Background: Iron deficiency is the most significant contributor to the onset of anemia accounting for 75% of anemia cases that occurs during pregnancy worldwide. Adherence to iron and folic acid supplementation is one of the determinant factors to prevent anemia during pregnancy. Thus, the aim of this study was to assess the magnitude of adherence and associated factors for iron-folic acid supplementation among pregnant women.
Method: Cross sectional study was conducted at Felege Hiwot Compressive Specialized Hospital from April 1 to August 30, 2019. Data was collected from 390 pregnant women who attended ANC follow up using interviewer administered structured questionnaire and from patients’ registry book. Descriptive analysis was done on socio-demographic, obstetric and medical related characteristics. Binary and multivariate logistic regression analysis was done to identify factors associated with IFAS adherence.
Results: 67.4% of pregnant women were adherent to iron and folic acid supplementation. Being counseled about IFAS (AOR=2.30; 95% CI: 1.21-4.34), having good knowledge about IFAS (AOR= 4.22; 95% CI: 2.43-7.31), more than 3 antenatal care visits (AOR=3.50; 95% CI: 1.55-7.92), having previous ANC follow up in tertiary hospital (AOR=2.61; 95% CI: 1.30-5.27), and having no history of hypertension (AOR=3.07; 95% CI: 1.37-6.89) were significantly associated with IFAS adherence. Lack of adequate counseling about anemia and IFAS mainly contributes to non-adherence.
Conclusion: In this study, counseling about IFAS, Knowledge about IFAS, frequency of ANC visit, previous ANC follow up center and history of hypertension were significantly associated with IFAS adherence.
Keywords: Adherence, Folic Acid, Iron, Pregnant Women.
Adherence, Folic Acid, Iron, Pregnant Women.
2. Zakia M. I, Seham A.E, Hend M and Maged S. K. Assessment of Adherence to Iron and Folic Acid Supplementation and Prevalence of Anemia in Pregnant Women Ismailia governorate. Med J Cairo Univ, 2011; 79(2):115-121.
3. Kraemer K and Zimmermann MB. Nutritional anemia: Sight and life press Basel; 2007.
4. World Health Organization, the global prevalence of anaemia in 2011. World Health Organization, Geneva, 2015. https://apps.who.int/iris/handle/10665/177094.
5. World Health Organization, Guideline: daily iron and folic acid supplementation in pregnant women. World Health Organization, Geneva, 2012.
6. Stoltzfus RJ, Dreyfuss ML. Guidelines for the use of iron supplements to prevent and treat iron deficiency anemia: Ilsi Press Washington, DC; 1998.
7. Melku M and Agmas A. Maternal anemia during pregnancy in Bahirdar Town, Northwestern Ethiopia: A facility-based retrospective study. Appl Med Res. 2015 (1). DOI: 10.5455/amr.20150129110510.
8. Gebreamlak B, Dadi AF, Atnafu A. High adherence to Iron/folic acid supplementation during pregnancy time among antenatal and postnatal care attendant mothers in governmental health centers in Akaki Kality Sub City, Addis Ababa, Ethiopia: hierarchical negative binomial Poisson regression. PloS one. 2017;12(1): e0169415. doi: 10.1371/journal.pone.0169415.
9. Bilimale A, Anjum J, Sangolli H, Mallapur M. Improving adherence to oral iron supplementation during pregnancy. AMJ, 2010; 3(5):281-290. Doi 10.4066/ AMJ.2010.291.
10. Ekström EM, Kavishe FP, Habicht J-P, Frongillo Jr EA, Rasmussen KM, Hemed L. Adherence to iron supplementation during pregnancy in Tanzania: determinants and hematologic consequences. Am J Clin Nutr, 1996; 64(3):368-374.
11. Gebremariam AD, Tiruneh SA, Abate BA, Engidaw MT, Asnakew DT. Adherence to iron with folic acid supplementation and its associated factors among pregnant women attending antenatal care follow up at Debre Tabor General Hospital, Ethiopia, 2017. PloS one. 2019;14(1): e0210086. https://doi.org/10.1371/journal.pone.0210086.
