Determinants of anemia among pregnant women attending antenatal care in Horo Guduru Wollega Zone, West Ethiopia: Unmatched case-control study

Autoři: Birhanu Daba Tulu aff001;  Emiru Merdassa Atomssa aff002;  Hylemariam Mihiretie Mengist aff003
Působiště autorů: Nekemte Town Health office, Nekemte, Ethiopia aff001;  Department of Public Health, College of Health Sciences, Wollega University, Nekemte, Ethiopia aff002;  Department of Medical Laboratory Sciences, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224514



Anemia is a common clinical problem contributing to increased maternal and fetal morbidity and mortality during pregnancy. Anemia can be caused by different factors apart from known diseases. The main aim of this study was to identify determinants of anemia among pregnant women attending antenatal care at the public health facilities of Horo Guduru Wollega Zone, West Ethiopia, 2017.


Health facility-based unmatched case-control study was conducted among 191 anemic and 382 non-anemic pregnant women from September 7, 2017, to October 25, 2017, in Horo Guduru Wollega Zone, West Ethiopia. Data were collected using pre-tested questionnaires from nine health facilities. Hemoglobin level determination, hemo-parasite diagnosis, venereal disease research laboratory (VDRL) test, and stool examination were done in the laboratories of the respective health centers. Cleaned and coded data were entered and analyzed using SPSS version 20. Frequency, proportion, mean and standard deviation were computed to summarize the data and presented by tables and bar graphs. Multivariate binary logistic regression analysis was used to determine the association of predictors and response variables at P ≤ 0.05. Adjusted odds ratio with 95% CI was used to show the strength of association between predictors and outcome variables.


A total of 573 pregnant women were enrolled in this study. Monthly income < 500 Ethiopian birr (AOR = 9.16, 95% CI: 4.23, 19.82), heavy menstrual bleeding (AOR = 2.38, 95%CI: 1.38, 4.09), taking iron supplement irregularly (AOR = 2.87, 95%CI:1.41, 5.84), Mid-upper Arm Circumference (MUAC) < 23 cm (AOR = 3.42, 95%CI: 2.07, 5.63), low dietary diversity score (AOR = 12.30, 95%CI: 4.64, 32.72), medium dietary diversity score (AOR = 3.40, 95%CI:1.48, 7.84) and intestinal helminthic infections (AOR = 6.31, 95%CI: 3.44, 11.58) were significantly associated with anemia during pregnancy.


Average monthly income < 500 Ethiopian birr, heavy menstrual bleeding, low and medium dietary diversity score, taking of iron supplements irregularly, MUAC < 23 cm and intestinal helminthic infections were identified as independent determinants of anemia during pregnancy. Therefore, improving dietary diversity intake, routine deworming and empowering women on taking iron regularly are vital to prevent anemia during pregnancy.

Klíčová slova:

Anemia – Antenatal care – Ethiopia – Gastrointestinal tract – Helminth infections – Pregnancy – Public and occupational health – Iron deficiency anemia


1. World Health Organization. Hemoglobin concentrations for the diagnosis of anemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva, WHO, 2011 (WHO/NMH/NHD/11.1).

2. Kumar G, Premarajan K. & Kar S. Anemia among pregnant mothers attending ANC with better health care services in rural areas of India. J Res Med. Sci., 2013; 18:171. 23914224

3. Yarlini B, Usha R, Emre O. & Anuraj S. Anemia in Low-income and Middle-income Countries: Lancet; 2011; vol. 378; pp: 2123–2135. doi: 10.1016/S0140-6736(10)62304-5 21813172

4. Siteti MC, Namaska DN, Ariya OP, Injete SD, & Wanyonyi WA. Anaemia in pregnancy: Prevalence and possible risk factors in Kakamega County, Kenya.sjph.2014; 2(3):216–22.

5. Jufar AH, & Zewde T. Prevalence of Anemia among Pregnant Women Attending Antenatal Care at Tikur Ambemssa Specialized Hospital, Addis Ababa, Ethiopia. Journal of Hematology and Thromboembolic Diseases. 2014; 2:125.

6. Melku M, Addis Z, Alem M & Enawgaw B. Prevalence and predictors of maternal anemia during pregnancy in Gondar, Northwest Ethiopia. J Interdiscipl Histopathol. 2013; 1(3): 137–44.

7. Gyorkos TW, Gilbert NL. Blood Drain: Soil-Transmitted Helminths and Anemia in Pregnant Women. PLoS Negl Trop Dis. 2014; 8(7): e2912, doi: 10.1371/journal.pntd.0002912 25010736

8. Kennedy E. Dietary reference intakes: development and uses for assessment of micronutrient status of women–a global prospective Am J Clin Nutr 2005; 81(suppl). 2014; 1194S–7S.

9. CSA, Ethiopia Demographic and Health Survey: Preliminary Report, CSA, Addis Ababa, Ethiopia, 2011.

10. Gedefaw L, Kefiyalew F, Zemene E, Asres Y. Anemia among pregnant women in South east Ethiopia: prevalence, severity and associated risk factors.MBC Res Notes. 2014; 7(1):1

11. Mihiretie H, Fufa M, Mitiku A, Bacha C, Getahun D, Kejela M, et al. Magnitude of Anemia and Associated Factors among Pregnant Women Attending Antenatal Care in Health Center, Nekemte, Ethiopia. J Med Microb Diagn 4: 197.doi: 10.4172/21610703.1000197

12. FAO & FANTA; New Dietary Diversity Indicator for Women, 2014.

13. Sullivan K, Mei Z, Grummer-Strawn L. & Parvanta I. Hemoglobin adjustments to define anemia. Tropical Med Int Health. 2008; 13(10):1267–71.

