International Journal of Public Health Science (IJPHS)

Vol. 8, No. 2, June 2019, pp. 202~210

ISSN: 2252-8806, DOI: 10.11591/ijphs.v8i2.19476  202

Pregnant mothers’ knowledge, attitude and practice towards

preventions of iron deficiency anemia in Harar Town, Ethiopia

Abdu Oumer1, Arif Hussein2

1 College of Health Sciences and Medicine, Department of Public Health, University, Ethiopia
2Department of Nursing, Harar Health Science College, Ethiopia

Article Info ABSTRACT

Article history: Low maternal risk perception, poor dietary practice and low adherence to iron
and folate tablets among pregnant women are major contributors for higher
Received Mar 14, 2019 burden of anemia. Iron deficiency anemia contribute to more than half of
Revised Apr 19, 2019 Anemia among pregnant women. Thus the level of maternal awareness and
Accepted May 13, 2019 attitude towards dietary and other prevention practices of anemia are not well
established in the study area. This study was to assess knowledge, attitude and
practice of pregnant mothers towards the prevention of iron deficiency anemia
Keywords: in Ethiopia, 2018. Hospital based Cross sectionals study was conducted on
randomly selected, 128 pregnant mothers attending antenatal care service in
Attitude Harar town. Data were collected by health professionals using pre tested
Iron Deficiency Anemia (IDA) questionnaire containing socio demographic, knowledge, attitude and practice
Knowledge related questions. Attitude questions were organized in five Likert scale from
Practices strongly disagree to strongly agree using positive statements.
Prevention Similarly, practices were assessed in yes/no (appropriate practices were scored
as yes or no otherwise). Data was analyzed using SPSS version 20 using
frequency, tables, graphs and means. Pearson correlation with r was used to
assess the relationship between knowledge, attitude and practice. Analysis of
Variance was used to compare the mean practice by different factors.
Knowledge, attitude and practice of pregnant women on preventions of IDA
are not satisfactory. Thus poor practice towards prevention of IDA is the main
contributing factor for high burden of anemia.
Copyright © 2019 Institute of Advanced Engineering and Science.
All rights reserved.

Corresponding Author:
Abdu Oumer,
Lecturer, Ethiopia,
Department of Public Health,
University, Ethiopia.
Email: [email protected]

1. INTRODUCTION
Anemia is a condition in which human body don't have enough healthy red blood cells to carry adequate
oxygen to the body's tissues which may be caused by numerous nutritional and other causes. According to World
Health organization (WHO) definition of Anemia is “a pathologic situation in which the Red Blood Cell mass
(RBCs) or its oxygen-carrying capacity is inadequate to meet physiologic demands of the body. This problem in
pregnants is identified by using hemoglobin cuts off point below 11g/dl [1-2]. Anemia is considered as top major
health problem worldwide. Globally, more than one thirds of world population are victims of anemia. Anemia is
common health related problem worldwide with great burden in low and mile income countries in children and
adults. An estimated, 43% and 9% of world population is affected by anemia in developing and
western countries, respectively [3].
Nutrition is a fundamental pillar for the human being, for the health and development of entire
life [4-6]. Now a days for both developed and developing country malnutrition is the great problem globally,
more specifically under-nutrition and micronutrient deficiencies are widespread problems in developing

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Int. J. Public Health Sci. ISSN: 2252-8806  203

