Socio-demographic and economic characteristics of study participants
A total of 634 pregnant women were interviewed with the response rate of 99%. The average mean age of study participants was 26.99 years with standard deviation (SD) of 5.99. The majority of age group belongs to 20–34 years which accounts 487(76.81%). Nearly all 609(96.06%) of study participants were with orthodox religion. Regarding to marital status, 13(2.05%) of study participants were not married whereas 552(87.07%) were married. Eighty five (13.41%) of participants were with housewife occupation and 277(43.69%) of the study participants were with primary educational level. Four hundred fifteen (65.46%) of the study participant’s household size were 1–4 and about a quarter of study participants 127(25.08%) were with second wealth quintile (Table
1).
Table 1
Socio-demographic and economic characteristics of pregnant women attending ANC in public health centers in central zone of Tigray region, northern Ethiopia, 2018
Age in years |
15–20 | 55 | 8.68 |
20–34 | 487 | 76.81 |
≥35 | 92 | 14.51 |
Mean = 26.99 (SD = 5.99) | | |
Religion |
Orthodox | 609 | 96.06 |
Muslim | 25 | 3.94 |
Marital status | | |
Not married | 13 | 2.05 |
Married | 552 | 87.07 |
Divorced | 20 | 3.15 |
Separated | 46 | 7.26 |
Others | 3 | 0.47 |
Occupation |
House wife | 85 | 13.41 |
Farmer | 399 | 62.93 |
Merchant | 89 | 14.04 |
Employee | 43 | 6.78 |
Others | 18 | 2.84 |
Level of education |
No formal education | 173 | 27.29 |
Primary | 277 | 43.69 |
Secondary | 126 | 19.87 |
Diploma and above | 58 | 9.15 |
Household size |
1–4 | 415 | 65.46 |
5–7 | 181 | 28.55 |
≥8 | 38 | 5.99 |
Wealth quintile |
Lowest | 127 | 20.03 |
Second | 159 | 25.08 |
Middle | 181 | 28.55 |
Fourth | 60 | 9.46 |
Highest | 107 | 16.88 |
Out of the total study participants, 175(27.6%) were nulliparous and 79(16.92%) had history of abortion. Fifty seven (12.42%) and 37(8.06%) of the study participants were with less than 2 years birth interval and had history of still birth respectively. Regarding to history of malaria attack 1 year prior to this study period, 112(17.67%) of the study subjects had history of malaria. Most of the participants 542(85.49%) and 582(91.8%) had no history of excessive menstrual bleeding and pregnancy related complications respectively. Only 132(20.82%) of study subjects were with planned pregnancy. Almost half 315(49.68%) of the participants were with MUAC less than 23 cm.
The magnitude of anemia (hemoglobin level < 11 mg/dl) were found that 16.88% (95% CI: 13.95%, 19.8%). The mean hemoglobin level of study participants were 12.3 (SD ± 1.33). Most of the pregnant women 489 (77.13%) who attend their first ANC were at the 3–6 months of gestational age (Table
2).
Table 2
Obstetric history characteristics of pregnant women attending ANC in public health centers in central zone of Tigray region, northern Ethiopia, 2018
Parity |
Nulliparous | 175 | 27.60 |
1–4 | 391 | 61.67 |
≥5 | 68 | 10.73 |
Ever had abortion |
No | 388 | 83.08 |
Yes | 79 | 16.92 |
Birth interval |
< 2 years | 57 | 12.42 |
≥2 years | 402 | 87.58 |
Had ever still birth |
No | 422 | 91.94 |
Yes | 37 | 8.06 |
Have got malaria in previous year |
No | 522 | 82.33 |
Yes | 112 | 17.67 |
Had excessive menstrual bleeding |
No | 542 | 85.49 |
Yes | 92 | 14.51 |
Had pregnancy related complication |
No | 582 | 91.80 |
Yes | 52 | 8.20 |
Planned pregnancy |
No | 132 | 20.82 |
Yes | 502 | 79.18 |
Nutritional status (MUAC) |
< 23 cm | 315 | 49.68 |
≥23 cm | 319 | 50.32 |
Hemoglobin level |
< 11 mg/dl | 107 | 16.88 |
≥11 mg/dl | 527 | 83.12 |
Mean 12.38(SD ± 1.33) | | |
HGB level by gestational age (Average HGB level) |
< 3 Months Mean = 12.2(SD ± 1.63) | 19 | 3 |
3–6 Months Mean = 12.22(SD ± 1.29) | 489 | 77.13 |
> 6 Months Mean = 12.13(SD ± 1.41) | 126 | 19.87 |
The meal frequency of study participants with greater than three times per day were 252(39.75%). Majority 541(85.33%) of the total participants were reported that they consume food made from cereals and grains daily. Besides, 179(28.23%) of the total participants didn’t take tea or coffee. Concerning to fruit and green leafy vegetables intake, only 11(1.74%) and 40(6.31%) of the total study participants reported with daily intake respectively (Table
3).
