Journal of Pregnancy

Journal of Pregnancy / 2020 / Article

Research Article | Open Access

Volume 2020 |Article ID 2139892 | https://doi.org/10.1155/2020/2139892

Prince Kubi Appiah, Daniel Nkuah, Duut Abdulai Bonchel, "Knowledge of and Adherence to Anaemia Prevention Strategies among Pregnant Women Attending Antenatal Care Facilities in Juaboso District in Western-North Region, Ghana", Journal of Pregnancy, vol. 2020, Article ID 2139892, 8 pages, 2020. https://doi.org/10.1155/2020/2139892

Knowledge of and Adherence to Anaemia Prevention Strategies among Pregnant Women Attending Antenatal Care Facilities in Juaboso District in Western-North Region, Ghana

Academic Editor: Marco Scioscia
Received04 Sep 2019
Revised27 May 2020
Accepted23 Jul 2020
Published01 Aug 2020

Abstract

Background. Anaemia in pregnancy is a major problem in both developed and developing countries. The commonest source of anaemia is nutritional deficiency of iron with evidence suggesting that up to 90% of maternal anaemia may be due to inadequate consumption of dietary iron; however, there are other causes which include worm infestation, HIV infection, and genetic disorders. There are some implemented approaches in Ghana including education and awareness creation, nutritional supplements, and control and prevention of parasitic infections among others to prevent and control anaemia in pregnancy. This study assessed pregnant women adherence to Ghana’s anaemia prevention strategies being implemented in the Juaboso District. Method. A descriptive cross-sectional data on knowledge of and adherence to anaemia prevention strategies among pregnant women was collected. Pearson’s chi-square and logistic regression models were used to assessed associations between predictor and outcome variables. A value <0.05 was considered as statistically significant. Findings. About 13.5% of the pregnant women had high knowledge on anaemia, while 58.4% and 28.1% had moderate and low knowledge, respectively. Less than half (39.1%) of the women adhered to anaemia prevention strategies. There were significant associations between knowledge of anaemia and where pregnant woman resides in the district (AOR: 2.04, 95% CI: 2.16-9.83, ), woman’s educational (AOR: 10.43, 95% CI: 6.14-51.63, ), and occupational status (AOR: 15.14, 95% CI: 13.57-18.43, ). Again, there were significant associations between adherence to anaemia prevention strategies and the woman’s ethnicity (AOR: 0.61, 95% CI: 0.04-0.92, ) and her knowledge of anaemia (AOR: 3.88, 95% CI: 1.32-7.93, ). Conclusions. Pregnant women’s knowledge of anaemia and adherence to anaemia prevention strategies are not encouraging. However, anaemia in pregnancy and its consequences could be devastating to all stakeholders if actions are not taken to reduce the phenomenon. Therefore, we recommend that more education and sensitisation programs including good nutritional practices in the diet of pregnant women be promoted to increase awareness and adherence to anaemia prevention strategies among pregnant women in the Juaboso District.

1. Introduction

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 [1]. However, it is more prevalent in pregnant women, young children, and other women in reproductive age [2]. Globally, anaemia prevalence is about 29% in nonpregnant women, 38% in pregnant women, and 43% in children with the highest prevalence in South Asia and Central and West Africa [3]. The commonest cause of anaemia is iron deficiency with evidence suggesting that up to 90% of maternal anaemia are due to inadequate intake of dietary iron. However, worm infestations (hookworm and schistosomiasis), bleeding haemorrhoids, vitamin B6 and B12 deficiencies, human immunodeficiency virus (HIV) infection, and genetic disorders such as sickle cell anaemia are other factors that cause anaemia in pregnancy [4, 5]. A cry of a baby immediately after birth gives joy to the mother. This means that a healthy mother and child after delivery is the ultimate outcome that the pregnant mother, her family, and the entire community expect. However, anaemia is associated with increased maternal and newborn health problems as well as death [6]. Ghana through the Ministry of Health has been at the forefront with interventions and strategies to control anaemia in pregnancy. These strategies include education and awareness creation, nutrient (iron) supplementation, and control and prevention of parasitic infections in pregnancy. Additionally, the use of insecticide-treated nets (ITNs) and intermittent preventive treatment (IPT) against malaria, effective deworming, and provision of improved water, sanitation, and hygiene services are also being implemented to prevent anaemia among pregnant women. These strategies are meant to address common preventive causes of anaemia such as iron deficiency, worm infestation, and malaria control in the country. However, data available indicates that 44.6% of pregnant women in Ghana are anaemic [7]. In view of this, the study examined pregnant women adherence to Ghana’s anaemia prevention strategies being implemented in the Juaboso District.

