Prevalence and Factors Associated with Anemia among Pregnant Women Attending Antenatal Clinic at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

Gebreweld, Angesom; Tsegaye, Aster

doi:https://doi.org/10.1155/2018/3942301

Advances in Hematology

On this page

Abstract Background Methods Discussion Conclusion Data Availability Disclosure Conflicts of Interest Authors’ Contributions Acknowledgments References Copyright Related Articles

Research Article | Open Access

Volume 2018 | Article ID 3942301 | https://doi.org/10.1155/2018/3942301

Prevalence and Factors Associated with Anemia among Pregnant Women Attending Antenatal Clinic at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

Angesom Gebreweld¹and Aster Tsegaye²

Academic Editor: Elvira Grandone

Received23 Mar 2018

Revised01 Jul 2018

Accepted07 Aug 2018

Published29 Aug 2018

Abstract

Background. In pregnancy, anemia is an important factor associated with an increased risk of maternal, fetal, and neonatal mortality, poor pregnancy outcomes, and impaired cognitive development, particularly in developing countries like Ethiopia. This study aimed to assess prevalence and factors associated with anemia among pregnant women attending antenatal clinic at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Method. A cross-sectional health facility based study was conducted on 284 pregnant women to assess prevalence and factors associated with anemia at St. Paul’s Hospital Millennium Medical College from June to August 2014. Data on sociodemographic and clinical characteristics of the study participants were collected using a pretested structured questionnaire by interview and review of medical records. About 4 ml of venous blood was collected from each subject for peripheral blood film and complete blood counts (CBC). Binary Logistic regression analysis had been used to check for association between dependent and independent variables. In all cases, P value less than 0.05 was considered statistically significant. Result. The prevalence of anemia was found to be 11.6% (95 % CI; 7.8%-14.8%). Pregnant women in the second [AOR (95% CI), 6.72 (1.17-38.45), and P=0.03] and third trimester [AOR (95% CI), 8.31 (1.24-55.45), and P=0.029] were more likely to be anemic when compared to pregnant women in their first trimester. Pregnant women who did not receive iron/folic acid supplementation [AOR (95%CI), 4.03(1.49-10.92), and P=0.01] were more likely to be anemic when compared to pregnant women who did take supplementations. Conclusion. In this study the prevalence of anemia in pregnancy was low compared to the findings of others. Gestational age (trimester) and iron/folic acid supplementation were statistically associated with anemia. Therefore, iron supplementation and health education to create awareness about the importance of early booking for antenatal care are recommended to reduce anemia.

1. Background

Anemia is a decrease in the oxygen carrying capacity of the blood. It can arise if the hemoglobin (Hb) concentration of the red blood cells (RBCs) or the packed cell volume of RBCs (PCV) is below the lower limit of the reference interval for the individual’s age, gender, geographical location, and physiological status [1, 2].

During pregnancy the total blood volume increases by about 1.5 liter [3]. The plasma volume increases more compared to red cell mass which leading to hemodilution and reduced hemoglobin concentration. This is termed physiological anemia of pregnancy [3, 4]. The World Health Organization (WHO) has suggested that anemia is present in pregnancy when Hb level is <11g/dl. It also classified anemia in pregnancy as mild (10.0-10.9 g/dl), moderate (7.0-9.9 g/dl), and severe (lower than 7.0 g/dl) based on the level of hemoglobin concentration [5].

Anemia is a public health problem in both developed and developing countries. It affects 1.62 billion people globally, which corresponds to 24.8% of the world population. Global prevalence of anemia in pregnant women is 41.8% and the highest proportions of pregnant women affected are in Africa (57.1%) [6, 7]. According to Ethiopia Demographic and Health Survey report of 2005, the prevalence of anemia in pregnant women is 30.6% [8].

Approximately 50% of cases of anemia are considered to be due to iron deficiency. Anemia resulting from iron deficiency in pregnancy is an important factor associated with an increased risk of maternal, fetal, and neonatal mortality; poor pregnancy outcomes such as low birth weight and preterm birth; impaired cognitive development, reduced learning capacity, and diminished school performance in children; and decreased productivity in adults, particularly in developing countries like Ethiopia. In neighboring Sudan, 20.3% of maternal deaths are associated with anemia [9–11].

