{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T17:20:08Z","timestamp":1793380808305,"version":"4.5.0"},"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T00:00:00Z","timestamp":1724630400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/T00326X\/1"],"award-info":[{"award-number":["MR\/T00326X\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Anaemia is one of the most common conditions in low- and middle-income countries, with prevalence increasing during pregnancy. The highest burden is in Sub-Saharan Africa and South Asia, where the prevalence of anaemia in pregnancy is 41.7% and 40%, respectively. Anaemia in pregnancy can lead to complications such as prematurity, low birthweight, spontaneous abortion, and foetal death, as well as increasing the likelihood and severity of postpartum haemorrhage. Identifying and mitigating anaemia in pregnancy is a public health priority. Here we present a mixed-methods situational analysis of facility readiness and community understanding of anaemia in Ghana and Uganda. Quantitative health assessments (adapted from service availability and readiness assessments) and qualitative key informant interviews (KIIs) with district-level stakeholders, in-depth interviews (IDIs) with maternity staff, and focus group discussions (FGDs) with community members were held in 2021. We carried out facility assessments in nine facilities in Ghana and seven in Uganda. We carried out seven KIIs, 23 IDIs, and eight FGDs in Ghana and nine, 17, and five, respectively, in Uganda. Many good practices and general awareness of anaemia in pregnancy were identified. In terms of bottlenecks, there was broad consistency across both countries. In health facilities, there were gaps in the availability of haemoglobin testing\u2014especially point-of-care testing\u2014staffing numbers, availability of standard operating procedures\/guidelines for anaemia in pregnancy, and poor staff attitudes during antenatal care. Amongst community members, there was a need for improved sensitisation around malaria and helminth infections as potential causes of anaemia and provision of education around the purpose of iron and folic acid supplementation for preventing or managing anaemia in pregnancy. Anaemia in pregnancy is a persistent challenge, but one with clear opportunities to intervene to yield improvements.<\/jats:p>","DOI":"10.1371\/journal.pgph.0003610","type":"journal-article","created":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T14:00:02Z","timestamp":1724680802000},"page":"e0003610","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Prevention and management of anaemia in pregnancy: Community perceptions and facility readiness in Ghana and Uganda"],"prefix":"10.1371","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8718-5110","authenticated-orcid":true,"given":"Tara","family":"Tancred","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4636-7847","authenticated-orcid":true,"given":"Vincent","family":"Mubangizi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1750-7049","authenticated-orcid":true,"given":"Emmanuel Nene","family":"Dei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syliva","family":"Natukunda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6031-0172","authenticated-orcid":true,"given":"Daniel Nana Yaw","family":"Abankwah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phoebe","family":"Ellis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imelda","family":"Bates","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Natukunda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Asamoah Akuoko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,8,26]]},"reference":[{"issue":"1","key":"pgph.0003610.ref001","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1186\/s12889-023-16187-5","article-title":"An unacceptably high burden of anaemia and it\u2019s predictors among young women (15\u201324 years) in low and middle income countries; set back to SDG progress.","volume":"23","author":"MW Merid","year":"2023","journal-title":"BMC Public Health"},{"issue":"7","key":"pgph.0003610.ref002","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1007\/s10995-022-03450-1","article-title":"Global prevalence of anemia in pregnant women: a comprehensive systematic review and meta-analysis.","volume":"26","author":"M Karami","year":"2022","journal-title":"Maternal and child health journal"},{"issue":"2","key":"pgph.0003610.ref003","doi-asserted-by":"crossref","first-page":"447","DOI":"10.3390\/nu12020447","article-title":"Iron deficiency and iron deficiency anemia: implications and impact in pregnancy, fetal development, and early childhood parameters","volume":"12","author":"RT Means","year":"2020","journal-title":"Nutrients"},{"issue":"1","key":"pgph.0003610.ref004","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1111\/j.1749-6632.2000.tb06223.x","article-title":"Anemia in pregnancy","volume":"900","author":"S Sifakis","year":"2000","journal-title":"Annals of the New York Academy of Sciences"},{"key":"pgph.0003610.ref005","author":"World Health Organization","year":"2016","journal-title":"WHO recommendations on antenatal care for a positive pregnancy experience: World Health Organization"},{"issue":"2","key":"pgph.0003610.ref006","doi-asserted-by":"crossref","first-page":"495","DOI":"10.3945\/ajcn.115.107896","article-title":"Maternal anemia and risk of adverse birth and health outcomes in low-and middle-income countries: systematic review and meta-analysis, 2","volume":"103","author":"MM Rahman","year":"2016","journal-title":"The American journal of clinical nutrition"},{"issue":"8","key":"pgph.0003610.ref007","doi-asserted-by":"crossref","first-page":"2565","DOI":"10.1111\/jog.14834","article-title":"Prenatal