Berhe et al.

BMC Res Notes (2019) 12:310

https://doi.org/10.1186/s13104-019-4347-4 BMC Research Notes

RESEARCH NOTE Open Access

Prevalence of anemia and associated factors

among pregnant women in Adigrat General
Hospital, Tigrai, northern Ethiopia, 2018
Brhane Berhe*, Fitsum Mardu, Haftom Legese, Aderajew Gebrewahd, Guesh Gebremariam, Kebede Tesfay,
Getachew Kahsu, Hadush Negash and Gebre Adhanom

Abstract
Objectives: Anemia remains a major public health problem in Ethiopia, which causes maternal and fetal severe
consequences. In Tigrai, there are limited literatures on prevalence of anemia and associated factors among pregnant
women. Thus, a hospital based cross-sectional study was conducted to determine the prevalence and associated fac-
tors of anemia in Adigrat General Hospital. Data was analyzed and computed using SPSS version 22. p value = 0.05 at
95% confidence interval was considered statistically significant.
Results: Overall prevalence of Anemia among the pregnant women attending Adigrat General Hospital was 7.9%.
About 62.5% and 37.5% of the anemic women were with mild (Hgb: 10.0–10.9 g/d1) and moderate (Hgb: 7–9.9 g/
dl) type respectively. Factors like, residing in rural areas increases risk of anemia by 6 times (AOR = 6, 95% CI 1.34, 27.6,
p = 0.019), participants having current blood loss (AOR = 3.4, 95% CI 1.16, 10.2, p = 0.026), having history of recent
abortion (AOR = 7.9, 95% CI 2.23, 28.1, p = 0.001) and gestational age in the third trimester (AOR = 4.9, 95% CI 1.39,
17.6, p = 0.013) were statistically associated with anemia. Generally, prevalence of anemia is found to be low in the
study area. However, it should be given due attention. Therefore, strong endeavor is needed to control anemia among
pregnant women by assessing different micronutrient deficiencies for further prevention.
Keywords: Anemia, Ethiopia, Factors, Pregnant women

Introduction Globally, Anemia is one of the public health concerns,

Anemia is a condition defined with less hemo- which affects 32.4 million (38.2%) pregnant women
globin (Hgb) level than the normal range in the body, around the world. Particularly, common in South East
which decreases oxygen-carrying capacity of red Asia (48.7%) [4, 5]. Worldwide, it has been reported that
blood cells to tissues [1]. World Health Organiza- nearly 510,000 maternal deaths occur per year associated
tion (WHO) and Center of Disease Control and Preven- with childbirth or early post-partum. Approximately 20%
tion (CDC) definitions for anemia differ with age, sex of maternal death is caused by anemia; with majority of
and pregnancy status. The classification is as follows: deaths occurred in developing countries [6].
children 6 months to 5 years anemia is defined as a Hgb Anemia is the main cause of morbidity and mortality
level < 11 g/dl, children 5–11 years Hgb < 11.5 g/dl, adult among pregnant women in developing countries with
males Hgb < 13 g/dl; non-pregnant women Hgb < 12 g/dl maternal and fetal consequences [7], which leads to pre-
and pregnant women Hgb < 11 g/dl [2, 3]. mature births [8], low birth weight [9], fetal cognitive
impairment, and death [10, 11].
According to the WHO report of 2008, in Africa, 57.1%
of the pregnant women were anemic [12]. Moreover,
*Correspondence: [email protected] anemia among pregnant women is having a severe pub-
Department of Medical Laboratory Science, College of Medicine lic health problem in Ethiopia with an overall prevalence
and Health Science, Adigrat University, Adigrat, Ethiopia of 62.7%. Seventeen percent of Ethiopian women in the

