Accord University Knowledge & Vision

RISK FACTOR OF ANEMIA IN PREGNANT WOMEN IN MCH

SHIBIS DISTRICT IN MOGADISHU SOMALIA

This dissertation submitted to as in partial fulfillment for the award of Master

of Public health from Accord University

-Somalia

Supervisor:

Mrs: Aliza Khaan

Submitted by:

Ifrah Mohamed Abdulle

Jun, 2023

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 DECLARATION

I herewith declare that this proposal is my own work and effort and that it has not been

submitted to Accord University for any award. Where other sources of info have been

used, they have been acknowledged.

Name: Ifrah Mohamed Abdulle

Signature ___________________________

Date: ___/ ___/ ________

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 APPROVAL

This research dissertation has been done under my guidance and Supervision as an

academic Supervisor and is due for submission to Accord University in Partial

fulfillment of the requirements for the award of a Master of Public health.

Supervisor: Mrs: Aliza Khaan

Signature: ______________________________

Date: 05 2023
……/……/…………
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 DEDICATION

First and foremost, I would like to dedicate this work to the Almighty Allah who has
made it possible for me to conduct effective study as well as to my cherished parents
for their unending support both financially and morally, not to mention my loving
brothers and lovely sisters. May Allah, the Highest, bless you all.

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 ACKNOWLEDGEMENT

Firstly, am greatly indebted to the Almighty Allah for enabling me complete my

academic career. I would like to extend my sincere gratitude to my supervisor for the
patience, guidance to ensure that this work is perfect. Thank you very much if it wasn’t
for you, I don’t think I would have achieved this. I would like to thank my best friends
especially my best friends, for their endless support during my academic career.

My profound gratitude is sent to my professors, who have helped me become a better

and more knowledgeable person over the two years I spent at Accord University
struggling in the classroom.

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 TABLE OF CONTENTS

DECLARATION ......................................................................................................... ii
APPROVAL................................................................................................................ iii
DEDICATION ............................................................................................................ iv
ACKNOWLEDGEMENT ........................................................................................... v
TABLE OF CONTENTS ............................................................................................ vi
LIST OF TABLES ...................................................................................................... ix
LIST OF FIGURES ..................................................................................................... x
LIST OF ACRONYMS .............................................................................................. xi
ABSTRACT ............................................................................................................... xii
CHAPTER ONE .......................................................................................................... 1
INTRODUCTION ....................................................................................................... 1
1.0 Overview ................................................................................................................ 1
1.1 Background of the study ........................................................................................ 1
1.2 Problem statement .................................................................................................. 3
1.3 Objective of the study ............................................................................................ 4
1.3.1 General objective ................................................................................................ 4
1.4 Research questions ................................................................................................. 4
1.6 Scope of the study .................................................................................................. 5
1.8 Significance of the study ........................................................................................ 5
1.8 Operational definitions of the study ....................................................................... 6
1.9 Conceptual framework ........................................................................................... 7
CHAPTER TWO ......................................................................................................... 8
LITERATURE REVIEW............................................................................................. 8
2.0 Introduction ............................................................................................................ 8
2.1 Anemia ................................................................................................................... 8
2.2 Pregnant women ................................................................................................... 10
2.3 Dietary intake Factors .......................................................................................... 11
2.4 Health System Factors ......................................................................................... 12
2.5 Socio-demographic Factors .................................................................................. 13
2.6 Research Gap ....................................................................................................... 14

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Summary .................................................................................................................... 16
CHAPTER THREE.................................................................................................... 17
METHODOLOGY..................................................................................................... 17
3.0 Introduction .......................................................................................................... 17
3.1 Research design .................................................................................................... 17
3.2 Target Population ................................................................................................. 17
3.3 Study area ............................................................................................................. 18
3.4 Sample size........................................................................................................... 18
3.6 Data collection instrument ................................................................................... 19
3.7 Data collection procedure .................................................................................... 19
3.8 Data analysis ........................................................................................................ 19
3.9 Quality controls .................................................................................................... 20
3.10 Ethical Considerations ....................................................................................... 21
CHAPTER FOUR ...................................................................................................... 22
FINDINGS AND DISCUSSION ............................................................................... 22
4.0 Introduction .......................................................................................................... 22
4.1 Demographic characteristics of respondents ........................................................ 22
4.2 General health information .................................................................................. 25
4.3 Health System Factors ......................................................................................... 28
4.4 Dietary intake Factors .......................................................................................... 33
4.5 Socio-demographic Factors .................................................................................. 38
4.6 Discussion on findings ......................................................................................... 43
4.6.1 Health System Factors....................................................................................... 43
4.6.2 Dietary intake Factors ....................................................................................... 44
4.6.3 Socio-demographic Factors ............................................................................... 45
CHAPTER FIVE ........................................................................................................ 48
CONCLUSSION AND RECOMMENDATIONS .................................................... 48
5.0 Introduction .......................................................................................................... 48
5.1 Conclusion ........................................................................................................... 48
5.2 Recommendations ................................................................................................ 50
References .................................................................................................................. 51
APPENDICES ........................................................................................................... 53
APPENDIX I: QUESTIONNAIRE ........................................................................... 53

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APPENDIX II ............................................................................................................ 58
TIME FRAME ........................................................................................................... 58
APPENDIX III ........................................................................................................... 59
BUDGET ................................................................................................................... 59

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 LIST OF TABLES

Table 4. 1 Educational level ....................................................................................... 23

Table 4. 2 Age of the respondents .............................................................................. 23
Table 4. 3 Stage of your pregnancy when you diagnosed with anemia ..................... 25
Table 4. 4 Patient in Somalia do not seek health care services due to insufficient fund
.................................................................................................................................... 28
Table 4. 5 Women hospitalization cost, more than twice yet women are less likely to
be insured those men .................................................................................................. 29
Table 4. 6 Physician and patient must form an alliance to more effectively
communicate the importance of starting .................................................................... 30
Table 4. 7 The link between salt and high blood pressure is especially compelling . 31
Table 4. 8 Essential anemia is also greatly influenced by diet and lifestyle .............. 32
Table 4. 9 Dietary intake includes specific foods and calories consumed and relative
quantities .................................................................................................................... 33
Table 4. 10 Milk proteins and egg proteins are considered as the standard for
comparing the nutritional value of dietary proteins ................................................... 34
Table 4. 11 Dietary factors play a role in the prevention of hypertensive disorders of
pregnancy ................................................................................................................... 35
Table 4. 12 Deficiency of dietary protein intake will lead to negative nitrogen balance
.................................................................................................................................... 36
Table 4. 13 Dietary proteins are either of plant or animal origin ............................... 37
Table 4. 14 Personal life may lead to good treatment compliance among pregnant
women diagnosed with PIH ....................................................................................... 38
Table 4. 15 Women with low and no education are more likely to be married early 39
Table 4. 16 Women at high risk of getting pregnant early and prone to PIH ............ 40
Table 4. 17 Treatment compliance more difficult for those diagnosed with anemia . 41
Table 4. 18 Most of Somalis women avoided health facilities antenatal care ........... 42

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 LIST OF FIGURES

Figure 4. 1 Gender of respondents ............................................................................. 22

Figure 4. 2 Marital Status ........................................................................................... 23
Figure 4. 3 Work Experience .................................................................................... 24
Figure 4. 4 Current pregnant ...................................................................................... 25
Figure 4. 5 How long have you been on anemia drugs .............................................. 26
Figure 4. 6 If this is not the first pregnancy, how long ago was your previous ......... 27
Figure 4. 7 If this is not the first pregnancy, did you experience PIH is the previous27
Figure 4. 8 Patient in Somalia do not seek health care .............................................. 28
Figure 4. 9 Women hospitalization cost, more than twice… ..................................... 29
Figure 4. 10 6 Physician and patient must form an alliance to more effectively ....... 30
Figure 4. 11 The link between salt and high blood pressure… .................................. 31
Figure 4. 12 Essential hypertension is also greatly influenced .................................. 32
Figure 4. 13 Dietary intake includes specific foods ................................................... 33
Figure 4. 14 Milk proteins and egg proteins are considered ...................................... 34
Figure 4. 15 Dietary factors play a role in the prevention ......................................... 35
Figure 4. 16 Deficiency of dietary protein intake will lead to negative….. ............... 36
Figure 4. 17 Dietary proteins are either of plant or animal origin ............................. 37
Figure 4. 18 Personal life may lead to good treatment compliance ........................... 38
Figure 4. 19 Women with low and no education ....................................................... 39
Figure 4. 20 Women at high risk of getting pregnant early ....................................... 40
Figure 4. 21 Treatment compliance more difficult for those ..................................... 41
Figure 4. 22 Most of Somalis women avoided health facilities ................................. 42

x
 LIST OF ACRONYMS

SSA Sub-Saharan Africa

WHO World health organization
DHS Demographic and Health Surveys
MCH Mother health for children
HDP Hypertensive disorders of pregnancy
PIH Pregnancy induced hypertension
ANC Antenatal care

