ETHIOPIAN POLICE UNIVERSITY

ADHERENCE AND ASSOCIATED FACTORS TO IRON/FOLIC ACID

SUPPLEMENTATION AMONG WOMEN ATTENDING ANTENATAL
CLINIC IN FEDERAL POLICE HOSPITALS ETHIOPIA, 2022

A RESEARCH PROPOSAL SUBMITTED TO ETHIOPIAN POLICE

UNIVERSITY RESEARCH INSTITUTE

INVESTIGATORS: Code: P03/15

INVESTIGATORS: ARARSA SOBOkSA (PI) (BSC, MSC)

Email;ararsa.soboksa@gmail.com

Phone no; +251931227633

: KETEMA GURMU (BSC, MPH/RH)

Email;gurmuketi@gmail.com

Phone no; +251910545312

July 2022

SENDAFA, ETHIOPIA

i
Acknowledgment
We would like to forward our deepest gratitude and thanks to Ethiopian Police University and
research and community service institute forgiving this opportunity. Our special thanks go to our
parents for their support and encouragement.

ii
SUMMARY
Anemia is a global public health problem affecting both developing and developed countries
with major Consequences for human health as well as social and economic development.
Globally 41.8% pregnant women are anemic with the highest proportion affected in developing
countries. According to the 2011 report of Ethiopian Demographic and Health Survey, moderate
and mild types of anemia are abundant among the pregnant and non-pregnant mothers in the
country, where, 1.2% of the cases are severe.

OBJECTIVE: To assess the adherence and associated factors to iron and folic acid supplements
among pregnant women attending antenatal clinic in Federal Police Hospitals, Ethiopia 2022.

METHODS: A mixed cross sectional study will be conducted from Oct 1 to Nov 15 at Federal
Police Hospitals among 418 pregnant women attending antenatal care. The sample size will be
determined by single population formula and systematic random sampling will be conducted for
quantitate method after proportional allocation and purposive sampling method will be used for
qualitative method. A pre-tested structured questionnaire which will be administered by
interviewers will be used for data collection. Data will be checked for completeness, consistency
and missed values and entered into Epi data and exported statistical package for social science
(SPSS) version 20.0 soft-ware. The result will be presented in the form of text, table and graphs.
Frequencies distribution and other summary statistics will be used to describe the data. To
identify factors associated with magnitude of folic acid supplementation, odds ratio with their
95% confidence intervals will be calculated using logistic regression analysis for each
independent variable separately, bivariate analysis will be performed to determine the effect of
each independent variable on the outcome variable, then multivariate logistic regression model
will be used to control the potential of effect confounding variables. Statistical significance will
be defined at 95% confidence intervals, 0.05 margin of error (p<0.05) and associated with the
magnitude of folic acid supplementation during multivariate analysis. Qualitative data will be
grouped into five categories and will be analyzed in thematic analysis method manually.

Work plan and budget break down: -The study will be conducted from Oct 1- 30/2022 and
the estimated budget for the proposed research project is 439,450 ETB.

Keywords; Iron/folic acid, Adherence and pregnant women

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TABLE OF CONETAINTS

Table of Contents
Acknowledgment.........................................................................................................................................ii
SUMMARY...............................................................................................................................................iii
List of tables.................................................................................................................................................v
List of Figure...............................................................................................................................................vi
ACRONYMS/ABBREVATION..............................................................................................................viii
CHAPTER ONE..............................................................................................................................................1
1. INTRODUCTION.......................................................................................................................................1
1.1 Background........................................................................................................................................1
1.2 Statement of problem.......................................................................................................................2
1.3 OBJECTIVES............................................................................................................................................3
1.3.1GENERAL OBJECTIVE....................................................................................................................3
1.3.2 SPECIFIC OBJECTIVE....................................................................................................................3
1.4 SIGNIFICANCE OF STUDY...................................................................................................................4
1.5. Scope of the study............................................................................................................................4
1.6 Operational Definition.......................................................................................................................5
CHAPTER TWO.............................................................................................................................................6
2. Literature Review....................................................................................................................................6
2.1Adherence of Pregnant Women to Iron and Folic Acid Supplementation..........................................6
2.2 Pregnancy and Need for Iron and Foliate..........................................................................................8
2.3 Obstetric Related Factor....................................................................................................................9
2.4 Factor associated with adherence...................................................................................................10
2.5 Conceptual Frame Work..................................................................................................................11
CHAPTER THREE........................................................................................................................................12
3.1 STUDY AREA.....................................................................................................................................12
3.2 STUDY DESIGN AND PERIOD............................................................................................................12
3.3 SOURCE POPULATION......................................................................................................................12
3.4 STUDY POPULATION........................................................................................................................12
3.5 INCLUSION AND EXCLUSION CRITERIA............................................................................................12

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 3.5.1INCLUSION CRITERIA..................................................................................................................12
3.5.2EXCLUSION CRITERIA............................................................................................................13
3.6 Sample Size Determinations............................................................................................................13
3.7 Sampling Procedures.......................................................................................................................13
3.8. Variables.........................................................................................................................................14
3.8.1 Dependent Variable..................................................................................................................14
3.8.2 Independent Variables..............................................................................................................14
3.10 Data Collection Procedures...........................................................................................................15
3.11 Data Quality Assurance..................................................................................................................15
3.12 Data Processing and Analysis.........................................................................................................15
3.13 Ethical Consideration.....................................................................................................................16
3.14Dissemination and Utilization of Results........................................................................................16
4. WORK PLAN...........................................................................................................................................17
5. BUDJET BREAK DOWN...........................................................................................................................18
Annex I. Questionnaire for data collection................................................................................................24
Annex II. Questionnaires in Amaric Language...........................................................................................31

List of tables

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Table 1:- work plan on assessment the adherence and factors associated to iron and folic acid
supplements among pregnant women attending antenatal clinic in Federal Police and Harar
Hospital, Ethiopia, 2022................................................................................................................17
Table 2: Budget breakdown for assess the adherence and factors associated to iron and folic acid
supplements among pregnant women attending antenatal clinic in Federal Police and Harar
Hospital, Ethiopia, 2022................................................................................................................19

List of Figure

vi
Figure 1:-Conceptual frame work of the adherence and factors associated to iron and folic acid
supplements developed from literature review..............................................................................11

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ACRONYMS/ABBREVATION
ANC Antenatal Care
EDHS Ethiopian Demographic Health Service
FA Folic Acid
FS Ferrous Sulfate
Hgb Hemoglobin
Hct Hematocrit
ID Iron deficiency
IDA Iron Deficiency Anemia
IFA Iron & Folic Acid
LBW Low Birth Weight
MCH Maternal and Child Health
SF Serum Ferritin
SPSS Statistical Package for Social Sciences
WHO World Health Organization

