Predictors of optimum antenatal iron-folate supplementation in a low resource rural set-up in Eastern Kenya

Abstract

There is depressed prevalence of the optimum iron-folate supplementation in Kenya and in other subSaharan Africa countries. The study was motivated by the paucity of area-specific data on predictors of optimum iron-folate supplementation. The aim of the study was to assess the maternal, knowledge and institutional factors that predict 90+ days (optimum) iron-folate supplementation among pregnant women in a rural set-up in Eastern Kenya. A descriptive cross-sectional study to collect quantitative data from 352 mothers of under-five years old children attending 7 health facilities in Kalama Division of Machakos constituency within Machakos County in lower Eastern Kenya. Using a standard questionnaire, mothers recalled the number of days they had ingested iron-folate supplements in their latest pregnancies. The overall prevalence of optimum supplementation (90+ days) during latest pregnancies was 18.3% and on average the study mothers were supplemented for ~38 days during the antenatal period. Mothers who visited antenatal care (ANC) for ≥4days (odd ratio 004-1.116). Those who were supplemented with a combined form of supplement were more likely to have more days of supplementation (p=0.004), but not optimum (OR: 1.125, 95% CI: 0.419-3.021) compared to those who used single iron and folate supplement. To increase the proportion of pregnant mothers taking iron-folate supplements for 90+ days in low resource rural set-ups, there should be intensified counselling/education on ANC attendance ≥ 4 times and on minimum number of days for optimum iron-folate supplementation. Use of tablets as opposed to syrup increases the likelihood for antenatal ingestion of iron-folate supplements for 90+ days in rural low-resource set-up.[

Compliance with Iron and folic acid supplementation (IFAS) and associated factors among pregnant women: results from a cross-sectional study in Kiambu County, Kenya

“…Compliance with IFAS is found to be dismal at 32.7%. Similar findings have been reported in the neighbouring County of Machakos, Kenya (18%) [ 22 ] signifying a widespread problem. There is similarity of compliance pattern among the two counties despite their cultural and demographic diversity.…”

“…Locally, at Thika hospital in Kiambu County, the County where this study was conducted, IFAS adherence rate (use of supplements for ≥4 days in a week) was shown to be 24.5% [ 21 ]. Similarly, in the neighbouring rural County of Machakos, the supplementation was found to be 18% [ 22 ] an indication that the problem is widespread.…”

Effect of a community-based approach of iron and folic acid supplementation on compliance by pregnant women in Kiambu County, Kenya: A quasi-experimental study

“…However, the findings were higher than reports on IFAS coverage from low and medium income countries (LMIC) with similar rural settings namely, South Ethiopia (39.2%), Pakistan (38.3%), [38], Nigeria (37.5%) [42] and Western Ethiopia (20.4%) [20]. Nevertheless, lower coverage (18%) has been reported in a neighbouring County of Machakos, Kenya [43]. Elsewhere, Bilimale and colleagues suggested adoption of "more open, cooperative health professional- patient relationships" as critical to improving compliance [3].…”

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

“…Similarly, studies conducted in Kiambu, Kenya (32.7%), and Amhara, Western Ethiopia (20.4%), also found the low adherence to IFAS among pregnant women [19,20]. Also, adherence to IFAS was modestly higher compared to the studies conducted in Eastern Kenya (18.3%), Uganda (12%), Norway (16%), and Northern Tanzania (16.1%) [21][22][23][24] and lower compared to studies conducted in Senegal (51%), Kathmandu-Nepal (73.2%), Tamil Nadu-India (60.6%), and Mizan-Aman-Ethiopia (70.6%) [25][26][27][28]. Some of the probable reasons of inconsistency might be a different study subject, sociodemographic characteristics, locality, follow-up and reminding mechanism, knowledge of IFAS, and qualities of health services offered in the health facilities including counseling on its benefits, the average number of IFAS recommended during pregnancy, and belief on the use of IFAS.…”