Determinants of anemia among pregnant women in northern Ghana

Abstract

ABSTRACTAnemia is a global public health issue affecting half of all pregnant women in developing countries. In 2014, 42% of Ghanaian pregnant women aged 15-49 years were anemic (<11.0g/dl) but information on the determinants of anemia, particularly dietary diversity during the critical third trimester of pregnancy is limited. We assessed the association between determinants and anemia among pregnant women in northern Ghana.We employed a cross-sectional design involving 624 pregnant women (≥20 weeks of gestation) attending four antenatal care (ANC) health facilities ~25 kilometres north of Tamale, Ghana between July and August 2017. Hemoglobin concentration (measured using Hemocue HB 301) was classified as severe, moderate, or mild. Other data included socio-demographic characteristics, malaria prevention, deworming, and iron/folate tablet use. The FAO Minimum Dietary Diversity (MDD-W) metric was used to categorize women into “inadequate” (MDD-W <5 food groups) and “adequate” (MDD-W ≥5). Logistic regression models were used to determine the association between moderate/severe anemia (Hb<9.0g/dl) and mild anemia (9.0-10.9g/dl), or with ‘no anemia’ (≥11.0g/dl) using STATA 14 software.Of 624 women sampled, hemoglobin data were available for 601. The mean age was 27.81±0.25 years, gestational age was 31.93±0.13 weeks, ANC attendance was 3.89±0.07; Hb concentration was 9.73g/dl±0.07, and MDD-W index for ten food groups was 5.33±0.04. Anemia (Hb<11.0g/dl) was observed in 74.8% of women (moderate/severe anemia=33.4% and mild anemia=41.4%). Using adjusted logistic regression, women who received deworming medication had lesser odds of being moderate/severe anemic (aOR=0.51, P=0.021). While women who were engaged in other occupation (herdsmen) and no previous parity had higher odds of being moderate/severe anemic (aOR=2.90, P=0.042) and (aOR=2.13, P=0.004) respectively. Moderate/severe anemia was not statistically associated with MDD-W, nor with socioeconomic status/wealth index. Conclusion, anemia in pregnancy was nearly twice that of Ghana as a whole. Deworming medication was found to be protective intervention for anemia during pregnancy.