DEBRE MARKOS UNIVERSTY

COLLEGUE OF MEDCEN AND HEAlTH SCINCE

DEPARTMENT OF MIDWIFERY

Prevalence and Associated Factors of Low Birth Weight among Mothers Who Gave
Birth in dangila primery Hospital,Awi zone, amhara Region ,Ethiopia 2009E.C

AStudent Research Proposal Submitted to Debremarkos University College of

medicine and Health Sciences Department of Midwifery in Partial Fulfillments for
the Degree of Bachelor of Science in Midwifery.

1. By:1 MollaTemesgen
2 MinichlBeweta
3 MelkamTesfaye
4 MelashuAdugna
5 MisganawLiyew

Advaisors:
1 Asmare A.
2 Tebkew
Examiners: March 2009 DagilaEthio

1
2
 DEBRE MARKOS UNIVERSITY
COLLEGE OF MEDICEN AND HEALTH SCINCE
DEPARTMENT OF MIDWIFERY

Prevalence and Associated Factors of Low Birth Weight among Mothers Who Gave
Birth in DangilaPrimery Hospital

A Student Research Project Submitted to DebreMarkos University College of

Medicine And Health Sciences and Department of Midwifery in Partial Fulfillments
for the Degree of Bachelor of Science in Midwifery.

 By:1 MollaTemesgen
2 MinichlBeweta
3 MelkamTesfaye
4 MelashuAdugna
5 MisganawLiywe

Advaisors:
1 Asmare A.
2 Tebkew
Examiners: March 2009 DagilaEthio

3
Acknowledgments
We would like to thank the following individuals for theire contribution to design thise research
proposal
First and for most we would like to thanks our advisors, Asmare.A and Tebkew, for their
unprecedented and unreserved support, comments and follow up throughout the development of
our research proposal.
we would like to forward our appreciation to DebremarkosuniverstyUniversity,College of
medicine and Health Science, and Department of Midwifery for giving this chance to conduct the
study in our carreir.
Finaly we would like to forward our acknowledgment to Danglaprimery hospital, Obstetrics and
Gynecology department staff members for giving relevant information about source of population
and their help during data collection.

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 Table of content

Acknowledgmet …………………………………………………………………………………………………………….3

Table of content……………………………………………………………………………………………………………..4

Acronyms………………………………………………………………………………………………………………………..6

Summary…………………………………………………………………………………………………………………………7

Chapter one. Introduction………………………………………………………………………………………………7

1.1Background of the study……………………………………………………………………………8

1.2.Statement of the problem……………………………………………………………………….10

1.3.Significance of the study………………………………………………………………………….12

Chapter two.Literatur review……………………………………………………………………………………….13

2.1 Magnitude of LBW…………………………………………………………………………………………...13

2.2.Risk factor for LBW……………………………………………………………………………………….… ..14

Chapter three.Objectives of the study………………………………………………………………………….20

3.1.General objective…………………………………………………………………………………………….20

3.2.Specific objective…………………………………………………………………………………………….20

Chapter four.Method and material…………………………………………………………………………….21

4.1Study area and period…………………………………………………………………………………….21.

4.2.Study design…………………………………………………………………………………………………..21

4.3.Population…………………………………………………………………………………………………….21

4.4.Eligibility criteria……………………………………………………………………………………………22

4.5.Sampling……………………………………………………………………………………………………….22

4.6.Variabilies of the study…………………………………………………………………………………23

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 4.7.Operational definitions……………………………………………………………………………………24

4.8.Data collection procedure……………………………………………………………………………….25

Chapter five.Ethical consideration……………………………………………………………………………….26

Chapter six.Dissemination of result……………………………………………………………………………..26

Chapter seven.Work plan of the study…………………………………………………………………………26

Chapter eight.Budget breakdown………………………………………………………………………………..26

Chapter nine.Reference………………………………………………………………………………………………27

ANNEX………………………………………………………………………………………………………………………30

1.Consent form…………………………………………………………………………………………….30

2.English version questionnaires…………………………………………………………………… 31

3.Amharic version questionnaires…………………………………………………………………34

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 Acronyms

ANC: Antenatal Care

ART:Active Anti-Retroviral Therapy
BW: Birth Weight
CI: Confidence Interval
DM: Diabetes Mellitus
DMU: DebreMarkosUniversty
DPH: Danglaprimery Hospital
EDHS: Ethiopian Demographic and Health Survey
HAART:Highly Active Anti-Retroviral Therapy
HIV: Human Immunodeficiency Virus
IOM: Institute of Medicine
IUGR: Intrauterine Growth Retardation
LBW: Low Birth Weight
MDG: milliniumdevlopmet goal
MUAC: Mid Upper Arm Circumference
NBW: Normal Birth Weight
PLWHA: People Living with HIV and AIDS
PROM: premature rupture of membrane
PIH: Pregnancy Induced Hypertension
RPC: Research and Publication Committee
SD: Standard Deviation
SGA: Small-For-Gestational Age
UNICEF: United Nations Children‘s Fund
VLBW: Very Low Birth Weight

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WHO: World Health Organization

summary

Introduction: Low birth weight is defined as birth weight less than 2,500 grams.irrespective of
gestationa age. It can be subdivided in to very low birth weight(VLBW) <1500g,extremely low
birth weight(EVLBW)<1000g and low birth weight 1500-2500g. birth weight should be
measueredwithen the first hour of life. More than 20 million infants are born each year weighing
less than 2500 gm., accounting for 17% of all births in the developing world. Similarly, according
to Ethiopian demographic and health survey (EDHS 2011), 11% weighed less than 2500 gm. Birth
weight plays an important role in infant mortality and morbidity, development, and future health of
the child. Weight at birth is directly influenced by general level of health status of the mother.
Objectives: The main objective of the study is to asses the prevalence and associated factor of low birth
weight among mothers delivered at Dangilaprimery hospital Awizone,Amhara region Ethiopia 2009 E.C

Methodology: Institutional based cross sectional study design will be conducted at Dangilaprimery
hospital from January 27 to June 10 . Simple random sampling techniques will be used to select the study
samples. Data was collected by using pre-tested, standardized questionnaire with interview type of data
collection method from mothers and recording the birth weight of new born. It will conducted by taking
accurate weight of new born and interviewing mother. The collected data will entered to and analyzed by
SPSS version 20.Bi-variant analysis were employed to see association between independent and
dependent variable.

Workplan:the study will be conducted from the study periode classified in three major
phases.the first phase involves proposal development, approval and ethical clearance .the second
phase involves data collection, supervision and monitoring data collection . the third phase involves
thesis write up and paper submission.

Budget.:the study will be expected to cost us tota of8245 Et birr.

