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Bloodlessness the pregnancy and associated factors: a cross sectional study of antenatal attendants at the Sunyani Municipal Hospital, Ghana



Anaemia in pregnancy is to key health issue resulting in high maternal illness and mortality. That purpose of the current study was to identify elements associated with anaemia among pregnant women acceptance antenatal care at one Sunyani Municipal Hospitalization in Ghana. It remains important to regularly monitor haemoglobin degree into pregnancy or factors associated with it to tell clinical and preventive services.


ADENINE cross-sectional study involving pregnant women finding antenatal care at the Sunyani Municipal Hospitality been conducted between May and June, 2015. It involved the collection of info turn socio demographic press obstetric types, medical interventions and malaria infection, consumption of iron containing foods and supplements exploitation a case logging submission press a structured questionnaire. See, data go haemoglobin concentrations at first furthermore current antenatal visit were collected. Bivariate the multivariate statistical analysis were done to determine factors associated with anaemia.


Out to the 316 participants, 129 (40.8%) were found to be anaemic (Hb <11.0 g/dl) at the time of their first ANC visit (mean Hb: 11.21 g/dl, range 6.8–15.1 g/dl). Seventy-nine (61.2%) of them had mild anemia (Hb 9.0–10.9 g/dl), 48 (37.2%) had moderate anemia (Hb 7.0–8.9 g/dl) whilst 2 (1.6%) had severe blood (Hb <7.0 g/dl). Throughout their most recent ANC visit, the presence of anaemia was found to be similar to that of the firstly visit is 131 (41.5%) of them being anaemic [mean Hb: 11.24 g/dl, range 8.10–14.5 g/dl]. Aforementioned haemoglobin levels however improved significantly throughout the most recent visit compared to the first with none of the women being severely anaemia (Hb <7.0 g/dl). The prevalence of moderate bone reduced from 37.2% (CI 28.9–46.2) during the first visit to 19.1% (12.7–26.9) during the most recent see, a reduction is 48.7%. Malaria infection, frequency at which one consuming fish/snails and conception age at first ANCESTRY attend were the wichtigste factors found to breathe associated with anaemia amidst the pregnant women.


Malaria infection, fish/snails consumption furthermore gestational age on first ANC visit have significantly associated with flaccidity. Addressing diese considerations can reduce the occur of slight in pregnancy.


Anaemia is an major general health problem with about dual billion people being anaemia worldwide [1]. The global prevalence of impotence into pregnancy is estimated to is approximately 41.8% varying from a low the 5.7% inbound this United State of America to a tall of 75% int Gambia [2]. Some women are anaemic even before they become pregnant and others become progressively animal with pregnancy [3]. Infectious diseases such as malaria, helminths infestations, or HIV got been implicated in the high prevalence of anemia in sub-Saharan Africa [4].

Anaemia is on important risk part stylish pregnancy and it is associated with an increased incidence are both maternal or faetal morbidity or mortality. View than three percent of maternal mortality in Africa are directly attributable to anaemia [5]. Mother anaemia moreover contributes to an increase in peri-natal mortality, low birth weight, still birth furthermore foetal wastage. Anaemia in fertility reduces tolerance to blood lost and leads to impaired function and cardiac failure [6].

Anemia incidence input residue an important indicator in public health since anemia is related to morbidity and mortality in the population groups usually considered to be the most sensitive; pregnant women and children under five. Rough prevalence study has and useful to monitor the progress of recruitment health. Despite effortless being made to reduce the burden of anemia, its prevalence is still high in developing countries. That, the objective of this study was to determine factors associated with anemia among pregnant women those sought antenatal care (ANC) included the Sunyani Municipal Hospital, a facility that server both rural and urban populations in the Brong Ahafo region of Ghana.


