Prevalence of anaemia and low intake of dietary nutrients in pregnant women living in rural and urban areas in the Ashanti region of Ghana

Autoři: Jessica Ayensu aff001;  Reginald Annan aff001;  Herman Lutterodt aff003;  Anthony Edusei aff004;  Loh Su Peng aff005
Působiště autorů: Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana aff001;  Department of Clinical Nutrition and Dietetics, University of Cape Coast, Cape Coast, Ghana aff002;  Department of Food Science and Technology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana aff003;  School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana aff004;  Department of Nutrition and Dietetics, Universiti Putra, Selangor, Malaysia aff005
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226026



Anaemia remains a major cause of morbidity and mortality among women and children worldwide. Because deficiencies in essential micronutrients such as iron, folate and vitamin B12 prior to and during gestation increase a woman’s risk of being anaemic, adequate dietary intake of such nutrients is vital during this important phase in life. However, information on the dietary micronutrient intakes of pregnant women in Ghana, particularly of those resident in rural areas is scanty. Thus, this study aimed to assess anaemia prevalence and dietary micronutrient intakes in pregnant women in urban and rural areas in Ghana.


A comparative cross sectional study design involving 379 pregnant women was used to assess the prevalence of anaemia and low intake of dietary nutrients in pregnant women living in rural and urban areas in the Ashanti region of Ghana. Anaemia status and mid upper arm circumference (MUAC) were used as proxy for maternal nutritional status. Haemoglobin measurements were used to determine anaemia prevalence and the dietary diversity of the women were determined with a 24-hour dietary recall and a food frequency questionnaire.


Overall, anaemia was present in 56.5% of the study population. Anaemia prevalence was higher among rural residents than urban dwellers. Majority of the respondents had inadequate intakes of iron, zinc, folate, calcium and vitamin A. The mean dietary diversity score (DDS) of the study population from the first 24-hour recall was 3.81 ± 0.7. Of the 379 women, 28.8% met the minimum dietary diversity for women (MDD-W). The independent predictors of haemoglobin concentration were, gestational age, maternal age and dietary diversity score. Such that respondents with low DDS were more likely to be anaemic than those with high DDS (OR = 1.795, p = 0.022, 95% CI: 1.086 to 2.967).


A large percentage of pregnant women still have insufficient dietary intakes of essential nutrients required to support the nutritional demands during pregnancy. Particularly, pregnant women resident in rural areas require interventions such as nutrition education on the selection and preparation of diversified meals to mitigate the effects of undernutrition.

Klíčová slova:

Anemia – Ghana – Malnutrition – Nutrients – Nutrition – Pregnancy – Rural areas – Urban areas


1. Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey KG. Maternal and child under nutrition: global and regional exposures and health consequences. The Lancet. 2008;371:243–60.

2. Schieve LA, Cogswell ME, Scanlon KS, Perry G, Ferre C, Blackmore-Prince C, et al. Prepregnancy body mass index and pregnancy weight gain: associations with preterm delivery. Obstetrics & Gynecology. 2000;96(2):194–200.

3. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, De Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet. 2013;382(9890):427–51.

4. Adu-Afarwuah S, Lartey A, Okronipa H, Ashorn P, Zeilani M, Baldiviez LM, et al. Impact of small-quantity lipid-based nutrient supplement on hemoglobin, iron status and biomarkers of inflammation in pregnant Ghanaian women. Maternal & child nutrition. 2017;13(2):e12262.

5. WHO. The global prevalence of anaemia in 2011. Geneva: World Health Organisation; 2015.

6. Miller JL. Iron deficiency anemia: a common and curable disease. Cold Spring Harbor perspectives in medicine. 2013:a011866. doi: 10.1101/cshperspect.a011866 23613366

7. Assessment WIDA. Prevention, and Control: A guide for programme managers. Geneva: World Health Organization. 2001.

8. Stephen G, Mgongo M, Hussein Hashim T, Katanga J, Stray-Pedersen B, Msuya SE. Anaemia in pregnancy: Prevalence, risk factors, and adverse perinatal outcomes in Northern Tanzania. Anemia. 2018;2018.