2. Methods

2.1. Study Site

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 [8]. The district has 25 health facilities including a hospital, 12 Community-based Health Planning and Services (CHPS) Compounds, 5 clinics, and 7 maternity homes providing health care services including information, education, and communication (IE&C) to the people. Economic activities in the district includes farming, trading, and rearing of livestock. The major crops cultivated in the area include cocoa, rice, cassava, yam, and maize. Tomatoes, garden eggs, and pepper are the abundant vegetables in the area. The district has two major markets for trading activities. The district also has 4 senior secondary schools, 33 junior secondary schools, and 75 primary schools providing formal education to people within and outside the district, with no tertiary institution [9].

2.2. Study Population

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.

2.3. Study Design

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.

2.4. Sample Size

Five hundred and ninety-eight (598) participants were involved; this was determined using the formula: [10]. Where is the sample size to be determined, is the z-score (reliability coefficient) of 1.96 at 95% confidence level (C.L), is the prevalence of anaemia among pregnant women in Ghana 44.6% [7], is 1-p, and is the degree of accuracy desired. With the extra implausibility about the true prevalence of anaemia among pregnant women due to a cluster sample survey design, design effect was considered in the sample size calculation. Therefore, the sample size became (which was 1.5 in this case) (). For a 5% nonresponse rate of 569.52, the sample size was upwardly adjusted and rounded to 598. This sample size ensured, with a probability of 95%, that the estimated prevalence was within ±5% of the true population coverage.

2.5. Sampling Method

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.

2.6. Data Collection Tool and Procedure

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.

2.7. Ethical Issues

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.

2.8. Data Analysis

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 value <0.05 was considered as statistically significant.

3. Results

3.1. Demographic Characteristics of Participants

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 1).


VariableFrequencyPercentage

SubdistrictJuaboso16327.3
Bonsu15225.4
Jato13923.2
Asempaneye14424.1
Age (years)10–197212.0
20–2926544.3
30–3919432.5
≥406711.2
Educational statusNone10918.2
Basic (primary)26143.7
Secondary15525.9
Tertiary7312.2
Marital statusLegally married47078.6
Cohabitation12821.4
ReligionChristianity41168.7
Islam12020.1
Traditionalist6711.2
EthnicityAkan33656.2
Ewe7913.2
Ga-Adangbe6310.5
Kussase12020.1
OccupationUnemployed11919.9
Nonformal jobs40667.9
Formal jobs7312.2
Gestational age of the pregnancy1st trimester14624.4
2nd trimester26744.7
3rd trimester18530.9
Parity0518.5
139165.4
210116.9
≥3559.2

3.2. Knowledge of Anaemia among Pregnant Women

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 1).

3.3. Adherence to Anaemia Prevention Strategies 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 2).

3.4. Associations between Knowledge on Anaemia and General Characteristics

The study showed significant associations between knowledge of anaemia and the subdistrict where the pregnant woman resides (), the woman’s educational status (), and occupational status ().

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, ), Jato (AOR: 3.06, 95% CI: 1.96-7.18, ) and Asempaneye subdistricts (AOR: 2.04, 95% CI: 2.16-9.83, ) were less likely to have high knowledge of anaemia than those who were residing in the Juaboso subdistrict. Also, pregnant women who attained basic (AOR: 1.78, 95% CI: 1.89-5.37, ), secondary (AOR: 4.22, 95% CI: 2.23-9.16, ), and tertiary education (AOR: 10.43, 95% CI: 6.14-15.63, ) were more likely to have high knowledge of anaemia than women who never went to school. Again, women who were engaged in nonformal (AOR: 2.18, 95% CI: 1.07-6.69, ) and formal jobs (AOR: 15.14, 95% CI: 13.57-18.43, ) were more likely to have high knowledge of anaemia than those who were unemployed (Table 2).


