Better-Educated, Older, or Unmarried Pregnant Women Comply Less with Iron-Folic Acid Supplementation in Southern Ethiopia

Determinants of compliance with iron-folic acid supplementation among pregnant mothers in Bule Hora district, Southern Ethiopia: unmatched case-control study

BACKGROUND

The World Health Organization has recommended daily supplementation with iron folic acid, to prevent anemias during pregnancy. However, due to many factors, compliance of pregnant women with this recommendation of iron and folic acid supplementation remains low, both in Africa and Ethiopia. Studies conducted in issue shows setting specific difference regarding determinants of iron and folic acid compliance.

OBJECTIVE

This study aimed to assess the determinants of iron and folic acid supplementation compliance among antenatal care attendee pregnant women in the Bule Hora district, South Ethiopia, in 2024.

METHODS

A health facility -based, unmatched case-control study was conducted in Bule Hora district from April 2024 to June 2024, via a pretested interviewer-administered questionnaire. The sample size for the study was calculated using Epi Info version 7.2.6 software. A total of 115 cases and 230 controls were included in the study. The sample size was proportionally allocated to each health facility on basis of the number of pregnant women supplemented with iron-folic acid at least one month before the data collection period; after that, systematic sampling techniques were used to select every 2nd participant from each health facility. Binary and multivariable logistic regression was conducted to identify determinants of iron folic acid compliance; AOR at a P-value < 0.05 with 95% CI was used to declare a statistically significant association after checking for the absence of multicollinearity (VIF < 1.65, tolerance > 0.6) and the Hosmer and Leme-show test of model fitness (p- value = 0.08).

RESULTS

A total of 345 pregnant women were included in the study with, a 100% response rate. Prim gravidity [AOR: 4.67, 95% CI (1.60, 13.57)], antenatal care contact 4 or more times [AOR: 7.84, 95% CI (3.34-18.41)], having a husband/family support to take iron folic acid [AOR: 4.48, 95% CI (2.19-9.13)] and good knowledge on anemia [AOR: 3.79, 95%CI (1.85-7.75)] were significantly associated with iron-folic acid compliance.

CONCLUSION

This study revealed that prim-gravidity, antenatal care contact 4 or more times, having husband support, and good knowledge of anemias were determinants of good compliance. Promotion of husbands' support and frequency of antenatal care contact and provision of information about anemias are needed to increase compliance with iron folic acid.

Compliance with iron-folate supplementation among pregnant women in Southern Ethiopia: a multi-center cross-sectional study

BACKGROUND

Iron-folate supplementation is a vital and economical approach to preventing iron deficiency anemia in pregnant women. The World Health Organization targets 70% compliance, while Ethiopia's 2030 National Nutrition Program-II aims for 50% of pregnant women receiving iron-folate for 90 days by 2023. Despite various initiatives, compliance in Ethiopia continues to be low. This study examined compliance with iron-folate supplementation and its influencing factors among pregnant women in Southern Ethiopia.

METHODS

A multi-center cross-sectional study was conducted among 604 systematically selected pregnant women from April 1 to 30, 2022, using structured interviewer-administered questionnaires. Data were collected via the open data kit application and analyzed in the SPSS version 25 software. Bivariable and multivariable analyses were used to identify factors associated with compliance. An odds ratio with a 95% confidence interval was used to assess the direction and strength of the association.

RESULTS

Iron-folate supplementation compliance was 47.7% [95% CI 43.71%, 51.68%]. Being an urban dweller [AOR: 2.8, 95% CI 1.70, 4.86], attending primary education [AOR: 2.0, 95% CI 1.13, 3.75], having secondary education or more [AOR: 5.3, 95% CI 2.83, 10.22], being multiparous [AOR: 1.9, 95% CI 1.05, 3.52], receiving home visits [AOR: 2.0, 95% CI 1.08, 3.83], receiving counseling on iron-folate [AOR: 2.5, 95% CI 1.30, 4.78], possessing good knowledge of iron-folate [AOR: 3.1, 95% CI 2.04, 4.72], and having a good understanding of anemia [AOR: 3.2, 95% CI 2.12, 4.88] were significantly associated with compliance.

CONCLUSION

Iron-folate supplementation compliance among pregnant women in Southern Ethiopia is progressing towards the 2030 national nutrition program target, although it remains below World Health Organization recommendations. Therefore, it is crucial to strengthen home visits and counseling to enhance knowledge of Iron-folate and anemia, as well as ensure consistent intake of iron-folate.

Challenges in rural maternal health: how received public services and policy awareness affect health knowledge and practices

Purpose

This study evaluates the effectiveness of rural maternal health services in improving pregnant women's health knowledge, practices, and outcomes in northwestern China, focusing on the roles of received public services and policy awareness.

