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Assessment of Adherence to Iron and Folic Acid Supplementation and Prevalence of Anemia in Pregnant Women
Abstract
Anemia during pregnancy is a worldwide problem, Iron deficiency and folate deficiency are considered as the first two causes of nutritional anemia. Many antenatal care program distributed iron and folic acid supplementation to pregnant women's the effectiveness of theses intervention in reducing maternal anemia's still has been in adequate. Some suggest that poor compliance is the probable reason for the ineffectiveness of such program. Aim of the Work: The aim of this study is to improve the adherence of pregnant women to Iron and Folic acid supple-mentation. Study Objectives: To measure the adherence (compliance) of pregnant women to iron and folic acid supplementation and prevalence of anemia in pregnant women and to study the different factors affecting the adherence to Iron and Folic acid supplementation. Material and Methods: This descriptive cross sectional study was conducted on 270 pregnant women in the second or third trimester attending El-Salam Primary Health Care center in Ismailia governorate were included in the study. study done on January, February, March 2008. Women were excluded from the study if have any of the following disorders including (Hemolytic anemia, hemoglobinopathies, mental disorders, chronic diseases, or chronic inflammatory disorders). All women were assessed for adherence to iron and folic acid supplement through self reported and pill count adherence. Hemoglobin concentration from follow-up charts was recorded. Results: According to self reported adherence; 58.9% showed no adherence and 41.1% shows adherence while concerning pill count adherence 63.3% showed no adherence and 36.7% showed adherence. Statistically significant differ-ence was found between results of self reported adherence and pill count adherence. 62.2% of the study group were anemic. Hemoglobin level ranged between 6.9-13.0g/dl, and mean ± SD were 10.5±0.7g/dl. 126/168 (75%) mild anemia, 39/168 (23,2%) moderate anemia, 3/168 (1.8%) severe anemia. Most prevalent cause of non-adherence was frustration from many tablets (75/270 pregnant women; 54.3%). When Correspondence to: Dr. Zakia M.. studying the best fitting multiple linear regression model for pill count adherence among pregnant women of study sample, it was found that age, income, pregnancy spacing, ANC visits, knowledge of folic acid and family encouragement were statistically significant independent positive predictors of pill count adherence. Conversely, crowding index, gravidity, and side effects occurrence were statistically significant indepen-dent negative predictors of pill count adherence. The model explains 24% of the variation of pill count adherence, as indicated by the value of r-square. Conclusion: Pill count is more accurate method for esti-mation of adherence to iron and folic acid supplement than self reported adherence. Age, income, pregnancy spacing, ANC visits, knowledge of folic acid and family encouragement were statistically significant independent positive predictors. Conversely, crowding index, gravidity, and side effects occur-rence were statistically significant independent negative predictors.
... The methods of assessment of adherence used in the current study has been utilised in other studies. [12][13][14] In the current study, adherence to pill intake was 50% across all follow-up groups. Non-adherence to pill intake was high: 20.8% of women returned ≥ 2 pills whilst 29.1% reported not knowing the number of pills remaining at follow-up visits. ...
... Self-reporting may overestimate compliance compared with pill count or biochemical methods. 13 In contrast, Ibrahim et al. 12 observed that self-reporting (41.1%) was a better indicator of adherence compared with pill count (36.7%). However, Bondarianzadeh et al. demonstrated that women may falsely report pill taking as confirmed by positive stool test. ...
Background: Iron and folic acid supplementation plays a major role in the prevention and control of iron-deficiency anaemia in pregnancy. Therefore, this study assesses adherence to prophylactic iron supplementation during the antenatal period in South Africa.
Methods: An observational study was conducted in a regional hospital from January to December 2016. HIV-uninfected (n = 100) and HIV-infected (n = 100)] women were enrolled and subdivided into three groups: (a) ≤ 34 weeks (n = 33), (b) 34–36 weeks (n = 34) and (c) ≥ 37 weeks (n = 33) gestational age respectively. A structured questionnaire was used for data collection. Data were coded and statistically analysed using SPSS software. Pill count and self-reported data from women (n = 24) at ≤ 34 weeks and 34–36 weeks reflected < 50% adherence and 46% non-adherence, being higher in the HIV-infected women (75%). Nausea was the commonest side effect across all trimesters (79. 2%). Adherence (27.8%) and non-adherence (72.1%) to iron, folic acid and calcium supplementation were found in 88% of women.
Conclusion: This study found that adherence to micronutrient supplementation is low in pregnancy, albeit higher in HIV-infected women receiving antenatal care at a regional hospital in Durban, South Africa.
Abbreviations: Haemoglobin (Hb), Human Immune Deficiency Virus (HIV), antiretroviral therapy (ARV), zidovudine (ZDV), tuberculosis (TB), low to middle- income countries (LMICs), World Health Organization (WHO), antenatal clinic (ANC).
... Counselling increases the mothers' knowledge about the importance of taking IFAS and consequences of non-adherence and this in turn facilitates adherence to IFAS. Some studies have identified the number of antenatal care visits attended by the woman as independent factor that increases adherence to IFAS since women get many sessions of counselling, however this was not found to be an independent factor in this study [23,29,30]. ...