© The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License
(http://creat​iveco​mmons​.org/licen​ses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium,
provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creat​iveco​mmons​.org/
publi​cdoma​in/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Berhe et al. BMC Res Notes (2019) 12:310 Page 2 of 6

reproductive age group are anemic and 22% of them Method of data collection
women were pregnant [13–16]. Questionnaire Data on sociodemographic characteris-
The reason of anemia during pregnancy in developing tics of study participants and determinant factors of ane-
countries includes nutritional deficiencies of iron, folate, mia were collected using interviewer based questionnaire
and vitamin B12 and parasitic diseases, such as malaria by taught data collectors.
and hookworm. The relative contribution of each of these
factors to anemia varies greatly by geographical loca- Stool examination Labeled stool cup with leak proof
tion, season, and dietary practices [7]. Despite the efforts covers possessing respective sequential numbers were
made by the government and other stakeholders, anemia offered for the study participants. Faecal specimens were
during pregnancy is still a public health problem in Ethi- carried out by wet mount.
opia. Since there is limitation of information in the study
area, this study was aimed to determine the prevalence Wet mount technique Fresh stool samples (about 2 mg
and associated factors of anemia in pregnant women in of stool) were placed on a slide with wooden applicator,
Adigrat General Hospital. emulsified with a drop of physiological saline (0.85%)
enclosed with cover slide and examined at 10× and 40×
microscopic objectives [17].
Main text
Study design, period and area Blood examination Labeled venous or heparinized
Hospital based cross-sectional study was conducted in blood samples giving sequential numbers of the study
Adigrat General Hospital from April-September 2018. participants were used. Blood samples were used for
The Hospital is found in Adigrat town, located around Hemoglobin determination (by using HemoCue). Thin
905 km north of Addis Ababa (capital city of Ethiopia) at smear was prepared to observe morphology of the red
an latitude and longitude of 14°16′N 39°27′E, with an ele- blood cells.
vation of 2457 m (8061 ft) above sea level. Based on the
2007 Census conducted by the Central Statistical Agency Hemoglobin determination A venous blood sample was
of Ethiopia (CSA), the town has a total population of taken, filled to micro cuvette, Wipe off excess blood from
57,588, people (26,010 are men and 31,578 women). the outside of the micro cuvette tip, and then placed in the
Currently, the Hospital is serving as a teaching hospital, cuvette holder of the device for measuring hemoglobin
emergency, inpatient and outpatients services for more concentration [17].
than 600,000 people who live in eastern zones of Tigrai
and Afar regional state. The Hospital has high prevalence Red blood cell morphology Blood sample was taken
of intestinal protozoan parasitic infection. from the study participants, a drop of blood was placed
on new slide, and thin smear was prepared. After being
air-dried, labeled with identification number, the smear of
Study participants the slide was fixed with absolute methanol and the smear
The study participants were pregnant women greater was stained with giemsa solution based on the standard
than 18 years of age and given informed consent who operational procedures (SOPs) and examined at 10× and
were requested for blood and stool examination in the 100× microscopic objectives [17].
Hospital during the study period. Convenience sampling
technique was employed to enroll the study participants. Quality control
Questionnaires were pre-tested prior to the actual data
collection. The collected data were checked for consist-
Sample size ency and completeness daily. All the laboratory pro-
A total of 304 participants were determined using single cedures were conducted as per the standard operating
population proportion formula by assuming: 95% level procedures (SOPs).
of confidence, 5% margin of error and P (proportion) of
0.235 [3] and non-response rate of 10%.
Statistical analysis
The degree for severity of anemia in pregnancy was
Data were entered and analyzed using SPSS version 22.
classified into three as per WHO criteria [12]:
Then, summarized using descriptive statistics. Bi-vari-
ate and multi-variate regression tests were employed to
• Mild anemia: 10.0–10.9 g/dl
measure the strength of association between dependent
• Moderate anemia: 7.0–9.9 g/dl
and independent variables. Variables with p < 0.20 in the
• Severe anemia: < 7.0 g/dl
Berhe et al. BMC Res Notes (2019) 12:310 Page 3 of 6

