Risk factors for anaemia among Ghanaian women and children vary by population group and climate zone

Authors: PETRY, NICOLAI - Groundwork Llc; WIRTH, JAMES - University Of Ghana; ADU-AFARWUAH, SETH - University Of Ghana; WEGMULLER, RITA - Groundwork Llc; WOODRUFF, BRADLEY - Groundwork Llc; TANUMIHARDJO, SHERRY - University Of Wisconsin; BENTIL, HELENA - University Of Ghana; DONKOR, WILLIAM - Groundwork Llc; WILLIAMS, THOMAS - Kemri Wellcome Trust Research Programme; Shahab-Ferdows, Setti; SELENJE, LILIAN - United Nations Children Fund; MAHAMA, ABRAHAM - United Nations Children Fund; STEINER-ASIEDU, MATILDA - University Of Ghana; ROHNER, FABIAN - (NCE, CECR)networks Of Centres Of Exellence Of Canada, Centres Of Excellence For Commercilization A

Submitted to: Maternal and Child Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 7/27/2020
Publication Date: 9/18/2020
Citation: Petry, N., Wirth, J.P., Adu-Afarwuah, S., Wegmuller, R., Woodruff, B.A., Tanumihardjo, S.A., Bentil, H., Donkor, W.E., Williams, T.N., Shahab-Ferdows, S., Selenje, L., Mahama, A., Steiner-Asiedu, M., Rohner, F. 2020. Risk factors for anaemia among Ghanaian women and children vary by population group and climate zone. Maternal and Child Nutrition. 17(2). Article e13076. https://doi.org/10.1111/mcn.13076.
DOI: https://doi.org/10.1111/mcn.13076

Interpretive Summary: There is little nationally representative information on the micronutrient status of Ghanaian women and children. The purpose of this survey was to document the current national prevalence of micronutrient deficiencies, anemia, malaria, inflammation, a-thalassemia, sickle cell disease and trait, and under- and over-nutrition in Ghana. In 2017, a two-stage cross-sectional design was applied to enroll pre-school children (6–59 months) and non-pregnant women (15–49 years) from three strata in Ghana: Northern, Middle and Southern Belt. Household and individual questionnaire data were collected along with blood samples. A total of 2123 households completed the household interviews, and 1165 children and 973 women provided blood samples. Nationally, 35.6% of children had anemia, 21.5% were iron deficient,12.2% had iron deficiency anemia, and 20.8% had vitamin A deficiency. In addition, 20.3% tested positive for malaria, 13.9% for sickle trait plus disease, and 30.7% for a-thalassemia. Anemia and micronutrient deficiencies were more prevalent in rural areas, poor households and the Northern Belt. Stunting and wasting affected 21.4% and 7.0% of children, respectively. Stunting was more common in rural areas and in poor households. Among non-pregnant women, 21.7% were anemic, 13.7% iron deficient, 8.9% had iron deficiency anemia; 1.5% were vitamin A deficient, 53.8% were folate deficient, and 6.9% were vitamin B12 deficient. Malaria parasitemia in women (8.4%) was lower than in children, but the prevalence of sickle cell disease or trait and a-thalassemia were similar. Overweight (24.7%) and obesity (14.3%) were more common in wealthier, older, and urban women. Our findings demonstrate that anemia and several micronutrient deficiencies are highly present in Ghana calling for the strengthening of Ghana’s food fortification program. Also overweight and obesity in women are constantly increasing and need to be addressed urgently through governmental policies and programs.

Technical Abstract: Anemia has serious effects on human health and has multifactorial aetiologies. This study aimed to determine putative risk factors for anemia in children 6–59 months and 15- to 49-year-old non-pregnant women living in Ghana. Data from a nationally representative cross-sectional survey were analysed for associations between anemia and various anemia risk factors. National and stratum-specific multivariable regressions were constructed separately for children and women to calculate the adjusted prevalence ratio (aPR) for anemia of variables found to be statistically significantly associated with anemia in bivariate analysis. Nationally, the aPR for anemia was greater in children with iron deficiency (ID; aPR 2.20; 95% confidence interval [CI]: 1.88, 2.59), malaria parasitaemia (aPR 1.96; 95% CI: 1.65, 2.32), inflammation (aPR 1.26; 95% CI: 1.08, 1.46), vitamin A deficiency (VAD; aPR 1.38; 95% CI:1.19, 1.60) and stunting (aPR 1.26; 95% CI: 1.09, 1.46). In women, ID (aPR 4.33; 95% CI: 3.42, 5.49), VAD (aPR 1.61; 95% CI: 1.24, 2.09) and inflammation (aPR 1.59; 95% CI: 1.20, 2.11) were associated with anemia, whereas overweight and obese women had lower prevalence of anemia (aPR 0.74; 95% CI: 0.56, 0.97). ID was associated with child anemia in the Northern and Middle belts, but not in the Southern Belt; conversely, inflammation was associated with anemia in both children and women in the Southern and Middle belts, but not in the Northern Belt. Anemia control programs should be region specific and aim at the prevention of ID, malaria, and other drivers of inflammation as they are the main predictors of anemia in Ghanaian children and women.