Purpose: Globally, about 40% of pregnant women have anemia. Pregnant women are at high risk of iron and folic acid deficiency anemia due to increased nutrient requirement during pregnancy. Iron/folic acid supplementation with optimal adherence is the main cost-effective strategy for prevention of iron deficiency anemia in pregnant women. However, there remains poor adherence to iron and folic acid supplementation in pregnancy in many countries especially low-income countries. The aim of this study was to evaluate the level of adherence and the factors influencing adherence to iron and folic acid supplementation among pregnant women attending antenatal care in Rubanda District, south Western-Uganda. Methodology: A multi-Health facility based observational and descriptive cross-sectional study was done. One hundred seventy two (172) pregnant mothers attending antenatal clinic in six selected health facilities in Rubanda District were enrolled in this study from December 2021 to March 2022. The interviewer administered questionnaire was used to study the participant characteristics and logistic regression was used to identify the factors influencing adherence to iron and folic acid supplements. Findings: Majority of women were aged between 20-29 years (57.56%), married (94.77%) and unemployed (80.23%). More than half of the respondents (62.21%, 95% CI 54.89%-69.53%) had taken at least 80% of the prescribed iron and folic acid tablets. This reflected good adherence level. Factors independently influencing adherence included maternal age below 20 years (aOR 3.83, 95% CI 1.12-13.08, p-value 0.032), age between 20-29 years (aOR=4.86, 95%CI: 2.03-11.63, p value <0.001), adherence partner (aOR=2.82, 95%CI: 1.34-5.91, pvalue <0.001) and being counselled on importance of iron and folic acid tablets (aOR=4.42, 95%CI: 2.08-9.42, p-value <0.001). Recommendations: Intensive counselling during antenatal care about the importance of iron and folic acid supplements should be done on a daily basis with particular attention to women aged 30 years and above.
... Even though many developing countries, including Ethiopia, are now implementing IFA supplementation through ANC programs, only a few nations have reported significant improvement in IFA supplementation and anemia control and prevention (19). Iron/folic acid supplementation is affected by many factors and maternal poor adherence to the regimen is the main reason for the ineffectiveness of the strategy to decrease maternal and child complications due to iron/folic deficiency (20,21) In Somaliland the iron folic acid adherence and associated factors is not much reported specially the study area and there is no published paper about it except the Somaliland demographic health survey, therefore the aim of this study is to address the adherence and associated factors of iron folic acid among pregnant mothers in a sample of Burao maternal and child health centers in 2021. ...
Iron folic acid adherence and associated factors among pregnant mothers at maternal and child health centers in Burao, Somaliland, 2021
... The factors associated with poor consumption in countries such as Ethiopia and Egypt include lack of IFA supplements owing to not getting enough supplements to last until the next visit, forgetfulness, side effects of oral medications, little knowledge about the importance of supplements, and poor knowledge of anemia in pregnancy [8,17]. In Eswatini, the problem of medication stock-outs is also common. ...
Background
During pregnancy, nutritional requirements increase and if not met, pregnancy-related complications may manifest. To prevent these undesirable outcomes, the World Health Organization recommends daily oral iron and folic acid (IFA) supplementation as part of antenatal care. Despite this recommendation, the use of IFA supplements is still very low in several developing countries. Additionally, no prior information exists regarding the level of consumption of IFA in Eswatini. Thus, this study aimed to determine the prevalence of consumption of IFA supplements and to identify factors associated with the consumption of IFA supplements among pregnant women in Eswatini.
Methods
A cross-sectional questionnaire survey was conducted among 330 pregnant women aged ≥ 18 years in their third trimester in Eswatini. Participants were recruited from eight purposively selected healthcare facilities from July 2019 to October 2019. Good consumption was defined as consuming all or almost all IFA supplements throughout pregnancy.
Results
During the first trimester, 10.3 % of the participants consumed all or almost all IFA supplements. In the second and third trimesters, those who consumed all or almost all supplements were 37 and 39.7 %, respectively, for iron and 37.6 and 40.9 %, respectively, for folic acid. Barriers, including side effects, forgetfulness, safe previous pregnancies without IFA, others’ advice against consumption, IFA stock-outs, inability to meet transport costs, and inadequate supply of IFA tablets, contribute to low consumption of IFA. Multivariate logistic regression models showed that the barriers were inversely associated with good consumption of IFA supplements. Better knowledge and attitude toward IFA and older maternal age were positively associated with good consumption of IFA supplements.
Conclusions
Low consumption of IFA supplements in overall pregnancy is mainly owing to the late antenatal care attendance. Strategies such as establishing a preconception care unit and school-based provision of IFA may be helpful. It is evident that most women still lack knowledge, and some have negative attitudes about IFA supplements. Health education to raise awareness and emphasize the importance of starting antenatal care early as well as consuming supplements on time should be revisited and intensified. Multiple strategies such as including community health care workers for distributing IFA supplements, discussing with clients about the measures to reduce forgetfulness, advising ways to prevent and manage the side effects, providing subsidies to cover transport costs, and ensuring adequate supply of IFA supplements in facilities may need to be employed to reduce the identified barriers.
... These results are consistent with those of earlier study. [22] However, side effects of taking folate were a major challenge for pregnant women in Egypt, Iran, [23,24] perhaps because doctors and pharmacists counseled this study's participants in the management of folate side effects. To overcome forgetfulness, as a pharmacist, it is highly encouraged to provide effective patient counseling and written instruction presented simply and attractively. ...