In Ethiopia, different studies were conducted on prevalence of anemia among pregnant women, the prevalence range being from 9.7% in North Shoa Zone to 56.8% in Eastern Ethiopia [12, 13]. Studying the specific etiology and prevalence of anemia in a given setting and population group is very important to prevent or treat anemia [11]. However, there is very little data available in the study area. Therefore, this study is aimed to assess the prevalence and factors associated with anemia in pregnant women at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.

2. Methods

2.1. Study Setting and Design

A facility based cross-sectional study was conducted from June to August 2014 at St. Paul’s Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia. SPHMMC was built in 1969 by Emperor Haile Selassie as a source of medical care for underserved populations. It currently has 392 beds, with an annual average of 200,000 patients and a catchment population of more than 5 million.

2.2. Study Population

All pregnant women attending antenatal cares in SPHMMC that fulfills the inclusion criteria during the study period were considered as study participants. Written informed consent was obtained from all. Pregnant women with Hepatitis B Virus infection, with human immunodeficiency virus, and less than 18 years of age were excluded from the study.

2.3. Sampling Procedure

The required sample size for this study was calculated using a single population proportion formula with a 95% CI, 5% margin of error, and assumption that 21.3 % of pregnant women are anemic [14]. By adding 10% for nonresponse, a total of 284 pregnant women were enrolled from antenatal care clinic of obstetrics and gynecology department of SPHMMC. Systematic random sampling technique was used to recruit the study participants from their sequence of ANC visit during the study period.

2.4. Data Collection

Interviewer administered structured pretested questionnaire and review of medical records were used to collect data on the sociodemographic characteristics, obstetric and gynecological, diet, and clinical characteristics of the study participants. The interview and record review were conducted by two trained ANC service provider nurses at ANC clinic of SPHMMC during ANC follow-up of the study participants. About 4 ml venous blood specimens were taken from each participant in K3-EDTA tubes for the hematological examinations. Automated hematology analyzer Cell-Dyn 1800 (Abbott Laboratories Diagnostics Division, USA) was used to determine complete blood count. Thin peripheral blood smears were prepared and stained by Wright’s stain for red cells morphological study. Quality control materials were run alongside the study participant’s sample to control performance of the hematological analyzer. All laboratory measurements were done by experienced laboratory technologists.

2.5. Data Analysis

Data from both questioner and laboratory were checked and cleaned for completeness and consistency. Data were then analyzed using Statistical Package for the Social Science (SPSS) Version 20 statistical software. Descriptive statistics such as frequency, percentage, and mean andstandard deviation were used to describe dependent and independent variables. Binary logistic regression analysis had been used to check for association between dependent and independent variables. In all cases P value less than 0.05 was considered statistically significant.

2.6. Ethical Considerations

Ethical clearance was obtained from both Research and Ethics Review Committee of the Department of Medical Laboratory Sciences, Addis Ababa University, and Institutional Review Board of SPHMMC. Written informed consent was obtained from each study participant after the purpose and importance of the study were explained. To ensure confidentiality, participants’ data were linked to a code number. Any abnormal test results of participants were communicated to their attending physician.

3. Result

3.1. Characteristics of the Study Participants

A total of 284 pregnant women were included in the study. The mean age of the participants was 27.3 ± 4.5 years (range from 18-40). The majority of the study groups, 118 (41.5%), were in the age range of 26-30 years and 102 (35.9%) were in the weight group of 60-69 Kg. Most of the respondents, 261(91.9%), 164 (57.7%), and 115 (40.5%), were urban dwellers, house wives by occupation, and elementary school education level, respectively (Table 1).

Concerning obstetrical history and dietary habit, 170 (59.9%) were in their third trimester, 194 (68.3%) of the women had previous pregnancy, 166 (58.5%) were multigravida (2-4 pregnancy), 124 (43.7%) had no child, 28 (9.9%) had blood loss during the current pregnancy, 77 (27.1%) experienced abortion, and 166 (58.8%) had taken iron/folic acid supplementation. Out of the 284 participants, 160 (56.3%) had the habit of eating meat and animal products and 120 (42.3%) had the habit of eating fruit and vegetables once in week (Table 1).

