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Mengistu T, Lencha B, Mekonnen A, Degno S, Yohannis D, Beressa G. Compliance to iron folic acid supplementation and its associated factors among pregnant women attending Antenatal clinic in Wondo district: a cross-sectional study. Sci Rep 2023; 13:17468. [PMID: 37838766 PMCID: PMC10576767 DOI: 10.1038/s41598-023-44577-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/10/2023] [Indexed: 10/16/2023] Open
Abstract
Pregnant women are at high risk for iron deficiency anemia due to increased nutrient requirements during pregnancy. Despite high coverage of iron and folic acid supplementation (IFAS), low compliance is reported. The study aimed to assess compliance with IFAS and its associated factors among antenatal care (ANC) attendees in Wondo District, Southern Ethiopia. A facility-based cross-sectional study was conducted among 400 pregnant women. Pregnant women were selected through systematic random sampling. Pre-tested structured questionnaire was used to collect data through face to face interview. Data were entered into Epi-info and exported to Statistical Package for Social Sciences for analysis. The variables with p-value < 0.25 in the bivariable analysis were entered into the multivariable logistic regression model. P values less than 0.05 were considered significant. Results were reported as crude and adjusted odds ratios with 95% confidence intervals. The prevalence of compliance to IFAS was (177, 44.3%). Factors significantly associated with compliance to IFAS were maternal age ≥ 25 years [AOR 2.27, 95% CI (1.21, 4.28)], maternal education [AOR 2.62, 95% CI (1.43, 4. 79)], husband's education [AOR 3.60, 95% CI (2.07, 6.25)], knowledge of anemia [AOR 4.40, 95% CI (2.65, 7.30)], and knowledge of IFA [AOR 2.21, 95% CI (1.40, 3.50)]. This study showed that compliance to IFAS was low. Maternal age, maternal education, husband's education, knowledge about anemia and iron folic acid was found to be significantly associated with adherence to IFAS. Emphasis should be placed on young, uneducated mothers and their husbands.
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Affiliation(s)
- Taye Mengistu
- Wondo District Health Office, Wondo West Arsi Zone, Oromia, Ethiopia
| | - Bikila Lencha
- Department of Public Health, Madda Walabu University, Shashemene, Oromia, Ethiopia.
| | - Ashenafi Mekonnen
- Department of Midwifery, Madda Walabu University, Shashemene, Oromia, Ethiopia
| | - Sisay Degno
- Department of Public Health, Madda Walabu University, Shashemene, Oromia, Ethiopia
| | - Daniel Yohannis
- Department of Midwifery, Madda Walabu University, Shashemene, Oromia, Ethiopia
| | - Girma Beressa
- Department of Public Health, Madda Walabu University, Bale Goba, Oromia, Ethiopia
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Hardido TG, Mikamo AA, Legesse CT. Adherence to Iron-Folic Acid Among Pregnant Women Attending Antenatal Care in Southern Ethiopia, 2022. Womens Health Rep (New Rochelle) 2023; 4:431-437. [PMID: 37638333 PMCID: PMC10457636 DOI: 10.1089/whr.2023.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/29/2023]
Abstract
Background Among the micronutrient deficiencies, iron and folic acid are the most common and frequently occur in pregnant women. So, the objective of this study was to assess the adherence to iron and folic acid among pregnant women booking antenatal services in the study area. Materials and Methods A facility-based cross-sectional study design was used from January to April 2022. A structured questionnaire was used to collect data using systematic sampling techniques to approach 339 pregnant women. Data were entered and analyzed using SPSS software version 20. A descriptive analysis was performed. Adjusted odds ratios and corresponding 95% confidence intervals (CIs) were used, and statistical significance was reported at p-values <0.05 with 95% confidence. Results In this study, 339 (99%) pregnant women participated. The mean age of the respondents was 28.04 years old, with a standard deviation of 5.3 years. The rate of adherence to iron and folic acid supplementation (IFAS) in pregnant women was 62.8%. Mothers under 19 years old (adjusted odds ratio [AOR] = 0.025; 95% CI [0.003-0.218]), daily (AOR = 0.127; 95% CI [0.028-0.568]), and those with a history of miscarriage (AOR = 0.276; 95% CI [0.086-0.891]) were less likely to be using IFAS. However, greater knowledge of IFAS was positively correlated with use of the supplements (AOR = 5.56; 95% CI [1.23-8.34]). Conclusions In this study, the adherence rate with IFAS of pregnant women in the study area was 62.8%. This indicates that one in four women is not in compliance with IFAS. Appropriate counseling and health education should be provided to pregnant women to improve compliance.
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Affiliation(s)
- Temesgen Geta Hardido
- School of Nursing, College of Medicine and Health Science, Wolaita Sodo University, Wolaita, Ethiopia
| | - Adisu Ashiko Mikamo
- School of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita, Ethiopia
| | - Cherinet Tilahu Legesse
- School of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita, Ethiopia
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Derbo ZD, Debelew GT. The Effect of Fresh Moringa Leaf Consumption During Pregnancy on Maternal Hemoglobin Level in Southern Ethiopia: Multilevel Analysis of a Comparative Cross-Sectional Study. Int J Womens Health 2023; 15:1125-1137. [PMID: 37489178 PMCID: PMC10363345 DOI: 10.2147/ijwh.s412241] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023] Open
Abstract
Purpose Anemia, especially iron-deficiency anemia during pregnancy, significantly impacts maternal health, fetal growth, and development. Moringa leaf is an iron-rich food that can overcome anemia, but there is a lack of evidence on the association between fresh moringa leaf consumption and maternal hemoglobin level during pregnancy. The aim of this study is to test the effect of fresh moringa leaf consumption during pregnancy on maternal hemoglobin levels in southern Ethiopia. Methods A community-based comparative cross-sectional study was conducted from May to June 2022 among 230 fresh moringa leaf consumers and 230 non-consumers pregnant women. Data were collected using an interviewer-administered structured questionnaire and hemoglobin level was determined by HemoCue Hb 301. Multivariate multilevel linear regression models were fitted using Statistical Software for Data Science (STATA) version 14. Results The overall mean hemoglobin level among pregnant women was 11.76 g/dl ± 1.47 [12.06 g/dl ± 1.22 among fresh moringa leaf consumers and 11.45 g/dl ± 1.64 among non-consumers] with a significant coefficient of association (β) of 0.90 g/dl [β = 0.90 g/dl, 95% CI: 0.54, 1.27]. A number of under-five children, bleeding during the current pregnancy, male-headed household, and current antenatal care visit were the individual-level factors. Distance from the nearest health facility and urban dweller was identified as the community-level factor associated with maternal hemoglobin level during pregnancy. Conclusion This study showed that the consumption of fresh moringa leaf during pregnancy increases the level of hemoglobin. So policymakers and maternal and child health program managers need to target moringa tree scale-up and encourage fresh moringa leaf consumption during pregnancy, but its use needs additional rigorous clinical trials. In addition to this, mark the above factors in their efforts to increase maternal hemoglobin levels during pregnancy.
