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Anaemia at antenatal care initiation and associated factors among pregnant

women in West Gonja District, Ghana: a cross-sectional study

Article  in  Pan African Medical Journal · August 2019

DOI: 10.11604/pamj.2019.33.325.17924

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Research
Anaemia at antenatal care initiation and associated factors among
pregnant women in West Gonja District, Ghana: a cross-sectional
study

Basil Addayire Tibambuya1, John Kuumuori Ganle 2,3,&, Muslim Ibrahim4

1
Department of Public Health, West Gonja Hospital, Damongo, Northern Region, Ghana, 2Department of Population, Family and Reproductive Health,
School of Public Health, University of Ghana, Accra, Ghana, 3Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at
Stellenbosch University, Stellenbosch 7600, South Africa, 4Nadowli Hospital, Ghana Health Service, Nadowli, Upper West Region, Ghana

&
Corresponding author: John Kuumuori Ganle, Department of Population, Family and Reproductive Health, School of Public Health, Univer sity of
Ghana, Accra, Ghana

Key words: Anaemia, pregnancy, preconception care, early antenatal care, antenatal care initiation, iron-rich food, Ghana

Received: 12/12/2018 - Accepted: 02/07/2019 - Published: 27/08/2019

Abstract
Introduction: anaemia in pregnancy remains a critical public health concern in many African settings; but its determinants are not clear. The
purpose of this study was to assess anaemia at antenatal care initiation and associated factors among pregnant women in a local district of Ghana.
Methods: a facility-based cross-sectional survey was conducted. A total of 378 pregnant women attending antenatal care at two health facilities
were surveyed. Data on haemoglobin level, helminths and malaria infection status at first antenatal care registration were extracted from antenatal
records booklets of each pregnant women. Questionnaires were then used to collect data on socio-demographic and dietary variables. Binary and
multivariate logistic regression analyses were done to assess factors associated with anaemia. Results: the prevalence of anaemia was 56%, with
mild anaemia being the highest form (31.0%). Anaemia prevalence was highest (73.2%) among respondents aged 15-19 years. Factors that
significantly independently reduced the odds of anaemia in pregnancy after controlling for potential confounders were early (within first trimester)
antenatal care initiation (AOR=5.01; 95% CI =1.41-17.76; p=0.013) and consumption of egg three or more times in a week (AOR=0.30; 95%
CI=0.15-0.81; P=0.014). Conclusion: health facility and community-based preconception and conception care interventions must not only aim to
educate women and community members about the importance of early ANC initiation, balanced diet, protein and iron-rich foods sources that may
reduce anaemia, but must also engage community leaders and men to address food taboos and cultural prohibitions that negatively affect pregnant
woman.

The Pan African Medical Journal. 2019;33:325. doi:10.11604/pamj.2019.33.325.17924

This article is available online at: http://www.panafrican-med-journal.com/content/article/33/325/full/

© Basil Addayire Tibambuya et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original
work is properly cited.

Pan African Medical Journal – ISSN: 1937- 8688 (www.panafrican-med-journal.com)

Published in partnership with the African Field Epidemiology Network (AFENET). (www.afenet.net)
Page number not for citation purposes 1
Introduction Methods