viii
 CHAPTER ONE
1. INTRODUCTION

1.1 Background
Anemia is a global public health problem affecting two billion people worldwide. Almost half of
all preschool children, pregnant women, and close to one-third of non-pregnant women are
anemic Worldwide. Africa has the largest number of women with anemia next to South and
Southeast Asia (Proj,2014).Anemia is a hematologic disorder characterized by a decline in the
concentration of circulating erythrocytes or hemoglobin in the blood (McLean E, et al ,2009).
Pregnant women are among the risk groups for anemia due to low Iron stores in their body. This
is supported by reports from the World Health Organization (WHO), indicating that anemia
affected 38.2% of pregnant women globally and 46.3% in Africa (Marti-Carvaja A.L. et al,
2016).According to the 2011 report of Ethiopian the Demographic and Health Survey, moderate
and mild types of anemia are abundant among the pregnant and non-pregnant mothers in the
country, where, 1.2% of the cases are severe (EDHS,2011). In Ethiopia, 17% women with
reproductive age and 22% of pregnant women are estimated to be anemic [EDHS,2012].Half of
anemia burden is assumed to be due to iron deficiency (WHO,2012).It is a reduction of
hemoglobin concentration less than 11g/dl, with physiological disorder if one of the following
micronutrients absent, Iron, vitamin B12 or folic acid. Many studies documented the adverse
effects of maternal anemia, 12.8% and 3.7% of maternal mortality in Asia and Africa
respectively is directly attributable to anemia
(WHO,2013).Thehighphysiologicalrequirementforironandfolicacidinpregnancyisdifficulttomeet
withtheusualdiet.Therefore,pregnantwomenshouldroutinelyreceiveironandfolicacidsupplements.
Adherencetoamedicationregimenisgenerally defined as the extent to which patients take
medications as
prescribedbytheirhealthcareproviders[.R.GallowayandJ.McGuire,2010].Adherenceratesforindivi
dualpatientsareusuallyreportedasthepercentage of the prescribed doses of the medication actually
taken by the patient toVeraspecifiedperiod[Z.M.Ibrahimetal,2019].The actual prevalence of
anemia in pregnant women in Africa and Asia is estimated to be 57.1% and 48.2% while that of
America and Europe is 24.1% and25.1% respectively (WHO,2005). Currently 17% of Ethiopian

1
women age 15-49 are anemic with the highest proportion of pregnant women (22%) than
breastfeeding (19 %) and neither pregnant nor breastfeeding women (15 %). Anemia prevalence
also varies among urban and rural residence; a higher proportion of women in rural areas are
anemic (18 %) than those in urban areas (11 %) (5).
In Ethiopia, anemia is the severe problem affecting 62.7% of pregnant mothers and 52.3% non-
pregnant women (Tarekegn SM, et al 2014).

During pregnancy anemia has negative consequence both for mother and the infant. For mother,
the consequences of anemia include reduced energy and capacity for work poor pregnancy and
birth outcomes including premature delivery, low birth weight, and increased prenatal mortality
and increased risk of death during delivery and postpartum. It is estimated that as many as 20%
of maternal deaths are caused by anemia and that anemia may be an associated cause in as many
as 50% of maternal deaths worldwide [Idowu O, 2007].

1.2 Statement of problem

Anemia is a global public health problem affecting both developing and developed countries
with major consequences for human health. Around two billion people accounting over 30% of
the world’s population are anemic, mainly due to iron deficiency (Stoltzfus RJ, et al 2016).In
addition to this most of the Africa and South East Asia are in the range of anemia, the report of
Ethiopian Demographic Health Survey in 2011 shares the serious outcomes of iron and folate
deficiency with sub- Saharan countries followed with maternal and children morbidity and
mortality (EDHS,2011). In Ethiopia, iron/foliate supplementation is the main strategy for
Anemia control and prevention. However, adherence rate remains very low. A survey done in
Ethiopia showed that only 16.1% of pregnant women took the IFA supplements for 90 or more
days (FMOH,2012).

The recommended dose by the Ministry of Health is 60mg/day for 90 days and 400ug/day for
folate. According to the Demographic Health Survey of (2011), adherence to iron/folate
supplements for pregnant women in Ethiopia is very low (0.4%) in National level comparing to
other studies (Fiedler,et al 2014).The factors for this low adherence are not clearly known.
Eighty-three percent of women did not take iron tablets during their last pregnancy. Fifteen
percent took them for less than 60 days, and less than 1 percent took them for three months or
more during their last pregnancy (EDHS,2011).A comparison of 2005 and 2011 EDHS data

2
reveals that the percent of women with at least one ANC visit who took iron tablets increased by
63 percent (Fiedler,et al 2014,CHA,2005).Ethiopia is known Implementing IFA supplementation
through antenatal care but adherence to iron folate supplementation is very low (Al.Abel
Gebre,et al 2015).This poor accomplishment may be due to low level of education, income,
unemployment, multiparty, fewer prenatal consults, inadequate prenatal care, presence of side-
effects of supplementation during pregnancy, not have been diagnosed with anemia during
pregnancy and unavailability of free supplement in sufficient quantities (Bisratemariam
Grebreamlak et al,2017). Even though adherence is a major problem in IFA supplementation
programs, limited researches have been done and to the investigators best knowledge no study is
done in the study area with this title. Therefore, this study will be done to determine the
adherence status and identify factors associated with adherence of IFAS among pregnant women
attending ANC in Federal Police and Harar Hospital, Ethiopia.

1.3 OBJECTIVES
1.3.1GENERAL OBJECTIVE
To assess the adherence and factors associated to iron and folic acid supplements among
pregnant women attending antenatal clinic in Federal Hospitals.

1.3.2 SPECIFIC OBJECTIVE

To assess adherence to iron/folate supplement among ANC attendants

To identify factors affecting adherence to iron/folate supplement among ANC attendants

To explore factors affecting adherence to iron/folate supplement among ANC attendants

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1.4 SIGNIFICANCE OF STUDY
This study aim is to contribute towards the improvement of adherence to iron-folate
supplementation in order to mitigate anemia status of pregnant women.

The findings from this study will give a highlight into the adherence rate and factors that
determine iron and folic acid supplementation among pregnant women.

This study will be helpful for policy makers in the planning and implementation of intervention
activities to improve the antenatal adherence to IFA supplement service in the hospital.

Other researchers who would like to conduct related studies in a similar setting can use the
finding of this study as a reference.

This study helpful for Federal Police Hospitals to show the gaps iron/folic acid adherence.

Finally it will play very great role to inform programs meant to increase pregnant women’s
awareness creation and sticking to the right dose supplement as standard national
recommendation

1.5. Scope of the study

A scope of this study includes only Ethiopian Federal Police Commission Hospitals that limiting
women in Iron/Folic Acid Adherence. The result of this study could not be generalizing to the
community, since its institutional based study.

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1.6 Operational Definition
 Adherence: a condition of Pregnant women taking the combine iron and folic acid tablet at
least 4days a week for at least three consecutive months during their pregnancy time
 Non-adherence: Pregnant women who have taken combine iron and folic tablet for less
than 4days a week consider being not adhere to the supplementation.
 Iron and folic acid supplement: a drug prepared from combination of Iron and Folic acid
to be taken by all pregnant women’s in order to build up their iron and folic acid nutritional
status
 Early registration to ANC clinic; those pregnant women who visited the ANC clinic
before 16 weeks of gestation.
 Late registration to ANC clinic; those pregnant women who visited the ANC clinic after
16 weeks of gestation.
 Rate of adherence ;is percentage of the prescribed dose of medication actually taken by
pregnant women over a specified period

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 CHAPTER TWO

2. Literature Review
2.1Adherence of Pregnant Women to Iron and Folic Acid Supplementation
Anemia is the most prevalent nutritional problem in the world mainly due to iron deficiency that
affects about one third of the population, women suffering the most. The global prevalence of
anemia in pregnant women is 42% and addition to Africa accounts for 68% of the prevalence of
anemia among pregnant women (Shrimpton R, 2009). Iron deficiency is the most common
nutritional disorder in the world, affecting approximately 25% of the world's population (Project,
2014).

