Int
ern
at
i
onal
Journ
al of
P
u
bli
c Hea
lt
h S
c
ie
nce (IJPH
S)
Vo
l.
6
,
No.
3
,
S
eptem
ber
201
7
, pp.
21
3
~
2
20
IS
S
N:
22
52
-
8806
, DO
I: 10
.11
591/ij
phs.
v6
i
3.793
1
213
J
o
u
r
n
a
l
h
o
m
e
p
a
g
e
:
https:
//
ww
w.i
aesco
re
.c
om
/j
our
nals/
ind
ex.
php/IJP
H
S
Prevalen
ce and Determi
na
nts of A
nemia
in
Pregn
an
cy
,
Sana’
a
, Yem
en
Yousef
M.
Alf
lah
1
,
Im
an
H. Wah
dan
2
,
Ali A. Has
ab
3
,
Dali
a
I.
T
ay
el
4
1
Public Health S
pec
ialist, Al
K
uwait
Univ
ersity Hos
pit
al,
San
a’
a
Univer
si
t
y
,
Ye
m
en
2,3
Depa
rtmen
t
o
f
Epi
d
emiolog
y
,
High
Instit
u
te
of
Public Healt
h,
Alexa
ndri
a
Univ
ersity
,
Eg
y
pt
4
Depa
rtment
of
Nutrit
ion
,
High
I
nstit
ute of
Publ
i
c
Hea
lt
h
,
Al
exa
n
dria
Univ
ersity
,
Eg
y
p
t
Art
ic
le
In
f
o
ABSTR
A
CT
Art
ic
le
history:
Re
cei
ved
Ma
y
28
, 201
7
Re
vised Jul
2
6
,
2017
Accepte
d Aug
11
, 201
7
Anem
ia
is
a
glo
bal
pub
li
c
he
al
th
proble
m
in
bot
h
developing
an
d
develope
d
count
ri
es,
esp
ec
i
al
l
y
among
pre
g
nant
wom
en.
Th
e
a
im
of
the
stu
d
y
was
to
esti
m
at
e
the
pr
eva
l
enc
e
of
an
emia
among
p
reg
nant
wom
en
in
San
a
'
a
gover
nora
t
e,
Ye
m
en,
and
to
identif
y
the
determ
i
nant
s
cont
ributi
ng
to
it
,
and
to
assess
knowledge
r
ega
rding
i
t.
Th
e
stud
y
wa
s
conduc
te
d
usi
ng
a
cro
ss
-
sec
ti
on
al
appr
oa
ch.
It
inc
lud
ed
360
pre
gnant
wom
en
at
te
nding
t
he
m
at
ern
i
t
y
cl
inics
of
m
aterni
t
y
hospi
ta
ls
.
A
pre
d
esign
ed
struct
u
red
i
nte
rvi
ewing
questi
onnaire
w
as
used
to
colle
c
t
da
ta
from
the
p
reg
nant
wom
en.
La
bora
to
r
y
inve
stigations
w
ere
don
e.
The
pr
eva
l
enc
e
of
anem
ia
was
found
t
o
be
40
.
3%,
and
was
highe
r
a
m
ong
femal
es
a
ged
35
to
le
ss
th
an
45
y
ea
rs,
those
with
poo
r
inc
om
e
and
poo
r
nutri
t
ional
l
ev
el
.
The
risk
of
ane
m
ia
inc
r
ea
se
d
with
th
e
gesta
ti
on
al
ag
e,
gra
vidi
t
y
,
dec
r
e
ase
d
birt
h
spac
i
ng,
drinki
ng
te
a
and
cof
fee
aft
er
m
e
al
s,
d
ecrea
sed
in
ta
k
e
of
prote
ins
and
lo
w
le
vel
o
f
k
no
wledge
and
inc
om
e.
Th
e
bin
ar
y
logi
sti
c
reg
r
ession
m
odel
indi
cate
d
a
sign
ifica
nt
impa
c
t
of
the
educ
a
ti
o
n
and
occ
upati
on
on
the
le
vel
of
knowledge
of
pre
gnant
wom
en.
Anem
ia
was
found
out
to
be
a
seve
r
e
publi
c
he
alth
probl
em
among
pre
gnant
wom
en
in
Yem
en.
I
den
ti
fie
d
risk
f
ac
tor
s
should
be
con
sidere
d
fo
r
it
s pre
v
ent
ion
an
d
cont
ro
l.
Ke
yw
or
d:
An
em
ia
Determ
inants of
a
nem
ia
Pr
e
gn
a
nt
w
om
en
Pr
e
valence
Copyright
©
201
7
Instit
ut
e
o
f Ad
vanc
ed
Engi
n
ee
r
ing
and
S
cienc
e
.
Al
l
rights re
serv
ed
.
Corres
pond
in
g
Aut
h
or
:
Youse
f
Mo
ha
m
m
ed
Ali Al
-
Flah
,
Publi
c H
eal
th
Sp
eci
al
ist
,
Alkuwait
Un
i
ve
rsity
H
ospit
al
,
Sana
’a
Un
i
ver
s
it
y, Sana’
a
, Ye
m
en
.
Em
a
il
:
al
flah2
014@gm
ai
l.com
1.
INTROD
U
CTION
An
em
ia
is
a
glo
bal
public
he
al
th
pro
blem
a
ff
ect
in
g
bo
t
h
de
velo
ping
a
nd
dev
el
op
e
d
c
ou
ntries
wit
h
m
ajo
r
c
on
se
qu
ences
f
or
hum
an
healt
h
as
w
el
l
as
so
ci
al
an
d
eco
no
m
ic
dev
el
opm
ent.
It
occurs
in
al
l
sta
ges
of
li
fe
but
it
is
m
or
e
prevale
nt
in
pr
e
gnant
wom
en
an
d
c
hild
re
n
[
1]
.
T
he
World
Healt
h
Orga
nizat
ion
(
WHO)
consi
der
e
d
a
nem
ia
to
be
one
of
the
te
n
m
os
t
i
m
po
rt
ant
facto
rs
c
ontrib
utin
g
to
t
he
gl
obal
bur
den
of
diseases
[
2]
.
T
he
Ce
nters
f
or
Disease
Co
ntr
ol
and
P
reventi
on
(C
DC)
,
est
im
at
ed
the
wo
rl
dw
i
de
prevale
nce
of
anem
ia
a
m
on
g
pr
e
gn
a
nt
w
ome
n
to
be
52%
i
n
2007.
T
he
m
ajorit
y
of
these
wo
m
en
wer
e
li
vin
g
in
dev
el
opin
g
countries
[
3]
.
Global
ly
,
acco
rd
i
ng
to
the
W
HO,
in
2014
,
t
he
prevale
nce
of
a
nem
ia
a
m
on
g
pr
e
gnant
w
om
en
aged 1
5
-
49 yea
rs
f
el
l by
12
%
betwee
n 199
5 and 2
011 f
ro
m
4
3%
to
38%
[4]
.
An
em
ia
in
pr
e
gn
a
ncy is def
i
ne
d
as a d
ec
reas
e in the
co
ncent
rati
on
of circ
ul
at
ing
r
e
d
bloo
d
cel
ls or
in
the
hem
og
lob
i
n
co
ncen
t
rati
on
(hem
og
lob
i
n
le
vels
of
belo
w
11
g/d
l
)
an
d
a
con
com
it
ant
i
m
paired
capa
ci
ty
to
trans
port
oxyg
en
[
2]
.
A
nem
i
a
is
a
m
ulti
-
factor
ia
l
disor
de
r.
At
le
ast
half
of
the
global
bur
den
of
a
ne
m
ia
in
pr
e
gnancy
is
du
e
to
iro
n
de
fici
ency.
