Prevalence and determinants of anaemia among pregnant women at the Tamale Teaching Hospital

ABSTRACT

BACKROUND: Anaemia during pregnancy is a major public health problem throughout the world, particularly the developing countries. It is a condition in which the number and size of red blood cells ,or hemoglobin concentration falls below the established cut-off value; less than 110g/L for children under 5years and pregnant women, and less than 120 g/L for non-pregnant women which consequently impair the capacity of blood to transport oxygen around the body. 

Globally, it affects half a billion of women of reproductive age. In West Africa, the prevalence among pregnant women was unacceptably high (56%) by 2013. In Ghana, the prevalence was estimated to be 42% and 45% in Northern region. The main aim of this study is to assess the prevalence and determinants of anaemia among pregnant women receiving antenatal care at the Tamale Teaching Hospital. 

METHODS: A cross- sectional study was carried out and systematic random sampling was used to obtain 400 pregnant women receiving antenatal care at Tamale Teaching Hospital. Structured questionnaire were used to interview pregnant women on the socio-demographic/economic characteristics of the participants, the various health practices during pregnancy, the dietary practices including the 24-hour dietary recall questionnaire and the knowledge of anaemia during pregnancy.

RESULTS: More than half (50.8%) of the respondents were anaemic as judged by their Hb level, with 25% were mild and moderately anaemic (Hb of 10 - 10.9g/dl) and (Hb of 7.9 -9.9g/dl) respectively. While 0.3% of the respondents was severely anaemic (Hb of 4-6.9 g/dl). Higher proportion of the respondents were married and obtained higher educational status. Religion and some food items such as mango, melon, carrot, pumkin leaves, sweet pepper etc. from the FAO food groups were significantly associated with the prevalence of anaemia.

CONCLUSION: The prevalence of anaemia is high (50.8%) and still remains a severe public health problem and needs immediate action to prevent the adverse consequences on both the mother and the foetus. The main determinants are dietary factors/qualities during pregnancy. 

Nutrition education for pregnant women should be intensified especially fruits consumption. It is recommended that nutrition professionals provided by Ministry of Health to all ante-natal professionals provided by Ministry of Health to all ante-natal care units and if possible food fortification should be done by the food industries in Ghana.

Table of content

ACKNOWLEGEMENT............................................................................................ iv

DEDICATION..................................... v

TABLE OF CONTENT......................................

LIST OF TABLES....................................................................................................................................... ix

LIST OF FIGURES ..................................................................................................................................... ix

ABBREVIATIONS ...................................................................................................................................... x

LIST OF APPENDICES............................................................................................................................... x

CHAPTER ONE xi

1.0 INTRODUCTION ................................................................................................................................. xi

1.1 BACKGROUND ..............................................................................................................................

1.2 PROBLEM STATEMENT............................................................................................................... xii

1.3 SIGNIFICANCE OF THE STUDY..................................................................................................xiii

1.4 RESEARCH OBJECTIVES .............................................................................................................xiii

1.5 LIMITATION TO THE STUDY......................................................................................................xiv

CHAPTER TWO ........................................................................................................................................xiv

2.0 LITERATURE REVIEW .................................................................................................................xiv

2.1 ANAEMIA........................................................................................................................................xiv

2.1.1 CAUSES ANAEMIA ................................................................................................................xiv

2.1.3 SOCIO-DEMOGRAPHIC AND SOCIO-ECONOMIC STATUS DETERMINANTS OF 

ANAEMIA IN PREGNANT WOMEN............................................................................................xviii

2.2 HEALTH CONDITIONS DURING PREGNANCY .......................................................................xix

2.2.1 HELMINTHS DURING PREGNANCY...................................................................................xix

2.2.2 MALARIA DURING PREGNANCY ........................................................................................xx

2.2.3 HIV/AIDS IN PREGNANT WOMEN......................................................................................xxi

2.3 DIETARY PRACTICES DURING PREGNANCY........................................................................xxii

2.3.1 PICA AMONG PREGNANT WOMEN...................................................................................xxii

2.3.2 FOOD AVERSION...................................................................................................................xxii

2.3.3 ALCOHOL CONSUMPTION..................................................................................................xxii

2.4 DIETARY QUALITY ....................................................................................................................xxiii

2.5 KNOWLEDGE AND EDUCATION ON ANAEMIA AND HEALTH PRACTICES DURING 

PREGNANCY ......................................................................................................................................xxiv

CHAPTER THREE .................................................................................................................................xxvii

3.0 METHODS ........................................................................................................................................xxvii

3.1 STUDY DESIGN...........................................................................................................................xxvii

3.2 STUDY SITE, POPULATION AND SUBJECTS........................................................................xxvii

3.3 SAMPLE SIZE DETERMINATION..................................................................................................... xxviii