Background: Pregnant women's compliance with a regimen of folate supplementation is an important factor in decreasing incidence of neural tube defects (NTDs). Because effective medication counseling can be used to enhance women's compliance with folate intake, pharmacists can help ensure good pregnancy outcomes by improving women's compliance through such counseling. Objectives: To determine the effect of medication counseling delivered by pharmacists on compliance among pregnant women in Tabuk, Saudi Arabia. Materials and Methods: A cross-sectional analytical study was conducted of 360 pregnant women who attended antenatal care clinics at primary health-care centers in 2018. A well-designed questionnaire was used for data collection. The data were analyzed using descriptive statistics and the Chi-squared test. Results: About half of the study participants began consuming folic acid after becoming pregnant (55.8%) and only 28.6% reported preconceptional intake. The most common reason for noncompliance was forgetfulness (64.40%). Almost two-thirds of women knew the importance of taking folate in pregnancy to prevent NTDs (64.2%). Their main sources of knowledge about folic acid were doctors (35.8%) and pharmacists (25%). A significant association was found between regular folate intake and pharmacist counseling as a source of folate information. Conclusion: Almost half of pregnant women complied with their folate supplementation regimen. However, lower preconceptional intake was observed. Participants' level of awareness of the importance of folic acid supplementation for pregnant women, though adequate, was not sufficient to ensure good pregnancy outcomes. Pharmacists were identified as a valuable source of information about folic acid, with their provision of medication counseling significantly associated with regularity of folate intake.
... Adherence to iron supplementation plays a major role in the prevention and treatment of iron deficiency anaemia particularly among pregnant women (Table 1). We evaluated the rate of compliance to prenatal Iron supplementations and investigated the factors associated with compliance of Iron folate supplementation during pregnancy ( Table 2 Primary Health Care Centre [13]. The extent of low-adherence in our study population was high (56%). ...
Introduction:
Anemia is a global problem affecting 41.8% of pregnant women. Iron deficiency is the leading cause during pregnancy. Its prevalence among Cameroonian pregnant women was estimated at 50.9% in 2004. Few studies have evaluated women's adherence to iron supplementation prescribed during pregnancy. We carried this study in order to evaluate the rate of adherence to iron supplementation and its determinants during pregnancy.
Methods:
The study was cross-sectional descriptive, on postpartum women at the Gynaeco-Obstetric and Pediatric Hospital of Yaoundé during three months. Adherence was measured using the 8-item Morisky Medication Adherence Scale (MMAS-8). The total score was classified as low, moderate and high adherence.
Results:
For a total of 304 recruited women, 16.4% were highly compliant, 27.6% moderately compliant, while 56% were low compliant with iron supplementation during pregnancy. The reasons for non-adherence were side effects (19.7%), forgetting (70.1%) and inaccessibility of iron supplements (20.1%). Up to 85 (or 28%) women found it boring to take medication daily. Women with no side effects were about thrice most likely to adhere to the iron supplementation than those with side effects: OR = 3.73 [2.43-5.71]; P = 0.04. Women aged 25 years and above were more likely to be non-compliant to iron supplementation than those youngers: OR = 0.40 [0.31-0.88]; P = 0.02.
Conclusion:
To improve adherence to antenatal iron supplementation, it is important to increase communication for behavior change and counseling before or during antenatal care. Forgetting being the main reason for non-adherence, women should keep their iron in a place of easy access.
... These findings are in agreement with the result of Tucker, et al., (1996) who found that only about one-third of patients comply with treatment, one-third partially comply & one-third never comply. While contradicted with the findings of Ibrahim et al., (2011) who reported that 63.3% of women in Suez Canal showed no compliance and 36.7% showed compliance. ...
Background: Folic acid fortification to reduce NTDs, such as spina bifida and anencephaly as well as congenital heart disease, is considered one of the most successful public health initiatives in the past 50-75 years. No representative data about folate intake are available for Egypt. Despite, if FA guideline is followed, an estimated 50-80% of NTDs could be prevented, compliance with this guidance is sub optimal among women of childbearing age in Egypt. Aim: Estimate the true prevalence of awareness, intention & compliance regarding FA intake, according to the health belief model in the Beni Suef city. Methods: A descriptive cross-sectional study in antenatal care units which affiliates to five settings in Beni-Suef city with a total of 500 pregnant women by using a structured interview questionnaire. Results: The great majority of the studied women had intention to follow a high Folate diet, only 3.6% had adequately used FA. Highly statistically significant difference between women's knowledge and their compliance with FA, HBM total score positively affects the studied women's intention to follow a high Folate diet. Conclusion: Lower reports of FA used before pregnancy as revealed by this study could serve as a good indicator for the need for improvements in Egyptian health organizations.
... This might be due to education would increase the women's access to information through reading and understanding the benefit of the supplement. Different studies reported the benefit of maternal knowledge and perception towards maternal compliance to the supplement [22][23][24]. Similarly, [25][26][27]. ...
Background
Iron deficiency during pregnancy is a risk factor for anemia, preterm delivery, and low birth weight. Iron/Folic Acid supplementation with optimal adherence can effectively prevent anemia in pregnancy. However, studies that address this area of adherence are very limited. Therefore, the current study was conducted to assess the adherence and to identify factors associated with a number of Iron/Folic Acid uptake during pregnancy time among mothers attending antenatal and postnatal care follow up in Akaki kality sub city.
Methods
Institutional based cross-sectional study was conducted on a sample of 557 pregnant women attending antenatal and postnatal care service. Systematic random sampling was used to select study subjects. The mothers were interviewed and the collected data was cleaned and entered into Epi Info 3.5.1 and analyzed by R version 3.2.0. Hierarchical Negative Binomial Poisson Regression Model was fitted to identify the factors associated with a number of Iron/Folic Acid uptake. Adjusted Incidence rate ratio (IRR) with 95% confidence interval (CI) was computed to assess the strength and significance of the association.
Result
More than 90% of the mothers were supplemented with at least one Iron/Folic Acid supplement from pill per week during their pregnancy time. Sixty percent of the mothers adhered (took four or more tablets per week) (95%CI, 56%—64.1%). Higher IRR of Iron/Folic Acid supplementation was observed among women: who received health education; which were privately employed; who achieved secondary education; and who believed that Iron/Folic Acid supplements increase blood, whereas mothers who reported a side effect, who were from families with relatively better monthly income, and who took the supplement when sick were more likely to adhere.