bi-variate logistic regression were transferred to multi- women participants responded having current blood
variate regression analysis to compute AOR. p-value less loss (AOR = 3.4, 95 CI 1.16, 10.2, p = 0.026), history of
than 0.05 was considered statistical significant. recent abortion (AOR = 7.9, 95 CI 2.23, 28.1, p = 0.001)
and women in third trimester gestational age (AOR = 4.9,
Ethical consideration 95 CI 1.39, 17.6, p = 0.013) were factors found statisti-
The study was approved by college of health Sci- cal significant association with anemia. Though, not sta-
ences Research Ethical review committee of Adi- tistically significant, prevalence of anemia was higher
grat University, Ethiopia (consent ref. Number AGU/ among those who didn’t use iron supplement, women
CMHS/096/2018APROVAL dated 18/02/2018. Offi- who gave birth after a year, among illiterate and house-
cial letter was obtained from Tigrai Regional Health wife (Table 1).
Bureau to Adigrat General Hospital. Permission was also
obtained from Administrator of Adigrat general Hospital. Discussion
Furthermore, after explaining the importance of study, an The prevalence of anemia in the present study was 7.9%.
informed written consent was obtained from study par- This was in line with previous studies conducted in
ticipants. No name was mentioned during the entire data Debre Berhan, 9.7% [18], Sudan, 10% [19], Addis Ababa,
collection and identification was based on the unique 11.6% [20] and Iran, 13.6% [21]. However, our finding
identification number given for each questionnaire and was observed to be lower than other similar studies [1,
corresponding specimen. Confidentiality of information 22–27] and in South-East Ethiopia, 27.9% [28]. The dif-
(results) was kept between the study participant, data ference might be due to geographical variation, differ-
collector/investigator and authorized physician. Those ences in socioeconomic status, dietary habits of the study
study participants who were anemic and showed intesti- participants [20] and pregnant women with iron supple-
nal parasites were reported to physician to treat accord- mentation were not excluded in this study. Additionally,
ing to the national protocol. the lower occurrence of anemia in this study might be
attributed by decreased prevalence of hemoparasites like
Results Malaria in the study area.
Socio‑demographic characteristics In this study, the majority of anemic cases, 62.5%
A total of 304 pregnant women were included in the (15/24) were mild type followed by 37.5% (9/24) mod-
study. The mean age of the study participants was erate cases of anemia. A similar provision was reported
25.3 ± 5.1 (ranged from 18 to 41 years). Out of 304 par- in Kenya (62.5% and 37.5%) [24] and Nepal (67.1%, and
ticipants, 217 (71.4%) were living in urban areas and the 28.6%) [29] in which majority of the cases was mild ane-
rest 87 (28.6%) were rural dwellers. More than Half, 235 mia followed by moderate anemia respectively. In con-
(77.3%), of the study participants were housewife fol- trast to this report, study performed in Kenya (70.7% and
lowed by self-employee, 39 (12.8%) and governmental 26.3%) [30] and southern Ethiopia (60% and 34.3%) [31]
employee, 30 (9.9%) (Table 1). majority of the anemia case was moderate followed by
mild correspondingly.
Laboratory findings History of blood loss (AOR = 3.4, 95 CI 1.16, 10.2,
Among 304 study participants, 24 (7.9%) were anemic p = 0.026) was significantly associated with the occur-
(Hgb: < 11 g/dl). The general distribution of anemia was rence of anemia. This study was consistent with studies
15 (62.5%) microcytic hypochromic, 6 (25.0%) normo- conducted in different parts Ethiopia [31–33]. Similar to
cytic hypochromic and 3 (12.5%) macrocytic hypochro- a report from South western Ethiopia, history of abor-
mic based on the morphology of red blood cells. tion (AOR = 7.9, 95 CI 2.23, 28.1, p = 0.001) was signifi-
Entamoeba histolytica 24 (7.9%), Giardia lamblia and cantly associated with anemia [33]. This might be due to
both Entamoeba histolytica/dispar and Giardia lamblia increased loss of blood which depletes stored iron that
15 (4.9%) were among intestinal parasites detected from leads extra requirement of iron than the usual [34].
stool of the pregnant women (Table 2). The majority of Moreover, elevated anemia was found with rural resi-
anemic cases 62.5% (15/24) showed mild type of anemia dence and third trimester of gestational age. The preg-
(Fig. 1). nant women of rural residence were about 6 times high
likely to be anemic than the urban dwellers. The risk of
Factors associated with anemia getting anemia was also 4.9 times higher among women
All variables with p value < 0.2 (20%) in the bivariate in the third trimester of gestational age. This study was
analysis were enter and analyzed by multivariate logis- parallel with the report in Pakistan [35], India [36], Libya
tic regression. Study participants those who were resid- [37], Nepal [38], eastern Ethiopia [39] and northwest
ing in rural areas (AOR = 6.0, 95 CI 1.34, 27.6, p = 0.019), Ethiopia [40]. In contrast to this study; as reported in
Berhe et al. BMC Res Notes (2019) 12:310 Page 4 of 6