Chapter One. Introduction

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1.1 Background of the study
Low birth weight (LBW) is defined by the World Health Organization (WHO) as weight at birth of
less than 2,500 grams (1). This is based on epidemiological observations that infants weighing less
than 2,500 g were approximately 20 times more likely to die than heavier babies. More commonly,
in developing than developed countries, a birth weight below 2,500 g contributes to several poor
health outcomes.
Birth weight is affected to a great extent by the mother‘s own fetal growth and her diet from birth
to pregnancy, and thus, her body composition at conception (1). Mothers in deprived socio-
economic conditions frequently have low birth weight infants. In those settings, the infant‘s low
birth weight emerges primarily from the mother‘s poor nutrition and health over a long period of
time. During pregnancy, the higher prevalence of specific and non-specific infections, or from
pregnancy complications, underpinned by poverty aggravates the situation. Physically demanding
work during pregnancy also contributes to poor fetal growth.
Several studies indicated that a baby‘s low weight at birth is either the result of preterm birth
(before 37 weeks of gestation) or of restricted fetal (intrauterine) growth (1). Many factors affect
the duration of gestation and of fetal growth, and thus, the birth weight. They are related either to
the infant, or to the mother. The physical environment also plays an important role in determining
the infant‘s birth weight and future health status.
The United Nations Children‘s Fund (UNICEF) report noted that, the global LBW rate was 15.5%
and more than 95% of these LBW infants lived in developing countries (1). More than 20 million
infants are born each year weighing less than 2500 gm, accounting for 17 percent of all births in
the developing world (3). There is a strong consensus that birth weight plays an important role in
infant mortality, morbidity, development, and future health of the child. Particularly, low birth
weight is a most significant risk factor for adverse health outcomes including common childhood
diseases. The association between LBW and a greatly elevated risk of infant mortality and other
physical and neurological impairments are well established fact.
Demographic risk factors include young maternal age, primi-parity and low education level and
poor maternal nutritional status –both before and during pregnancy—are well-recognized
determinants of birth outcomes. Empirical studies from developed and developing countries show
that maternal anthropometric measurements are associated with birth outcome (i.e. LBW) (4).

9
A recent study indicates the incidence of LBW to be 13% in Ethiopia. Consistently, another study
from Jimma reported a prevalence of 11.8%. At a regional level, for East Africa, estimates indicate
13 % prevalence. The same estimate for Africa indicates up to 15% prevalence of LBW (5). It was
established that early delivery and retarded fetal growth to be the major reason to the cause of low
birth weight. Thus, the discussion about the cause and epidemiology of LBW should focus around
risk factors that shorten the gestation's age and those that influence this.
World Health Organization (WHO) shows that factors contributing to LBW in developing
countries include, in order of importance; inadequate weight gain during pregnancy, low pre
pregnancy weight, short stature, malaria and female sex of the fetus (6). Other factors which are
associated with LBW include hard physical work during pregnancy, and illness,especially
infections, social factors such as lower status of women, malnutrition, lack of antenatal care (ANC)
etc. Mothers who had multiple gestations had a higher risk of delivering LBW babies.

According to UNICEF statistics, the global rate of LBW is 17%, out of which 6% is observed in
industrialized countries and 21% in developing (7); LBW is caused by preterm birth and
intrauterine growth retardation (IUGR) or both. The predominant cause of LBW in the developed
countries is pre term birth, whereas in developing countries, it is frequently caused by IUGR (7).
In Ethiopia, studies showed that the prevalence of LBW varies from 6-10 %.
Another retrospective study conducted to establish BW changes at TikurAnbessa Hospital
showed that LBW has increased trend between 1976 and 1996 (8). According to the 2005/06
annual activity report of the Addis Ababa City Administration, Health Bureau, the rate of LBW
among all deliveries attended from health institutions reporting to the city health bureau is 11%.
half of all low birth weight babies are born in south centraasia countries , where 27% are below
2500g at birth. The commonest cause of LBW in sub Saharan African countries are malaria and
malnutrition in pregnancy. Malaria also leads to premature delivery.
The fourth millinium development goals,(MDG) is to reduce child mortality by 2/3 from 1990 to
2015. Under five mortality and infant mortality ratsare two of the indicators used to monitor the
fourth MDGs.

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1.2 Statement of the problem
More than 20 million infants worldwide, representing 15.5 percent of all births, are born with low
birth weight, 95.6 percent of them in developing countries (1). The level of low birth weight in
developing countries (16.5 percent) is more than double the level in developed regions (7 per cent).
Half of all low birth weight babies are born in South-central Asia, where more than a quarter (27
percent) of all infants weighs less than 2,500 gm at birth. A low birth weight level in sub-Saharan
Africa is around 15 percent (1). Central and South America have, on average, much lower rates (10
percent), while in the Caribbean the level (14 percent) is almost as high as in sub- Saharan Africa.
About 10 percent of births in Oceania are low birth weight births.
The WHO country cooperation strategy 2008 – 2011 showed that the prevalence of low
birth weight in Ethiopia, estimated that 14%, it is one of the highest in the world (9 ,10).
Low birth weight, thus defines a heterogeneous group of infants: some are born early, some are
born growth restricted, and others are born both early and growth restricted (1). It is generally
recognized that being born with low birth weight is a disadvantage for the baby. Short gestation
(preterm birth) is the main cause of death, morbidity and disability .The shorter the gestation, the
smaller the baby and the higher the risk of death, morbidity and disability. It has been shown that
the mortality range can vary 100-fold across the spectrum of birth weight and rises continuously
with decreasing weight.
Low birth weight due to restricted fetal growth affects the person throughout life and is associated
with poor growth in childhood and a higher incidence of adult diseases, such as type 2 diabetes,
hypertension and cardiovascular disease (1). An additional risk for girls is having smaller babies
when they become mothers.
Birth weight has a significant impact on newborn mortality. Low birth weight (LBW) increases the
risk of neonatal deaths and further increases the likelihood of developing cerebral palsy and the
risk of infection (sepsis) (11). As adults, these LBW infants may continue to be lower in weight
and shorter in stature in comparison to population averages. LBW is also associated with the
development of chronic diseases such as hypertension, cardiovascular diseases, type II diabetes,
metabolic syndrome, ischemic heart disease, decreased lung capacity and chronic lung disease.
Deliveries in low and middle income countries are often complicated by adverse birth outcomes
such as stillbirth, early neonatal mortality and morbidity. Low birth weight (LBW) remains to be a