Conclusion
Adherence to Iron/Folic Acid supplement during their pregnancy time among mothers attending antenatal and postnatal care was found to be high. Activities that would address the above mentioned factors were highly recommended to ensure the sustainability of mothers’ adherence to the supplement.
... However, the figure is relatively comparable to other studies conducted in African countries such as Nigeria at 54.5% [16] and Ethiopia at 56.8% [17]. But it is lower than the findings from Uganda at 63.1% [18] and Egypt at 62.2% [19] and higher than Tanzanian finding at 47.4% [20]. In the present study the odds of anaemia were observed to rise as maternal age advances. ...
Background
Iron folic-acid deficiency anemia among pregnant women is a common public health problem in developing countries, particularly in low-income countries, and is associated with serious adverse health outcomes.
Objective
This study aimed to determine the level of Iron-Folic Acid Supplementation (IFAS) adherence and associated factors among pregnant women in Sire District, Ethiopia.
Methods
A facility-based study was conducted among randomly selected 345 pregnant women in Sire District. A structured and pre-tested interviewer-administered questionnaire was used to collect the data. EPI INFO7 was used to enter the data and export it to SPSS Version-21.0 for analysis. An AOR with a 95%CI was used to display the level of significance with a p-value of < 0.05.
Result
The overall adherence rate was 59.4%. Maternal information access [AOR=2.49, 95%CI (1.21, 5.13)], knowledge on IFAS [AOR=2.94, 95%CI (1.86, 4.62)], knowledge of anemia prevention [AOR=2.56, 95%CI (1.40, 4.68)], medical advice during antenatal care [AOR=10.7, 95%CI (2.33, 48.9)], anemia history [AOR=15.2, 95%CI (8.69, 26.5)], and currently diagnosed anemia [AOR=5.33, 95%CI (2.98, 9.57) had positively significant association. Whereas, having children [AOR= 0.57, 95%CI = (0.21, 0.70)] and awareness about iron-folic acid supplementation prevent low birth weight [AOR= 0.34, 95%CI = (0.19, 0.60)] had negatively significant association.
Conclusion
and Recommendation: The overall adherence was lower than WHO recommendations. Therefore, health workers regularly provide information for all antenatal care users about iron-folic acid supplementation and its adherence to preventing anemia and its consequence. MOH mobilizes the community for timely initiation and delivers comprehensive nutrition education to enhance adherence.
Background:
The prevalence of iron-deficiency anemia in pregnant Indian women is reportedly quite high. Despite the sustained efforts of the current national control program and undisputed efficacy of iron-folic acid supplementation (IFAS), the onslaught of anemia has not been curtailed, probably as a result of noncompliance to IFAS. The objective of this study was to assess the effect of direct monitoring of pregnant women by family members, counseling by health professionals, and other variables on adherence to IFAS in Puducherry, India.
Materials and methods:
A cross-sectional study was conducted among 250 pregnant women visiting Outpatient Clinic, Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry. Missing ≥2 doses of IFAS in the preceding 7 days was considered as nonadherence. The Pearson Chi-square test was applied to identify the association between the different variables. Bivariate and multivariate logistic regressions revealed variables affecting adherence.
Results:
Around 34.4% of respondents reported nonadherence to IFAS. Direct monitoring by family members (Adjusted Odds Ratio [aOR] = 7.04; P < 0.001), counseling by health professionals (aOR = 2.97; P = 0.002), and improvement in hemoglobin (Hb) levels (aOR = 2.4; P = 0.01) were associated with better adherence. Vomiting, abdominal pain, and diarrhea were common ADRs. The distance to hospital, improvement in Hb levels, counseling by health professionals, and direct monitoring by family members significantly reduced the odds of ADRs.
Conclusion:
Direct monitoring of intake by family members and counseling by health professionals improved adherence to IFAS. Further in-depth formative research studies are recommended for strategies to improve adherence to IFAS in the vulnerable pregnant population of Puducherry and streamline the implementation of anemia national control program in a specific context.
Anemia is a multifactorial condition, with a complex etiology that involves nutritional and non-nutritional factors. The misconception that iron deficiency is equivalent to anemia may mask the need to address other potential causative factors. This review paper aims to (1) assess the burden of anemia vs. iron deficiency anemia (IDA) amongst women of reproductive age (WRA), pregnant women (PW), and children under five years old (underfive children, U5C) in the Eastern Mediterranean region (EMR); (2) evaluate trends in anemia prevalence and whether countries are on track towards meeting the World Health Assembly (WHA) target for 2025; and (3) characterize anemia reduction efforts and provide a road map for future programs. A search of pertinent literature and databases was conducted. Anemia prevalence in the EMR ranged between 22.6% and 63% amongst PW, 27% and 69.6% amongst WRA, and 23.8% and 83.5% amongst U5C. Data showed that the EMR is not on course towards meeting the WHA target. The contribution of IDA to anemia was found to be less than half. Other potential contributors to anemia in the region were identified, including micronutrient deficiencies, parasitic infestations, and poor sanitation. A framework of action was proposed as a roadmap to meet the targets set by the WHA.
Background:
Iron-deficiency anemia in pregnancy is a major public health problem despite the efforts taken by the Ministry of Health and Family Welfare for the past five decades. Adherence to iron and folic acid supplementation (IFAS) is the key factor for the prevention and management of nutrition anemia.
Aim:
The aim of this study was to assess the adherence to its associated factors and to explore the reasons for the non-adherenc among pregnant women attending a tertiary care center.
Materials and methods:
It is an explanatory mixed-methods design (quantitative cross-sectional analytical design and qualitative descriptive design).