Globally, anaemia affects an estimated 43% of children, 38% of Study design and respondents: a facility based cross-sectional
pregnant women, and 29% of non-pregnant women of childbearing quantitative survey was conducted at the west Gonja District Hospital
age [1]. In low-income countries, anaemia affects 40 to 60% of and the Damango Health Centre, all in the West Gonja District of the
pregnant women [2, 3]. The World Health Organization defines Northern region of Ghana between November 2017 and April 2018.
anaemia as decreased concentration of haemoglobin (Hb) level of less All pregnant women aged 15-49 years who were attending these two
than 11g/dL [1]. Anaemia during pregnancy is considered severe health facilities to receive their first ANC between November 2017 and
when Hb concentration level is less than 7.0g/dL; moderate when April 2018 were eligible for the study. However, pregnant women who
haemoglobin level falls between 7.0-9.9g/dL; and mild from 10.0- reported a recent history of blood transfusion (within the past three
10.9g/dL [4]. The causes of anaemia during pregnancy are multi- months) before initiation of first ANC were excluded from the study.
factorial, and includes nutritional deficiencies of iron, folate, and
vitamin B12 [1]. Economic and socio-cultural factors such as cultural Study setting: the west Gonja District has an estimated population
and religious food taboos also significantly contribute to anaemia of 49,386 [13]. Women form 51% of the district's population, with
among pregnant women [3, 5]. Other causes of anaemia in about 1,975 women expected to have become pregnant in 2017 [12].
pregnancy include parasitic infections like helminths and other The main occupations of women in the district are farming and retail
conditions such as low intake or poor absorption of iron [4]. Iron trade and services, with few engaged in teaching and nursing [12].
deficiency is the most common cause of anaemia in pregnancy in Health service delivery in the district is done through a total of thirteen
many low-income settings [2, 4]. While evidence suggests that most (13) community-based health planning and services (CHPS)
women in low-income countries, including Ghana, enter pregnancy compounds, five (5) health centres, and one (1) district hospital. All
with less than adequate stores of nutrients [6], anaemia in pregnant the 19 facilities provide basic ANC services. However, the West Gonja
women could have serious adverse pregnancy outcomes, including Hospital (the main referral hospital) provides comprehensive
high maternal death, impaired mental development in children, prenatal, delivery and postnatal services. The West Gonja hospital
increased risk of fetal growth retardation, low birth weight, premature and Damongo Health Centre (the largest first-tier primary public
delivery and perinatal mortality [7, 8]. Like many countries in Africa, healthcare facility) were purposively selected for this study. These
anaemia remains an important threat to safe motherhood and facilities are the largest public health facilities and receive the largest
newborn health in Ghana [9, 10]. Anaemia is the number two cause number of ANC registrants on annual basis.
of all admissions and the number five cause of death among all
admitted patients in Ghana [11]. Indeed, health facility level data Sample size: a total of 433 pregnant women reported for their first
suggest that the prevalence of anaemia among pregnant women in ANC in the two facilities (224 in West Gonja hospital and 209 in
Ghana is on the rise, from 34% in 2014 to 37% in 2016 [11]. There Damongo health centre) between November 2017 and April 2018.
are however regional disparities. In the Northern region where this However, 34 women had history of recent blood transfusion and 21
study was conducted, 43.2% of pregnant women attending ANC in women who met the inclusion criteria declined to participate. They
2016 were anaemic [11]. The situation in the specific district (West were therefore excluded from the study, leaving a final sample size
Gonja District) where this study was conducted is worse: anaemia of 378.
among ANC attendants rose from 23.4% in 2012 to 43.9% in
2016 [12]. While the potential adverse health consequences of Recruitment and data collection: all respondents were
anaemia in pregnancy are widely recognised, few empirical studies recruitment at the ANC clinics of the two health facilities. Two
have been conducted in Ghana to identify key determinants [10]. research assistants were trained and stationed at each of the two ANC
Indeed, the lack of evidence on anaemia in many low-income clinics. Starting from November 1, 2017 to April 30, 2018, the
countries is acknowledged as one of the reasons why the fight against research assistants attended all weekly ANC clinic sessions organised
anaemia in pregnancy still remains a problem [1]. This study aimed by midwives/nurses. Pregnant women who reported to the clinics for
to assess anaemia at antenatal care initiation and its determinants their first ANC were all approached after they (women) had completed
among pregnant women in a local district of Ghana. all service procedures and were exiting. They were individually told