countries [7-8]. Malnutrition during this periods of life is associated with poor maternal health and different poor
neonatal and adulthood chronic illness risks. Thus micronutrient deficiencies during the first 1,000 days of life
are associated with poor maternal health and neonatal outcomes like morbidity, mortality, cognitive loss and
congenital deformities. Low birth weight from anemia and other causes accounts more than 800,000 deaths each
year in neonatal death [9-10].
Pregnancy is a period of significant increase in iron requirement; the demand for iron is higher a result
of numerous maternal adaptations like increase in number of red blood cell and higher needs for iron by
developing and growing organs, placenta and fetus [6]. Iron is needed in significant amount to support maternal
and fetal growth. Despite increased iron requirements, pregnancy is also a period of increased risk for anemia
which is higher than in non-pregnant state [5, 11]. Iron Deficiency Anemia (IDA) among pregnant have a
potential to cause cognitive decline, increased prevalence of underweight children and higher early neonatal
and infant mortality [12].
Among the main causes of anemia, inadequate iron intake or higher iron loss are the predominant one
accounting for above 50% of cases. Especially in low income countries where about 38% of pregnant women
had iron depletion, it has even greater share in anemia causation [13]. Out of the total global burden of anemia,
over 40 million are pregnant women are anemic, in which IDA account for 75%-95% of cases [1, 6].
But the majority of pregnant mothers lack correct perception [14]. As global effort to achieve the sustainable
development goals, as one of the strategic objective awareness raising has got a great deal especially with
invisible forms of malnutrition like anemia. In 2018, an estimated 264 million women are were victims of IDA.
With the current global effort to eliminate the current global malnutrition by 2025, IDA is one of the great
Nutritional concern worldwide [15].
Worldwide estimates of IDA showed the prevalence of anemia in Africa, reaches up to 52%. Thus about
18% and 52% of population was affected in developed and developing countries respectively.
Globally, about 29.4 women were affected by anemia while, magnitude of 38.2% (32.4 million pregnant women)
was reported among pregnant. [16]. Even though the burden of anemia among pregnant mothers has declined
from 43% to 38% over the past decades, it still showed that the world Health Assembly (WHA) target of 50%
(as compared to 12%), reduction of anemia by 2025 is far and countries need to focus on achieving this target in
near future [6].
In Ethiopia, about 17% of women in reproductive age group had anemia, while about 22% of pregnant
were anemic [17]. Additionally, magnitudeof anemia varies as 27.9% in southeast Ethiopia [15] and 39.4% in
southern Ethiopia [18]. Higher burden of anemia is reported in different parts of Ethiopia [19-21].
Lack of awareness, poor dietary practice and inappropriate dietary counselling of pregnant mothers are major
contributors to the high burden of anemia. Additionally, it is evident that only 72% of mothers are aware of
anemia. Anemia is also a severe public health important problem in Ethiopia in which greater than 40% of
pregnant women were anemic [17].
Despite anemia have been major public health problem for decades, no promising movements has been
observed towards reducing anemia burden by half, still anemia is high globally [1]. Strategies for the reduction
and control of anemia in vulnerable groups as women is one of the priority agendas globally [2].
In addition, improving the knowledge, attitude and dietary practice of the mothers through dietary diversification,
fortification (Iron and other supplements) are important nutrition specific interventions to alleviate anemia [10].
Therefore, the aim of this particula survey was to assess knowledge, attitude and practice of Pregnant mothers
attending Antenatal Care (ANC) on prevention and control of IDA. This study will give baseline evidence on the
level of maternal awareness and intention to practice good dietary practices among pregnant. Thus, it will be
valuable input for targeted behavioral interventions at community or facility level in order to improve the
hemoglobin level and overall health of pregnant.

2. RESEARCH METHOD
2.1. Study setting
Hospital based survey was employed in Harar town, Harari region, Eastern Ethiopia with total
population of 250,903 in 2018. Out of these, 139,200 (60%) resides in urban while 116,928 are males with
estimated 64,939 were in reproductive age groups. The region is composed of 9 districts with 19 urban and
17 rural Kebeles [22]. According to Harari Health Bureau reported in 2015 Harari region health coverage was
estimated to be 100%. There are three public hospitals, two private hospital, eight health centers, 20 health posts
and about 18 private clinics in the region. There were an estimated 7169 pregnant women in the region.

2.2. Sample size determination

The sample size was estimated by using population proportion formula using the prevalence estimate of
good knowledge (p1), attitude (p2) and practice (p3) from previous studies. Thus taking knowledge towards

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nutritional anemia among pregnant women (P1), as 69% had good knowledge about prevention of IDA [23],
margin of error (5%), zα/2 the critical value with 95% confidence level as 1.96, the minimum sample size
became 329. Similarly using attitude towards nutritional anemia among pregnant women (P2=82.2%) and
59.5% ANC attending women were following good practices to prevent anemia in pregnancy [23], the sample
size goes 73 and 372 respectively. Since the expected monthly flow of antenatal mothers were below the stated
sample size, thus using the finite population correction the final sample size became 128.

2.3. Sampling technique/ procedures

The total sample size was proportionally allocated to Hiwot Fana specialized University Hospital and
Jugol Hospital. Jugol Hospital with an average monthly flow of pregnant mothers (n=70) and Hiwot Fana
specialized university Hospital (n=116). Thus 48 and 80 clients were selected from Jugol and Hiwot Fana
specialized university Hospital respectively.

