Antenatal iron and folic acid supplementation use by pregnant women in Khartoum, Sudan

Routine uptake of prenatal iron-folic acid supplementation and associated factors among pregnant women in peri-urban areas of Dodoma City, Tanzania: a cross-sectional study

BACKGROUND

The physiological requirements for iron and folic acid in pregnancy are a significant challenge to achieve through normal dietary intake, especially in low resource settings. The World Health Organization recommends daily oral iron and folic acid supplementation (IFAS) to prevent maternal anaemia and related adverse effects in community settings where the prevalence of anaemia during pregnancy is > 40%. The objective of this study was to assess the routine uptake of prenatal iron-folic acid supplementation and associated factors among pregnant women at peri-urban areas of Dodoma City, Tanzania.

METHODS

A cross-sectional study was conducted in peri-urban areas. Data was collected through face-to-face interviews and review of records from maternal clinic card (RCH 4 card). Routine uptake of iron-folic acid supplementation was defined as pregnant woman who reported taking iron-folic acid supplements at least once within the past seven days prior to data collection. Frequency and percentage were used to report respondents' characteristics and uptake of prenatal iron-folic acid supplementation. Chi-square test and logistic regression were conducted to determine the relationship and association of routine uptake of iron-folic acid supplementation with respondents' characteristics.

RESULTS

The total respondents were 452. Overall routine uptake of iron-folic acid supplementation was 35.6% (161). The majority of the respondents (66.5%) initiated iron-folic acid supplementation during the second trimester of pregnancy. Most of the respondents (86.3%) obtained IFA supplements at the health centers where they were receiving antenatal care. The prevalence of routine uptake of iron-folic acid supplementation was significantly higher among women in the third trimester of pregnancy (54.9%), those with more than a five-year interval since last pregnancy (40.6%), those with at least four antenatal care (ANC) visits (73.7%) and women who had undergone haemoglobin testing in the current pregnancy (63.0%). Factors associated with routine uptake of iron-folic acid supplementation were; frequency of ANC visits (AOR = 1.69) and haemoglobin testing (AOR = 3.02).

CONCLUSION

Approximately one third of the pregnant women took iron-folic acid supplementation at least once a week. The current frequency for intake of iron-folic acid supplementation can be described as intermittent. This practise is unacceptable for prevention of maternal anaemia and associated adverse pregnant outcomes. Frequency of ANC visits and haemoglobin testing during pregnancy were found to be associated with routine uptake of iron-folic acid supplements. Stakeholders are urged to consider novel systems for provision of prenatal IFAS in community settings with limited access to health-care professionals to ensure a timely and continuous supply of supplements.

Community-based nutrition education and counselling provided during pregnancy: effects on knowledge and attitude towards iron-folic acid supplementation

Maternal malnutrition is pervasive throughout the world, notably in sub-Saharan Africa, including Ethiopia. This study examined the effect of community-based iron-folic acid supplementation (IFAS) nutrition education on IFAS knowledge and attitude among pregnant women in urban settings in South Ethiopia. A community-based quasi-experimental study was conducted among 198 randomly selected pregnant women attending antenatal care (ANC) (99 intervention and 99 control). We used a multistage sampling technique followed by systematic sampling to select the pregnant women. Pregnant women who participated in the intervention arm received six nutrition education sessions and counselling using a health belief model (HBM), while the control group received only routine ANC services. Baseline and endline data were collected during the ANC and compared. The data was analysed using statistical package for social sciences. Analyses of the effect of the intervention were done using difference-in-difference and generalised estimation equation to allow correlation of repeated observations over time. The results indicated a significant effect of intervention on maternal knowledge towards IFAS; with intervention, group levels increased by 35 percentage points (P < 0.001). The odds of being knowledgeable at the endpoint in the intervention group were 2.6 times higher than baseline (OR = 2.67, 95% CI 1.88-3.80). There was a significant (P = 0.001) change in proportion with a favourable attitude towards IFAS between the two time points. The community-based nutrition education intervention approach has significantly improved maternal knowledge and a favourable attitude towards IFAS among pregnant women. The HBM is effective in improving knowledge and attitude among pregnant women.

Is Oral Iron and Folate Supplementation during Pregnancy Protective against Low Birth Weight and Preterm Birth in Africa? A Systematic Review and Meta-Analysis

BACKGROUND

Despite recent evidence demonstrating iron and folate supplementation reduces the risk of low birth weight and preterm births, synthesis of the evidence is not sufficient to understand their impacts in Africa.

