Academic journal article American Journal of Health Education

Socio-Ecological Factors Affecting Pregnant Women's Anemia Status in Freetown, Sierra Leone

Academic journal article American Journal of Health Education

Socio-Ecological Factors Affecting Pregnant Women's Anemia Status in Freetown, Sierra Leone

Article excerpt

ABSTRACT

Background: Sierra Leone has high maternal mortality. Socio-ecological factors are considered contributing factors to this high mortality. Anemia is considered to be a direct cause of 4% of maternal deaths and an indirect cause of 20-40% of maternal deaths. Purpose: The current study explores socio-ecological contributing factors to the anemia status of 171 pregnant Sierra Leone women. Methods: A structured questionnaire framed around the Modified Ecological Model for Health Behavior and Health Promotion was distributed to women visiting five health care facilities in Freetown, Sierra Leone. Results: Participants were more likely to have anemia in the second and third trimester than the first trimester ([chi square] = 6.12; [chi square] = 6.33). Participants indicating economic difficulties were likely to have anemia. Seventy-seven percent of participants had anemia (hemoglobin < 11.0g/dL). Discussion: Findings indicate that poverty, time of intervention, and socio-cultural factors have an impact on anemia. In addition, use of radio communication is beneficial to deliver health messages to the masses. Translation to Health Education Practice: Developing and implementing comprehensive programs that consider socio-cultural factors are necessary to raise awareness and address misconceptions about anemia causes, prevention, and treatment. These programs must be multi-sectored and include participants, health care workers, government, non-governmental agencies and community.

BACKGROUND

More than 500,000 pregnant women die from childbirth complications every year. (1) Cited are several causes of maternal mortality including hemorrhage, sepsis, complications with abortion and anemia. Anemia is listed as direct cause of 4% of maternal deaths and an indirect cause of morbidity and 20-40% of maternal deaths due to exacerbation of conditions in HIV/AIDS and hemorrhagic situations. (1) A major contributing factor to anemia is iron deficiency, which contributes to 100,000 maternal deaths. (1,2) According to an anemia report, Sierra Leone has anemia prevalence over 40% (59.7%), which is considered severe, with approximately 160,000 pregnant women having the condition. (1,3,4) A previous report by the Helen Keller International found anemia prevalence to be almost 70%. (5)

Several social determinants of health have been cited as having an impact on maternal health such as poverty, access to health care, health disparities and societal inequalities, among others. (6,7) Social determinants of health also may impact anemia status of pregnant women.

Poverty is considered an underlying factor affecting health access. According to the first Sierra Leone Poverty Reduction Strategy Paper (SL-PRSP), the total poor in Sierra Leone are 70%. In urban Western Area, however, this figure is much lower: that full poor in urban Western Area made up 17.1% of the population (earn [less than or equal to] $2/ day; [less than or equal to] Le 64,223/month), whereas, the food poor made up 3.2% of the population in that region (earn [less than or equal to] $1/day: [less than or equal to] Le 31,420/ month). (8) Poverty affects nutrition status, likely to have food insecurity and access to health services. (9-11)

To combat high maternal mortality, global efforts are returning to primary health care to "put people at the center of health care," (12(p xii)) where essential health care is "made universally accessible to individuals and families in the community by means acceptable to them through their full participation and at a cost that the community and country can afford," (12(p xii)) and the Declaration of Alma-Ata to address health inequalities and pursue "social justice and the right to better health for all, participation and solidarity." (12(p xii))

Global health policies are intended to have government support and are geared to address disparities and make services comprehensive, available and accessible. …

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