12. Mithra P, Unnikrishnan B, Rekha T, Nithin K, Mohan K, Kulkarni V, et al. Compliance with ironfolic acid (IFA) therapy among pregnant women in an urban area of south India. African health sciences. 2013;13(4):880-885. http://dx.doi.org/10.4314/ahs.v13i4.3.
13. Rai S, Ratanasiri T, Arkaravichien T, Thapa P, Koju R. Compliance and its Determinants Regarding Iron and Folic Acid Supplementation during Pregnancy in Kathmandu, Nepal. Kathmandu Univ Med J. 2016; 14(56):311-317.
14. Getachew M, Abay M, Zelalem H, Gebremedhin T, Grum T, Bayray A. Magnitude and factors associated with adherence to Iron-folic acid supplementation among pregnant women in Eritrean refugee camps, northern Ethiopia. BMC pregnancy and childbirth. 2018;18(83). https://doi.org/10.1186/s12884-018-1716-2.
15. Taye B, Abeje G, Mekonen A. Factors associated with compliance of prenatal iron folate supplementation among women in Mecha district, Western Amhara: a cross-sectional study. Pan African Medical Journal. 2015;20(43). doi:10.11604/pamj.2015.20.43.4894.
16. Gebre A, Afework M, Belachew E. Assessment of factors associated with adherence to iron-folic acid supplementation among urban and rural pregnant women in North Western Zone of Tigray, Ethiopia: comparative Study. Int J Nutr Food Sci. 2015; 4(2):161-168.
17. Haile MT, Jeba AB, Hussen MA. Compliance to prenatal Iron and Folic acid supplement and associated factors among women during pregnancy in South East Ethiopia: A Cross-sectional study. J Nutr Health Food Eng. 2017;7(2):272‒277.
18. Kiwanuka TS, Ononge S, Kiondo P, Namusoke F. Adherence to iron supplements among women receiving antenatal care at Mulago National Referral Hospital, Uganda-cross-sectional study. BMC research notes. 2017;10(1):510.
19. Sadore AA, Gebretsadik LA, Hussen MA. Compliance with iron-folate supplement and associated factors among antenatal care attendant mothers in Misha District, South Ethiopia: Community based cross-sectional study. Journal of environmental and public health, 2015. http://dx.doi.org/10.1155/2015/781973.
20. Shewasinad S, Negash S. Adherence and associated factors of prenatal iron folic acid supplementation among pregnant women who attend ante natal care in health facility at Mizan-Aman Town, Bench Maji Zone, Ethiopia, 2015. J Pregnancy Child Health. 2017; 4:5. doi:10.4172/2376-127X.1000335.
21. Godara S, Hooda R, Nanda S, Mann S. To study compliance of antenatal women in relation to iron supplementation in routine ante-natal clinic at a tertiary health care centre. Journal of Drug Delivery and Therapeutics. 2013; 3(3):71-75.
22. Vongvichit P, Isaranurug S, Nanthamongkolchai S, Voramongkol N. Compliance of pregnant women regarding iron supplementation in Vientiane municipality, Lao PDR. Journal of Public Health. 2003; 1(1):42.
23. Nisar YB, Dibley MJ, Mir AM. Factors associated with non-use of antenatal iron and folic acid supplements among Pakistani women: a cross sectional household survey. BMC pregnancy and childbirth. 2014, 14:305. http://www.biomedcentral.com/1471-2393/14/305.
24. Gebremedhin S, Samuel A, Mamo G, Moges T, Assefa T. Coverage, compliance and factors associated with utilization of iron supplementation during pregnancy in eight rural districts of Ethiopia: a cross-sectional study. BMC public Health. 2014, 14:607. http://www.biomedcentral.com/1471-2458/14/607.