PREVALENCE OF ANEMIA AND ASSOCIATED FACTORS AMONG PREGNANT

PREVALENCE OF ANEMIA AND ASSOCIATED FACTORS AMONG PREGNANT WOMEN ATTENDING ANTENATAL IN L. BILBILO WEREDA HEALTH FACILITY , ARSI ZONE, SOUTH E AST ETHIOPIA. Gebi Tufa (Bsc, BA, MPH/RH)

Outline of presentation üIntroduction üSignificance of the study üMethods and Materials üResult üDiscussion üConclusion üRecommendations

Introduction Ø Anemia in pregnancy is defined by world health organization as hemoglobin concentration level less than 11 (WHO, 2015) Ø The prevalence of anemia in developing country varies from country to country that is 33%-75% in developing country as compared to 15% developed country (Grewal A. Anemia and pregnancy 2014, P. Lacente, 2011, WHO 2015) • Anemia is a public health problem over the world especially in sub Saharan Africa including Ethiopia • The prevalence of anemia in Africa is 62. 4% and globally 42. 3 peoples were anemic and prevalence women of reproductive age 29. 1%, 146 countries of the world suffer from moderate anemi, 37 suffer countries from severe anemia (WHO , 2011).

Introduction • Even though, the prevalence is high, there is no study conducted at study area; On factors that associated with anemia and its magnitude. So , this study is intended to estimate the problem/fill this gap. • Hence this study will provide more information about the burden of Anemia &associated factors and facilitates the identification of anemia and anemia related problems found in the study areas.

Conceptual frame work Anemia Sociodemograph Age, sex, occupation, educ ation, residency Nutritiona l status Obsteteric charect Parity/gravidity. FANC Economy and knowledge Socio economic status Knowledge abut anemia healthesrvice related Availability and acessibility, sa nitation (WHO: 2015, Mulugeta M: 2014, CSA: 2007 ) Disease and parasitic infection Dietary diversity, variet y, frequency 5

Objectives • General objectives • To determine the prevalence of anemia and associated factors among pregnant women attending ANC in Lemu Bilbilo District; 2015/16 • Specific objectives • To determine magnitude of anemia among pregnant women attending ANC. • To identify factors associated with anemia among pregnant women attending ANC

Methods and Material • Institution based cross sectional study design was conducted among pregnant women in Lemu Bilbilo Woreda Oromia regional state, South East Ethiopia 223 Km from Addis Ababa from May 20 - June 20/2016 • sample size was determined by using a single population proportion formula and the final sample sizes is 367. • There are seven health facilities in the area and all seven health facilities within Wereda were taken. • Proportional allocation was made for each health facilities and based on the average daily client flow in each institution the study unit will be selected by systematic random sampling method. • Structured interviewer administered questionnaire adapted from previous similar studies were used • Hemoglobin was measured using portable hemocue, stool were tested for helmints • Data was edited , coded and was entered to Epidata Version 3. 1 then exported to SPSS 20. 0 and analysed.

Result Ø From the total sample size of the pregnant women the response rate were 97 %. thirty two %(115) feed food three times per day, 47. 8%( 171) less than two times per day, and 20. 1%(72) greater than three times per day. Ø Thirty two %(108) practice low food diversity, 78(21%) , minimum food diversity and the rest practice high food diversity. the mean food diversity was 5± 1. 87. Ø The most of the respondents 40. 5%(145) get focused antenatal care in previous pregnancy. Ø Most of the respondents 41. 5%(148) were nulliparous, 38. 5%( 138) delivered one child 14%(52) experienced abortion. Ø One hundred fifty eight 44. 4%(158) were less than 16 weeks, 35. 6%(125) were between 24 -28 weeks. Ø Twenty four % (88) here diseased with different medical disorder greater than one in past one month before collection of this data.

Result Ø As far as the interview was concerned pregnant women 83. 8%(252)were with normal MUAC, 26%(106) were malnourished. Ø Seventy %(252) have good or adequate knowledge about anemia and information on feeding habit that prevent anemia. Ø : The overall prevalence of anemia was 22. 3%. 6. 15% were moderately anemic and mild anemia is 16. 2%. Ø The comparison between the profiles of the pregnant women who had anemia and who did not from the bivariate logistic regression analysis revealed that food diversity, education of women and husband, occupation of husband women, nutritional status , parasite , marital status, gave birth, wealth index are factors that are associated with anemia.