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Affiliation(s)
- Zeritu Dewana Derbo
- Department of Midwifery, Arba Minch Health Science College, Arba Minch, Ethiopia
| | - Gurmesa Tura Debelew
- Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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Yalew M, Getachew S, Mohammed K, Hankarso H, Bayile A, Asmamaw SD, Assefa MG, Bazie GW, Mebratu W, Kefale B, Damtie Y, Arefaynie M, Birhane T, Dewau R, Cherie N, Addisu E, Mitiku K, Tadese F, Wendie TF, Habtie A, Mekonnen TC, Tadesse SE, Bedane GT, Wasihun Y, Tsega TD, Taddele M, Tefera Z, Adane B, Wagaye B, Ayele FY, Zerga AA, Molla A, Desalegn B, Birkie M, Bewket B, Alemu BK, Zewdie S, Tsegaye MK, Bitew A, Mehari K, Derseh L. Individual and contextual-level factors associated with iron-folic acid supplement intake during pregnancy in Ethiopia: a multi-level analysis. BMC Pregnancy Childbirth 2023; 23:260. [PMID: 37072714 PMCID: PMC10111777 DOI: 10.1186/s12884-023-05593-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/10/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Anemia is still one of the major public health problems in many developing countries including Ethiopia. Thus, this study aimed to assess individual and contextual-level factors associated with iron-folic acid supplement intake during pregnancy in Ethiopia. METHODS A secondary analysis was done on the 2019 mini-Ethiopian Demographic and Health Survey (EDHS) dataset. A total of 3,927 pregnant women who gave birth five years before the survey were included in the analysis. Multi-level mixed-effect logistic regression analysis was done by STATA/SE version 14.0 to identify individual and contextual-level factors. Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was used to show the strength and direction of the association. The level of statistical significance was declared at a P value less than 0.05. RESULTS Those primary educated [AOR = 1.83, 95% CI: (1.24, 2.74)], secondary educated [AOR = 2.75, 95% CI: (1.57, 4.824)], women who had greater than 5 living children [AOR = 2.02, 95% CI: (1.25, 3.27)], women who had ANC visit [AOR = 21.26, 95% CI: (13.56, 33.32)] and women who lived in a cluster with high proportion of women had ANC visit [AOR = 1.72, 95% CI: (1.17, 2.54)] and women who lived in Somali [AOR = 0.44 0.73, 95% CI: (0.22, 0.87)] were significantly associated with iron-folic acid intake during pregnancy. CONCLUSIONS Both individual and contextual-level factors were significantly associated with iron-folic acid intake during pregnancy. From individual-level factors: education status of women, the total numbers of living children, and ANC follow-up are significant and from contextual-level factors: region and living in a high proportion of women who had ANC follow-up were found to have a statistically significant association. Promoting women's education and maternal health services like ANC and intervention targeting the Somali region would be the recalled area of the government.
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Affiliation(s)
- Melaku Yalew
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Injibara University, Injibara, Ethiopia.
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Shiferaw Getachew
- Head office manager of Mida Weremo woreda, North Shewa, Amhara Regional State, Ethiopia
| | - Keriya Mohammed
- Independet researcher, Dessie, Amhara Regional State, Ethiopia
| | - Hailu Hankarso
- Yirgalem Medical College, Hawassa University, Hawassa, Ethiopia
| | - Adane Bayile
- Head manager of Maternal and Child Health, Boru Meda Hospital, Amhara Regional State, Bahir Dar, Ethiopia
| | | | | | - Getaw Walle Bazie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Wondwosen Mebratu
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bereket Kefale
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yitayish Damtie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- Department of Reproductive and Family Health, School of Public Health, College of Health Sciences, Injibara University, Injibara, Ethiopia
| | - Mastewal Arefaynie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tesfaye Birhane
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Reta Dewau
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Nigus Cherie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Elsabeth Addisu
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Kefale Mitiku
- Department of Physiology, College of Health Sciences, Injibara University, Injibara, Ethiopia
| | - Fentaw Tadese
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | | | - Adane Habtie
- Department of Health Promotion, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Tefera Chane Mekonnen
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Sisay Eshete Tadesse
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | | | - Yitbarek Wasihun
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tilahun Degu Tsega
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Injibara University, Injibara, Ethiopia
| | - Mekuanint Taddele
- Department of Health Promotion and Behavior, School of Public Health, College of Health Sciences, Injibara University, Injibara, Ethiopia
| | - Zenebe Tefera
- Department of Midwifery, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bezawit Adane
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Injibara University, Injibara, Ethiopia
| | - Birhanu Wagaye
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Fanos Yeshanew Ayele
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Aregash Abebayehu Zerga
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Abebaw Molla
- Department of Public Health Nutrition, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Biruk Desalegn
- Department of Epidemiology and Biostatistics, Kotebe Health Science College, Kotebe University, Addis Abab, Ethiopia
| | - Mengesha Birkie
- Department of Psychiatry Nursing, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Bekalu Bewket
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Belete Kassa Alemu
