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Risk factors of anaemia among postpartum women in Bolgatanga Municipality, Ghana | BMC Nutrition

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Study design, site and population

The study was a cross-sectional facility-based study conducted in Bolgatanga Municipality. The Municipality is the regional capital and located in the center of the Upper East Region, approximately between latitudes 10 ° 30’and 10 ° 50’North and longitudes 0 ° 30’and 1 ° 00’West. It covers a total land area of ​​729 square kilometers and is bordered to the north by the Bongo District, south and east by the Talensi and Nabdam Districts, and to the west by the Kassena-Nankana Municipality The Bolgatanga Municipality has a total population of 131,550, longitude for 12.6% of the population of the Upper East Region, with females separately 52.0% of the total population.

The study population included postpartum women aged 18–49 years and resident in the Municipality who delivered in the last 6 weeks and were available in the postpartum wards or were in attendance at the postpartum clinics of the participating health facilities at the time of the study. Women were interviewed if they were clinically stable with no active or symptomatic opportunistic infections and were willing to take part in the study.

Sample size determination and sampling technique

The required sample size was determined using a single population proportion formula [21]assumed prevalence of anaemia in postpartum women in the area (50%), reliability coefficient associated with 95% confidence interval (1.96), and margin of error (5%) to obtain 385. Five percent of the estimated sample size (20) was added to obtain the final sample of 405.

The study participants were sampled from 9 health facilities in 9 sub-districts in the Municipality namely Bolgatanga Regional Hospital, Afrikids Medical Center, Plaza Health Center, Sherigu Health Center, Nyarega Health Center, Sumbrugu East Health Center, Ananega Health Center, Sumbrugu West CHPS , and Kalbeo CHPS.

On each visit to a health facility, thirty (30) postpartum women were randomly selected using balloting without replacement. This allowed consented participants to either pick “Yes” or “No” which was written on folded pieces of paper and placed in a container and thoroughly shaken to ensure randomization. Those who picked “Yes” were interviewed. The procedure was repeated until the total sample size was achieved.

Data collection

The data collection took eight weeks from February—April, 2021 with the use of a semi-structured, interviewer-administered questionnaire in one-on-one interviews in health facilities. reliability and accuracy using 10 randomly picked women in War Memorial Hospital, Navrongo. Four research assistants who had knowledge on the research topic and had been in similar data collection exercises were trained to collect the data. Training on the questionnaire provided an opportunity for the research assistants to get a good understanding of the questions.

Socio-demographic data included: age in years, occupational status, Data were collected on socio-demographic characteristics, obstetric characteristics, dietary diversity, haemoglobin in pregnancy and after delivery, and knowledge on iron-folic acid, iron, and anaemia of women. marital status, education level, and parity status.

Data were collected on the knowledge of the women on iron-folic acid, iron, and anaemia. With iron-folic acid knowledge, the questions were on its benefits such as prevention of anaemia, protecting women from sickness, and making the foetus healthy. Others are the effects of iron and folic acid deficiencies such as a baby having congenital anomaly or being low birth weight, the dosage regimen of iron-folic acid for pregnant women, and side effects of iron-folic acid.

Haemoglobin measurement

The haemoglobin measurements in pregnancy of the women recorded in their ANC booklets were recorded and used to determine anemia in pregnancy. In the postpartum period, the research project measured the haemoglobin concentration of the women using two experienced laboratory technicians. The haemoglobin estimation was determined. by taking finger-pricked blood test samples of participants using URIT-12 Haemoglobin photometer (URIT Medical Electronics Co., LTD, China). The haemoglobin values ​​displayed on the Haemoglobin photometer were recorded.

Definition of study variables

Dependent variable

Anaemia in postpartum women: There is no consensus on the definition of anaemia in postpartum women. However, we defined anaemia in postpartum women with haemoglobin less than 12 g / dl [5]..

Independent variables

Anaemia in pregnancy

Anaemia in the first and third trimesters of pregnancy was diagnosed using a cut-off of haemoglobin <11 g / dl [22]..

Household Wealth Index

A household wealth index of the respondents was obtained based on the availability of electricity, water, and toilets in the households, possession of household items (eg, bicycles, television, and radio), and livestock in the household based on an earlier concept [23]. Using principal component analysis, a wealth score was derived for the respondents, sorted in ascending order and divided into 3 categories, poorest, middle, and richest.

Minimum Dietary Diversity—Women (MDD-W)

Dietary diversity score was calculated from 10 designated food groups [24]For each food group, the women ate from, they got a score of “1” (irrespective of the number of foods eaten), otherwise a score of “0”. The scores were added up to give the dietary diversity score (range) 0 – 10) for each woman. Using the dietary diversity score, an indicator variable, MDD-W, was obtained. Women who had a dietary diversity score of 5 or more were classified as having received MDD-W, otherwise they did not receive it. The proportion of women receiving MDD-W at the population level is an indicator of higher micronutrient adequacy [24]..

IFA knowledge index

An IFA knowledge index was constructed using responses from 18 questions. Each correct answer attracted a score of “1” otherwise a score of “0”. The scores were totaled and divided into two halves using the mean score; women scoring lower than the mean score (7.2 out of 18.0) were classified into the low category and those scoring the mean score or higher into the high category.

Iron knowledge index

Iron knowledge index was based on knowledge of the mothers of 6 food sources of iron and divided into high and low categories using the mean score of 2.5 out of 6.

Anaemia knowledge index

Similarly, the anaemia knowledge index was constructed from 6 questions on sign / symptoms of anaemia and divided into two halves, high and low, using the mean score (2.5).

Composite index of IFA, iron, and anaemia

Using the scores of IFA knowledge, iron knowledge, and anemia knowledge, a composite maternal nutrition knowledge index was constructed with scores ranging theoretically from 0–30. The mean score of 12.3 was used to divide the index into high (≥ 12.3) and low (<12.3) categories.

Data analysis

The questionnaire was double-checked for completeness and accuracy before entry into the software for data analysis. The data were analyzed using Stata (Stata Corps, College Road, Texas). Descriptive and inferential statistics were used to present the results. Bivariate tests with Chi -square test of independence were carried out and statistically significant factors entered into a logistic regression model to yield adjusted odds ratios with 95% confidence intervals for the identification of risk factors for postpartum anaemia. The fit of the model was evaluated using Hosmer–Lemeshow Goodness of fit test. Multicollinearity among the independent variables was checked using the “collin” command in Stata. All statistical tests were performed using two-sided tests at the 0.05 level of significance.

Ethics approval and consent to participate

The methodology of this research conformed to the ethical principles of the Helsinki Declaration, and ethics approval was obtained from the Committee on Human Research, Publication and Ethics of Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital, Kumasi, Ghana (CHRPE / AP / 063/21). Moreover, permission was sought from Bolgatanga Municipal Health Directorate, Ghana. Written informed consent was obtained from participants before they participated in this study. No person identifiable information was collected and confidentiality of the information of study participants was assured. ..

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