Malaria and anaemia prevalence and associated factors among pregnant women initiating antenatal care in two regions in Ghana: an analytical cross-sectional study

Background Malaria and anaemia in pregnancy remain public health problems because they increase the risk of adverse pregnancy outcomes. This study assessed malaria and anaemia prevalence and associated risk factors among pregnant women initiating antenatal care in selected districts of 2 regions of Ghana. Methods An analytical cross-sectional study was conducted using data obtained from 5196 pregnant women at their booking antenatal care (ANC) visit. Women of any age, gestational age, parity and at any ANC visit, who consented were enrolled consecutively into the study. Data on socio-demographic and obstetric characteristics, bed net ownership and use were obtained using structured questionnaires. Haemoglobin concentration and malaria, Schistosoma and helminth infections were determined using an automated haematology analyser and microscopy, respectively. Summary statistics to describe study variables and chi-square test and logistic regression set at p < 0.05 to determine risk factors for anaemia and malaria were conducted using Stata SE14. Results Overall malaria prevalence was 5.74% [95% CI: 5.1-6.4] and anaemia prevalence was 55.22% [ 95% CI: 53.85-56.58]. Living in Volta region (p < 0.001), being secondi- (p = 0.003) or multigravida (p < 0.001) and being of lower middle socio-economic status (p = 0.004) reduced the women's risk of malaria parasite infection. Being anaemic (p = 0.001) and reporting a symptom (p < 0.001) increased the odds of Plasmodium infection among the women. Residing in Volta region (p < 0.001), having malaria infection (p < 0.001), and booking ANC in the 2nd (p < 0.001) and 3rd trimesters (p < 0.001) increased the odds of anaemia among the women. Age 25-34 years (p < 0.001) and >= 35 years (p = 0.008) and belonging to middle (p = 0.009), upper middle (p = 0.006) or upper-level (p < 0.001) quintile of wealth index reduced the odds of anaemia among the women at their booking ANC visit. Conclusions More than half the women were anaemic signifying a severe public health problem. Malaria prevalence, though low, was a significant risk factor for anaemia. Existing malaria and anaemia control strategies through ANC need strengthening, especially among young, first-time pregnant women. This study further highlights socio-economic status as an important risk factor for anaemia in pregnancy.