Methods

Baseline surveys were conducted in rural Shaanxi Province in 2021 and 2023, involving 1,152 pregnant women from 85 townships, selected via multistage cluster random sampling. Data were collected through structured face-to-face interviews, covering health knowledge and behaviors. Statistical analyses were performed to assess the impact of maternal health services.

Results

Both received public services (Coefficient: 0.130, 95% CI: 0.015-0.246) and policy awareness (Coefficient: 0.114, 95% CI: 0.001-0.227) significantly improved nutrition and health knowledge but had limited impact on prenatal checkups or health outcomes. Policy awareness (OR: 3.826, 95% CI: 2.743-5.337) significantly increased picking up free folic acid, however, the rate of taking folic acid remained low.

Conclusion

While received public services and policy awareness improved nutrition and health knowledge, and policy awareness increased picking up free folic acid, they did not significantly influence prenatal checkups or health outcomes. More targeted efforts are needed to foster consistent health practices and improve maternal health outcomes in rural areas.

Pathway linking unwanted pregnancy to low birth weight in Indonesia: A conditional mediation analysis

Unwanted pregnancies resulting in detrimental consequences for both the mother and the child, including low birth weight, pose a remarkable challenge in developing countries. Although the association between low birth weight (LBW) and unwanted pregnancy is widely demonstrated, the results have been inconsistent, and the underlying mechanisms remain unclear. We examined maternal antenatal care (ANC) completeness as a potential mediating factor of the association between unwanted pregnancy and LBW among women in Indonesia, as well as the moderating effect of family support during pregnancy. We used women's records from the Indonesian Demographic and Health Survey (IDHS), a population-based survey conducted in 2017. This study involved 13,179 women aged 15-49 whose most recent child was aged 1-5 years. The multiple logistic regression results demonstrated that unwanted pregnancy was not associated with LBW. The generalized structural equation modeling (GSEM) results depicted that the effect of unwanted pregnancy on LBW was overwhelmingly explained by incomplete ANC, suggesting the mediation and suppression effect in the model (b = 0.32; 95 % Bias-corrected CI = 0.19-0.50; p = <0.001). The indirect impact of unwanted pregnancy on LBW also varied among different family support levels. This study filled the gaps in previous research on how unwanted pregnancy affects maternal and health outcomes. In conclusion, adequate ANC intervention and positive family support should be strengthened in future policy implementation to prevent the adverse effects of unwanted pregnancy.

The compliance of free folic acid supplements among pregnant women in rural areas of Northwestern China: The role of related knowledge

Background

High prevalence of neural tube defects remains one of the major threats to newborns in rural China. Folic acid supplementation before and during early pregnancy can effectively reduce the risk of neural tube defects. Despite the efforts of the free folic acid mass distribution, the actual usage of folic acid supplements was still suboptimal among rural pregnant women in China. The objective of this study is to investigate if and how knowledge can influence the picking up and intake of the free folic acid supplements distributed by the government.

Methods

We collected survey data from 821 pregnant women in rural areas of Shaanxi, China, in March and December of 2021. Face-to-face interviews and questionnaire surveys were conducted with every participant. Univariate and multivariate logistic regression analyses were performed to test the relationship between knowledge and dependent variables.

Results

Our study found that there were 76.4% of pregnant women would pick up folic acid supplements distributed by the government and only 44.5% of women would use folic acid before current pregnancy. Awareness of folic acid policy both affects the picking up (OR: 6.708, 95% CI: 4.672-9.632) and periconceptional intake (OR: 1.912, 95% CI:1.326-2.758) of folic acid supplements. Knowledge of health and nutrition in pregnancy showed no significant relationship with the picking up and periconceptional intake of folic acid supplements but was positively associated with the intake duration (Coefficient: 9.278, 95% CI: 2.966-15.591).

Conclusion

Despite the relatively high level of picking up, the actual folic acid usage was not ideal among pregnant women in rural areas of China. Folic acid policy awareness was positively associated with the picking up and intake of folic acid before and during conception. Knowledge of health and nutrition about pregnancy was related to a longer duration of folic acid intake but had no impact on the picking up rate and periconceptional intake of folic acid supplements.

Trend of adherence to iron supplementation during pregnancy among Ethiopian women based on Ethiopian demographic and health surveys: A Multivariable decomposition analysis

Background

Iron deficiency is one of the significant factors of anemia during pregnancy. Iron supplementation is the main method of prevention and control of iron deficiency anemia, and its effectiveness depends on adherence to the iron supplementation.