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 ABSTRACT

One of the most prevalent nutritional deficiency illnesses seen worldwide is anemia.
Although nutritional anemia affects people of all ages and genders, it is more common
in women and is a factor in low birthweight, maternal morbidity, and mortality and the
study was based on the risk Factor of Anemia in Pregnant women in MCH Shibis
District in Mogadishu Somalia and the basic objectives of the study that is the level of
dietary intake that related factors influence induced risk Factor of Anemia among
pregnant women at MCH Shibis District in Mogadishu Somalia, the health system
factors that influence induced risk Factor of Anemia among pregnant women and the
socio-demographic factors that influence induced risk Factor of Anemia among
pregnant women at MCH Shibis District in Mogadishu Somalia. The study was based
on cross-sectional research design. The study was used a target population of 110
women. The study was conducted from MCH Shibis, it located in Shibis district in
Mogadishu. The study was used Sloven’s formula. Therefore, the sample size is 87
women. The study was based on simple random sampling. The researcher was used
questionnaire. In this study of at MCH Shibis District pregnant women, hookworm
infection, lack of iron supplement intake, impaired dark adaptation and a diet deficient
in heme iron were associated with increased risk of severe anemia and iron deficiency.
when the researcher analyzed the data from the respondents the study found out that
37(42.5%), of the respondents were agreed, 2(2.3%) of the respondents were
disagreed, 9(10.3%) of the respondents were strongly disagreed, 17(19.5%) of the
respondents were neutral and 22 (25.3%) of the respondents were strongly agreed with
the statement that patient in Somalia do not seek health care services due to insufficient
fund. The study was concluded that the first objective of the study that is the health
system factors that influence induced hypertension among pregnant women at MCH
Shibis District in Mogadishu Somalia, so the patient in Somalia do not seek health care
services due to insufficient fund. Finally, the researcher recommends that MCH Shibis
District in Mogadishu Somalia should provide services like treating pregnant women
should be aware of the importance of routine BP measurement and monitoring of
women, including after delivery, and its documentation. Routine monitoring and
documentation should include urine albumin as well.

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 CHAPTER ONE

INTRODUCTION

1.0 Overview

This chapter was contained background of the study, problem statement of the study,
research objectives, research questions, scope of the study, significance of the study,
operational definition of the study and conceptual framework.

1.1 Background of the study

Globally, one of the most prevalent nutritional deficiency illnesses seen worldwide is
anemia. Although nutritional anemia affects people of all ages and genders, it is more
common in women and is a factor in low birthweight, maternal morbidity, and
mortality (Taner et al., 2015). In developing nations, nutritional anemia is thought to
affect nearly two thirds of expectant mothers (Hossain et al., 2019). Although anemia
is thought to affect nearly 50% of non-pregnant women in developing nations, many
of these women were already anemic at the time of conception. One of the most
frequent preventable causes of maternal morbidity and a poor neonatal outcome during
pregnancy is anemia (Taner et al., 2015). Anemia during pregnancy is mostly brought
on by food shortages, infections, and parasite disorders.

According to reports, anemia affects ever-married women in Pakistan between the ages
of 15 and 44 at a prevalence of 26% in urban regions and 47% in rural areas. Pregnant
women who visit antenatal clinics at a sizable private, tertiary hospital in Karachi have
a similar frequency of anemia to pregnant women who live in metropolitan regions,
with rates ranging from 29 to 50 percent (Macdonald et al., 2010).

As one of the etiologic factors, iron deficiency is frequently recognized as the main
cause of anemia during pregnancy. Routine iron supplementation for all pregnant
women has also been recommended in Turkey since 2005. Anemia in pregnancy still

1
ranks among the nation's significant health issues with a prevalence of 32.6%, despite
the program's operation for a decade. Demographic, cultural, and socioeconomic
factors may have an impact on the prevalence of anemia in pregnancy in developing
nations (Macdonald et al., 2010).

A strong link between maternal anemia and unfavorable perinatal outcomes, including
placenta previa, placental abruption, preterm birth, and low birth weight, has also been
observed in earlier research. Identification of the "at-risk" group and the
implementation of measures to reduce anemia will both benefit from the determination
of these criteria, which will contribute to the provision of valuable information
(Hussain et al., 2020). These investigations on the causes of anemia during pregnancy,
however, involved anemic women either before or during the first trimester of the
pregnancy. Studies examining the prevalence of anemia and risk factors for it that are
present at delivery are necessary.

In Africa, at every stage of life, anemia is a public health concern. Sub-Saharan Africa
(SSA) has the largest regional prevalence of anemia, and its prevalence is declining
more slowly over time than in other regions (Makhoul et al., 2012). According to
WHO guidelines, anemia affects both pregnant and non-pregnant women in SSA, and
it is a serious public health issue. However, there are differences within the area, with
West and Central Africa's subgroups experiencing the highest frequency and least
progress (Adamu et al., 2017). The anemia burden in SSA is being driven by a mix of
population expansion, aging populations, infectious illnesses, and iron deficiency. The
majority of studies on anemia in SSA that have been published concentrate on kids
and expectant mothers.

Anemia prevalence in Malawi has been calculated using data from the Demographic
and Health Surveys (DHS) for women of reproductive age, pregnant women, and
children under the age of five. The study sample sites are dispersed, and men and
women past the age of reproduction are not included(Hussain et al., 2020). The
prevalence of mild, moderate, and severe anemia was 21.7, 5.8, and 0.6 percent for
non-pregnant women and 19.5, 17.8, and 0.2 percent for pregnant women in Malawi
in 2010.

In Somalia, has some of the worst maternal and child health indicators in the world
due to years of widespread internal conflict, extreme poverty, civil war and lack of

2
access to an appropriate health care facility (Corresponding, 2021). Somali maternal
mortality is high and is among top high countries in the numbers of women dying in
pregnancy, the major common causes is preeclampsia and hypertensive disorders
hypertension caused by pregnancy is the leading cause of maternal and perinatal
morbidity and mortality (jama, 2019). However, while a few studies are looking into
the prevalence and associated factors of risk anemia in Somalia, none have been done
in our study field.

Currently, in MCH Shibis District in Mogadishu Somalia treats many patients

specially women but the magnitude of the death caused by anemia among pregnant
women rate is high making it the second leading cause of pregnancy-related severe
care unit admissions after obstetric hemorrhage (jama, 2019). One quarter of stillbirth
and neonatal deaths in shibis district are associated with preeclampsia. MCH Shibis
include diagnosis and treatment more serious medical conditions, such as autoimmune
disorders and managing medical conditions effecting infants, children and diagnose
and treat newborns with conditions such as breathing disorders, infections, and birth
defects and work mainly in the special-care nurseries or newborn intensive care units
of hospitals.

1.2 Problem statement

Anemia associated with pregnancy is a serious health problem and its control requires
the initial identification of the major factors responsible (Mostafa et al., 2022). The
study is intended to determine the consequences of poor pregnancy Health Care,
illnesses during pregnancy, and socio-economic conditions of the mother in
developing anemia during pregnancy (Makhoul et al., 2012)

Currently, in Shibis District in Mogadishu Somalia, Pregnancy mothers in that district

have very poor health seeking behavior, unreachable health facilities in the area that
caused lack of economic, since the area is high malarial endemic zone, this may also
contribute to severity of anemia in pregnancy. Pregnant mothers who come to MCH
Shibis, are more likely to or complain of anemia and poor health seeking behavior
seems to be augment the cause of anemia in pregnancy in that district, therefore the
study intends to uncover the factors that contribute to the cause of anemia in
pregnancy.

3
As a consequence, the problem of anemia is getting more and more common in
pregnant women, though gaps are many so the researcher was examined the risk Factor
of Anemia in Pregnant women in MCH Shibis District in Mogadishu Somalia.

1.3 Objective of the study

The study was attendant by both general and specific objectives of the study that
presented below:

1.3.1 General objective

The general objective of the study is to the risk Factor of Anemia in Pregnant women
in MCH Shibis District in Mogadishu Somalia.

1.3.2 Specific objectives

✓ To examine the level of dietary intake that related factors influence induced
risk Factor of Anemia among pregnant women at MCH Shibis District in
Mogadishu Somalia.

✓ To identify the health system factors that influence induced risk Factor of
Anemia among pregnant women at MCH Shibis District in Mogadishu
Somalia.

✓ To determine the socio-demographic factors that influence induced risk Factor

of Anemia among pregnant women at MCH Shibis District in Mogadishu
Somalia.

1.4 Research questions

1. What is the level of dietary intake that related factors influence induced risk
Factor of Anemia among pregnant women at MCH Shibis District in
Mogadishu Somalia?

4
 2. What is the health system factors that influence induced risk factor of anemia
among pregnant women at MCH Shibis District in Mogadishu Somalia?

3. What is the socio-demographic factors that influence induced risk factor of

anemia among pregnant women at MCH Shibis District in Mogadishu
Somalia?

1.6 Scope of the study

The scope of study will be consisting of content scope, geographical scope and time scope as
present below:

1.6.1 Geographic scope

The study was conducted from MCH Shibis, it located in Shibis district in Mogadishu,
the study was used this MCH to investigate the risk Factor of Anemia in Pregnant
women.

1.1.1 Content Scope

The study was focused on the level of knowledge on the factors influence induced
hypertension among pregnant women and the risk Factor of Anemia in Pregnant women
in MCH Shibis District in Mogadishu Somalia.

1.6.3 Time scope

The study was covered the information in 6 months that is December-May 2023.