Ot
her
co
ntributi
ng
f
act
or
s
i
nclu
de
nutrit
ion
al
de
fici
encies
of
f
olate
,
vitam
in
B12
a
nd
vitam
in
A,
chro
nic
inflam
m
at
ion
,
pa
rasit
ic
infecti
ons
a
nd
i
nherit
ed
di
so
r
de
rs
[
5]
.
A
nem
ia
i
n
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
6
, No
.
3
,
Septem
ber
201
7
:
21
3
–
2
20
214
pr
e
gnancy
is
al
so
af
fected
by
so
ci
oec
onom
ic
con
diti
on
s,
li
festy
le
s
and
healt
h
-
see
ki
ng
be
hav
i
or
s
acr
os
s
diff
e
re
nt cu
lt
ur
es
[
2]
.
Stud
ie
s
ha
ve
s
how
n
that
ane
m
ia
in
pr
eg
na
nc
y
has
adv
e
rse
conseq
ue
nces
that
m
ay
no
t
only
aff
ect
t
he
pr
e
gnant
but
al
so
aff
ect
s
the
neonate
an
d
in
fan
t
[
6]
.
Durin
g
preg
na
ncy,
anem
ia
is
associat
ed
with
m
ulti
ple
adv
e
rse
outc
om
es
for
bo
t
h
m
oth
er
an
d
in
f
ant,
in
cl
udin
g
an
inc
rease
d
risk
of
hem
orrhage,
sepsis
,
m
at
ern
a
l
m
or
ta
lity
,
per
i
natal
m
or
ta
li
ty,
lo
w
birt
h
w
ei
gh
t
[7]
a
nd
reduce
d
wor
k
capaci
ty
[
8]
.
Fo
rty
pe
rcen
t
of
al
l
per
i
natal
death
s
are
li
nk
ed
to
anem
ia
[7]
.
Ther
e
is
usual
ly
a
2
to
3
fo
l
d
increase
in
pe
r
inata
l
m
or
ta
li
t
y
rate
wh
e
n
m
at
ern
al
hem
og
lo
bin
l
evels
fall
bel
ow
8.0
g/
d1
a
nd
8
-
10
f
old
s
i
ncr
ease
w
he
n
m
at
ern
al
hem
og
lo
bin
le
vels f
al
l
belo
w 5.
0 g/dl
[9]
.
The
m
anag
em
ent
of
a
nem
ia
i
n
a
pr
e
gnant
w
om
an
dep
e
nds
on
the
durati
on
of
preg
na
ncy,
sever
it
y
of
the
anem
ia
and
com
plica
ti
on
s
[10]
.
The
WH
O
re
porte
d
that
a
com
bin
ed
treat
m
ent
wi
th
iro
n
an
d
vitam
in
A
cou
l
d
ha
ve
a
great
er
im
pact
on
a
nem
ia
treatm
ent
especial
l
y
du
ri
ng
the
s
econd
trim
est
e
r
of
pr
e
gnancy
[11]
.
In
te
r
ve
ntions
to
co
ntr
ol
ane
m
ia
in
pr
egna
ncy
inclu
de
ir
on
s
upplem
entat
ion
an
d
iro
n
fo
rtific
at
io
n,
d
ie
ta
ry
m
od
ific
at
ion
,
nu
t
riti
on
al
an
d
healt
h
e
du
cat
ion
,
c
on
t
rol
of
pa
rasit
ic
infecti
ons,
a
nd
im
pr
ovem
ent
of
sanita
ti
on
[
5],[12
]
,
[13]
.
In
Yem
en,
an
e
m
ia
is o
ne
of
t
he
seri
ou
s
heal
th p
r
oble
m
s a
m
on
g
pr
e
gnant
w
om
en.
In 20
11, th
e
World
Ba
nk
est
im
at
e
d
the
pre
vale
nc
e
of
a
nem
ia
i
n
Yem
en
to
be
36
%
am
ong
preg
na
nt
wo
m
en
[
14
]
.
T
her
e
f
or
e
,
the
assessm
ent
of
t
he
e
xtent
of
th
e
pro
blem
and
the
fact
or
s
res
pons
i
ble
f
or
it
is
nee
ded.
T
he
present
stu
dy
aim
ed
to
est
i
m
at
e
the
pr
e
valence
of
anem
ia
a
m
on
g
pr
e
gnant
w
ome
n
in
Sa
na'
a
gov
e
r
norate,
Ye
m
en,
to
ide
ntif
y
the
determ
inants c
on
t
rib
uting t
o
i
t, an
d
to
assess
knowled
ge re
gardin
g
it
.
2.
METHO
D
The
stu
dy
wa
s
carrie
d
out
a
m
on
g
preg
nan
t
wo
m
en
at
te
nd
in
g
the
ou
t
patie
nt
cl
inics
of
f
our
gove
rn
m
ental
ho
s
pital
s
in
Sa
na'
a
govern
or
a
te
(
Als
ba'
aen
Ho
s
pital
,
Al
kuwait
U
niv
er
sit
y
Ho
s
pital
,
Alt
hawr
a
Gen
e
ral
H
ospit
al
and
Aljum
hory
H
ospit
al
)
us
in
g
a
c
ro
s
s
sect
ion
al
de
sign.
T
he
sam
ple
siz
e
was
cal
culat
ed
us
in
g
Stat
s
Di
rect
3.0.1
35,
2015.
Ba
se
d
on
pr
e
valence
of
anem
ia
of
36%
a
m
on
g
preg
nan
t
wo
m
en,
(
14)
th
e
m
ini
m
u
m
r
equi
red
sam
ple size
w
as cal
culat
e
d
to
be
36
0
pre
gn
a
nt wom
en
at
9
5%
c
onfide
nc
e interval, a
nd
5
%
acce
ptable a
bsolute
dev
ia
ti
on
of the
sam
ple f
r
om
the p
op
ulati
on
rate.
A
pr
e
-
de
sig
ne
d
str
uct
ur
e
d
i
nterv
ie
wing
qu
e
s
ti
on
nai
re
was
prepa
red
by
the
r
esearc
hers
to
colle
ct
data
from
pr
eg
nan
t
wo
m
en
ab
ou
t
their
so
ci
ode
m
og
ra
phic
char
act
erist
ic
s
includi
ng
age
,
educat
ion
al
l
evel,
occupati
on,
in
com
e
le
vel,
and
reside
nce.
Ob
ste
tric
a
nd
gyneco
l
og
ic
a
l
histor
y
was
ob
ta
ine
d
(inc
lud
i
ng
tri
m
est
er
of
pr
egn
a
ncy,
gravi
dity
,
previ
ous
birth
s
,
a
nd
histor
y
of
ab
or
ti
on)
.
Me
dical
hi
story
(chronic
an
d
current
disease
s),
dieta
ry
ha
bi
ts
(
us
e
of
vit
a
m
in
and
m
ineral
su
pple
m
e
nts
,
co
nsum
pti
on
of
en
ha
nce
rs
an
d
inh
ibit
ors
of
i
ron
a
bsor
ptio
n
wer
e
obta
ine
d.
T
he
quest
ionnaire
al
so
i
nclu
d
ed
kn
owle
dg
e
a
bout
s
ign
s
,
sy
m
pto
m
s,
co
m
pl
ic
at
ion
s
an
d
risk
facto
rs
of
a
nem
ia
,
iron
rich
foo
ds
and
e
nh
a
nce
rs
and
in
hi
bitor
s
of
ir
on
abs
orption.