- Department of Pharmacy, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Segenet Zewdie
- Department of Pharmacy, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Meseret Kefale Tsegaye
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abebayehu Bitew
- Department of Gynecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kassu Mehari
- Department of Statistics, College of Natural Sciences, Wollo University, Dessie, Ethiopia
| | - Lemma Derseh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Sanin KI, Alam Shaun M, Rita RS, Hasan MK, Khanam M, Haque MA. What Makes Bangladeshi Pregnant Women More Compliant to Iron-Folic Acid Supplementation: A Nationally Representative Cross-Sectional Survey Result. Nutrients 2023; 15:1512. [PMID: 36986242 PMCID: PMC10058832 DOI: 10.3390/nu15061512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Iron-Folic Acid Supplementation (IFAS) is an effective strategy to prevent iron deficiency anemia during pregnancy. We aimed to explore the key factors associated with compliance to IFA tablets in Bangladesh. METHODS This study analyzed the 2017-2018 Bangladesh Demographic and Health Survey data of 3828 pregnant women aged 15-49 years. We categorized compliance into two categories; at least 90 days and full 180 days of consumption. We performed multivariable logistic regression to identify the association between key factors and IFAS compliance. RESULTS The prevalence of consumption of IFA tablets for at least 90 days was 60.64%, and only 21.72% of women consumed the IFA for the full 180 days. About three-quarters of the women (73.36%) having at least four antenatal care visits (ANC) consumed IFA for at least 90 days, whereas only three in ten women (30.37%) consumed IFA for a minimum of 180 days. For compliance with IFA for at least 90 days, respondent's age of 20-34 years (aOR 1.26, 95% CI 1.03-1.54), respondent's educational qualification of secondary (aOR 1.77, 95% CI 1.16-2.70) or higher (aOR 2.73, 95% CI 1.65-4.53), husband's educational qualification of secondary (aOR 1.33, 95% CI 1.00-1.77) or higher (aOR 1.75, 95% CI 1.22-2.52), and having received at least four antenatal care (ANC) visits from medically skilled providers (aOR 2.53, 95% CI 2.14-3.00) were significantly associated with higher odds of compliance. For compliance with IFA for at least 180 days, respondent's educational qualification of higher (aOR 2.45, 95% CI 1.34-4.48), and having received at least four ANC visits from medically skilled providers (aOR 2.43, 95% CI 1.97-3.00) were significantly associated with higher odds of compliance. Intimate partner violence was negatively associated with compliance with IFA for at least 180 days (aOR 0.62, 95% CI 0.48-0.81). CONCLUSIONS The full compliance to IFAS is still sub-optimal in Bangladesh. Further precise context-specific intervention strategies must be developed and implemented with fidelity.
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Affiliation(s)
- Kazi Istiaque Sanin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Mahbubul Alam Shaun
- Department of Biochemistry and Food Analysis, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki, Barisal 8602, Bangladesh
| | - Razia Sultana Rita
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Md. Khaledul Hasan
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Mansura Khanam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Md. Ahshanul Haque
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
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Tefera AA, Ibrahim NA, Umer AA. Adherence to iron and folate supplementation and associated factors among women attending antenatal care in public health facilities at Covid-19 pandemic in Ethiopia. PLOS Glob Public Health 2023; 3:e0000825. [PMID: 36962981 PMCID: PMC10021611 DOI: 10.1371/journal.pgph.0000825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/06/2022] [Indexed: 06/18/2023]
Abstract
Adhesion is the degree to which a patient complies with treatment recommendations made by a health care professional. The majority of pregnant women worldwide don't get the recommended amounts of iron and folic acid (30 to 60 mg of iron and 400 g of folic acid/day for 6 months) pregnant women are more likely to develop iron- and folic acid deficiency anemia. For iron and folate supplementation programs to be effective in Ethiopia, adherence is a significant issue. So, this study aimed to evaluate the level and barriers preventing women receiving antenatal care from taking iron and folate supplements. A phenomenological qualitative study design was added to a facility-based cross-sectional study. The sample was established using a double population proportion formula. For the quantitative and qualitative study, 308 pregnant women and the focal points for the health facilities were chosen at random, using systematic random sampling and purposive sampling techniques. For the quantitative study, a face-to-face interviewer-guided, pre-tested structured questionnaire was used; for the qualitative study, a semi-structured questionnaire was used. Data was entered twice, cross-checked by comparing the two separate entries in Epi Data version 7.2.2.6, and exported to SPSS version 25 for analysis. COR and AOR with 95% CI are used to evaluate the relationship between variables and control for confounding factors. Statistical significance was declared at a p-value < 0.05. All, 308 (100%) participants were involved. 56.5% of pregnant women attending an ANC clinic (95% CI: 51%-62.2%) adhered to Iron and folate supplementation. Mothers with primary education], Urban residents mothers, Mother who had four or more ANC visits, mothers who had registered for their first ANC at early gestational age, mothers who had good awareness about birth defects were independent predictors of adherence to Iron and folate supplementation. In our study, adherence to iron and folate supplementation was low relative to previous research findings. Promoting early and frequent ANC visits and improving pregnant women's awareness of anemia and birth defects through education is necessary to increase the adherence status.