VariablesKnowledge of anaemiaOR (95% CI) valueAOR (95% CI) value
(86.5%) (13.5%)

Subdistrict
Juaboso136 (83.4)27 (16.6)10.0031
Bonsu134 (88.2)18 (11.8)0.49 (2.01-8.95)0.41 (2.31-8.81) 0.004
Jato116 (83.5)23 (16.5)0.71 (1.89-7.43)0.76 (1.96-7.18) 0.002
Asempaneye131 (91.0)13 (9.0)0.23 (2.15-9.30)0.24 (2.16-9.83) 0.003
Age-group (years)
10–1953 (73.6)19 (26.4)10.258
20–29244 (92.1)21 (7.9)0.54 (0.04-7.10)
30–39172 (88.7)22 (11.3)0.67 (0.11-6.88)
≥4048 (71.6)19 (28.4)1.72 (0.02-3.48)
Educational status
None105 (96.3)4 (3.7)10.0021
Basic240 (92.0)21 (8.0)2.34 (1.25-5.62)1.78 (1.89-5.37) 0.001
Secondary126 (81.3)29 (18.7)4.23 (2.33-9.89)4.22 (2.23-9.16) 0.002
Tertiary46 (63.0)27 (37.0)12.31 (10.24-17.98)10.43 (6.14-15.63) 0.002
Marital status
Legally married424 (90.2)46 (9.8)10.364
Cohabitation93 (72.7)35 (27.3)3.59 (1.03-7.23)
Religion
Christianity375 (91.2)36 (8.8)10.347
Muslim94 (78.3)26 (21.7)5.23 (3.11-8.81)
Traditionalist48 (71.6)19 (28.4)7.72 (4.30-11.33)
Ethnicity
Akan311 (92.6)25 (7.4)10.063
Ewe62 (78.5)17 (21.5)3.84 (0.51-6.61)
Ga-Adangbe45 (71.4)18 (28.6)4.57 (0.33-8.15)
Kussase99 (82.5)21 (17.5)2.46 (1.60-4.79)
Occupation
Unemployed108 (90.8)11 (9.2)1<0.0011
Nonformal jobs359 (88.4)47 (11.6)2.48 (2.04-6.37)2.18 (1.07-6.69) 0.001
Formal jobs50 (68.5)23 (31.5)18.09 (5.42-25.28)15.14 (13.57-18.43) <0.001
Gestational age of the pregnancy
1st trimester133 (91.1)13 (8.9)10.736
2nd trimester230 (86.1)37 (13.9)2.25 (0.84-6.17)
3rd trimester154 (83.2)31 (16.8)2.62 (0.34-7.34)
Parity
047 (92.2)4 (7.8)10.682
1360 (92.1)31 (7.9)1.67 (0.34-8.76)
274 (73.3)27 (26.7)3.74 (0.23-9.82)
≥336 (65.5)19 (34.5)6.93 (0.19-9.14)

3.5. Associations between Adherence to Anaemia Prevention Strategies and General Characteristics and Knowledge on Anaemia

The study revealed significant associations between adherence to anaemia prevention strategies and ethnicity of the pregnant woman () and woman’s knowledge of anaemia ().

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, ), Ga-Adangbe (AOR: 0.53, 95% CI: 0.09-0.90, ), and Kussase (AOR: 0.61, 95% CI: 0.04-0.92, ) were less likely to adhere to anaemia prevention strategies than women who were Akans. Also, pregnant women who had high knowledge of anaemia (AOR: 3.88, 95% CI: 1.32-7.93, ) were more likely to adhere to anaemia prevention strategies than women who had low or fair knowledge of anaemia prevention strategies (Table 3).


VariablesAdherence to anaemia prevention strategiesOR (95% CI) valueAOR (95% CI) value
Partial adherence 364 (60.9)Complete adherence 234 (39.1)