14. Cheesbrough M, District Laboratory Practices in Tropical Countries, Part 1, United Kingdom, and Cambridge University Press. Open Access Library Journal. 2009; 2(7)195–216.

15. Nayak S, Acharjya B. VDRL test and its interpretation, Indian J. Dermatol, 2012; 57:3–8. doi: 10.4103/0019-5154.92666 22470199

16. Mackey R. The Impact of Confounder Selection Criteria on Effect Estimation. AMJ Epidemiol, 1989; 129:125–37.

17. Paul P, Pennell ML, S Lemeshow- Statistics in medicine, 2013-Wiley online Library.

18. Michael O, Hussaini G, Agboola S. Regression Analysis;2015:5754–767.

19. Juan C. A review on ROC Curves in the Presence of Covariates. Statistical Journal, 2014; 12: 21–42.

20. Sudha S, Vrijesh T, Rajvir S, Harsha SG. Evaluation of Hematological Parameters in partial Exchange and Packed Cell Transfusion in Treatment of Severe Anemia in Pregnancy. BJA Hindawi. 2012; 7:608658.

21. Abay A, Yalew HW, Tariku A, Gebeye E. Determinants of prenatal Anemia in Asosa zone, Benishangul Gumuz, Ethiopia. APH. 2017; 75:51

22. Getachew M, Yewhalaw D, Tafess K, Getachew Y, Zeynudin A. Anemia and Associated Risk Factors among Pregnant Women in Gilgel Gibe Dam Area, Southwest Ethiopia. MBC Research notes.2012; 5(1):296.

23. Mengist HM, Zewdie O, Belew A. Intestinal helminthic infection and anemia among pregnant women attending ante-natal care (ANC) in East Wollega, Oromia, Ethiopia. BMC research notes. 2017;10(1):440. doi: 10.1186/s13104-017-2770-y 28870241

24. Abriha A, Yesuf ME, Wassie MM. Prevalence and Associated Factors of Anemia in Pregnant Women in Mekelle Town, North Ethiopia. MBC research notes. 2014;7(1):888

25. Argaw B, Argaw-Denboba A, Taye B, Worku A. Major Risk Factors Predicting Anemia Development during Pregnancy, Sidama zone, Ethiopia, Unmatched Case-control study. J Community Med Health Educ. 2011; 5(1):1

26. Getahun W, Belachew T, Wolide AD. Burden and associated factors of anemia among pregnant women attending antenatal care, Buta Jira General Hospital, South Ethiopia: Cross-sectional study. BMC Res Notes. 2017; 10:276. doi: 10.1186/s13104-017-2605-x 28705235

27. Derso T, Abera Z, Tariku A. Magnitude and associated factors of anemia among pregnant women in Dera District: cross-sectional study, Northwest Ethiopia. MBC research notes.2017; 10(1):1

28. Kefiyalew F. Anemia among pregnant women in Southeast Ethiopia: prevalence, severity and associated risk factors, 2014; 7(2): 771–79.

29. Ojukwu et al. Determinants and Patterns of Anemia in Pregnancy at Booking in Federal Medical Center Owemi, South East Nigeria, 2108; 33(2):1–13

30. Mulepati S, Chaudery T. Determinants of Anemia among Pregnant Women Attending a Tertiary Level Hospital, Kathamandu, United States, 2017; (2):24–33

31. Okubatsion T. Prevalence and factors associated with anemia among pregnant women attending Antenatal clinic in the second and third trimesters at Pumwani maternity hospital, Kenya. OJ of Obstetrics and Gynecology. 2015; 06(01): 16–27.

32. Tadesse SE, Seid O, Gariam Y, Fikadu A, Wasihun Y, Endris K, et al. Determinants of Anemia among Pregnant Mothers Attending Antenatal Care in Dessie Town Health Facilities, Northern Central Ethiopia, unmatched case -control study. PLoS ONE, 2017; 12(3):0173173.

33. Alene KA, Dohe AM. Prevalence of Anemia and Associated Factors among Pregnant Women in Gode town, East Ethiopia.2014; 2014:561567.

34. Lebso M, Anato A, Loha E. Prevalence of Anemia and Associated Factors among Pregnant Women, Lemo District, South Ethiopia, Community Based Cross-sectional Study. Plos One. 2017; 12(12): e0188783. doi: 10.1371/journal.pone.0188783 29228009

35. Bisoi S, Haldar D, Majumdar T K, Bhattacharya N, Sarkar G N, Ray S K. Correlates of Anemia among Pregnant Women in Rural Areas of West Benga, India. J Fan Elf, 2011; 57(1):72–8

36. Onoh R C, Lawani O L, Ezeonu P O, Onoh T, Ajah L O. Predictors of Anemia in Pregnancy among Pregnant Women Accessing Antenatal Care in Poor Resource Setting in South Eastern Nigeria. Sahel Med J 2015; 18:182–7.

37. Obse N, Mossie A, & Gobena T. Magnitude of anemia and associated risk factors among pregnant women attending antenatal care in Shalla Woreda, West Arsi Zone, Ethiopia. Ethiopian Journal of Health Sciences.2013; 23(2):165–173. 23950633

38. Asri F. Prevalence of anemia and its factors among pregnant women receiving ANC at Aymiba Health Center, North West Ethiopia. J Blood Med. 2017;8;35–40. doi: 10.2147/JBM.S134932 28442940

39. Nega D, Dana D, Tefera T, Eshetu T. Anemia Associated with asymptomatic malaria among pregnant women in the rural surroundings of Arba Minch Town, South Ethiopia. MBC research notes. 2015; 8:110.

Článek vyšel v časopise


2019 Číslo 10