Prevalence and Correlates of Maternal Anemia in Rural Sidama, Southern Ethiopia

Samson Gebremedhin, Fikre Enquselassie, Melaku Umeta


In order to assess the prevalence and correlates of prenatal anemia, a survey was conducted among 700 randomly selected pregnant women in rural Sidama, Southern Ethiopia. The prevalences of anemia, Iron Deficiency (ID) and ID anemia were 31.6%, 17.4% and 8.7%, respectively. The burden of anemia was significantly high among illiterates, women devoid of selfincome, lowlanders, multiparas and women aged 25-34 years. Women who weren’t on iron-folate supplementation had 1.90 (95% Confidence Interval (CI): 1.14-3.19) times increased odds of anemia. Anemia was associated with ID, zinc deficiency and elevated C-reactive protein with odds ratio of 2.46 (95%CI: 1.63-3.73), 2.29 (95%CI: 1.62-3.23) and 1.98 (95%CI: 1.12-3.47) respectively; however, it was not associated with vitamin A deficiency. Though ID was a significant correlate of anemia, only 11.8% of anemia was attributable to it. Zinc, iron and vitamin A deficiencies did not show synergistic interaction in associating with anemia. (Afr J Reprod Health 2014; 18[1]: 44-53).


Keywords: Maternal nutrition, maternal anemia, anemia in pregnancy




Afin d'évaluer la prévalence et les corrélats de l'anémie prénatale, une enquête a été menée auprès de 700 femmes enceintes sélectionnées au hasard à Sidama rural,  au sud de l'Ethiopie. Les taux de prévalence de l'anémie, la carence en fer (CF) et l’anémie de CF étaient de 31,6 %, 17,4 % et 8,7%, respectivement. La charge de l'anémie était significativement élevée chez les analphabètes, les femmes dépourvues de revenu de soi, des plaines, multipares et les femmes âgés de 25-34 ans. Les femmes qui ne prennent pas des suppléments en fer et en folate avaient 1,90 (95 % intervalle de confiance (IC) : 1.14 à 3.19) fois des risques accrus d'anémie. L'anémie a été associée à une CF , le zinc et la protéine C -réactive avec un rapport de cotes de 2,46 ( IC à 95% : 1,63 à 3,73 ) , 2,29 (IC 95% : 1,62 à 3,23 ) et de 1,98 (IC 95% : 1,12 à 3,47 ) respectivement, mais il n'était pas associée à la carence en vitamine A . Bien que la CF soit un corrélat important de l'anémie,  on ne pouvait lui en attribuer que 11,8%. Les carences en zinc, en fer et en vitamine A n'ont pas montré d'interaction synergique en s’associant à une anémie. (Afr J Reprod Health 2014; 18[1]: 44-53).


Mots-clés: nutrition maternelle, anémie maternelle, anémie pendant la grossesse 

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McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B. Worldwide prevalence of anemia: WHO vitamin and mineral nutrition information system 1993–2005. Public Health Nutr 2008;12(4):444–54.

De Benoist B, McLean E, Egli I, Cogswell M, eds. Worldwide prevalence of anemia 1993-2005: WHO global database on anemia. Geneva: WHO Press; 2008.

Badham J, Zimmermann MB, Kraemer K, eds. The guidebook nutritional anemia. Basel: Sight and Life Press, 2007.

Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look P. WHO analysis of causes of maternal death: a systematic review. Lancet 2006;367:1066-74.

Allen LH. Anemia and iron deficiency: Effects on pregnancy outcome. Am J Clin Nutr 2000;


Stoltzfus RJ, Mullany L, Black RE. Iron deficiency anemia. In: Ezzati M, Lopez AD, Rodgers A, Murray C, eds. Comparative quantification of health risks. Geneva: WHO Press, 2004:163-209.

Measure DHS, Central Statistical Agency. Ethiopia demographic and health survey 2011: Preliminary report. Addis Ababa, Ethiopia and Calverton, USA: Central Statistical Agency and Measure DHS, 2011.

ORC Macro, Central Statistical Agency. Ethiopia demographic and health survey 2005. Addis Ababa, Ethiopia and Calverton, USA: Central Statistical Agency and ORC Macro, 2006.

Haidar J, Pobocik R. Iron deficiency anemia is not a rare problem among women of reproductive ages in Ethiopia: A community based cross-sectional study. BMC Blood Disorders 2009, 9(7): doi: 10.1186/14712326-9-7.

