yes/no)
a. Ascaris…………………………………
b. Trichuris trichuria ……………..
c. Hookworms …………………………..
d. E. histolytica ………………………….
e. S. mansoni ……………………………
APPENDIX III

CONSENT FORM

Study participation consent form

Prevalence of anemia among pregnant women attending HAHC Ante Natal clinic hiwot amba
health center
Investigators

Investigators' statement

We are asking you to be in a research study. The purpose of this consent form is to give you the
information you will need to help you decide whether to be in the study. Please lesson as
cheerfully when we read and you may ask questions about what we will ask you to do, the risks,
the benefits and your rights as a volunteer, or anything about the research or in this form that is
not clear. When
all your questions have been answered, you can decide if you want to be in this study or not.
This process is called “informed consent”.

Purpose and benefits

The aim of this study is determine the factors that determine the prevalence of anemia among
pregnant women attending ante natal clinic at HAHC. Through this study we want to understand
the prevalence of anemia and factors that predispose women to anemia and which type of anemia
is prevalent among pregnant women.
This study will benefit society by providing information that can be used to improve services to
ensure more pregnant women are diagnosed and treated early for anemia so as to manage the
potential complications that arise. This will ultimately lead to healthier births and improved rates
of maternal and neonatal mortality.

Procedures

This is what will happen if you decide to participate in this study. I will ask you questions about
yourself, your past pregnancies, and your social economic status and on the current pregnancy. If
your hemoglobin level is less than 11g/dl I will do further examinations i.e. I will draw 2ml of
blood for a full haemogram and blood slide for malaria parasites. Also I will require a stool
sample to investigate further causes of the anemia
Risks, stress, or discomfort

You may become embarrassed, worried, or anxious when answering some of the questions as
they are of a personal nature e.g. the socio-economic history. Participation in the study will
require you to commit your time. Completing the questions will take 30-40 minutes. However,
we will try to serve you as quickly as possible.

Other information

We will keep your identity as a research subject confidential. Only the investigator and Research
Committee will have access to information about you. The information about you will be
identified by the study number and will not be linked to your name in any records. Your name
will not be used in any published reports about this study.
Although we will make every effort to keep your information confidential, no system for
protecting your confidentiality can be completely secure. It is still possible that someone could
find out you were in this study and could find out information about you. You may withdraw
from the study; refuse to answer any of the questions asked or to have any of the tests described
above at any time without loss of benefit or penalty. If you have any questions regarding the
study you can contact the investigator listed above. You are free to refuse to participate in the
study, if you decide not to participate in the study you will receive similar care to that provided
to ANC mothers participating in the study.
Signature of investigator ______________________Date_________________
Name of Investigator______________________________________________