2.4. Data collection methods

Data were collected using pre prepared structured questionnaire, containing socio-demographic,
knowledge related, attitude and practice related questions on prevention of IDA among pregnant women.
The tool was prepared by English version and translated into the local language by trained nurse professionals.
A sets of questions were adapted from previous studies and literatures was used to assess knowledge,
attitude and practice towards IDA. One day supportive training, close supervision and daily checkup of the
collected data was done to improve the quality of data. The collected data were entered in computer software and
checked for consistency and outliers before analysis.

2.5. Methods of data analysis

SPSS version 20 was used to process and analyze the data. The data were presented using frequency,
percentage, table and graph. In addition the knowledge, attitude and practice score was done by using the compute
command. The knowledge, attitude and practice score were categorized in to good versus poor knowledge and
practice and positive versus negative attitude using the mean score as cut off point. Thus one way analysis of
variance was done with F statistics and p value. Association at p value below 0.05 was used to declare statistically
significant difference in mean practice level of the mothers.

2.6. Ethical consideration

Before actual field work, formal ethical clearance was issued by ethical review committee from Harar
Health Science College. Respondent’s willingness to participate in the study was obtained verbally with an honest
explanation of the objectives of the study. No personal identifiers were collected from the respondents.

3. RESULTS AND DISCUSSION

This study assessed the knowledge, attitude and practice towards a prevention method of IDA.
In this study, awareness related to cause of anemia most had known poor nutrition, bleeding during pregnancy
and multiple pregnancy as cause for IDA. A similar study done in Palestine [25], inadequate nutrition,
including not having a balanced diet containing protein-rich foods, not consuming iron supplements and the
presence of malaria were reported as the main cause of anemia. But study in another part [14] showed that only
3% of mothers elicited iron deficiency as a cause of anemia. While similar study [11] showed that malaria is
main cause of anemia. In another study [26] showed more than half, (68.1%) recognized lack of iron in food as
the cause for anemia.
But our study also showed a poor awareness level (31.3%) on the role of Iron in causing anemia.
Thus, as more than half of anemia is attributed to Iron deficiency, mothers had poor knowledge of the major
cause of anemia [1]. This difference can be due to the difference in socioeconomic level of participants and the
quality of health care (ANC) given in the two countries. This emphasizes the need for better integration and
implementation of counselling schedules with each visit. Awareness level towards IDA is above average (88.1%)
which is similar in a study done Sierra Leone [26] shows 99% had heard about anemia. While 58.6% of mothers
were found to be aware of prevention of IDA. Almost half of mothers are not aware that the role of fibers,
coffee and tea after meals in decreasing the fractional absorption iron by almost 70% responded negatively.
There is a need for focused and simple counselling by health professionals (specifically ANC care givers) on the
causes and managements of IDA.
Despite this scientific fact, almost 46% of pregnant reported to have a habit of drinking coffee or tea
immediately after meals. Study done in Ethiopia showed that consuming tea/coffee immediately after meal
(AOR=3.58) and not eating meat frequently (AOR: 2.07) were associated with significant risk of anemia [27].
This low awareness level in conjunction with low practice of three day meal, use of iron rich foods and low

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compliance to iron tablets (32%), it’s high likely that the study participants are at higher risks of anemia.
But in other side of the fact shows that almost 50% of IDA can be prevented by iron supplementation [16].
Also, regarding awareness on sign and symptoms of IDA, body weakness (fatigue) and shortness of breath was
mostly, but still majority did not mention the listed manifestations in advance. This will greatly impede the health
care seeking behaviors of mothers by early detection of minor symptoms. This in turn greatly advance the stage
of anemia and its adverse pregnant and neonatal outcomes [12].
In this study most of the participants agree and strongly agreed on use of family planning and consuming
of iron tablets in order to prevent IDA. It is advised that pregnant women should be supplemented with iron and
folic acid for a period of six months with aim to reduce anemia and neural tube defects. In addition, it is well
known that birth spacing practice by mother prevents anemia [1, 5]. Similarly, almost greater than half of mother
reported that they strongly recommend iron supplementation, family planning for the prevention of IDA [25, 28],
which is similar finding with the responses of pregnant mothers in this study. Study done on 400 admitted
pregnant women [29] only 45.3% of participants had used iron supplements during pregnancy, which is higher
in our study. Despite the universal recommendation to use iron tablet during recommendation, in our study only
32% had reported that they regularly took an iron folic acid tablet for prevention or treatment of anemia.
While, relatively higher adherence to Iron tablet use of 62% was reported by 79.4% of participants have had
regular meal which is three times in a day. Still, there is a great geographical variation in the practice of
IDA prevention strategies.
In a study conducted in Ethiopia regarding knowledge and prevention practices, 57.3% and 50% of
pregnant women had a good knowledge ad good attitude respectively [30]. Generally 61%
(95% CI=52.6% to 69.5%) of pregnant women had a good knowledge on prevention methods of IDA. More than
half, 52.3% (95% CI=43.7% to 61.0%) had a favorable attitude towards prevention of IDA. While majority of
pregnant women, 58.6% (95% CI=50.1% to 67.1%) had poor adherence to prevention practice of IDA.
Even if the results are comparable with other studies [14, 23, 30], the level of knowledge, attitude and practices
towards IDA prevention were not satisfactory. In that it still needs great effort by hospitals and the government
at large to improve their awareness and practice. As the role of husbands is tremendously improving the health
care plan of women, husbands need to be part of the ANC service. Thus, there are tremendous factors that
aggravate and made pregnant at risks of anemia in addition to the physiological vulnerability. These behavioral
and other factors need to be addressed in the country specific targets for making the Sustainable Development
goals in reality in the near future and decreasing anemia by half in the coming 2025 [6].