Pregnant women are particularly at high risk for iron deficiency and iron deficiency anemia
because of increased iron needs during pregnancy. The prevalence of iron-deficiency anemia in
pregnant women is estimated to be an average of 56% in developing countries whereas in
industrialized countries the average prevalence is 18% (WHO, 2002). Anemia is defined as a
condition where there is less than 11g/dl hemoglobin (Hb) level in the pregnant female body,
which decreases oxygen-carrying capacity with levels for the pregnant female at Hb< 11g/dL.
Severe anemia is defined as having Hb< 7.0 g/dL (WHO,2016).

A descriptive cross-sectional study conducted to assess the maternal, knowledge and institutional
factors that predict 90+ days (optimum) iron-folate supplementation among pregnant women in a
rural set-up in Eastern Kenya from 352 mothers of under-five years old children attending 7
health facilities Using a standard questionnaire, mothers recalled the number of days they had
ingested iron-folate supplements in their latest pregnancies. The overall prevalence of optimum
supplementation (90+ days) during latest pregnancies was 18.3% and on average the study
mothers were supplemented for ~38 days during the antenatal period (Juma m,et al) In Kenya,
routine iron supplementation is the current cornerstone of efforts to reduce iron-deficiency
anemia during pregnancy (KNBS,2010).

WHO recommends a 6-month regimen of a daily supplement containing 60 mg of elemental iron

along with 400 μg of folic acid for all pregnant women. In settings where anemia prevalence is

6
high (>40%), WHO has recommended postpartum treatment for three additional months
(Proj,2014).

The Ethiopian study conducted in 2012 among eight rural districts of the four major regions
(Amhara, Tigray, Oromiya, and Southern Nations Nationalities and Peoples) showed that only
3.5% of the study participants have taken the supplementation for 91 or more days
(KDHS,2010).

A cross sectional study conducted in eight rural districts in SNNP, Ethiopia to assess the
coverage, compliance and factors associated with the use of prenatal iron supplements. Suggest
that among 414 pregnant women asked structured questionnaire that gave birth in the preceding
year, 35.4% were given/prescribed prenatal iron supplement during the index pregnancy and
among pregnant women who were given/prescribed supplements, the average level of
compliance was 74.9% (Gebremedh S,et al,2014).

Another Ethiopian study done in 2013, in Mecha district, Western Amhara showed that only
20.4% of the study participants were compliant (took iron folate tablets for 90 days during entire
pregnancy). The total tablets taken range from 3-120 tablets with a median of 65 tablets (Bekele
Taye,et al,2015).

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2.2 Pregnancy and Need for Iron and Foliate
There is a marked increase in foliate use during pregnancy, due to the acceleration of reactions
requiring single-carbon transfer, the rapid rate of cell division in maternal and fetal tissues, and
deposition in the fetus. Randomized, controlled trials have shown that taking folic acid
supplements before conception and through about the first four weeks of pregnancy lowers risk
of genetically predisposed women having a baby with a neural tube defect (Scholl,2019).

Cross-sectional data from India’s third National Family Health Survey used to examine the
association between adequately diversified dietary intake, iron and folic acid supplementation
during pregnancy and symptoms suggestive of Preeclampsia or eclampsiain Indian women. The
likelihood of reporting Preeclampsia or eclampsia symptoms was also 36% lower among those
mothers who consumed iron and folic acid supplementation for at least 90 days during their last
pregnancy (Agrawal S,et al,2015).

In the study done in 2009, in northern Tanzania, only 16.1% took IFAS (Ogundipe,et al,2012).
A cross-sectional study conducted at Khartoum Hospital, Sudan, to assess the rates of iron folic
supplementation and the associated factors during pregnancy and the effects of taking iron-folic
acid supplementation on rates of maternal anemia and low birth weight (LBW) infants, revealed
that of 856 women, enrolled and answered a questionnaire, 788 (92.1%) used iron-folic acid
supplementation during pregnancy and 65.4% used folic acid (Abdullahi H,et al,2014).

In a Rapid Initial Assessment of the Distribution and Consumption of IFA tablets through
Antenatal Care in Ethiopia, only less than 1% consume the ideal number of tablets (minimum of
180 IFA tablets) (Ogundipe,et al,2012).Other Ethiopian study done in 2014 in North Western
Zone of Tigray, the rate of adherence to iron and folic acid supplementation among the pregnant
women in the urban and rural communities was 37.2% and 28.9% respectively (18).

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2.3 Obstetric Related Factor
The common Pregnancy and health related factors associated with compliance of iron folic acid
use were Prim parity and use of antenatal care (32). Compared to women who had 4 or more
ANC visits, those with 0, 1, 2 and 3 visits had 0.04, 0.33, 0.50 and 0.60 times less odds of iron
supplement utilization, respectively. Mothers who visited antenatal care (ANC) for ≥4days were
more likely to take iron-folate supplements for 90+ days and be supplemented for more days
than <4 days visitors (23).

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2.4 Factor associated with adherence
Specifically maternal employment was the one of factors associated with folic acid compliance
(29). In the study conducted in 2012, in south India, age, birth order and socio economic status
had significant association with adherence. Perceived side effects (vomiting, constipation and
gastritis) and lack of awareness on the benefits of IFAS lead to decreased adherence (Al.Abel
Gebre,et al 2015).The study conducted in two districts of Pakistan with aim to understand
women and healthcare providers’ perceptions, and to investigate the cultural and behavioral
factors influencing the use of antenatal IFA supplements in rural and urban settings of Pakistan.
The majority of women were aware of the perceived benefits of antenatal IFA supplements.
However, the rural women had more limited information about the benefits of IFA supplements
than the urban women (Tran TD, et al. (2013)).The facilitating factors for the women’s use of
supplements were: they had knowledge of benefits, Compliance increased with birth order (Nisar
Y Bin,2014). Knowledge on supplementation for a minimum of 90 days predicted optimum
supplementation, knowledge on when to start supplementation and importance of
supplementation only predicted higher days of supplementation, but not the optimum
supplementation (Nisar Y Bin,et al 2019).

Knowledge of anemia and iron folate tablets and history of anemia during pregnancy were
significantly associated with compliance to iron folate supplementation (P < .05) (26). The
common barriers to iron and folic acid adherence were, Women lacking comprehensive
knowledge of anemia (Tran TD, et al., 2013). The lack of antenatal care services (FMOH, 2012).

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2.5 Conceptual Frame Work

Obstetric history
 Parity.  Health service factor

 Number of ANC visit. Shortage of supplement

 Abortion. with in the facility.

 Still birth.  Health education.

 ANC follow up started  Collected tablet per

time visit

 Number of gravid  Barrier of language

Adherence to iron and folate

supplement

Individual factor
 Side effect,
Women’s awareness about
 Forget fullness,
 Anemia.
 Unpleasant tests,
 Benefits of IFAS.
 Fear of gaining weight,
 Duration of the
 Fear of harm to the
supplementation
fetus

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Figure 1:-Conceptual frame work of the adherence and factors associated to iron and folic
acid supplements developed from literature review (24, 29, 32, and 35)

CHAPTER THREE

3.1 STUDY AREA

A mixed study design method will be conducted from Nov1 to Jan 15, 2022 on 418 pregnant
women who are attending antenatal care at Harar and Ethiopian Federal Police Hospital.
Ethiopian Federal Police Hospital is found at the capital city Addis Ababa Lideta sub-city. It
provides health care services for all police members and their families in the country as referral
Hospital.

According to the hospital report 2022, more than 143319 Outpatient attendant services, more
than 15,000 maternal care in which 1588 was delivery service. The expected monthly all ANC
visit is 863.Both hospital administered under Ethiopian Federal Police Commission.