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Affiliation(s)
| | - Neil Abdurashid Ibrahim
- Department of Midwifery, College of Medicine and Health Science, Dire-Dawa University, Dire-Dawa, Ethiopia
| | - Abdurezaq Adem Umer
- Public Health Department, College of Medicine and Health Science, Dire-Dawa University, Dire-Dawa, Ethiopia
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Edeo Berarti A, Gebrie M, Beyene B. Adherence To Iron Folic Acid Supplementation and Associated Factors Among Antenatal CARE Attending Women in Sire District Primary Health Care Units, South-East Ethiopia: A Facility Based Cross-Sectional Study. International Journal of Africa Nursing Sciences 2023. [DOI: 10.1016/j.ijans.2023.100526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Delie AM, Gezie LD, Gebeyehu AA, Tarekegn GE, Muche AA. Trend of adherence to iron supplementation during pregnancy among Ethiopian women based on Ethiopian demographic and health surveys: A Multivariable decomposition analysis. Front Nutr 2022; 9:955819. [PMID: 36590221 PMCID: PMC9800971 DOI: 10.3389/fnut.2022.955819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
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.
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Affiliation(s)
- Amare Mebrat Delie
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Asaye Alamneh Gebeyehu
- Department of Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gebrekidan Ewnetu Tarekegn
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia,*Correspondence: Gebrekidan Ewnetu Tarekegn
| | - Achenef Asmamaw Muche
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Beressa G, Lencha B, Bosha T, Egata G. Utilization and compliance with iron supplementation and predictors among pregnant women in Southeast Ethiopia. Sci Rep 2022; 12:16253. [PMID: 36171347 PMCID: PMC9519626 DOI: 10.1038/s41598-022-20614-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 09/15/2022] [Indexed: 11/30/2022] Open
Abstract
Anemia is predicted to affect 38% (32 million) of pregnant women worldwide. However, evidence for utilization and compliance with iron supplementation and predictors during pregnancy in low-income countries, including Ethiopia, is sparse and inconclusive. Therefore, we aimed to assess utilization and compliance with iron supplementation and predictors among pregnant women in Robe Town, Southeast Ethiopia. A community-based cross-sectional study was employed among randomly selected 445 pregnant women attending antenatal care at health facilities from May to July 2015. A systematic random sampling was used to select respondents. Data were collected using a pre-tested, interviewer-administered, structured questionnaire. Bivariable and multivariable logistic regression analyses were conducted to identify predictors of compliance with iron supplementation. An odds ratio, along with a 95% confidence interval (CI), was used to estimate the strength of the association. In this study, 54% [95% CI (49.4, 58.4%)], 45.2% [95% CI (40.9, 49.4%)], 4.3% [95% CI (2.5, 6.3%)], and 2.2% [95% CI (1.1, 3.6%)] of women received iron supplements during their first, second, third, and fourth antenatal care visits, respectively. The level of compliance with iron supplementation was 92.4% [95% CI (89.9, 94.6%)]. Having a formal education (AOR = 4.45, 95% CI 1.41, 13.99), being in the high wealth quintile (AOR = 0.18, 95% CI 0.05, 0.68), medium wealth quintile [(AOR = 0.33, 95% CI (0.11, 0.98)], receiving iron supplements for free (AOR = 3.77, 95% CI 1.33, 10.69), not experiencing discomfort related to iron supplements intake (AOR = 2.94, 95% CI 1.17, 7.39), having comprehensive knowledge about anemia (AOR = 2.62, 95% CI 1.02, 6.70), being knowledgeable about iron supplements (AOR = 3.30, 95% CI 1.12, 9.76), having information about importance of iron supplementation during pregnancy (AOR = 2.86; 95% CI 1.04, 7.87), and ever being visited by urban health extension workers (AOR = 0.31; 95% CI 0.12, 0.83) was significantly associated with compliance with iron supplementation during pregnancy. The utilization of iron supplementation during pregnancy was low, with relatively high compliance with the supplements. Thus, comprehensive nutrition education and free provision of iron supplementation are crucial tools to increase utilization and compliance with iron supplementation during pregnancy. Further research with a strong study design using golden standard methods is warranted.
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Affiliation(s)
- Girma Beressa
- School of Health Sciences, Madda Walabu University, P.O. Box 302, Goba, Ethiopia.
| | - Bikila Lencha
- School of Health Sciences, Madda Walabu University, P.O. Box 302, Goba, Ethiopia
| | - Tafese Bosha
- School of Nutrition, Food Science and Technology, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
| | - Gudina Egata
- School of Public Health, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia
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Mejía-Rodríguez F, Quezada-Sánchez AD, Gómez-Humarán IM, García-Feregrino R, García-Guerra A, Fernández-Gaxiola AC, Neufeld LM. Differential Effects of Three Nutritional Supplements on the Nutrient Intake of Pregnant Women Enrolled in a Conditional Cash Transfer Program in Mexico: A Cluster Randomized Trial. Nutrients 2022; 14. [PMID: 35893857 DOI: 10.3390/nu14153003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 02/04/2023] Open
Abstract
Supplementation in malnourished pregnant women should not displace natural healthy foods. Objective: To estimate the differential effects of three nutritional supplements on macro- and micronutrient intake of pregnant women beneficiaries of the conditional cash transfer program Prospera (CCT-POP). Methods: Prospective cluster randomized trial. Communities were randomly assigned to receive a fortified beverage (Beverage), micronutrient tablets (Tablets), or micronutrient powder (MNP). Pregnant women (at <25 weeks) were recruited. The food frequency questionnaire was applied at 25 and 37 weeks of pregnancy and at one and three months postpartum (mpp). Differential effects of the three supplements on the median change in nutrient intake from baseline to each follow-up stage were estimated. Results: Median change in protein intake from dietary and supplement sources were significantly lower for MNP and Tablets than for Beverages (baseline to 37 w: −7.80 ± 2.90 and −11.54 ± 3.00, respectively; baseline to 1 mpp: −7.34 ± 2.90 for MNP, p < 0.001). Compared to Beverages, median increases were higher for the MNP for vitamins C (31.2 ± 11.7, p < 0.01), E (1.67 ± 0.81, p < 0.05), and B12 (0.83 ± 0.27, p < 0.01) from baseline to 37 wk; from baseline to 1 mpp, there was a higher median increase in B12 (0.55 ± 0.25, p < 0.05) and folate (63.4 ± 24.3, p < 0.01); and from baseline to 3 mpp, a higher median increase in iron (2.38 ± 1.06, p < 0.05) and folate (94.4 ± 38.1, p < 0.05). Conclusions: Intake of micronutrients was higher for MNP and Tablets, likely due to food displacement among Beverage consumers. Although iron bioavailability and absorption inhibitors were not considered for the present analyses, the distribution of Tablets or MNP had several advantages in this context where micronutrient deficiency remains high among pregnant women, but macronutrient intake is generally adequate or even high.