Methods

This study was based on a secondary analysis of 2005, 2011, and 2016 EDHS data. After the data was weighted using sampling weight, 696, 1,282, and 3,096 in 2005, 2011, and 2016 EDHS data, respectively, were used for the final analysis. The data were edited, cleaned, coded, managed, and analyzed using StataCorp version 16 software. A logit-based multivariable decomposition analysis was used to identify variables significantly associated with the change in the adherence level during pregnancy.

Results

Adherence levels increased from 1.1% (95% CI; 0.4, 2.7) in 2005 EDHS to 12.4% (95% CI; 10.9, 14.1) in 2016 EDHS. About 30.9% of the overall change in the adherence level to iron supplement use during pregnancy was due to the difference in women's sociodemographic-related variables. After adjusting for these compositional changes, ~69.1% of the change in the adherence level was because of the difference in the coefficients (behavior-related variables). Among the behavioral characteristics, women's age-group, rich wealth index, and secondary and above-secondary educational status of their husbands had a statistically significant effect on the positive change in the adherence level of pregnant mothers.

Conclusion

The adherence level to iron supplement use during pregnancy has increased significantly over the last decade in Ethiopia. Both the compositional and behavioral characteristics of women play a major role in the increasing trend of adherence levels.

Prevalence and determinants of anemia among pregnant women in East Africa; A multi-level analysis of recent Demographic and Health Surveys

Introduction

Anemia during pregnancy is a public health problem that leads to different life-threatening complications and poor pregnancy outcomes. So far, the evidence is scarce on pooled prevalence and determinants of anemia during pregnancy in East Africa for integrated intervention. Therefore, this study aimed to assess the prevalence and determinants of anemia among pregnant women in eastern Africa using recent Demographic and Health Surveys.

Method

Secondary data analysis was conducted using data from recent Demographic and Health Survey datasets from 10 East African countries. A total of 8583 (weighted sample) pregnant women were included in the analysis. The multi-level mixed-effects generalized linear model (Poisson regression with robust error variance) was fitted to identify determinants of anemia. Finally, the adjusted prevalence ratio (aPR) with 95% CI and random effects for the multilevel generalized linear mixed-effects model was reported.

Results

In this study, the overall prevalence of anemia among pregnant women was 41.82% (95% CI: 40.78, 42.87) with a large difference between specific countries which ranged from 23.36% in Rwanda to 57.10% in Tanzania. In the multi-level analysis, teenage pregnant women (aPR = 1.22;95%CI:1.02, 1.40), unmarried women (aPR = 1.14; 95% CI;1.02,1.28), pregnant women who had unimproved toilet facility (aPR = 1.17;95%CI:1.06,1.27), and those women from countries with high illiteracy level (aPR = 1.12;95%CI; 1.07,1.18) had a higher prevalence of anemia during pregnancy.

Conclusion

Anemia is still a public health problem in East Africa. Therefore, enabling the households to have improved toilet facilities by strengthening the existing health extension program, reducing teenage pregnancy, and improving the community literacy level is vital to reduce the prevalence of anemia during pregnancy in East Africa.

Association of husbands' education status with unintended pregnancy in their wives in southern Ethiopia: A cross-sectional study

Background

Unintended pregnancy rates are substantially higher in developing regions, have significant health consequences, and disproportionately affect subgroups with socio-economic disadvantage. We aimed to examine whether there is an association between husbands’ education status and their wives unintended pregnancy in southern Ethiopia.

Methods

The data source for this study was from a cross-sectional study on iron-folate supplementation and compliance in Wolaita, South Ethiopia. Data were collected from October to November 2015 in 627 married pregnant women regarding their husbands’ education status, socio-demographic characteristics, and if they wanted to become pregnant at the time of survey using an interviewer administered questionnaire. Logistic regression was used to estimate Odds Ratios (ORs) with associated z-tests and 95% Confidence Intervals (95% CI) for variables associated with unintended pregnancy.

Results

The proportion of unintended pregnancy in this sample was 20.6%. Husbands’ education status, age, residence, and using family planning methods were associated with unintended pregnancy (all P-values < 0.05). Multivariable models consistently showed that being married to a husband with at least some college or university education was associated with a decreased OR for unintended pregnancy after controlling for age and use of family planning at conception period (OR 0.36 [95%CI: 0.17, 0.82]) and age and rural residence (OR 0.40 [95%CI: 0.18, 0.90]).

Conclusion

Unintended pregnancy among Ethiopian woman was consistently associated with being married to least educated husbands in southern Ethiopia. Increasing age and living in a rural vs urban area were also independently associated with unintended pregnancy. Strategies for addressing family planning needs of women with poorly educated husbands should be the subject of future research.