Statistical analysis used:
Results presented as proportion with 95% confidence interval (CI). Chi-square test was done to assess the association of the factors to adherence. Qualitative data were transcribed verbatim, translated to English, and analyzed by manual content analysis.
Results:
A total of 340 pregnant women were included, and the adherence to IFAS among the antenatal mothers was 63.8 (95% CI [58.61-68.6]). The factors associated with adherence to IFAS (prevalence ratio with 95% CI) were primigravida status [1.22 [1.02-1.45]), nonanemic in the first trimester (1.27 [1.09-1.49]), and absence of side effects (3.16 [1.95-5.12]). Conceptual framework was constructed using the emerging themes: (i) knowledge-related factors, (ii) behavior-related factors, and (iii) facilitating factors.
Conclusion:
About three-fourth of the participants were adherent to IFAS. Compliance is directly influenced by the gravida status, anemic status, and absence of side effects. Based on qualitative results, measures to improve palatability and the quality of IFAS are recommended.
Introduction
Anemia during pregnancy has a significant adverse effect on both the mother and fetus. Iron and folic acid supplementation (IFAS) is the feasible and cost effective strategy to control and prevent anemia in pregnancy. However, the success of this strategy is suboptimal due to poor maternal adherences to the regimen. The aim of this study was to assess prevalence of anemia, rate of adherence to IFAS and associated factors among pregnant women at Tikur Anbessa Specialized Hospital (TASH), Ethiopia.
Method
Institution based cross sectional study was conducted among 250 pregnant women who were selected using systematic random sampling from antenatal care clinic (ANC) attendants of TASH. Data was collected through interview and medical chart review by using structured questionnaire. The data was analyzed by SPSS v.24. Binary logistic regression was used to identify the associated factors for IFAS and P < 0.05 was used to declare the association.
Results
The prevalence of anemia was 4.8% and half of the study participants were knowledgeable about anemia. The rate of adherence to IFAS was 63.6%. Forgetfulness and fear of side effect were the commonest reasons for poor adherence to IFAS. Gestational age at first ANC visit and educational level were significantly associated with adherence to IFAS. Thus, pregnant women who started their ANC follow up at first trimester (AOR = 1.87, 95% CI (1.18–3.36)) and education level of college and above (AOR = 4.236, 95% CI (1.35–13.25)) and completed secondary education (AOR = 4.09, 95% CI (1.39–12.02)) were more likely to be adherent to IFAS compared with their comparators.
Conclusion
Even though anemia prevalence was very low among the study participants, adherence to IFAS was still a challenge during pregnancy. Therefore, counseling about IFAS and anemia prevention and promoting the benefits of early ANC visit are recommended to improve adherence to IFAS.
Background:
Despite the supplementation of iron-folic acid is the recommended strategy during the antenatal period; iron deficiency anemia is the commonest hematologic complication during pregnancy. Therefore, this systematic review and meta-analysis aimed to assess the level of adherence to iron-folic acid supplementation and its associated factors among pregnant women in Ethiopia.
Methods:
Systematic review and meta-analysis guideline was followed for this study. Different online databases were used for the review: PubMed, HINARI, EMBASE, Google Scholar and African Journals Online. Different searching terms were applied based on the adapted PICO principles to achieve and access all the essential articles. The data were entered and analyzed using Microsoft Excel and Stata 11 software respectively.
Results:
Fifteen studies were included in this systematic review and meta-analysis with a total of 5808 pregnant women. The overall pooled prevalence of adherence to iron-folic acid supplementation among pregnant women in Ethiopia was 41.38% (95% CI: 33.09, 49.67). Having secondary and above educational status of the women (AOR:2.68,95%CI:1.25, 5.74), having an early registration of antenatal care follow-up (≤16 weeks) (AOR:2.54,95%CI:1.99, 3.24), having anemia complication during current pregnancy (AOR:3.01,95%CI:1.88, 4.81), having good knowledge of iron-folic acid supplementation (AOR: 2.96, 95%CI:1.76, 4.99), having four times or more antenatal care follow up (AOR:3.66, 95%CI:2.81, 4.77), getting health education about benefit of iron and folic acid (AOR:2.62,95%CI:1.46,4.72), and having good knowledge about anemia (AOR:2.99,95%CI:2.32, 3.85) were associated risk factors for adherence to iron-folic acid supplementation.
Conclusion:
The overall pooled prevalence adherence of IFAS among pregnant women was lower than the WHO recommendations. Educational status, early registration of ANC, anemia in the current pregnancy, good knowledge of IFAS, number of ANC visits, good knowledge of anemia and receiving health education about the benefit of IFAS were factors associated with the adherence of IFAS among pregnant women in Ethiopia. This finding is important to design strategic policies and to prevent anemia and congenital anomaly resulted from inadequate intake of iron and folic acid.
Background:
Iron deficiency is the leading nutrient deficiency globally affecting the lives of more than two billion people worldwide. Pregnant women are at higher risk of iron and folic acid deficiency due to lack of iron and folic acid or due to poor adherence. Adherence to iron and folic acid supplement is taking 65% or more of the recommended supplement, equivalent to taking the supplement at least 4 days a week during 3 months period using recording, reporting, and checking cards.
Objective:
The current study aimed at assessing adherence to iron and folic acid supplement during pregnancy and its associated factors among pregnant women attending antenatal care.
Methods:
Institution based cross-sectional study was conducted from February to March 2017. Systematic random sampling technique was used to select the study subjects. Data were collected using structured and pretested interviewer-administered questionnaire. Bivariable and multivariable logistic regression analysis were used to identify factors associated with adherence to iron and folic acid supplement among pregnant women. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to display the level of significance. Variables with a p-value less than 0.05 had been considered statistically significant.