Subdistrict
Juaboso98 (60.1)65 (39.9)10.123
Bonsu92 (60.5)60 (39.5)0.81 (0.03-8.76)
Jato83 (59.7)56 (40.3)1.78 (0.04-5.84)
Asempaneye91 (63.2)53 (36.8)0.65 (0.05-7.51)
Age-group (years)
10–1961 (84.7)11 (15.3)10.237
20–29160 (60.4)105 (39.6)4.73 (0.26-8.47)
30–39101 (52.1)93 (47.9)6.65 (0.22-10.58)
≥4042 (62.7)25 (37.3)4.54 (0.01-9.29)
Educational status
None98 (89.9)11 (10.1)10.371
Basic201 (77.0)60 (23.0)3.29 (0.23-7.67)
Secondary58 (37.4)97 (62.6)7.57 (0.11-11.32)
Tertiary7 (9.6)66 (90.4)8.24 (0.64-14.56)
Marital status
Legally married262 (55.7)208 (44.3)10.421
Cohabitation102 (79.7)26 (20.3)0.48 (0.07-11.43)
Religion
Christianity248 (60.3)163 (39.7)10.394
Muslim52 (43.3)68 (56.7)2.12 (0.03-4.45)
Traditionalist64 (95.5)3 (4.5)0.32 (0.02-11.41)
Ethnicity
Akan181 (53.9)155 (46.1)10.0011
Ewe51 (64.6)28 (35.4)0.69 (0.01-0.89)0.68 (0.02-0.87) 0.001
Ga-Adangbe53 (84.1)10 (15.9)0.51 (0.07-0.91)0.53 (0.09-0.90) 0.002
Kussase79 (65.8)41 (34.2)0.67 (0.06-0.92)0.61 (0.04-0.92) 0.001
Occupation
Unemployed76 (63.9)43 (36.1)10.321
Nonformal jobs274 (67.5)132 (32.5)0.07 (0.13-2.43)
Formal jobs14 (19.2)59 (80.8)3.21 (0.28-7.25)
Gestational age of the pregnancy
1st trimester89 (61.0)57 (39.0)10.408
2nd trimester169 (63.3)98 (36.7)0.72 (0.19-8.03)
3rd trimester106 (57.3)79 (42.7)1.94 (0.21-3.67)
Parity
039 (76.5)12 (23.5)10.421
1280 (71.6)111 (28.4)1.67 (0.17-3.92)
241 (40.6)60 (59.4)3.34 (0.62-4.27)
≥34 (7.3)51 (92.7)7.56 (0.41-9.18)
Knowledge of anaemia
Low/fair355 (68.7)162 (31.3)10.0011
High9 (11.1)72 (88.9)4.12 (2.76-8.66)3.88 (1.32-7.93) 0.001

4. Discussion

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 [11], while about 19% and 9.9% of pregnant women in Nigeria and Uyo State, respectively, had never been to school [12, 13]. The findings of this study are similar to what was reported (19.1%) in the Ghana demographic and health survey [7]. The unemployment status reported in this study is lower than what was reported in the Southern Ghana, Kenyan, and South African studies [1416].

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 [17]. Also, a study to assess the knowledge and risk factors of anaemia among pregnant women in Libya revealed that all of the women had moderate knowledge on anaemia [11]. Again, a study conducted in the Brosankro in Ghana reported that less than 30% of pregnant women knew signs and symptoms of anaemia [18]. The present study indicates that a significant number of the pregnant women knew that treatment of worm infestation can help prevent anaemia. This is in contrast to the lower finding reported in the Nepal and Nigeria studies [19, 20]. The reason for the differences in the treatment of worm infestation as one of the anaemia prevention strategies could be the sample size of the studies. The use of insecticide-treated nets (ITNs) has been recommended as an integral part of maternal and child health policies in Sub-Saharan Africa where malaria infection is endemic and a major cause of severe anaemia in pregnancy [21, 22]. Therefore, it is not surprising that most of the pregnant women in the current study knew that sleeping under ITNs prevents malaria and is an anaemia prevent strategy, which agrees with the Nigerian study [20]. Though, a good proportion of the pregnant women were aware that the use of ITNs is a strategy to prevent anaemia in pregnancy; this awareness should be sustained, and efforts towards achieving 100% awareness should be enhanced.

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 [23, 24]. Generally, the current study revealed that only 39.1% of the pregnant women were fully adhering to anaemia prevention strategies. This finding is similar to a study conducted in Kathmandu, Nepal, which revealed that the majority of pregnant women did not adhere to practices required to prevent anaemia in pregnancy [19]. However, the finding of the present study is in contrast with a study conducted among pregnant women in Mecha district, Western Ethiopia [25]. This discrepancy could be that the Ethiopia study was based on pregnant women who took iron folate tablets for 90 or more days during the entire pregnancy, while this study was based on pregnant women who took iron folate supplement within the entire duration of the pregnancy. Moreover, the probable reason may be the difference in geographical locations and accessibility of health institutions in these countries.

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 [25]. Again, pregnant woman’s ethnicity was significantly associated with adherence to anaemia prevention strategies. This finding agrees with Barroso et al. and the Belgium studies [26, 27].

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 [2830]. Again, the current study showed that pregnant women who had jobs were more likely to be associated with high knowledge of anaemia as compared to women who were not employed, with a study showing that people who have low economic are more likely to suffer from anaemia [31]. This could be due to the fact that education level attained is required in job seeking, which in turn increases earning power of those employed and also increases their number of ANC visits at the health facilities where education on anaemia prevention is always given.

