Trends, Regional Inequalities, and Future Projections of Anemia among Women of Reproductive Age (15-49 years) in Ghana (2000–2030)

Introduction Anemia, characterized by a deficiency in haemoglobin, remains a public health problem in Ghana among women of reproductive age (WRA) and children under five, as it hinders cognitive development, physical growth and well-being. This study examines sub-national prevalence and inequalities from 2000 to 2019. It also forecast the prevalence of anemia through to 2030 to inform Ghana’s efforts towards achieving the global anemia reduction targets. Methods We used population-representative estimates of anemia among WRA drawn from the WHO Equity Database. Using the WHO Health Equity Assessment Toolkit, we calculated both prevalence and regional inequalities across four inequality dimensions: difference(D), ratio(R), population-attributable risk(PAR), and population-attributable fraction(PAF). An Autoregressive Integrated Moving Average (ARIMA) model, specifically ARIMA(1, 1, 0), was used to forecast anemia prevalence from 2020 to 2030 using Python package. Results Anemia prevalence in Ghana among WRA age showed a modest decline from 47.8% in 2000 to 44.3% in 2019, representing a 3.5% reduction. The Ashanti region experienced the highest decline, from 43.3% (95% CI: 27.6%, 60.6%) in 2000 to 37.3% (95% CI: 28.7%, 46.3%) in 2019. Paradoxically, Upper West observed the highest increase in prevalence from 41% (95% CI: 26.1%, 56.8%) to 45.2% (95%: 36.6%, 53.5%). The gap in prevalence between the region with the highest burden and one with the lowest burden keeps widening across the four inequality dimensions from 2000 to 2019; D(18.1% to 22.2%), PAF(-16.2% to -18.4%), R (1.5 to 1.6) and PAR (7.8 to -8.2). Forecasting results revealed an insignificant decline, as prevalence was projected to decrease marginally from 44.1% (95% CI: 43.8% – 44.4%) in 2020 to 43.6% (95% CI: 40.4% – 46.9%) in 2030. Overall, the study shows absolute and relative fluctuation in inequalities across regions over-time. Conclusion The marginal declines in the anemia prevalence over the two decades and the widening inequalities between the highest and lowest burdened regions required urgent public health intervention to avert the trends. Without intensified, equity-focused strategies such as those addressing socio-economic inequalities, health system strengthening and scaling-up of nutrition-sensitive and malaria control interventions, Ghana is not on track to achieve the WHO Target 50% anemia reduction by 2030.