3.2. Prevalence and Associated Risk Factors of Anemia

The mean ± SD hemoglobin concentration of the study participants was 13.0 ± 1.64 g/dl (ranges from 7.1-22.9 g/dl). In this study, the overall prevalence of anemia was 11.6% (95 % CI; 7.8%-14.8%) [15].

The rate of anemia was high in pregnant women who were in 26-30-year age range (15.3%), 60-69 weight group (17.6%), house wives (14.0%), elementary school (14.8%), and urban residents (12.6%) (Table 2).

Based on obstetric history and dietary habit, the prevalence of anemia was higher in pregnant women who were at the second trimester (16.7%), had previous history of pregnancy (12.4%), multigravida (12.7%), had one child (17.6%), had ≥ 4-year gap between the current and last child (16.7%), had history of abortion (14.3%), and did not take iron/folic acid supplementation (14.5%). The prevalence of anemia was also higher in those pregnant women who did not have a habit of eating meat and animal products (16.7%) and fruits and vegetables (33.3%) (Table 2).

All variables were analyzed using bivariate analysis to assess the association between the variables and anemia. Then, variables that show P value less than or equal to 0.3 in bivariate analysis were taken to multivariate analysis. Out of those variables treated under multivariate analysis, trimester and iron/folic acid supplementations were statistically significantly associated with anemia. Pregnant women in the second [AOR (95% CI), 6.72 (1.17-38.45), and P=0.03] and third trimester [AOR (95% CI), 8.31 (1.24-55.45), and P=0.029] were more likely to be anemic when compared to pregnant women in their first trimester. Pregnant women who did not receive iron/folic acid supplementation [AOR (95%CI), 4.03(1.49-10.92), and P=0.01] were more likely to be anemic when compared to pregnant women who did take supplementations.

4. Discussion

The prevalence of anemia in the present study was 11.6% (95 % CI; 7.8%-14.8%) [15]. This prevalence was almost consistent with studies conducted in Awassa (15.1%), Gondar (16.6%), Debre Berhan (9.7%), Sudan (10%), Iran (13.6%), and Nakhon Sawan, Thailand (14.1%) [12, 16–20]. However, our finding is much lower than studies conducted in Pakistan (90.5%), India (87.2%), Malaysia (57.4%), Benin (68.3%), Nigeria (54.5%), Somali Region (56.8%), Walayita Sodo (40%), West Arsi zone (36.6%), and north western zone of Tigray (36.1%) [13, 21–28]. Our result is also lower than results reported from Uganda (22.1%), Southern Ethiopia (29%), Southeast Ethiopia (27.9%) Mekelle (19.7%), and Addis Ababa (21.3%) [14, 29–32].

The difference may be due to geographical variation, differences in socioeconomic status, and dietary habits of the study participants. The lower finding of our study also may be due to the governments’ effort to achieve Millennium Development Goals (MDGs) since improving maternal health is one of the eight MDGs and targeted to reduce the maternal mortality ratio by three-quarters in 2015. The United Nations Population Fund (UNFPA) report showed a significant decline in the prevalence of anemia among all women from 20% to 13% between 2005 and 2011 in Ethiopia [33].

Only the association of gestational age (trimester) and iron/folic acid supplementations did reach to a statistically significance level. Pregnant women in second and third trimester were more likely to be anemic when compared to pregnant women in first trimester. This might be due to the higher maternal plasma volume increments (40–50%) relative to red cell mass (20–30%) and accounts for the fall in hemoglobin concentration [34]. Our study is similar with studies conducted in Malaysia [22], west Algeria [35], and Tikur Anbessa hospital [14].

The risk of developing anemia increased in pregnant women who did not receive iron supplementation during pregnancy when compared to those who received iron supplementation. This may be due to iron deficiencies developing during pregnancy because of the increased iron requirements to supply the expanding blood volume of the mother and the rapidly growing fetus and placenta. The study is in agreement with study conducted in Karnataka India, Uganda, and Eastern Ethiopia [13, 36, 37].