1.8 Significance of the study

The researcher was ed all the hospital managers in Shibis MCH district and all of the
Somalis MCH in Somalia, about the role played by the factors influence induced the
risk Factor of Anemia among pregnant women. The study was acted as a source of

5
refences to the future researchers to get more information that concerning about the
factors influence induced hypertension among pregnant women in MCH Shibis
District in Mogadishu Somalia.

The study will enable the researcher to complete his bachelor’s degree about Faculty
of nutrition and food Science, and also the study will support women than cause
hypertension time of pregnancy period and Local works on PIH and treatment
compliance are scarce in MCH Shibis District in Mogadishu Somalia and the
information obtained in this study will be useful to the NGOs, policy makers, medical
personnel and health institutions in the sub-County and at National level to reduce
occurrence.

1.8 Operational definitions of the study

Anemia in pregnancy is one of the most common preventable causes of maternal

morbidity and poor perinatal outcome. Anemia during pregnancy is mostly brought on
by food shortages, infections, and parasite disorders (Hussain et al., 2020).

Anemia is one of the most common nutritional deficiency diseases observed globally.
The issue is more common in women and contributes to low birthweight, maternal
morbidity, and mortality (Adamu et al., 2017).

Iron deficient is an essential mineral that is needed to produce red blood cells, which
are important for a healthy immune system, mental function, muscle strength and
energy (Hossain et al., 2019). Its main role is in red blood cells, where it helps make a
protein called hemoglobin.

Pregnant woman of any age who is medically determined to be pregnant. The

pregnant woman definition is met from the first day of the earliest month that the
medical practitioner certifies as being a month in which the woman was pregnant
(Corresponding, 2021).

Pregnant the state of carrying a developing embryo or fetus within the female body.
(Hossain et al., 2019), This condition can be indicated by positive results on an over-
the-counter urine test, and confirmed through a blood test, ultrasound, detection of
fetal heartbeat.
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1.9 Conceptual framework

Independent variable (IV) Dependent variable (DV)

Risk Factor of Anemia Pregnant women

dietary intake factors

Health system factors Pregnant women

Socio-demographic factors

Figure 1. 1 Conceptual framework

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 CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

This chapter was contained the literature review and it is straightforward of the
objectives of the study that includes; The level of dietary intake that related factors
influence induced risk Factor of Anemia among pregnant women, The health system
factors that influence induced risk Factor of Anemia among pregnant women and the
socio-demographic factors that influence induced risk Factor of Anemia among
pregnant women.

2.1 Anemia

Anemia is defined as a condition in which the blood has low quantities of hemoglobin
and has a low number of functioning red blood cells. Anemia status and severity were
defined based on the WHO criteria for different hemoglobin cut-offs for men, non-
pregnant, and pregnant women (Bastola et al., 2020). Based on recommendations by
both the WHO and International Nutritional Anemia Consultative Group (INACG),
we adjusted hemoglobin values for altitude and smoking (Zewar, 2022). This was done
by subtracting 0.2 g/dl from individual hemoglobin values for participants in the
Lilongwe study site (altitude: 1056 m above sea level). No adjustments are
recommended for altitudes less than 1000 m; thus, none were made for Karonga site
subjects (altitude: 475 m). Smoking was adjusted for by subtracting 0.3 g/dl from
individual hemoglobin values for current smokers (irrespective of how heavily an
individual smoked). (Makhoul et al., 2012)Twelve observations were excluded due to
extreme and unlikely hemoglobin values (less than 4 g/dl for all, >18 g/dl for women,
and >20 g/dl for men). We grouped anemia severity: no anemia, mild, and moderate-
to-severe anemia for analysis. Any anemia was defined as hemoglobin values.

Anemic women for following improper dietary habits such as avoiding food during
pregnancy, craving for non-food substances, and inadequate women’s dietary
8
diversity. The nutritional status of iron is determined by consuming sufficient amounts
of iron in the diet or taking iron supplements Several studies have shown that iron
supplementation has a positive impact on improving hemoglobin levels in women of
reproductive age which is similar to our study (Hussain et al., 2020).

Anemia is one of the most common nutritional deficiency diseases observed globally.
Although nutritional anemia affects members of both sexes and all age groups, the
problem is more prevalent among women and contributes to maternal morbidity and
mortality, as well as to low birthweight (Kurer, 2014). It has been estimated that
nutritional anemia affects almost two-thirds of pregnant women in developing
countries. However, many of these women were already anemic at the time of
conception, with an estimated prevalence of anemia of almost 50% among
nonpregnant women in developing countries. Anemia is defined as a low level of
hemoglobin in the blood, resulting in lower quantities of oxygen available to support
the body’s activities. Internationally accepted hemoglobin values which define anemia
in women (Hussain et al., 2020).

Anemia is defined as a condition in which the number of red blood cells or their oxygen
carrying capacity is insufficient to meet the body’s physiologic needs which vary with
a person’s age, gender, residential elevation above sea level (altitude), smoking, and
different stages of pregnancy (Namatovu, 2018). It occurs at all stages of the life cycle,
but is more prevalent in pregnant women and young children. It has been shown to be
a public health problem affecting low-, middle- and high-income countries. It has a
significant adverse health consequence, as well as adverse impacts on social and
economic development (Baig-Ansari et al., 2008). It may result from a number of
causes, with the most significant contributor being iron deficiency. An estimated 50%
of anemia in women worldwide is due to iron deficiency (Mostafa et al., 2022). Other
important causes of anemia worldwide include infections, other nutritional
deficiencies (especially folate and vitamin B12, A and C) and genetic conditions
(including sickle cell disease, thalassemia) (Gangopadhyay et al., 2011). Anemia is an
indicator of both poor nutrition and poor health and when it is used with other
measurements of iron status the hemoglobin concentration can provide information on
the severity of iron deficiency (Zewar, 2022). Anemia resulting from iron deficiency
is the most common anemia in South Asia (UNICEF, 2002) which adversely affects
cognitive and motor development, causes fatigue and low productivity and, when it

9
occurs in pregnancy, may be associated with low birth weight and increased risk of
maternal and perinatal mortality (Baig-Ansari et al., 2008).

Pregnancy is a period of significant increase in iron requirement over and above the
non-pregnant state. The increased iron requirement is due to expansion of maternal red
blood cell mass for increased oxygen transport, including transfer of iron, to both the
growing fetus and the placental structures, and as a needed reserve for blood loss and
lochia at parturition. Due to increased iron requirements, a high proportion of women
become anemic during pregnancy (Jamila Ahmed Aden, 2018).

2.2 Pregnant women

Pregnancy is the state of fertilization and development for one or more offspring within
a woman’s uterus (Haque et al., 2011). The prenatal offspring is referred to as an
embryo or fetus. In a pregnancy, there can be multiple gestations, as in the case of
twins or triplets (Jamila Ahmed Aden, 2018). Childbirth usually occurs about 38 weeks
after conception. In women who have a menstrual-cycle length of four weeks, this is
approximately 40 weeks from the start of their last normal menstrual period (Bastola
et al., 2020). In many societies’ medical or legal definitions, human pregnancy is
somewhat arbitrarily divided into three trimester periods as a means to simplify
reference to the different stages of prenatal development. The first trimester carries the
highest risk of miscarriage (natural death of embryo or fetus). (Leslie & Collis,
2016)During the second trimester, the development of the fetus is more easily
monitored. (Belay & Wudad, 2019), The beginning of the third trimester often
approximates the point of viability, or the ability of the fetus to survive, with or without
medical help, outside of the uterus.

The Carnegie stages is a standardized system of 23 stages used to provide a unified

description of the developmental maturation of the vertebrate embryo (Kurer, 2014).
This system bases stages on the development of structures instead of days of
development or the size of the conceptus (Bastola et al., 2020). This staging method is
used only for the first 56 days in humans (prior to the fetal period). One scientific term
for the state of pregnancy is gravidity, which is Latin for heavy. (Jamila Ahmed Aden,
2018) A pregnant female is sometimes referred to as a gravida.

10
Similarly, the term parity (abbreviated as para) is used for the number of times a female
has given birth; parity counts twins and other multiple births as one pregnancy (Kurer,
2014). Medically, a woman who has never been pregnant is referred to as a
nulligravida, and a woman in subsequent pregnancies is referred to as a multigravida.
(Belay & Wudad, 2019), A woman who has had more than one live birth is referred to
as multiparous, and a woman who has never given birth is referred to as nulliparous.
(Agbeno et al., 2022), During a second pregnancy, a woman would be described as
gravida 2, para 1 and, upon live delivery, as gravida 2, para 2. An in-progress
pregnancy, as well as abortions, miscarriages, or stillbirths, account for parity values
being less than the gravida number (Namatovu, 2018). In the case of twins, triplets,
and so on, the gravida number and parity value are increased by one only. Pregnancy
is the term used to describe the period in which a fetus develops inside a woman's
womb or uterus. (Owiredu et al., 2012), Pregnancy usually lasts about 40 weeks, or
just over 9 months, as measured from the last menstrual period to delivery Health care
providers refer to three segments of pregnancy, called trimesters.