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Tamirat KS, Kebede FB, Gonete TZ, Tessema GA, Tessema ZT. Geographical variations and determinants of iron and folic acid supplementation during pregnancy in Ethiopia: analysis of 2019 mini demographic and health survey. BMC Pregnancy Childbirth 2022; 22:127. [PMID: 35168542 PMCID: PMC8848817 DOI: 10.1186/s12884-022-04461-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 02/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background One of the packages of critical antenatal care treatments for pregnant women includes iron and folic acid (Fe/FA) supplementation. Using recently available and nationwide representative survey data, this study aimed to determine the spatial patterns and drivers of Fe/FA supplementation during pregnancy. Method The data for this study was obtained from Ethiopia’s 2019 Mini Demographic and Health Survey (EMDHS). We used the Kid’s Record (KR) dataset, and a total weighted sample of 3926 reproductive-age women who gave birth within the previous 5 years was used as the study’s final sample size. To analyze the spatial distributions (geographic variation of Fe/FA supplementation) different statistical software like Excel, ArcGIS, and Stata 14 were used. A two-level multilevel binary logistic regression model was fitted to identify both individual and community-level factors associated with Fe/FA supplementation during pregnancy. Result This study found that there were significant geographical variations of iron and folic acid supplementation across Ethiopia, eastern and southern parts of the country were predicted to have low Fe/FA supplementation coverage. Advanced maternal age (AOR = 0.75: 95%CI: 0.59 0.96), resides in developing region (AOR = 0.57, 95%CI: 0.43 0.74), not attended formal education (AOR = 0.60, 95%CI: 0.39 0.92), middle (AOR = 1.51, 95%CI: 18 1.93) and rich wealth status (AOR = 1.48, 95%CI: 1.15 1.91), and four and above ANC visits (AOR = 4.35 95%CI: 3.64 5.21) were determinants of iron and folic acid supplementation among pregnant women. Conclusion Our research found that there were geographical variations across the country, with low coverage seen in Ethiopia’s eastern and southern regions. Iron and folic acid supplementation coverage were inadequate among pregnant women with low education, advanced maternal age, and those from underdeveloped countries. Conversely, increasing iron and folic acid uptake was associated with higher socioeconomic class and four or more ANC visits. The findings of this study highlight the importance of increasing maternal health care, such as iron and folic acid supplements, for underserved populations.
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Affiliation(s)
- Koku Sisay Tamirat
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | | | - Tajebew Zayede Gonete
- Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getayneh Antehunegn Tessema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Saragih ID, Dimog EF, Saragih IS, Lin CJ. Adherence to Iron and Folic Acid Supplementation (IFAS) intake among pregnant women: A systematic review meta-analysis. Midwifery 2021; 104:103185. [PMID: 34784576 DOI: 10.1016/j.midw.2021.103185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 10/01/2021] [Accepted: 10/23/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Adherence to iron and folic acid supplementation represents a significant factor contributing to the prevention and treatment of anaemia in pregnancy. However, limited studies have systematically investigated iron and folic acid supplementation adherence among pregnant mothers using a global perspective. We aimed to systematically identify iron and folic acid supplementation adherence and associated factors among pregnant women. DESIGN For this systematic review and meta-analysis, we did a systematic search of Academic Search Complete, CINAHL, MEDLINE, PubMed, and Web of Science from inception to October 20, 2020. We included all cohort, case-control, and cross-sectional studies and used the Joanna Briggs Institute tool to assess study quality. A meta-analysis was performed to synthesise the pooled odds ratio for iron and folic acid supplementation adherence using a random-effects model. Heterogeneity was measured using the I2 statistic, and Egger's test was used to assess publication bias. MEASUREMENTS AND FINDINGS Eighteen studies were included in systematic review and meta-analysis, including a total of 5,537 pregnant women. The pooled odds ratio for iron and folic acid supplementation adherence in primipara vs multipara, anaemia vs non-anaemia, knowledgeable vs limited knowledge of anaemia, and knowledgeable vs limited knowledge of iron and folic acid supplementation were 3.91 (95% confidence interval: 1.75-8.75), 1.09 (95% confidence interval: 0.67-1.77), 0.32 (95% confidence interval: 0.15-0.69), and 2.48 (95% confidence interval: 1.13-5.47), respectively. KEY CONCLUSIONS This review yielded evidence that having one pregnancy, having anaemia, and having satisfactory knowledge of both anaemia and iron and folic acid supplementation were positively associated with iron and folic acid supplementation adherence.
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Mekonen EG, Alemu SA. Determinant factors of poor adherence to iron supplementation among pregnant women in Ethiopia: A large population-based study. Heliyon 2021; 7:e07530. [PMID: 34296018 PMCID: PMC8282951 DOI: 10.1016/j.heliyon.2021.e07530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/17/2021] [Accepted: 07/06/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Anemia during pregnancy increases the risk of premature delivery as well as maternal and child mortality. More than 40% and almost one-third of pregnant women are anemic worldwide and in Ethiopia respectively. Iron supplementation is important to prevent anemia during pregnancy in developing countries including Ethiopia. Despite this fact, it is at a substandard level in Ethiopia. Therefore, this study was conducted to identify the determinant factors of poor adherence to iron supplementation among pregnant women in Ethiopia. Methods A cross-sectional study was conducted based on the EDHS data for 2016 from two city administrations and nine regions of Ethiopia. A total of 3, 266 women were included. Bivariable and multivariable logistic regression analysis was employed. P-value < 0.05 and odds ratios were used to determine the significance and strength of association. Results Those pregnant women who had no mobile telephone [AOR; 0.79, 95% CI (0.65–0.95)], a history of cigarette smoking & alcohol use [AOR; 0.20, 95% CI (0.09–0.45)] and [AOR; 0.77, 95% CI (0.64–0.93)], and less than four antenatal care visits [AOR; 0.56, 95% CI (0.46, 0.68)] had higher odds of poor adherence. Conclusion Not having a mobile telephone, a history of smoking and alcohol use, and less than four antenatal care visits were determinant factors of poor adherence to iron supplementation. It is important to empower women, strengthen communication for behavioral change, and give attention to counseling pregnant women.