3.1. Socio-demographic characteristics of the participants

Out of the total 128 pregnant women, majority 39 (30.5%) found under age category of 23-27 years and
107 (83.6%) were married. A total of 50 (39.1%), attended their education at level of diploma and above,
with 59 (46.1%) working in governmental institution. Regarding family size, 78 (60.9%) have two family
members, with the majority, 106 (82.8%) of them live in urban, Socio-demographic characteristics of pregnant
women attending ante-natal care is shown in Table 1.

Table 1. Socio-demographic characteristics of pregnant women attending ante-natal care

Variables Options Frequency Percentage
18 – 22 38 29.7
23 – 27 39 30.5
28 – 32 33 25.7
Age categories in years
33 – 37 13 10.2
38 – 42 2 1.6
43 – 47 3 2.3
Single 3 2.3
Married 107 83.6
Marital status
Divorced 15 11.7
Widowed 3 2.3
Primary school 28 21.9
Educational Status Secondary school 50 39.1
Diploma and above 50 39.1
Farmer 13 10.2
Governmental 59 46.1
Occupational status
Private 34 26.6
House wife 22 17.2
2 78 60.9
Number of families 3 43 33.6
≥3 7 5.5
1000-1500 27 21.1
Family monthly income (ETB)
1500-2500 42 32.8
1 ETB = $ 28.34
≥ 2500 59 46.1
Urban 106 82.8
Living area
Rural 22 17.2

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3.2. Maternal characteristics

Regarding age at first marriage, about 65 (50.8%) of pregnant women married at age between
16-20 years. About, 65 (50.8%) gave their first birth at age of 18-22 years. A majority, 103 (80.5%) of the
respondents did not suffer from health related problem during the first birth. Almost half of them were their initial
visit to the hospital as can be seen in Table 2.

Table 2. Maternal related characteristics of pregnant women attending antenatal care at hospitals
Variables Options Frequency Percentage
16-20 65 50.8
Age at first 21-25 33 25.8
marriage in Years 26-30 26 20.3
≥31 4 3.1
18-22 65 50.8
23-27 41 32
Age in Years
28-32 22 16.4
≥33 1 0.8
1 66 51.6
Number of
2 42 32.8
pregnancy
3 18 14.1
(Gravidity)
4 2 1.6
<3 Years 51 39.8
Years of child
3-4 Years 11 8.6
spacing
No child ever 66 51.6
1st trimester 50 39.1
Stage of pregnancy 2nd trimester 50 39.1
3rd trimester 28 21.9
Do you suffering Yes 25 19.5
from health problem No 103 80.5
1st time 60 46.9
Number visit to the
2nd time 43 33.6
health institution
3rd time 25 19.5

3.3. Knowledge on iron deficiency anemia

Out of the total, 113 (88.3%) of pregnant mothers have ever heard about IDA, in which health
professionals were main source of information. About 40 (31.3%) of pregnant mothers correctly defined the main
cause of anemia as iron deficiency. While only small proportion, 18 (14.1%) of respondents identified some
common symptoms of IDA namely general body weakness, dizziness or fainting, poor appetite and shortness of
breathing as main sign and symptom of anemia. On knowledge related to prevention of anemia.
Majority, 75 (58.6%) of respondents knew how anemia can be prevented. About one third, 40 (31.3%) of mother
knew that anemia can be prevented by healthy and balanced nutrition as shown in Table 3.
Generally 61% (61% (95% CI: 52.6% to 69.5%) of pregnant women had a good knowledge on
prevention methods of IDA. While 39% of pregnant women had low knowledge score towards prevention of
IDA. (Those who score above the mean after coding all correct options as 1 and the other as 0),
as shown in Figure 1.