2.3 Dietary intake Factors

Dietary intake refers to the daily eating patterns of an individual, including specific
foods and calories consumed and relative quantities (Namatovu, 2018). Dietary factors
are those that are directly related to eating habits. These include what you eat, how
much you eat, and how often you eat them. (Owiredu et al., 2012), Some specific
examples of dietary factors include, how many servings of different food groups you
normally eat over a given time period. (Namatovu, 2018), Nutrition status refers to the
availability of nutrients and calories in the individual's diet compared to nutrition
recommendations for the individual's age group and overall health status.

According to (Belay & Wudad, 2019), Dietary intake and nutrition status are evaluated
by recording the types and amounts of foods consumed daily by the individual and the
health and lifestyle factors that influence eating patterns. Weight is an important factor
in determining nutritional needs and changes required in diet. (Namatovu, 2018),
Dietary factors have been suggested to play a role in the prevention of hypertensive
disorders of pregnancy (HDP), including gestational hypertension and pre-eclampsia,
but inconsistent findings have been reported.

11
Dietary intake is the most important determinant of over- or undernutrition, but it is
not the only influence on an individual's nutritional status. (Belay & Wudad, 2019) A
series of extrinsic environmental factors or intrinsic clinical or physiological disorders
can alter the absorption, retention, utilization, and integrity of nutrients. Proteins in the
diet serve as the source of essential as well as non-essential AAs for cellular
metabolism. (Kurer, 2014), Deficiency of dietary protein intake will lead to negative
nitrogen balance, primarily due to the non-availability of the essential AAs. Proteins
provide approximately 10% to 15% of energy intake in an average Western diet, which
amounts to about 70 to 100 g protein per day. (Kurer, 2014), In addition to the
exogenous proteins present in the diet, the intestinal tract is also exposed to
endogenous proteins, which arise from salivary, gastric, intestinal, pancreatic, and
biliary secretions, and also from desquamated cells of the intestinal tract; collectively,
this amounts to about 30 g protein per day. (Namatovu, 2018), Proteins are digested
and absorbed mostly in the small intestine with little or no proteins entering the large
intestine under normal conditions.

Dietary proteins are either of plant or animal origin. (Namatovu, 2018), The nutritional
value of dietary proteins depends primarily on their composition of AAs, particularly
the essential AAs. The body needs all essential AAs; even when just one of the
essential AAs is deficient, it will lead to negative nitrogen balance. Milk proteins and
egg proteins are considered as the standard for comparing the nutritional value of
dietary proteins, with the nutritional value of these standard proteins taken as 100.
(Belay & Wudad, 2019) In general, animal proteins have higher nutritional value than
plant proteins. However, plant proteins from different dietary sources can be combined
to increase their overall nutritional value, and the deficiency of a given essential AA
in one particular plant protein can be complemented by another plant protein that is
rich in that selective essential Associate of Applied Science.

2.4 Health System Factors

The health sector is plagued with inequalities, for example, 70% urban dwellers have
access to health Facilities within 4km, only 30% of the rural population has a similar
access (WHO, 2006). About 44% of patient in Somalia do not seek health care services
due to insufficient fund while 18% don’t seek care because of long distance to the

12
nearest health facility (Namatovu, 2018). In a study at Mogadishu city it was reported
that 58% of patients had to travel more than 5km to access health services (Kurer,
2014). In addition, women hospitalization cost, more than twice yet women are less
likely to be insured those men. (Bastola et al., 2020), Only 12 of the 147 public health
facilities in Mogadishu have equipment to diagnosis high blood pressure in pregnant
women and only a few can treat high blood pressure and fatal complication in
pregnancy.

Physician and patient must form an alliance to more effectively communicate the
importance of starting treatment, and establish goals for therapy (Corresponding,
2021). Not only do physicians often fail to recognize medication non-adherence in
their patients, they may also contribute to it by prescribing complex drug regimens,
failing to explain the benefits and adverse effects of a medication effectively, and
inadequately considering the financial burden to the patient. (Corresponding,
2021)Further in a meta-analysis once daily administration vs. two or more daily
administrations was found to be associated with a reduction of about 50% in risk of
non-adherence to treatment thus less frequent dosing is associated with a significant
reduction in non-adherence to treatment. Mogadishu is also faced with challenges of
funding, lack of equipment supplies and shortage of staff, further regulatory standard
to ensure high quality are poorly developed

2.5 Socio-demographic Factors

According to (Bastola et al., 2020), Socio-demographic factors involve knowledge,

occupation, income, age marital status which when adequate on personal life may lead
to good treatment compliance among pregnant women diagnosed with PIH. (Jamila
Ahmed Aden, 2018), In Somalia especially rural women with low and no education
are more likely to be married early, be in polygamous marriage and have high parity
(Bastola et al., 2020), therefore this puts the women at high risk of getting pregnant
early and prone to PIH and not going for the ANC and high possibility of delivering
at home by unskilled personnel. Poor education is associated with low screening
attendance in the country. About 30% of Somalis women are illiterate. a factor that
contributes to high maternal mortality rates in the country. (Belay & Wudad, 2019),
This could be attributed to the fact that they lack knowledge on methods of preventing
pregnant induced women.
13
Misconception that ANC screening test also include cervical cancer with fear of
screening in cervical cancer embarrassment are associated with pelvic examination
have been cited as reason why most Somalis women avoided health facilities antenatal
care (Hossain et al., 2019). As a long-term treatment women require social support
from family members especially their spouses since it has been recognized to play a
critical role in enhancing treatment compliance(Corresponding, 2021). In many Africa
cultures, women tend to be subservient to men and lack authority to make decisions
concerning their health (Namatovu, 2018).

In Sub-Saharan Africa, prenatal coverage rates have somewhat increased over the last
two decades, with a minor rise from 47 to 49 percent of pregnant women receiving the
necessary care (UN, 2015). Poverty is a major contributor to the wide differences in
maternal health outcomes since it prevents women from accessing antenatal care
owing to inaccessibility, making treatment compliance more difficult for those
diagnosed with PIH (Aden et al., 2019). Furthermore, the opportunistic cost of losing
their jobs and income slows and prevents individuals from seeking medical help
(Corresponding, 2021). Archegonia Sub-County is one of the places with poor
infrastructure, dispersed health facilities, and a poverty rate of 44%, so the majority of
women prefer home deliveries by unskilled attendants, with only 42% delivering under
skilled attendance, and the few who manage skill attendance delivery normally come
late in the process while having maternal complications, indicating a challenge in
treatment compliance.

2.6 Research Gap

This assumption, pomposity of adopted strategies and conditions to ensure the factors
influences induced hypertension among pregnant women and extermination have been
properly outlined in the literature by an author such as (Belay & Wudad, 2019) and
many others. However, the information analyzed from this author does not replicate
the condition of the factors influences induced hypertension among pregnant women.
(Thanthirige et al., 2016)Therefore, most of literature lacks Somalis view; the level of
hypertension among pregnant women particularly by(Jamila Ahmed Aden, 2018),
were published long ago and the role of the factors influences induced hypertension
among pregnant women, after a period has not received acceptable research attention
in Mogadishu, Somalia especially from the above-mentioned authors. That is why this

14
study surveyed the factors influences induced hypertension among pregnant women,
so as to supplement the existing theories on the study variables. (Belay & Wudad,
2019), In reference to review of previous scholars and researchers work, pregnant
hypertension in times of knowledge need always to be sustained in order to meet the
inevitable ever-changing demands.

15
Summary

physician and patient must form an alliance to more effectively communicate the
importance of starting treatment, and establish goals for therapy. Not only do
physicians often fail to recognize medication non-adherence in their patients, they may
also contribute to it by prescribing complex drug regimens, failing to explain the.
benefits and adverse effects of a medication effectively, and inadequately considering
the. financial burden to the patient. Further in a meta-analysis once daily
administration vs. two or more daily administrations was found to be associated with
a reduction of about 50% in risk of non-adherence to treatment thus less frequent
dosing is associated with a significant reduction in non-adherence to treatment is also
faced with challenges of funding, lack of equipment supplies and shortage of staff,
further regulatory standard to ensure high quality are poorly developed.

16
 CHAPTER THREE

METHODOLOGY

3.0 Introduction

This chapters contains research design, target population, Study area, sample size,

sampling techniques, data sources, data collection tools, validity and reliability of

instrument, data processing, data analysis, Inclusion and exclusion criteria and ethical

considerations.

3.1 Research design

The study was based on cross-sectional research design. Cross-sectional study design

is a type of observational study design. In a cross-sectional study, the investigator

measures the outcome and the exposures in the study participants at the same time.

Data collecting for the project was adopted a quantitative approach. This type of study

design was used by the researcher because it is far less expensive to carry out than the

alternatives that are available to researchers.

3.2 Target Population

The study was used a target population of 110 women. The target population is the

total group of individuals from which the sample might be drawn. The researcher was

used these women to fill the questionnaire form because they are believed to have

important information about the risk Factor of Anemia in Pregnant women.

17
3.3 Study area

The study was conducted from MCH Shibis, it located in Shibis district in Mogadishu,

the study was used this MCH to investigate the risk Factor of Anemia in Pregnant

women.