La
borato
ry
in
vest
igati
on
s
we
re
done
t
o
as
sess
the
le
vel
of
he
m
og
lob
in,
hem
at
ocr
it
(
Hct),
pa
cke
d
cel
l vo
lum
e (PC
V)
,
m
ean co
r
pu
s
cular
h
em
og
lo
bin
c
once
ntrati
on (
MC
HC
)
a
nd volum
e of the
r
e
d blo
od
cel
l.
MC
HC = Hb (
g/d
l)
/ Hct
(%)
x 100
The
c
ollec
te
d data we
re r
e
vis
ed,
c
od
e
d, an
d analy
zed
us
in
g t
he
sta
ti
sti
cal
pack
a
ge fo
r
s
oc
ia
l sci
ences
(S
PS
S
ve
rsion
21).
G
raphica
l
pr
esentat
io
ns
wer
e
do
ne
for
visu
al
iz
at
io
n
us
in
g
Mi
cro
s
of
t
Excel
.
Me
an
(
X)
with
sta
nda
rd
de
viati
on
(SD)
we
re
cal
c
ulate
d
to
des
c
ribe
norm
al
l
y
distrib
uted
s
cal
e
data.
C
ount
a
nd
per
ce
ntage
we
re
us
e
d
desc
ribing
a
nd
s
umm
arizi
ng
qual
i
ta
ti
ve
data.
A
sp
eci
al
sco
rin
g
syst
e
m
was
prepa
red
for
assessm
ent
of
dieta
ry
intake
an
d
knowle
dg
e
.
Chi
-
s
qu
a
r
e
(X
2
)
was
us
e
d
for
analy
sis
of
s
om
e
ca
te
go
rical
data.
Odds
rati
o
was
us
e
d
t
o
assess
the
risk
of
a
pa
rtic
ular
ou
tc
om
e
(or
diseas
e)
if
a
certai
n
factor
(
or
expos
u
re
)
is
pr
esent.
L
og
ist
ic
r
eg
ressio
n
was
us
e
d
to p
re
dic
t
a
dep
e
ndent vari
able
ba
sed
on
co
ntin
uous
a
nd
/
or
cat
egorical
inde
pende
nts
an
d
to
determ
ine
t
he
eff
ect
siz
e
of
the
in
de
penden
t
va
riables
on
the
depen
de
nt;
to
rank
the
relat
iv
e
i
m
po
rtance
of
in
dep
e
ndents
and
to
unde
rstand
t
he
im
pact
of
c
ovariat
e
c
on
t
ro
l
var
ia
bles.
T
he
Re
cei
ver
Op
e
r
at
ing
Ch
aracte
r
ist
ic
(
ROC) c
urve a
naly
sis w
as also
us
e
d
to
stud
y t
he
d
ia
gnos
ti
c p
e
rfor
m
ance
of
HB for dia
gnosi
s o
f
a
nem
ia
a
m
on
g
pre
gn
a
nt
f
em
al
es and
di
scrim
inate
an
e
m
ic
cases f
r
om n
or
m
al
cases.
The
resea
rch
e
r
sou
gh
t
t
he
a
ppr
oval
of
t
he
Ethic
s
Com
m
ittee
of
the
Hi
gh
In
sti
tute
of
Publi
c
Healt
h
for
co
nductin
g
the
researc
h
and
c
om
plied
with
the
internat
ion
al
guideli
ne
s
fo
r
researc
h
et
hics.
A
n
inf
orm
ed
wr
it
te
n
c
on
se
nt
was
ta
ke
n
f
r
om
t
he
stud
y
par
ti
ci
pa
nts
aft
er
ex
planati
on
of
t
he
pur
pos
e
and
be
nef
it
s
of
t
he
researc
h. A
nonym
i
ty
an
d
c
onf
identia
li
ty
w
er
e assure
d
a
nd
m
ai
ntained.
T
he
re
was no co
nfl
ic
t of
i
nterest.
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N:
22
52
-
8806
Prevalenc
e
and Dete
rmi
nant
s o
f A
ne
mia
i
n Preg
nancy,
Sa
na'a, Ye
me
n
(
A
lf
lah
Y.
)
215
3.
RESU
LT
S
The
total
nu
m
ber
of
pr
egn
ant
wo
m
en
included
in
the
stud
y
was
36
0
w
om
en.
Their
So
ci
od
em
og
rap
hi
c
char
act
erist
ic
s
are
sh
ow
n
in
T
able
1.
The
age
of
the
pr
egn
ant
wo
m
en
ran
ged
between
15
and
45
ye
ars.
The
m
ean
age
was
26
.5
5
ye
ars
±
5.
71
3
SD
.
Most
pr
egn
ant
wo
m
en
(8
9.
4%)
wer
e
fr
om
ur
ban
areas.
More
than
three
qu
arters
of
pr
egn
ant
wo
m
en
(7
6.
4%)
wer
e
ho
us
ewives.
On
ly
19
.6
%
wer
e
stud
ents.
2.
8%
wer
e
em
plo
ye
es
and
fr
ee
wo
rk
ers
a
nd
pr
of
essionals
con
sti
tuted
0.
6%.
On
ly
12
.2
%
of
pr
egn
ant
wo
m
en
wer
e
il
li
te
rate.
Tho
se
with
pr
im
ary
edu
cat
ion
con
sti
tuted
26
.4
%.
Near
ly
half
(4
8.
6%)
of
the
stud
y
po
pu
la
ti
on
had
secon
dar
y edu
cat
ion
, w
hile 12
.8
%
had
u
niv
ersit
y and
p
os
t gr
adu
at
e
edu
cat
ion
. P
r
egn
ant w
om
en
wh
o
had
eno
ug
h
incom
e
con
sti
tuted
70
.5
%,
com
par
ed
to
21
.7
%
wh
o
did
no
t
hav
e
eno
ug
h
incom
e
and
bo
rr
ow
.
On
ly
7.
8%
had
en
ou
gh
inco
m
e and
sav
ed.
Table
1.
Distri
bu
ti
on
of
P
regnan
t
Wo
m
en A
ccordin
g
t
o
S
oc
io
-
dem
og
raph
ic
Char
act
erist
i
cs
So
cio
d
e
m
o
g
raph
ic
data (n=3
6
0
)
No
%
Ag
e (
y
ears
)
15
-
148
4
1
.2
25
-
169
4
6
.9
35
–
45
43
1
1
.9
Mean ±S
D= 26
.55
±5.7
y
ea
rs
Res
id
en
ce
Urban
322
8
9
.4
Ru
ral
38
1
0
.6
Occup
atio
n
Ho
u
sewiv
es
275
7
6
.4
Stu
d
en
ts
71
1
9
.6
E
m
p
lo
y
e
es
10
2
.8
Free
wo
rkers
2
0
.6
Prof
ess
io
n
als
2
0
.6
Edu
catio
n
al level
Illiter
at
e
44
1
2
.2
Pri
m
a
r
y
95
2
6
.4
Seco
n
d
ary
175
4
8
.6
Un
iv
ersity
and
po
st g
radu
ate
46
1
2
.8
Inco
m
e
Eno
u
g
h
and
sav
e
28
7
.8
Eno
u
g
h
254
7
0
.5
No
t eno
u
g
h
and
b
o
rr
o
w
78
2
1
.7
The
stu
dy
re
ve
al
ed
that
the
ov
e
rall
pr
e
vale
nce
of
anem
ia
a
m
on
g
t
he
stud
y
popula
ti
on
was
40.
3%,
wh
e
re
16.
6%
of
a
nem
ic
pr
egn
a
nt
w
om
en
had
m
il
d
ane
m
ia
,
23
.
1%
had
m
od
erate
anem
ia
,
and
on
ly
0
.
