Anaemia is one of the topmost causes of death globally and has been of a grave public health worry for both developing and developed countries affecting people of different age groups [
The study was conducted in the Juaboso District, which is located in the Western-North Region, Ghana. The district has an estimated population of about 173,878 and annual population growth rate of 2%, with a landmass of 1,284 km with 99 communities [
The study population comprised pregnant women in the district. However, only those who have stayed in the district for three or more months, have registered, and were attending antenatal clinics (ANC) were willing to be part of the study and agreed to sign the informed consent forms that were included in the study. Non-Ghanaians, even if they had stayed up to the required period of time, as well as health professionals, and those who were severely ill were excluded.
Descriptive cross-sectional study and quantitative method of data collection was used to collect data from pregnant women on adherence to Ghana’s anaemia prevention strategies being implemented in the Juaboso District.
Five hundred and ninety-eight (598) participants were involved; this was determined using the formula:
Different (multistage) sampling techniques were used to select respondents. The district was stratified into the existing number (4) of subdistricts. A list of all ANC centres with registered pregnant women from each stratum was obtained from the district health directorate. A sample size was proportionately allocated to each stratum based on the list of pregnant women who have registered and were attending ANC. For each stratum, 2 ANC centres were randomly selected, and based on the sample size calculated for each stratum and the total population of pregnant women who have registered at each of the selected ANC centre, proportionate allocation was again used to allocate sample size to each selected ANC centre. With reference to the sample size for each ANC centre, special numbers were assigned to all registered women and randomly selected the required respondents.
Data was collected through administration of a semistructured questionnaire using a face-to-face interview technique. The questionnaire was pretested on 20 pregnant women with similar characteristics of the study participants from adjacent district for necessary modifications before being administered to the study participants. Data collection tool was a semistructured questionnaire comprised of demographic characteristics of the participants, women’s knowledge of anaemia (causes, signs and symptoms, and available preventive strategies), and adherence to anaemia preventive strategies sections. Participants’ ages were accessed using their birth certificates and ANC record cards. Participants contact information obtained from the facilities were used to trace to their homes and residence for data collection. Field assistants used these methods and tools to collect data from the pregnant women between May and June 2019. Data collected from each participant averaged 20 minutes.
Knowledge of anaemia was assessed based on 22 questions with 22 scores; pregnant women who scored 0-7 points were considered as having low knowledge of anaemia; those who scored 8-15 point were also considered as having fair knowledge of anaemia, while those who scored 16-22 points were classified as having high knowledge of anaemia. Seven questions with 7 points were used to assess adherence to anaemia prevention strategies; pregnant women who scored 6 or less points were considered as partially adhering, while those who scored all the 7 points were considered as completely adhering to anaemia preventive strategies.
The study conformed to the required ethical regulations regarding the use of humans and was approved by the Ethical Review Committee of the Ghana Health Services, Research and Development Division, Accra with protocol number GHS-ERC 150/05/17. Participation in the study was voluntary; consent and assent were sought from the participants and guardians after the study processes had been explained to them.
Double data entry was performed and checked for completeness and consistency using Epi data version 3.1. and Stata version 13 for data analysis, with illustrations in tables and graphs. In addition to descriptive statistics, associations between dependent and independent variables were analysed using Pearson’s chi2 and multiple (univariate and multivariate) logistic regression models. A
A total of 598 pregnant women were involved in the study with mean age of 24.4 years (±2.6 sd), and most (44.3%) of them were 20-29 years old. A comparative majority (27.3%) of them were from Juaboso subdistrict. About 18.2% of the women never went to school. The majority (78.6%) of the pregnant women were legally married, 68.7% of them were Christians, while 56.2% were Akans. Again, the majority (67.9%) of the pregnant women were involved in nonformal jobs, while 19.9% of them were unemployed. Most (44.7%) of the women were in 2nd trimester of gestational period, while 65.4% of them have had 1 pregnancy (parity 1) before the current pregnancy (Table
Demographic characteristics of participants.