Harar Hospital is found in Harar city and it provides health care services for all police members
and their families around the west region as referral Hospital. In2022 more than 42112
Outpatient attendant services, more than 5000 all maternal care services in which 345 was
delivery service. The expected monthly all ANC visit is 450.

3.2 STUDY DESIGN AND PERIOD

A mixed cross-sectional study design method will be conducted from Nov 1 to Jan 15, 2022 at
Federal Police Hospitals, Ethiopia 2022.

3.3 SOURCE POPULATION

All pregnant women who are attending ANC at Ethiopian Federal Police and Harar Hospital

3.4 STUDY POPULATION

The study population is pregnant women attending ANC clinics in Federal Police and Harar
Hospital during data collection period and that fulfill the inclusion criteria.

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3.5 INCLUSION AND EXCLUSION CRITERIA

3.5.1INCLUSION CRITERIA
Pregnant women who had at least one ANC visit at Federal Police and Harar Hospital and
supplemented with IFA tablets for at least one month before the date of interview.

3.5.2EXCLUSION CRITERIA
Pregnant women who come for the first antenatal visit and those who refused to take the
supplement.

3.6 Sample Size Determinations

The required sample size for the first specific objective of this study will be calculated using
single population proportions estimation formula by taking 55.5% on the rate of adherence to
iron folic acid supplementation among the pregnant women. The sample size of this study will be
calculated by using the formula to estimate a single Population proportions n = (Z α/2) 2 p (1-p)/
d2

n = sample size, Z α/2= significance level at α =0.05

d = margin of error of 0.05

P= P = Rate of adherence to iron folic acid supplementation among the pregnant women in debre
markos 55.5% (36).

n =¿ ¿

Accordingly, n=380

With the assumptions of 95% confidence interval, 10% non-responsive rate the total sample size
will be 418 for quantitative method, four FGD and twelve KII will be purposely selected

3.7 Sampling Procedures

A systematic random sampling technique will be used to obtain a total sample of 418
respondents for quantitative study and purposive sampling will be used for qualitative method.
By using the flow of pregnant women visiting ANC clinic in the previous months as a baseline
there are a total of 1313 pregnant women in Harar and Federal Police Hospital, who fulfill the
eligibility criteria during the study period. With the total number of pregnant women federal

13
police hospital N = 863 and 450 for Harar hospital, and the final sample size will be n =
418.sample will be taken with an interval of k = N/n = 1313/418 = 3. Starting from the third
attendant of ANC the data will be taken with every three other pregnant woman until the sample
size reach.

3.8. Variables
3.8.1 Dependent Variable

Adherence to Iron and Folic Acid Supplement

3.8.2 Independent Variables

Socio-demographic: - Age, marital status, socioeconomic status, income, family size and
maternal education.

Obstetric factors: - Number of gravidity, Parity, number of ANC visit, abortion, still birth, and
ANC follow up starting time.

Women Awareness: - Knowledge of anemia, knowledge about benefits of IFA and knowledge
about duration of the supplementation

Individual factors: - Side effects, forget fullness, unpleasant tests, fear of gaining weight, and
fear of harm the fetus.

Health service factor; shortage of supplement with in the facility, lack 0f health education and
collected tablet per visit

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3.10 Data Collection Procedures
Data will be collected by using a pre-tested interviewer administered structured questionnaire
for quantitative method and FGD/KII Guide for qualitative method. The questionnaires will be
prepared in English and translate in to Amharic and afaan oromoo language by a language
expert. The questionnaire consists of socio demographic status, obstetrics history, awareness on
anemia and folic acid, adherence to iron and folic acid and health care system factors. Ten BSc
Midwives and Five BSc nurses and two supervisors will be participated in data collection.
Training will be given to data collectors and supervisors for four days on purpose of the study,
details of the questionnaire, data collection procedure and filling the questionnaire.

3.11 Data Quality Assurance

Quantitative study, the quality of data for will be assured through carful adaptation and
pretesting of the questionnaire. Proper training of data collectors and supervisors, close
supervision of the data collection procedures will be done. The questionnaire will be pretested on
5 %of the study participants at Gandhi Hospital modification will be made on the basis of the
findings. The data collect will be checked for accuracy and completeness on daily basis, data
cleaning and checking will be done before analysis

For qualitative study, FGD will be conducted by recruiter, note taker and modulator on the date
and place of discussion appointment. Tape recorder will be used and FGD will be conducted by
local language and transcribed back into English by investigators

3.12 Data Processing and Analysis

Quantitative data will be entered into Epi data and exported to SPSS version 20.0 soft-ware for
cleaning and analysis. Frequencies distribution and other summary statistics such as mean,
standard deviation and percentage will be used to describe the data. To identify factors
associated with adherence to iron folic acid supplementation, odds ratio with their 95%
confidence intervals will be calculate using binary logistic regression analysis for each
independent variable separately. First a bivariate analysis is performed to determine the effect of
each independent variable on the outcome variable. Then variables with p-value <0.25 by
bivariate analysis will be entered into multivariate logistic regression model to control the
potential of effect confounding variables. And statistical significance is define at a probability

15
level of 0.05 (p<0.05), that associated with the assessment of adherence to iron and folic acid
supplementation during multivariate analysis.

For qualitative data obtained from FGD and KII will be recorded and transcribed verbal into
English by invistgators.Then similarly ideas will be collected into themes and groped into five
category of factor influence IFA adherence and analysis in thematic analysis method manually.
The result will be presented in the form of text, table and graphs.

3.13 Ethical Consideration

A letter of support will be obtained from Ethiopian Federal Police University Research
Institutional and official letter of co-operation to the study area will be taken to communicate
officials. Data will be collected after respondents communicated about the purpose, potential
risks and benefits of participating and the right to withdraw from the study at any time
throughout their interview. Confidentiality will be maintained by assuring and maintaining the
respondent’s answers not to share with anyone other than members of our study team. They will
be told that they can stop if they encounter any question they do not want to answer. Participants
will be interviewed a place where they feel comfortable and sitting alone with the interviewer.
Instead of study participant names, codes are used for identification purpose to maintain
participants’ trustworthiness of confidentiality.
3.14Dissemination and Utilization of Results
Result of this study will be submitted to Ethiopian Police University, Federal Holice and Harar
Hospital. Furthermore, the paper will be presented workshops, seminars, and efforts will be
made to present the results scientific conferences and publishing articles in peer reviewed
journals will be considered.

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 4. WORK PLAN

Table 1:- work plan on assessment the adherence and factors associated to iron and folic acid
supplements among pregnant women attending antenatal clinic in Federal Police and
Harar Hospital, Ethiopia, 2022

Activities Resp Time schedule in 2022G.C

onsi Aug sept Oct Nov Jan. Feb. Aprl May Jun July
ble ust e
body

Proposal PI
1. Development
Finalize proposal PI
2. Defense

Training for PI
3. dataCollectorsand
Pre test
5. Data collection& DC
Make field
Observation

6. Data mgt, entry & PI

Cleaning

Data analysis & PI

7. report writing

8. 1st,2nd and final PI

draft
thesis Submission
9. Final thesis
defense

17
 5. BUDJET BREAK DOWN
Table 2: Budget breakdown for assess the adherence and factors associated to iron and folic acid
supplements among pregnant women attending antenatal clinic in Federal Police and Harar
Hospital, Ethiopia, 2022