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Affiliation(s)
- Enyew Getaneh Mekonen
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Samrawit Abebe Alemu
- Department of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Nimwesiga C, Murezi M, Taremwa IM. Adherence to Iron and Folic Acid Supplementation and Its Associated Factors among Pregnant Women Attending Antenatal Care at Bwindi Community Hospital, Western Uganda. Int J Reprod Med 2021; 2021:6632463. [PMID: 34195259 DOI: 10.1155/2021/6632463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 11/17/2022] Open
Abstract
Methods This was a cross-sectional study that used an interviewer-administered questionnaire and reviewed medical records. Binary and multivariable logistic regression analyses were used to identify factors associated with iron and folic acid supplementation. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p value < 0.05 were used to assess for statistical significance. Results We enrolled 438 pregnant women aged 16 to 41years. Participants' mean age (±standard deviation (SD)) was 25.9 (±3.17) years. The self-reported adherence to iron and folic acid supplementation (consumed ≥4 tablets a week or 20 tablets in a month daily without missing the prescribed dosage) was 22.37% (N = 98). Among the adherent pregnant women, the reported reasons (and their respective proportionality) for adherence were getting advice and counseling from the healthcare worker about the good effects of iron and folic acid supplementation (N = 34, 34.69%) and knowledge about the health benefits of iron and folic acid supplementation such as preventing anemia (N = 16, 16.33%), among others. On the other hand, the reported reasons (and their respective proportionality) for iron and folic acid nonadherence were forgetfulness (N = 158, 46.47%), taking too many pills (N = 7, 2.06%), not knowing the usefulness of iron and folic acid supplementation (N = 29, 8.53%), fear of the side effects of the medication (N = 119, 35.00%), and not getting the supplement from the hospital (N = 27, 7.94%). Bivariable and multivariable logistic regression analyses indicated that pregnant women who were primigravida (adjusted odds ratio (AOR) = 4.5), who have parity of 2 or 3 (AOR = 3.4), who perceived importance of iron and folic acid supplementation to prevent anemia (AOR = 2.9), and who considered it important to take iron and folic acid supplementation (AOR = 2.9) showed a statistically significant association with adherence to iron and folic acid supplementation. Moreover, pregnant women who perceived the risk of not taking iron and folic acid supplementation (AOR = 5.2), those who received sufficient health education regarding the goals of iron and folic acid supplementation as well as the dangers of not taking the supplements (AOR = 4.4) and adequate counseling, and those who obtained an explanation of the effects of iron and folic acid (AOR = 4.8) showed a significant association with adherence to iron and folic acid supplementation. Conclusion This study found a low adherence of iron and folic acid supplementation and was associated with obstetric and client- and health system-related characteristics. To this end, there is a need for individualized strategies targeting such factors and intensifying health education, guidance, and counseling to optimize adherence to iron and folic acid supplementation.
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Fite MB, Roba KT, Oljira L, Tura AK, Yadeta TA. Compliance with Iron and Folic Acid Supplementation (IFAS) and associated factors among pregnant women in Sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2021; 16:e0249789. [PMID: 33852614 DOI: 10.1371/journal.pone.0249789] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background Anemia is one of the world’s leading cause of disability and the most serious global public health issues. This systematic review and meta-analysis was conducted very carefully in order to give up the pooled compliance of Iron and Folic-Acid Supplementation in Sub-Saharan Africa. Methods To conduct this brief systematic review and meta-analysis, a related literature search was done from different sources, PubMed Medline and Google Scholar Journals. Then IFA Supplementation related searching engine was used to make the work more meaningful and intensive. Moreover, we used modified Newcastle-Ottawa quality assessment scale for cross sectional studies to assess the quality of the study in terms of their inclusion. Then, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed to carry out the work in a carful manner. Finally, the pooled effect size was computed using the review manager and Compressive Meta-analysis software. Results Twenty-three studies, which encompassed 24272 pregnant women, were chosen for the analysis. From those an overall prevalence of compliance with Iron and Folic Acid Supplementation (IFAS) in pregnancy in SSA was 39.2%. However, the result from meta-analysis showed that women who were counseled on IFAS in their courses of pregnancy were 1.96 times more likely to adhere to IFAS compared to those who were not counseled [OR:1.96, 95% CI (1.76-,5.93)]. Moreover, it showed that women who had knowledge of IFAS were 2.71 times more likely to have compliance with IFAS as compared to those who had no knowledge of IFAS [OR:2.71, 95% CI (1.33,5.54)]. Also it revealed that those women who had knowledge of anemia were 5.42 times more likely to have compliance with IFAS as compared with those who had no knowledge of anemia [OR5.42, 95% CI (1.52, 19.43)]. Furthermore, women who had received fourth visit for ANC were 1.54 times more likely to have compliance with IFAS as compared to those who had not received for ANC [OR 1.54, 95% CI (0.66, 3.58.43)]. Conclusions Our finding from this systematic review and meta-analysis shows the low case in prevalence of compliance to IFAS among pregnant women in SSA. Predictors for this includes: knowledge about anemia, knowledge about IFAS, counseling on IFAS and receiving fourth antenatal care visit were statistically correlated positively with compliance to IFAS. This demands careful appraisal of effect of prevention work for functioning policy, programs and plan nutrition intrusions for refining maternal dietary intake in gestation. Also dietary education intrusion requires to be planned to satisfy the needs of pregnant women. So we hope that the result of this study might be essential as a bridging stone for policy makers of Africa; exclusively for maternal and child health care. Finally, we recommended further studies to be conducted in the area of the study for more intensive and detailed suggestions.