One of the limitation of this study is the cross-sectional nature of the study design; it did not reveal causal links between anemia and risk factors. Even though this study tried to address some important factors, other factors such as stool examination, malaria, inherited, or acquired disorders that affect hemoglobin or red blood cell synthesis were not addressed due to constraint of time and resource. The other limitation is that this study is done only at single hospital; hence, further studies should be conducted in different hospitals of Addis Ababa to have findings representing the whole population.

5. Conclusion

This study has revealed that the prevalence of anemia in pregnancy was low (11.62%) compared to the findings of other areas of Ethiopia. Gestational age (trimester) and iron/folic acid supplementation were statistically associated with anemia in this study. Therefore, iron supplementation and health education to create awareness about the importance of early booking for antenatal care are recommended to reduce anemia.

List of Abbreviations

ANC:	Antenatal care
EDTA:	Ethylenediaminetetraacetic acid
Hb:	Hemoglobin
MDGs:	Millennium Development Goals
RBC:	Red blood cell
SPHMMC:	St.Paul’sHospital MillenniumMedicalCollege
WHO:	World Health Organization.

Data Availability

The data of this study cannot be shared publicly due to presence of sensitive (confidential) participants’ information and additional data compared to that used in this publication. But the data are available from the corresponding author on reasonable request.

Disclosure

The funder has no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

Conflicts of Interest

The authors declare no conflicts of interest.

Authors’ Contributions

All authors participated in the study design, interpretation of the data, and writing of the paper and all authors have seen and approved the final version of the paper.

Acknowledgments

We would like to thank Wollo University and Addis Ababa University for their financial and material support for this project. St. Paul’s Hospital Millennium College is gratefully acknowledged for the support given to undertake this study in the hospital. Our special thanks and appreciation go to all pregnant women who voluntarily participated in this study. This study was funded by Addis Ababa University.

