Comparison of Anaemia Prevalence Between Women in Fish Smoking and Non-Fish Smoking Livelihoods in Biriwa in the Central Region of Ghana

Abstract

Background and objective: Anaemia among Ghanaian women of reproductive age is an important public health concern that contributes to morbidity, poor reproductive outcomes, low productivity and mortality. Chronic smoke inhalation from the use of biomass fuel for cooking has been shown to be associated with anaemia in some populations. Fish smoking using biomass fuel is an important livelihood among women living in coastal communities in Ghana which may increase their risk of anaemia. The objective of the study was to determine whether women who smoke fish as their primary livelihood had a greater risk of anaemia compared to women not engaged in fish smoking livelihood. Methodology: This was a cross-sectional study with 330 randomly selected non-pregnant, non-lactating adult women (18-49 years) living in Biriwa (a fishing community in the Central Region of Ghana) whose primary livelihood was either fish smoking (n=175) or a non-fish smoking activity (n=155). A structured questionnaire was used to interview the women on their socioeconomic and household characteristics, reproductive history, anaemia-related health information and exposure to biomass smoke. The 24-hour recall method was used to record dietary intake in the past 24 hours and a 7-day animal source food frequency questionnaire used to capture types of animal source foods (ASF) consumed in the past week. The Urit12 HemoCue system was used to measure the finger-prick blood haemoglobin concentration. Continuous outcome variables (dietary diversity and haemoglobin concentration) were compared using General linear model and ANCOVA for unadjusted and adjusted analysis, respectively while anaemia prevalence was compared using simple logistic regression (unadjusted analysis) and multiple logistic regression (adjusted analysis). Multiple logistic regression was used to determine whether fish smoking, as a primary livelihood, independently predicts anaemia among the women. The SAS PROC GLIMMIX procedure was used for these analyses. For anaemia, binary distribution and the log-link function were specified in the SAS procedures, so that relative risks between groups and their 95% CIs were calculated Results: Women who smoked fish as their primary livelihood were on average older (38 vs 29; P<0.001) and had a higher parity (5 vs. 2; P<0.001) than women engaged in other livelihoods (primarily vocational occupations included hairdressing and dressmaking. After adjusting for potential confounders, there was no significant group difference in mean dietary diversity but women in non-fish smoking livelihoods consumed a wider variety of animal source foods (3.3 ± 0.1 vs. 2.8 ± 0.1; P=0.002). Fish and seafood was the most commonly consumed animal source food by both groups of women). Adjusted anaemia prevalence was higher among women in fish smoking livelihood compared with women in non-fish smoking livelihood (32.0% vs. 20.3%: P=0.023). The relative risk of anaemia was 1.8 (95% CI: 1.1, 3.1) times greater among women in fish smoking livelihood than women in non-fish smoking livelihoods. Other factors such as age, marital status and animal source food diversity were not significantly associated with anaemia in the population. Conclusion: The risk of anaemia was greater among women who smoke fish as a primary livelihood compared to women engaged in other types of livelihoods.