3.1 Socio-demographic characteristics of the study participants
Of 640 study participants, a total of 625 pregnant were included in the analysis, with a response rate (97.6%). The mean ± SD age of pregnant women was 28.8 (5.27). Nearly 85% (531) of respondents were in the age range of 20-35 and 590 (94.6%) had no formal education. Concerning the educational status of the husband, 406 (65%) had no formal education, 12.5% had primary education, 15.2% had secondary education and 7.3% were high school graduates. All study participants worked as housewives. Most (91.2%) of the respondents’ husbands were self-employed. The majority (83.5%) of the study participants were living with families having six or more than six members while 574 (91.8%) and 51 (8.2%) had a monthly income of 150-200 and >200 USD, respectively (Table.1).
Table.1. Socio-demographic characteristics of pregnant women receiving antenatal care at Qarabagh district Hospital, 2020.
Variable Category Frequency (%)
Age (in Years) < 20 36 (5.8)
20-35 531 (85)
>35 58 (9.8)
Educational status Educated 35 (5.4)
No formal education 590 (94.6)
Husband level of education Primary 78 (12.5)
Secondary 95 (15.2)
High school graduate 46 (7.3)
No formal education 406 (65)
Occupation Housewife 625 (100)
Husband employment status Self-employed 572 (91.2)
Formal employed 53 (8.5)
Family size 3-5 101 (16.2)
> 6 524 (83.3)
Household monthly income (USD) 150-200 574 (91.8)
>200 51 (8.2)
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3.2 Reproductive and other medical-related characteristics of the study participants
Of the total respondents, 305 (48.8%) married before the age of eighteen. Concerning the menstrual cycle, the majority 522 (83.5%), 500 (80%) of study participants had menstruation cycle regular and 5-8 days by duration before this pregnancy, respectively. About one-fifth (19.5%) of the respondents had more than five parities. Among those who had a history of at least one birth, 407 (73.4%) of the study subjects had a birth interval of less than two years, while 72 (12.9%) experienced complications in their last pregnancy. Nearly half (44.5%) of the study participants were at the second trimester. More than half (365, 58%) of the respondents reported that they have not utilized contraceptives in the past. Among ANC attendees, most (391, 62.6%) of the pregnant women were at their first or second visit and two-third (64%) were consuming iron and folic acid supplementations. Of all the participants, 71 (11.4%) of the study participants had history of vaginal bleeding in the current pregnancy. Regarding medical assessment of the study participants, malarial infestation (2.6%), intestinal helminths (10.4%) and history of stress (31.4%) were the predominant medical conditions. Table 2 shows detailed characteristics of the respondent’s reproductive and other medical-relates variables.
Table.2. Reproductive and medical characteristics of pregnant women receiving antenatal care Qarabagh district Hospital, 2020.
Variable Category Frequency (%)
Age at marriage (in years) < 18 305 (48.8)
>18 320 (51.2)
Regularity of menstrual cycle Regular 522 (83.5)
Irregular 103 (16.5)
Mensuration period (in days) < 5 74 (11.8)
- 500 (80.0)
>8 51 (8.2)
Parity Nullipara 70 (11.0)
primipara 203 (32.6)
3-5 211 (33.8)
>5 122 (19.5)
Type of pregnancy (n=555) Single 101 (16.2)
Multiple 524 (83.3)
Place of delivery (n=555) Health facility 423 (76.3)
Home 132 (23.7)
Type of delivery (n=555) Normal 488 (87.9)
Assisted/Cesarean 67 (12.7)
Birth Interval (n=555) < 2 years 407 (73.4)
>2 years 148 (26.6)
Complications in last pregnancy (n=555) Yes 72 (12.9)
No 483 (87.1)
Gestational age 1st trimester 187 (29.9)
2nd trimester 278 (44.5)
3rd trimester 160 (25.6)
Access to health facility Yes 510 (81.6)
No 115 (18.4)
Contraceptive use before pregnancy Yes 260 (41.6)
No 365 (58.4)
Type of contraceptive (n=260) Oral 75 (12)
Injectables 97 (15.5)
Condoms 63 (10.1)
IUD 25 (4.0)
Number of ANC visits 1 or 2 391 (62.6)
>2 234 (37.5)
Iron+ Folic acid Yes 400 (64)
No 225 (36)
Vaginal bleeding Yes 71 (11.4)
No 554 (88.6)
History of malaria (last year) Yes 16 (2.6)
No 609 (97.4)
History of intestinal helminths Yes 65 (10.4)
No 560 (89.6)
History of stress Yes 196 (31.4)
No 429 (68.6)
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3.3 Dietary characteristics of the study participants
About half (52.3%) of the study participants had a meal frequency of three. Of all the respondents, 228 (36.4%) and 151 (24%) of the pregnant women consumed vegetables and fresh fruits daily, respectively. Moreover, 266 (42.5%) of pregnant women consumed meat once a week. About 61% (389) of study subjects had a habit of drinking green tea after the meal (Table.3).
Table.3. Dietary characteristics of pregnant women receiving antenatal care Qarabagh district Hospital, 2020.