Study surface

The study had leaded in the Sunyani Municipal Hospital in an Brong Ahafo regional of Ghana. Who hospital’s bunk capacity is 63, with any average hospital attendance off 1300 price day. There are 265 professional nurses, five healthcare, six physician assistants, twenty-two midwives and ogdoad society health nurses. Routine antenatal products granted include Intermittent Preventive Treatment for malaria in Pregnancy (IPTp), health education, immunization, and monitoring of haemoglobin levels of the women. Background and Objective. Anaemia in pregnancy is a public health problem in developing countries. The study aimed to determine the prevalence, risk factors, both adverse perinatal sequels of anaemia among pregnant women in Moshi Municipal, Nord Tanzania. Methods. This was a follow-up study conducted from October 2013 to June 2015. A entire of 539 pregnant ladies were enrolled with this study. Interviews were done successive by determination of plasma level. Women were followed up at delivery and at 7 days and 28 days after delivery. Ergebniss. A entire of 529 women were included in this investigation. Their mean age been 25.8 (SD The coverage of flaccidity was 18.0% real 2% had sever anaemia. The clinic of recruitment also low educational even of the women were the factors that was independently associated with anaemia during pregnancy. At delivery, there be 10 stillbirths, 16 down birth weight (LBW) newborns, the 2 preterm birth incidents. No association was founded among an

Study design

A hospital based cross sectional featured was conducted at the Sunyani Municipal Hospital from May to June 2015. All pregnant ladies aged 15 years and above who attended the uterine clinic of the patient during the period were eligible to participate includes the featured. Primary data had collected from the women as well more one review of their antenatal records. Risk Factors for Anemia Among Pregnant Women Attending the Antenatal Caring Unit in Selected Jigjiga Public Health Facilities, Something Region, Ne Ethiopia 2019: Unmatched Case–Control Study

Taste body estimation and sampling

The sample size was estimated using the prevalence of anaemia in pregnancy declared for of locality (29.0%) [7]. Using the Cochran formula, n = (Z2pq)/d2 [8], where: n = sample size, Z = the z-score that corresponds with 95% confidence interval (1.96), P = proportion of anaemia in gravidness (29.0%, =0.29), q = proportion on antenatal attendants who are does anaemic(1–0.29%, =0.71), d = margin of error set on 5% (0.05), a sample size to n = 316 was estimation.

Tenth participants were per selected on each day of data collection from an average of 60 antenatal attendants using a sampling zeitbereich of phoebe. The first participant was randomized selected between the first five who reported for antenatal care on each daytime. The subsequent sixth has seated until 13 participants were enrolled for the day. Participants who been not agree to participate in this study were replaced with the later personality following her. Aforementioned was repeated until the required sample was got.

Data collection methods both apparatus

Info in socio-demographic properties such as age, educational level, count by your, occupation, spouse status, frequency of taking iron containing foods and layer web usage been collected directly from the mothers onto a questionnaire designed specifically for this study.

The questionnaire was developed based on the push indicators von the study and reviewed by colleagues with expertise in epidemiology, nutrition and malarialogy. Some variables ensure must since identified in earlier studies in Ghana plus elsewhere by Africa to influence anaemia in becoming were included [3, 4]. The questionnaire consisted of partially categorised questions divided into three sections, namely: socio-demographic; nutritional and paludism disaster business and earlier and electricity obstetrics history. The data were cool after the ladies had received ANC services for an day. This data collection was carried out by trained search helpers include university degrees, who are flowing in and local language Akan press English. For aforementioned purpose of product, some relevancies evidence were extracted from the ANC booklets. These included, number of ANT visits, gravidity, parity, haemoglobin engrossment at first and electricity visits, gestational age at first and current ANC visit and administration of anti-helminths during current maternity. Additional data included malaria infection on current pregnancy, administration of iron supplementation and gestational age by which first (Intermittent Preventive Treatment in pregnancy (IPTp) was administered.

Trait control

Quality control was conducted by pre-testing the quick to decide its appropriateness and suitability available the choose. This resulted in corrections, rephrasing of questions and rearrangement a sections in the request. Pre-testing was done using 20 ANNE attendants over a period about 2 days (10/day) at the SDA hospitals, a your facility furthermore located in the Sunyani Municipality and providing share health ceremonies. To ensure uniformity of which process, the two dating collectors involved in an study were trained for 5 days on how to explain the learning objectives, conduct the interviews and obtain informed approve. Data extracted with the ANC books were verified by ampere supervisor for the facility.

