Characteristics of the respondents
A total of 349 pregnant women following ANC took part in the study making the response rate 99.1%. The participants were selected from five health centers located at altitude ranging from 1,761 to 2,690 meters ASL. Nearly three-fourths (72.2%) of the study participants were drawn from the midland kebeles. The majority of the women (72.2%) were rural dwellers.
The mean (± SD) age of the women was 25.7(± 4.7) years and the vast majority (87.1%) were within the age bracket of 20 to 35 years. The majority of women worked as housewives (80.2%), were from the Sidama ethnic group (72.8%), were predominantly Protestant (85.4%) and nearly 1 in 3 (29.2%) were illiterate. The median monthly income was 2,500 Ethiopian birr (equivalence of 90 USD) and ranged from 600 to 5,995 birr. The average (± SD) household size was 4.8 (±1.8) (Table 1).
During the study the mean gestational age of the women was 26.6 (±5.5) weeks. Near to two-thirds (63.3%) were in their third trimester and the remaining (36.7%) were in the second trimester. The median parity was 2 and ranged from 0-8. About 18.6% and 11.7% of the study participants were nulliparas and grand multiparas, respectively. Among those who had at least two births before, 45.0% had short (less than 2 years) birth interval.
Three fourth (78.5%) of the respondents use piped water as their usual source of drinking water; while remaining 14.6% and 6.9% use protected and unprotected well/spring, respectively. Majority (81.4%) of the women reported that they somehow treat water before consumption. The approaches used for treating water include: adding disinfectants (74.3%), strain through cloth (16.9%), use of water filter (6.7%) and boiling (2.1%). About three-fourths (71.3%) owned a toilet facility.
Knowledge of pregnant women on anemia
Out of the 349 respondents, 76.8% reported they had ever heard of anemia before. Among those who were aware of anemia, 83.9%, 96.3% and 48.1% knew anemia during pregnancy can be caused by bleeding, under-nutrition and infections, respectively. Out of total respondents, 72.8% were aware of at least one possible consequence of anemia in pregnancy. The most frequently mentioned consequences were: perinatal mortality (92.5%), maternal mortality (82.3%), low birthweight (66.1%) and neonatal morbidity and mortality (55.5%). Three-fourths of the respondents (74.5%) knew anemia is a preventable condition. The most commonly cited preventive measures were: eating diversified diet (97.7%), taking iron and folic acid tablets during pregnancy (94.6%), birth spacing (88.46%), preventing infection including intestinal parasites (47.7%) and specifically taking deworming medications (43.0%).
Dietary diversity and nutritional status of pregnant women
The overall quality of diet of the pregnant women was also assessed based on the diet consumed in the preceding day. Cereals (99.1%), vitamin A rich fruits and vegetables (88.3%), roots and tubers (86.2%) and foods made of oil, fat or butter (83.1%) were consumed by the vast majority of the subjects. Legumes (69.6%) and milk or milk products (55.3%) were also taken by more than half of them. Food groups that were less frequently consumed were: other fruits (37.0%), other vegetables (23.5%), eggs (18.1%), flesh foods (12.6%) and fish (0.0%).
The mean (± SD) DDS was 4.0 (± 1.6). Only 19.5% consumed from 6 or more groups indicative of high dietary diversity. Conversely, 38.4% had medium (4-5 food groups) and 42.1% had low DDS (less than 4 food groups).
The mean MUAC of the respondents’ was 22.8 (±1.9) cm. About one-fifth (20.6%) of the pregnant women had MUAC less than 21cm suggestive of acute malnutrition. Smaller proportions (1.1%) of the pregnant women had short stature (height less than 145 cm).
Fifty five percent of the pregnant women took deworming medication at least once in the preceding 6 months of the survey. Similarly, 45.3% reported that they took iron supplement during the current pregnancy.
Prevalence of intestine parasitosis and anemia
The overall prevalence of intestinal parasite infection was 38.7% (95% CI: 33.6-43.8%). One-tenth (9.7%) were infected with polyparasites. A. lumbricoides was the most common infection (24.9%) followed by hookworms (11.2%), G. lamblia (5.4%), E. histolytica (3.4%), T. trichiura (2.9%) and S. mansoni (2.3%).
The mean hemoglobin concentration was 12.3 (±1.9) g/dl and ranged from 7.1 to 18.2 g/dl. It was found that 31.5% (95% CI: 26.6-36.4%) pregnant women were anemic. The prevalence of mild and moderate anemia were 21.5% and 10.0%, respectively. None of the women had severe anemia.
Association between intestinal parasitosis and anemia
The prevalence of anemia among pregnant women infected with intestinal parasite (55.6%) was significantly higher than the prevalence among women who were not infected (16.4%) (p<0.001). Nearly all of the mothers infected with hookworm (92.3%) were anemic. Further the prevalence of anemia was alarmingly high among mothers diagnosed with other parasites: G lamblia (78.9%), S mansoni (75.0%), E histolytica (50.0%), T trichiura (50.0%) and A lumbricoides 40.2%. Statistically significant association was observed between anemia and hookworm, G. lamblia, S. mansoni and A. lumbricoides infections (p<0.05) (Table 2).
The bivariable logistic regression analysis suggested women who were infected with intestinal parasites had 6 times increased odds of anemia (COR = 6.39, 95% CI: 3.89-10.50) as compared to their counterparts. In the multivariable model in which 13 potential confounders were adjusted, the odds of anemia were also six times increased (AOR=6.14, 2.04-18.45) among individuals infected with intestinal parasites (Table 3). The outputs of the full regression model is now provided as a supporting file (Supporting File 2).