Variable Category Frequency (%)
Meal frequency in a day 2 96 (15.4)
3 327 (52.3)
>3 202 (32.3)
Meat Once a week 266 (42.5)
Twice a week 42 (6.7)
Once in two weeks 165 (26.4)
Once in a month 152 (24.3)
Vegetables Everyday 228 (36.4)
Twice a week 116 (18.5)
Thrice a week 92 (14.7)
Once a week 62 (9.9)
Once in two weeks 127 (20.4)
Fresh fruits Everyday 151 (24.1)
Twice a week 101 (16.1)
Thrice a week 87 (13.9)
Once a week 70 (11.2)
Once in two weeks 117 (18.7)
Once a month 99 (15.8)
Green tea after meal Yes 389 (62.2) No 236 (37.8)
3.4 Knowledge of study participants on anemia
Among study participants, 446 (71.4%) had heard about anemia before. As shown in table.4, health facilities were the primary (73%) source of information. About 80% of the respondent thought anemia was treatable and 48% thought that it is very important to take medications to treat anemia. Also, 20% thought eating nutritious food during pregnancy could treat anemia. Concerning the benefits of anemia treatment, half (48%) of pregnant women thought that anemia is beneficial for the health of both mother and baby. Interestingly, we found that half (53%) of our respondents thought pregnant women need an extra diet (Table.4).
Table.4. Knowledge of anemia among pregnant women receiving antenatal care Qarabagh district Hospital, 2020.
Variable Category Frequency (%)
Heard about anemia Yes 446 (71.4)
No 179 (28.6)
Source of information (n=446) Health facility 326 (73.1)
Media 110 (24.6)
Relatives (Friends) 10 (2.3)
How to treat anemia in pregnancy? Medication 298 (47.7)
Eating nutritious food 147 (23.5)
Iron+ folic acid tablets 57 (9.2)
Don’t know 123 (19.7)
Treatment of anemia is beneficial for? Mother’s health 151 (24.2) Baby health 173 (27.7)
Both 301 (48.2)
History of pica Yes 301 (48.2)
No 324 (51.8)
Do pregnant women need extra diet? Yes 336 (53.8)
No 289 (46.2)
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3.5 Prevalence of anemia
Of the 625 study participants, 285 (45.6%, CI: 41.64%-49.60%) were anemic (Figure.1). The mean (± S.D.) hemoglobin level of study participant was 10.76 (± 1.12). Of the anemic pregnant women, 54.4%, 40.7% and 4.9% were mildly, moderately and severely anemic, respectively.
3.5 Determinants of anemia
Factors that were significantly associated with anemia among pregnant women in the bivariate analysis included respondent’s age, household monthly income, husband occupation, access to the health facility, regularity of menstruation cycle, iron and folic acid supplementation, drinking green tea after a meal, gestational age, and history of complications in last pregnancy. Variables with a p-value of less than 0.25 were retained in the multivariable logistic regression. The factors that remained significantly associated with anemia in multivariable analysis were household monthly income, husband occupation, regularity of menstrual cycle and history of complications in last pregnancy. Consequently, the likelihood of anemia was higher among pregnant women who were in the household with an income of less than 15000 Afghanis (150-200 USD) [AOR=2.24 (95%CI:1.06-4.71)]. Increased odds of anemia were observed among pregnant women who had complications in their last pregnancy [AOR=1.53 (95%CI: 1.02-2.28)] and those who experienced irregular menstrual cycle before this pregnancy [AOR=2.21 (1.35-3.64)]. Besides, the odds of anemia were higher among pregnant women whose husbands were self-employed [AOR=2.04 (95%CI:1.04-3.97)] (Table.5).
Table 5: Determinants of anemia among pregnant women receiving antenatal care at Qarabagh District, Hospital, 2020.
Independent Variable
|
Categories
|
Anemia status
|
Crude Odds Ratio
(95% CI)
|
Adjusted Odds Ratio
(95% CI)
|
Yes
|
No
|
Age of respondent
|
< 20
>20
|
22
231
|
14
300
|
1
2.04 (1.02-4.07)
|
-
-
|
Monthly income
|
>15000
10000-15000
|
16
269
|
35
305
|
1
1.93 (1.04-3.56)
|
1
2.24 (1.06-4.71)
|
Husband Occupation
|
Formal employed
Self-employed
|
16
269
|
37
303
|
1
2.05 (1.12-3.77)
|
1
2.04 (1.04-3.97)
|
Access to health facility
|
Yes
No
|
219
66
|
291
49
|
1
1.79 (1.18-2.69)
|
-
-
|
Menstruation cycle
|
Regular
Irregular
|
219
66
|
291
49
|
1
2.23 (1.44-3.45)
|
1
2.21 (1.35-3.64)
|
Complication’s history
|
No
Yes
|
221
64
|
301
39
|
1
1.99 (1.24-3.22)
|
1
1.53 (1.02-2.28)
|
Gestational age
|
3rd trimester
2nd trimester
1st trimester
|
82
97
106
|
81
177
82
|
1
0.54 (0.36 – 0.8) 2.36 (1.61 – 3.44)
|
-
-
-
|
Green tea after meal
|
Yes
No
|
104
181
|
160
180
|
1.55 (1.12-2.13)
1
|
-
-
|
Iron + folic acid supplement
|
Yes
No
|
117
168
|
108
232
|
1
1.49 (1.07 – 2.07)
|
-
-
|