Coverage, compliance and factors associated with utilization of iron supplementation during pregnancy in eight rural districts of Ethiopia: a cross-sectional study

Two independent community-based cross-sectional surveys of adult women: pregnant women (n=414) and women who delivered in the preceding year (n=1563); multistage sampling; data collected via structured questionnaires in eight rural districts across four major Ethiopian regions; analyses used ordinal logistic regression to identify predictors of iron supplementation.

Prenatal iron supplementation during pregnancy; initiation around 5.6 months gestation; total duration data show median 30 days; duration categories: 1-30 days, 31-60 days, 61-90 days, >90 days; dosage and mode of administration not specified.

Prenatal iron supplementation coverage was limited (34.7% took at least once; 3.5% took 90+ days). Fewer ANC visits markedly reduced iron-use odds (0.04 for 0 visits; 0.33 for 1 visit; 0.50 for 2 visits; 0.60 for 3 visits, vs 4+ visits). Not having comprehensive anemia knowledge (OR 0.75) or not being informed about iron supplementation (OR 0.05) reduced uptake. In pregnant women, each additional month of supplementation linked to a 0.23 g/dL rise in hemoglobin after adjusting for trimester. Among those on supplements, average adherence was 74.9% (32.6% <90%; 25.1% <70%). Side-effects (63.3%) and forgetfulness (16.7%) were leading reasons for non-adherence. Recommendations: promote early and frequent ANC, improve ANC counseling (including side-effect management), increase anemia knowledge, and involve community health workers to promote prenatal iron supplementation.

Recall bias for the number of supplements; selection bias due to sampling in relatively accessible districts; limited generalizability beyond the study districts; underrepresentation of first-trimester pregnancies (1.5%), potentially overestimating anemia and supplement utilization; adherence self-report may overestimate; cross-sectional design limits causal inference.