3.4 Sample size

The study was used Sloven’s formula to determine the sample size of the actual
N
respondents. Sloven’s formula states: n = 1+N(e)2

Where; 𝐧 = sample size; 𝐍 = target population; and 𝐞 = 0.05 level of significance

110 110
n = n= 1.275 = 87 women
1+110(0.0025)

Therefore, the sample size is 87 women

3.5 Sampling procedure

The study was based on simple random sampling. Simple random sampling is a type

of probability sampling in which the researcher randomly selects a subset of

participants from a population. women that living in Shibis district was selected simple

random sampling because it provides a possibility to conduct data analysis with a

lower danger of carrying an error, the researcher was applied simple random sampling

in this study.

18
3.6 Data collection instrument

The researcher was used questionnaire. A questionnaire is a research instrument that

consists of a set of questions for the purpose of gathering information from respondents

through survey or statistical study. The researcher was distributed questionnaires to

mothers in Shibis district. The researcher was used only questionnaire because

respondents answer at their suitability.

3.7 Data collection procedure

Accord University was provided an introduction letter. Once it has been authorized,

the researcher was compiled a list of suitable respondents from the civil society,

educators, elders, and leaders. The researcher was then asked the respondents to sign

an informed consent form after explaining the study's purpose to them. The researcher

was applied and educate research assistants to guarantee timely, accurate data

collection. Respondents was required to answer every question in the surveys and not

omit any information. The surveys was collected by the researcher and her helpers

within two weeks of the distribution date. A questionnaire will be verified if it is sent

with all accurate answers.

3.8 Data analysis

The quantitative data was involved information from the questionnaires only. Data

from the field was too raw for proper interpretation. It will therefore be vital to put it

into order and structure it, so as to drive meaning and information from it. The raw

data obtained from questionnaires will be cleaned, sorted and coded. The coded data

will be entered into the computer, checked and statistically analyzed using the

19
statistical package for social scientists (SPSS) software package to generate descriptive

and inferential statistics.

3.9 Quality controls

The researcher was also used validity of the instrument and reliability of instrument.

So, the validity is the extent to which findings from data analysis accurately reflect the

phenomenon being studied. 2009's Mugeda. In order to ensure that the data collected

yields meaningful and reliable results reflected by variables in the study, the researcher

was confirmed that the questions are pertinent before calculating validity. The

researcher was applied this formula to determine the study instrument's validity.

Number of questions deemed legitimate divided by the total number of questions in

the survey is known as the content validity index (CVI). The instrument was

considered as legitimate if its overall Content Validity Index (CVI) equals or exceeds

the median acceptable Index of 0.7 and to confirm the reliability of the instrument, the

researcher was used the test-retest method. The questionnaire will be given to 30

people and after two weeks, the same questionnaire will be given to the same people

and the Cronbatch Alpha was computed using SPSS. The minimum Cronbatch Alpha

coefficient of 0.75 was used to declare an instrument reliable.

3.10 Inclusion and exclusion criteria

The respondents were targeted were academic respondents, who had information my

research study. These are the following members The target population from MCH

Shibis, it located in Shibis district in Mogadishu, the study was used this MCH to

investigate the risk Factor of Anemia in pregnant women of it. The researcher will use

these respondents from this MCH, because they are believed to have important

information about this field.

20
3.11 Ethical Considerations

To confirm ethical considerations in undertaking the study and the safety, social and

psychological well-being of the respondents involved in the study, the researcher was

got an introductory letter from the, Accord University of Somalia. On the other hand,

to ensure the safety of the person or community involved in the study the researcher

was got their consent of the respondent before they fill in the questionnaires. The study

was also ensured the privacy and confidentiality of the information provided by the

respondent which was solely used for academic purposes.

21
 CHAPTER FOUR

FINDINGS AND DISCUSSION

4.0 Introduction

This chapter was confined data presentation, data analysis and discussion on finding
from questionnaire about five sections were include the general health information,
health System Factors, dietary intake Factors and socio-demographic Factors.

4.1 Demographic characteristics of respondents

Demographic of their physical appearance needed examination of gender, marital

status, educational level and age of the respondents. Demographic characteristics of
respondents was deemed necessary because the researcher wanted to show that
respondents with different profile characteristics were presented in the study.

Figure 4. 1 Gender of respondents

The figure 4.1 above shows that 97.7% of the respondents were female and 2.3% of
the respondents were male. This implies that the majority of the respondents were
female. This is because this study was focused on the pregnant women at MCH Shibis
District in Mogadishu Somalia.

22
Figure 4. 2 Marital Status

The figure 4.2 above shows that 90.80% of the women were married and 9.20% of the
women were single. This implies that the majority of the respondents were married.
because they have a good knowledge of factor of Anemia in Pregnant women.

Table 4. 1 Educational level

Frequency Percent
Valid Certificate 22 25.3
Degree 39 44.8
Diploma 26 29.9
Total 87 100.0
Primary data 2023

The table 4.1 above indicates that 22(25.3%) of the respondents were certificate,
39(44.8%) of the respondents were degree and rest were diploma. This implies that the
majority of the women were degree holders. This is because these kinds of women
were believed to have more information about the factor of Anemia in Pregnant
women.
Table 4. 2 Age of the respondents

23
 Frequency Percent
Valid Below 25 22 25.3
Between 25-40 46 52.9
Between 40-55 19 21.8
Total 87 100.0
Primary data 2023

The table 4.2 above indicates that 22(25.3%) of the respondents below 25 years of
their ages, 46(52.9%) of the respondents were between 25-40 years, and 19(21.8%) of
the respondents were between 40-55 of their ages. This implies that the majority of the
respondents were between 25-40. This is because the people we interviewed were
mostly older people who knew a lot about the study.

Figure 4. 3 Work Experience

Primary data 2023

The figure 4.3 above shows that 60.9% of the respondents were below 2-5 their years
of experience, 33.3% of the respondents were below a year and 5.75% of the
respondents were 6 and above. This is because the majority of the respondents were
between 2-5 their experience.

24
4.2 General health information

Figure 4. 4 Current pregnant

The figure 4.4 above illustrates that 30% of the respondents were first, 46% of the
respondents were pregnant again, and 24% of the respondents were third time. This
implies that the majority of the respondents were pregnant again. This is because they
are usually knowledgeable about the stages a pregnant woman goes through.

Table 4. 3 Stage of your pregnancy when you diagnosed with anemia

Frequency Percent
Valid 0-3 months 28 32.2
4-6 months 54 62.1
6-9 months 5 5.7
Total 87 100.0

Primary data 2023

It displays that the stage of your pregnancy when you diagnosed with PIH so the
researcher found that 28(32%) of the respondents were 0-3 months, 54(62%) of the
respondents were between 4-6 months and 5(5.7%) of the respondents were 6-9

25
 months. The majority of the respondents were between 4-6 months. Because it is the
most common season for pregnant women feel Pregnancy-induced hypertension.

Figure 4. 5 How long have you been on anemia drugs

According to the figure 4.5 above shows that how many months pregnant women have
taken the medicine anemia. So, the study found out that 39.08% of the respondents
were a month, 49.43% of the respondents have taken two months and the rest
respondents have taken the medicine three months and above. This implies that the
majority of the respondents were took the medicine two months. This is because it is
the best time to take the medicine for vitamins.

26
Figure 4. 6 If this is not the first pregnancy, how long ago was your previous

When we asked this question "If this was not your first pregnancy, how long was it in
the first place?" to respondents we received data showing the figure 4.6 above shows
that 8% of the respondents were above two years, 63% of them were between one and
two years and 29% of the respondents were less than a year. This implies that the
majority of the respondents were between one and 2years.

Figure 4. 7 If this is not the first pregnancy, did you experience PIH is the previous

Source primary data 2023

27
The table 4.7 above indicates that 25.3% of the respondents said no for the question
above and also, another respondent said yes for the question about “If this is not the
first pregnancy, did you experience PIH is the previous. This implies that the majority
of the respondents were answered yes. This is because most of them have experienced
this condition of Pregnancy-induced hypertension.

4.3 Health System Factors

Table 4. 4 Patient in Somalia do not seek health care services due to insufficient
fund

Frequency Percent
Valid Agree 37 42.5
disagree 2 2.3
Disagree 9 10.3
Neutral 17 19.5
Strongly agree 22 25.3
Total 87 100.0
Source (Primary date 2022)

Figure 4. 8 Patient in Somalia do not seek health care

Table 4.4 and the figure above shows that the majority of the respondents 37(42.5%)
of the women can’t buy any medicine cause of fund, they agreed with that statement
about patient in Somalia do not seek health care services due to insufficient fund.

28
Table 4. 5 Women hospitalization cost, more than twice yet women are less likely to
be insured those men

Frequency Percent
Valid Agree 36 41.4
Disagree 20 23.0
Neutral 18 20.7
Strongly agree 13 14.9
Total 87 100.0
Source (Primary date 2022)

Figure 4. 9 Women hospitalization cost, more than twice…

The table 4.5 and the figure above indicates that 36(41.4%) of the respondents were
agreed, 20(23%) of the respondents were disagreed, 18(20.7%) of the respondents
were neutral 13 (14.9%) of the respondents were strongly agreed with the statement
that Women hospitalization cost, more than twice yet women are less likely to be
insured those men. This implies that the majority of the respondents were agreed.

