Abstract
BackgroundFish smoking using biomass fuel is an important livelihood for women living in the coastal regions of Ghana and may contribute to anaemia risk. We assessed whether women who smoke fish as their primary livelihood are at increased risk of anaemia compared to women in other livelihoods in the Central Region of Ghana.MethodsWe conducted a comparative cross-sectional study of 330 randomly selected adult women (18–49 years) whose primary livelihood was either fish smoking (FSL) involving the burning of biomass fuel (n = 175) or other livelihoods (OL) not involving burning of firewood (n = 155). Data on participants’ recent diet were collected from a single, quantitative 24-h dietary recall and qualitative 7-day food frequency questionnaire of animal-source food (ASF) consumption. We further assessed participants’ haemoglobin concentration using the Urit 12 Hemocue system. We compared total iron intakes, the proportion of dietary iron from animal and plant sources, mean haemoglobin concentrations, and anaemia prevalence between FSL and OL women.ResultsFish was the most frequently consumed ASF by both groups of women. Although OL women consumed more diverse ASFs in the past week compared with the FSL women (3.4 ± 1.2 vs. 2.7 ± 1.3; p < 0.001), the contribution of ASFs to total iron intake in the past day was greater for the FSL women (49.5% vs. 44.0%; p = 0.030). Estimated total dietary iron intake in the past day was generally low (5.2 ± 4.7 mg) and did not differ by group. The unadjusted prevalence of anaemia was 32 and 27.1% among the FSL and OL women, respectively (p = 0.33). After covariates adjustment, the FSL women had statistically higher anaemia prevalence (36.4% vs. 20.5%; p = 0.032) and 80% greater risk of being anemic (RR: 1.8; 95% CI: 1.1, 3.0) than the OL women.ConclusionWomen who use biomass fuel to smoke fish as their primary livelihood had an increased risk of anaemia. Furthermore, the average 24-h dietary iron intake among both the FSL and OL women was below their daily iron requirement. Interventions to enhance women’s dietary iron intake and reduce their livelihood related biomass smoke exposure may be warranted in this population.
Highlights
Fish smoking using biomass fuel is an important livelihood for women living in the coastal regions of Ghana and may contribute to anaemia risk
A screening census was completed to list all adult women in the community according to their primary livelihood for the past two years; whether fish smoking involving burning of firewood (FSL women) or other livelihoods not involving burning of firewood and living in a household where no one smokes fish as a major economic activity (OL women)
A sample size of 175 participants per group (i.e., Fish Smoking Livelihood (FSL) and OL) was estimated based on a 5% level of significance, 80% power, expected anaemia prevalence of 50% and 35% where fish smoking is expected to be only minimally practiced [1] among the FSL women and OL women, respectively, and 3% contingency to cater for incomplete surveys
Summary
Fish smoking using biomass fuel is an important livelihood for women living in the coastal regions of Ghana and may contribute to anaemia risk. We assessed whether women who smoke fish as their primary livelihood are at increased risk of anaemia compared to women in other livelihoods in the Central Region of Ghana. According to the World Health Organization [4], about 50% of all anaemia is due to iron deficiency associated primarily with inadequate iron intake. In a systematic analysis of national surveys, the authors reported that countries with very high burden of inflammation (determined by an index derived from infection, hygiene, and/or overnutrition indicators) had the lowest prevalence of anaemia among WRA [5]. Anaemia attributable to iron deficiency among WRA was considerably lower (about 16%) for countries with a severe public health burden of anaemia (i.e. prevalence greater than 40%) [5]
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