Study design, site and population
The study was a facility-based cross-sectional study conducted in the municipality of Bolgatanga. The municipality is the regional capital and is located in the center of the Upper East Ghana region, approximately between latitudes 10°30′ and 10°50′ north and longitudes 0°30′ and 1°00′ west. It covers a total area of 729 square kilometers and is bordered to the north by the district of Bongo, to the south and east by the districts of Talensi and Nabdam, and to the west by the municipality of Kassena-Nankana. The dominant tribe within the municipality is Frafra and the dominant religions in the region are Christianity and Islam. The municipality of Bolgatanga has a total population of 131,550, or 12.6% of the population of the Upper East Region, with women constituting 52.0% of the total population.
The study population included postpartum women aged 18-49 years residing in the municipality who gave birth within the last 6 weeks and were available in postnatal services or attending postnatal clinics at participating health facilities at the time of delivery. the study. Women were asked if they were clinically stable with no active or symptomatic opportunistic infections and if they were willing to participate in the study.
Sample size determination and sampling technique
The required sample size was determined using a single population proportion formula assumed prevalence of anemia in postpartum women in the region (50%), reliability coefficient associated with a 95% confidence interval (1.96) and margin of error (5%) to obtain 385 Five percent of the estimated sample size (20) was added to get the final sample of 405.
Study participants were sampled from 9 health facilities in 9 sub-districts of 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.
The number of subjects sampled at each health facility was determined using probability proportional to size. At each visit to a health facility, thirty (30) postpartum women were randomly selected using a ballot without replacement. This allowed consenting participants to choose ‘Yes’ or ‘No’ which was written on folded pieces of paper and placed in a container and carefully shaken to ensure randomisation. Those who chose “Yes” were interviewed. The procedure was repeated until the total sample size was reached.
Data collection lasted eight weeks from February to April 2021 with the use of a semi-structured questionnaire administered by an interviewer during individual interviews in health facilities. The drafted questionnaire underwent pre-testing and facial validation to improve reliability and accuracy using 10 randomly selected women at Navrongo War Memorial Hospital. Four research assistants who had knowledge of the research topic and who had participated in similar data collection exercises were trained to collect the data. The training on the questionnaire provided the research assistants with a good understanding of the questions.
Data were collected on socio-demographic characteristics, obstetrical characteristics, dietary diversity, hemoglobin during pregnancy and after delivery, and knowledge of iron-folic acid, iron and women’s anemia . Socio-demographic data included: age in years, occupational status, marital status, level of education and parity.
Data were collected on women’s knowledge of iron-folic acid, iron and anemia. With the knowledge of iron and folic acid, the questions focused on its benefits such as preventing anemia, protecting women from disease, and fetal health. Others are the effects of iron and folic acid deficiencies, such as a baby with a birth defect or low birth weight, the iron-folic acid regimen for pregnant women, and the side effects of iron-folic acid. folic.
Both of the women’s pregnancy hemoglobin measurements recorded in their antenatal care cards were recorded and used to determine anemia during pregnancy. In the postpartum period, the research project measured the women’s hemoglobin concentration with the help of two experienced laboratory technicians. Hemoglobin estimation was determined by taking finger-prick blood samples from participants using the URIT-12 hemoglobin photometer (URIT Medical Electronics Co., LTD, China). The hemoglobin values displayed on the hemoglobin photometer were recorded.
Definition of study variables
Anemia in postpartum women: There is no consensus on the definition of anemia in postpartum women. However, we have defined anemia in postpartum women with hemoglobin less than 12 g/dl .
Anemia during pregnancy
Anemia in the first and third trimesters of pregnancy was diagnosed using a hemoglobin threshold
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 (e.g. bicycles, television and radio) and livestock in the household based on an earlier concept. . Using principal component analysis, a wealth score was derived for respondents, sorted in ascending order and divided into 3 categories, poorest, middle and richest.
Minimum Dietary Diversity—Women (MDD-W)
The dietary diversity score was calculated from 10 designated food groups . For each food group the women ate, they got a score of ‘1’ (regardless of how many foods they ate), otherwise a score of ‘0’. The scores were added 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 greater 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 .
IFA knowledge index
An IFA knowledge index was constructed from the responses to 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 with a score lower than the average score (7.2 out of 18.0) were classified in the low category and those with an average or higher score in the high category.
Iron Knowledge Index
The iron knowledge index was based on mothers’ knowledge of 6 dietary sources of iron and divided into high and low categories using the average score of 2.5 out of 6.
Anemia Knowledge Index
Similarly, the anemia knowledge index was constructed from 6 questions on the signs/symptoms of anemia and divided into two halves, high and low, using the mean score (2.5).
Composite index of IFA, iron and anemia
Using scores for IFA knowledge, iron knowledge, and anemia knowledge, a composite maternal nutrition knowledge index was constructed with scores theoretically ranging from 0 to 30. The mean score of 12.3 was used to divide the index into high (≥ 12.3) and low (
The questionnaire was double-checked for completeness and accuracy before entering the software for data analysis. Data was 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 performed and statistically significant factors were entered into a logistic regression model to produce adjusted odds ratios with 95% confidence intervals for the identification of risk factors. risk of postpartum anemia. Model fit was assessed using the Hosmer-Lemeshow fit test. Multicollinearity between independent variables was checked using the “collin” command in Stata. All statistical tests were performed using two-tailed tests at the significance level of 0.05.
Ethical approval and consent to participate
The methodology of this research complied with the ethical principles of the Declaration of Helsinki, and ethical approval was obtained from the Human Research, Publication and Ethics Committee of the Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital, Kumasi, Ghana (CHRPE/AP/063/21). In addition, permission was sought from the Municipal Department of Health in Bolgatanga, Ghana. Written informed consent was obtained from participants prior to their participation in this study. No personally identifiable information was collected and confidentiality of study participant information was ensured.