Umeta M, Haidar J, Demissie T, Akalu G, Ayana G. Iron deficiency anemia among women of reproductive age in nine administrative regions of Ethiopia. Ethiop J Health Dev 2008;22(3):252-8.

Haidar J, Nekatibeb H, Urga K. Iron deficiency anemia in pregnant and lactating mothers in rural Ethiopia. East Afr Med J 1999;76(11):618-22.

Gies S, Brabin BJ, Yassin MA, Cuevas LE. Comparison of screening methods for anemia in pregnant women in Awassa, Ethiopia. Trop Med Int Health


Belachew T, Legesse Y. Risk factors for anemia among pregnant women attending antenatal clinic at Jimma University Hospital, Southwest Ethiopia. Ethiop Med J 2006;44(3):211-20.

Hinderaker SG, Olsen BE, Per Bergsjø P, Lie Rt, Gasheka P, Kvåle G. Anemia in pregnancy in the highlands of Tanzania. Acta Obstet Gynecol Scand 2001;80:18-26.

Dim CC, Onah HE. The prevalence of anemia among pregnant women at booking in Enugu, South Eastern Nigeria. MedGenMed 2007;9(3):11.

Idowu OA, Mafiana CF, Sotiloye D. Anemia in pregnancy: A survey of pregnant women in Abeokuta, Nigeria. Afr Health Sci 2005;5(4):295-9.

Adam I, Khamis AH, Elbashir MI. Prevalence and risk factors for anemia in pregnant women of eastern Sudan. Trans R Soc Trop Med Hyg 2005;99(10):739-

Gautam VP, Bansal Y, Taneja DK, Saha R. Prevalence of anemia amongst pregnant women and its sociodemographic associates in a rural area of Delhi. Indian J Community Med 2002;27(4):10-2.

Mockenhaupt FP, Rong B, Günther M, Beck S, Till H, Kohne E, et al. Anemia in pregnant Ghanaian women: Importance of malaria, iron deficiency, and haemoglobinopathies. Trans R Soc Trop Med Hyg 2000;94(5):477-83.

Gibson RS, Abebe Y, Stabler S, Allen RH, Westcott JE, Stoecker BJ, et al. Zinc, gravida, infection and iron, but not vitamin B-12 or folate status, predict hemoglobin during pregnancy in Southern Ethiopia. J Nutr 2008;138:581-6.

Population Census Commission of Ethiopia. Summary and statistical report of the 2007 population and housing census of Ethiopia. Addis Ababa: CSA, 2008.

UN emergency unit for Ethiopia. Uncertain food security situation for farmers in Sidama zone. Retrieved on Aug 20, 2011 from DownloadableReports/SidamaReport062002.pdf.

World Bank. Ethiopia country economic memorandum: Regional characterization background report. Retrieved on Aug 21, 2011 from http://siteresources. pdf.

Gebremedhin S, Enquselassie F. Correlates of anemia among women of reproductive age in Ethiopia: Evidence from DHS Ethiopia 2005. Ethiop J Health Dev 2011;25(1):22-30.

Mohamed AA, Ali AA, Ali NI, Abusalama EH, Mustafa

I, Elbashir MI, et al. Zinc, parity, infection, and severe anemia among pregnant women in Kassla, Eastern Sudan. Biol Trace Elem Res 2011;140(3):284-90.

Swindale A, Bilinsk P. Household dietary diversity score (HDDS) for measurement of household food access: indicator guide version 2. Retrieved on Oct 13, 2011 from HDDS_v2_Sep06.pdf.

Food and Agriculture Organization of the United Nations. Guidelines for measuring household and individual dietary diversity. Rome; FAO, 2011.

The International Nutritional Anemia Consultative Group. Adjusting hemoglobin values in program surveys. Retrieved on Aug 18, 2011 from pdf_docs/PNACQ927.pdf.

Ahlbom A, Alfredsson L. Interaction: A word with two meanings creates confusion. Eur J Epidemiol 2005;20:563-4.

Andersson T, Alfredsson L, Kallberg H, Zdravkovic S, Ahlbom A. Calculating measures of biological interaction. Eur J Epidemiol 2005;20:575-9.

Kalilani L Atashili J. Measuring additive interaction using odds ratios. Epidemiol Perspect Innov 2006;3:5 doi: 10.1186/1742-5573-3-5.

Hosmer DW, Lemeshow S. Confidence interval estimation of interaction. Epidemiol 1992;3(5):452-6.

Earl RO, Woteki CE, eds. Iron deficiency anemia: Recommended guidelines for the prevention, detection and management among US children and women of childbearing age. Washington DC: National Academy Press, 1993.

