The study was done in Shire town northwestern zone which was located in north part of Ethiopia 1087 km from Addis Ababa, and 300 km from Mekelle city, the Capital of Tigray with a total population of 47,284 (21,867 male and 25,417 female). Based on the 2007 national census conducted by the central statistical agency, this town has total population of 47,284, of whom 21,867 are men and 25,417 women. Majority of the inhabitants (85.11%) follow Ethiopian Orthodox Christianity but 14.67% are Muslims. The Suhul hospital found in shire town is estimated to serve more than one million people residing in the town and neighboring areas [5,6,7,8,9,10,11,12]. The study was conducted from April 1–30, 2018.
The institutional based cross-sectional study design was conducted.
A total of 313 samples were calculated using a single population proportion formula by assuming 5% marginal error and 95% confidence interval (σ = 0.05) and prevalence of anemia 27.4%  and by adding 10% of non-response rate.
From all health facilities in the study area, one hospital and two health centers were selected. Random sampling method was used to select participants from women attending antenatal care follow-up.
Data collection tool
A structured questionnaire was adopted and adapted from review of relevant literature and arranged according to particular objective it can address. Before actual data collection, the tool was pre-tested in St. Mary Hospital. Three days of training was given to all data collectors and supervisors prior to pretesting. Eight data collectors who had completed a degree in midwives were recruited. The data was collected through self-administer questionnaire.
Dependent variable: Magnitude of anemia
Independent variables: Age, education, gravida/parity, gestational age, medical/surgical problems (intestinal parasite, HIV, malaria, malnutrition)
Data processing and analysis
Data were entered and analyzed using SPSS version 22.0. Descriptive statistics were employed to calculate frequencies and display findings. Association was measured using binary logistic regression. Based on Bivariate analysis variables that showed significant association at (p < 0.25) were entered into the multivariable analysis to select Predictor variables of factors affecting anemia in pregnant women. The final model were then tested for its goodness of fit by Hosmer and Lemeshow p-value and p-value > 0.05 was the best fitted. Finally, variables that showed significant associations at (p < 0.05) were identified as independent predictors of affecting anemia in pregnant women.
The Ethical approval was approved by the Institutional Review Board (IRB) of the College of Health Sciences, Aksum University. Communications with the health center administrations were made through a formal letter obtained from Aksum University, College of Health Science and TRHB. The objective and importance of the study were explained to the study participants. Data was collected after full informed written consent was obtained from participants aged 18 years and more, but age less than 18 years from the guardian. Confidentiality of the information was maintained throughout by excluding names as identification in the questionnaire and keeping their privacy during the interview by interviewing them alone.