Nutritonal Anemia in Pregnant Teenage Girls in Selected Communities in the Greater Accra Region

ABSTRACT

Background Nutritional anaemia in pregnancy still remains a problem of public health concern particularly in developing countries such as Ghana. The period of adolescence and pregnancy are both critical periods that place the individual at risk of developing nutrient deficiencies because of the rapid and increased demands in nutrients. Failure to meet the nutritional demands can affect the growth of the adolescent mother and that of the developing baby. Literature gaps exist in the micronutrient (iron, folate and vitamin B12) status, quality of diets, as well as dietary practices, myths and misconceptions of nutritional anaemia among pregnant adolescent girls in Ghana. Aim To determine the prevalence of nutritional anaemia, quality of the diet and to assess the myths and misconceptions concerning nutrition of pregnant adolescent girls in three communities in the Greater Accra Region. Methods A mixed method design (cross sectional and qualitative focus group discussions) was employed. The cross sectional component recruited pregnant adolescent girls (N=265) between the ages of 15-19 years from 3 hospitals in the Greater Accra Region. Dietary intake data were obtained based on a 3-day 24 hour dietary recall and a food frequency questionnaire. Minimum Dietary Diversity for women of reproductive ages (MDD-W) was determined based on FAO guidelines (FAO & FHI360, 2016). . Serum concentrations of iron, folate and vitamin B12 were determined using VITROS Chemistry Fe Slides method, ID-Vit® ELISA Folate and IDVit® ELISA Vitamin B12 test kits respectively. Serum TIBC and ferritin were also determined with VITROS Chemistry products Total Iron Binding Capacity (TIBC) kit and AccuBind iv ELISA microwells respectively. Four (4) focus group discussions were held to obtain information on nutrition knowledge, myths and misconceptions and sources of information on nutritional anaemia. Differences between means were tested using independent t-tests and ANOVA. Z-tests were used to test for differences between proportions. Logistic regressions were employed in determining the odds of being anaemic and the odds of obtaining good dietary diversity. Thematic approach of analysis was employed in analysing the qualitative data. Results Two hundred and six five (265) and twenty four (24) pregnant adolescents were involved in the cross sectional and qualitative studies respectively. Their mean age was 17.88 (SD = 1.08) years for the cross sectional study and 17.44 (SD = 1.29) years for the qualitative component. The prevalence of anaemia was 71.6%. Deficiencies in iron, folate and vitamin B12 were 61.4%, 50.4% and 11.7% respectively. Mean nutrient intakes of iron, folate and vitamin B12 were 9.10 (SD = 4.26; CI 8.54 -9.66) mg, 110.90 (SD = 56.36; CI 103.46-118.34) µg and 1.61 (SD = 1.26; CI 1.44-1.78) µg respectively. Proportion of girls with adequate intakes of iron (1.3%); and vitamin B12 (22.5%)) were significantly low (p < 0.001). None of the pregnant girls had adequate intake of folate. Prevalence of good MDD-W was 24.6% and average MDD-W score was 3.85 (SD = 0.95). The significant predictor of MDD-W was dietary folate (p = 0.010). The significant predictors of anaemia were dietary vitamin B12 (p = 0.022) and dietary iron (p = 0.039). Turkey berries (Solanum torvum), milk and malt drinks were regarded as foods that promote blood formation. The pregnant girls mentioned inadequate food intakes, drinking a lot of water, paradoxically not drinking a lot of water and exposure to sunlight as the main causes of anaemia.