Anaemia prevention among pregnant women: Views and experiences of pregnant women and antenatal care providers in Accra, Ghana

Abstract

Background and Objective
Anaemia among pregnant women is a public health challenge in Ghana. Although there is a national programme of routine iron-folic acid (IFA) supplementation, coverage is
suboptimal. The current study explored experiences and perceptions of anaemia prevention, and IFA use among pregnant women and antenatal care providers at two hospitals in Accra, Ghana, for enhancing the supplementation programme.

Methods
Utilizing a qualitative approach, 6 focus group discussions with 48 purposively selected pregnant women, and 10 in-depth interviews with care providers in two hospitals were
conducted. Interviews were transcribed verbatim. Using both deductive and inductive approaches, priori themes that informed the design of the interview guides, and emerging
codes from transcripts were used in data analysis.

Results
In both hospitals, pregnant women reported awareness of anaemia and identified poor quality diets and failure to take IFA as the predominant causes. Regular IFA supplementation, and consumption of fruits, vegetables, and animal-source foods were indicated as the main anaemia remedies by the pregnant women. Turkey berry, beetroot,
and hibiscus flower were also reported as therapeutic remedies for anaemia. IFA use was linked with improved appetite, haemoglobin, and health status of mothers and their fetus. Both providers and pregnant women indicated that IFA is freely accessible through government facilities but may also be purchased. IFA supplements are recommended to be taken three times daily; however, non-adherence to the recommended frequency was reported. This was attributed to adverse reactions including nausea and vomiting,
unanticipated cost of increased appetite, forgetfulness to take IFA, misperceptions about adverse effects of IFA, transportation cost to access IFA, and long waiting time at
hospitals. Community-level focused antenatal care, follow-up visits, and phone calls were reported by providers as strategies to improve IFA uptake. Community sensitization,
enhanced access to IFA, and participatory approach to ANC services were suggested by pregnant women as strategies for improving IFA uptake.

Conclusions
Food insecurity and misperceptions about IFA should be addressed as part of efforts to address low IFA adherence and high maternal and child anaemia rates in Ghana.