Mixed-methods exploration of knowledge about causes and prevention of anaemia in reproductive-aged women; a two-centre study

Abstract

BACKGROUND: Reproductive-aged women are disproportionately represented in the high anaemia burden in sub-Saharan Africa. Understanding the knowledge on anaemia among reproductive-aged women represents a significant milestone towards meeting SDG 3.1 and 3.2 targets. This study acquired biological data on anaemia prevalence and curated knowledge on anaemia among reproductive-aged women in urban and peri-urban settings. METHOD: This exploratory QUANT-qual study recruited 18 - 42 years old women from Koforidua (urban) and Kade (peri-urban), Eastern region, Ghana. Participants' full blood counts were measured using a haematology analyzer followed by the administration of semi-structured questionnaires to explore participants' knowledge about anaemia. Subsequently, two focus group discussion (FGD) sessions and structural equation modelling (SEM) were employed to explore participants' understanding of causes, consequences and prevention strategies of anaemia. A p-value < 0.05 was considered statistically significant under two-tailed assumptions. RESULTS: The anaemia prevalence was 25% (95% CI: 0.1945 - 0.3151) with a disproportionate representation in participants from Kade (p < 0.001; 42.5% [34/80] vs 13.3% [16/120] from Koforidua), or with non-tertiary education (p = 0.004; 35.3% [30/85] vs 17.4% [20/115] of those with tertiary education). In logistic regression analyses, a non-tertiary educational attainment (p < 0.001, aOR: 11.252), age (p < 0.001, aOR: 0.028), and marital status (p < 0.001, aOR: 0.009) significantly predicted anaemia. SEM found that participants' knowledge about causes of anaemia was neither significantly associated with knowledge about anaemia consequences (b = 0.211), nor its prevention strategies (b = 0.051). However, participants' knowledge about the consequences of anaemia significantly positively moderated a positive association between participants' knowledge about at-risk groups and anaemia prevention strategies (b = 0.316, p < 0.05), resulting in a > two-fold increase in beta coefficient (0.316 to 0.663; p < 0.05). Misconceptions such as "anaemia is only present in sickly-looking individuals" and "frustrations from the husband or working with firewood cause anaemia" were expressed by participants in the FGD. CONCLUSION: Anaemia data disaggregation is important in contextualizing its public health relevance. Systems thinking approaches, such as health sector-community working groups adopting culturally-sensitive educational intervention strategies, are needed to address the anaemia knowledge-gap and its public health implications among these reproductive-aged women.