11
leading cause of neonatal death, and is a major contributor to infant and under-five mortality (8).
Infants weighing less than 2,500 gm at birth are regarded as LBW infants. LBW is associated with
early and late morbid conditions such as coronary heart disease, non-insulin dependent diabetes,
childhood hypertension, behavioral disorders, impaired cognitive function, psychological
disorders, and these usually have long-term financial burden. Infants can have LBW either as a
result of small-for-gestational age (SGA) or preterm delivery (12, 13). An infant is said to be
small-for gestational-age when the gender-specific birth weight is below the 10th
Pre term (<37 weeks of gestation), percentile for the appropriate gestational age; such a condition
could be constitutional or pathological, in the latter case; it is referred to as Intrauterine Growth
Retardation (IUGR) (12, 13). LBW is a leading cause of neonatal mortality (14). It is now also
incriminated in the occurrence of many chronic diseases in adult life time; these include adult-
onset diabetes, coronary heart disease, and high blood pressure, intellectual, physical and sensory
disabilities (15). However, little attention is paid to birth weight improvement as a means of
reducing child mortality. In most developing countries, it was approximated that every ten seconds
an infant dies from a disease or infection that can be attributed to LBW (16). Those who had a
history of very low birth weight (VLBW) are 2.6 times at risk of respiratory failure requiring
mechanical ventilation (8, 17).
Although about one-half of all LBW infants in industrialized countries are born most LBW
infants in developing countries are born at term and are affected by intrauterine growth
restriction that may begin early during pregnancy (8, 18). As children, LBW infants are more
likely to have disabilities, hospitalizations, brain damage, and poorer language development, be
placed in special education classes, and display more intellectual impairments. Across the
world neonatal mortality is 20 times more likely for LBW babies compared to heavier babies
(>2500gm) and it increases sharply as birth weight (BW) decreases (8, 19).
According to the World Health Organization (WHO) definition, infants with birth weight less than
2500 gm are low birth weight (LBW). Out of 121 million births in a year 23 million has LBW and
high proportion of who are found in developing countries (20). Birth weight is an important
indicator of health status of an infant and is a principal factor that determines the infant‘s,
physical, survival and mental growth. It also indicates past and present health status of the
mother (21). LBW is considered as the single most important predictor of infant mortality,
especially of deaths within the first months of life (10, 22). It is also a significant determinant of
12
infant and childhood morbidity, particularly of neurodevelopment impairment such as mental
retardation and learning disability. Half of all prenatal and one third of all infant deaths are directly
or indirectly related to LBW. Mortality of LBW babies is 40 times more than the normal weight
babies. Infants born with very low weight are more than 100 times more likely to die in the first
year of life than are infants of normal birth weight (10, 22).
There is no study had yet been done before in Danglaprimery hospital, to determine the prevalence
of LBW and associated risk factors with LBW. Therefore, this study aims to determine the
prevalence and identify associated risk factors of low birth weight in Danglaprimeryhospital ,Awi
zone Amhara region, Ethiopia,2009E.C.

1.3 Significance of the study

This study will be conducted to determine the prevalence and associated factors that may cause for
LBW and contributing to infant mortality in the study area of mother.
The reduction in the incidence of LBW also forms an important component of MDGs on childrens
health. Activities towards the achievement of MDGs will need to ensure healthy start in life by
making certain that women commenence pregnancy healthy and well nourished and go through
pregnancy and child birth safly.Increase awareness about the associated factors of LBW will lead
to a better evidence based interventions in Ethiopia aimed at reducing neonatal mortality.
This study provides information in the burden of low birth weight and its relation to the different
factors, and provides a working base for planning, improving, programs and interventions.
This study provides valuable information on the prevalence and associated factor of LBW to health
professionals, researchers, regional health bureau and other stakeholders. By using this study the

13
above professional plan their resource for interventions and for researchers used this research result
as a baseline for future studies.
The result of this study will be serve as a baseline for further studies as well as for planning health
intervention to improve the wellbeing of children and women in Awi zone particularly dangla
town. Thise research proposal designs to seek and investigate the effect of some factors that affect
Birth weight in DPH.
So far the prevalence and traditional maternal feeding practice correlates of LBW have not been
explored in dangla .therefore the purpose of thise study is to determine the prevalence and
associated factor of LBW in the study area.

Chapter Two. Literature Review

2.1 Magnitude of LBW

Different studies in different parts of the world indicated that level of LBW durig delivery is
different from place to place and which is related to different factors.The study done in India
shows that the majority (89%) of neonates had normal birth weight and eleven percent of them
belonged to the low birth weight category. 46% males and 43% females had normal birth weight,
whereas 5% males and 6% females had low birth weight(4).
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Survey conducted in jimma hospital showed that out of a total of One thousand four hundred and
forty one live births One hundred forty seven (10.2%) mothers gave birth to LBW babies (5). Five
(0.4%) mothers gave birth to twins (5). The study subjects with babies of LBW and NBW
accounted to 25% and 75%, respectively (5).
A study done in Mekele university showed that 135 (75%) mothers gave birth to LBW and 45
(25%) gave birth to VLBW babies whereby the mean BW was 1.8+0.46kg within a range of
0.7-2.4 kg (8).
EDHS 2011 data shows that among children born in the five years before the survey with a
reported birth weight, 11 percent weighed less than 2.5 kilograms (23). As noted, a mother‘s
subjective assessment of the size of the baby at birth, in the absence of birth weight, may be useful.
Mothers reported 21 percent of all live births in the five years preceding the survey to be very
small and 9 percent as smaller than average (23). Nearly three children of every ten born to
mothers residing in Affar (30 percent), Amhara (28 percent), Somali (26 percent), and Gambela
(27 percent) were reported as very small at birth (23).
Another study in Gondar shows that the prevalence of low birth weight was found to be 17.4%
(22.7% female and 13.5% male) (10).

2.2 Risk factors for low birth weight

Infant sex
Survey conducted in Jimma hospital showed that there were 316(53.7%) males making a male to
female ratio of 1.2:1. A Chi-square test gave no significant association of sex with LBW (p>0.05).
Tests of strength of any association using other tests also indicated no association between sex and
LBW (V= 0.06) (5).
A study done in Mekele university showed that 128 (71.1%) of new born babies with LBW were
females (8). The result of this study indicated that there was statistically significant
association between baby sex and BW that is; female newborn babies had a lower BW
(1.74+0.44) than male babies (1.95+0.48)(8).
Another study in Gondar showed that Sex of the infant was significantly associated with birth
weight; being female has two fold risks for low birth weight. (AOR= 2.1, 95%CI 1.18, 3.76)
(10).

