Adherence to Iron-Folic Acid Supplementation and Associated Factors among Pregnant Women in Kasulu Communities in North-Western Tanzania

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.

High Burden of Anemia Among Pregnant Women in Tanzania: A Call to Address Its Determinants

“…These analyses showed a difference between regions in Tanzania like in other subpopulations (24). Like in other contexts (8), this can be explained by factors such as food preferences and feeding restrictions that go hand in hand with differences in traditions and customs (5,23); food security (23); agricultural activities, access to and coverage of essential preventive interventions including antenatal services, prevention and treatment of malaria, and iron and folic acid provision (14). Contrary to anemia among under ves in Tanzania (24), women in most of food rich regions have lower magnitude of anemia.…”

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

“…The other factors were the consideration of the importance of IFAS, the perception of the importance of IFAS to prevent anemia during pregnancy, and the perception of risk of not taking IFAS. These factors have been widely studied, and they affirm the importance of pregnant women understanding the positive attributes of IFAS [ 12 , 16 , 42 ]. These factors are as well supported by other research findings [ 5 , 12 , 16 ] and highlight a potential improvement in the uptake of iron and folic acid supplementation in pregnant women to know anemia and its consequences towards the pregnancy outcome.…”

“…Also, understanding the dangers of not taking the supplements is critical as pregnant women ensures adherence to subvert the likely consequences. Studies show that lack of health education on IFAS among pregnant women has greatly affected the adherence to IFAS [ 5 , 12 , 40 , 42 ], necessitating targeted and focused information, training, and counseling on the importance of IFAS during pregnancy [ 43 ]. The understaffing, late coming of mothers, and workload could be contributing to nonhealth education of mothers which are mentioned to contribute to low adherence among participants in this study area.…”

Adherence to iron and folic acid supplementation among antenatal mothers attending a tertiary care center, Puducherry: A mixed-methods study

“…The prevalence of adherence found in this study is higher than the studies done in other African nations. [ 4 17 18 19 20 ] This difference could be explained by the sociocultural differences of the study population, setting, quality and delivery of health-care services, and the definition of adherence to IFAS.…”