Figure 1. Overall knowledge score of pregnant mothers on IDA in Ethiopia, 2018.

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Int. J. Public Health Sci. ISSN: 2252-8806  207

Table 3. Knowledge of mothers on prevention of IDA among pregnant women attending ANC
Variables Frequency Percentage
Yes 113 88.3
Ever heard of IDA
No 15 11.7
Poor nutrition 33 25.8
Iron deficiency 40 31.3
Causes of anemia
Low hemoglobin 7 5.5
I don't know 48 37.5
shortness of breathing 14 10.9
Exceptional fatigue 12 9.4
General body weakness 18 14.1
Sign and symptom of anemia Poor appetite 15 11.7
Dizziness or fainting 18 14.1
All can be observed 3 2.3
I don't know 48 37.5
Poor nutrition 45 35.2
Bleeding during pregnancy 26 20.3
Causes of IDA Multiple pregnancy 3 2.3
All listed above 6 4.7
I don't know 48 37.5
Yes 75 58.6
Awareness on Prevention of IDA
No 53 41.4
By good nutrition 40 31.3
Using Iron supplement 25 19.5
Ways to Prevent IDA Drinking or Eating fruits 7 5.5
All listed above 3 2.3
I don't know 53 41.4
Drinking tea, coffee and milk can cause Yes 39 30.5
anemia No 89 69.5
Yes 78 60.9
Spacing child can prevent anemia
No 50 39.1

3.4. Attitude of pregnant mothers on IDA

Regarding the mother’s attitude towards IDA, majority 52 (40.6%) and 53 (41.4%) were strongly agreed
and agree to the statements regarding regular visit have benefits both for the mother and fetus health during
pregnancy respectively. The significantly higher proportion of women, about 45 (35.2%) and 35 (27.3%) agreed
and strongly agreed that related to drinking of tea, coffee and milk may predispose an individual to IDA
respectively. Related to feeding regular meal to prevent anemia and iron supplement, almost half 64 (50%) agreed
and recommend the use of an extra iron tablet (iron supplementation) for pregnant in addition to regular diet to
prevent IDA. About 46 (35.9%) and 15 (11.7%) were agreed and strongly agreed, that family planning have
greater role in the prevention of anemia. Almost half of pregnant women, agreed that child spacing is important
to prevent IDA, Attitude of pregnant mothers towards iron deficiency anemia among ANC attendants is shown
in Table 4. More than half, 52.3% (95% CI: 43.7% to 61.0%) had favorable attitude towards prevention of IDA.
While 67.75 of pregnant women attending ANC had unfavorable attitude towards IDA, attitude level of pregnant
women attending ANC on the preventions of Iron deficiency anemia is shown in Figure 2.

Figure 2. Attitude level of pregnant women attending ANC on the preventions of Iron deficiency anemia

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Table 4. Attitude of pregnant mothers towards iron deficiency anemia among ANC attendants
Variables Frequency Percentage
Strongly disagree 5 3.9
Disagree 1 8
Regular ANC visit is good to prevent IDA. Neutral 17 13.3
Agree 53 41.4
Strongly agree 52 40.6
Strongly disagree 1 .8
Iron supplement can affect mother and fetus Agree 45 35.2
health? Neutral 47 36.7
Strongly agree 35 27.3
Disagree 10 7.8
Drinking coffee, tea or milk can affect iron Agree 37 28.9
absorption Neutral 70 54.7
Strongly agree 11 8.6
Strongly disagree 3 2.3
Disagree 2 1.6
Iron supplements can prevent IDA Agree 50 39.1
Neutral 52 40.6
Strongly agree 21 16.4
Strongly disagree 1 0.8
Disagree 2 1.6
Regular meals or feeding can prevent
Agree 64 50.0
anemia
Neutral 48 37.5
Strongly agree 13 10.2
Strongly disagree 4 3.1
Disagree 10 7.8
Pregnant women should consume Iron
Agree 46 35.9
tablets in spite of healthy diet
Neutral 53 41.4
Strongly agree 15 11.7
Strongly disagree 1 0.8
Disagree 2 1.6
Promotion of family planning methods for
Agree 60 46.9
spacing with prevent anemia
Neutral 54 42.2
Strongly agree 11 8.6
Strongly disagree 8 6.3
Disagree 0 0
Spacing child can prevent anemia Agree 54 42.2
Neutral 51 39.8
Strongly agree 15 11.7
Strongly disagree 4 3.1
Disagree 9 7.0
Any pregnant women can be affected by
Agree 53 41.4
anemia
Neutral 49 38.3
Strongly agree 13 10.2