15
Maternal height
The finding from India study showed that 43% of subjects heights were in the range between 156 -
162 cm (4). It is clear from this study that taller pregnant women (taller than 162 cm) gave birth to
significantly heavier babies (3.6 kg) than shorter women (4).
Utilizing the knowledge from Donnelley, et al (24) maternal height of 150 cm or less was taken to
constitute a risk factor to LBW. The study conducted on Jimma hospital showed that (height and
LBW) gave a significant association (p<0.005). Other tests also confirm this (V= 0.328) and the
estimated odds ratio =0.98 (0.64<OR< 1.50(5). Mothers of cases are shorter than controls (5).
Maternal pre-pregnancy weight
The study from India showed that pregnant women who weighed less than 60 kg gave birth to
neonates with the mean birth weight of 2.7 kg, while subjects who weighed more than 75 kg gave
birth to heavier neonates (3.6 kg)(4).
Maternal age
Survey conducted in Jimma hospital showed that the age of most of the mothers in both groups lies
between the age group of 25-29 years, which is 18.4% and 35.8% for LBW and NBW, respectively
(5). But this study showed that mothers of cases of LBW are older than control mothers (5).
It is evident from India study that as maternal age increased from 20 to 36, the birth weight
increased from 2.9 to 3.4 kg (4).
A study done in Mekele showed that the Chi-square test gave significant statistical association (p =
0.0001) between age of the mothers and birth weight .When Phi and Creamer's measures were
applied to determine the strength of this association, a V value of -0.007 was obtained which was
not conclusive. But a proportion of LBW was highest (42%) among mothers≥ 35years (8).There
was statistically significant association between the age of the mothers and mean BW (F=122.08,
p=0.0001) (8). Mothers who belong to the age category of 15-19 years had babies weighing
1.41+0.47 kg. Whereas mothers in the range of 20-34 years old gave birth to babies weighing
2.14+0.15 kg (8).
EDHS 2011 data shows that Low birth weight is more common among children of the youngest
mothers, age less than 20 (13 percent) and older mothers, age 35-49 (17 percent) (23). Children
born to very young mothers (<20 years) were the most likely to be reported as very small (23).
Socioeconomic status

16
The study from India showed that Subjects who had an income of less than 2.5 million in Rials per
month gave birth to neonates with the mean birth weight of 2.9 kg, while pregnant women with>
3.5 million in Rials per month gave birth to neonates with the mean birth weight of 3.6-4kg.(5).
Different levels of education in pregnant women showed no significant influence on the birth
weight of babies (4).
A study done in Mekele showed that Chi-square test gave no significant statistical association (p>
0.05) between maternal education and LBW. The Odd ratio was estimated as 0.81 with 95%
confidence limits, which confirms there are significant associations (8).
EDHS 2011 data shows that children of mothers with no education were the most likely to be
reported as very small (23). Children born to mothers in the lowest wealth quintile were the most
likely to be reported as very small LBW (23).
Marital status
A study done in Mekele showed that there was a mean BW difference among mothers of
different marital status, ethnicity and religion, BW was not found to be statistically significant
with the variables as supported by Turkey‘s test (8).
Fundal height
The study from India showed that fifty eight percent of subjects had fundal heights between 34 - 36
cm (4). Pregnant women with higher levels of fundal height (34-36 cm) at the end of the third
trimester gave birth to neonates with significantly heavier birth weights (4).
Parity
The study from India showed that pregnant women who were pregnant for the second and third
time gave birth to neonates with the mean birth weight of 3.5 kg, while women with first gravida
gave birth to neonates with 2.9 kg (4).
Survey conducted in Jimma hospital showed that the higher the parity, the lesser the chance of
having LBW baby (5). The examination in the trend of proportion of LBW decreases from 0.05 to
0.1 as one move from one parity to a higher one (the mothers of cases are less parous than controls)
indicating a negative association between LBW and parity (5).
A study done in Mekele shows that on reproductive characteristics the finding indicated that
80(44.4%) of the mothers were primi-parous (8). A Significant association was found between
parity and BW; thus primi-para mothers had babies with mean BW of 1.41+ 0.41 as compared to
grand multi-parous which is 2.17+ 0.18 (130.12, P=0.0001) (8).
17
Birth or pregnancy interval
A study done in Mekele showed that Seventy seven (42.8%) of the index baby belongs to the first
birth order (8). BW was directly proportional to birth order and the association was found to be
statistically significant (F=89.24, P= 0.0001) (8).
EDHS 2011 data showed that children of birth order six and above (16 percent) and first-order
births were the most likely to be reported as very small (23).
Intrauterine growth and gestational duration in prior pregnancies
Survey conducted in Jimma hospital shows that Fifty two (51.0%) of these babies were born below
37 completed weeks of gestation (pre-term), 32(31.4%) were considered small for date and
18(17.6%) were above 42 completed weeks of gestation (post-term) making the incidence rate of
low birth weight to be 11.02% (5).
A study done in Mekele shows that Most (61.1%) of the mothers had given birth before they
became a term (8).Significant association was also found between gestational age and BW (t=7.76,
P=0.0001). The mean BW of preterm babies was (1.62+0.47kg), however, the BW for term babies
was (2.09+0.27kg) (8).
Another study in Gondar shows that the mean gestational age of the newborns was 39.49±1.53
weeks with minimum 31 and maximum 44 weeks (10). Out of the 540 newborn 516(95.5%) was
delivered at greater than or equal to 37 weeks gestation. Of the total under weight babies 76
(14.7%) were term small-for gestational age infants and 18 (75%) preterm were low birth weight.
Those newborns with gestational age less than 37 weeks were 18 times (AOR=18, 95%CI
5.84,31.2) more likely to be delivered low birth weight than those new born greater than or equal
to 37 weeks of gestation(10) .
Prior spontaneous abortion
A study done in Mekele showed that Forty one (22.8%) of the mothers had a history of abortion
and out of the mother who had abortions, 39.0 % of them had a history of repeated abortion (8).
Mothers who had not history of abortion gave birth to babies with higher BW (2.11+0.16 kg) than
mothers who had a history of abortion (1.70+0.48). This was also found to be significant at a P
value of 0.0001. However, the number of abortion and BW was not found to be statistically
significant (P- value = 0. 67)(8).
Gestational weight gain