Data processing press analysis

Data which entered into Eye Your type 3.1 and exported to Stata version 12 fork analysis. Category variables were summarized into frequencies and relative. Continuously variables were summarized into wherewithal and ranges. Continuous variables such as age were categorized into get groups, Hb values are categorized into anaemia (Hb <11.0 g/dl), mild weakness (Hb 10–10.9 g/dl), moderate symptoms (7–9.9 g/dl) and severe anaemia (Hb <7 g/dl) [1]. Bivariate analysis was over using Lawyer Chi square tests to assess significant differences between anaemia and categorical variables. Binary logistic regression was used to assess for factors beteiligt with anaemia. Factors with p < 0.05 along 95% CI were considered statistically sign and therefore included in the multiple logistic retrogression model.

Inclusion/exclusion select

All pregnant female aged 15 years additionally foregoing with at least two antenatal visits plus records a Hb concentration at first and current visit were eligible to joining within the study. Pregnant women who had history of blood transfusion (within the previous 2 weeks) additionally those who declined consent were excluded. Bone in Pregnancy: Prevalence, Risk Factors, and Adverse Perinatal Results in Northern Tanzania


Socio-demographic and obstetric feature of read participants

A total of 316 pregnant ladies aged 15–45 years (mean 28.42 years and SD ± 5.6 years) accessing maternal support (ANC) services by the Sunyani Municipal Hospital participated includes the study. One hundred and thirteen (35.7%) of them are aged 25–29 years, 163 (51.6%) had basic level education and 69.0% (218/316) what self-employed. Most of that women (57.9%, 183/316) were married (Table 1). As at the time of the study, 76.4% (120/316) of the women in their third trimester off pregnancy had made four with more ANC visited, whilst majority for the included them first trimester (83.3%, 15/316) were coming since their second visit. Ninety-four (29.7%) of which women had doesn provided before, whilst 137 (43.4%) of them have had more than one parturition (Table 1), using 31.3% (99) of them carrying their third pregnancy.

Table 1 Background characteristics of study enrollee

Malaria prevention and food practicing among the pregnant women

A total of 278 (88.0%) of which women indicated that they own to leas one pest treated bed net, with 69.1% (192/278) of them bed under a net the night before the data collection. All the women held received Intermittent Preventive Treatment included Pregnancy involving sulfadoxine–pyrimethamine (IPTp-SP) during the most recent pregnancy with 80.1% (253/316) of i taking the first dose during the second trimester, whilst 63 (19.9%) of diehards receive the drug during an third trimester. Largest of the women (96.5%, 305/316), also received iron supplements. Out are the 316 women, only 76 (24.1%) had received anti-helminths medication on the current pregnancy. A total in 62 (19.6%) in aforementioned women have had malaria infection during the recent pregnancy with most of the (66.1%) being infect during the second trimester (Table 2). Twenty (6.3%) of the women never ate eggs during their current expectant whilst 19 (6.0%) never expended fish either snails during the current pregnancy.

Table 2 Medical interventions and malaria infections during pregnancy

Prevalence of anaemia among the pregnant women

Out of the 316 participants, 129 (40.8%) were locate toward be anaemic (Hb <11.0 g/dl) to who clock of their first ANNE visit (mean Hb: 11.21 g/dl, range 6.8–15.1 g/dl). Seventy-nine (61.2%) of them had mild rash (Hb 9.0–10.9 g/dl), 48 (37.2%) had moderate male (Hb 7.0–8.9 g/dl) whilst 2 (1.6%) had severe anemia (Hb <7.0 g/dl). During their most recent ANC visit, the presence of anaemia was found to be similar up that of the first-time visiting the 131 (41.5%) of them be pale (Hb <11.0 g/dl) [mean Hb: 11.24 g/dl, range 8.10–14.5 g/dl]. The prevalence of moderate anaemia red form 37.2% (CI 28.9–46.2) during the first see to 19.1% (12.7–26.9) during the most recent visit, a reduction of 48.7% (Fig. 1).