9. Tatala S, Svanberg U, Mduma B. Low dietary iron availability is a major cause of anemia: a nutrition survey in the Lindi District of Tanzania. The American journal of clinical nutrition. 1998;68(1):171–8. doi: 10.1093/ajcn/68.1.171 9665111

10. Khalafallah AA, Dennis AE. Iron deficiency anaemia in pregnancy and postpartum: pathophysiology and effect of oral versus intravenous iron therapy. Journal of pregnancy. 2012;2012.

11. Ren A, Wang J, Ye R, Li S, Liu J, Li Z. Low first-trimester hemoglobin and low birth weight, preterm birth and small for gestational age newborns. International Journal of Gynecology & Obstetrics. 2007;98(2):124–8.

12. Ayensu J, Annan RA, Edusei A, Badu E. Impact of maternal weight on pregnancy outcomes: a systematic review. Nutrition & Food Science. 2016;46(4):542–56.

13. GSS GSS. Ghana Demographic and Health Survey 2014. Ghana Health Service (GHS), and ICF Macro. 2015.

14. Cochran WG. Sampling techniques: John Wiley & Sons; 1977.

15. University of Ghana. Ghana Micronutrient Survey 2017(GroundWork, University of Wisconsin-Madison, KEMRI-Wellcome Trust, UNICEF. Accra, Ghana).

16. Saaka M, Oladele J, Larbi A, Hoeschle-Zeledon I. Dietary diversity is not associated with haematological status of pregnant women resident in rural areas of northern Ghana. Journal of nutrition and metabolism. 2017;2017.

17. Boke MM, Geremew AB. Low dietary diversity and associated factors among lactating mothers in Angecha districts, Southern Ethiopia: community based cross-sectional study. BMC research notes. 2018;11(1):892. doi: 10.1186/s13104-018-4001-6 30547839

18. Ecker O, Trinh Tan J, Alpuerto V, Diao X. Economic growth and agricultural diversification matters for food and nutrition security in Ghana. Washington, DC: International Food Policy Research Institute. 2012.

19. Bhagowalia P, Kadiyala S, Headey D. Agriculture, income and nutrition linkages in India: Insights from a nationally representative survey. 2012.

20. Aftab S, Ara J, Kazi S, Deeba F. Effects of poverty on pregnant women. Pakistan Journal of Medical Research. 2012;51(1):5.

21. McLean E, Cogswell My, Egli I, Wojdyla D, De Benoist B. Worldwide prevalence of anaemia, WHO vitamin and mineral nutrition information system, 1993–2005. Public health nutrition. 2009;12(4):444–54. doi: 10.1017/S1368980008002401 18498676

22. Little M, Humphries S, Patel K, Dewey C. Factors associated with BMI, underweight, overweight, and obesity among adults in a population of rural south India: a cross-sectional study. BMC obesity. 2016;3(1):12.

23. Varadharajan KS, Thomas T, Kurpad AV. Poverty and the state of nutrition in India. Asia Pacific journal of clinical nutrition. 2013;22(3):326. doi: 10.6133/apjcn.2013.22.3.19 23945402

24. Khandelwal S, Kurpad A. Nurturing public health nutrition education in India. European journal of clinical nutrition. 2014;68(5):539. doi: 10.1038/ejcn.2014.42 24642778

25. Saaka M, Abdul Rauf A. Role of dietary diversity in ensuring adequate haematological status during pregnancy. 2015.

26. Ali F, Thaver I, Khan SA. Assessment of dietary diversity and nutritional status of pregnant women in Islamabad, Pakistan. Journal of Ayub Medical College Abbottabad. 2014;26(4):506–9.

27. Torlesse H, Kiess L, Bloem MW. Association of household rice expenditure with child nutritional status indicates a role for macroeconomic food policy in combating malnutrition. The Journal of nutrition. 2003;133(5):1320–5. doi: 10.1093/jn/133.5.1320 12730417

28. Zerfu TA, Umeta M, Baye K. Dietary diversity during pregnancy is associated with reduced risk of maternal anemia, preterm delivery, and low birth weight in a prospective cohort study in rural Ethiopia. The American journal of clinical nutrition. 2016;103(6):1482–8. doi: 10.3945/ajcn.115.116798 27169832

29. Kumar KJ, Asha N, Murthy DS, Sujatha MS, Manjunath VG. Maternal anemia in various trimesters and its effect on newborn weight and maturity: an observational study. International journal of preventive medicine. 2013;4(2):193. 23543625

Článek vyšel v časopise


2020 Číslo 1