Result:
Adherence to iron and folic acid in the current study was 28.7% with 95% CI (24.3, 33.6%). Educational status of mothers (AOR= 9.27 (95%CI: 2.47, 34.71)), educational status of husband (AOR= 0.31(95% CI: 0.11,0.88)), family size of four (AOR=3.70(95%CI: 1.08,12.76)), family size of five and above (AOR= 4.88(95% CI: 1.20, 19.85)), mothers who had 2500-3500 Ethiopian birr household average monthly income (AOR= 0.46(95% CI: 0.24,0.89)), mothers who had registered at 17-24 weeks of gestation (AOR=0.40(95% CI: 0.22-0.74)) and registered at 25-28 weeks (AOR=0.20(95% CI 0.10, 0.41)), and mothers who had collected their iron and folic acid starting at first visit at first month of pregnancy (AOR= 2.42(95% CI:1.05, 5.58)) had significant association with iron and folic acid adherence.
Conclusion and recommendation:
Adherence of iron and folic acid was only 28.7% in the current study. Maternal and husband education status, family size, registration time, economic status, and first visit in the first month with duration of iron and folic acid taken were factors significantly associated with adherence to iron and folic acid supplement. Therefore, anaemia prevention strategy via improved iron and folic acid supplement adherence should comprise strategies of educating pregnant mothers, improving economic status, and early antenatal care (ANC) registration that can improve adherence to iron and folic acid supplement.
Introduction
Nutritional anemia is a major public health problem throughout the world, particularly in developing countries. Iron with folic acid supplementation (IFAS) is recommended to mitigate anemia and its resulting complications during pregnancy. There has been limited study on IFAS adherence of pregnant women in the study area. The aim of this study was to assess adherence to IFAS and its associated factors among pregnant women attending antenatal care service in Debre Tabor General Hospital, Ethiopia.
Methods
An institution-based cross-sectional study was conducted from January 9 to April 8, 2017, at Debre Tabor General Hospital. A total of 262 study participants were included and selected by systematic random sampling. The entire interviewed questionnaire was checked and entered into EpiData version 3.1 and then exported to SPSS version 20 for windows for analysis. IFAS adherence status was defined as, if pregnant mothers took 65% or more of the IFAS which is equivalent to taking IFAS at least 4 days a week during the 1-month period preceding the study. Regressions were fitted to identify independent predictors of IFAS adherence. A P-value of less than 0.05 was used to declare statistical significance.
Results
A total of 241 pregnant women were included (92% response rate), of which 107 (44%) were adherent to IFAS. Only 39% received IFAS counseling, and 52% had some knowledge of IFAS. Gravidity (AOR = 2.92 95% CI (1.61, 5.30)), gestational age at first ANC visit (AOR = 3.67, 95% CI (1.94, 6.97)), pregnant women who got advice about IFAS (AOR = 2.04, 95%CI (1.12, 3.75)), current anemia (AOR = 2.22, 95%CI (1.45, 4.29)), and had knowledge about IFAS (AOR = 3.27, 95% CI (1.80, 5.95)) were statistically associated with adherence to IFAS among pregnant women.
Conclusion
Overall, IFAS adherence among pregnant women was low. The associated factors with adherence of IFAS were counseling and knowledge, early ANC attendance, pregnancy history, and current anemia diagnosis. IFAS counseling by health workers was low but, when given, was associated with improved IFAS adherence. Health workers and health extension workers should consistently counsel on IFAS benefits during ANC visit, to improve IFAS adherence during the current and subsequent pregnancies.
Objective
To evaluate the sociodemographic and lifestyle factors associated with insufficient and excessive use of folic acid supplements (FAS) among pregnant women.
Design
A pregnancy cohort to which multinomial logistic regression models were applied to identify factors associated with duration and dose of FAS use.
Setting
The Growing Up in New Zealand child study, which enrolled pregnant women whose children were born in 2009–2010.
Subjects
Pregnant women ( n 6822) enrolled into a nationally generalizable cohort.
Results
Ninety-two per cent of pregnant women were not taking FAS according to the national recommendation (4 weeks before until 12 weeks after conception), with 69 % taking insufficient FAS and 57 % extending FAS use past 13 weeks’ gestation. The factors associated with extended use differed from those associated with insufficient use. Consistent with published literature, the relative risks of insufficient use were increased for younger women, those with less education, of non-European ethnicities, unemployed, who smoked cigarettes, whose pregnancy was unplanned or who had older children, or were living in more deprived households. In contrast, the relative risks of extended use were increased for women of higher socio-economic status or for whom this was their first pregnancy and decreased for women of Pacific v. European ethnicity.
Conclusions
In New Zealand, current use of FAS during pregnancy potentially exposes pregnant women and their unborn children to too little or too much folic acid. Further policy development is necessary to reduce current socio-economic inequities in the use of FAS.
Background:
Globally, anemia is a public health problem affecting the life of more than two billion people. Pregnant women are at high risk of iron deficiency anemia due to increased nutrient requirement during pregnancy. Iron-folic acid supplementation is the main strategy for prevention and control of iron deficiency anemia and its effectiveness depends on adherence to Iron-Folic Acid tablets. In the refugee camps of Ethiopia, despite the efforts made to reduce iron deficiency anemia during pregnancy, information about adherence to iron-folic acid supplementation and its associated factors are lacking. The objective of this study was to assess magnitude and factors associated with adherence to iron-folic acid supplementation, among pregnant women, in Shire refugee camps.