Variable | Frequency | Percentage | |
---|---|---|---|
Subdistrict | Juaboso | 163 | 27.3 |
Bonsu | 152 | 25.4 | |
Jato | 139 | 23.2 | |
Asempaneye | 144 | 24.1 | |
Age (years) | 10–19 | 72 | 12.0 |
20–29 | 265 | 44.3 | |
30–39 | 194 | 32.5 | |
≥40 | 67 | 11.2 | |
Educational status | None | 109 | 18.2 |
Basic (primary) | 261 | 43.7 | |
Secondary | 155 | 25.9 | |
Tertiary | 73 | 12.2 | |
Marital status | Legally married | 470 | 78.6 |
Cohabitation | 128 | 21.4 | |
Religion | Christianity | 411 | 68.7 |
Islam | 120 | 20.1 | |
Traditionalist | 67 | 11.2 | |
Ethnicity | Akan | 336 | 56.2 |
Ewe | 79 | 13.2 | |
Ga-Adangbe | 63 | 10.5 | |
Kussase | 120 | 20.1 | |
Occupation | Unemployed | 119 | 19.9 |
Nonformal jobs | 406 | 67.9 | |
Formal jobs | 73 | 12.2 | |
Gestational age of the pregnancy | 1st trimester | 146 | 24.4 |
2nd trimester | 267 | 44.7 | |
3rd trimester | 185 | 30.9 | |
Parity | 0 | 51 | 8.5 |
1 | 391 | 65.4 | |
2 | 101 | 16.9 | |
≥3 | 55 | 9.2 |
About 13.5% of the pregnant women had high knowledge of anaemia, while 58.4% and 28.1% of them had fair knowledge and low knowledge, respectively, (Figure
Knowledge of anaemia among pregnant women.
The majority of the pregnant women were partially adhering to anaemia prevention strategies, 39.1% of them completely adhering to the preventive strategies (Figure
Adherence to anaemia prevention strategies among pregnant women.
The study showed significant associations between knowledge of anaemia and the subdistrict where the pregnant woman resides (
Additionally, when the variable that showed associations with knowledge of anaemia from univariate analysis were tested for confounding effects using multivariate logistic regression analysis, it was confirmed that pregnant women who were residing in the Bonsu (AOR: 0.21, 95% CI: 2.31-8.81,
Associations between knowledge of anaemia and demographic characteristics.
Variables | Knowledge of anaemia | OR (95% CI) | AOR (95% CI) | ||
---|---|---|---|---|---|
Subdistrict | |||||
Juaboso | 136 (83.4) | 27 (16.6) | 1 | 1 | |
Bonsu | 134 (88.2) | 18 (11.8) | 0.49 (2.01-8.95) | 0.41 (2.31-8.81) | |
Jato | 116 (83.5) | 23 (16.5) | 0.71 (1.89-7.43) | 0.76 (1.96-7.18) | |
Asempaneye | 131 (91.0) | 13 (9.0) | 0.23 (2.15-9.30) | 0.24 (2.16-9.83) | |
Age-group (years) | |||||
10–19 | 53 (73.6) | 19 (26.4) | 1 | 0.258 | |
20–29 | 244 (92.1) | 21 (7.9) | 0.54 (0.04-7.10) | ||
30–39 | 172 (88.7) | 22 (11.3) | 0.67 (0.11-6.88) | ||
≥40 | 48 (71.6) | 19 (28.4) | 1.72 (0.02-3.48) | ||
Educational status | |||||
None | 105 (96.3) | 4 (3.7) | 1 | 1 | |
Basic | 240 (92.0) | 21 (8.0) | 2.34 (1.25-5.62) | 1.78 (1.89-5.37) | |
Secondary | 126 (81.3) | 29 (18.7) | 4.23 (2.33-9.89) | 4.22 (2.23-9.16) | |
Tertiary | 46 (63.0) | 27 (37.0) | 12.31 (10.24-17.98) | 10.43 (6.14-15.63) | |
Marital status | |||||
Legally married | 424 (90.2) | 46 (9.8) | 1 | 0.364 | |
Cohabitation | 93 (72.7) | 35 (27.3) | 3.59 (1.03-7.23) | ||
Religion | |||||
Christianity | 375 (91.2) | 36 (8.8) | 1 | 0.347 | |
Muslim | 94 (78.3) | 26 (21.7) | 5.23 (3.11-8.81) | ||
Traditionalist | 48 (71.6) | 19 (28.4) | 7.72 (4.30-11.33) | ||
Ethnicity | |||||
Akan | 311 (92.6) | 25 (7.4) | 1 | 0.063 | |
Ewe | 62 (78.5) | 17 (21.5) | 3.84 (0.51-6.61) | ||
Ga-Adangbe | 45 (71.4) | 18 (28.6) | 4.57 (0.33-8.15) | ||
Kussase | 99 (82.5) | 21 (17.5) | 2.46 (1.60-4.79) | ||
Occupation | |||||
Unemployed | 108 (90.8) | 11 (9.2) | 1 | 1 | |
Nonformal jobs | 359 (88.4) | 47 (11.6) | 2.48 (2.04-6.37) | 2.18 (1.07-6.69) | |
Formal jobs | 50 (68.5) | 23 (31.5) | 18.09 (5.42-25.28) | 15.14 (13.57-18.43) | |
Gestational age of the pregnancy | |||||
1st trimester | 133 (91.1) | 13 (8.9) | 1 | 0.736 | |
2nd trimester | 230 (86.1) | 37 (13.9) | 2.25 (0.84-6.17) | ||