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about the purpose of the study and the study procedures. Those who independently compared the two data entries. All errors were
could read (in English) were immediately provided with information discussed and resolved before data were exported into Stata (version
leaflets about the study. Those who could not read were asked if they 15.0) for further cleaning and analysis.
wanted to receive the information leaflet so that a family member or
friend could later read and explain to them. Nearly all such women Variables: the main outcome variable is anaemia, which we defined
accepted the information leaflets. The research assistants enlisted the and measured primarily as a binary outcome. We followed the WHO's
names and contact numbers of all the women approached. Those definition and categorisation: women whose haemoglobin (Hb)
without personal telephone numbers were requested to provide the concentration levels were >11g/dl and <11g/dl were classified as 'not
numbers of their husband/partner, family member or friend. anaemic' and 'anaemic' respectively [1]. We re-categorized all
Following from this, each woman was given two weeks to decide on anaemic women into mild (10-10.9g/dl), moderate (7-9.9g/dl) and
their participation. They were each re-contacted via telephone after severe (<7g/dl). Several independent variables were also defined and
the two-week period. Where the decision was in favor of participation, measured, including socio-demographic factors such as age, maternal
interview dates were arranged, usually on the next ANC visit. education, occupation, marital status, religion, husband's occupation,
However, where the decision was against participation (there were and place of residence as well as maternal and dietary characteristics.
21 such cases), such women were dropped. Timing of ANC initiation was determined by whether the woman came
within the first, second or third trimester. Malaria infection was
In terms of data collection, two methods were employed: data determined by whether a woman tested Positive or Negative for the
extraction from ANC booklets of respondents and administration of presence of malaria parasite at the time of ANC initiation. Helminthic
structured questionnaires. First, the following information was infection was also determined by whether the woman tested Positive
extracted from the ANC booklet: timing of ANC initiation, Hb level at or Negative for any intestinal worm infection during her current
registration, helminths infection, malaria infection, number of times pregnancy at the time of ANC initiation.
the woman became pregnant and number of children delivered by the
woman. HB level, helminths infection and malaria infection are routine Statistical analysis: categorical variables were summarised into
blood tests done for all pregnant women at ANC initiation. A simple frequencies and proportions. Continuous variables were summarised
tool was designed and used to extract this information from the into means and ranges and continuous variables like age were re-
maternal and child health record books of each of the 378 women categorised into age groups. Bivariate analysis was first done using
who agreed to participate in the study. This information was then chi-square test of independence to assess association between
subsequently linked to information collected from each woman using anaemia and categorical independent variables. Binary logistic
the questionnaires. Second, questionnaires were used to collect data regression was used to assess for factors associated with anaemia.
on other socio-demographic, maternal and dietary characteristics. Factors with p-value < 0.05 at 95% confidence level were considered
The questionnaires were pre-tested at two other smaller health statistically significant and were therefore included in a multiple
centres located in the district. All necessary corrections were made logistic regression model for further analysis. Odd ratios were
before actual data collection from November 2017 to April 2018. estimated.
Actual data collection occurred alongside recruitment: as women
reported to the ANC clinic on weekly basis for the first time, they were Ethical considerations: the research was conducted in accord with
approached, recruited and subsequently interviewed. The two prevailing ethical principles. Ethical approval was obtained from the
research assistants conducted all interviews in a designated small Ghana Health Service Ethical Review Committee (GHS-ERC Number:
room within the premises of each health facility. Women were GHS-ERC 20/02/2017). Informed written consent was obtained
interviewed one at a time. English and Gonja (local dialect) were the (either by signing or thumb printing) from each respondent before
interview languages. interviewing.

Data entry and processing: completed questionnaires were

manually examined for completeness, then hand-coded and entered
into Epi info version 7. The data were independently entered by the
two research assistants. The first and second authors then