S No. Items/ Description Unit Qty Unit price total ETB rem
rk
1.Per-dime for Researcher’s per diem 45day 2 2*500*45 45,000
s
data collection
Training for data collectors 4day 10 15*500*4 30,000 ***
Per diem for data collectors 45day 15 *15*500*45 337,500 ***
s
2.Stationary Note pad Pcs 15 30*15 450
Materials 4A paper Ream 06 400.00 3000
Flip charts Pcs 03

Pens, CD, Flash 8GB Each 05 - 3000

Parker Pack 02 - 400

Questionnaire duplication Pages 2000 4*2000*2.00 16000

4page for each documentation

4.Transportatio Transportation and Per-dime Trip two 4*1000 4000

allowance time
n
s
and
2
pers
on
Grand total 439,450

ETB: Ethiopian birr QG: questionnaire guide

18
1. Project,2014. A Rapid Initial Assessment of the Distribution and Consumption of Iron–Folic
Acid Tablets through Antenatal Care in Ethiopia, 2014

2.McLean E, Cogs well M, Eglin I, Wojdyla D, De Benoist B: Worldwide prevalence of

anaemia, WHO vitamin and mineral nutrition information system. Public health nutrition 2009,
12 (4):444–454

3. Marti-Carvaja A.L. et al, Prevalence of anemia during pregnancy: results of Valencia

(Venezuela) anemia during pregnancy study. 2002.

4. Ethiopia Demographic and Health Survey Addis Ababa, Ethiopia: March 2012.

5. EthiopiaCentralStatisticalAgencyandICFInternational,2011 Ethiopia Demographic and Health

Survey: Key Findings, ICF International,Calverton,Maryland,USA,2012

6. Organization WHO. Proposed global targets for maternal, infant, and young child nutrition.
Summary of main issues raised and WHO responses Geneva: World Health Organization. 2012.

7. World Health Organization (2013). Essential nutrition actions: improving maternal, newborn,
infant and young child health and nutrition. Geneva:
WHO.8.R.GallowayandJ.McGuire,“Determinantsofcompliancewith iron supplementation:
supplies, side effects, or psychology?” SocialScience&Medicine,vol.39,no.3,pp.381–390,1994

9.Z.M.Ibrahimetal.,“Assessmentofadherencetoironandfolic acid supplementation and prevalence

of anemia in pregnant women,”TheMedicalJournalofCairoUniversity,vol.79,no.2, 2011.WHO.
10.Worldwide prevalence of anemia: institution of food science and nutrition.
GenevaSwitzerland.2005;4-51.

11. Tarekegn SM, Lieberman LS, Giardiasis V (2014) Determinants of maternal health service
utilization in Ethiopia: analysis of the 2011 Ethiopian Demographic and Health Survey. BMC
Pregnancy Childbirth 14: 161.5.

12. Idowu O, Mafiana C, Dopu S (2007) Anemia in pregnancy.

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13.Stoltzfus RJ, Dreyfuss ML, Organization WH. Guidelines for the use of iron supplements to
prevent and treat iron deficiency anemia: Ilsi Press Washington^ eDC DC;2016

14. Usha Malagi, Madhavi Reddy, Rama K. Naik. Evaluation of National Nutritional Anaemia
Control Programme in Dharwad (Kar) J Hum Ecol. 2006; 4:279–81.

15.FMOH (Federal Ministry of Health). 2012. Best practice, progress updates, initiatives and
articles, special bulletin.

16. Fiedler, Jack, D’Agostino, Alexis, Sununtnasuk and Celeste. 2014. Nutrition Technical Brief:
A Rapid Initial Assessment of the Distribution and Consumption of Iron-Folic Acid Tablets
through Antenatal Care in Ethiopia.

17. CSA (Central Statistical Agency). 2005. Addis Ababa, Ethiaopia and Calverton, Maryland,
USA: Ethiopia Demographic and Health Survey. Central Statistical Agency and ICF
International

18.Al.Abel Gebre, Afework Mulugeta,Belachew Etana ,et al.2015.Assessment of factors

Associated with adherence to iron-folic acid supplementation among urban and rural of pregnant
women in north estern zone of Tigray,Ethiopia.International Journal of Nutriion and food
science.

19.Bisratemariam Grebreamlak ;Abel Fekadu Dadi.2017 High Adherence to Iron/Folic Acid

Supplementation During Pregnancy Time Among Atenatal And Postnatal Care Attendants
Mothers In Governmental Health Center In Akaki Qality Addis Ababa,Ethioppia:Availabble at
http://journal.phone 0169415.

20.Shrimpton R, Huffman SL, Zehner ER, Darnton-Hill I, Dalmiya N. Multiple micronutrient

supplementation during pregnancy in developing-country settings: policy and program
implications of the results of a meta-analysis. Food & Nutrition Bulletin. 2009;30(Supplement

21.WHO. (2002) The World Health Report: Reducing risks, promoting healthy life. Geneva:
World Health Organization. : 1-248. 4):556-73.

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22.WHO. (2016) Iron deficiency anemia assessment prevention and control: a guide for program
managers. Geneva: World Health Organization. NHD/01.3.

23. Juma m, o os, o ks. Predictors of optimum antenatal iron-folate supplementation in a low
resource rural set-up in eastern kenya. Journal of Public Health and Epidimology. 2015; 337–
345.

24.Kenya National Bureau of Statistics (KNBS) and ICF Macro. 2010 Kenya Demographic and
Health Survey 2008-09. Calverton, Maryland: KNBS and ICF Macro. : 158-160.

25.Kenya National Bureau of Statistics (KNBS) and ICF Macro. 2010 Kenya Demographic and
Health Survey 2008-09. Calverton, Maryland: KNBS and ICF Macro. : 158-160.

26.Gebremedh S, Samuel A, Mamo G, Moges T, Assefa T. Coverage, compliance and factors

associated with utilization of iron supplementation during pregnancy in eight ruraldistricts of
Ethiopia, 2014.8

27.Bekele Taye, Gedefaw Abeje and Alemetsehaye Mekonen. 2015. Factors associated with
compliance of prenatal iron folate supplementation among women in Mecha district, Western
Amhara: a cross-sectional study. Pan African Medical Journal.

28. Scholl, T.O. and Johnson, W.G. (2019) Folic acid: influence on outcome of pregnancy.
American Journal of Clinical Nutrition, 71 (5): 1295S-1303S.

29. Agrawal S, Fledderjohann J, Vellakkal S, Stuckler D (2015) Adequately DiversifiedDietary

Intake and Iron and Folic Acid Supplementation during Pregnancy Is Associated With Reduced
Occurrence of Symptoms Suggestive of Pre- Eclampsia or Eclampsia in Indian Women. PLoS
ONE 10(3): e0119120. Doi: 10.1371/ Journal. Pone. 0119120

30.Ogundipe, O., C. Hoyo, T. stbye, O. Oneko, R. Manongi, R. Lie, et al. 2012. Factors
associated with prenatal folic acid and iron supplementation among 21,889 pregnant women in
Northern Tanzania: A cross-sectional hospital-based study. BMC Public Health, 12(481).

21
31.Abdullahi h, g Gasim Gi, Saeed A, Imam AM, Adam I. Antenatal iron and folic acid
supplementation use by pregnant women in Khartoum, Sudan. 2014;7(1):498.

32. Dinga LA. factors associated with adherence to iron / folate supplementation among

pregnant women attending antenatal clinic at thika district hospital in kiambu county.

kenya . 2013.

33.Tran TD, Biggs B-A, Tran T, Simpson JA, Hanieh S, et al. (2013) Impact on
Infants’Cognitive Development of Antenatal Exposure to Iron Deficiency Disorder andCommon
Mental Disorders. PLoS ONE 8(9): e74876. Doi: 10.1371 /journal. Pone.0074876.