3rd trimester | 154 (83.2) | 31 (16.8) | 2.62 (0.34-7.34) | ||
Parity | |||||
0 | 47 (92.2) | 4 (7.8) | 1 | 0.682 | |
1 | 360 (92.1) | 31 (7.9) | 1.67 (0.34-8.76) | ||
2 | 74 (73.3) | 27 (26.7) | 3.74 (0.23-9.82) | ||
≥3 | 36 (65.5) | 19 (34.5) | 6.93 (0.19-9.14) |
The study revealed significant associations between adherence to anaemia prevention strategies and ethnicity of the pregnant woman (
Additionally, when the variable that showed associations with adherence to anaemia prevention strategies from univariate analysis were tested for confounding effects using multivariate logistic regression analysis, it was confirmed that pregnant women who were Ewes (AOR: 0.68, 95% CI: 0.02-0.87,
Associations between adherence to anaemia prevention strategies and general characteristics and knowledge on anaemia.
Variables | Adherence to anaemia prevention strategies | OR (95% CI) | AOR (95% CI) | ||
---|---|---|---|---|---|
Partial adherence 364 (60.9) | Complete adherence 234 (39.1) | ||||
Subdistrict | |||||
Juaboso | 98 (60.1) | 65 (39.9) | 1 | 0.123 | |
Bonsu | 92 (60.5) | 60 (39.5) | 0.81 (0.03-8.76) | ||
Jato | 83 (59.7) | 56 (40.3) | 1.78 (0.04-5.84) | ||
Asempaneye | 91 (63.2) | 53 (36.8) | 0.65 (0.05-7.51) | ||
Age-group (years) | |||||
10–19 | 61 (84.7) | 11 (15.3) | 1 | 0.237 | |
20–29 | 160 (60.4) | 105 (39.6) | 4.73 (0.26-8.47) | ||
30–39 | 101 (52.1) | 93 (47.9) | 6.65 (0.22-10.58) | ||
≥40 | 42 (62.7) | 25 (37.3) | 4.54 (0.01-9.29) | ||
Educational status | |||||
None | 98 (89.9) | 11 (10.1) | 1 | 0.371 | |
Basic | 201 (77.0) | 60 (23.0) | 3.29 (0.23-7.67) | ||
Secondary | 58 (37.4) | 97 (62.6) | 7.57 (0.11-11.32) | ||
Tertiary | 7 (9.6) | 66 (90.4) | 8.24 (0.64-14.56) | ||
Marital status | |||||
Legally married | 262 (55.7) | 208 (44.3) | 1 | 0.421 | |
Cohabitation | 102 (79.7) | 26 (20.3) | 0.48 (0.07-11.43) | ||
Religion | |||||
Christianity | 248 (60.3) | 163 (39.7) | 1 | 0.394 | |
Muslim | 52 (43.3) | 68 (56.7) | 2.12 (0.03-4.45) | ||
Traditionalist | 64 (95.5) | 3 (4.5) | 0.32 (0.02-11.41) | ||
Ethnicity | |||||
Akan | 181 (53.9) | 155 (46.1) | 1 | 1 | |
Ewe | 51 (64.6) | 28 (35.4) | 0.69 (0.01-0.89) | 0.68 (0.02-0.87) | |
Ga-Adangbe | 53 (84.1) | 10 (15.9) | 0.51 (0.07-0.91) | 0.53 (0.09-0.90) | |
Kussase | 79 (65.8) | 41 (34.2) | 0.67 (0.06-0.92) | 0.61 (0.04-0.92) | |
Occupation | |||||
Unemployed | 76 (63.9) | 43 (36.1) | 1 | 0.321 | |
Nonformal jobs | 274 (67.5) | 132 (32.5) | 0.07 (0.13-2.43) | ||
Formal jobs | 14 (19.2) | 59 (80.8) | 3.21 (0.28-7.25) | ||
Gestational age of the pregnancy | |||||
1st trimester | 89 (61.0) | 57 (39.0) | 1 | 0.408 | |
2nd trimester | 169 (63.3) | 98 (36.7) | 0.72 (0.19-8.03) | ||
3rd trimester | 106 (57.3) | 79 (42.7) | 1.94 (0.21-3.67) | ||
Parity | |||||
0 | 39 (76.5) | 12 (23.5) | 1 | 0.421 | |
1 | 280 (71.6) | 111 (28.4) | 1.67 (0.17-3.92) | ||
2 | 41 (40.6) | 60 (59.4) | 3.34 (0.62-4.27) | ||
≥3 | 4 (7.3) | 51 (92.7) | 7.56 (0.41-9.18) | ||
Knowledge of anaemia | |||||
Low/fair | 355 (68.7) | 162 (31.3) | 1 | 1 | |
High | 9 (11.1) | 72 (88.9) | 4.12 (2.76-8.66) | 3.88 (1.32-7.93) |
This study showed that 18.2% of the pregnant women had never been to school, while 19.9% of them were unemployed. However, a study in Libya revealed that only 1.7% of pregnant women in the country were not educated; though, there is a civil war in the country that might have affected the educational system of the country [
This study showed that 86.5% of the pregnant women had insufficient (low/fair) knowledge of anaemia. This finding is in contrast with a study conducted among pregnant women in Nepal, which revealed that 56% of the women had insufficient knowledge of anaemia [