Table 1 Socio-demographic characteristics of participants and outcome of different factors on the prevalence of anemia
in pregnant women attending Adigrat General Hospital, northern Ethiopia, from April to September 2018
Variables Frequency N (%) Anemia prevalence COR (95% CI) p-value AOR (95% CI) p-value
Positive (%)

Age (in years)

18–25 169 (55.6) 5.32 1
26–34 117 (38.5) 10.26 0.40 (0.2, 1.2) 0.100
> 34 18 (5.9) 16.67 0.28 (0.06, 1.1) 0.070
Educational level
Illiterate 32 (13.8) 43.75 0.87 (0.7, 2.3) 0.700
1–8 87 (28.6) 3.45 0.50 (0.9, 3.5) 0.350
9–12 160 (52.6) 2.50 0.40 (0.061, 5.03) 0.900
> 12 15 (4.9) – 1
Residence
Urban 213 (70.1) 3.75 1 1
Rural 91 (29.9) 17.58 8.70 (2.01, 38.4) 0.004 6.00 (1.34, 27.6) 0.019
Occupation
Housewife 235 (77.3) 7.65 0.39 (0.051, 3.04) 0.370
Self employed 39 (12.8) 7.69 1.30 (0.08, 21.8) 0.850
Governmental 30 (9.9) 10.00 1
Pregnancy gap (last and current pregnancy)
1 year 37 (12.2) 32.43 0.02 (0.005, 0.08) 0.000 0.19 (0.02, 1.70) 0.138
2 years 42 (13.8) 7.14 1.13 (0.12, 11.3) 0.900
3 years 42 (13.8) 7.14 0.50 (0.09, 3.5) 0.500
> 3 years 72 (23.7) 4.17 1.90 (0.19, 18) 0.600
First pregnancy 111 (36.5) 2.70 1 1
Iron supplements
Yes 190 (62.5) – 1 1
No 114 (37.5) 7.90 0.08 (0.02, 0.31) 0.000 0.06 (0.01, 1.22) 0.089
Presence of current blood loss
Yes 43 (14.1) 41.86 5.90 (2.17, 16.2) 0.001 3.40 (1.16, 10.2) 0.026
No 261 (85.9) 2.29 1 1
Trimester (weeks)
1 60 (19.7) – 1 1
2 96 (31.6) 3.12 2.00 (0.79, 12) 0.005 0.14 (0.65, 9.12) 0.070
3 148 (48.7) 14.18 5.00 (1.49, 17.67) 0.010 4.90 (1.39, 17.6) 0.013
Recent history of abortion
Yes 88 (29) 17.04 9.60 (2.76, 33.2) 0.000 7.90 (2.23, 28.1) 0.001
No 216 (71) 4.17 1 1
Current history of malaria
Yes 42 (13.8) 14.28 0.04 (0.01, 0.1) 0.000 0.08 (0.02, 1.26) 0.061
No 262 (86.2) 6.87 1
History of coffee (the
last 3 months)
Yes 212 (69.7) 8.01 0.12 (0.014, 0.81) 0.030 0.09 (0.010, 1.84) 0.054
No 92 (30.3) 7.61 1
Home delivery (previous pregnancy delivery)
Yes 43 (14.1) 6.97 0.05 (0.02, 0.13) 0.000 0.26 (0.04, 1.60) 0.145
No 261 (85.9) 8.01 1
COR, crude odds ratio, CI, confidence interval, AOR, adjusted odds ratio); 1 (referent); − (no)
Berhe et al. BMC Res Notes (2019) 12:310 Page 5 of 6

Table 2 Laboratory finding of the pregnant women and health education promotion programs regarding the
attending Adigrat General Hospital, northern Ethiopia, cause and prevention of anemia among pregnant women
April–September 2018 by assessing micronutrients and other causal related fac-
Hematocrit value (Hgb value) Number of cases (%) tors for anemia.