29
Table 4. 6 Physician and patient must form an alliance to more effectively
communicate the importance of starting

Frequency Percent
Valid Agree 30 34.5
Disagree 23 26.4
Neutral 24 27.6
Strongly agree 10 11.5
Total 87 100.0
Source (Primary date 2023)

Figure 4. 10 6 Physician and patient must form an alliance to more effectively

The table 4.6 and the figure above indicates that 30(34.5%) of the respondents were
agreed, 23(26.4%) of the respondents were disagreed, 24(27.6%) of the respondents
were neutral 10 (11.5%) of the respondents were strongly agreed with the statement
that physician and patient must form an alliance to more effectively communicate the
importance of starting treatment. This implies that the majority of the respondents were
agreed.

30
Table 4. 7 The link between salt and high blood pressure is especially compelling

Frequency Percent
Valid Agree 32 36.8
Disagree 5 5.7
Neutral 33 37.9
Strongly agree 13 14.9
Strongly disagree 4 4.6
Total 87 100.0
Source (Primary date 2023)

Figure 4. 11 The link between salt and high blood pressure…

According to the table 4.7 and the figure above indicates that the majority of the
respondents 33(37.9%) of the women they are sure with this statement that the link
between salt and high blood pressure is especially compelling because they complain
only about anemia that occurs in women during pregnancy.

31
Table 4. 8 Essential anemia is also greatly influenced by diet and lifestyle

Frequency Percent
Valid Agree 29 33.3
Disagree 10 11.5
Neutral 31 35.6
Strongly agree 12 13.8
Strongly disagree 5 5.7
Total 87 100.0

Source (Primary date 2023)

Figure 4. 12 Essential hypertension is also greatly influenced

The table 4.8 and the figure above indicates that 29(33.3%) of the respondents were
agreed, 10(11.5%) of the respondents were disagreed, 31(35.6%) of the respondents
were neutral 12(13.8%) of the respondents were strongly agreed and 5(5.7%) of them
were strongly disagreed with the statement that essential anemia is also greatly
influenced by diet and lifestyle. This implies that the majority of the respondents were
neutral because most of the respondents were not sure this statement.

32
4.4 Dietary intake Factors

Table 4. 9 Dietary intake includes specific foods and calories consumed and relative
quantities

Frequency Percent
Valid Agree 36 41.4
Disagree 7 8.0
Neutral 25 28.7
Strongly agree 16 18.4
Strongly disagree 3 3.4
Total 87 100.0
Source (Primary date 2023)

Figure 4. 13 Dietary intake includes specific foods

The table 4.9 and the figure above indicates that 36(41.4%) of the respondents were
agreed, 7(8%) of the respondents were disagreed, 25(28.7%) of the respondents were
neutral 16(18.4%) of the respondents were strongly agreed and 3(3.4%) of them were
strongly disagreed with the statement that dietary intake includes specific foods and
calories consumed and relative quantities. This implies that the majority of the
respondents were agreed.

33
Table 4. 10 Milk proteins and egg proteins are considered as the standard for
comparing the nutritional value of dietary proteins

Frequency Percent
Valid Agree 28 32.2
Disagree 1 1.1
Neutral 44 50.6
Strongly agree 14 16.1
Total 87 100.0
Source (Primary date 2023)

Figure 4. 14 Milk proteins and egg proteins are considered

According to the table 4.10 and the figure above shows that 28(32.2%) of the
respondents were agreed, 1(1.1%) of the respondents were disagreed, 44(50.6%) of
the respondents were neutral and 14(16%) of the respondents were strongly agreed
with the statement that milk proteins and egg proteins are considered as the standard
for comparing the nutritional value of dietary proteins. This implies that the majority
of the respondents were neutral because most of the respondents were not sure this
statement.

34
Table 4. 11 Dietary factors play a role in the prevention of hypertensive disorders of
pregnancy

Frequency Percent
Valid Agree 34 39.1
Disagree 2 2.3
Neutral 37 42.5
Strongly agree 12 13.8
Strongly disagree 2 2.3
Total 87 100.0

Source (Primary date 2023)

Figure 4. 15 Dietary factors play a role in the prevention

The table 4.11 and the figure above illustrates that 34(39.1%) of the respondents were
agreed, 2(2.3%) of the respondents were disagreed, 37(42.5%) of the respondents were
neutral, 12(13.8%) of the respondents were strongly agreed and 2(2.3%) of the
respondents were strongly disagreed with the statement that dietary factors play a role
in the prevention of hypertensive disorders of pregnancy. This implies that the majority
of the respondents were neutral because most of the respondents were not sure this
statement.

35
Table 4. 12 Deficiency of dietary protein intake will lead to negative nitrogen balance

Frequency Percent
Valid Agree 25 28.7
Disagree 3 3.4
Neutral 39 44.8
Strongly agree 18 20.7
Strongly disagree 2 2.3
Total 87 100.0

Source (Primary date 2023)

Figure 4. 16 Deficiency of dietary protein intake will lead to

negative…..

According to the table 4.12 and the figure above shows that 25(28.7%) of the
respondents were agreed, 3(3.4%) of the respondents were disagreed, 39(44.8%) of
the respondents were neutral, 18(20.7%) of the respondents were strongly agreed and
2(2.3%) of the respondents were strongly disagreed with the statement that deficiency
of dietary protein intake will lead to negative nitrogen balance. This implies that the
majority of the respondents were neutral because most of the respondents were not
sure this statement.

36
Table 4. 13 Dietary proteins are either of plant or animal origin

Frequency Percent
Valid Agree 23 26.4
Disagree 9 10.3
Neutral 38 43.7
Strongly agree 15 17.2
Strongly disagree 2 2.3
Total 87 100.0
Source (Primary date 2022)

Figure 4. 17 Dietary proteins are either of plant or animal origin

The table 4.13 and the figure upstairs shows that 23(26.4%) of the respondents were
agreed, 9(10.3%) of the respondents were disagreed, 38(43.7%) of the respondents
were neutral, 15(17.2%) of the respondents were strongly agreed and 2(2.3%) of the
respondents were strongly disagreed with the statement that Dietary proteins are either
of plant or animal origin. This implies that the majority of the respondents were neutral
because most of the respondents were not sure this statement.

37
4.5 Socio-demographic Factors

Table 4. 14 Personal life may lead to good treatment compliance among pregnant
women diagnosed with PIH

Frequency Percent
Valid Agree 38 43.7
Disagree 3 3.4
Neutral 26 29.9
Strongly agree 16 18.4
Strongly disagree 4 4.6
Total 87 100.0

Source (Primary date 2023)

Figure 4. 18 Personal life may lead to good treatment compliance

The table 4.14 and the figure upstairs shows that 38(43.7%) of the respondents were
agreed, 3(3.4%) of the respondents were disagreed, 26(29.9%) of the respondents were
neutral, 16(18.4%) of the respondents were strongly agreed and 4(4.6%) of the
respondents were strongly disagreed with the statement that personal life may lead to
good treatment compliance among pregnant women diagnosed with PIH. This implies
that the majority of the respondents were agreed with the statement.

38
Table 4. 15 Women with low and no education are more likely to be married early

Frequency Percent
Valid Agree 35 40.2
Disagree 5 5.7
Neutral 33 37.9
Strongly agree 9 10.3
Strongly disagree 5 5.7
Total 87 100.0
Source (Primary date 2023)

Figure 4. 19 Women with low and no education

The table 4.15 and the figure above indicates that 35(40.2%) of the respondents were
agreed, 5(5.7%) of the respondents were disagreed, 33(37.9%) of the respondents were
neutral, 9(10.3%) of the respondents were strongly agreed and 5(5.7%) of the
respondents were strongly disagreed with the statement that women with low and no
education are more likely to be married early. This implies that the majority of the
respondents agreed with the statement.

39
Table 4. 16 Women at high risk of getting pregnant early and prone to PIH

Frequency Percent
Valid Agree 30 34.5
Disagree 10 11.5
Neutral 29 33.3
Strongly agree 12 13.8
Strongly disagree 6 6.9
Total 87 100.0

Source (Primary date 2023)

Figure 4. 20 Women at high risk of getting pregnant early

The table 4.16 and the figure above shows that 30(34.5%) of the respondents were
agreed, 10(11.5%) of the respondents were disagreed, 29(33.3%) of the respondents
were neutral, 12(13.8%) of the respondents were strongly agreed and 6(6.9%) of the
respondents were strongly disagreed with the statement that women at high risk of
getting pregnant early and prone to PIH. This implies that the majority of the
respondents agreed with the statement.

40
Table 4. 17 Treatment compliance more difficult for those diagnosed with anemia

Frequency Percent
Valid Agree 39 44.8
Disagree 3 3.4
Neutral 28 32.2
Strongly agree 11 12.6
Strongly disagree 6 6.9
Total 87 100.0

Source (Primary date 2022)

Figure 4. 21 Treatment compliance more difficult for those

The table 4.17 and the figure above shows that 39(44.8%) of the respondents were
agreed, 3(3.4%) of the respondents were disagreed, 28(32.2%) of the respondents were
neutral, 11(12.6%) of the respondents were strongly agreed and 6(6.9%) of the
respondents were strongly disagreed with the statement that treatment compliance
more difficult for those diagnosed with PIH. This implies that the majority of the
respondents agreed with the statement.