18
The study from India showed that the majority of pregnant women (68%) weighed more than 65
kg, and 48% had normal gestational weight gain with reference to IOM guidelines (18). Women
with normal weight gain gave birth to babies with the mean birth weight of 3.3 kg, while pregnant
women with low gestational weight gain gave birth to babies with the mean birth weight of 2.5 kg
(4).
The study from India shows that the majority of subjects (63%) had hemoglobin levels greater than
11 g/dl, which is considered normal as per WHO standards (4). Pregnant women with hemoglobin
levels less than 9 g/dl, which is considered anemic, gave birth to neonates with low birth weights,
while pregnant women with higher hemoglobin levels (> 11 g/dl), who were considered normal,
gave birth to heavier and normal babies (3.5 kg)(4).
Another study in Gondar shows that regardless of anemia of the mothers 112 (20.7%) were
screened. Out of them 17 (15.17%) were anemic (10).
Maternal morbidity during pregnancy
Survey conducted in Jimma hospital showed that Thirty (20.4%) of mothers with LBW had clinical
diagnosis of malaria as compared to 12.4% among those with NBW (5).
Another study in Gondar shows that Malaria during pregnancy was also a risk factor for low
birth weight. Those women attacked by malaria during pregnancy were 5 times (AOR=4.9,
95%CI= 1.95, 12.32) more likely to deliver low birth weight baby than their counterparts
(10).
Survey conducted in Jimma hospital showed that Fifteen (10.2%) of LBW mothers had pre-
eclampsia toxemia as against less than 2% among mothers with NBW. As shown from the result
greater proportion of mothers with LBW (20.4%) had these complications and other complications
as compared to mothers who had NBW. About 53% of mothers with LBW babies had one kind of
complication during pregnancy, when compared to only 21.5% for mothers with NBW. When all
kinds of complications are grouped together and tested for association between LBW and maternal
complication all the measures indicated statistically significant association (V=0.34) (5).
Another study in Gondar show that Out of 540 women 499(92.4%) were tested for HIV infection
and 28(5.6%) were positive for the infection. Out of the 540 mother 27(5%) were have UTI (10).
Those women with PIH were 9 times (AOR=9.23, 95%CI= 3.36, 25.36) more likely to
deliver low birth weight baby than those women without PIH (10).
Antenatal care
19
Survey conducted in Jimma hospital showed that the time when subjects visited antenatal clinic
(1st, 2nd or 3rd trimester) was recorded to determine whether or not the time of the visit has any
effect on LBW. Chi-square test gave a significant statistical association (p <0.0001). Creamers V
measure was relatively high (V= 0.51). Mothers who commenced ANC in the third {84(57.1%}
and second trimester {46(31.3%)} have highest number of LBW babies; the least 17(11.6%) was
among those mothers who commenced ANC in early pregnancy, that is the controls attended ANC
more than cases (5).
A study done in Mekele showed that Mothers who had ever attended ANC follow up gave birth to
babies with higher mean BW (2.16+0.14) than the mothers who had never attended
(1.45+0.42) and this was statistically significant at a P value of 0.001(8).
Another study in Gondar show that Four hundred eighty five (89.8%) mothers have ANC follow
up during the course of pregnancy (10). Three hundred twenty four (66.8%) have four and
above antenatal care visit during their pregnancy (10).
Overall, pregnant women who gave birth to LBW babies had significantly lower age, parity, family
income, height, weight, fundal height, gestational weight gain and hemoglobin levels than women
who gave birth to neonates with normal birth weight. Thus the results of the study revealed that
age, parity, family income, height, fundal height, weight, gestational weight gain and hemoglobin
levels influenced the birth weight of the neonates (4).
A case control study done in Addis Ababa in public health facilities showed that mean birth
weight was 2199.5gm (S.D±252.79) for the neonates with low birth weight and 3230.0
(S.D±449.73) for the neonates with normal birth weight (25). According to the findings of this
study the determinant factors for term LBW are: Gestational weight gain of less than 8Kg,
Maternal height of less than 155 cm, Maternal MUAC of less than 23 cm, Not taking antenatal iron
& folic acid supplementation, ANC visits of three or less , Experiencing antenatal intimate partner
violence and Experiencing antenatal depression of any grade (25). When we see factors
associated with low birth weight on Gondar study shows that the covariates pregnancy induced
hypertension, malaria attack during pregnancy, being female sex and gestational age less than
37 week was found to be significantly associated with low birth weight in multiple logistic
regression analysis (10).

20
 Chapter Three. Objectives of the Study

3.1 General objective

 To assess the prevalence and associated factor of low birth weight among mothers who
gave birth in Dangila primery hospital,Awi Zone Amhara Region Ethiopia, 2009 EC.

3.2 Specific objectives

 To determine the prevalence of low birth weight among mothers who gave birth in Dangila
primery hospital,Awi Zone Amhara Region Ethiopia, 2009 EC.
 To describe the factors associated with LBW among neonats born at DPH in the study
peroide.
 To identify the sociodemographic characterstics of women deliverd at DPH during the
study periode.

21
 Chapter Four. Method and Materials

4.1 Study area and period

The study will be conducted at Dangila primery hospital (DPH),which is found in Dangila woreda ,
AwiZone,Amhara Rigion North West Ethiopia 2009.
DPH is established in 2007E.C /2015 G.C as District hospital in DangilaWoreda,Awi zone. It
provides curative and rehabilitative services for about 100,000 catchment populations. At the time
of its establishment, about 80 staffs were recruited, of them 58 are health professionals and the
remaining are supportive staffs. Now the hospital has five wards, namely Medical (19 bed),
surgical (21 beds), oby/gyn (24 beds), Pediatrics (10 beds) . Under oby/gyn have separate labor,
delivery and post natal ward. And also have Family planning,HighRisk,maternity, ANC and
GynOpd. Currently the hospital serves around 34200 peoples.The study was conducted from
January to May 27, 2017 G.C.

4.2 Study design

Institutional based cross sectional study design will be conducted among women who delivered in
Dangila Primary Hospital.from January 27 to may 27 2009 EC.

4.3 Population
4.3.1 Source population
Our source population is all delivered mothers in Dangila primary hospital during the study period.
4.3.2 Study population and units
The study population is all sampled mothers who delivered in Dangila primary hospital during the
study period. And the study units are mothers who delivered in DPH during the study period.

22
4.4 Eligibility criteria
4.4.1 Inclusion criteria
All mothers who delivered both low birth weight and normal birth weight during the study period
will be included.
4.4.2 Exclusion criteria
All women who are mentally ill, deaf, dumb, critically ill were excluded because they cannot
respond to the questions.
Babies with congenital anomalies and multiple births were also excluded from the study.

4.5 Sampling
4.5.1 Sample size determination
Sample size was calculated by using single population proportion formula by taking of 17.4% as p-
value from the similar recent research performed in Gonder referral hospital, northern Ethiopia
(10). Using the desired precision 5%, confidence level 95%
A total sample size was determined as follows: -
n= (Za/2)2p (1-p)
d2
Where, n=sample size
d=desired precision 5 %=( 0.05)
z=standard normal distribution value at confidence level 95%=1.96
p=prevalence rate of low birth weight=17.4%
Therefore, d=0.05
(Za/2)2= 3.8416
P=17.4%=0.174
d= (0.05)2 =0.0025
So, n=3.8416 (0.174) (0,826) = 220.85=221
0.0025
Therefore, the total sample size is 221
The formula for population (N) <10,000 so using correction formula by taking this sample size and
total population size.