34.Nisar Y Bin, Alam A, Aurangzeb B, Dibley MJ. Perceptions of antenatal iron-folic acid
supplements in urban and rural Pakistan: a qualitative study. BMC Pregnancy
Childbirth[Internet]. 2014;14(1):344. Available from: http://www. ncbi.nlm. nih.
gov/pubmed/25269515

35.Mithra P, Unnikrishnan B, Rekha T, Nithin K, Mohan K, Kulkarni V, et al. Compliance

with iron-folic acid (IFA) therapy among pregnant women in an urban area of south India.
African Health Science [Internet].2013;13(4):880–5.Availablefrom:
http://www.pubmedcentral.nih.gov

36.Berhanu Abebaw Adherence Status and Associated Factors of Iron and Folic Acid
Supplementation among Pregnant Women Attending Antenatal Care Service in Debre Markos
Town, Northwest Ethiopia.

22
Consent form

I have heard the information sheet that has been read for me before. I have understand the
objective, advantage and disadvantage of the study. In addition to this the information that I
give will be confidential, and will not be given to other person without my permeation,
therefore, I can make sure my agreement to involve in the study through my

Signature

Signature of interviewee __________________

Name of interviewer ______________________

Signature of interviewer ___________________

Date: _________________

23
Annex I. Questionnaire for data collection
Part I: socio- economic and demographic information

S/N Questions Response categories Skips

01 Age in years
02 What is your current 1.Single
Marital Status? 2.Married
3.Divorced
4.Widow
03 Place of residence 1.Rural
2.Urban
04 Number of total Family Size
05 What is your educational 1.Can read and write
Status 2.Primary (grade 1-
8)
3.Secondary (9-12)
4.Above secondary
06 What is the educational 1.Can read and write
Level of your Husband? 2.Primary (grade 1-
8)
3. Secondary (9-12)
4. Above secondary
07 What is the average Ethiopia Birr……
Monthly income of your family?

24
Part II. Obstetrics factors

08 How many pregnancy have

you had till now?(in
number)
09 How many deliveries you
had till now
10 Do you have the history of 1.Yes
Still birth? 2. No
11 If yes, How many still births you had?
12 Do you have a history of 1.Yes
Abortion? 2.No
13 If yes, How many abortions do you
have?
14 Have you received 1.Yes
Antenatal care for the recent 2.No
pregnancy?
15 How many times did you receive 1.No follow up
ANC service? 2.2
3.3
4.4
16 At what gestational age did you start 1.First trimester
ANC? (THE 2.Second trimester
DATA COLLECTOR PUT IT IN 3.Third trimester
TRIMESTER)
17 Did you face anemia in 1.Yes
your previous pregnancy 2.No
Did you face anemia in your current 1.Yes
18 pregnancy 2.No

25
Part III Knowledge on anemia and its prevention

19 Do you know any illness called 1.Yes

anemia? 2.No
20 If yes Do you know the 1.Yes
cause? 2.No
21 What is the cause? 1.Unbalanced diet
Multiple choice possible 2.Deficiency iron/folate
3. Loss of blood
4. Being worried
5. Other (specify)
22 Do you know what anemia 1.Yes
resulted in pregnancy? 2.No
23 What are they? (more than 1. Maternal mortality…
one answer is possible) 2. Still birth…
3.Infant mortality
4.Impaireddevelopmentinchildren
5. Increase Blood pressure.
6. Other (Specify)
24 Who are the most 1.Pregnant women
susceptible groups to 2. Children
anemia (more than one answer is 3.None pregnant women
possible 4.Male adults
5.Other (Specify)
25 Is anemia during 1.Yes
pregnancy can be 2.No
Prevented?
26 How does anemia in pregnancy can be 1.Supplementation with iron/folate
prevented?(more than tab
one answer is possible) 2.Consumption of food rich in

26
 dietary iron/folate
3. Avoidance of food that interfere
with bioavailability to iron/folate
4. Other (specify)…
27 What is your source 1.Health workers
of information? 2. Media
3. Friends
4. School
5.Other (specify)

Part IV Knowledge on iron/foliate supplement categories

Do you know the drug called 1.Yes

iron/folate? (show 2.No
28 the strip)
29 Do you know the benefit 1.Yes
of iron/ folate supplement? 2. No
what is its benefit of taking 1.Prevent Maternal Death
iron/folate supplement 2.Prevent infant mortality
30 (more than one answer is 3.Prevent Birth defects
possible) 4.Increase maternal blood
5.Give strength for the mother
6. Other (specify)
Do you think that taking 1.Yes
iron/folate supplement has 2.No
31 risk for your baby?
32 What are the risk of Supplementing 1.Harm fetus growth
iron/folate supplement 2.Cause bigger fetus Result in
3.complicate delivery
4.Other (specify)

27
 Do you know during 1.One month
pregnancy time how many 2.Two months
33 months tablet of iron/folate 3.Three months
supplement must be taken 4.More than three months
5.I don’t now
6.Other (specify)
From whom do you got a 1.Health workers
information about tablet 2.Media
34 iron/folate 3.Friends
supplement(more 4.School
than one answer is 5.Other specify)
possible)

Part V Adherence to iron/folate supplement and related factor

35 For how long did you take 1.One month

the supplement? 2.Two months
3.Three months
4. More than three months
5.Other (specify)
36 Have you taken the 1.Yes
medication properly without 2.No
fail?
How did you take your 1.On daily base
37 Supplement? 2.Weekly
3.When I feel sick
4.Other (specify)
How many tablets have you 1. <4
taken in the past 1 week? 2.>=4

38

28
 If, you had taken < 4 tabs
per a week What was reason
for not taking the supplement
properly?(MORE THAN
ONE ANSWER POSSIBLE,
CHOICE DOESN’T
ALLOWED TO READ)
39
If the answer to question No
507 is due to side effect,
which side effects were
responsible(more than one
answer is possible)
If, you had taken >48 tablets(
>4 tabs per a week)What
was the reason for not taking
41 the supplement
properly?(more than one
answer possible, but choice doesn’t take properly
allowed to read)
1.Forget fullness
2. Because of too many pills Fear
of side effects
3.Unpleasant tests
BUT 4.Fear of big weight
5.Fear of harm to fetus
6.Failure to get adequate
supplement in the health facility
7.Long waiting time at health
facility
8. Service is Far from residence
9.Poor communication with
health provider
10.Other (specify)
1Vomiting
2.Diarrhea
3.Constipation
4.Heartburn
5.Abdominal cramp
6.Other (specify)
1.I get the medication in free
2. I use my own note book to
remember
3.I fear to be sick
4.The health worker told me to
5. B/c I know it prevent anemia
6.Other (specify)

29
Part VI Health care system related factor

Is health education given 1.Yes

42 During ANC Visit 2.No
If yes, related to what issue 1.Purpose of supplement
the health education given to 2.Duration of the supply
43 you? 3. Side effect
4.Follow up visit
How many tablets did you 1.30 tables
collect per visit? 2.60 table
44 3.90 table
4.>90 table
5.Other (specify)
Do you face any problem in 1.Yes
the health center/ hospital, 2.No
while you were collecting
45 your supplement?
If yes, which problem do you 1.Shortage of supplement in
face? more than one answer facility
46 will be acceptable 2.Long waiting time in the
health institution
3. Poor health care provider
communication….
4.Other (Specify)

