Validity of pallor for detecting anemia and factors associated with anemia among pregnant women attending antenatal care in Butajira General Hospital, Southern Ethiopia

Abstract

Background: Anemia is a clinical abnormality characterized by reduction in hemoglobin concentration below normal for age, sex, physiological condition and altitude. Most health provider’s in resource poor settings rely on physical signs to diagnose anemia. Objective: The main objective of this study was to assess the validity of pallor for detecting anemia and factors associated with anemia among pregnant women attending ANC in Butajira General Hospital, Southern Ethiopia 2015. Methods: Hospital based cross-sectional study design was conducted in Butajira General Hospital from March 01 to April 30/2015. A total of 217 pregnant women who fulfilled the inclusion criteria were selected systematically. Socio- demographic and medical history of the participants were collected using a structured interviewer administered questionnaire and detail physical examination of pallor on nail bed, conjunctiva, palmar and tongue was done. Laboratory test of hemoglobin and intestinal parasite was determined. Results: The overall prevalence of anemia in this study using a cut off level of hemoglobin <11 g/dl was 27.6%. The degrees of anemia were mild, moderate and severe (50%), (45%) and (5%) respectively. On multivariable logistic regression analyses, the following variables were independent significant predictors of anemia: Residence-rural (AOR=0.151, 95%CI=0.030, 0.765), excess menstrual bleeding (AOR=0.027, 95%CI= 0.005, 0.138), ANC use (AOR = 0.081, 95% CI: 0.018-0.368), and inter pregnancy interval(less than two years (AOR = 0.021, 95% CI: 0.004-0.098)). From these results, where severe anemia is relatively rare (5%), clinical pallor of common anatomic sites (conjunctiva, nail bed, palm and tongue) detected hemoglobin <7 g/dl with a sensitivity ranging from 33 – 100% and specificity of 99%. Conclusion: Pallor of common anatomic sites is a useful screening strategy for severe anemia in pregnant women in whom severe anemia is most prevalent and where hemoglobin or hematocrit cannot be directly determined. The present study has shown a statistically significant association between anemia and residence, antenatal care use, excess menstrual bleeding, and birth interval. Recommendation: Health posts should use pallor in detecting severe anemia as part of their routine screening service of pregnant women. This study showed moderate prevalence of anemia among the pregnant women, Therefore, there should be an emphasis on the anemia intervention programs during antenatal check-ups.