Study setting and design
Facility based cross-sectional study was done at Butajira General Hospital from March 01 to April 30, 2015 Southern Ethiopia. Butajira General Hospital is located in the South Nation Nationality and Peoples Region (SNNPR), which is 135 km far from Addis Ababa, the capital city of Ethiopia. On average, 405 pregnant women have been registered in the ANC follow up.
Study population
All pregnant women visiting ANC follow up from March 01 to April 30, 2015 and fulfilled the inclusion criteria included to the study. Current illness and drug treatment for chronic illness were the exclusion criteria. Subject recruitment was conducted on volunteer basis after having a clear understanding of the research.
Sample size determination and sampling procedures
The sample size was determined based on the single population proportion formula using Z2 × p × q/d2 with a 95% confidence interval, 5% margin of error and an assumption that 50% of pregnant women are anemic in the study area. Thus, the total sample size was 384.16. Since the total ANC followers in the study area are 405 which is less than 10,000 we used correction formula to calculate the final sample size. Therefore, considering non-response rate (10%), the final sample size for this study were 217. The sample random sampling (lottery) method was used to select the first study participant and a systematic random sampling method (k = N/n = 405/217 = 1.86 = 2) was used to select the rest of the others. Thus, every second (k = 2) pregnant women who mate our inclusion criteria was selected.
Methods of data collection
Information on socio-demographic characteristics, obstetric and gynecological history, and dietary patterns were collected using interviewer-administered pretested questionnaires. Hematological parameters such as Mean cell volume (MCV), Mean cell hemoglobin (MCH) and Mean cell hemoglobin concentration (MCHC) and the analysis were done using CELL-DYN 1800. Anemia in pregnancy was defined as Hemoglobin (Hb) less than 11 g/dl [16]. Stool specimens were collected from each study participant and an examination of intestinal parasitic infections was conducted using saline wet smear and formol-ether concentration techniques [17]. Bivariate and multivariate logistic regression analysis were done to assess the independent risk factors associated with anemia. The goodness of fit of the final logistic model was tested using Hosmer and Lemeshow test (p < 0.05).
Data quality assurance
To assure the quality of the data Standard operating procedures (SOPs) were followed during specimen collection and other laboratory procedures. All reagents used were checked for their expiry date and prepared according to the manufacturer’s instructions. Training was given for the data collectors to minimize technical and observer biases.
Methods of data analysis
Data were edited, cleaned and checked for its completeness and entered into EpiData 3.1 then exported to Statistical packages for social sciences (SPSS) Version 20 for analysis. Categorical variables were summarized as numbers and percentages. Both bivariate and multivariate logistic regression analysis were done to assess the independent risk associated factors for anemia. All variables with a p value less than 0.05 were considered as statistical significance. The goodness of fit of the final logistic model was tested using Hosmer and Lemeshow test at a p value less than 0.05.
Ethical statement
Ethical clearance was obtained from Jimma University Ethical Review Committee. Letter of permission to conduct the study was obtained from Butajira General Hospital ANC clinic. Written informed consent was obtained from each study participant. The purpose of the study was clearly described to the study participants including the benefits and risks of the study. Any information concerning the participants was kept confidential and the specimen collected from the participants was only analyzed for the intended purposes. The participants were enrolled only after they were sufficiently counseled and their informed consents have been obtained. Positive findings for intestinal helminths and hemoglobin value below accepted value were communicated with the respective health professionals of Butajira General Hospital ANC clinic for possible interventions.