Anemic < 33% (< 11 gm/dl) 24 (7.9)

Limitation of the study
Not-anemic > 33% (> 11 gm/dl) 280 (92.1)
The study was institutional based study. Further study
Red blood examination
should be conducted based on community level to make
Microcytic–hypochromic 15 (62.5)
this finding stronger. Besides, the study was restricted
Normocytic–hypocromic 6 (25)
cross-sectional study design and didn’t address every
Macrocytic–hypocromic 3 (12.5)
nutritional variable.
Stool examination
Entamoeba histolytica/dispar 24 (7.9)
Giardia lamblia 15 (4.9) Abbreviations
ANC: antenatal care; CDC: Center of Disease Control and Prevention; CSA:
Entamoeba histolytica/dispar and Giardia 15 (4.9)
Central Statistical Agency; Hgb: hemoglobin; SPSS: statistical product and
lamblia
service solution; SOPs: standard operating procedures; WHO: World Health
No ova or parasite 250 (82.2) Organization.

Acknowledgements
We are thankful to laboratory personnel, clinicians of Adigrat General Hospital
and study participants for their willingness of participation.
0.00%
Authors’ contributions
BB designed the study, analyzed data and drafted manuscript; FM, HL and
GK participated in the design of the study, data analysis and revision of the
manuscript; AG participated in the design of the study, data analysis and revi-
sion of the manuscript, GG, KT, HN and GA designed the study, analyzed data
and wrote and revised the manuscript. All authors read and approved the final
37.50% manuscript.

Funding
Not applicable.

62.50% Availability of data and materials

The data sets used and/or analyzed during the current study are available
from the corresponding author on reasonable request.

Ethics approval and consent to participate

Ethical approval was sought from Adigrat University, College of Health Sci-
ences institutional review board (IRB). Written consents were collected from
the study participants. Participants’ positive for anemia and intestinal parasites
severe (<7 g/dl) moderate (7-9.9 g/dl) mild (10-10.9 g/dl) were reported to physician to treat according to the national protocol.

Fig. 1 Illustrates the prevalence of the degree of anemia among Consent for publication
pregnant women attending Adigrat General Hospital, North Ethiopia, Not applicable.
April–September 2018
Competing interests
The authors declare that they have no competing interests.

western Nepal [29] and Nigeria [41], the distribution of Received: 5 February 2019 Accepted: 29 May 2019

anemia was higher in second trimester of gestational age.

Conclusions References
1. Alem M, Enawgaw B, Gelaw A, Kena T, Seid M, Olkeba Y. Prevalence of
This study revealed that the prevalence of anemia among anemia and associated risk factors among pregnant women attending
pregnant women was relatively low compared to the find- antenatal care in Azezo Health Center Gondar town, Northwest Ethiopia.
ings of other reports in Ethiopia. Rural residence, his- J Interdiscipl Histopathol. 2013;1(3):137–44.
2. Iron Deficiency Anemia. Assessment prevention and control. Geneva:
tory of abortion, current blood loss and third trimester WHO; 2001.
gestational age were statistical significant associated fac- 3. Zekarias B, Meleko A, Hayder A, Nigatu A, Yetagessu T. Prevalence of
tors with anemia in this study. Therefore, further large anemia and its associated factors among pregnant women attending
antenatal care (ANC) In Mizan-Tepi University Teaching Hospital, South
scale longitudinal studies should be done in respect to West Ethiopia. Health Sci J. 2017;11(5):529.
the importance of regular visit to maternal care centers
Berhe et al. BMC Res Notes (2019) 12:310 Page 6 of 6