3.4 SAMPLING TECHNIQUE .......................................................................................................... xxviii

3.5 STUDY TOOL................................................................................................................................xxix

3.6 PARTICIPANTS INCLUSION CRITERIA ..................................................................................xxix

3.7 DATA COLLECTION ...................................................................................................................xxix

3.7.1 QUESTIONNAIRE ADMINISTRATION..............................................................................xxix

3.8 DATA ENTRY AND ANALYSIS.................................................................................................xxxi

3.9 ETHICAL CONSIDERATION ......................................................................................................xxxi

CHAPTER FOUR.................................................................................................................................... xxxii

4.0 RESULTS .......................................................................................................................................... xxxii

4.1 SOCIO-DEMOGRAPHIC AND SOCIO-ECONOMIC CHARACTERISTICS OF WOMEN 

(RESPONDENTS)............................................................................................................................... xxxii

4.1.1 SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS ............................. xxxii

4.1.2 SOCIO-ECONOMIC STATUS OF RESPONDENTS.......................................................... xxxiv

4.2 BEHAVIOURS THAT PRECIPITATE OR PREVENT INCIDENCE OF ANAEMIA .............. xxxv

4.3 HEALTH BAHAVIOURS, PRACTICES AND STATUS OF THE RESPONDENTS ............. xxxvii

4.3.1 MALARIA DURING PREGNANCY ...................................

4.3.2 HIV/AIDS and worms infestation in pregnancy................................................................... xxxvii

4.4 DIETARY HABITS OF RESPONDENTS ................................................................................. xxxvii

4.4.1 PICA PRACTICES............................................................................................................... xxxvii

4.4.2 FOOD CRAVING................................................................................................................. xxxvii

4.4.3 FOOD AVERSIONS ........................................................................................................... xxxviii

4.4.4 SUBSTANCES THAT AFFECT IRON ABSORPTION.................................................... xxxviii

4.4.5 ALCOHOL CONSUMPTION AMONG THE RESPONDENTS....................................... xxxviii

4.5 DIETARY DIVERSITY OF THE RESPONDENTS............................................................... xxxix

4.6 KNOWLEDGE OF RESPONDENTS ABOUT ANAEMIA ..........................................................xliv

4.8.1 HAEMOGLOBIN STATUS AND EDUCATION..................................................................xlvii

4.8.2 HAEMOGLOBIN STATUS AND AGE RANGES...............................................................xlviii

4.8.3 HAEMOGLOBIN STATUS AND RELIGION .....................................................................xlviii

4.8.4 HAEMOGLOBIN STATUS AND MARITAL STATUS......................................................xlviii

4.8.5 HAEMOGLOBIN STATUS AND NUMBER OF CHILDREN............................................xlviii

4.8.6 HB STATUS AND SOCIO-ECONOMIC STATUS OF THE RESPONDENTS..................xlviii

CHAPTER 5 ............................................................................................................................................... liii

5.0 DISCUSSION....................................................................................................................................... liii

5.1 SOCIO-DEMOGRAPHIC AND SOCIO-ECONOMIC CHARACTERISTIC OF RESPONDENTS

................................................................................................................................................................ liii

5.2 HEALTH BEHAVIOURS, PRACTICES AND STATUS OF PREGNANT WOMEN.................. liv

5.3 DIETARY HABITS AMONG THE STUDY SUBJECTS ......................................................

5.4 DIETARY DIVERSITY OF PREGNANT WOMEN ..................................................................... lvii

5.5 KNOWLEDGE OF PREGNANT WOMEN ON ANAEMIA......................................................... lvii

5.6 PREVALENCE AND DETERMINANTS OF ANAEMIA ............................................................lviii

CHAPTER SIX............................................................................................................................................ lx

6.0 CONCLUSION AND RECOMMENDATION..................................................................................... lx

6.1 CONCLUSION.................................................................................................................................. lx

6.2 RECOMMENDATION ..................................................................................................................... lx

LIST OF TABLES

Table: 4. 1 Socio-demographic characteristics of the respondents........................................... xxxii

Table: 4. 2 Socio-economic status of respondents................................................................... xxxiv

Table: 4. 3 Behaviours that precipitate or prevent incidence of anaemia................................ xxxv

Table: 4. 4 FAO food groups’ women ate from over the past 24 hours.................................. xxxix

Table: 4. 5 Food craving, food aversions and pica practice among the respondents.................... xli

Table: 4. 6 Nutritional knowledge of anaemia among the respondents....................................... xlv

Table: 4. 7 Trimester of respondents and trimester of haemoglobin recorded .......................... xlvii

Table: 4. 8 Association between anaemia status and socio-demographic/economic variables xlviii

LIST OF FIGURES

Figure: 2. 1 Conceptual model of the determinants of anaemia (Yarlini et al, 2011) ............... xx