5. Conclusion

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.

5.1. Recommendations

(i)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(ii)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(iii)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.

Data Availability

Answer: Yes. Comment: The data used to support the findings of this study can be made available from the corresponding author upon request.

Conflicts of Interest

The authors to this work declare that they have no conflict of interest regarding the study and the publication of this paper.

Acknowledgments

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.

References

  1. S. R. Pasricha, H. Drakesmith, J. Black, D. Hipgrave, and B. A. Biggs, “Control of iron deficiency anemia in low-and middle-income countries,” Blood, vol. 121, no. 14, pp. 2607–2617, 2013. View at: Publisher Site | Google Scholar
  2. E. McLean, M. Cogswell, I. Egli, D. Wojdyla, and B. De Benoist, “Worldwide prevalence of anaemia, WHO vitamin and mineral nutrition information system, 1993–2005,” Public Health Nutrition, vol. 12, no. 4, pp. 444–454, 2009. View at: Publisher Site | Google Scholar
  3. G. A. Stevens, M. M. Finucane, L. M. De-Regil et al., “Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non- pregnant women for 1995-2011: a systematic analysis of population- representative data,” The Lancet Global Health, vol. 1, no. 1, pp. e16–e25, 2013. View at: Publisher Site | Google Scholar
  4. L. K. Elder, Issues in Programming for Maternal Anaemia, Mother Care, 2000.
  5. S. Ouédraogo, M. M. K. Accrombessi, A. Massougbodji, G. K. Koura, F. Bodeau-Livinec, and M. Cot, “Maternal anemia at first antenatal visit: prevalence and risk factors in a malaria-endemic area in Benin,” The American Journal of Tropical Medicine and Hygiene, vol. 87, no. 3, pp. 418–424, 2012. View at: Publisher Site | Google Scholar
  6. L. H. Allen, “Anemia and iron deficiency: effects on pregnancy outcome,” The American Journal of Clinical Nutrition, vol. 71, no. 5, pp. 1280S–1284S, 2000. View at: Publisher Site | Google Scholar
  7. Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF International, Ghana Demographic and Health Survey 2014, GSS, GHS, and ICF International, Rockville, Maryland, USA, 2015.
  8. Ghana Statistical Service, 2010 Population and Housing Census Report, Ghana Statistical Service, 2014.
  9. Juaboso District Health Service, Annual report, Unpublished, 2017.
  10. G. W. Snedecor and W. G. Cochran, Analysis of variance: the random effects model, Statistical Methods, Iowa State University Press, Ames, Iowa, 8th edition, 1989.
  11. B. Jiji Darling and K. Rajagopal, “A study to assess the knowledge and risk factors of anemia among the pregnant women attending selected health care facilities in Sebha, Libya,” Journal of Science Obstetrics & Gynaecology, vol. 4, no. 1, 2014. View at: Google Scholar
  12. A. Ankomah, S. B. Adebayo, E. D. Arogundade et al., “Determinants of insecticide-treated net ownership and utilization among pregnant women in Nigeria,” BMC Public Health, vol. 12, no. 1, 2012. View at: Publisher Site | Google Scholar
  13. F. Abasiubong, E. A. Bassey, J. A. Udobang, O. S. Akinbami, S. B. Udoh, and A. U. Idung, “Self-medication: potential risks and hazards among pregnant women in Uyo, Nigeria,” Pan African Medical Journal, vol. 13, no. 1, 2012. View at: Google Scholar
  14. M. Dako-Gyeke and H. M. Kofie, “Factors influencing prevention and control of malaria among pregnant women resident in urban slums, Southern Ghana,” African Journal of Reproductive Health, vol. 19, no. 1, pp. 44–53, 2015. View at: Google Scholar
  15. L. Ikamari, C. Izugbara, and R. Ochako, “Prevalence and determinants of unintended pregnancy among women in Nairobi, Kenya,” BMC Pregnancy and Childbirth, vol. 13, no. 1, 2013. View at: Publisher Site | Google Scholar
  16. M. Muzigaba, T. L. Kolbe-Alexander, and F. Wong, “The perceived role and influencers of physical activity among pregnant women from low socioeconomic status communities in South Africa,” Journal of Physical Activity and Health, vol. 11, no. 7, pp. 1276–1283, 2014. View at: Publisher Site | Google Scholar
