Adherence to Iron and Folic Acid Supplementation and Its Associated Factors among Pregnant Women Attending Antenatal Care at Bwindi Community Hospital, Western Uganda

Abstract

Aims/Objectives. This study assessed the adherence to iron and folic acid supplementation and the associated factors among pregnant women attending antenatal care at Bwindi Community Hospital, in Western Uganda. 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.

Utilization and compliance with iron supplementation and predictors among pregnant women in Southeast Ethiopia

“…The current finding was higher than many previous reports in Ethiopia, such as the compliance rate, which varied from 60 to 63.6% in Addis Ababa 32 , 44 , 45 , 87.6% in Ethiopia 37 , Dire Dawa 46 , Shalla District 47 , 43.4% Dilla town 48 , 38.3% Hadassah 28 , 51.4% Burin district 49 , 52.9% Debbie 50 , 28.1% Denbiya District 36 , 28.7% Lay Armachiho 31 , 55% Gondar 51 , 47.6% Aykal town 30 , 44% Debre Tabor 52 , 43% Wollo 53 and 74.9% in four regions of Ethiopia 20 , 67.6% Simada district 54 , 52.8% Debay Tilat Gen district 55 , 37.2% Northwestern zone of Ethiopia 35 , 55.5% Debre Markos town 56 , 76.9% Dangila, Northern Ethiopia 57 , 40.9% in Adwa town 58 , and meta-analyses, 46.15, 46.1, 41.38 and 43.63% 59 – 62 . The present finding was also higher than many others, for example, a meta-analysis in SSA 63 , Uganda 64 , Kenya 65 , Nigeria 24 , Northwest Tanzania 66 , Northern Tanzania 67 , 22 sub-Saharan African countries 23 , Niger 68 , West Iran 69 , Cambodia 34 , Nepal 70 , 71 , India 72 , and Sri Lanka 73 . Likewise, the current finding was higher than the study finding conducted in a high-income country (HIC) in which the compliance rate was 85% in Sweden 74 .…”

Factors Influencing Adherence to Iron and Folic Acid Supplementation among Pregnant Women attending Antenatal Care in Rubanda District, South Western-Uganda

“…The adherence also depended on taking IFAS for at least 90 days which also explains why the adherence level in this study is high. Other findings with a low prevalence were found in Uganda (11.6% in Mulago National Referral Hospital and 34.5% in Bwindi Community Hospital) and Tanzania (20.3%) [10,19,20]. This is explained by the stringent criteria used for classifying Adherence in these studies.…”

Determinants of non-adherence to Iron Folic Acid Supplementation among Pregnant Women Attending Public Health Facilities in Bishoftu Town, Ethiopia: Case-Control study

“…Pregnant women who started ANC service and take iron/folate supplements one month before data collection on the selected health facility and who take IFA tablets less than 4 days per week were considered as cases (15,23,37). Controls: Pregnant women who started ANC service and take iron/folate supplements one month before data collection on the selected health facility and who take IFA tablets greater or equal to 4 days per week were considered as controls (15,23,37)…”

“…According to the WHO and Ethiopia's national guidelines for the control and prevention of micronutrient de ciencies, all pregnant women should receive and consume a standard dose of 60mg iron and 400 mg folic acid daily for 6 months starting from the rst month of pregnancy or at the time of their rst antenatal visit and three months of postnatal period (8) Previous studies showed that pregnant women were not fully adhered to their iron folate supplement because of many factors; among factors non-adherent to iron/folate supplementation age, didn't get nutrition counseling, and women lacking knowledge of anemia were associated with a higher likely hood of non-adherence with IFAS (14). Similarly, factors contributing to iron and folic acid non-adherence were forgetfulness, taking too many pills, not knowing the usefulness of iron and folic acid supplementation, fear of the side effects of the medication including nausea, vomiting, and unpleasant tests of the supplement (15,16). Also, misinformation includes; fear to give birth to a big baby, spot-on teeth of children and face of mothers, di cult delivery, not bene cial to babies, mothers experience with no history of having children with neural tube defects, and more bleeding during delivery was associated with low adherence to IFAS (17,18).…”