4. WHO. The global prevalence of anemia in 2011. 25. Acheampong K, Appiah S, Awuah DB, Arhin YS. Prevalence of anemia
5. Tadesse SE, Seid O, Gariam Y, Fekadu A, Wasihun Y, Endris K, et al. Deter- among pregnant women attending antenatal clinic of a selected Hospi-
minants of anemia among pregnant mothers attending antenatal care tal in Accra, Ghana. IJHSR. 2018;8:1.
in Dessie town health facilities, northern central Ethiopia, unmatched 26. Haniff J, Das A, Teck I, Sun CW, Mrcog NM, Rampal S, et al. Anemia in
case–control study. PLoS ONE. 2017;12(3):0173173. pregnancy in Malaysia: a cross-sectional survey. Asia Pac J Clin Nutr.
6. Crawley J. Reducing the burden of anemia in infants and young children 2007;16(3):527–36.
in malaria endemic countries of Africa: from evidence to action. Am J 27. Zhanga Q, Lic Z, Ananth CV. Prevalence and risk factors for anaemia in
Trop Med Hyg. 2004;71:25–34. pregnant women: a population-based prospective cohort study in China.
7. Getahun W, Belachew T, Wolide AD. Burden and associated factors Paediatr Perinat Epidemiol. 2009;23:282–91.
of anemia among pregnant women attending antenatal care in southern 28. Kefiyalew F, Zemene E, Asres Y, Gedefaw L. Anemia among pregnant
Ethiopia: cross sectional study. BMC Res Notes. 2017;10:276. women in Southeast Ethiopia: prevalence, severity and associated risk
8. Levy A, Fraser D, Katz M, Mazor M, Sheiner E. Maternal anemia during factors. BMC Res Notes. 2014;7(1):1.
pregnancy is an independent risk factor for low birth weight and preterm 29. Singh P, Khan S, Mittal RK. Anemia during pregnancy in the women of
delivery. Eur J Obstetrics Gynecol Reprod Biol. 2005;122(2):182–6. western Nepal. BMJ. 2013;2(1):14–6.
9. Banhidy F, Acs N, Puho EH, Czeizel AE. Iron deficiency anemia: preg- 30. Tekeste O. Prevalence and factors associated with anaemia among preg-
nancy outcomes with or without iron supplementation. Nutrition. nant women attending antenatal clinic in the second and third trimesters
2011;27(1):65–72. at Pumwani maternity Hospital, Nairobi, 2015 (un-published).
10. Kalaivani K. Prevalence & consequences of anemia in pregnancy. Indian J 31. Gedefaw L, Ayele A, Asres Y, Mossie A. Anemia and associated factors
Med Res. 2009;130(5):627–33. among pregnant women attending antenatal care clinic in Wolayita
11. Walter T. Effect of iron-deficiency anemia on cognitive skills and neuro- Sodo Town, southern Ethiopia. Ethiop J Health Sci. 2015;25:2.
maturation in infancy and childhood. Food Nutr Bull. 2003;24(4):104–10. 32. Jufar AH, Zewde T. Prevalence of anemia among pregnant women
12. Benoist B, McLean E, Egli I, Cogswell M. World Health Organization, cent- attending antenatal care at Tikur Anbessa Specialized Hospital, Addis
ers for disease control and prevention: worldwide prevalence of anemia Ababa Ethiopia. J Hematol Thromb Dis. 2014;2:125.
1993–2005. Geneva: World Health Organization; 2008. 33. Zekarias B, Meleko A, Hayder A, Nigatu A, Yetagessu T. Prevalence of
13. Gebre A, Mulugeta A. Prevalence of anemia and associated factors anemia and its associated factors among pregnant women attending
among pregnant women in North Western zone of Tigray, Northern antenatal care in Mizan-Tepi University Teaching Hospital, South West
Ethiopia: a cross-sectional study. J Nutr. 2015;2015:165430. Ethiopia. Health Sci J. 2017;11(5):529.