3.5. Iron deficiency anemia prevention practices

Regarding IDA prevention practice of pregnant mothers, majority 68 (53.1%) reported that they did not
drink tea, coffee and milk along with their meal. While, 87 (68%) of pregnant women did not take an iron tablet
(Iron supplementation) regularly and 76 (59.4%) reported that they take regular feeding three times per day.
On the other hand, 62 (48.4%) had a habit of Eating red meat. Overall, one third 41 (32%) were found to be
anemic (Hgb<11mg/dl). While the more than half of pregnant women, 58.6% (95% CI: 50.1% to 67.1%) had
a poor adherence to prevention practice of IDA, while 41.4% of ANC attending pregnant women had a good
adherence to prevention practice of IDA as shown in Table 5.
The mean knowledge, attitude and practice score of women was 5.4 (SD=3.7), 32.8 (SD=5.4) and
3.4 (SD=0.71) respectively. The higher knowledge score was positively correlated with attitude score
(r=0.75, p<0.001). Similarly, higher attitude is associated with increased practice towards prevention of IDA
(r=0.55, p<0.001). Rather, there is relatively moderate correlation between the mother knowledge and practice
of IDA (r=0.45, p<0.001). The mean practice score of rural mother was significantly lower than urban
(F=12.478 p=0.01). Higher knowledge score, favorable attitude and age were positive predictors of good
nutritional practices while family size is inversely related with it, shows the IDA prevention practice of Pregnant
mother against Residence (urban versus rural) is shown in Table 6.

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Table 5. Practice of pregnant mothers on prevention of iron deficiency anemia among ANC ante-natal care in
Eastern Ethiopia, 2018.
Variables Options Frequency Percentage
Yes 60 46.9
Have you drink tea, coffee and milk with meal?
No 68 53.1
Yes 41 32.0
Have you used regular iron Tablets?
No 87 68.0
Yes 76 59.4
Have you use three regular meals?
No 52 40.6
Have you taken Folic acid supplements in current Yes 76 59.4
pregnancy? No 52 40.6
Do you have the habit of Eating red meat, liver, Yes 62 48.4
chicken, fish No 66 51.6
Yes 72 56.3
Do you include fiber rich food frequently?
No 56 43.8
Do you include green leafy vegetable in your diet Yes 75 58.6
every day? No 53 41.4
Overall IDA practice level Poor 75 58.6
IDA prevention practice Good 53 41.4

Table 6. Shows the IDA prevention practice of pregnant mother against residence (urban versus rural)
Sum of Squares df Mean Square F Sig.
Between Groups 5.767 1 5.767 12.478 .001
Practicescore * Residence
Within Groups 58.233 126 .462
Linear Regression output
Β (coefficient) Se (standard error of β) P value
Knowledge score 0.085 0.015 0.0001
Attitude score 0.073 0.010 0.0001
Age in year 0.028 0.011 0.01
Family 0-.118 0.105 0.264

4. CONCLUSION
Knowledge, attitude and practice of pregnant women on preventions of IDA are not satisfactory.
Thus poor practice towards prevention of IDA are the main contributing factor for high burden of anemia.
Thus, it is advised to have focused, simple, easy to understand and customer friendly counseling service at ANC
facilities. It should specifically focus on symptoms of anemia, causes, what makes pregnancy at risk,
how to prevent IDA among pregnant. This program should involve males/husbands for sustained impact.
The need for adherence counselling and follow up on Iron supplement should be focused by health professionals.

ACKNOWLEDGEMENTS
We are delighted to thank our study participants (pregnant women) and our students for their valuable
contributions for this research.

ABBREVIATIONS
ANC: Ante Natal Care: A/COR: adjusted/Crude Odds ratio: CI: Confidence Interval: IDA: Iron
deficiency anemia: r: correlation coefficient: WHO: World health Organization, UNICEF: United Nations
Children Education Fund

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