anemia and postpartum hemorrhage risk: a systematic review and meta\u2010analysis","volume":"47","author":"MO Omotayo","year":"2021","journal-title":"Journal of Obstetrics and 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Childbirth"},{"issue":"7","key":"pgph.0003610.ref032","doi-asserted-by":"crossref","first-page":"e058693","DOI":"10.1136\/bmjopen-2021-058693","article-title":"Correlates of late initiation and underutilisation of the recommended eight or more antenatal care visits among women of reproductive age: insights from the 2019 Ghana Malaria Indicator Survey","volume":"12","author":"EA Anaba","year":"2022","journal-title":"BMJ open"},{"key":"pgph.0003610.ref033","first-page":"11","article-title":"Community mobilization to strengthen support for appropriate and timely use of antenatal and postnatal care: a review of reviews","author":"S Dada","year":"2021","journal-title":"Journal of Global Health"},{"key":"pgph.0003610.ref034","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2393-13-189","article-title":"Trends in antenatal care attendance and health facility delivery following community and health facility systems strengthening interventions in Northern Uganda.","volume":"13","author":"M Ediau","year":"2013","journal-title":"BMC pregnancy and childbirth."},{"issue":"10","key":"pgph.0003610.ref035","doi-asserted-by":"crossref","first-page":"e031890","DOI":"10.1136\/bmjopen-2019-031890","article-title":"Determinants of antenatal care utilisation in sub-Saharan Africa: a systematic review","volume":"9","author":"IN Okedo-Alex","year":"2019","journal-title":"BMJ open"},{"issue":"6","key":"pgph.0003610.ref036","doi-asserted-by":"crossref","DOI":"10.1002\/14651858.CD012392.pub2","article-title":"Provision and uptake of routine antenatal services: a qualitative evidence synthesis.","author":"S Downe","year":"2019","journal-title":"Cochrane Database of Systematic Reviews."},{"issue":"3","key":"pgph.0003610.ref037","first-page":"114","article-title":"A review on anaemia in pregnancy.","volume":"6","author":"O Ifeanyi","year":"2018","journal-title":"Hematol Transfus Int J"},{"issue":"1","key":"pgph.0003610.ref038","first-page":"1","article-title":"Increasing access to institutional deliveries using demand and supply side incentives: early results from a quasi-experimental study.","volume":"11","author":"E Ekirapa-Kiracho","year":"2011","journal-title":"BMC international health and human rights."},{"key":"pgph.0003610.ref039","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-017-1623-y","article-title":"Effects of demand-side incentives in improving the utilisation of delivery services in Oyam District in northern Uganda: a quasi-experimental study.","volume":"17","author":"W Massavon","year":"2017","journal-title":"BMC pregnancy and childbirth."},{"issue":"1","key":"pgph.0003610.ref040","doi-asserted-by":"crossref","DOI":"10.5334\/aogh.2934","article-title":"Emergency transportation interventions for reducing adverse pregnancy outcomes in low-and middle-income countries: a systematic review.","volume":"86","author":"H Alaofe","year":"2020","journal-title":"Annals of global health."},{"issue":"5","key":"pgph.0003610.ref041","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.3390\/microorganisms10051027","article-title":"Soil-Transmitted Helminths and Anaemia: A Neglected Association Outside the Tropics.","volume":"10","author":"S Caldrer","year":"2022","journal-title":"Microorganisms."},{"key":"pgph.0003610.ref042","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/j.clnesp.2022.03.016","article-title":"Efficacy of iron-folic acid treatment for reducing anemia prevalence and improving iron status in women of reproductive age: A one-year longitudinal study.","volume":"49","author":"R Palika","year":"2022","journal-title":"Clinical Nutrition ESPEN."},{"key":"pgph.0003610.ref043","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2458-11-S3-S21","article-title":"Effect of routine iron supplementation with or without folic acid on anemia during pregnancy.","volume":"11","author":"MY Yakoob","year":"2011","journal-title":"BMC public health."},{"key":"pgph.0003610.ref044","doi-asserted-by":"crossref","first-page":"e12532","DOI":"10.1111\/mcn.12532","article-title":"Barriers and enablers for iron folic acid (IFA) supplementation in pregnant women.","volume":"14","author":"K Siekmans","year":"2018","journal-title":"Maternal & child nutrition."},{"issue":"5","key":"pgph.0003610.ref045","first-page":"176","article-title":"Association between knowledge and compliance of taking iron\/folic acid supplements during pregnancy","volume":"10","author":"CR Titaley","year":"2017","journal-title":"Asian J Pharm Clin Res"},{"key":"pgph.0003610.ref046","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-018-5437-2","article-title":"Compliance with Iron and folic acid supplementation (IFAS) and associated factors among pregnant women: results from a cross-sectional study in Kiambu County, Kenya.","volume":"18","author":"MW Kamau","year":"2018","journal-title":"BMC public health."},{"issue":"4","key":"pgph.0003610.ref047","doi-asserted-by":"crossref","first-page":"e0249789","DOI":"10.1371\/journal.pone.0249789","article-title":"Compliance with Iron and Folic Acid Supplementation (IFAS) and associated factors among pregnant women in Sub-Saharan Africa: A systematic review and meta-analysis.","volume":"16","author":"MB Fite","year":"2021","journal-title":"PLoS One."}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0003610","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T14:00:45Z","timestamp":1724680845000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0003610"}},"subtitle":[],"editor":[{"given":"Marie 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