14. Ethiopia Demographic, Survey Health. Central statistics agency. Ethiopia: 34. Tadesse SE, Seid O, Mariam YG, Fekadu A, Wasihun Y. Determinants of
Addis Ababa; 2011. anemia among pregnant mothers attending antenatal care in Dessie
15. Ayano B, Amentie B. Assessment of prevalence and risk factors for anemia town health facilities, northern central Ethiopia, unmatched case–control
among pregnant mothers attending ANC Clinic at Adama Hospital Medi- study. PLoS ONE. 2017;12:e0173173.
cal Collage, Adama, Ethiopia. J Gynecol Reprod. 2018;6(3):31–9. 35. Ullah I, Zahid M, Khan MI, Shah M. Prevalence of anemia in preg-
16. WHO. Hemoglobin concentrations for the diagnosis of anemia and nant women in district Karak, Khyber Pakhtunkhwa, Pakistan. IJB.
assessment of severity, vitamin and mineral nutrition information system. 2013;3(11):1–7.
Geneva: WHO; 2011. 36. Suryanarayana R, Santhuram AN, Chandrappa M, Shivajirao P, Rangappa
17. Cheesbrough M. District laboratory practice in tropical countries 2009, SS. Prevalence of anemia among pregnant women in rural population of
part 1. 2nd ed. Cambridge: Cambridge University Press; 2009. Kolar district. Int J Med Sci Public Health. 2016;5:3.
18. Abere Y. Pregnancy anemia prevalence and associated factors among 37. Elzahaf R, Omar M. Prevalence of anaemia among pregnant women in
women attending ante natal care in North Shoa Zone, Ethiopia. RSSDIJ. Derna city, Libya. Int J Community Med Public Health. 2016;3(7):1915–20.
2014;3:3. 38. Rayamajhi N, Mishra SK, Gautam N, Doshi NR. Prevalence of anemia in
19. Abdelgader EA, Diab TA, Kordofani AA, Abdalla SA. Hemoglobin level, pregnant women attending a tertiary level hospital in western region,
RBCs Indices, and iron status in pregnant females in Sudan. Basic Res J Nepal. JUCMS. 2016;4(2):14.
Med Clin Sci. 2014;3(2):8–13. 39. Bereka SG, Gudeta AN, Reta MA, Ayana LA. Prevalence and associated risk
20. Gebreweld A, Tsegay A. Prevalence and factors associated with anemia factors of anemia among pregnant women in rural part of JigJiga City,
among pregnant women attending antenatal clinic at St. Paul’s Hospital Eastern Ethiopia: a cross sectional study. J Preg Child Health. 2017;4:337.
Millennium Medical College, Addis Ababa, Ethiopia. Adv Hematol. 40. Asri F. Prevalence of anemia and its associated factors among pregnant
2018;2018:3942301. women receiving antenatal care at Aymiba Health Center, northwest
21. Barooti M, Rezazadehkermani B, Sadeghirad S, Motaghipisheh S, Arabi M. Ethiopia. J Blood Med. 2017;8:35–40.
Prevalence of iron deficiency anemia among Iranian pregnant women; a 41. Dattijo LM, Daru PH, Umar NI. Anaemia in pregnancy: prevalence and
systematic review and meta-analysis. J Reprod Fertil. 2010;11(1):17–24. associated factors in Azare, North-East Nigeria. IJTD. 2016;11(1):1–9.
22. Kumari S, Priya J. Prevalence of anemia risk factors in pregnant women.
IJSR. 2016;5:4.
23. Lelissa D, Yilma M, Shewalem W, Abraha A, Worku M, Ambachew H, et al. Publisher’s Note
Prevalence of anemia among women receiving antenatal care at Boditii Springer Nature remains neutral with regard to jurisdictional claims in pub-
Health Center, Southern Ethiopia. J Clin Med Res. 2015;4(3):79–86. lished maps and institutional affiliations.
24. Siteti M, Namasaka SD, Ariya OP, Injete SD, Wanyonyi WA. Anae-
mia in pregnancy: prevalence and possible risk factors in Kakamega
County, Kenya. SJPH. 2014;2(3):216–22.