Knowledge, perceptions and dietary practices of iron-absorption modulation, and the prevalence of anaemia, among pregnant women attending antenatal care in Ogun State, Nigeria: an exploratory sequential mixed-methods study

Abstract Background Iron-deficiency anaemia (IDA) remains the leading nutritional contributor to anaemia in pregnancy and a severe public health problem in Nigeria. Emerging evidence suggests that a specific gap in knowledge of dietary iron-absorption enhancers and inhibitors, rather than a general lack of dietary iron, may be an important, modifiable determinant of persistent anaemia. This study assessed the knowledge, perceptions and dietary practices of dietary modulation of iron absorption, and the prevalence of anaemia, among pregnant women attending antenatal care in Ogun State, Nigeria. Methods An exploratory sequential mixed-methods design was used. Seventeen in-depth interviews were conducted with pregnant women at three Primary Health Care facilities in Ewekoro and Abeokuta South, Ogun State, and analysed using reflexive thematic analysis; findings informed a structured, interviewer-administered questionnaire subsequently administered by census to 258 pregnant women at the same three facilities. The questionnaire assessed knowledge (43 items), perception (Health Belief Model constructs) and dietary practice of iron-absorption modulation, and capillary haemoglobin concentration was measured for each respondent. Spearman's correlation, chi-square tests and the Mann-Whitney U test were used to examine associations between knowledge, perception, dietary practice and anaemia status. Results Qualitatively, participants held a fragmented, experience-based understanding of anaemia and showed minimal spontaneous awareness of iron-absorption enhancers or inhibitors, alongside contested beliefs that avoiding tea, coffee or milk protects against an oversized baby rather than iron malabsorption. Quantitatively, 57.4% of respondents had moderate and 20.9% good overall knowledge, yet only 10.9% correctly identified milk as an absorption inhibitor. Perception was predominantly positive (98.4%), but perceived personal susceptibility to anaemia was low (23.3%) despite an anaemia prevalence of 68.2%. Dietary practice was the weakest construct (only 0.8% good practice; mean score 51.7%). Knowledge was significantly, negatively correlated with dietary practice (ρ = −0.218, p = 0.0004), while perception was significantly, positively correlated with dietary practice (ρ = 0.159, p = 0.0107). Dietary-practice but not knowledge category, was significantly associated with anaemia status (χ² = 20.911, p < 0.001 versus χ² = 5.05, p = 0.08). Anaemia prevalence varied markedly by facility, from 14.3% to 44.8% not anaemic. Conclusions Antenatal nutrition counselling should move beyond generic iron-rich food messaging toward explicit, skills-based food-pairing guidance, individualised risk communication, and facility-level anaemia surveillance.