The Causes of Anaemia in Agogo, Ashanti Region, Ghana

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Anaemia, an intractable nutritional problem, remains an important public health problem in developing countries including Ghana. This homeostatic imbalance whereby the production of erythrocytes is outpaced by its destruction is an indicator of poor health and nutrition. Despite the social and economic cost of anaemia in Ghana, there is paucity of data on its aetiology, raising questions about the appropriateness of the current strategies being employed to achieve progress in the fight against this public health problem. This study aimed at establishing the aetiology of anaemia in Agogo by identifying the most significant contributors to the burden of the disease. A cross sectional study was conducted among 200 adult patients (18-60years) without any established chronic disease from September 2011 to February 2012 at the Out-patients Department of the Agogo Presbyterian Hospital. The participant selection was based on the WHO definition of anaemia in adults as Hb<12.0g/dl (female) and Hb<13.0g/dl (male). Venous blood samples were drawn for FBC, total iron, ferritin, folate, vitamin B12 and malaria parasite tests. Total iron was estimated with the colorimetric method and the Enzyme Immunoassay technique was used for measuring ferritin, folate, vitamin B12. Stool samples were also collected for intestinal helminth screening. The mean age of the study participants was 36.9±13.7 years with the female group outnumbering the male group by a 4:1 ratio. One hundred and forty-eight (74%) participants presented with mild anaemia, 40(20%) had moderate anaemia and 12(6%) had severe anaemia. Study participants with mild anaemia had significantly higher red blood cell count (4.14±0.51 M/μL) when compared to those with moderate (3.71±0.67 M/μL) and severe (2.30±0.73 M/μL) anaemia. The mean MCH and MCHC for participants in the moderate (24.79± 4.39 pg; 31.38±2.12 g/dl) anaemia category were significantly lower than those in the mild (27.62±2.92 pg; 33.01±1.29 g/dl) anaemia category (p<0.001). Of the 200 study participants, 75(37.5%) had microcytosis, 10(5%) had macrocytosis and 115(57.5%) had normocytosis. Hypochromasia was seen in 45.5% of the study participants. Hypochromasia and microcytosis had a significant association with the severity of the anaemia (p<0.05). The odds of hypochromasia (OR=2.9; 95%CI=1.4-6.0) and microcytosis (OR=3.1; 95%CI=1.5-6.4) were three times more in the moderate anaemia group compared to the mild anaemia group. Twenty-five (12.5%) of the study participants had P. falciparum malaria infestation and malaria impacted significant risk (p<0.001) on the severity of the anaemia. Two different intestinal parasites were present in the stool samples of 17 (8.5%) study participants. In all, 51 (25.5%) study participants had folate deficiency (serum folate <5.0ng/ml) and 60 had vitamin B12 deficiency (serum vitamin B12<200ng/L). Iron deficiency (serum iron <8.9μmol/L), the most prevalent cause of anaemia, occurred in 69(34.5%) of the study participants and had a statistically significant association with the severity of the anaemia (p=0.0028). Twenty-four (12%) participants had depleted iron stores showing significant association with the severity of the anaemia (p<0.0001). Vitamin B12 deficiency, folate deficiency and intestinal parasite infection though may result in anaemia, did not have any significant association with the severity of the anaemia (p>0.05) in the study. This study has succeeded in the advocacy for investigating the cause of anaemia before blindly treating patients with haematinics.
A Thesis Submitted to the Department of Molecular Medicine, Kwame Nkrumah University of Science and Technology in partial fulfilment of the requirement for the award of Master Of Philosophy, August-2012