30
Annex II. Questionnaires in Amaric Language
ክፍል 1 ኢኮኖሚያዊእናማህበራዊመረጃዎችየሚሰበሰቡበትክፍል

ተ. ጥያቄ የመልስክፍ ዝለ
ቁ ል
01 እድሜሽስንትነው ……….
02 የትዳርሁኔታሽምንአይነትነው 1.ያላገባች
2.ያገባች
3.የፈታች
4.ባለቤቷየሞተባት
03 የመኖረያቦታሽየትነው 1.ገጠር
2.ከተማ
04 የቤተሰብሽብዛትበቁጥርስንትነው ………..
05 የትምርትደረጃሽስንትነው 1.መፃፍእናማንበብየማትችል
2.መፃፍእናማንበብየምትችል 3.የመጀመርያደረጃትምርትያ
ላት (1-8)
4.የሁለተኛደረጃትምርትያላት (9-12)
5.ከሁለተኛደረጃትምርትበላይያላት
06 1.መፃፍእናማንበብየሚችል
2.መፃፍእናማንበብየሚችል 3.የመጀመርያደረጃትምርትያለ
ው (1-8)
4.የሁለተኛደረጃትምርትያለው (9-12)
5.ከሁለተኛደረጃትምርትበላይያለው
07 በኢትዮጵያብርበአማካኝየወርገቢሽስንትነ …………………..
ው

ክፍል 2 ከወሊድጋርየተያያዙጉዳይዎችየሚጤየቁበትክፍል

31
09 እስካሁንስንትጊዜፀንስሽ …….
09 እስካሁንስንትጊዜወለድሽ …….
10 በሆድሽውስጥየጠፋፅንስነበር 1.አለ
2.የለም
11 ስንትፅንስነውየጠፋብሽ
12 ከዚህበፊትአሶርደሽታውቂየለሽ 1.አሶርጃለው 2.አላሶረድኩም
13 ስንትጊዜነውያሶረድሽው
14 ላሁኑእርግዝናሽየቅድመወሊድከትትልበሆስፒታልወይ 1.አድርጌያለው 2.አላደረኩም
ምበጤናጣቢያአድርገሻል
15 የቅድመወሊድክትትሉንስንትጊዜአድርገሻል 1.ክትትልየላቸውም
2
3
4
>4
1.ከሶስትወርበታች 2.ከሶስትእስከስድስት 3.ወርሲሆነ
የቅድመወሊድክትትልየጀመርሽውእርግዝነውስንትጊዜ ኝከስድስት 4.ወርበኃላ
1
ሲሆነውነው
6

1 ከበዚህበፊቱእርግዝናሽየደማነስችግርገጥሞሽነበር 1.ገጥሞኛል 2.አልገጠመኝም

7

18 በአሁኑእርግዝናሽየደማነስችግርገጥሞሽነበር 1.ገጥሞኛል 2.አልገጠመኝም

ክፍል 3 ተሳታፊዎችስለደምማነስእናስለመከላከያውያላቸውንእውቀትየሚጠየቁበትክፍል

19 የደማነስህመምምንእንደሆነያውቃሉ 1.አውቃለው
2.አላውቅም
20 በምንምክንያትእንደሚመጣየውቃሉ 1.አውቃለው
2.አላውቅም
21 አውቃለውካሉምክንያቱምንድንነው 1.ያልተመጣጠነምግብ
ከአንድበላይመልስይቻላል 2.የአይረንንጥረነገርማነስ
3.የደምመፍሰስ
4.ጭንቀት

32
 5.ከዚህውጭነው
22 የደምማነስበእርግዝናላይየሚያመጣውንችግር 1.አውቃለው
ታውቂለሽ 2.አላውቅም
23 የሚያመጣውችግርምንድን 1.የእናትሞት
ከአንድበላይመልስይቻላል 2.የፅንስሞት
3.የጨቅላሞት
4.ያልተስተካከለየህፃናትእድገት 5.የደምግፊትይጨምራል
6.ከዚህውጭነው
24 ለደምማነስችግርበብዛትየሚጋለጡትእነማን 1.ነፍሰጡርእናቶች
ናቸው 2.ህፃናት
3.ያላገቡሴቶች
4.ወጣትወንዶች
5.ከዚህውጭነው
25 በርግዝናሰዓትየሚመጣንየደምማነስመከላከል 1.ይቻላል
ይቻላል 2.አይቻልም
26 እንዴትመከላከልይቻላል 1.ተጨማሪየደምማነስ
ከአንድበላይመልስይቻላል 2.መከላከያእንክብልንበመውሰድ
3.የአይረንእናየፎሌትይዘታቸው
4.ጥሩየሆኑምግቦችንበመመገብ
5.የአይረንእናየፎሌትወደደምውስጥእንዳገቡየሚያደርጉምግቦ
ችንበማስወገድ
6.ከዚህውጭነው
2 1.ከጤናባለሙያ
7 ይህንንመረጃከየትነውገኘሽው 2.ከሬድዮ
3.ከገደኞቼ
4. ከትምርትቤት
5.ከዚህውጭነው

ክፍል 4 ተሳታፊዎችስለተጨማሪአይረንፎሊክአሲድንጥረነገርያላቸውንእውቀትየሚጠየቁበትክፍል

2 አይረንፎሌትሚባልመዳኒትየውቃሉ 1.አውቃለው
8 2.አላውቅም

33
2 የአይረንፎሌትንንጥረነገርጥቅሙምንእነደሆነያውቃሉ 1.አውቃለው
9 2.አላውቅም
3 የኤረንፎሌትንንጥረነገርመውሰድጥቅሙምንድንነው 1.የእናትሞትንይቀንሳል
0 ከአንድበላይመልስይቻላል 2.የህፃናትሞትንይቀንሳል
3.በተፈጥሮአካልመጉደልንይቀንሳል
4.የእናትንደምይጨምራል
5.ለእናትጉልበትንይጨምራል
6.ከዚህውጭነው
3 የተጨማሪኤረንፎሌትንጥረነገርንመውሰድህፃኑላተፅኖያመጣልብልያስባ 1.አስባለው
1 ሉ 2 አላስብም
3 የተጨማሪኤረንፎሌትንጥረነገርንመውሰድህፃኑላተፅኖምንድንነው 1.የፅንሱንእድገትቀንሳል
2 2.ፅንሱትልቅእንዲሆንያደርጋል
3.ወሊዱውስብስብእንዲሆንያደርጋ
ል
4.ከዚህውጭነው
3 በእርግዝናሰዓትየተጨማሪየአይረንእንክብልለስንትጊዜነውየሚወሰደው 1.ለአንድወር
3 2.ለሁለትወር
3.ለሶስትወር
4.ከሶስትወርበላይ
5.አላውቅም
3 ስለተጨማሪእንክብልእውቀትኬትነውያገኙት 1.ከጤናባለሙያ
4 2.ከሬድዮ
3.ከገደኞቼ
4.ከትምርትቤት
5.ከዚህውጭነው

ክፍል 5
ተጨማሪአይረንፎሊክአሲድንጥረነገርበአግባቡመወሰዱንእናበአግባቡእንዳይወሰድስለሚያደርጉተያያዥጉዳዮችየሚጠይ
ቅክፍል

3 ለምንያህልጊዜነውየተጨማሪእንክብሉንየወሰዱት 1.ለአንድወር
5 2.ለሁለትወርለሶስትወር

3.ከሶስትወርበላይ

34
 4.አላውቅም
3 መዳኒቱንያለማቐረጥነውየወሰዱት 1.አዎን
6 2.አይደለም
3 እንዴትነውመዳኒቱንየወሰዱት 1.በየቀኑ
7 2.በየሳምንቱ