41
Table 4. 18 Most of Somalis women avoided health facilities antenatal care

Frequency Percent
Valid Agree 34 39.1
Disagree 13 14.9
Neutral 31 35.6
Strongly agree 9 10.3
Total 87 100.0

Source (Primary date 2022)

Figure 4. 22 Most of Somalis women avoided health facilities

The table 4.18 and the figure above shows that 34(39.1%) of the respondents were
agreed, 13(14.9%) of the respondents were disagreed, 31(35.6%) of the respondents
were neutral, and 9(10.3%) of the respondents were strongly agreed with the statement
Most of Somalis women avoided health facilities antenatal care. This implies that the
majority of the respondents agreed with the statement. This is because these kinds of
respondents were aware this statement.

42
4.6 Discussion on findings

In this study of at MCH Shibis District pregnant women, hookworm infection, lack of
iron supplement intake, impaired dark adaptation and a diet deficient in heme iron
were associated with increased risk of severe anemia and iron deficiency. These risk
factors differed among non-iron-deficient anemic, iron-deficient anemic and
irondeficient non-anemic women. The study was discussed in this section, the risk
factor of anemia in pregnant women in MCH Shibis District in Mogadishu Somalia
Therefore, when the researcher analyzed the data from the respondents.

4.6.1 Health System Factors

The study was discussed in this section, the three objectives of the study that
mentioned above so the first objective of the study was health System Factors that
includes many factors like housing, financial security, community safety, employment,
education and the environment. Therefore, when the researcher analyzed the data from
the respondents the study found out that 37(42.5%), of the respondents were agreed,
2(2.3%) of the respondents were disagreed, 9(10.3%) of the respondents were strongly
disagreed, 17(19.5%) of the respondents were neutral and 22 (25.3%) of the
respondents were strongly agreed with the statement that patient in Somalia do not
seek health care services due to insufficient fund. This implies that the majority of the
respondents were agreed with that statement. This is in line with (Jamila Ahmed Aden,
2018) who noted that patient in Somalia do not seek health care services due to
insufficient fund. It was found that 36(41.4%) of the respondents were agreed,
20(23%) of the respondents were disagreed, 18(20.7%) of the respondents were neutral
13 (14.9%) of the respondents were strongly agreed with the statement that Women
hospitalization cost, more than twice yet women are less likely to be insured those
men. This implies that the majority of the respondents were agreed. This is in line with
(Namatovu, 2018) who suggested that women hospitalization cost, more than twice
yet women are less likely to be insured those men. So, Women also need health care
more and access the health care system more than do men.

The researcher revealed that 30(34.5%) of the respondents were agreed, 23(26.4%) of
the respondents were disagreed, 24(27.6%) of the respondents were neutral 10 (11.5%)

43
of the respondents were strongly agreed with the statement that physician and patient
must form an alliance to more effectively communicate the importance of starting
treatment. This implies that the majority of the respondents were agreed. this is in line
with (Belay & Wudad, 2019) who noted that physician and patient must form an
alliance to more effectively communicate the importance of starting treatment. The
physician-patient relationship is a foundation of clinical care. The study was found out
the link between salt and high blood pressure is especially compelling. This implies
that the majority of the respondents were agreed. This is in line with (Namatovu, 2018)
who noted that High blood pressure raises the risk of having a heart attack, heart
failure, stroke, or kidney disease.

It was found that that 29(33.3%) of the respondents were agreed, 10(11.5%) of the
respondents were disagreed, 31(35.6%) of the respondents were neutral 12(13.8%) of
the respondents were strongly agreed and 5(5.7%) of them were strongly disagreed
with the statement that essential hypertension is also greatly influenced by diet and
lifestyle. This implies that the majority of the respondents were neutral because most
of the respondents were not sure this statement. This is in line with (Austin, 2017) who
noted that essential hypertension is also greatly influenced by diet and lifestyle.
hypertension occurs when you have abnormally high blood pressure that's not the
result of a medical condition.

4.6.2 Dietary intake Factors

The study was found out that 36(41.4%) of the respondents were agreed, 7(8%) of the
respondents were disagreed, 25(28.7%) of the respondents were neutral 16(18.4%) of
the respondents were strongly agreed and 3(3.4%) of them were strongly disagreed
with the statement that dietary intake includes specific foods and calories consumed
and relative quantities. This implies that the majority of the respondents were agreed.
This is in line with (Belay & Wudad, 2019) who noted that dietary intake includes
specific foods and calories consumed and relative quantities. but it is not the only
influence on an individual's nutritional status. The study was revealed that 28(32.2%)
of the respondents were agreed, 1(1.1%) of the respondents were disagreed, 44(50.6%)
of the respondents were neutral and 14(16%) of the respondents were strongly agreed

44
with the statement that milk proteins and egg proteins are considered as the standard
for comparing the nutritional value of dietary proteins. This implies that the majority
of the respondents were neutral because most of the respondents were not sure this
statement. This is in line with (Owiredu et al., 2012) who suggested that milk proteins
and egg proteins are considered as the standard for comparing the nutritional value of
dietary proteins.

It was revealed that 34(39.1%) of the respondents were agreed, 2(2.3%) of the
respondents were disagreed, 37(42.5%) of the respondents were neutral, 12(13.8%) of
the respondents were strongly agreed and 2(2.3%) of the respondents were strongly
disagreed with the statement that dietary factors play a role in the prevention of
hypertensive disorders of pregnancy. This implies that the majority of the respondents
were neutral because most of the respondents were not sure this statement. This is in
line with (Yassin, 2015) who noted that dietary factors play a role in the prevention of
hypertensive disorders of pregnancy. Hypertensive disorders of pregnancy (HDP) are
among the major causes. A novel fixed-dose combination pill. deficiency of dietary
protein intake will lead to negative nitrogen balance. This implies that the majority of
the respondents were neutral because most of the respondents were not sure this
statement. It was found that 23(26.4%) of the respondents were agreed, 9(10.3%) of
the respondents were disagreed, 38(43.7%) of the respondents were neutral, 15(17.2%)
of the respondents were strongly agreed and 2(2.3%) of the respondents were strongly
disagreed with the statement that Dietary proteins are either of plant or animal origin.
This implies that the majority of the respondents were neutral because most of the
respondents were not sure this statement.

4.6.3 Socio-demographic Factors

The researcher was discovered that 38(43.7%) of the respondents were agreed,
3(3.4%) of the respondents were disagreed, 26(29.9%) of the respondents were neutral,
16(18.4%) of the respondents were strongly agreed and 4(4.6%) of the respondents
were strongly disagreed with the statement that personal life may lead to good
treatment compliance among pregnant women diagnosed with anemia. This implies
that the majority of the respondents were agreed with the statement. This is in line with
(Austin, 2017) who noted that personal life may lead to good treatment compliance

45
among pregnant women diagnosed with PIH. Women experience unique health care
challenges and are more likely to be diagnosed with certain diseases than men.

The researcher was revealed that 35(40.2%) of the respondents were agreed, 5(5.7%)
of the respondents were disagreed, 33(37.9%) of the respondents were neutral,
9(10.3%) of the respondents were strongly agreed and 5(5.7%) of the respondents were
strongly disagreed with the statement that women with low and no education are more
likely to be married early. This implies that the majority of the respondents agreed with
the statement. This is in line with (Austin, 2017) who noted that low and no education
are more likely to be married early. Child for early marriage when she is still young
may lead to lack of health, lack of care, unwanted pregnancies and she might be
overburdened with domestic work.

It was revealed that 30(34.5%) of the respondents were agreed, 10(11.5%) of the
respondents were disagreed, 29(33.3%) of the respondents were neutral, 12(13.8%) of
the respondents were strongly agreed and 6(6.9%) of the respondents were strongly
disagreed with the statement that women at high risk of getting pregnant early and
prone to PIH. This implies that the majority of the respondents agreed with the
statement. This is in line with (Hossain et al., 2019) who noted that women at high risk
of getting pregnant early and prone to PIH. These pregnancies require close monitoring
to reduce the chance of complications. It was discovered that 39(44.8%) of the
respondents were agreed, 3(3.4%) of the respondents were disagreed, 28(32.2%) of
the respondents were neutral, 11(12.6%) of the respondents were strongly agreed and
6(6.9%) of the respondents were strongly disagreed with the statement that treatment
compliance more difficult for those diagnosed with PIH. This implies that the majority
of the respondents agreed with the statement. This is in line with (Austin, 2017) who
suggested that compliance more difficult for those diagnosed with anemia.

The study was found out that 34(39.1%) of the respondents were agreed, 13(14.9%)
of the respondents were disagreed, 31(35.6%) of the respondents were neutral, and
9(10.3%) of the respondents were strongly agreed with the statement Most of Somalis
women avoided health facilities antenatal care. This implies that the majority of the
respondents agreed with the statement. This is because these kinds of respondents were
aware this statement. This is in line with (Aden et al., 2019) who noted that most of

46
Somalis women avoided health facilities antenatal care. three times more likely to have
a low birth weight and five times more likely to die than those born to mothers who do
get care.