Table 3
Dietary factors characteristics of pregnant women attending ANC in public health centers in central zone of Tigray region, northern Ethiopia, 2018
Meal frequency |
≤3times per day | 382 | 60.25 |
>3times per day | 252 | 39.75 |
Eating food made from cereals, grains |
Daily | 541 | 85.33 |
Weekly | 84 | 13.25 |
Monthly or above | 9 | 1.42 |
Drinking tea or coffee |
No | 179 | 28.23 |
Before meal | 73 | 11.51 |
Within 1 h | 249 | 39.27 |
After 1 h | 133 | 20.98 |
Fruit intake |
No | 291 | 45.9 |
Daily | 11 | 1.74 |
Weekly | 266 | 41.96 |
Monthly or above | 66 | 10.41 |
Green leafy vegetables intake |
No | 91 | 14.35 |
Daily | 40 | 6.31 |
Weekly | 463 | 73.03 |
Monthly or above | 40 | 6.31 |
Dairy products/ milk product intake |
No | 297 | 46.85 |
Daily | 58 | 9.15 |
Weekly | 211 | 33.28 |
Monthly or above | 68 | 10.73 |
Meat intake |
No | 100 | 15.77 |
Daily | 16 | 2.52 |
Weekly | 172 | 27.13 |
Monthly or above | 346 | 54.57 |
Egg intake |
No | 132 | 20.82 |
Daily | 62 | 9.78 |
Weekly | 343 | 54.10 |
Monthly or above | 97 | 15.30 |
Socio-demographic factors like; age of women, religion, marital status, occupation, household size and wealth quintile were not significantly associated with the anemia in Bivariable analysis at P-value < 0.05. Similarly, parity of women, history of abortion, birth interval, history of still birth and nutritional status were not significantly associated with anemia in Bivariable analysis. Regarding to dietary intake, variables which were not significantly associated with anemia in Bivariable analysis at P-value < 0.05 were; eating food made from cereals and grains, drinking tea or coffee, fruit intake, green leafy vegetables intake, dairy products/ milk product intake, meat intake and egg intake.
Variables which were significantly associated with anemia in Bivariable analysis but remains insignificant in multivariable analysis were; women’s level of education, birth interval and had pregnancy related complication. However, history of malaria attack 1 year prior to study period, women who had history of excessive menstrual bleeding, planned pregnancy and meal frequency were significantly associated with anemia in the multivariable analysis. Women with history of malaria attack were significantly associated with anemia comparing to women who had no malaria attack (AOR = 4.73, 95% CI: 2.64, 8.46). Comparing to women who had no history of excessive menstrual bleeding, anemia was 3.94 times higher in women with history of excessive menstrual bleeding (AOR = 394, 95% CI: 2.11, 7.35). Similarly anemia was higher in pregnant women who had no pregnancy planning (AOR = 2.5, 95% CI: 1.4, 4.42) comparing to their counter parts. Meal frequency less than or equal to 3 times per day was also significantly associated with anemia (AOR = 1.89, 95% CI: 1.02, 3.5) (Table
4).
Table 4
Bivariable and multivariable analysis of factors associated with anemia among pregnant women attending ANC in public health centers of central zone of Tigray region, northern Ethiopia, 2018
Women’s level of education |
No formal education | 39(36.45%) | 134(25.43%) | 1 | 1 |
Primary | 35(32.71%) | 242(45.92%) | 2.01(1.22, 3.33)* | 1.53(0.81, 2.89) |
Secondary | 20(18.69%) | 106(20.11%) | 1.54(0.89, 2.8) | 0.98(0.43, 2.25) |
Diploma and above | 13(12.15%) | 45(8.54%) | 1.01(0.49, 2.06) | 0.52(0.17, 1.61) |
Birth interval |
< 2 years | 16(20.78%) | 41(10.73%) | 2.2(1.2, 4.13) * | 0.57(0.27,1.2) |
≥2 years | 61(79.22%) | 341(89.27%) | 1 | 1 |
Malaria attack in last 1 year |
No | 64(59.81%) | 458(86.91%) | 1 | 1 |
Yes | 43(40.19%) | 69(13.09%) | 4.46(2.8, 7.1) * | 4.73(2.64, 8.46) * |
Had excessive menstrual bleeding |
No | 69(64.49%) | 473(89.75%) | 1 | 1 |
Yes | 38(35.51%) | 54(10.25%) | 4.82(2.0, 7.84) * | 3.94(2.11,7.35) * |
Had pregnancy related complication |
No | 93(86.92%) | 489(92.79%) | 1 | 1 |
Yes | 14(13.08%) | 38(7.21%) | 1.94(1.01, 3.72) * | 1.87(0.77, 4.54) * |
Planned pregnancy |
No | 38(35.51%) | 94(17.84%) | 2.54(1.61, 4.0) | 2.5(1.4,4.42) * |
Yes | 69(64.49%) | 433(82.16%) | | 1 |
Meal frequency |
≤3 times per day | 74(69.16%) | 308(58.44%) | 1.6(1.02, 2.49) | 1.89(1.02, 3.5) * |
>3times per day | 33(30.84%) | 219(41.56%) | 1 | 1 |