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Mekonnen A, Alemnew W, Abebe Z, Demissie GD. Adherence to Iron with Folic Acid Supplementation Among Pregnant Women Attending Antenatal Care in Public Health Centers in Simada District, Northwest Ethiopia: Using Health Belief Model Perspective. Patient Prefer Adherence 2021; 15:843-851. [PMID: 33911855 PMCID: PMC8071691 DOI: 10.2147/ppa.s299294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/25/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Even though the World Health Organization recommends daily oral iron with folic acid (IFA) supplementation as part of the antenatal care to prevent anemia, still the utilization remains low in Sub-Saharan Africa, particularly in Ethiopia. Therefore, the aim of this study was to assess the magnitude of adherence of iron with folic acid supplementation and associated factors among pregnant women who were attending antenatal care (ANC). METHODS A facility-based cross-sectional study was conducted from February 24 to March 23, 2020. Four hundred and twenty-two participants were selected using systematic random sampling technique. Data were collected using a structured questionnaire through face-to-face interview. Data were entered and analyzed using EpiData and SPSS version 20.0, respectively. Bivariate and multivariable logistic regression analyses were done to identify associated factors of adherence, and P<0.05 was used as cutoff to determine statistical significance at multivariable logistics regressions. RESULTS In this study, 414 (98%) pregnant women participated. The mean age of the respondents was 28.69 ±SD 5.49 years. The magnitude of adherence of IFA supplementation among pregnant women was 67.6% (95%CI: 63.3-72.5). Pregnant women who had a past history of preterm delivery (AOR=3.70; 95%CI: 1.46-9.37), counseling on IFA supplementation (AOR=2.28; 95%CI: 1.15-4.53), high perceived benefit (AOR=2.72; 95%CI: 1.25-5.90) and high self-efficacy (AOR=2.91; 95%CI: 1.40-6.04) were found to be significant associated factors of adherence to IFA supplementation. CONCLUSION In this study, adherence to IFA supplementation among pregnant women is relatively high. Past history of preterm delivery, counseling on IFA supplementation, perceived benefit and self-efficiency had association with adherence to IFA supplementation. Proper counseling and health education should be given to pregnant women to increase their adherence.
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Affiliation(s)
| | - Wallelign Alemnew
- Department of Health Education and Behavioral Health Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Correspondence: Wallelign Alemnew Email
| | - Zegeye Abebe
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getu Debalkie Demissie
- Department of Health Education and Behavioral Health Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Lyoba WB, Mwakatoga JD, Festo C, Mrema J, Elisaria E. Adherence to Iron-Folic Acid Supplementation and Associated Factors among Pregnant Women in Kasulu Communities in North-Western Tanzania. Int J Reprod Med 2020; 2020:3127245. [PMID: 32566646 DOI: 10.1155/2020/3127245] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/18/2020] [Accepted: 04/15/2020] [Indexed: 12/30/2022] Open
Abstract
Introduction Pregnant women are at a high risk of anaemia, with iron-folate deficiency being the most common cause of anaemia among pregnant women. Despite the well-known importance of iron and folic acid supplementation (IFAS) during pregnancy, adherence to these supplements is relatively low and associated factors were not well identified in the study area. This study is aimed at investigating adherence to IFAS and associated factors among pregnant women in Kasulu district, north-western Tanzania. Methods A health facility cross-sectional survey with a mixed-method approach was conducted in Kasulu district from March to April 2019. A structured questionnaire was given to 320 women with children aged 0-6 months to assess factors associated with adherence to IFAS among pregnant women. Data were entered into SPSS version 22.0 for analysis. Binary logistic regression was further employed to determine the factors associated with adherence to IFAS. Focus group discussions were done with 19 pregnant women and 15 mothers of children aged 0-6 months to obtain more clarifications on the factors associated with adherence to IFAS. Furthermore, in-depth interviews were done with six health care providers to explore their perceptions of IFAS. Results Out of the 320 respondents of the survey, 20.3% (n = 65) adhered to IFAS. Factors associated with adherence to IFAS among pregnant women included time to start ANC (AOR = 3.72, 95% CI: 1.42, 9.79), knowledge of anaemia (AOR = 3.84, 95% CI: 1.335, 10.66), counseling on the importance of the iron-folic acid (AOR = 3.86, 95% CI: 1.42, 10.50), IFAS given during clinical visit (AOR = 15.72, 95% CI: 5.34, 46.31), number of meals consumed (AOR = 3.44, 95% CI: 1.28, 9.21), number of children (AOR = 3.462, 95% CI: 1.035, 11.58), and distance to health facility (AOR = 0.34, 95% CI: 0.131, 0.886). Qualitative findings revealed that delayed first ANC visit, lack of remainder for pregnant women to take IFAS, low awareness about the negative effects of anaemia, low of knowledge of IFAS and management of side effects, negative beliefs about the use of IFAS, and follow-up mechanism were major reasons for poor adherence. Conclusion Adherence to iron-folic acid supplementation during pregnancy was low. Strengthening systems for creating reminding mechanism, raising community awareness through educational programs to pregnant women and health providers could improve adherence to IFAS.
