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

International Journal of Reproductive Medicine

Jun 2020

DOI: 10.1155/2020/3127245

Citations:57

Influential Citations:10

Observational Studies (Human)

Enhanced Details

Methods

Health facility-based cross-sectional study with mixed-methods in Kasulu district, Kigoma region, Tanzania (March–April 2019). Quantitative survey of 320 women with children aged 0–6 months attending antenatal/postnatal services; qualitative components included four focus group discussions (19 pregnant women and 15 mothers) and six in-depth interviews with health care providers; two facilities (Kasulu Hospital and Kiganamo Health Center). Participants were women of reproductive age (pregnant women and mothers of children aged 0–6 months) and health care providers.

Intervention

Iron and folic acid tablets; one tablet daily containing 30-60 mg iron and 400 mcg folic acid; started at the first antenatal visit; for at least 90 days.

Results

Adherence to IFAS among 320 respondents was 20.3% (65/320). Positive associations with adherence included: first-trimester ANC initiation (AOR 2.73; 95% CI 1.56–4.77); high knowledge of anaemia (AOR 3.84; 95% CI 1.34–10.69); counseling on IFAS importance (AOR 3.86; 95% CI 1.42–10.50); IFAS given at each visit (AOR 9.42; 95% CI 4.85–18.31); having 2 meals or fewer daily (AOR 3.39; 95% CI 1.72–5.89); fewer than four children (AOR 3.19; 95% CI 1.81–8.65); distance to facility showed limited predictive value after adjustment. Side effects reduced adherence (AOR 0.38; 95% CI 0.19–0.76). Qualitative findings highlighted delayed ANC, reminder gaps, low awareness of anaemia and IFAS benefits, side-effect concerns, negative beliefs, and follow-up gaps as barriers. Conclusion: Adherence to IFAS during pregnancy was low. Strengthening reminder systems and education for pregnant women and health providers could improve adherence.

Limitations

Self-reported adherence may bias results; potential recall/reporting bias. No objective adherence measures (no pill counts) or Hb concentration data. Cross-sectional design; limited to two facilities in Kasulu district; may not generalize to other settings.

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. show less