Methods:
Institution based cross-sectional study with mixed design (quantitative and qualitative) was carried out among pregnant women in Shire refugee camps from September to November 2015. For quantitative data, a sample of 320 pregnant women was systematically selected and data were collected via interview administered structured questionnaire. Quantitative data were coded and entered into Epi-info version 3.5.1 and exported into a statistical package for social sciences (SPSS) Version 19.0 software for analysis. Bivariable and multivariable logistic regressions were employed to identify the predictors at p-value < 0.2 and 0.05 respectively. For the qualitative part, six focus group discussions and three key informant interviews were conducted on purposely-selected individuals. Open-Code version 3.6.2.0 was used for analysis. Identified themes were arranged into coherent groupings and triangulated with quantitative findings.
Results:
The adherence rate was found to be 64.7% [95% CI (59.7%, 70.0%)]. Women who were having lower knowledge about anemia [AOR; 0.23 95% CI (0.14, 0.38)] and not receiving information about importance of iron-folic acid supplementation [AOR; 0.43 95% CI (0.25, 0.74)] were negatively associated with adherence to iron and folic acid., Having four or more antenatal care visits [AOR; 2.83 95% CI (1.46, 5.48)] were positively significantly associated with adherence to iron-folic acid supplementation.
Conclusions:
Adherence rate of iron-folic acid supplementation during pregnancy in the study area is relatively low. Proper counseling and health promotion about Iron-Folic Acid tablet intake, promoting the benefits of early and frequent ANC visit, health promotion on anemia prevention and health benefits of the importance of iron-folic acid supplements are recommended to increase adherence with iron-folic acid supplementation.
Abstract: Micronutrient deficiencies and inadequacies constitute a global health issue, particularly
among countries in the Middle East. The objective of this review is to identify micronutrient deficits
in the Middle East and to consider current and new approaches to address this problem. Based on
the availability of more recent data, this review is primarily focused on countries that are in
advanced nutrition transition. Prominent deficits in folate, iron, and vitamin D are noted among
children/adolescents, women of childbearing age, pregnant women, and the elderly. Reports
indicate that food fortification in the region is sporadic and ineffective, and the use of dietary
supplements is low. Nutrition monitoring in the region is limited, and gaps in relevant information
present challenges for implementing new policies and approaches to address the problem.
Government‐sponsored initiatives are necessary to assess current dietary intakes/patterns, support
nutrition education, and to reduce food insecurity, especially among vulnerable population groups.
Public–private partnerships should be considered in targeting micronutrient fortification programs
and supplementation recommendations as approaches to help alleviate the burden of micronutrient
deficiencies and inadequacies in the Middle East.
Limited adherence to iron supplementation is thought to be a major reason for the low effectiveness of anemia-prevention programs. In rural Tanzania, women at 21-26 wk of gestation were randomly given either 120 mg of a conventional (Con) iron supplement or 50 mg of a gastric-delivery-system (GDS) iron supplement for 12 wk. Adherence was assessed by using a pill bottle equipped with an electronic counting device. Adherence in the GDS group was 61% compared with 42% for the Con group. In both groups, women experiencing side effects had about one-third lower adherence. Fewer side effects were observed in the GDS group. In a subgroup of women with a low initial hemoglobin concentration (< or = 120 g/L), the response to the iron supplements suggested that both of the applied doses were unnecessarily high for adequate hematologic response in a population with a marginal hemoglobin concentration. The GDS group appeared to require a dose one-fourth as high as that of the Con group for an equal effect on improving hemoglobin to normal concentrations.
Anaemia in pregnancy is a common and severe problem in many developing countries. Because of lack of resources and staff motivation, screening for anaemia is often solely by clinical examination of the conjunctiva or is not carried out at all. A new colour scale for the estimation of haemoglobin concentration has been developed by WHO. The present study compares the results obtained using the new colour scale on 729 women visiting rural antenatal clinics in Malawi with those obtained by HemoCue haemoglobinometer and electronic Coulter Counter and with the assessment of anaemia by clinical examination of the conjunctiva. Sensitivity using the colour scale was consistently better than for conjunctival inspection alone and interobserver agreement and agreement with Coulter Counter measurements was good. The Haemoglobin Colour Scale is simple to use, well accepted, cheap and gives immediate results. It shows considerable potential for use in screening for anaemia in antenatal clinics in settings where resources are limited.
Low adherence to prescribed medical regimens is a ubiquitous problem. Typical adherence rates are about 50% for medications and are much lower for lifestyle prescriptions and other more behaviorally demanding regimens. In addition, many patients with medical problems do not seek care or drop out of care prematurely. Although accurate measures of low adherence are lacking for many regimens, simple measures, such as directly asking patients and watching for appointment nonattendance and treatment nonresponse, will detect most problems. For short-term regimens (< or =2 weeks), adherence to medications is readily achieved by giving clear instructions. On the other hand, improving adherence to long-term regimens requires combinations of information about the regimen, counseling about the importance of adherence and how to organize medication taking, reminders about appointments and adherence, rewards and recognition for the patient's efforts to follow the regimen, and enlisting social support from family and friends. Successful interventions for long-term regimens are all labor-intensive but ultimately can be cost-effective.
In the United States, the prevalence of third trimester anemia among low-income pregnant women is 29% and has not improved since the 1980s. Although low adherence has been linked to the ineffectiveness of iron supplementation programs, data regarding adherence to supplementation in low-income women are currently lacking. Hence this study was conducted to better understand the factors associated with adherence to the use of iron-containing prenatal multivitamin/mineral supplements among low-income pregnant women. Adherence to supplement use was assessed by pill counts among 244 pregnant women of 867 women who were initially randomized to receive 1 of 3 prenatal supplements. All women received care at a public prenatal clinic. Maternal characteristics associated with adherence were identified using predictive modeling. Women took 74% of supplements as prescribed. Adherence was higher among non-Hispanic white women than among non-Hispanic black women (79% vs. 72%, P </= 0.01). Interactions of ethnicity with age group, smoking status, and prior supplement use were significant. Multivariate regression analysis stratified by ethnicity revealed that among the white women education beyond high school, unmarried status, nulligravidity, and smoking were positively associated with adherence. In contrast, among the black women, supplement use 3 mo prior to current pregnancy and no loss of appetite were positively associated with adherence. Further research investigating the influence of cultural factors is necessary to better understand adherence to supplement use and the differences in adherence among ethnic groups.