6%
of
them
had
se
ve
re
a
nem
ia
as
sh
ow
n
i
n
F
i
gur
e
1
.
T
he
m
ean
H
b
le
vel
am
on
g
pr
e
gn
a
nt
w
om
en
was
11.
4±
1.8
g/d
l.
It r
a
nge
d betwee
n 4 a
nd
17 g
/
dl.
Figure
1. Distri
bu
ti
on
of
pr
e
gnant
w
om
en
by
their
hem
og
lob
i
n
le
vel
Table
2
sho
ws
that
the
hig
he
st
pr
evale
nce
of
an
em
ia
(4
8.8%)
was
f
ound
am
on
g
pr
e
gnant
w
om
en
aged
35
-
45
ye
a
rs,
f
ollo
wed
by
tho
se
age
d
25
to
le
ss
than
35
ye
ars
(42.6
%).
T
he
dif
fere
nce
bet
ween
var
i
ous
age
gro
ups
in
r
el
at
ion
to
ane
m
ia
was
no
t
sign
i
ficant
(
p
=
0.190
).
Th
e
prevalence of
a
nem
ia
increased
with
the
decr
ease
i
n
the
le
vel
of
inc
ome
.
The
hi
gh
e
st
pr
e
valenc
e
of
anem
ia
(4
9.
9%
)
was
am
on
g
preg
na
nt
wo
m
en
w
ho
had
poor
inc
om
e.
The
relat
ion
betwee
n
in
com
e
and
ane
m
ia
was
sta
ti
s
ti
cal
ly
sign
ific
ant
(p
=
0.036
).
Th
e
pr
e
valence
of
anem
ia
increased
with
the
inc
rease
in
ge
sta
ti
on
al
a
ge.
It
wa
s
29.
2%
am
ong
wo
m
en
in
t
he
first
40
.30
%
59
.70
%
A
nemi
c
(
<11
g
/
d
l
)
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
6
, No
.
3
,
Septem
ber
201
7
:
21
3
–
2
20
216
tri
m
est
er
and
increase
d
t
o
42.5
%
a
nd
48.7%
am
on
g
th
ose
in
sec
ond
a
nd
thi
rd
t
rim
ester
res
pecti
vely
.
Thi
s
increase is
stat
ist
ic
al
ly
sign
ific
ant (x
2
=
9.3
56, p =
0
.
009).
Table
2.
C
om
par
iso
n
Be
twee
n An
em
ic
and
Non
-
anem
i
c Pr
egn
a
nt
Wo
m
en
in
Re
la
ti
on to
So
ci
odem
og
ra
ph
ic
C
har
act
e
risti
cs
and
Gy
ne
colo
gical
H
ist
ory
So
cio
d
e
m
o
g
raph
ic
characte
ristics an
d
g
y
n
ecol
o
g
ic his
to
ry
An
e
m
ic
n
=1
4
5
No
t ane
m
ic
n
=2
1
5
X
2
p
-
v
alu
e
No
%
No
%
Ag
e (
y
ears
)
15
-
52
3
5
.1%
96
6
4
.9%
25
-
72
4
2
.6%
97
5
7
.4%
3
.31
7
0
.19
0
35
–
45
21
4
8
.8%
22
5
1
.2%
Inco
m
e level
Eno
u
g
h
and
sav
e
5
1
7
.9%
23
8
2
.1%
Eno
u
g
h
105
4
1
.3%
149
5
8
.7%
6
.65
4
0
.03
6
No
t eno
u
g
h
and
b
o
rr
o
w
35
4
4
.9%
43
5
5
.1%
Period
of
the cu
rr
e
n
t preg
n
an
cy
First
tri
m
este
r
33
2
9
.2%
80
7
0
.8%
Seco
n
d
tr
i
m
este
r
57
4
2
.5%
77
5
7
.5%
9
.35
6
0
.00
9
Third
tr
i
m
ester
55
4
8
.7%
58
5
1
.3%
Cu
rr
en
t preg
n
an
cy
ord
er
1
-
62
3
2
.8%
127
6
7
.2%
3+
83
4
8
.5%
88
5
1
.5%
8
.57
3
0
.00
3
Sp
acin
g
between
preg
n
an
cies (Ye
a
rs)
< 1
38
3
3
.0%
77
6
7
.0%
1
-
10
6
6
.7%
5
3
3
.3%
1
0
.62
9
0
.01
4
2
-
67
4
6
.9%
76
5
3
.1%
3+
30
3
4
.5
57
6
5
.5%
Re
gardin
g
the
relat
ion
s
hip
be
tween
cu
rr
e
nt
pr
e
gnancy
ord
er
and
a
nem
ia
,
the
hig
hest
pr
evalence
of
anem
ia
(4
8.
5%
)
was
am
ong
preg
na
nt
w
om
en
whose
pregn
a
ncy
was
t
he
thir
d
an
d
m
or
e
.
(c
OR
=
0
.518
(0
.338, 0
.793)
, x
2
MH = 8
.573, p
= 0
.
003). The pr
ev
al
ence of
an
em
ia
d
ecre
ased w
it
h
the in
crease in the
in
te
rv
al
betwee
n
preg
na
ncies:
The
hi
gh
e
st
pr
e
valen
ce
of
anem
ia
was
am
on
g
pr
egn
a
nt
w
om
en
who
ha
ve
ha
d
sp
aci
ng
betwee
n pr
e
gn
ancies
on
e
yea
r
a
nd b
el
ow (
X
2
=1
0.629, p
=
0.014.).
Lo
gisti
c reg
res
sion
a
naly
sis shows
that
pr
e
gnant
wo
m
en
how
at
e li
ver
w
eekly
, th
os
e
w
ho
dr
a
nk m
i
lk
on
e
to
six
da
ys
per
week
and
th
os
e
w
ho
wer
e
in
the
third
an
d
second
trim
est
ers
of
pr
e
gnancy
had
a
sign
ific
a
nt im
pact o
n occ
urre
nce
of anem
ia
t
han the
releva
nt
cate
gories
(
T
able 3)
.
Table
3.
L
ogist
ic
Re
gr
ess
i
on
An
al
ysi
s
of
A
nem
ia
A
m
on
g P
regna
nt
Wo
m
e
n
Variable
B
Sig
.
Exp
(B)
9
5
% C.I.
f
o
r
EXP
(
B)
Lower
Up
p
er
Interval b
etween p
regn
an
cies
.10
4
.41
6
1
.10
9
.86
4
1
.42
4
Liver ea
tin
g
1
.08
0
.00
9
2
.94
5
1
.30
4
6
.65
0
Milk d
rink
in
g
-
1
.26
0
-
.00
0
.28
4
.16
8
.47
8
Ti
m
e
of
d
rink
in
g
t
ea
.10
6
.69
0
1
.11
2
.65
9
1
.87
6
Cu
rr
en
t preg
n
an
cy
-
.54
9
-
.06
0
.57
8
.32
6
1
.02
3
Ti
m
e
of
cola d
rink
in
g
-
.62
8
-
.15
7
.53
3
.22
3
1
.27
5
Ti
m
e
of
cof
f
ee drink
in
g
.31
0
.48
0
1
.36
4
.57
7
3
.22
3
Cu
rr
en
t preg
n
an
cy
tr
i
m
ester
-
.67
3
-
.00
0
.51
0
.37
1
.70
2
Co
n
stan
t
4
.36
1
.00
0
7
8
.36
3
Re
gardin
g
t
he
knowle
dge
of
pr
e
gn
a
nt
w
om
en
ab
out
an
e
m
ia
,
it
app
ea
rs
from
F
igu
r
e
2
that
th
e
pr
e
valence
of
anem
ia
a
m
on
g
pr
e
gna
nt
w
om
en
was
high
est
am
on
g
th
ose
w
ho
ha
d
po
or
le
vel
of
kn
ow
le
dg
e
const
it
uted (63
.2
%
)
c
om
par
ed
to
th
os
e
wh
o
ha
d goo
d
a
nd f
a
ir
le
vel
of
kn
owle
dge
(
F
ig
ur
e
2)
.