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Results Discussion

Characteristics of respondents: Table 1 shows the background This study is one of the few to assess anaemia prevalence and
characteristics of the 378 respondents who took part in the study. associated factors among pregnant women attending ANC services in
The mean age was 26.9, and the majority (29.1%) were aged 25-29 Ghana. Results suggest that the prevalence of anaemia among
years. Table 2 also shows the maternal characteristics of respondents. pregnant women in the study is quite high (56%), with mild anaemia
Majority (51.9%) initiated ANC in the second trimester (13 to 24 being the highest (31.0%) form. Two factors significantly
weeks). Some 13.8% of the respondents tested positive for malaria independently predicted anaemia in pregnancy after adjusting for
at their first ANC visit, while 31.2% tested positive for helminths other factors, namely timing of ANC initiation and egg consumption
infection. Table 3 describes the dietary characteristics of respondents. per week. Several aspects of these results deserve further reflection
A combined 55.8% of the respondents took meat (including liver) and on. The prevalence of anaemia in this study is highest (73.2%) among
fish at least three times a week. Some 51.1% also consumed egg 1- respondents aged between 15-19 years. This is consistent with
2 times per week. Green leafy vegetable consumption was generally findings from Mangla & Singla's study [6]. A number of factors could
high among respondents: 21.4% and 76.7% consumed green leafy contribute to high anaemia in this age group. One of the important
vegetable 1-2 times and 3+ times per week respectively. causes of anaemia is iron deficiency, and studies suggest that the 15-
19year age band is a period of intense physical and mental growth,
Prevalence of anaemia: in terms of prevalence of anaemia, 55.8% with a higher demand for iron and other nutrients [4, 10]. Pregnancy
of the respondents were anaemic (Hb less than 11g/dl), with the and childbirth during this age group could place further demands on
mean Hb level being 10.8g/dl and a range of 6.7g/dl to 14.4g/dl. the already inadequate iron stores in teenage mothers. This could
Among the 55.8% who had anaemia, 0.3% had severe anaemia, easily predispose pregnant teenagers to anaemia. Apart from the fact
24.5% had moderate anaemia, and 31.0% had mild anaemia. that young girls may be unprepared biologically, they may also be
unprepared emotionally and economically to deal with pregnancy.
Predictors of anaemia: to determine factors associated with This is particularly likely because in many contexts in Ghana, sexual
anaemia in pregnancy, chi-square tests of independence were first and reproductive health topics remain taboo subjects for most parents
performed between a total of 24 independent variables and anaemia to discuss with their adolescent children, and teen pregnancy is often
in pregnancy. From this initial analysis, 11 factors were statistically not welcome [14]. This could easily undermine social and economic
associated with anaemia in pregnancy. These 11 factors were then support for teenage mothers, which could in turn affect their
pulled into binary and multiple logistic regression models and odds nutritional status. This would suggest a need to intensify early sexual
ratios were estimated. The results are shown in Table 4 and Table 4 and contraception education and counselling for female adolescents
(suite). After adjusting for potential confounders, two factors at home and in school as well as self-efficacy training and skills
significantly independently predicted anaemia in pregnancy: timing of acquisition to help them negotiate peer-pressures to initiate sex early
ANC initiation and egg consumption per week. Women who initiated and to protect themselves during sexual intercourse. The role of
ANC within the second and third trimesters were, respectively, 2.71 parents and guardians in providing sexual and reproductive health
and 5.01 times more likely to be anaemic compared to those who education needs to be encouraged given that early sexual debut and
started ANC within the first trimester (AOR=2.71; 95% CI=2.09-5.81; childbearing among female adolescents is a widely reported
P<0.01) and (AOR=5.01; 95% CI =1.41-17.76; p=0.013). The odds phenomena in Africa [15-17]. Apart from interventions to stop or
of getting anaemia in pregnancy significantly declined as a pregnant reduce early sexual debut and childbearing, interventions to
woman consumed eggs more frequently per week. When compared encourage teen mothers to seek early ANC together with targeted
to women who reported not consuming egg at all, the odds of being nutritional counselling and support services, would also be essential.
anaemic in pregnancy were 0.51 lower for women who consumed egg
1-2 times per (AOR=0.51; 95% CI=0.29-1.39; p=0.257), and 0.30 The timing of ANC initiation emerged as an important predictor of
times lower for women who consumed egg 3+ times per week anaemia among first time registrants. Compared to women who
(AOR=0.30; 95% CI=0.15-0.81; P=0.014). initiated ANC in the first trimester, the odds of having anaemia in
pregnancy were still significantly higher among pregnant women who

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initiated ANC in the second trimester (AOR=2.71; 95% CI=2.09-5.81; be essential. Taken together, this study has provided important
P<0.01) and third trimester (AOR=5.01; 95% CI=1.41-17.76; insights into the anaemia and dietary situation among pregnant
p=0.013). This is also consistent with what has been reported in women who started ANC between November 2017 and April 2018 in
Bangladesh [18], and in a regional health facility study in the west Gonja District. The findings give an indication of the factors
South Africa [8], where anaemia in pregnancy was higher among that may be contributing to anaemia in pregnancy. This could
women who registered in the second and third trimesters compared potentially afford policy makers and healthcare workers an
to those who registered within the first trimester. That late ANC opportunity to plan and implement contextually relevant interventions
initiation is associated with anaemia in pregnancy is however not to reduce anaemia and its associated adverse consequences. The
surprising. This is not only because majority of women in our study findings also provide a basis for large-scale further quantitative and
initiated ANC either in the second or third trimester, but also because qualitative studies in different contexts in Ghana to estimate anaemia
late ANC initiation means that many of the interventions and services prevalence, identify important determinants and explore detailed
routinely offered to pregnant women at ANC clinics to prevent contextual, structural and personal level explanatory factors. The
anaemia in pregnancy such as IFA supplementation, provision of study however has some limitations. First, the study only assessed
LLINs, and IPT dosing, as well as laboratory investigations (e.g. Hb anaemia at registration and did not examine anaemia at various
check and stool tests) to diagnose early anaemia in pregnancy and stages of pregnancy (e.g. anaemia at 28 weeks and at 36 weeks).
offer early treatment, are delayed for such women. This would Such an analysis could provide better understanding on the
suggest a need for both health facility and community-based prevalence at each stage. Second, data on Hb level, malaria and
preconception and conception care interventions to educate women helminths infection were extracted from maternal and child health
and community members on the importance of early antenatal care records of each woman. Any original data errors resulting from
initiation and the need to seek ANC services early. In doing this, inaccurate test results or improper data capture could not have been
efforts must be made to address health system barriers such as long addressed. Finally, there could be recall bias since respondents were
distances to service centres as well as engage community members asked about dietary and other behaviours that might have taken place
(men and mothers-in-law in particular) to address socio-cultural long before this study.
barriers such as the need to perform traditional pregnancy-related
rituals before permission is granted for pregnant women to access
services as shown in previous research in northern Ghana [19, 20]. Conclusion