Context:
Landmark clinical trials have demonstrated the survival benefits of statins, with benefits usually starting after 1 to 2 years of treatment. Research prior to these trials of older lipid-lowering agents demonstrated low levels of 1-year adherence.
Objective:
To compare 2-year adherence following statin initiation in 3 cohorts of patients: those with recent acute coronary syndrome (ACS), those with chronic coronary artery disease (CAD), and those without coronary disease (primary prevention).
Design and setting:
Cohort study using linked population-based administrative data from Ontario.
Patients:
All patients aged 66 years or older who received at least 1 statin prescription between January 1994 and December 1998 and who did not have a statin prescription in the prior year were followed up for 2 years from their first statin prescription. There were 22,379 patients in the ACS, 36,106 in the chronic CAD, and 85,020 in the primary prevention cohorts.
Main outcome measures:
Adherence to statins, defined as a statin being dispensed at least every 120 days after the index prescription for 2 years.
Results:
Two-year adherence rates in the cohorts were only 40.1% for ACS, 36.1% for chronic CAD, and 25.4% for primary prevention. Relative to the ACS cohort, nonadherence was more likely among patients receiving statins in the chronic CAD (relative risk [RR], 1.14; 95% CI, 1.11-1.16) and primary prevention cohorts (RR, 1.92; 95% CI, 1.87-1.96).
Conclusions:
Elderly patients with and without recent ACS have low rates of adherence to statins. This suggests that many patients initiating statin therapy may receive no or limited benefit from statins because of premature discontinuation.
Objective:
The objective of this study was to demonstrate the utility of continuous monitoring and enhancement of medication compliance during a long-term clinical trial, predictors of compliance, and relationships to drinking outcomes.
Methods:
Alcohol-dependent patients enrolled in a multicenter VA cooperative study were randomly assigned to once-daily naltrexone (NTX) for 3 or 12 months (short-term or long-term NTX) or placebo for 12 months of treatment. All medications were dispensed in bottles with medication event monitoring (MEMS, AARDEX, Union City, CA) caps with a microprocessor that recorded openings as presumptive doses. Patients were trained to develop personal cues as dosing reminders. Monthly feedback sessions included review of compliance data and cues.
Results:
There were no significant differences among short-term NTX, long-term NTX, and placebo (209 each) groups in measures of compliance. Overall compliance rates were 71% +/- 31% of doses for the first 13 weeks and 43% +/- 33% of doses over 52 weeks. Some doses were taken during 83% +/- 27% of the first 13 weeks. Higher medication compliance predicted fewer drinks per drinking day (P = .02) throughout follow-up and a lower percentage of drinking days (P = .002 during the first 13 weeks) with no significant effect for treatment group.
Conclusions:
The feedback and monitoring programs were important features to demonstrate that lack of treatment effect was not a result of poor compliance. Medication compliance data supported the internal validity of the trial by demonstrating that good compliers had better outcomes, irrespective of treatment with NTX or placebo. The MEMS feedback methodology is feasible for use in multicenter trials.
A cross-sectional study was carried out on a sample of 900 pregnant women attending MCH centers in Alexandria to determine the incidence of high risk pregnancy and to demonstrate the common risk factors among them. The simplified scoring system developed by Morrison and Olsen (1979) was used. Mothers with scores 0-2 were considered at low risk those with score 3 and more were categorised as high risk. Results revealed that high risk women constituted 27.78% of the sample. Twenty three risk factors were identified among all pregnant women screened. The most frequently encountered were anaemia (37.33%), age 35+ (15.66%), parity 5+ (16.66%), previous gynecological surgery (8.88%) and history of previous stillbirth or neonatal death (6.11%). The mean number of risk factors in the low risk group was 0.95 compared to 3.03 in the high risk group. Stepwise regression analysis indicated that the reproductive history score was the best one variable predictor of total risk score explaining about 74% of the variation in the total score while the present history score explained a further 16% of the variation and the associated conditions score explained 9% only of the variation. The use of scoring technique is recommended to be used in identification of high risk pregnant women in MCH centers.
Iron deficiency anemia affects over 2 billion people. Particularly at risk are pregnant women and young children. Although distribution of iron supplements is practised in many antenatal care programs in developing countries, it has often been alleged that pregnant women do not take them. Poor compliance arises not only because of patient behavior but also from factors out of the patient's control. This paper presents the results of a review of the literature on medical compliance to determine whether iron supplementation is different from other medications, to assess the known levels of compliance, and to synthesize recommendations for improving compliance relevant to iron supplementation.
A social marketing program promoting weekly iron-folic acid supplementation improved hemoglobin levels in women of reproductive age in Cambodia. Supplementation was increasingly effective among women of higher socioeconomic status (SES). Among higher SES schoolgirls, 58% took the supplements, compared with 49% for lower SES (P = 0.07). Garment factory workers with an 11th- or 12th-grade education had a mean improvement in hemoglobin of 0.72 g/dL over those with a 5th-grade education or less (P = 0.04). The percentage of rural village women taking supplements increased with increasing SES (linear trend P = 0.046). These results suggest that women with lower SES be given special attention for future programs.
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