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N:
22
52
-
8806
Prevalenc
e
and Dete
rmi
nant
s o
f A
ne
mia
i
n Preg
nancy,
Sa
na'a, Ye
me
n
(
A
lf
lah
Y.
)
217
Figure
2. Re
la
ti
on
s
hip bet
wee
n
le
vel
of
knowle
dge a
nd anem
ia
The
di
ff
e
ren
ce
was
sta
ti
sti
cally
sign
ific
ant
(
p
=
0.0
12).
L
ogist
ic
regressi
on
a
naly
sis
of
the
facto
r
s
aff
ect
in
g
know
le
dg
e
sho
we
d
that
the
li
te
rate
and
work
i
ng
preg
na
nt
wo
m
en
ha
d
a
sign
ifi
cant
good
knowle
dge
scor
e
tha
n
the
re
le
van
t cat
e
gor
ie
s
(
T
a
ble 4).
Table
4.
L
ogist
ic
Re
gr
essi
on
An
al
ysi
s
of
the
Fact
ors
Affec
ti
ng
K
nowled
ge
Am
on
g Pre
gna
nt
Wo
m
en
(S
a
na'
a, Y
em
en
)
Variable
B
Sig
.
Exp
(B)
9
5
% C.I.
f
o
r
EXP
(
B)
Lower
Up
p
er
Ag
e
.28
7
.28
5
1
.33
2
.78
8
2
.25
1
Edu
catio
n
1
.64
5
.00
0
*
5
.18
1
2
.33
9
1
1
.47
7
Inco
m
e
-
.26
4
-
.34
6
.76
8
.44
3
1
.33
0
Occup
atio
n
-
.21
9
-
.01
0
*
.80
3
.68
0
.94
8
Res
id
en
ce
-
.54
5
-
.14
1
.58
0
.28
1
1
.19
8
Co
n
stan
t
-
1
.45
0
-
.16
6
.23
4
Accurac
y
of
the
m
o
d
el was 64
.4%
.
*
Sig
n
if
ican
t (
p
< 0.0
5
)
Figure
3. ROC
curve
an
al
ysi
s
of
prob
a
bili
ty
o
f
no a
nem
ia
c
al
culat
ed
f
r
om
bin
a
ry lo
gisti
c m
od
el
0.00%
20.00
%
40.00
%
60.00
%
80.00
%
Good
≥75%
(A
dequ
ate)
Fa
i
r
50%-7
5%
(Moder
ate)
Poor
<5
0% (I
na
dequate)
45
.20
%
33
.90
%
63
.20
%
54
.80
%
66
.10
%
36
.80
%
A
nemi
c
Non
ane
mic
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
6
, No
.
3
,
Septem
ber
201
7
:
21
3
–
2
20
218
Figures
3
sho
w
s
t
hat
the
Area
unde
r
t
he
R
OC
c
urve
(AU
C)
of
H
b
as
a
pr
e
dictor
of
a
nem
ia
a
m
on
g
pr
e
gnant
w
ome
n
in
Sa
na'
a
gove
r
norate
in
Yem
en.
The
ar
ea
unde
r
t
he
R
OC
c
urve
was
sign
ific
a
ntly
di
ff
e
ren
t
from
0.
5
(
null
hypot
hesis
a
r
ea)
a
nd
that
t
her
e
fore
t
her
e
is
e
vid
e
nce
t
hat
Hb
ha
s
a
n
abili
ty
to
disti
nguish
betwee
n
the
tw
o po
sit
ive
and
neg
at
ive
gr
oups (P
(Area=
0.5 was<0
.00
0).
4.
DISCU
SSI
ON
The
ov
e
r
al
l
pr
evalence
of
an
e
m
ia
in
the
pre
sent
stu
dy
was
40.3%
am
on
g
pr
e
gnant
w
ome
n
at
te
ndin
g
m
at
ern
al
ou
t
pa
ti
ent
cl
inics
of
the
sel
ect
e
d
hos
pital
s.
This
prevale
nce
is
con
sist
ent
with
the
globa
l
stud
y
resu
lt
s
(
41.8
%
and
38%)
re
porte
d
from
W
HO
in
20
08
[
1]
and
20
14
[
4]
res
pecti
vely
.
Also
,
the
pre
valen
c
e
est
i
m
at
ed
in
the
current
st
ud
y
is
in
accor
da
nc
e
with
fi
nd
i
ngs
of
a
s
urvey
cond
ucted
in
Yem
en
by
the
World
Ba
nk
in 2011
wh
ic
h
f
ound
th
at
36
% o
f
pr
e
gnant w
om
en
w
ere
anem
ic
[1
4]
.
Other
st
ud
ie
s
done
in 2
01
1
by
the
World
Ba
nk
es
tim
a
te
d
the
pr
e
valence
of
a
ne
m
ia
a
m
on
g
pr
e
gn
a
nt
w
om
en
t
o
be
40
%
i
n
S
aud
i
Ar
a
bia,
38%
i
n
Boli
via,
39%
i
n
Ma
ldives
a
nd
44%
in
Afg
ha
nistan
[
14]
.
Ma
ny
stud
ie
s
done
in
dif
fer
e
nt
co
un
t
ries
ar
ound
the
world
show
ed
that
the
pr
e
valence
of
a
nem
i
a
was
41.
4%
i
n
J
orda
n
(
2012
)
[
15]
41.
6%
i
n
T
urkey
(
2015)
[
16
]
and 39.
9%
in S
ou
t
hern Et
hiop
ia
(
20
15)
[17]
.
The
pre
valenc
e
of
a
nem
ia
i
n
the
cu
rr
e
nt
stud
y
is
lowe
r
than
that
re
porte
d
in
the
WHO
gl
obal
database
on
an
e
m
ia
between
1993
an
d
2005
in
Ye
m
en
whic
h
was
58.
1%
a
m
on
g
preg
na
nt
wo
m
en
[1]
.
This
m
igh
t
be
at
tri
bute
d
t
o
im
pr
ov
e
m
ent
of
healt
h
ca
re
se
rv
ic
es
an
d
s
ocioec
on
om
ic
sta
te
.
It
is
lowe
r
t
han
fi
nd
i
ngs
of
s
om
e
dev
el
opin
g
co
untrie
s
wh
ic
h
we
re
re
ported
by
the
World
Ba
nk
in
2011,
(
Nige
ria
58
%
,
I
nd
ia
54%
a
nd
Pakistan
51%
)
[14
]
.
T
he
pr
e
valence
of
ane
m
ia
in
the
current
stu
dy
was
hig
he
r
than
t
hat
repor
te
d
by
the
World
Ba
nk
i
n
2011,
in
gu
lf
and
Ar
a
bian
c
ountries.
It
wa
s
25%
in
K
uw
ai
t,
26
%
in
U
ni
te
d
Ar
a
b
Em
i
rates,
27% in Leb
a
non,
27% in
J
ord
an,
28% in Qata
r,
31% in
I
raq, 3
4%
in
Om
a
n
and
30% in
E
gypt
[
14
]
. I
t i
s m
uch
higher
t
han
som
e
dev
el
ope
d
countries
as
re
ported
by
the
World
Ba
nk
in
2011,
s
uc
h
as
17%
in
Un
it
e
d
Stat
es,
23% in
Unit
ed Kin
gdom
an
d 27% i
n Japa
n
[
14
]
.