47
 CHAPTER FIVE

CONCLUSSION AND RECOMMENDATIONS

5.0 Introduction

This chapter was covered conclusion and recommendations that includes the level of
dietary intake that related factors influence induced risk Factor of Anemia among
pregnant women, the health system factors that influence induced risk Factor of
Anemia among pregnant women and the socio-demographic factors that influence
induced risk Factor of Anemia among pregnant women at MCH Shibis District in
Mogadishu Somalia

5.1 Conclusion

The study was concluded that the first objective of the study that is the health system
factors that influence induced hypertension among pregnant women at MCH Shibis
District in Mogadishu Somalia, so the patient in Somalia do not seek health care
services due to insufficient fund. It was concluded that women hospitalization cost,
more than twice yet women are less likely to be insured those men. So, Women also
need health care more and access the health care system more than do men. The study
was concluded that physician and patient must form an alliance to more effectively
communicate the importance of starting treatment. The physician-patient relationship
is a foundation of clinical care. It was summarized that High blood pressure raises the
risk of having a heart attack, heart failure, stroke, or kidney disease. The researcher
was concluded that essential hypertension is also greatly influenced by diet and
lifestyle. hypertension occurs when you have abnormally high blood pressure that's
not the result of a medical condition. most of the respondents agreed with this
objective.

This paragraph the study was concluded the second objective of the study that was
level of dietary intake that related factors influence induced hypertension among

48
pregnant women. So, the researcher was resolved that dietary intake includes specific
foods and calories consumed and relative quantities. but it is not the only influence on
an individual's nutritional status. It was concluded that milk proteins and egg proteins
are considered as the standard for comparing the nutritional value of dietary proteins.
The researcher was concluded that who noted that dietary factors play a role in the
prevention of hypertensive disorders of pregnancy. Hypertensive disorders of
pregnancy (HDP) are among the major causes, most of respondents were very
impressed with this objective.

The researcher was concluded the last objective of the study that personal life may
lead to good treatment compliance among pregnant women diagnosed with PIH.
Women experience unique health care challenges and are more likely to be diagnosed
with certain diseases than men. And the study was summarized that low and no
education are more likely to be married early. Child for early marriage when she is still
young may lead to lack of health, lack of care, unwanted pregnancies and she might
be overburdened with domestic work. It was concluded that women at high risk of
getting pregnant early and prone to PIH. These pregnancies require close monitoring
to reduce the chance of complications it was concluded that compliance more difficult
for those diagnosed with PIH. It summarized that most of Somalis women avoided
health facilities antenatal care. three times more likely to have a low birth weight and
five times more likely to die than those born to mothers who do get care.

49
5.2 Recommendations

When we conducted this study, 87 respondents including pregnant and non-pregnant

women responded. They were very impressed with the questions we asked, so we offer
them as a recommendation.

1. Iron deficiency is the most common cause of anemia in pregnancy. therefore,

pregnant women must find the things that can prevent this anemia such as
Folate that is found naturally in certain foods like green leafy vegetables A type
of B vitamin, the body needs folate to produce new cells, including healthy red
blood cells.
2. The study recommends that pregnant women should take a prenatal vitamin
that contains iron can help prevent and treat iron deficiency anemia during
pregnancy.
3. When they are pregnant, their Hb decreases, and this study recommends that
pregnant women should eat blood-repellent food that can be good nutrition.
and that they always use iron medicine to raise their blood and also the pregnant
women should eat nutritious food, so that they will be able to give birth.
4. Anemia in Pregnancy considered a significant public health problem. It has an
essential role in disabled life and death of pregnant women and their future
children. so that the study recommends that to provide medical institutions with
assistance to people who are unable to provide nutrition to their children and
their children. they should stand up for the weak community.
5. The study recommends that civil society in Mogadishu, especially Shibis
district, stand up and take care of their poor communities, especially pregnant
women, who are suffering from anemia and malnutrition.

50
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M., & Fine, P. (2017). Prevalence and risk factors for anemia severity and type
in Malawian men and women:
Aden, J. A., Ahmed, H. J., & Östergren, P. O. (2019). Causes and contributing factors
of maternal mortality in Bosaso District of Somalia. A retrospective study of 30
cases using a Verbal Autopsy approach. Global Health Action, 12(1).
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Amponsah, J. A., Ashong, J. A., Amanfo, A. O., Ken-Amoah, S., Kudjonu, H. T.,
& Mohammed, M. (2022). Knowledge of hypertensive disorders of pregnancy
among pregnant women attending antenatal clinic at a tertiary hospital in Ghana.
SAGE Open Medicine, 10,
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to Washington State from 2003–2013. ProQuest Dissertations and Theses, 37.
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Moss, N., McClure, E. M., & Goldenberg, R. L. (2008). Anemia prevalence and
risk factors in pregnant women in an urban area of Pakistan. Food and Nutrition
Bulletin, 29(2), 132–
Bastola, K., Koponen, P., Härkänen, T., Luoto, R., Gissler, M., & Kinnunen, T. I.
(2020). Pregnancy complications in women of Russian, Somali, and Kurdish
origin and women in the general population in Finland. Women’s Health, 16.
https://doi.org/10.1177/1745506520910911
Belay, A. S., & Wudad, T. (2019). Prevalence and associated factors of pre-eclampsia
among pregnant women attending anti-natal care at Mettu Karl referal hospital,
Ethiopia: cross-sectional study. Clinical Hypertension, 25(1), 1–8.
https://doi.org/10.1186/s40885-019-0120-1
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7292(11)60005-2
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Hossain, S., Roy, S., Kirk, K., & Warren, C. (2019). Hypertensive Disorders in
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Their Infants in Bangladesh. The Population Council, Inc, December, 1–26.
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a sample of pregnant women in babylon governorate, Iraq. Revista
Latinoamericana de Hipertension, 15(4), 275–279.
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52
 APPENDICES

APPENDIX I: QUESTIONNAIRE

Dear respondent

My name is Ifrah Mohamed Abdulle, a student of Accord University, pursuing Master

of Public health. I am currently carrying out a study about “the risk Factor of Anemia
in Pregnant women in MCH Shibis District in Mogadishu Somalia.” as a requirement
for the award of department of health science. I humbly request you to be one of the
participants in this study and your cooperation will be of great importance to this study.
Your answers will be kept with utmost confidentiality.

SECTION 1: Demographic characteristics of respondents

1. Gender of respondent
Male
Female

2. Marital Status
Married
Single

3. Educational level

Certificate
Diploma
Degree
Master

53
4. Age of the respondent

Below 25
Between 26-40
Between 41-55
56 and above

5. Work experience
Below 1
Below 2- 5
6 and above

SECTION 2: General health information

1. The current pregnancy

First
Second
Third

2. Stage of your pregnancy when you diagnosed with PIH

0-3 months
4-6 months
7-9 months

3. How long have you been on PIH drugs?

1 month
2 months
3 or above months

54
4. If this is not the first pregnancy, how long ago was your previous
birth/miscarriage?

Less than 1 year

Between 1 and 2 Years
Above 2 years

5. If this is not the first pregnancy, did you experience PIH is the previous
pregnancy?

Yes
No

Instructions: Please write your rating on the space before each option which
corresponds to your best choice in terms of level of motivation. Kindly use the scoring
system below:

Score Response Mode Description Interpretation

1 Strongly agree You agree with no doubt at all Very satisfactory

2 Agree You agree with some doubt Satisfactory

3 Neutral You are not sure about any None

4 Disagree You disagree with some doubt Fair

Strongly disagree You disagree with no doubt at all Poor

5

55
SECTION 3: Health System Factors

No Statement 1 2 3 4 5
1 Patient in Somalia do not seek health care
services due to insufficient fund

2 Women hospitalization cost, more than twice yet

women are less likely to be insured those men

3 Patient must form an alliance to more effectively

communicate the importance of starting
treatment
4 The link between salt and high blood pressure is
especially compelling

5 Essential hypertension is also greatly influenced

by diet and lifestyle

SECTION 4: Dietary intake Factors

No Statement 1 2 3 4 5
1 Dietary intake includes specific foods and
calories consumed and relative quantities

2 Milk proteins and egg proteins are considered as

the standard for comparing the nutritional value
of dietary proteins
3 Dietary factors play a role in the prevention of
hypertensive disorders of pregnancy

4 Deficiency of dietary protein intake will lead to

negative nitrogen balance

56
5 Dietary proteins are either of plant or animal
origin

SECTION 5: Socio-demographic Factors

No Statement 1 2 3 4 5
1 Personal life may lead to good treatment
compliance among pregnant women diagnosed
with PIH
2 Women with low and no education are more
likely to be married early

3 Women at high risk of getting pregnant early and

prone to Anemia
4 Treatment compliance more difficult for those
diagnosed with anemia

5 Most of Somalis women avoided health facilities

antenatal care

57
 APPENDIX II

TIME FRAME

Activity April May Jun

Topic formulation

Introduction writing

Literature review writing

Methodology

Data collection and analyze

Findings and Discussion, conclusion and

recommendations

Final copy submission

58
 APPENDIX III

BUDGET

ITEM QUANTITY AMOUNT ($)

Communication Air time and data 30

Transport To & from 10

Meals Lunch 12

Printing 3copies 12

Binding 3copies 9

Papers 1 box 5

Total budget $78.00

59