23
The final sample will be nf = { n ___}
1+n/N
nf = { 221____} = 181.15
1+ __ 221___
Where n = sample size 1000
nf = final sample
N= total population
Taking an anticipated non-response rate 10%, of 181.15=18.15
Total sample size will be 181.15+18.15=199.25 ~ 200
4.5.2 Sampling technique

Non probability sampling method will be used to select the study samples.
4.5.3 Sampling procedure
A sample size of 200 mothers with newborn baby who delivered in Dangila primery hospital who
received care within 24 hours of delivery during study period will be considered. Mothers will
selected by non probability sampling method, i.e taking volunteer pregnant women with complain
of labour until the required number reached.

4.6 Variables of the study

Dependent variable
Birth weight
Independent variables
 Socio demographic characteristics including newborn sex, maternal age, family monthly
income, educational level, maternal occupation, religion, marital status ethnicity, residence.

 Maternal and obstetrics characteristics (parity, counseling about diet, substance use, history
of abortion, iron or folic acid supplementation during pregnancy, gestational age at birth, no
of ANC follow up, medical complication during pregnancy,
including:STDs,malaria,PIH,anemia,bleeding during pregnancy like placenta abraptio and
placenta previa).
24
  General health care behaviuor like history of marijuana,alcohol intake and cigarette
smooking.

4.7 Operational definitions

Abortion: termination of pregnancy.

Intra uterin growth restriction(IUGR):refers to poor growth of afetus while in the
mothers uters during pregnancy.

Gastationalage : the duration of time measured from the first day of conception and
expressed in completed week.

Preterm birth: it the birth of newborn before 37 weeks gestational age

Low birth weight: neonate birth weight less than 2,500 gm (up to and including 2,499 gm).
Very low birth weight: neonate birth weight less than 1,500 gm (up to and including 1,499 gm).
Extremely low birth weight: neonate birth weight less than 1,000 gm (up to and including 999
gm).
Gravida: number of pregnancy.
Para: number of live births.

4.8 Data collection procedure

Data will be collected by using pre-tested, standardized questionnaire with interview type of data
collection method from mothers and recording the birth weight of new born. Weight of new born
25
will be measured immediately after birth by using neonate measurement scale. A semi-structured
close-ended interview questions will be also used. Oral translation to Amharic language will be
done by data collector. Data collectors will be hospital staff workers and fourth year midwifery
students .And training will be given for data collectors.

4.8.1 Data analysis

Statistical package for social sciences (SPSS) software version 20.0 will be used to process the
data. Odds ratio and p-value will be computed. P-value < 0.05 considered statically significant.
Frequency table and statistical graphs were used to describe variables and bi-variable analysis will
be used to show the association between dependent and independent variables.

4.8.2 Data quality management

To ensure data quality training will be given to the data collectors, to prevent any confusion and
have a common understanding about the study. Supervision of data collectors by principal
investigator will be done. And also to ensure the validity of the information gathered by data
collector accurate weighing of new born is neccessary. We will supervising the data collector
randomly while interviewing mother and weighing new born baby. The filled questionnaire will
checked for completeness by data collectors and principal investigator. Consequently, any problem
encountered is discussed among the team and solved immediately.

5 Ethical considerations
The research proposal will approved and ethically cleared by the ethical review department of
midwifery head and advisors together with cooperation obtained from Dangila primery hospital
staff workers. The respondents will informed about the aim of the study and verbal consent will
obtained before the data collection. The confidentiality will be kept by not writing their names on
the questionnaires.

6 Dissemination of results
After the research have been completed, the result will be presented to Debre Markos University
College of Medicine and health science, department of midwifery and to other stakeholders after
approval by the advisor and department.
.
26
7 Work plan of the study
the study will be conducted from January 27 to may 27 2009 EC with three phases.
The first phase involves proposal development, approval, ethical clearance and assurance.and this
will be performed jaunary27 to march 20 2009EC .
The second phase will be performed from march 20 to may 1 2009 E.c.This phase involves training
of data collection,supervision and monitoring data collection.The third phase will be conducted
from March 22 to June 1 2009 E.C.It includes data cleaning,editing analysis,thesis
Writing,submission,defense and final paper submission.

8 .Budget breakdown
Budget breakdown for assessment of prevalence and associated factor of low birth weight among
mothers delivered at Dangla primary hospital Awi zone Amhara region Ethiopia 2009E.C

Table 1.1

S e r i N O Budget categor y U n i t c o s t Multiplying factor T o t a l c o s t ( E T B )

1 T r a i n i n g5 0 . 0 05 0 * 3 * 57 5 0 . 0 0
2 Data collector personel 6 0 . 0 0 6 0 * 3 0 * 3 5 4 0 0 . 0 0
3 Supplies paper,pen 2 p a c k 2 * 2 0 0 4 0 0 . 0 0
4 Transportation7 57 5 * 3 * 36 7 5 . 0 0
5 Grand total 7 , 2 2 5 . 0 0