An
em
ia
in
pre
gn
a
ncy
is
relat
ed
to
dif
fer
e
nt
so
ci
o
-
dem
ographic
a
nd
be
h
avi
or
al
facto
r
s
[
17
]
.
Th
e
causes
of
an
e
m
ia
are
m
ult
i
-
factor
ia
l,
i
nclu
ding
gestat
iona
l
factors
a
nd
diet,
in
fecti
on
and
ge
netic
s
[
14
]
.
The
current
stu
dy
r
eveale
d
an
ass
ociat
ion
bet
we
en
pr
e
valence
of
anem
ia
and
m
any
factor
s
as
gestat
ion
al
age,
gr
a
vid
it
y,
chil
d
sp
aci
ng,
m
ilk
dr
i
nk
i
ng,
tim
e
of
te
a
dr
in
kin
g,
tim
e
of
cof
fee
dr
i
nk
i
ng,
ti
m
e
of
cola
dr
i
nk
i
ng,
chicke
n
eat
in
g,
li
ver
eat
in
g
a
nd
le
vel
of
knowle
dge.
The
re
la
ti
ve
con
t
rib
ution
of
eac
h
fac
tor
t
o
a
nem
ia
du
ri
ng
pr
e
gnancy
var
i
es
gr
eat
ly
by
ge
ogra
ph
ic
al
lo
cat
ion
,
seas
on,
and
dieta
ry
pr
act
ic
e
[18]
.
In
the
cu
rr
e
nt
stu
dy,
the
pr
e
valence
of
anem
ia
increas
ed
with
the
de
crease
in
the
le
vel
of
inc
om
e.
The
hi
gh
e
st
pr
e
valence
of
anem
i
a
(49.9%
)
was
a
m
on
g
preg
na
nt
wo
m
en
w
ho
had
poor
inc
om
e.
Stud
ie
s
c
onduct
ed
i
n
T
urkey
(
2010
an
d
2015
)
[9
]
,
[16]
,
Aza
d
Kash
m
ir,
Paki
sta
n
(20
12)
[
19]
,
Ethio
pia
(2013
an
d
20
16)
[20],[
21
]
,
we
r
e
con
sist
ent
with
the
current
st
ud
y
and
f
ound
a
sta
ti
sti
cally
sign
ific
ant
associat
ion
betwee
n
t
he
le
vel
of
in
com
e
and
ane
m
ia
in
pr
e
gnancy.
In
the
prese
nt
stud
y
,
the
ris
k
of
de
velo
ping
anem
ia
increased
with
the
a
dv
a
nce
in
preg
nan
cy
.
T
he
risk
of
dev
el
oping
a
nem
ia
a
m
ong
preg
na
nt
f
e
m
al
es
was
hig
he
r
i
n
thi
rd
a
nd
sec
ond
trim
est
er
w
he
n
c
om
par
ed
with
th
os
e
in
t
he
fir
st
trim
es
t
er.
T
his
fi
nd
i
ng
is
co
ns
ist
ent
with
the
st
ud
y
cond
ucted
am
on
g
preg
na
nt
fe
m
al
es
at
te
nd
in
g
the
pr
im
ary
healt
h
care
cente
rs
in
Ma
kka
h,
Saudi
A
rab
ia
(20
12)
[
22]
,
Additi
on
al
ly
,
stud
ie
s
cond
ucted
i
n
Turkey
(20
10
and
20
15)
[9
]
,
[16]
,
Pa
kistan
(20
13)
[23]
,
E
thiop
ia
(
2015)
[
17
]
,
f
ound
t
hat
the
increase in
ges
ta
ti
on
al
ag
e is sign
ific
a
ntly
asso
ci
at
ed
with t
he
risk of
dev
e
lop
in
g
an
em
ia
.
Th
is cou
l
d
be du
e to
the
fact
that
w
hen
the
gestat
ion
al
a
ge
inc
rea
ses
the
m
oth
er
beco
m
es
weak
an
d
the
ir
on
i
n
the
bloo
d
is
sh
are
d
with the
f
et
us
i
n
the
wom
b
th
eref
or
e
d
ec
reas
ing
t
he
ir
on
bindin
g
ca
pacit
y o
f
the
m
oth
er’
s
blood
[
18]
.
In
th
e
prese
nt
stud
y,
m
ulti
gr
avidity
was
sig
ni
ficantl
y
associat
ed
with
a
ne
m
ia
(p
=
0.0
03)
.
The
risk
of
dev
el
op
i
ng
a
nem
ia
in
pr
egnant
wo
m
en
w
ho
had
t
hr
ee
a
nd
m
or
e
preg
na
ncies
is
incre
ased
w
he
n
co
m
par
ed
with
th
os
e who
ha
d
le
ss
tha
n
3
pr
e
gn
a
ncies.
Th
is
fi
nd
i
ng
is consi
ste
nt
with
stud
ie
s con
duct
e
d
in Saudi A
ra
bia
(20
12)
[
22]
an
d
East
er
n
Ethi
op
ia
(20
14)
[18].
T
his
co
uld
be
at
trib
uted
t
o
los
s
of
ir
on
and
ot
her
nutri
ents
as
resu
lt
of
re
pea
te
d
pr
e
gn
a
ncie
s
[18]
.
Higher
gr
a
vid
it
y
was
do
c
um
ented
in
a
nu
m
ber
of
stud
ie
s
as
a
cause
of
anem
ia
in
pr
e
gnancy,
a
s
st
ud
i
es
done
in
Jor
dan
(
2012)
[
15]
,
Ma
la
ysi
a
(2012
)
[
24]
,
Pa
kistan
(
2013
)
[
23]
an
d
Ethio
pia
(2015
)
[17]
.
This
is
because
of
re
duci
ng
m
a
te
rn
al
iron
rese
rv
e
s
at
ever
y
pr
eg
na
ncy
and
bl
ood
loss
at
each
delivery
[
22
]
.
Chil
d
sp
aci
ng
was
al
so
fou
nd
to
be
si
gn
i
f
ic
antly
associat
ed
with
the
oc
currence
of
a
nem
ia
in
the
current
stu
dy
(
p=
0.0
14).
Ot
he
r
stud
ie
s
do
ne
in
Saud
i
A
rabi
a
(2
012)
[
22
]
,
and
Ethio
pia
(
2012)
[
25]
,
revea
le
d
si
m
il
ar
find
ings.
It
cou
ld
be
no
ti
ced
that
th
e
pr
evale
nce
of
anem
ia
decre
ased
with
the
incr
ease
in
spa
ci
ng
betwee
n
pr
e
gn
ancies.
Thes
e
fin
dings
are
con
sist
e
nt
with
the
resu
lt
s
of
the
current
stud
y
an
d
co
ul
d
be
exp
la
ine
d
by
the
fact
that
s
hort
inter
vals
betwee
n
birt
hs
m
ay
no
t
pr
ovide
wo
m
en
with
en
ough
tim
e
to
rep
le
nish
lo
st
nu
t
rient
sto
res
befor
e
a
nothe
r
re
producti
ve
cy
cl
e
beg
ins.
Anothe
r
ex
pl
anati
on
is
that
child
sp
aci
ng
m
ini
mize
s
bleedin
g
durin
g
delive
r
y
and
en
hance
s
iron
reserve
in
the
body
[25]
.
Re
su
lt
s
of
th
e
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N:
22
52
-
8806
Prevalenc
e
and Dete
rmi
nant
s o
f A
ne
mia
i
n Preg
nancy,
Sa
na'a, Ye
me
n
(
A
lf
lah
Y.