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Sendeku FW, Azeze GG, Fenta SL. Adherence to iron-folic acid supplementation among pregnant women in Ethiopia: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2020; 20:138. [PMID: 32131751 PMCID: PMC7057669 DOI: 10.1186/s12884-020-2835-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/24/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Despite the supplementation of iron-folic acid is the recommended strategy during the antenatal period; iron deficiency anemia is the commonest hematologic complication during pregnancy. Therefore, this systematic review and meta-analysis aimed to assess the level of adherence to iron-folic acid supplementation and its associated factors among pregnant women in Ethiopia. METHODS Systematic review and meta-analysis guideline was followed for this study. Different online databases were used for the review: PubMed, HINARI, EMBASE, Google Scholar and African Journals Online. Different searching terms were applied based on the adapted PICO principles to achieve and access all the essential articles. The data were entered and analyzed using Microsoft Excel and Stata 11 software respectively. RESULTS Fifteen studies were included in this systematic review and meta-analysis with a total of 5808 pregnant women. The overall pooled prevalence of adherence to iron-folic acid supplementation among pregnant women in Ethiopia was 41.38% (95% CI: 33.09, 49.67). Having secondary and above educational status of the women (AOR:2.68,95%CI:1.25, 5.74), having an early registration of antenatal care follow-up (≤16 weeks) (AOR:2.54,95%CI:1.99, 3.24), having anemia complication during current pregnancy (AOR:3.01,95%CI:1.88, 4.81), having good knowledge of iron-folic acid supplementation (AOR: 2.96, 95%CI:1.76, 4.99), having four times or more antenatal care follow up (AOR:3.66, 95%CI:2.81, 4.77), getting health education about benefit of iron and folic acid (AOR:2.62,95%CI:1.46,4.72), and having good knowledge about anemia (AOR:2.99,95%CI:2.32, 3.85) were associated risk factors for adherence to iron-folic acid supplementation. CONCLUSION The overall pooled prevalence adherence of IFAS among pregnant women was lower than the WHO recommendations. Educational status, early registration of ANC, anemia in the current pregnancy, good knowledge of IFAS, number of ANC visits, good knowledge of anemia and receiving health education about the benefit of IFAS were factors associated with the adherence of IFAS among pregnant women in Ethiopia. This finding is important to design strategic policies and to prevent anemia and congenital anomaly resulted from inadequate intake of iron and folic acid.
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Affiliation(s)
- Fikadu Waltengus Sendeku
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Getnet Gedefaw Azeze
- Department of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Selamawit Lake Fenta
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Desta M, Kassie B, Chanie H, Mulugeta H, Yirga T, Temesgen H, Leshargie CT, Merkeb Y. Adherence of iron and folic acid supplementation and determinants among pregnant women in Ethiopia: a systematic review and meta-analysis. Reprod Health 2019; 16:182. [PMID: 31864397 PMCID: PMC6925441 DOI: 10.1186/s12978-019-0848-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 12/11/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Iron and folic acid deficiency anaemia are one of the global public health challenges that pose 1.45% of all disability-adjusted life-years. It is recognized as a cause for an unacceptably high proportion of maternal and perinatal morbidity and mortality. Adherence to iron and folic acid supplementation during the antenatal period is paramount to reduce anaemia and its associated morbidities. Although several studies have been conducted across the country, their reports were inconsistent and inconclusive for intervention. Therefore, this systematic review and meta-analysis were aimed to estimate the pooled national level adherence to iron and folic acid supplementation and its determinants among pregnant women in Ethiopia. METHODS This systematic review and meta-analysis were pursued the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guideline. An extensive search of databases including, PubMed, Google Scholar, and African Journals Online were conducted to access articles. The Newcastle- Ottawa quality assessment tool was used to assess the quality of each study and meta-analysis was conducted using a random-effects model. I2 test and Egger's test were used to assess the heterogeneity and publication bias respectively. The meta-analysis of estimating national level adherence were done using STATA version 11 with 95% CI. RESULTS Twenty studies with a total of 16,818 pregnant women were included in this meta-analysis. The pooled national level iron and folic acid supplementation's adherence were 46.15% (95%CI:34.75,57.55). The highest adherence was observed in Addis Abeba, 60% (95%CI: 55.93, 64.07) followed by Tigray, 58.9% (95% CI: 33.86, 84.03). Women who received supplemental information [OR = 2.34, 95%CI: 1.05, 5.24], who had good knowledge [OR = 2.2, 95%CI: 1.05, 5.24], began the ANC visit before 16 weeks [OR = 2.41, 95%CI: 1.76, 3.29], and had ≥4 ANC visits [OR = 2.59, 95% CI: 1.09, 6.15] were more likely adhere to the supplementation. Fear of side effects (46.4, 95% CI: 30.9 61.8) and forgetfulness (30.7, 95% CI: 17.6, 43.8) were the major barriers of adherence of the supplementations. CONCLUSIONS More than four of nine pregnant women have adhered to the iron and folic acid supplementation. This meta-analysis revealed that receiving supplemental counselling, knowledge of the supplement; early registration and frequent ANC visit were significantly associated with the adherence of the iron and folic acid supplementation. Therefore, provision of strengthened supplemental counselling service, antenatal care services, and improving the knowledge of the supplementation is a crucial strategy to increase the adherence among pregnant women in Ethiopia. Besides, addressing the barriers of the adherence of the supplement mainly counseling or managing of side effects and reducing of forgetfulness to take the tablet through getting family support or male involvement during visit is mandatory.
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Affiliation(s)
- Melaku Desta
- Department of Midwifery, College of Health Science, Debre Markos University, PO. Box: 269, Debre Markos, Ethiopia.
| | - Bekalu Kassie
- Department of Midwifery, College of Health Science, Debre Markos University, PO. Box: 269, Debre Markos, Ethiopia
| | - Habtamu Chanie
- Department of Midwifery, College of Health Science, Debre Markos University, PO. Box: 269, Debre Markos, Ethiopia
| | - Henok Mulugeta
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Tadesse Yirga
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Habtamu Temesgen
- Department of Nutrition and Food Science, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Cheru Tesema Leshargie
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Yoseph Merkeb
- Department of Biomedical Science, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
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