  17. T. Ratanasiri and R. Koju, “Effect of knowledge and perception on adherence to iron and folate supplementation during pregnancy in Kathmandu, Nepal,” Journal of the Medical Association of Thailand, vol. 97, no. 10, pp. S67–S74, 2014. View at: Google Scholar
  18. B. Dwumfour-Asare and M. A. Kwapong, “Anaemia awareness, beliefs and practices among pregnant women: a baseline assessment at Brosankro community in Ghana,” Journal of Natural Science Research, vol. 3, no. 15, pp. 1–10, 2013. View at: Google Scholar
  19. N. Ghimire and N. Pandey, “Knowledge and practice of mothers regarding the prevention of anemia during pregnancy, in teaching hospital, Kathmandu,” Journal of Chitwan Medical College, vol. 3, no. 3, pp. 14–17, 2013. View at: Publisher Site | Google Scholar
  20. T. A. Ekwere and A. M. Ekanem, “Maternal knowledge, food restriction and prevention strategies related to anaemia in pregnancy: a cross-sectional study,” International Journal of Community Medicine and Public Health, vol. 2, no. 3, pp. 331–338, 2015. View at: Publisher Site | Google Scholar
  21. M. Singh, G. Brown, and S. J. Rogerson, “Ownership and use of insecticide-treated nets during pregnancy in sub-Saharan Africa: a review,” Malaria Journal, vol. 12, no. 1, 2013. View at: Publisher Site | Google Scholar
  22. World Health Organization (WHO), Insecticide-treated net to reduce the risk of malaria in pregnant women, 2014.
  23. L. Hallberg, “Iron balance in pregnancy,” Vitamins and minerals in pregnancy and lactation, vol. 16, pp. 115–127, 1988. View at: Google Scholar
  24. T. H. Bothwell, “Iron requirements in pregnancy and strategies to meet them,” The American Journal of Clinical Nutrition, vol. 72, no. 1, pp. 257S–264S, 2000. View at: Publisher Site | Google Scholar
  25. B. Taye, G. Abeje, and A. Mekonen, “Factors associated with compliance of prenatal iron folate supplementation among women in Mecha district, Western Amhara: a cross-sectional study,” Pan African Medical Journal, vol. 20, no. 1, 2015. View at: Publisher Site | Google Scholar
  26. F. Barroso, S. Allard, B. C. Kahan et al., “Prevalence of maternal anaemia and its predictors: a multi-centre study,” European Journal of Obstetrics & Gynecology and Reproductive Biology, vol. 159, no. 1, pp. 99–105, 2011. View at: Publisher Site | Google Scholar
  27. M. A. Baraka, S. Steurbaut, M. Laubach, D. Coomans, and A. G. Dupont, “Iron status, iron supplementation and anemia in pregnancy: ethnic differences,” The Journal of Maternal-Fetal & Neonatal Medicine, vol. 25, no. 8, pp. 1305–1310, 2012. View at: Publisher Site | Google Scholar
  28. R. K. Yadav, PG Student, MPH, Department of public Health, JN Medical College, KLE University, India, M. K. Swamy, and B. Banjade, “Knowledge and Practice of Anemia among pregnant women attending antenatal clinic in Dr. Prabhakar Kore hospital, Karnataka-A Cross sectional study,” IOSR Journal of Dental and Medical Sciences, vol. 13, no. 4, pp. 74–80, 2014. View at: Publisher Site | Google Scholar
  29. S. Upadhyay, A. R. Kumar, R. S. Raghuvanshi, and B. B. Singh, “Nutritional status and knowledge of hill women on anemia: effect of various socio-demographic factors,” Journal of Human Ecology, vol. 33, no. 1, pp. 29–34, 2017. View at: Publisher Site | Google Scholar
  30. F. Rizvi, “Impact of maternal education, and socioeconomic status on maternal nutritional knowledge and practices regarding iron rich foods and iron supplements,” Ann Pak Inst Med Sci, vol. 8, no. 2, pp. 101–105, 2012. View at: Google Scholar
  31. Y. Balarajan, U. Ramakrishnan, E. Özaltin, A. H. Shankar, and S. V. Subramanian, “Anaemia in low-income and middle-income countries,” The Lancet, vol. 378, no. 9809, pp. 2123–2135, 2011. View at: Publisher Site | Google Scholar

Copyright © 2020 Prince Kubi Appiah et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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