)
219
pr
ese
nt
stu
dy
sh
owe
d
that
a
war
e
ness
ha
d
a
ver
y
si
gn
ifi
cant
ef
fect
on
the
occ
urre
nc
e
o
f
a
nem
ia
a
m
on
g
pr
e
gnant
wo
m
en.
An
em
ic
pr
eg
na
nt
w
om
e
n
w
ho
had
poor
le
vel
of
knowle
dge
c
onsti
tuted
63.2%.
Th
e
pr
e
valence
of
a
nem
ia
a
m
on
g
pr
e
gnant wom
en
increase
d
w
it
h
the d
ecreas
e in k
nowle
dg
e
level. Th
is fin
ding is
consi
ste
nt w
it
h st
udy d
one in
Sudan (
2014)
[
26
]
.
In
the
c
urre
nt
stud
y,
lo
gisti
c
regressio
n
a
naly
sis
of
the
factors
af
fecti
ng
knowle
dge
sh
owe
d
tha
t
edu
cat
io
n
a
nd
occupati
on
(
li
te
racy
an
d
w
ork
)
wer
e
sig
nificantl
y
associat
ed
with
knowl
edg
e
of
the
pregn
a
nt
wo
m
en.
This
f
ind
in
g
is
con
si
ste
nt
with
fin
din
gs
of
pre
viou
s
stud
ie
s
done
in
India
(2014
)
[27]
.
Re
su
lt
s
of
the
pr
ese
nt
stu
dy
sh
owe
d
that
t
he
area
under
the
ROC
c
urve
of
H
b
as
a
pr
edict
or
of
an
e
m
ia
a
m
on
g
pr
egn
a
nt
wo
m
en
was
th
e
hig
hest
of
al
l
var
ious
red
c
el
l
ind
ic
es.
Other
stu
dies
we
re
in
agr
eem
e
nt
and
f
ound
that
the
ROC
f
or
H
b
gi
ve
the
m
axi
m
um
area
unde
r
it
s
curve
a
nd
c
a
n
pre
dict
iro
n
def
ic
ie
ncy
a
ne
m
ia
in
the
seco
nd
a
nd
third t
rim
est
er w
it
h
a
high
sen
sit
ivit
y and
s
pe
ci
fici
ty
[2
8],
[29]
.
5.
CONCL
US
I
O
N
An
em
ia
is
a
gl
ob
al
public
he
al
th
pro
blem
a
ff
ect
in
g
both
de
velo
ping
a
nd
dev
el
op
e
d
co
untrie
s
with
m
ajo
r
co
ns
e
quences
for
hu
m
an
healt
h
as
wel
l
as
so
ci
al
an
d
econom
ic
dev
e
lop
m
ent.
A
ne
m
ia
was
f
ound
out
to
be
a
se
ve
re
public
healt
h
pro
blem
in
Yem
e
n.
Id
e
ntifie
d
ri
sk
factors
s
houl
d
be
co
ns
ide
r
ed
f
or
pr
e
ven
ti
on
an
d
con
t
ro
l
of ane
m
ia
a
m
on
g pr
e
gn
a
nt
wo
m
en.
ACKN
OWLE
DGE
MENTS
Th
e a
uthor
s
w
ou
l
d
li
ke
t
o
t
ha
nk
al
l t
he
st
ud
y
p
a
rtic
ipants
for
their
coo
per
at
ion
.
REFERE
NCE
S
[1]
W
orld
Hea
lt
h
O
rga
nizati
on
,
“
W
orldwide
pre
v
alenc
e
of
ane
m
ia
1993
–
2005
.
W
HO
globa
l
data
base
on
an
emia
,”
Gene
va
,
W
HO
,
pp.
40
,
2008
.
[2]
W
orld
Hea
lt
h
O
rga
nizati
on
,
“
W
orldwide
pr
eva
l
e
nce
of
an
emia,
W
HO
Vita
m
in
a
nd
Mineral
Nutr
it
ion
In
form
at
io
n
S
y
stem,
1993
–
2
005
,”
G
ene
va
,
W
HO
,
pp.
11,
2
008.
[3]
Cent
ers
for
Disea
se
Control
and
Preve
nti
on
,
“
Indic
a
tors
and
m
e
thods
for
cro
ss
-
sec
ti
on
al
surve
ys
of
vit
amin
an
d
m
ine
ral
st
at
us of
populations
,”
A
tl
anta
,
CDC
,
pp
.
152,
2007
.
[4]
W
orld
Hea
lt
h
Or
gani
z
at
ion
,
“
Glo
bal
ta
rge
ts 202
5.
Anem
ia
po
li
c
y
brie
f
,”
Gen
eva
,
W
HO
,
pp.
7,
20
14.
[5]
W
orld
Hea
lt
h
O
rga
nizati
on
,
“
Guidel
in
e:
Da
ily
i
r
on
and
folic
a
cid
su
pple
m
ent
ati
on
in
pre
gnan
t
wom
en
,”
Gene
v
a
,
W
HO
,
pp.
27,
2
012.
[6]
Kala
iv
ani
K.
,
“
Preva
le
n
ce
and
conse
quences
of
ane
m
ia
in
pr
eg
nancy
,”
India
n
J
Me
d
Re
s
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,
vo
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627
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W
orld
Hea
lt
h
O
rga
nizati
on
,
“
Iro
n
def
i
ci
en
c
y
anem
ia
:
assess
m
ent
,
pre
ven
ti
on
,
and
cont
ro
l.
A
guid
e
for
p
rogra
m
m
e
m
ana
ger
s
,”
Gen
eva
,
W
HO
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pp.
1
14,
2001
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[8]
Charl
es
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.
V.
,
“
Public
Hea
lt
h
-
Methodol
og
y
,
e
nvironmenta
l
an
d
s
y
stems
issues.
Iron
def
iciency
ane
m
ia
:
A
public
hea
l
th
probl
em o
f
global
propor
tions
,”
InTe
ch
,
pp
.
432
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2012
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[9]
Kara
oglu
L
.
,
et
al
.
,
“
The
pre
v
alenc
e
of
nutri
t
io
nal
ane
m
ia
in
p
reg
nancy
in
an
ea
st
Anatol
i
an
provinc
e
,
Turkey
,”
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Pub
li
c
He
alt
h
,
vol.
10
,
pp
.
329
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2010
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[10]
Olive
r E
.
and
Ol
ufunto
K.
,
“
Ane
m
ia
.
Man
age
m
e
nt
of anemia
in
p
reg
nancy
,”
Nige
ria
,
InT
ec
h
,
pp
.
246,
2012
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[11]
W
orld
Hea
lt
h
Organi
z
at
ion
,
“
Sta
ndar
ds
for
Mate
rna
l
and
Neona
t
a
l
Care
.
Int
egr
a
ted
Mana
gement
of
Pregna
nc
y
and
Chil
dbirt
h
.
Iron
and
fol
at
e
suppl
ementa
t
ion
,”
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neva
,
W
HO
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[12]
P
.
R
osas
J
.
P
.
an
d
Vite
ri
F
.
E.
,
“
Eff
ects
and
safe
t
y
of
pre
ven
ti
v
e
ora
l
iron
or
iron
and
foli
c
ac
id
su
pple
m
ent
a
ti
on
fo
r
wom
en
during
p
reg
nancy
(Rev
iew
).
Th
e
Cochr
an
e
Col
la
bora
ti
on
,”
John W
ile
y
&
Sons
Lt
d
,
vo
l.
4
,
pp.
239
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[13]
W
orld
Hea
lt
h
Organi
z
at
ion
,
“
Guidel
in
e:
Preve
n
ting
and
cont
roll
i
ng
iron
def
ic
i
en
c
y
an
emia
throu
gh
primar
y
healt
h
ca
re
,”
Gene
v
a
,
W
HO
,
pp.