References

M. L. Turgeon, Clinical Hematology: Theory and Procedures, Wilkins, a Wolters Kluwer business, Philadelphia, Lippincott Williams, 5th edition, 2012.
B. F. Rodak, G. A. Fritsma, and E. M. Keohane, Hematology: Clinical Principles and Applications, Elsevier Saunders, 4th edition, 2012.
S. Chandra, A. K. Tripathi, S. Mishra, M. Amzarul, and A. K. Vaish, “Physiological changes in hematological parameters during pregnancy,” Indian Journal of Hematology and Blood Transfusion, vol. 28, no. 3, pp. 144–146, 2012.
View at: Publisher Site | Google Scholar
S. Pavord and B. Hunt, The Obstetric Hematology Manual, Cambridge University Press, New York, NY, USA, 2018.
View at: Publisher Site
WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System: Geneva, World Health Organization;2011. http://www.who.int/vmnis/indicators/haemoglobin. pdf.
B. d. Benoist, E. McLean, I. Egll, and M. Cogswell, Worldwide Prevalence of Anaemia 1993-2005: WHO Global Database on Anaemia, World Health Organization, 2008.
E. McLean, M. Cogswell, I. Egli, D. Wojdyla, and B. De Benoist, “Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005,” Public Health Nutrition, vol. 12, no. 4, pp. 444–454, 2009.
View at: Publisher Site | Google Scholar
Central Statistical Agency, ORC Macro. Ethiopia demographic and health survey 2005. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Cent Stat Agency ORC Macro. 2006.
L. H. Allen, “Anemia and iron deficiency: effects on pregnancy outcome,” American Journal of Clinical Nutrition, vol. 71, no. 5, pp. 1280s–1284s, 2000.
View at: Publisher Site | Google Scholar
A. A. Mohammed, M. H. Elnour, E. E. Mohammed, S. A. Ahmed, and A. I. Abdelfattah, “Maternal mortality in Kassala State - Eastern Sudan: Community-based study using Reproductive age mortality survey (RAMOS),” BMC Pregnancy and Childbirth, vol. 11, no. 1, pp. 102–107, 2011.
View at: Google Scholar
WHO., WHO. The global prevalence of anaemia in 2011. World Health Organization Geneva; 2015.
F. A. Yohannes Abere, “Pregnancy Anaemia Prevalence and Associated Factors among Women Attending Ante Natal Care in North Shoa Zone, Ethiopia,” Reproductive System & Sexual Disorders, vol. 03, no. 03, 2014.
View at: Publisher Site | Google Scholar
K. A. Alene and A. Mohamed Dohe, “Prevalence of Anemia and Associated Factors among Pregnant Women in an Urban Area of Eastern Ethiopia,” Anemia, vol. 2014, pp. 1–7, 2014.
View at: Google Scholar
A. H. Jufar and T. Zewde, “Prevalence of anemia among pregnant women attending antenatal care at Tikur Anbessa Specialized Hospital,” Journal of Hematology Thromboembolic Diseases, vol. 2, no. 1, pp. 1–6, 2014.
View at: Google Scholar
A. Gebreweld, D. Bekele, and A. Tsegaye, “Hematological profile of pregnant women at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia,” BMC Hematology, vol. 18, no. 1, pp. 15–21, 2018.
View at: Publisher Site | Google Scholar
S. Gies, B. J. Brabin, M. A. Yassin, and L. E. Cuevas, “Comparison of screening methods for anaemia in pregnant women in Awassa, Ethiopia,” Tropical Medicine & International Health, vol. 8, no. 4, pp. 301–309, 2003.
View at: Publisher Site | Google Scholar
M. Melku, Z. Addis, M. Alem, and B. Enawgaw, “Prevalence and predictors of maternal anemia during pregnancy in Gondar, Northwest Ethiopia: an institutional based cross-sectional study,” Anemia, vol. 2014, Article ID 108593, 9 pages, 2014.
View at: Publisher Site | Google Scholar
E. A. Abdelgader, TA. Diab, A. A. Kordofani, and S. E. Abdalla, “Hemoglobin level, RBCs Indices, and iron status in pregnant females in Sudan,” Basic Res J Med Clin Sci, vol. 3, no. 2, pp. 8–13, 2014.
View at: Google Scholar
E. Barooti, M. Rezazadehkermani, B. Sadeghirad, S. Motaghipisheh, S. Tayeri, and M. Arabi, “Prevalence of iron deficiency anemia among Iranian pregnant women; a systematic review and meta-analysis,” Journal of Reproduction & Infertility, vol. 11, no. 1, pp. 17–24, 2010.
View at: Google Scholar
B. Sukrat, P. Suwathanapisate, S. Siritawee, T. Poungthong, and K. Phupongpankul, “The prevalence of iron deficiency Anemia in pregnant women in Nakhonsawan, Thailand,” Journal of the Medical Association of Thailand, vol. 93, no. 7, pp. 765–770, 2010.
View at: Google Scholar
P. Lokare, P. Gattani, V. Karanjekar, and A. Kulkarni, “A study of prevalence of anemia and sociodemographic factors associated with anemia among pregnant women in Aurangabad city, India,” Annals of Nigerian Medicine, vol. 6, no. 1, p. 30, 2012.