Some aspects of dietary characteristics were also significantly

The main objective of this study was to assess anaemia prevalence
associated with anaemia in pregnancy. While meat/fish and green
and associated factors among pregnant women attending ANC
leafy vegetable consumption did not surprisingly show significant
services in the West Gonja District. The study revealed a relatively
statistical association with anaemia in pregnancy as we expected,
high (56%) anaemia prevalence among the study respondents.
frequency of egg consumption did show strong statistical association
Timing of ANC and regular egg consumption were the strongest
with anaemia such that women who consumed eggs three or more
predictors of anaemia in pregnancy. These findings and discussion
times in a week were less likely to be anaemic in pregnancy compared
together suggest that awareness and knowledge about anaemia
to those who did not consume eggs at all. This is similar to findings
among pregnant women attending ANC alone may not even be
by Gebre & Mulugeta in northern Ethiopian where frequency of egg
sufficient to bring about reduced prevalence. Therefore, interventions
consumption per day was strongly associated with anaemia in
need to go beyond awareness and knowledge creation through
pregnancy [3]. Our results here support existing evidence that
information provision to focusing on other important dietary,
highlights the nutritional benefits of egg consumption (at least in the
economic and cultural factors that may impact negatively on the
context of anaemia) during pregnancy and suggest a need for
possibility of getting anaemia in pregnancy. In this regard, health
pregnant women to incorporate eggs into their diet. We acknowledge
facility and community-based preconception and conception care
that poverty and socio-cultural food laws and taboos could deny
interventions must not only aim to educate women and community
pregnant women otherwise nutritionally rich food sources including
members on the importance of early ANC initiation, balanced diet and
meat and egg. Nutrition supplementation and community-based
sources of iron rich foods that may reduce anaemia, but must also
interventions to address harmful food taboos during pregnancy could

Page number not for citation purposes 5

engage community leaders to address issues related to food taboos
and prohibitions during pregnancy that could expose pregnant
women to adverse health outcomes, including anaemia. Acknowledgements

What is known about this topic

This manuscript was first drafted when the second author was a
 Anaemia affects 40-60% of pregnant women in low-
Fellow at the Stellenbosch Institute for Advanced Study, Stellenbosch
income countries;
University, South Africa. Writing space for the manuscript was
 Anaemia is a significant contributory factor to adverse
graciously provided by the Stellenbosch Institute for Advanced Study.
pregnancy outcomes, including high maternal death, We are grateful for this support.
impaired mental development in children, increased risk of
fetal growth retardation, low birth weight, premature
delivery and perinatal mortality;
Tables
 But its determinants are not exactly clear.

What this study adds Table 1: demographic and economic characteristics

 Early (within first trimester) antenatal care initiation and Table 2: maternal characteristics
consumption of egg three or more times in a week Table 3: dietary and cultural characteristics
significantly independently reduced the odds of being Table 4: predictors of anaemia in pregnancy (multivariable logistic
anaemic in pregnancy; regression analysis)
 Preconception and conception care interventions must Table 4 (suite): predictors of anaemia in pregnancy (multivariable
stress the importance of early antenatal care initiation, logistic regression analysis)
consumption of balanced diet and protein and iron-rich
foods;

