Awareness, knowledge and the factors that affect the use of folic acid among pregnant and non-pregnant women in the reproductive age in a selected area in Colombo district, Sri Lanka

Abstract

Background:The prevalence of neural tube defects in Sri Lanka is estimated to be 1.21 per 1000 births. According to the WHO, programs to increase folic acid (FA) consumption among women of reproductive age may benefit countries where the NTD rate is higher than 0.6/1,000 live births. Food fortification is an effective method but there is still no mandatory fortification policy in Sri Lanka. Therefore, improving knowledge and voluntary use of FA remains a high priority. The study aimed to determine the awareness and knowledge on FA among pregnant and non pregnant women.Methods: A comparative cross-sectional study was conducted among 400 pregnant and 400 non-pregnant women aged 18-45 years from Colombo District in Sri Lanka. Data were collected using an anonymous, standardized, intervieweradministered questionnaire, which included questions about socio-demographic data, obstetric history, FA knowledge and use.Results: FA awareness and knowledge on its pre-conceptional use were significantly low among non-pregnant women younger than 25 years (OR=0.120, 95% CI=0.068-0.211, p=0.000; OR=0.153, 95% CI=0.090-0.262, p=0.000).Pregnant women with knowledge that FA prevents birth defects were significantly more likely to take FA during pregnancy (OR=10.760, 95% CI=1.244-93.068, p=0.007) and the pre-conceptional period (OR=1.807, 95% CI=1.172-2.786, p=0.007).Women who received information from field clinics were significantly more likely to have FA awareness (OR=4.779, 95% CI=0.913-25.021, p=0.042), knowledge on pre-conceptional use of FA (OR=2.972, 95% CI=1.179-7.491, p=0.016) and took FA during pregnancy (OR=39.773, 95% CI=4.542-348.271, p=0.000). Those who received information from home visits were significantly more likely to have knowledge on the role of FA in preventing birth defects (OR=1.958, 95% CI=1.133-3.384, p=0.015), took FA during their pregnancy (OR=15.102, 95% CI=1.743-130.841, p=0.001) and in the pre-conceptional period (OR=2.117, 95% CI=1. 316-3.405, p=0.002). Women who got information through media were also significantly more likely to have knowledge on the role of FA in preventing birth defects. (OR=2.487, 95% CI=1.006-6.149, p=0.042). Conclusions:Health education campaigns have to be specifically targeted for younger women from ethnic minorities and from low household income families. Field clinics and home visits from public health midwives have been a significant sources of information and media campaigns can be an effective means of promoting health education regarding use of preconceptional folic acid.

Assessment of knowledge, attitude, and practice on preconception care among pregnant women at National Hospital, Thimphu, Bhutan

“…Although the overall knowledge was good, knowledge on the preconception folic acid supplementation was low (47.1%) in our study when compared to a study done in Sri Lanka where 94.3% of the women were aware of preconception folic acid supplementation 22 . This could be due to the sources of information on PCC in our study where major sources were from friends, family and social media, rather than from health workers.…”

“…In this study, only 25.3% of our participants had taken preconception folic acid supplementation which was lower than some of the studies carried out in Sri Lanka (44.9%) and China (37.9%) 19,22 . The reason for this low level of practice of preconception folic acid supplementation was that our participants had low level of knowledge on preconception folic acid usage and its benefits on reduction of congenital malformation by folic acid supplementation.…”

Knowledge and Practices on Periconceptional use of Folic Acid for the Prevention of Neural Tube Defects Among Women in Childbearing Age in Boralesgamuwa Medical Officer of Health Area, Sri Lanka

“…However, previous studies conducted in different parts of the world have reported that majority of participating women had poor knowledge of the role of FA regarding prevention of NTDs (Nosrat, 2012;Alanazi et al, 2021;Begashaw et al, 2022). The same is true for Sri Lanka, where a study focusing on knowledge about preconceptual use of FA using pregnant and non-pregnant women, revealed that participants' knowledge related to preconceptual use of FA was significantly low (Pathiraja & Prathapan., 2020).…”

“…It is estimated that around 300,000 infants are born each year with NTDs, and approximately 88,000 deaths occur due to NTDs (Zaganjor et al, 2016). In Sri Lanka, the estimated prevalence of NTDs is 1.21 per 1000 births and recurrence risk of NTDs as 2%-3% (Pathiraja & Prathapan, 2020).…”

“…It is widely acknowledged that folic acid (FA) plays a vital role in reducing the risk of development of NTDs (Dessie et al, 2017;Kim et al, 2018;Pathiraja & Prathapan., 2020). As per the findings of the previous research, FA supplementation before pregnancy is crucial to reduce the risk of NTDs (De Wals et al, 2007;Denny et al, 2013;Kim et al, 2018).…”