3.ሲያመኝ

4.ከዚህውጭነው
3 በባለፈውሳምንትውስጥስንትእንክብልነውየወሰዱት 1.<4
8 2.>=4
3 ከ 4 1.መርሳት
9 እንክብልበታችበሳምንትከሆነየወሰዱትምክንያቱምንነበርወይምበእርግዝናወ 2.እንክብሉብዙስለሆነ

ቅት(ከአንድበላይመልስመመለስይቻላል 3.የጎንዮሽጉዳቱንበመፍራትጠዓ

ሙስለሚያስጠላ

4.ክብደቴንእንዳይጨምርብኝ

5.ፅንሱንይጎዳልብዬስላሰብኩ

6.በቂእንክብልከጤናተቐሙስላል

ተሰጠኝ

7.ረዥምሰዓትበጤናተቐሙስለ

ሚያቆዩኝ

8.ቤቴከጤናተቐሙስለሚርቅ

9.ከጤናባለሙያዎቹጋርስላልተስ

ማማን

10.ከዚህውጭነው
4 ለ 1.ወደላይማለት
0 507 ኛጥያቄመልሱየጎንዮሽጉዳቱንበመፍራትከሆነየቱንየጎንዮሽጉዳትበመፍራ 2.ወደታችማለት

ትነው 3.የሆድድርቀት

4.ልብማቃጠል

5.የሆድቁርጠት

6. ከዚህውጭነው

35
4 ከ 4 1.መዳኒቱንበነፃስለማገኝ
1 እንክብልበላይበሳምንትከሆነየወሰዱትምክንያቱምንነበርወይምበእርግዝናወቅ 2.እንዳልረሳውየራሴንማስታወ

ትከ 48 እንክብልበላይከሆነየወሰዱትምክንያቱምንነበር ሻስለምይዝ

3.መታመምስለምፈራ

4.የጤናባለሙያውበትክክልእንድ

ወስድስለነገረኝ

5.የደምማነስእንደሚከላከልስለ

ማውቅ

6.ከዚህውጭነው

ክፍል 6 ከጤናአሰጣጥስርዓቱጋርየተያያዙጉዳዮችየሚጠየቁበትክፍል

4 በቅድመወሊድጊዜየጤናተምህርትተሰጥቶ 1.ተሰጥቶኛል
2 ታል 2.አልተሰጠኝም
4 ከምንጋርየተያያዘትምህርትነውየተሰጦት 1.ስለተጨማሪአንክብሉጥቅም 2.የተጨማሪእንክብሉለምንያህል
3 ጊዜእንደሚወሰድ

3.የጎንሽጉዳቱንበተመለከተየቅድመወሊድክትትሉንበተመለከተ
4 በአንድየቅድመወሊድክትትልስንትእንክብል 1.30
4 ይሰጦታል 2. 60
3. 90
4.›90
5.ከዚህውጭነው
4 እንክብሉንለመውሰድሲመጡየገጠሞትጭ 1.አለ
5 ግርአለ 2.የለም
4 ምንአይነትችግርነውየገጠሞት 1.የእንክብልእጥረትመኖር
6 2.እንክብሉንለመስጠትረዥምሰዓትያቆዩኛል

3.የጤናባለሙያዎቹአይግባቡም

4.ከዚህውጭነው

36
INVESTIGATORS CARRICULLUM VITTAE

ARARSA SOBOKSA (PI)

1. Personal Information

 Full name Ararsa Soboksa

 Sex Male
 Nationality Ethiopian
 Date of Birth: 05/12/1989
 Marital Status:married
 Phone No 0931227633/0968144418
 Email ararsa.soboksa@gmail.com

2 Education Background

No Type Of school School Name Level Yrs.0f Credit

&Place Attendance Awarded
1 College Addis Ababa, Master 2009-2011e.c MSC In
Santé Medical Community

37
 College Nutrition
2 University Hawassa Heath Degree 2001-2005e.c BSC
Science Midwifery
3 High School Ambo 9-12 1997-1996 Certificate
4 Secondary School Ambo, Awaro 5-8 1992-1996 Certificate
5 Primary school Ambo, Awaro 1-4 1988-1992 Certificate
3. Qualification BSC in Mid-Wifery and MSC in Community nutrition.

4 Language Skills

Language Listening Speaking Writing Reading

English Excellent Excellent Excellent Excellent
Amharic Excellent Excellent Excellent Excellent
Afan oromo Excellent Excellent Excellent Excellent
5. Computer Skills ms Word, excel PowerPoint, excellent knowledge of inter application

6. Training Certified

 Field Epidemiology Trading Program-Frontline Course

 PMCT option
 HHS (health management service).
 Ethiopian Society Of Obstetricians and Gynecologist(ESOG)
 National Partner and Family Based Index Case Testing Service.
 Gender Based VIOLENCE/GBV and Rape

7. Work Experience Eight years at Ethiopian Federal Police Referral Hospital (EFPRH)& MSC

8. At Ethiopian Police University Health science college fromAugust/2021 until now

9. References Dr EndriasLenhamoGyn&Obs department at EFPRH phone no 0911178870

10. Dr Mohammad Gyn & Obs department at EFPRH phone no 0911618768

38
KETEMA GURMU (CO-INV)

1. PERSONAL DATA
 Name:- KetemaGurmu Faye
 Sex:male
 Date of Birth: June26/1988G.C
 Placeof Birth:YayaHaro,Degem, Oromia /Ethiopia
 Maritalstatus: Married
 Contact address:Tel.mobile 0910545312,Email: gurmuketi@gmail.com
2. EDUCATIONALBACKGROUND
 Elementary School: YayaHaroEleneterySchool
 High school:Fitche Senior Secondary School
 University: Addis Ababa medical University College, DebreBerhan University
3. EDUCATION
 Higher National Diploma in Public health nursing
 From shashemene health science college,Oct/2009
 BSC Degree in public healthprofessional

39
  From Addis Ababa medical University college, Sept/2016
 Master’sDegree in Reproductive and Family healthspecialty
 From DebreBerhanUniversity, Jun/2020
4. WORKEXPERIENCE
 Public health nursing and HEW Supervisor
Under OromiaHealth Beraue/ Aleltumikewa health center / from Oct/2009-Dec/2012

 Public Health Professional

Ethiopian Police University (sendafa) Health service division from/2013-
OctAugust/2021
 Lecturer
At Ethiopian Police University Health science college fromAugust/2021 until now

5. SKILLS
 LANGUAGE SKILL

Language Listening Reading speaking Writing

Afaanoromoo Excellent Excellent Excellent Excellent
Amharic Excellent Excellent Excellent Excellent
English Excellent Excellent Excellent Excellent

 COMPUTER SKILL
 Advanced computer skill: StatisticalAnalysis software skills: SPSS,EPI-
DATA,EPI-INFOsoftware application.
 Report generation and data analysis
 OTHER SKILLS
 Team building and managing
 Time managing and coordinating training
6. COURSES AND TRAINING

40
  TOT on LAFP
 HCT and VCT
 TOT on SAM/MAM malnutrition management OTP/SC
 MDR-TB and OI Prevention Training
 Basic Military training (Ethiopian Federal police commission)
 One publication on maternal health
7. REFERENCE

 AyubAman MPH/HEP(co-worker) telephone,+251911857235

 YonasAzanaw( MPH/RH) Telephone, +251925330862,
Email; yyaet21@gmail.com
 Ararsasaboksa,Bsc,msc(co-worker)
Email;ararsa.soboksa@gmail.com
Tell. +251931227633,

41