 Community-based engagement and interventions to References

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Table 1: demographic and economic characteristics
Characteristic Frequency Percent Characteristic Frequency Percent
(n=387) (n=387)
Mother’s Age Monthly earnings (GH¢)
Mean age (SD) 26.9+10.1 <200 257 68.0
15-19 41 10.9 200-500 98 25.9
20-24 104 27.5 600-1,000 16 4.2
25-29 110 29.1 1,100+ 7 1.9
30-34 75 19.8 Partner’s Education Level
35+ 48 12.7 None 132 34.9
Mother’s Education Primary 37 9.8
None 131 34.7 JHS 52 13.8
Primary 57 15.1 Secondary 80 21.2
Junior High School (JHS) 85 22.5 Tertiary 77 20.4
Secondary 65 17.2 Partner’s Occupation
Tertiary 40 10.6 Government worker 73 19.3
Marital Status Self-employed 233 61.6
Cohabitation 11 2.9 Unemployed 72 19.1
Divorced 1 0.3
Married 315 83.3
Single 51 13.5
Religious Affiliation
Christianity 91 24.1
Islam 285 75.4
Traditional 2 0.5
Place of Residence
Rural 163 43.1
Urban 215 56.9
Mother’s Occupation
Government worker 28 7.4
Self-employed 195 51.6
Unemployed 155 41.0
Distance to Facility for ANC (km)
<1 139 36.8
2-4 142 37.6
5-7 79 20.9
8-10 18 4.8
Monthly Expenditure (GH¢)
<200 278 73.5
200-500 89 23.5
600-1,000 9 2.4
1,100+ 2 0.5

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Table 2: maternal characteristics
Characteristic Frequency Percent
(n=387)
Timing of ANC Initiation
First trimester 161 42.6
Second trimester 196 51.9
Third trimester 21 5.6
Parity
0-4 341 90.7
5+ 35 9.3
Gravidity
1- 4 337 89.2
5+ 41 10.9
Birth Spacing (years)
1 15 4.0
2+ 272 72.0
Primigravida 91 24.0
Ownership of Treated Bed Net
Yes 360 95.2
No 18 4.8
Sleep Under Treated Bed Net Everyday
Yes 331 87.6
No 47 12.4
Malaria Infection at ANC Initiation
Yes 81 21.5
No 297 78.5
Helminths Infection at ANC Initiation
Yes 118 31.2
No 260 68.8

Table 3: dietary and cultural characteristics

Characteristic Frequency (n=387) Percent
Lipton/Coffee Tea Consumption (at least once a week)
Yes 176 46.6
No 202 53.4
Meat/Fish Consumption Per Week*
None 15 4.0
1-2 times 152 40.2
3+ times 211 55.8
Egg Consumption Per Week
None 56 14.8
1-2 times 193 51.1
3+ times 129 34.1
Green leafy Vegetable Consumption Per Week
None 7 1.9
1-2 times 81 21.4
3+ times 290 76.7
Food Prohibited during Pregnancy
Egg 15 4.0
Meat 11 2.9
None 352 93.1
*The purpose for measuring meat(liver) and fish together was to assess meat-based sources of iron