27
 9. References

1. United Nations Children‘s Fund, World Health Organization: Low Birth weight: Country,
regional and global estimates. New York: UNICEF and WHO; 2004.
2. Ministry of Health and Population (MOHP) [Nepal], New ERA, ICF International Inc.: Nepal
Demographic and Health Survey 2011.Kathmandu, Nepal: Ministry of Health and Population,
New ERA, and ICF International, Calverton, Maryland; 2012.
3. UNICEF. Progress for Children: A Report Card on Nutrition. Other Nutrition Indicators, Low
Birth weight. New York: UNICEF; 2006.
4. BaurN,Bandyopadhyay G, Maternal anthropometric measurements and other factors: relation
with birth weight of neonates Department of Studies in Food Science and Nutrition, University
of Mysore, Mysore 500 006, India, Nutrition Research and Practice (Nutr Res Pract)
2012;6(2):132-137.
5. Gebremariam. A. Factors predisposing to low birth weight in Jimma hospital south western
Ethiopia, East African Medical Journal Vol 82 No. 11 November 2005.
6. Tema T. Prevalence and determinants of low birth weight in Jimma Zone, Southwest Ethiopia.
East African Medical Journal 2006; 83:366-371.
7. WHO Regional Office for Europe the Introduction to Health for all policy for the
WHO European Region. Copenhagen: Health 21; 1998.
8. Gessessew. B, Balem.D and Mussie .A Socio Demographic and Maternal Determinants of Low
Birth Weight at Mekelle Hospital, Northern Ethiopia: A Cross Sectional Study, American
Journal of Advanced Drug Delivery www.ajadd.co.uk.
9. WHO. Nutrition and food safety, WHO country cooperation strategy 2008-2011, Ethiopia,
page12.
28
10. Kahsay Z, Tadese A, Nigusie B , Low Birth Weight & Associated Factors Among Newborns
in Gondar Town, North West Ethiopia: Institutional Based Cross Sectional Study, Indo Global
Journal of Pharmaceutical Sciences, 2014; 4(2): 74-80.
11. Lawn J, Cousens S, Zupan J: 4 million neonatal deaths: When? Where? Why? Lancet 2005,365
(9462):891–900.
12. Report of the Ad Hoc Committee of the Whole of the twenty-seventh special session of the
General Assembly New York, United States: United Nations. Available:
http://www.unicef.org/specialsession/documentation/documents/A-S27-19-Rev1E.pdf.
Accessed 2013 July 25.
13. Gbenga A. Kayode, Mary Amoakoh-Coleman, Irene AkuaAgyepong , Evelyn Ansah,
Diederick E. Grobbee, et.al. Contextual Risk Factors for Low Birth Weight: A Multilevel
Analysis GbengaA.Kayode, Mary Amoakoh-Coleman, Irene AkuaAgyepong, Evelyn Ansah,
Diederick E. Grobbee, Kerstin Klipstein-Grobusch PLOS ONE | www.plosone.org October
2014 | Volume 9 | Issue 10.
14. CSA and ICF International the 2011 Ethiopia Health and Demographic Survey, Central
Statistical Agency and ICF International, Addis Ababa, Ethiopia & Calverton, Maryland, USA
(2012).
15. Zeleke B, Zelalem M, Mohammed N. Incidence and correlates of low birth weight at a referral
hospital in Northwest Ethiopia. Pan African Medical Journal 2012; 12:4.
16. Siza JE. Risk factors associated with low birth weight of neonates among pregnant women
attending a referral hospital in northern Tanzania. Tanzania Journal of Health Research 2008;
10:1210-1219.
17. Walter EC, EhlenbachWJ, Hotchkin DL, ChienJW, Koepsell TD. Low Birth Weight and
Respiratory Disease in Adulthood: A Population-based Case Control Study. American Journal
of Respiratory and Critical Care Medicine 2009; 180:176-180.
18. Ramakrishnan U. Nutrition and low birth weight. American Journal of Clinical Nutrition 2004;
79:17-21.
19. Badshah S, Mason L, McKelvie K, Payne R, Lisboa P. Risk factors for low birth weight
in the public-hospitals at Peshawar, NWFP-Pakistan. BMC Public Health 2008;
8:197doi:10.1186/1471-2458-8-197.

29
20. Roudbari M, Yaghmaei M, Soheili M. Prevalence and risk factors of low-birth-weight
infants in Zahedan, Islamic Republic of Iran. East Mediter Health J. 2007; 13: 838–845.
21. LouangpradithViengsakhone, Yoshitoku Yoshida, harun-or-rashi and Junichi. Determinant of
low birth weight in Vientiane Laos, Sakamoto1 nagoyaJ.Med. Scl, 2010, 72.51-58.
22. U.S. Department of Health and Human Services, Health Resources and Services
Administration, Maternal and Child Health Bureau. Child Health USA 2011.Rockville,
Maryland: U.S. Department of Health and Human Services, 2011.
23. Ethiopia Demographic and Health Survey, 2011.
24. Donnelley, J. F., Flowers, C. E., Creadik, R. N., Greenberg, B. G., and Surles, K.B. Maternal,
fetal and environmental factors in prematurity. Amer J. Obstet. Gynaec, 1994; 88:918.
25. MahariYihdego, Mizan-Tepi University Dr. AlemayohuMekonnen, AAU, Assessment of
maternal risk factors associated with full-term low birth weight neonates in public health
facilities of Addis Ababa, Ethiopia: a case-control study.
26. Lasker JN, Coyle B, Li K, Ortynsky M. Assessment of risk factors for low birth weight
deliveries. Health Care Women Int. 2005; 26:262–80. 42.
27. Dilla university human resource management office, 2008E.C
28.Mitku,K, THE Link between contents and perceived quality of ante natal care with low birth
weight among term neonates in puplic health facilities of Bahire Dar special zone north west
Ethiopia.
29.centrastastical agency; Ethiopia demography and health survey, centeralstastical agency and
ORL macro 2005.
30.Gonderworeda annual health report 2004 E.C.

30
10. Annexes

AnnexI .English and Amharic Version Consent form and Questionnaires

10.1 Consent Form

Good morning/afternoon, my name is ……………………………………I am a fourth year
Midwifery student at Debre Markos university college of medicine and health scince, department
of Midwifery. I am here to study the factors associated with low birth weight among mothers who
gave birth in Dangla primery hospital. I am glad to inform you that, you are one of the eligible
participant and you are welcome to take part in this study. I am also delighted to tell you I am relay
value your participation as your individual contribution to the study output will definitely very
significant, however it is up to you to decide whether to participate in this study or not. I would
like to inform you that your name will not write in anywhere in this study.
Are you willing to participate in this study?
1. Yes…………..
2. No……………

10.2 English Version Questionnaires

Part one. Socio-demographic characteristic of mothers
S. no
100. What is your current age?
1, 15-25 3, 37-47
2, 26-36 4, >48
101. What is your current religion?
1. Muslim 3.ortodox
2. Protestant 4.chatolic 5.others (specify)
102. What is your current marital status?
1. Married 3.divorced
31
2. Single 4. Widowed
103. What is your educational status?
1. Illiterate 3.secondary school
2. primary school 4.college and above
104. How much your monthly income in birr?
1. <500 3.1001-1500
2.501-1000 4.>1500
105. What is your current occupation?
1. House wife 3.merchant
2. Government employ 4.daily laborer 5. Other (specify)
106. What is your ethnicity?
1.SNNPE 3.Tigrie
2. Oromo 4amhara 5.others (specify)

107. Where do you live now?

1. Urban
2. Rural
108.Do you smoke ciggarte?
1.yes
2.no
109.if your ansewer is yes from Q no 108,are you
1.currentsmooker
2.exsmooker
3.nosmooke
109.Do you drink alcohol?
1.yes
2.no
110 if your ansewer to Qno 109 is yes how frequent do you drink
1.daily
32
2.1-3 times aweek
3.every week

Part two. Maternal obstetrics and Neonatal characteristics

S. no
200. How many times do you get birth?
1. First time 3.third time
2. Second time 4.forth and above
201. Have you ever had a pregnancy was miss carried before seven month?
1. Yes
2. No
202. During this pregnancy have you got nutrational counseling during pregnancy?
1. Yes
2. No
203. During this pregnancy, did you take additional diet than usual?
1. Yes
2. No
204. During this pregnancy were you given or buy any iron tablets?
1. Yes
2 .no
205. During this pregnancy you had ANC follow up?
1. Yes
2. No
206. If yes .Q.no (205) how many times receive antenatal care during pregnancy?
1. Ones 3.three
2. Two 4.four and above
207. During this pregnancy did you use any type of substance?
1. Yes
2. No
208. Did you have any medical illness in this pregnancy?
33
1. Yes
2. No
209. Have you ever had history of small baby?(mothers perception’s)
1. Yes
2. No
210. What is your gestational age during this pregnancy?
211. Birth weight of the child………………..in grams?
212. Sex the child
1. Male
2. Female
213.do you have any other disease diagonosed with health worker?