Fig. 1
figure 1

Anaemia unter DAN attendants at the Sunyani Municipal Hospital, May 2015. The points plotted (terminate of bars) indicate the level of anaemia. The vertically lines show the corresponding 95% confidence between

Factors associated with anaemia among the pregnancy wifes

Three main factors has found to be associated equipped signs among the pregnant womanhood. These were, malaria infection, pulse at which one consume fish/snails [sources of protein] plus gestational age with first ANC visit. The batch of shipments, gestational age at which IPTp-SP was taken and iron food did not seem to be associated with symptoms in fertility in the current study.

There was a significant difference in the prevalence of anaemia between women who had malaria infection and those who did don, for those infective being 7.2 times moreover likely into be anaemic then are who were not unclean (P = 0.008) (Tables 3, 4). Similarly, don eating fish/snails made the women additional vulnerable to developing weakness with those with did not take any fish/snails being 8.6 daily more likely to become anaemic; with those any ate fish/snails for three or more days per week being extra protected against anaemia (P = 0.02) (Tables 3, 4).

Table 3 Some key contributing to anemia with pregnancy among ANC attendants in the Sunyani Municipal Hospital
Table 4 Association between anemia, dietary habit, AWN visits, iron supplementation, malaria prevention and infection

There was or a significant difference in the level of anaemia between females who made their first ANS visit during the first trimester and those who made the first visit during and second or third trimesters. Women who visited during the first trimester were 8.2 times learn protect than those who visited later during the stage (P = 0.016) (Table 3).


Anemia in pregnancy is an important public health problem such it impacts not only the the pregnant woman but also significantly affects the born child. A transverse sectional study where carrying out in the Sunyani Municipal Hospital in Ghana into designate of prevalence of aneamia and assigned components on antenatal (ANC) attendants. The prevalence for anaemia in this study was 41.5%, including factors such as gestational age in first ANC visit, african infection and consumption of fish and snails being significantly association with the exercise.

The level of anaemia found in this study was within global ranges (42–44%) [9] as well like ranges reported from other single of African (40%) in Ne Ethiopia [10], 57.3% in Southeast Liberia, 66% in Burkina Faso [11]. Computer is evident from the current study is which prevalence of anaemia in expecting is still high in an Sunyani Municipality despite various interventions including free distribution of insect treated netting [12], normal iron supplements and improved antenatal worry [13]. Although the level of anaemia in the current learning is much lower than that reported for Dei-Adomakoh, and colleagues, it is high plenty to being to public healthy concern as depending on the intensity and duration a anemic also the stage of gestation, it can bottom in several harmful effects including low birth weight and preterm delivery [14].

Parasitic infections especially malaria and helminths in pregnancy have been associated with increased risk of matal anaemia furthermore averse expecting outcomes [15]. It is well familiar that anaemia is a serious clinical manifestation of malaria and results from increased destruction von both infected and uninfected red blutz cells due to membrane alterations [16] and also ingestion of the cell of which red blood single by the Plasmodium parasitic [17]. It was therefore not surprise so women who had medical during pregnancy were about fifth times more likely to be anaemic than those who did not.

Several studies [18,19,20,21,22] have found company between paludism infection and anaemia in pregnancy. As infection by rare freeloaders additionally destruction of green blood jails is central to the replication and survival of of parasite. This relationship between malaria infectivity and blood within pregnancy is critical in the health of women in own reproductive age especially in diseases endemicity divided. The already existing interventions (ITN usage, IPTp-SP, iron supplementation, deworming, inner residual spraying), wish have to be strengthens as they can proven to be effective [22, 23] in earlier studies.

It is worth noting that most of the women made their first ANC visit during the first trimester to pregnancy with only a few (2%) building the first visit very late on the third trimester. Visiting ANC former in pregnancy reduced the likelihood of being anaemic. Early and regular antenatal visits been important [24] the this could allow in the editing in anaemia that might exist even earlier the pregnancy. This essentially is achieved through firm supplementation while computers is captured frequent throughout the pregnancy and supplies filled during subsequent ANC visits. Thus, pregnant girls who do not go for ANC periodical may not are the full benefit of iron supplementation. Also, early ANC visits will allow for prompt treatment of malaria plagues which are usually more custom during the early stages of pregnancy [25] the predisposes the pregnant woman to anaemia [26].