View at: Publisher Site | Google Scholar
R. N. Nik, N. S . Mohd, and Ismail I. M., “The Rate and Risk Factors for Anemia among Pregnant Mothers in Jerteh Terengganu, Malaysia,” Journal of Community Medicine & Health Education, vol. 2, no. 150, pp. 2161–0711, 2012.
View at: Publisher Site | Google Scholar
N. Baig-Ansari, S. H. Badruddin, R. Karmaliani et al., “Anemia prevalence and risk factors in pregnant women in an urban area of Pakistan,” Food and Nutrition Bulletin, vol. 29, no. 2, pp. 132–139, 2008.
View at: Publisher Site | Google Scholar
S. Ouédraogo, G. K. Koura, M. M. K. Accrombessi, F. Bodeau-Livinec, A. Massougbodji, and M. Cot, “Maternal anemia at first antenatal visit: Prevalence and risk factors in a malaria-endemic area in Benin,” The American Journal of Tropical Medicine and Hygiene, vol. 87, no. 3, pp. 418–424, 2012.
View at: Publisher Site | Google Scholar
O. A. Olatunbosun, A. M. Abasiattai, E. A. Bassey, R. S. James, G. Ibanga, and A. Morgan, “Prevalence of anaemia among pregnant women at booking in the University of Uyo teaching hospital, Uyo, Nigeria,” BioMed Research International, vol. 2014, Article ID 849080, 8 pages, 2014.
View at: Publisher Site | Google Scholar
L. Gedefaw, A. Ayele, Y. Asres, and A. Mossie, “Anemia and Associated Factors Among Pregnant Women Attending Antenatal Care Clinic in Wolayita Sodo Town, Southern Ethiopia,” Ethiopian Journal of Health Sciences, vol. 25, no. 2, pp. 155–162, 2015.
View at: Publisher Site | Google Scholar
N. Obse, A. Mossie, and T. Gobena, “Magnitude of anemia and associated risk factors among pregnant women attending antenatal care in Shalla Woreda, West Arsi Zone, Oromia Region, Ethiopia,” Ethiopian Journal of Health Sciences, vol. 23, no. 2, pp. 165–173, 2013.
View at: Google Scholar
A. Gebre and A. Mulugeta, “Prevalence of anemia and associated factors among pregnant women in north western zone of tigray, northern ethiopia: A cross-sectional study,” Journal of Nutrition and Metabolism, vol. 2015, Article ID 165430, 2015.
View at: Publisher Site | Google Scholar
G. Obai, P. Odongo, and R. Wanyama, “Prevalence of anaemia and associated risk factors among pregnant women attending antenatal care in Gulu and Hoima Regional Hospitals in Uganda: A cross sectional study,” BMC Pregnancy and Childbirth, vol. 16, no. 1, 2016.
View at: Google Scholar
R. S. Gibson, Y. Abebe, S. Stabler et al., “Zinc, gravida, infection, and iron, but not vitamin B-12 or folate status, predict hemoglobin during pregnancy in Southern Ethiopia,” Journal of Nutrition, vol. 138, no. 3, pp. 581–586, 2008.
View at: Publisher Site | Google Scholar
F. Kefiyalew, E. Zemene, Y. Asres, and L. Gedefaw, “Anemia among pregnant women in Southeast Ethiopia: prevalence, severity and associated risk factors,” BMC Research Notes, vol. 7, no. 1, pp. 771–778, 2014.
View at: Publisher Site | Google Scholar
A. Abriha, M. E. Yesuf, and M. M. Wassie, “Prevalence and associated factors of anemia among pregnant women of Mekelle town: A cross sectional study,” BMC Research Notes, vol. 7, no. 1, 2014.
View at: Google Scholar
Y. Mekonnen, Trends in Maternal Health in Ethiopia; Challenges in achieving the Millennium Development Goal for maternal mortality In-depth Analysis of the Ethiopian Demographic and Health Surveys, UNFPA, 2000.
D. M. Townsley, “Hematologic complications of pregnancy,” Seminars in Hematology, vol. 50, no. 3, pp. 222–231, 2013.
View at: Publisher Site | Google Scholar
A. Demmouche, S. Khelil, and S. Moulessehoul, “Anemia among pregnant women in the Sidi Bel Abbes Region (West Alegria): an epidemiologic study,” Journal of Blood Disorders & Transfusion, vol. 2, no. 3, pp. 1–6, 2011.
View at: Publisher Site | Google Scholar
R. Viveki, A. Halappanavar, P. Viveki, S. Halki, V. Maled, and P. Deshpande, “Prevalence of anaemia and its epidemiological determinants in pregnant women,” Al Ameen J Med Sci, vol. 5, no. 3, pp. 216–223, 2012.
View at: Google Scholar
M. A. Mbule, Y. B. Byaruhanga, M. Kabahenda, and A. Lubowa, “Determinants of anaemia among pregnant women in rural Uganda.,” Rural and Remote Health, vol. 13, no. 2, p. 2259, 2013.
View at: Google Scholar

Copyright

Copyright © 2018 Angesom Gebreweld and Aster Tsegaye. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

PDF Download Citation

Download other formats

Order printed copies

Views

16479

Downloads

4697

Citations