1.HIV AIDS

2.Diabeticmellites

3.hepatitus

4.renal disease

5.ather( specifiy)

10.3 Amharic version information sheet and consent from

የዳግላሆስፒታለለሚወልዱእናቶችየተዘጋጀመጠይቅ

የስምምነትቅጽ

ጤናይስጥልኝ፡፡እኔ …………………………………………………………እባላለው፡፡በደብረማርቆስ
ዩንቨርሲቲበህሙማንፋካሊቲእናበጤናትምህርትክፍልየአራተኛዓመትየሚደዋይፍሪየመጀመሪያድግሪተማሪሲሆነበዚህሆስፒታል
ውስጥየሚወለዱህጻናትክብደታቸውአነስተኛሆኖየሚወለዱትንምክንያትለማወቅጥናትእያደረኩነው፡፡
እርሶከተመረጡትተሳታፊዎችበመሆኖበዚህጥናትእንኳንደህናመጣችሁለማለትእወዳለውበዚህጥናትውስጥመሳተፍቀጥተኛየሆነጥ

34
ቅምየሌለውሲሆንበጥናቱውስጥበመሳተፍየሚመጣምንምአይነትችግርወይምጉዳትየለውም፡፡
የእርሶተሳትፎለጥናታችንከፍተኛየሆነአስተዋጾእንዳለውመገንዘብይገባዎታል፡፡

ጥናቱውስጥመሳተፍየሚፈልጉእናቶችበፍቃደኝነትላይብቻተመሰረተተሳትፎመሆኑንመገንዘብአለባቸውየእርሶስምበማንኛውምጥ
ናትቦታአይገለጽም፡፡

በዚህጥናትለመሳተፍፍቃደኛኖዎት?

1. አዎ
2. ኤደለውም

Amharic questioner

ክፍልአንድየእናትየዋማህበራዊናአከባባዊሁኔታዎችንበተመለከተ

ተራቁጥር

100. የእርሶእድሜስንትነው ?

1. 15-25 3. 37-47

2. 26-36 4. 48

101. የቱንሀይማኖትነውእርሶየሚከተሉት ?

1. ሙስሊም 3. ኦርቶዶክስ

2. ፕሮቴስታነት 4. ካቶሊክ 5.ሌላ( ይግለጹ)

102. የእርሶየጋብቻሁኔታ ?

1. አግብቻለው (ህጋዊጋብቻ) 3. አግብታየፈታች

2. አላገባሁም 4. አግብታባሏየሞተባት 5.ሌላ ( ይግለጹ)

103. ትምህርትተምረሽታውቂያለሽ ?

35
 1. አልተማርኩም 3. ሁለተኛደረጃ

2. የመጀመሪያደረጃ 4. ኮሌጅናከዚያበላይ

104. በአንድወርውስጥየሚያገኙትገቢ (በብር )ስንትነው?

1. ‹500 3. 1001-1500

2. 501-100 4 ›500

105. በአብዘኛውጊዜየምትሰሩትሥራምንድነው?

1. የቤትእመቤት 3. ነጋዴ

2.የመንግስትሠራተኛ 4.የቀንሠራተኛ 5.ሌላ( ይግለጹ)

106 የእርሶብሔርምንድነው ?

1. ደቡብ ብሔርብሔረሰቦችናሕዝቦች 3. ትግሬ

2. ኦሮሞ 4. አማራ 5.ሌላ( ይግለጹ)

107. በአሁኑጊዜየሚኖሩበትቦታየትነው ?

1. ከተማ 2. ገጠር

ክፍልሁለትየእናትየዋንየመህጸንናየህጻኑንሁኔታዎችበተመለከተ

ተራቁጥር

200. ለስንተኛጊዜነውአሁንስትወልጂ ?

1. ለመጀመሪያጊዜ 3. ለሶስተኛጊዜ

2. ለሁለተኛጊዜ 4. አራተኛናከዚያበላይ

201 ከአሁንበፊትሰባትወርያለሞላውውርጃአጋጥሞሽያውቃል?

1. አዎ

2. አይደለም
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202. በዚህእርግዝናውስጥስለአመጋገብምክርአጊንተሸል ?

1. አዎ

2. አላጋጠመኝም

203. በዚህእርግዝናወቅትከወትሮየተለየተጨማሪምግብትወስጂነበር?

1. አዎ

2. አልወሰድኩም

204. በዚህእርግዝናወቅትየተሰጠሸገስተሸየወሰድሽውየደምማነስክኒንአለ?

1. አዎ

2. የለም

205. በዚህእርግዝናወቅትየነብሰጡርክትትልአርገሽታውቂያለሽ ?

1. አዎ

2. አላደረኩም

206 ምሰዉአዉከሆነተ.ቀ(205) ስንትጊዜያክልክትትልአድርገሻል?

1. አንድጊዜብቻ 3. ሶስትጊዜ
2. ሁለትጊዜ 4. አራትጊዜ

207. በዝህእርግዝናወቅትእንደ (ስጋራ፣አልኮልትንባሆእናጫትየመላሰሱትን )እፅትጠቀሚነበር?

1. ወደ

2. አልተጠቀኩም

208. በህክምናየተረጋገጠህመምአለብሽ?

1. አወ

2. የለም

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209. ከአሁንበፊትትንሽልጅወልደሽታዉቂያለሽወይንምከመጠንያነሳ (በአያትየዋእይታ?

1 አወ

2. አላዉቅም

210. የአሁንልጅበስንትሳምንተትእርግዝናሽነዉየተወለደዉ…………………………….?

211. አሁንየተወለደዉህፃንክብደት……………………………….በ/ኪግ/ራም

212. አሁንየተወለደዉህፃንጾታ…………………………………?

1. ወንድ

2. ሴት

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