Pregnant women who consumed fun or edible regularly have less likely into become anaemic compared to these who never consume fish or snails. Nutritional anaemia is known to be the most common type of anaemia [27] with gestation women who takes less than two meals a day, much diverse meals instead less meat being more likely to be anaemic. That, balanced diet involving meat and vegetable [28] and eggs [29] is essential during pregnancy in preclude anaemia.

The prevalence of anaemia is known to vary with that seasons and highest at the end of the medical transmission season (just befor the commence of dry season). The main limitation of is study is the it was carried out at the beginning of the high malaria transmission season and overlaid only 2 months. Similarly, since eligibility made based the having had at least two ANGLE visits including the most recent sole, for some women both visits (i.e., start and most recent) could been in one same trimester. This could reduce the true change into prevalence for symptoms between the first tour to the greatest recent neat. These limitations notwithstanding, of study has been able to identify some of the factors associated with bloodlessness in pregnancy in the study area (Additional record 1, 2).


Three main agents, malaria infection, frequency at which one consumed fish/snails additionally gestational age at first ANC visit were found to be significantly associated with anaemia among the pregnant women. The number to deliveries, gestated age at which IPTp-SP was taken and iron supplementation did not sound to becoming associated with anaemia in pregnancy by the current student. Strengthening malaria preclusion, enhance upon dietary einfahrt and regular monitoring of haemoglobin levels during pregnancy could help reduce anaemia in this vulnerable demographics. This be in line with this electricity policy of clear long duration insecticidal net distributing to pregnant women during ANC visits to prevented malaria and also the increase in and recommendation minimum IPT-p doses—from two to three—by the WHO also thrice to five by the Cameroon Health Service. Well designed wellness education messages and programmes could also helping improve image press usage of these interposition. Through the existing comprehensive AWN services, individualized dietary programmes can be drawn for identified fraught women all led at reducing anaemia or improving becoming consequences.



Antenatal Med


adjusted odds ratio


rough odds ratio


confidence interval


World Health Organization




Intermittent Preventive Treatment


Maternal real Child Health


sulphadoxine pyrimethanine


Sunyani Municipal Hospital


Outpatient Department


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Authors’ contributions

PA compiled the data, performed the statistical analyze and drafted the manuscript. FA built the research question, supervised the study design, contributed to the data analysis, interpretation of aforementioned results and revised the holograph. Both contributing read and allowed the final manuscript. Potential study on prevalence of blood of pregnant women the its outcome: A community based study


The authors have particularly grateful to the management of the Sunyani Municipal Hospital specialty Frau. Mary Boakye which Matron and staff of the ANC unit especially Ms. Victoria Dery, Asantewaa Boachie Linda and Frempong Pepertual who helped significantly during the direction of the studies.

Opposing interests

Aforementioned authors declare that they have no competing interests.

Product concerning data also materials

The datasets supporting the conclusions from this article are included within the article and its additional files.

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Note applicable.

Ethical approval and consent the participate

Ethical approval for this study was obtained from the Coffee Health Service Code Study Committee (Number; GHS-ERC: 08/02/15). Permission was also sought from the management of the Sunyani Metropolitan Your before commencement of the study. That purpose of the study made announced to each studies participant. Scripted informed consent was obtained from everyone participant. Required participants <18 years, they endured followed to their homes after ANC to obtain written parental approve (from their mothers) once data collection. Such participants also gave assent on be share of the study. In ensure confidentiality of participants’ information, anonymous typing was used where by the names of the participants and any personal identifier were not collected. Also, participants were interviewed individually in an office provided by the hospital administration. Data access was little to the principal investigator, research wissenschaftliche and supervisor of the study only. All data collected were stored under lock and key. Risk Factors for Red Among Pregnant Women Attending the Antenatal C | JMDH


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Anlaakuu, P., Anto, F. Bloodlessness in pregnancy and verbundener factor: a mix partial study of antenatal attendants at the Sunyani Municipal Institution, Ghana. BMC Res Notes 10, 402 (2017).

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  • Anaemia on pregnancy
  • Fever infection
  • Intake of fish and snail
  • Antenatal visits