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Table 4: predictors of anaemia in pregnancy (multivariable logistic regression analysis)
Anaemic, Not Anaemic, Unadjusted Adjusted
Characteristic P-value P-value
n (%) n (%) OR (95%CI) OR (95%CI)
Mother’s age
15-19 (ref) 30(73.2) 11(26.8) 1 1
20-24 64(61.5) 40(38.5) 0.59(0.26-1.30) 0.189 0.99(0.37-2.70) 0.992
25-29 60(54.6) 50(45.5) 0.44(0.20-0.97) 0.041* 1.02(0.35-2.97) 0.971
30-34 37(49.3) 38(50.7) 0.36(0.16-0.82) 0.015* 0.69(0.22-2.17) 0.522
35+ 20(41.7) 28(58.3) 0.26(0.11-0.64) 0.003* 0.37(0.11-1.22) 0.102
Mother’s Education
Tertiary (ref) 13(32.5) 27(67.5) 1 1
Secondary 34(52.3) 31(47.7) 2.28(1.00-5.18) 0.049* 0.44(0.12-1.61) 0.216
JHS 48(56.5) 37(43.5) 2.69(1.23-5.93) 0.014* 0.40(0.10-1.57) 0.187
Primary 36(63.2) 21(36.8) 3.56(1.52-8.35) 0.004* 0.68(0.16-2.78) 0.586
None 80(61.1) 51(38.9) 3.26(1.54-6.89) 0.002* 0.80(0.20-3.29) 0.762
Marital Status
Single (ref) 38(74.5) 13(25.5) 1 1
Married 165(52.4) 150(47.6) 0.38(0.19-0.73) 0.004* 0.50(0.21-1.20) 0.122
Cohabitation 7963.6) 4(36.4) 0.60(0.15-2.38) 0.466 0.52(0.11-2.59) 0.427
Divorced 1(100.0) 0(0.0)**
Mother’s Occupation
Unemployed (ref) 101(65.2) 54(34.8) 1 1
Self-employed 103(52.8) 92(47.2) 0.60(0.39-0.92) 0.020* 0.89(0.50-1.59) 0.700
Government worker 7(25.0) 21(75.0) 0.18(0.07-0.45) 0.000* 0.36(0.08-1.77) 0.210
Monthly Expenditure
(GH¢)
<200 (ref) 171(61.5) 107(38.5) 1 1
200-500 38(42.7) 51(57.3) 0.47(0.29-0.76) 0.002* 1.27(0.53-3.03) 0.588
600-1,000 2(22.2) 7(77.8) 0.18(0.04-0.88) 0.034* 1.45(0.16-3.52) 0.744
1,100+ 0(0.0) 2(100.0)**
Monthly Earnings (GH¢)
<200 162(63.0) 95(37.0) 1 1
200-500 3(18.8) 13(81.3) 0.48(0.30-0.77) 0.002* 0.65(0.29-1.44) 0.288
600-1,000 44(44.9) 54(55.1) 0.14(0.04-0.49) 0.002* 0.21(0.04-1.16) 0.074
1,100+ 2(28.6) 5(71.4) 0.23(0.05-1.23) 0.087 1.69(0.12-2.93) 0.693
*p<0.05; OR= odds ratio; CI=confidence interval; ref=reference categories
**Marital Status! =0 predicts success perfectly, hence marital status was dropped and 1 observation not used. Also, monthly e xpenditure! =0 predicts
failure perfectly, hence monthly expenditure was dropped and 2 observations not used

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Table 4 (suite): predictors of anaemia in pregnancy (multivariable logistic regression analysis)
Characteristic Anaemic, n Not Anaemic, Unadjusted P-value Adjusted P-value
(%) n (%) OR (95%CI) OR (95%CI)
Partner’s Education
Tertiary (ref) 29(37.7) 48(62.3) 1 1
Secondary 43(53.8) 37(46.2) 1.92(1.02-3.64) 0.044* 1.85(0.55-6.51) 0.339
JHS 39(75.0) 13(25.0) 4.97(2.28-10.82) 0.000* 3.89(0.89-17.07) 0.072
Primary 26(70.3) 11(29.7) 3.91(1.69-9.08) 0.002* 3.59(0.76-16.89) 0.106
None 74(56.1) 58(43.9) 2.11(1.19-3.75) 0.011* 1.48(0.36-6.11) 0.590
Partner’s Occupation
Unemployed (ref) 44(61.1) 28(38.9) 1 1
Self-employed 137(58.8) 96(41.2) 0.91(0.53-1.56) 0.727 0.69(0.35-1.38) 0.293
Government worker 30(41.1) 43(58.9) 0.44(0.23-0.86) 0.017* 1.48(0.40-5.47) 0.557
Timing of ANC Initiation
First trimester (ref) 66(41.0) 95(59.0) 1 1
Second trimester 128(65.3) 68(34.7) 2.71(1.76-4.17) 0.000* 3.49(2.09-5.81) 0.000*
Third trimester 17(81.0) 4(19.0) 6.12(1.97-19.01) 0.002* 5.01(1.41-17.76) 0.013*
Birth Spacing (yrs)
1 (ref) 11(73.3) 4(26.7) 1 1
2+ 139(51.1) 133(48.9) 0.38(0.12-1.22) 0.105 0.53(0.14-2.08) 0.368
Primigravida 61(67.0) 30(33.0) 0.74(0.22-2.52) 0.629 0.84(0.20-3.42) 0.804
Egg Consumption per
Week
Never (ref) 41(73.2) 15(26.8) 1 1
1-2 times 112(58.0) 81(42.0) 0.51(0.26-0.96) 0.042* 0.63(0.29-1.39) 0.257
3+ times 58(45.0) 71(55.0) 0.30(0.15-0.59) 0.001* 0.35(0.15-0.81) 0.014
*p<0.05; OR= odds ratio; CI=confidence interval; ref=reference categories

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