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Addis Ababa University College of Health Sciences Department of Medical Laboratory Sciences ADDIS ABABA UNIVERSITY COLLEGE OF HEALTH SCIENCES DEPARTMENT OF MEDICAL LABORATORY SCIENCES Determination of Common Hematological Parameters Reference Intervals among Apparently Healthy Pregnant and Non-Pregnant women of South Wollo Zone, Amhara region, Northeast Ethiopia. By: Mesfin Fiseha (Bsc) Advisors: Dr. Aster Tsegaye (MSc, PhD) Zemenu Tamir (MSc, PhD candidate) Mikias Negash (MSc, PhD candidate) A research thesis submitted to the Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, in partial fulfillment of Master of Science Degree in Clinical Laboratory Sciences (Hematology and Immunohematology). Dec, 2019 Addis Ababa, Ethiopia Addis Ababa University School of Graduate Studies This is to certify that the thesis prepared by Mesfin Fiseha, entitled: Determination of Hematological Parameters Reference Intervals among apparently healthy pregnant and non-pregnant women of south wollo zone, Amhara region, Northeast Ethiopia and submitted in partial fulfillment of the requirements for Master of Science degree in Clinical Laboratory Sciences (Hematology and Immunohematology) complies with the regulations of the University and meets the accepted standards with respect to originality and quality. Signed by the Examining Committee: Examiner_________________ Signature ___________Date ____________ Examiner_________________ Signature ___________Date ____________ Advisor__________________ Signature ___________Date ____________ Advisor__________________ Signature ___________Date ____________ Advisor__________________ Signature ___________Date ____________ Page | I Acknowledgement First and foremost, praises and thanks to God, the almighty, for helping me in all challenges throughout my research thesis work. I am grateful to Addis Ababa University (AAU), College of Health Sciences, Department of Medical Laboratory Sciences for giving me the opportunity to perform this research thesis. I would like to express my deep and sincere gratitude to my research advisor Dr. Aster Tsegaye, Mr Zemenu Tamir and Mr Mikias Negash for providing me invaluable guidance, comments and constructive suggestions throughout this research thesis work. My grateful thanks also extended to Dessie health center laboratory staffs for their support in sample collection, processing and analysis, and to all participants that took part in this study. Finally, I would like to express my heartfelt gratitude to my wife and parents for their unfailing support and continuous encouragement throughout the study. Page | II Table of Contents Page Acknowledgement ........................................................................................................................................ II List of Tables .............................................................................................................................................. VII List of Figures ............................................................................................................................................ VIII Abbreviations ............................................................................................................................................... IX Abstract ........................................................................................................................................................ XI 1. Introduction ............................................................................................................................................... 1 1.1Background .......................................................................................................................................... 1 1.2 Statement of the problem .................................................................................................................... 4 1.3 Significance of the study ..................................................................................................................... 6 2. Literature review ....................................................................................................................................... 7 3. Objectives ............................................................................................................................................... 13 3.1 General objective .............................................................................................................................. 13 3.2 Specific objectives ........................................................................................................................... 13 4. Hypothesis Testing .................................................................................................................................. 13 5. Materials and Methods ............................................................................................................................ 14 5.1 Study Area ........................................................................................................................................ 14 5.2 Study Design and Period ................................................................................................................... 15 5.3 Population ......................................................................................................................................... 15 5.3.1 Source Population ...................................................................................................................... 15 5.3.2 Study Population ........................................................................................................................ 15 5.4 Inclusion and Exclusion criteria ........................................................................................................ 15 5.4.1Inclusion criteria ......................................................................................................................... 15 5.4.2 Exclusion criteria ....................................................................................................................... 16 5.5 Study variables .................................................................................................................................. 17 5.5.1 Dependent variables ................................................................................................................... 17 Page | III 5.5.2 Independent Variables................................................................................................................ 17 5.6 Measurement and Data collection ..................................................................................................... 17 5.6.1 Sample size determination ......................................................................................................... 17 5.6.2 Sampling Method and Techniques ............................................................................................. 20 5.7 Measurement and Data collection ..................................................................................................... 21 5.7.1 Data collection procedure .......................................................................................................... 21 5.7.2 Laboratory Analysis ................................................................................................................... 22 5.8 Data quality assurance ...................................................................................................................... 25 5.8.1 Data collection tool quality assurance........................................................................................ 25 5.8.2 Laboratory quality assurance ..................................................................................................... 25 5.9 Data analysis, Interpretation and Presentation .................................................................................. 26 5.10 Operational Definitions ................................................................................................................... 27 5.11 Ethical consideration ....................................................................................................................... 27 5.12 Dissemination of the result ............................................................................................................. 28 6. Result ...................................................................................................................................................... 30 6.1 Socio demographic characteristics of the study subjects .................................................................. 30 6.2 Anthropometric measurement of study subjects ............................................................................... 32 6.3 Life style and Nutritional habits........................................................................................................ 35 6.4 Determination of hematological parameter RIs ................................................................................ 38 6.4.1 Hematological parameter RIs in pregnant women and non-pregnant women ........................... 38 6.4.2 Hematological parameter RIs in pregnant women according to trimester ................................. 43 6.4.3 Hematological parameters RIs for pregnant women according to Altitude ............................... 47 6.4.4Comparison of hematological parameters of Non-pregnant women with each trimester ........... 51 6.4.5 Proportion of out of range values
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