58,
1
989.
[14]
The
W
orld
Bank
,
“
Preva
le
nc
e
of
ane
m
ia
among
pre
gnant
wom
en.
W
orld
deve
l
opm
ent
indi
cato
rs
,”
W
ashingt
on
,
W
orld
Bank
,
pp.
6,
2015.
[15]
Moham
m
ad
A
.
and
Sala
h
at
I
.
,
“
Preva
le
n
ce
of
a
nemia
amo
ng
Jordania
n
p
reg
nan
t
wom
en
and
th
e
eff
ec
t
of
e
ar
l
y
pre
gnancy
on
Al
kal
in
e
phosphat
a
se
activit
y
,”
JJ
B
S
,
vol
/i
ss
ue:
5(1)
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pp
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65
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2
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[16]
Ta
ner
C
.
E
.
,
et
a
l
.
,
“
Preva
l
ence
a
nd
risk
fac
tors
of
ane
m
ia
among
pre
gnant
wom
en
at
te
nd
ing
a
high
-
volume
te
rt
i
a
r
y
ca
re
c
ent
er
for
d
el
iv
er
y
,”
J
Tur
k Ger Gyne
co
l
Ass
oc
,
vo
l.
16
,
pp.
2
31
-
6
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2015
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[17]
Gede
faw
L
.
,
et
al.
,
“
Anem
ia
an
d
associa
t
ed
fa
c
tors
among
pre
gnant
wom
en
attendi
ng
ant
en
ata
l
ca
r
e
c
li
ni
c
in
W
olay
it
a
Sodo
Town,
Southern
Et
hiopia
,”
Et
hio
p
J
H
eal
th
Sci
.
,
vol/
issue:
25(2)
,
pp.
155
-
62
,
201
5
.
[18]
Alene
K
.
A
.
and
Dohe
A
.
M
.,
“
Preva
le
n
ce
of
a
nemia
and
associa
t
ed
fac
tors
among
pre
gnant
wom
en
in
an
urba
n
are
a
of East
ern
Et
hiopia
,”
J
of
H
indawi
,
vol/is
sue:
10(1155)
,
pp.
1
-
7
,
2014
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[19]
Abbasi
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.
,
et
al
.
,
“
Causes
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ane
m
ia
in
pre
gnant
wom
en
of
the
Stat
e
of
Aza
d
Ka
shm
ir:
A
cro
ss
-
sec
ti
on
al
surve
y
,”
J
of
Heal
th. Sc
i
R
e
s
.
,
vol
.
5
,
pp
.
35
-
44
,
2014
.
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
6
, No
.
3
,
Septem
ber
201
7
:
21
3
–
2
20
220
[20]
Alem
M
.
,
et
a
l.
,
“
Preva
le
nc
e
of
a
nemia
and
associa
t
ed
risk
fa
ct
ors
among
pre
gnant
wom
en
at
te
ndin
g
ant
en
at
a
l
c
ar
e
in
Aze
zo
Hea
l
th
Cent
er
Gond
ar
town,
Northwest
Et
hiop
ia
,”
J
Int
erdisci
pl
Histop
athol
,
vo
l/
issue:
1(3)
,
pp.
137
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44
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[21]
Beke
l
e
A
.
,
et
al.
,
“
Preva
le
nc
e
of
ane
m
ia
and
it
s
a
ss
oci
at
ed
fa
ct
ors
among
pre
gnant
wom
en
at
te
nding
ant
ena
t
al
c
are
in
hea
l
th
insti
tu
t
ions
of
Arba
Minch
Town,
Gam
o
Gofa
Zone
,
E
t
hiopi
a:
A
Cross
-
Sect
ion
al
Stud
y
,”
J
of
Hindawi
,
vol/
issue:
10(11
55)
,
pp
.
1
-
9
,
201
6
.
[22]
Abdelha
fe
z
A
.
M
.
and
E
.
Soad
a
a
S
.
S.
,
“
Preva
l
e
nce
and
risk
f
ac
t
ors
of
ane
m
ia
a
m
ong
a
sam
ple
of
pre
gnan
t
fem
al
es
at
t
endi
ng
pr
imary
h
ealth
ca
r
e
c
e
nte
rs
in
Makka
h
,
Saudi
Arabi
a
,”
Pakistan
J
Nut
.
,
vol
/i
ss
ue:
11(1
2)
,
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1113
-
20
,
2012
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[23]
Naz
H
.
and
Beg
um
B.
,
“
Preva
lence
and
associa
t
ed
risk
factors
of
ane
m
ia
in
pr
egn
ant
wom
en
in
a
t
ea
ch
ing
ho
spital
,
Korangi
Industri
al
Are
a
,”
Pak J
Surg
,
vol/is
sue:
29(2)
,
pp
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131
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3
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2013
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[24]
Rosm
awa
ti
N
.
H
.
,
et
a
l.
,
“
The
rat
e
and
risk
f
ac
tors
for
an
emia
among
pre
gna
nt
m
othe
rs
in
Jerte
h
Te
r
engga
n
u,
Malay
s
ia
,”
J
Co
mm
unit
y
Me
d
H
eal
th
Educ
.
,
vol
/
issue:
2(5)
,
pp.
1
-
4
,
2012
.
[25]
Obs
e
N
.
,
et
al.
,
“
Magnit
ude
of
a
nemia
and
assoc
ia
t
ed
risk
factors
among
pre
gn
ant
wom
en
at
t
endi
n
g
antena
t
al
car
e
in
Shall
a
W
ore
d
a,
W
est
Ars
i
Zone
,
Orom
ia
Region,
Et
hiopia
,”
E
thi
op
J
Healt
h
S
ci
.
,
vol/
issue:
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,
pp.
165
-
73
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[26]
Mors
y
N
.
and
A
lha
d
y
S.
,
“
Nutri
ti
onal
sta
tus
and
socio
-
e
conomic
conditions
inf
lu
enc
ing
pre
v
al
en
ce
of
an
emia
in
pre
gnant wom
en
,”
I
JSTR
,
vol
/i
ss
ue:
3(7)
,
pp
.
54
-
60
,
2014
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[27]
Yada
v
R
.
K
.
,
et
al.
,
“
Know
le
dge
and
pra
ct
i
ce
of
ane
m
ia
among
pre
gnant
wom
en
at
t
endi
ng
ant
en
a
ta
l
cl
in
ic
in
Dr.
Prabha
kar
Kor
e Hos
pit
al
,
Karna
t
aka
,”
JDMS
,
vo
l
/i
ss
ue:
13(4)
,
pp
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74
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80
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2014
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[28]
Ti
wari
L
.
M
.
,
e
t
al.
,
“
Corre
l
at
ion
of
hemoglobin
and
red
ce
ll
ind
ices
with
serum
fe
rrit
in
in
Indi
an
wom
en
in
sec
ond
a
nd
th
ird
t
rimest
er
of
Pregna
nc
y
,”
Me
d
ic
al
Journ
al
Armed Forces
India
,
vol
.
69
,
p
p.
31
-
6
,
2013
.
[29]
Casanova
B
.
F
.
,
et
al
.
,
“
Deve
lo
pm
ent
of
a
clin
ic
a
l
pre
di
ct
ion
r
ule
for
iron
d
ef
ic
i
ency
an
emia
in
pre
gnan
c
y
,
”
Ame
rican Journal
of
Obs
te
tric
s
and
Gyne
co
logy
,
vol/
issue:
193(2
)
,
pp
.
460
-
6
,
200
5
.
Evaluation Warning : The document was created with Spire.PDF for Python.