CDC: Morbidity and mortality weekly report: Recommendations to prevent and control iron deficiency in the United States. Georgia: CDC, 1998.

Alto I. Iron deficiency anemia. In: Stang J, Story M, eds. Guidelines for adolescent nutrition services. Minneapolis: University of Minnesota, 2005:101-8.

International Zinc Nutrition Consultative Group. Assessing population zinc status with serum zinc concentration: Technical brief number 2. Retrieved on Aug 20, 2011 from publications/files/English_brief2.pdf.

WHO. Global prevalence of vitamin A deficiency in population at risk 1995-2005: WHO global database of vitamin A deficiency. Geneva: WHO press, 2009.

Ferro-Luzzi A, James WP. Adult malnutrition: Simple assessment techniques for use in emergencies. Br J Nutr 1996;75(1):3-10.

WHO: Iron deficiency anemia: Assessment, prevention, and control. Geneva: WHO press, 2001.

Bentley ME, Griffiths PL. The burden of anemia among women in India. Eur J Clin Nutr 2003;57:52-60.

Bharati P, Som S, Chakrabarty S, Bharati S, Pal M. Prevalence of anemia and its determinants among nonpregnant and pregnant women in India. Asia Pac J Public Health 2008;20(4):347-59.

Haidar J. Prevalence of anemia, deficiencies of iron and folic acid and their determinants in Ethiopian women. Health Popul Nutr 2010; 28(4): 359-68.

Mirzaie F, Eftekhari N, Goldozeian S, Mahdavinia J. Prevalence of anemia risk factors in pregnant women in Kerman, Iran. Iranian J Reprod Med 2010;8(2):66-

Al-Farsi YM, Brooks DR, Werler MM, Cabral HJ, AlShafei MA, Wallenburg HC. Effect of high parity on occurrence of anemia in pregnancy: A cohort study. BMC Pregnancy and Childbirth 2011; 11:7 doi:10.1186/1471-2393-11-7.

Uche-Nwachi EO, Odekunle A, Jacinto S, Burnett M, Clapperton M, David Y, et al. Anemia in pregnancy: Associations with parity, abortions and child spacing in primary healthcare clinic attendees in Trinidad and Tobago. Afr Health Sci 2010;10(1):66–70.

World Health Organization, United Nations Children's Fund. Focusing on anemia: Towards an integrated approach for effective anemia control. Retrieved on Sep 23, 2011 from LinkFiles/Nutrition_for_Health_and_Development_W HO_UNICEF_statement_anaemia.pdf.

Thurlow RA, Winichagoon P, Green PT, Wasantwisut E, Pongcharoen T, Bailey KB, et al. Only a small proportion of anemia in northeast Thai schoolchildren is associated with iron deficiency. J Clin Nutr 2005;82:380-7.

Hettiarachchi M, Liyanage C, Wickremasinghe R, Hilmers DC, Abrams SA. Prevalence and severity of micronutrient deficiency: A cross-sectional study among adolescents in Sri Lanka. Asia Pac J Clin Nutr 2006;15(1):56-63.

Borna S, Haghollahi F, Golestan B, Norouzi M, Hanachi P, Shariat M, et al. A comparative study of zinc deficiency prevalence in pregnant and non-pregnant women. Tehran Univ Med J 2009; 67(5):360-7.

Chandyo RK, Strand TA, Mathisen M, Ulak M, Adhikari RK, Bolann BJ, et al. Zinc deficiency is common among healthy women of reproductive age in Bhaktapur. Nepal J Nutr 2009;139:594-7.

Badham J, Zimmermann MB, Kraemer K, eds. Nutritional anemia. Basel: Sight and Life Press, 2007.

Semba RD, BloemMW. The anemia of vitamin A deficiency: Epidemiology and pathogenesis. Eur J Clin Nutr 2002;56:271–81.

Galloway P, McMillan DC, Sattar N. Effect of the inflammatory response on trace element and vitamin status. Ann Clin Biochem 2000;37:289-97.

Wieringa FT, Dijkhuizen MA, West CE, NorthropClewes CA, Muhilal. Estimation of the effect of the acute phase response on indicators of micronutrient Status in Indonesian infants. J Nutr


Hinderaker SG, Olsen BE, Lie RT, Bergsjø PB, Gasheka P, Bondevik GT, et al. Anemia in pregnancy in rural

Tanzania: Associations with micronutrients status and infections. Eur J Clin Nutr 2002;56:192-9.


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