Adherence to anaemia prevention strategies plays a major role in the prevention and treatment of anaemia particularly among pregnant women whose iron requirement increases at the second trimester and progresses until the third trimester [
There was a strong statistically significant association between adherence to anaemia prevention strategies and woman’s knowledge of anaemia and showed that pregnant women who had high knowledge were completely adhering to anaemia prevention strategies as compared to those who had poor knowledge. This association is an indication that the level of knowledge significantly contributed to the level of adherence. What it means is that nonadherence occurs as a result of ignorance and inadequate knowledge a pregnant woman has about anaemia. Consequently, sustained education of pregnant women on anaemia and its preventive strategies are central to maximize adherence to anaemia prevention strategies. Also, these findings are in harmony with a study conducted in Mecha district, Western Amhara in Ethiopia [
This study also revealed significant associations between where a pregnant woman resides in the district, woman’s educational, and occupational status. The finding indicated that pregnant women who went to school were more likely to have high knowledge of anaemia than women who never went to school. This revelation agrees with the studies in India and Pakistan [
Knowledge of anaemia and adherence to anaemia prevention strategies among pregnant women in the district were generally not encouraging. This trend if continued could hinder efforts to reduce anaemia in pregnancy in the country, as well as preventing the country from achieving the targets of Sustainable Development Goals 3. Hence, more efforts are needed to promote awareness on and adherence to anaemia prevention in the district as anaemia in pregnancy could be detrimental to both mother and the foetus, as well as the community and the country as a whole.
The presence of low knowledge and adherence to anaemia prevention suggests the need for an intensification of education on anaemia and its prevention strategies by health professionals and collaborators at all levels of health delivery services to all women in reproductive age. This should include more education and sensitisation on good nutritional practices in the diet of pregnant women Early childhood education on anaemia and other health conditions among women and children should be encouraged and instituted in educational curriculum to offer them with knowledge on important health issues before they reach adulthood, this should be done in collaboration with Ghana Education Service, Ghana Health Service, and other relevant agencies Male involvement and active participation in women and child health issues should be encouraged and promoted since women need support of all people to be able to adhere to all health promotion strategies. This can be achieved through durbars to highlight the roles and duties of men in women’s health and also to establish awards for men who accompany their spouses to antenatal clinics and other health facilities for healthcare.
Answer: Yes. Comment: The data used to support the findings of this study can be made available from the corresponding author upon request.
The authors to this work declare that they have no conflict of interest regarding the study and the publication of this paper.
The authors express their appreciations to the Juaboso District Director of Health Service for granting us the permission to carry out the study in his jurisdiction, and also to the heads of antenatal clinics in the area, as well as all participants. Funding for the study and its publication is personal contributions from the authors.