Second Trimester Anaemia in Pregnant Ghanaians

Anaemia is considered a severe public health problem by WHO and is seen as such in Ghana. Its prevalence in pregnancy has remained high despite improved antenatal care. The main purpose of this study was to determine the current anaemia prevalence and aetiology other than iron deficiency.

This was a cross-sectional study. A total of 214 pregnant women were studied. Women were administered a questionnaire related with the subject and blood samples were drawn. Full blood count was performed within four hours and serum iron, folate and vitamin B12 were studied. Other tests done included sickling and Hb electrophoresis , stool routine examination for hookworm infestation, thick and thin film for malaria parasitaemia. Dietary intake was also looked at to determine whether it contributed to anaemia seen in these subjects.

Anaemia was detected in 150 (70%) of the 214 pregnant women studied. Using the World Health Organisation criteria for anaemia, 81 subjects had mild, 66 moderate and 3 had severe anaemia. Anaemia was more prevalent in young adults (82%) than in teenagers and subjects above 35years (p=0.018). Primigravidae (21%) and multigravidae (67%) were more likely to be anaemic than grandmultigravidae (12%). Anaemia was more prevalent in the low social class group (94%). Nutritional intake of both anaemic and non-anaemic subjects was found to be adequate and thus iron deficiency anaemia, which was found to be the commonest cause of anaemia, was probably due to intake of diet low in bioavailable iron. There was very little consumption of fruits and vegetables that facilitate iron absorption. Twenty seven anaemic subjects had low serum iron levels. Transferrin saturation was low in 39 subjects; 24 of these also had low serum iron, which was suggestive of iron deficiency. Folate and vitamin B12 deficiency did not play significant role in the aetiology of anaemia. Malaria and hookworm infestation were also not found to be significant in the causation of anaemia.

The prevalence of anaemia (70%) in pregnant Ghanaians in their second trimester is unacceptably high. Twenty seven (18%) of the 70% anaemic subjects had low serum iron and six (4%) had low serum folate levels. None of the subjects had vitamin B12 deficiency. Generally dietary intake in pregnant women in this study was adequate, but significant proportion of their meals was of the type low in bioavailable iron as more cereals and tubers were consumed. The kind of diet, which most people can afford in Africa is low in proteins and vitamins, but high in carbohydrate with high phytate contents and this reduces iron absorption. Iron and folic acid prophylaxis for all women of child bearing age is recommended and emphasis on a more balanced nutritional intake at antenatal clinics should be encouraged.