This study aimed to determine the prevalence of anaemia and its causative factors among pregnant adolescents receiving Antenatal Care (ANC) at the Ussher Hospital, Accra, Ghana.

Socio-demographic factors

Results from the study showed that the adolescents were in their childbearing stage. As their ages increased from 15 to 19 years, the likelihood of childbearing also increases. This could be so because increasing the age of adolescents is associated with sexual activeness and fertility [25]. In addition, a high percentage of participants was of the Ga/Adangbe ethnic group. This is due to the fact that, the study community is densely populated by the Ga/Adangbes who are the indigenes. Other ethnic sects such as the Akans and the Ewes constitute a few proportions.

In Ghana, religious sects are predominated by Christians followed by Muslims. Thus, the observe high percentage of participants belonging to Christianity and Islam in this study only confirms this fact.

This study further reports that, a large proportion of the participants lived with single parent. This single parenting could serve as a risk factor for teenage pregnancy. This is because single parenting is widely known to place several burdens on a family. Lack of financial support from the parents and time spent with children and adolescent to provide guidance could have compelled the participants into engaging in sexual activities resulting in teenage pregnancy [8]). Lack of parental guidance largely reported to compel the adolescents to succumb to peer pressure relating to sexual misconduct with the opposite sex as a means of obtaining financial assistance could have attributed to this observation. This observation is further in concordance with the findings of Thobejane [24] in South Africa that showed that about 80 percent of participants in a study of factors that contribute to adolescent teenage pregnancy had friends that influenced their decision to engage in teenage sexual intercourse that resulted in pregnancy. Earlier, de Groot et al., [10] had reported similar findings stating Peer pressure as the main contributing factor for teenage pregnancy due to the association of most teenagers with peers who may be sexually active. In furtherance to the above, majority of the participants in this study lived with guardians who were either petty traders or artisans that are known to live below the poverty belt or slightly below the average economic ladder often classified as the third class [23]. This further suggests the strong role of peer pressure and lack of financial support as contributing factors to the high prevalence of teenage pregnancy observed in this study respectively.

Dietary contribution to anaemia among the study participants

The observed poor dietary intake and non-compliance with the iron and folate supplement intake could have transiently contributed to the observed high prevalence of anaemia among the study participants. Iron deficiency is the most frequent nutritional cause of anaemia, accounting for nearly 50% of all global cases and anaemia incidence in pregnancy [13]. Iron deficiency is mainly caused by a lack of iron in the diet. Some other haemopoietic micronutrient deficiencies like folate, riboflavin, and Vitamins A and B12 may increase the risk for anaemia [13]. W.H.O. recommends oral daily iron and folic acid supplementation for pregnant women because of the high iron requirements in pregnancy which cannot be met from dietary sources alone. In this study, participants who did not adhere to the iron supplement intake claimed they were not provided with the supplement at the hospital and did not have money to buy. Others however attributed it to having unpleasant side effects. This may have resulted in the high prevalence of anaemia recorded in this study. This observation is in consonance with the investigation by Sifakis & Pharmkides, [20] reported that the most common type of anaemia in pregnancy is the iron deficiency anaemia which contributes to 75% of anaemia in pregnancy. A related study by Annan et al. [4] revealed that, participants who were anaemic suffered from both severe deprivation of food and exhausted body iron reserves, suggesting a combined effect. Wemakor [26] earlier suggested that, among adolescents, anaemia is most commonly caused by nutritional deficits induced by fast development and physical changes associated with adolescence.

In this study, we observed that, the majority of the participants depended on their parents, guardians, or partners for income. Because education has an impact on employment possibilities, money, and potential dietary consequences, a parent’s economic or income level is likely to reflect their child’s nutritional status. As a result, the education and income of the parent, guardian, or partner may have influenced how much iron was consumed, either through well-informed decisions or greater incomes making iron-rich foods such as meat and fish more readily available in the households. This observation is parallel to the findings of Nelima, [14] that indicated that, teenage girls whose fathers had no formal education were reported to have higher risk of anaemia than those whose fathers had obtained a considerable level of education.

Behavioural attitude towards antenatal care (ANC) services

The ANC services in Ghana has its incorporated mandate to provide iron and folate supplements to pregnant women to boost their haemoglobin levels and to prevent haemoglobin and iron deficiency-related maternal and child birth complications such as low birth weight and preterm birth. Thus, pregnant women who attend the ANC service regularly are thus well monitored and provided with the appropriate doses of the supplements. Participants in this study had varied attitudes towards visitation to the hospital for ANC services. This variation resulted in the findings that, participant who did not attend ANC services regularly were found to be anaemic as compared to those who frequently attended antenatal care. An earlier supporting finding by Saapiire et al. [18] stated that, pregnant women who could not achieve adequate ANC services were 2–3 times more likely to be anaemic compared with their counterparts who regularly attended ANC services.

Effect of gestational stage on anaemia

This study found no significant differences in percentage wise in anaemia cases between different gestational stages among the study participants. This suggests that, the occurrence of anaemia among the adolescent participants in this study was independent of the gestational stage of the pregnancy. On the contrary, a similar study conducted in rural northern Ghana revealed an important association between anaemia and gestational stage [5]. An earlier report by Menon et al. [12] also indicated an association between anaemia in the second trimester of gestation and postnatal infant growth. These contrasting findings calls for a more rigorous research that seeks to address the relation between anaemia and developmental stages of pregnancy and the contribution of dietary supplements to these complications.

Contribution of malaria and sickling to maternal anaemia

The prevalence of sickle cell among the study participants was found to be slightly below the 15% frequency reported by WHO (2024) in African countries. This study confirmed that, being sickling positive confers a high risk of becoming anaemic on the affected individual. This is because the majority of the participants who tested positive to sickling were also anaemic. In addition, the observed high cases of anaemia among sickling negative participants shows that, maternal anaemia observed in this study was independent of sickling status. This observation further confirms the role of other factors not limited to lack of regular intake of iron and folate supplements and poor dietary regimen.

Malaria in pregnancy is associated with poor maternal outcomes such as intrauterine growth retardation, preterm birth, low birth weight, and maternal anaemia. In this study, only 9.4% of participants tested positive to malaria during the study period. This could be attributed to the Ghana Health Service nationwide campaign to provide mosquito nets for all pregnant women who attend AND services. Although malaria remains a burden on anaemia in pregnancy [5], data reported in this study showed an insignificant percentage contribution of malaria to anaemia in pregnancy.

Our research has revealed that the prevalence of anaemia among teenagers is greater than that among pregnant adults as reported in previous studies conducted in Ghana [6]. This study, which included UN (2020), Ayensu et al. [6] reported that, the prevalence of anaemia among pregnant adults was 56.0%. These studies have reported anaemia prevalence rates in pregnant adults. Furthermore, Ampiah et al. [3] found that 70% of pregnant teenagers in Ghana were anaemic. In comparison to the outcome of similar studies in other African countries, our prevalence rate is relatively higher than estimates made for pregnant women in South Eastern Nigeria (58%), Eastern Ethiopia (56.8%), Southern Ethiopia (51.9%), Kiboga, Uganda (63.1%), Derna, Libya (54.6%), and Niger Delta, Nigeria (69.6%), South West Ethiopia (23.5%), North West Ethiopia (25.2%), and Mpigi, Uganda (32.5%) [26].

Study limitation

The study did not take into consideration the vegetarian status of the respondent in assessing the contribution of dietary intake to anaemia. In addition, the study did not consider other contributing factors such as worm infestation, HIV status and G6PD status which could have been the underlining cause of the anaemia cases recorded in this study.