Result Table 1: Multivariate logistic regression model on anemia prevalence and associated factor variables category Anemia Adjusted OR P. Value Yes(NO. /%) NO(NO. /%) Low 27(7. 5) 92(25. 6) 2. 4(1. 1 -5. 6) . 031* Mild 33(9. 2) 20(5. 5) 2. 69(1. 27 -5. 4) 1 . 01* High 145(40. 5) 41(11. 5) Merchant Govdaily 8(2. 2) 12(3. 4) 5715. 9() 42(11. 7) 6(2 -20. 1) 1. 3(. 54 -2. 9) . 001*. 597 Farming&other Merchant 60(16. 8) 16(4. 4) 179(50) 43(12) 1. 31(. 11 -. 84) . 021* Farming Housewife 16(4. 4) 48(13. 4) 76(21. 2) 159(44. 4) 1. 31(. 64 -2. 7) 1 Nutritional status Normal(=>23 cm 47(13. 1) Malnutrition(<2 33(9. 2) 3 cm 205(57. 3) 73(20. 4) 1 1. 8(1. 00 -3. 2) 0. 047* Pregnancy interval = <2 year back 76 (21. 1) 245(68. 4 ) . 37(. 115 -1. 193) . 096 = >5 year back 4(1. 1) 33(9. 2) 1 Gave birth nulliparous 34(9. 5) 112(31. 3) 1 one 27(7. 5) 114(31. 8) 1. 7(. 60 -2. 1) . 727 2 -6 19(5. 3) 52(14. 5) . 902(. 429 -1. 89) . 788 Dietary diversity Husband occupation Women occupation . 0. 459

Discussion Ø The prevalence of anemia among pregnant women was 22. . 3 %. Ø Seventy two %(58/80) were of the mild &27. 4%% cases of moderate anemia. Ø This finding was similar with the prevalence in study done in (Gonder 22%, Tikur Anbessa specialized hospital that is 21. 3%(M. Alem: 2013, Alemayuh. H : 2014) Ø but higher than study done in Mekele 11. 7%(11) and lower than study done in west Arsi zone 36. 6%(14). But, consisted with EDHS 22%(13). (A. Abriha: 2014, Niguse. Obse: 2011 Ø Anemia in pregnancy related with different demographic (WHO: 2008, 2011, F. Bánhidy 2011, Mulugeta M 2013). Ø occupation of husband found to be associated with anemia. from statically analysis of multi logistic regression husband jobs such as being Merchant is six times more anemic as compared to farming (AOR=6. 00, 95% CI: 2. 1 -20. 1) and women occupation being merchant is 0. 31 less likely anemic as compared to those women whose occupation house wife (AOR=. 31. 95% CI: 0. 11 -. 84). Ø According to this study pregnant women who are malnourished were 1. 8 times more likely to be anemic as compared to their counter parts. .

…Contn… Ø This finding also consisted with study done in Somali regional state MUAC less than 23 cm is found to increase the risk of developing anemia. According to this finding pregnant women with MUAC ≥ 23 cm had 59% less risk of developing anemia (37). • This can be explained by the fact that undernourished pregnant women have a higher probability of being micronutrient deficient and which can leads iron deficient and anemic. • According to this study pregnant women who practice mild dietary diversity were 2. 69 more likely anemic as compared to those who practice high dietary diversity. • This finding is consisted with study done in rural part of Ethiopia and Mekele. According to this finding pregnant women with mild dietary diversity were more likely anemic as compared their countr part. (A. Abriha 2014, Taddese A 2016). • This could be due to that pregnant women with low or mild dietary diversity have chance to get diet with low iron content

Conclusion and Recommendations Ø The over all prevalence of anemia was 22. 3%. No severe case’s of anemia was detected. Ø Even though the finding of this study is low compared to other study, anemia is moderate public health problem(20 -40%). In this study anemia was associated with occupation of the husband(merchant) , women occupation, eating diversified food, nutritional status of pregnant women Ø To alleviate the problem of anemia all responsible body have to play his role. Ø All health professional specially who have direct contact with mother have to educate pregnant women on feeding practice that can prevent anemia and some feeding practice that decrease nutritional value of iron containing dietary items. Ø To decrease effect of malnutrition; pregnant women should be counseled on dietary intake that can prevent malnutrition. Werede health office and primary health care unit should educate pregnant women and family member (husband) about dietary diversity. Ø Husband of women should give great attention to care of women specially during pregnancy. Ø Werede administration and werede health office should educate pregnant women and family (husband) on their jobs activities and the effect their jobs (activities) fatigue, shortness of breath, dizziness, vertigo (anemia) sign and symptoms

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