METHOD

MEDLINE, PsycINFO, Embase, Scopus, CHINAL, Web of Science, Cochrane databases, and Google Scholar were searched for the published and grey literature. Either iron-only, folate-only, or iron-folic acid (IFA) oral supplementation during pregnancy was the primary exposure/intervention. The focus of this review was low birth weight and preterm births in the African region. Qualitative synthesis, meta-analysis, and subgroup analysis were employed.

RESULTS

In the qualitative synthesis (n = 4), IFA supplementation showed a positive impact on reducing preterm birth. Additionally, the meta-analysis showed that IFA and iron-only supplementation reduced the odds of low birth weight by 63% (OR 0.37; 95% CI: 0.29, 0.48) and 68% (OR 0.32; 95% CI: 0.21 to 0.50), respectively.

CONCLUSION

Both iron-only and IFA supplementation are effective in reducing the risk of low birth weight in Africa. There is also promising evidence suggesting a potential reduction in preterm births. Consequently, further research is needed, particularly targeting high-risk groups such as women residing in rural areas with limited support and low levels of literacy.

Utilization of iron-folic acid supplementation and related factors in pregnant women in Leka Dulecha District, East Wollega Zone, Western Ethiopia: The case study

Background

To treat neural tube closure abnormalities and maternal anemia during pregnancy, iron and folic acid (FA) supplements are typically necessary. Ethiopian Ministry of Health plan to increase the numbers of pregnant women who take iron and FA supplements from 11% to 50%, and by 2029, to 90% by 2024.

Aim

Hence, the main objective of this study was to investigate the degree of iron-folic acid supplementation (IFAS) and associated factors among pregnant women receiving antenatal care at Leka Dulecha Woreda public health facilities from May 1 to October 31, 2022.

Methods

In this study, about 316 pregnant women who visited Leka Dulecha prenatal care services were selected. A facility-based cross-sectional study was conducted. Multivariable logistic regression was utilized to examine parameters associated with the utilization of IFAS.

Results

These findings suggest that maternal educational status (adjusted odds ratio, AOR = 2.00, 95% confidence interval, CI [1.5, 3.05]), the timing of the first prenatal consultation (AOR = 1.93, 95% CI [1.47, 2.62]), having a good understanding of anemia (AOR = 1.50, 95% CI [1.00, 2.11]), and a history of anemia during the current pregnancy (AOR = 1.60, 95% CI [1.11, 3.16]) are important factors to consider when promoting adherence to iron-FA supplementation among pregnant women.

Conclusion

It is crucial for healthcare providers to address these factors to improve the overall health outcomes for pregnant women attending Leka Delecha Health Facility.

Periconceptional folic acid usage and its associated factors in eastern Sudan: A cross-sectional study

BACKGROUND

Several countries poorly adhere to the World Health Organization's recommendation of folic acid supplementation in the periconceptional period, especially in limited-resource settings.

OBJECTIVE

The objective of this study was to investigate the prevalence of and the factors associated with folic acid usage in the periconceptional period among pregnant women at Gadarif Maternity Hospital in eastern Sudan.

STUDY DESIGN

This is a cross-sectional study.

METHODS

This study was conducted in eastern Sudan from April to September 2022. A total of 720 pregnant women in their first trimester were enrolled. The sociodemographic characteristics and clinical and obstetrical data of pregnant women in their first trimester were assessed using a face-to-face questionnaire. In addition, multivariate regression analysis was performed.

RESULTS

In this study, the median (interquartile range) of the age and gravidity of the enrolled women was 26.3 (24.14-29.52) years and 2 (1-4), respectively. Of these 720 women, 423 (58.8%) used folic acid during the periconceptional period, while 27 (3.7%) women used folic acid in the preconceptional period. None of the investigated factors (age, residence, education, employment, body mass index, or gravidity) were associated with periconceptional use of folic acid.

CONCLUSION

The study revealed a low prevalence of folic acid usage in preconceptional period among pregnant women in eastern Sudan. Additional efforts are needed to promote folic acid usage in the preconceptional period as well as in the first trimester.

Telephonic intervention to combat non-adherence to oral iron-folic acid supplementation in pregnancy: A randomized controlled trial

Introduction

Iron deficiency anemia is a public health problem globally attributing to high incidences of maternal and infant mortality and morbidity. Iron and folic acid supplementation (IFAS) is essential and provided free of cost by the public health sectors, however, a systematic review shows that the national-level adherence to oral Iron-Folic Acid Supplementation (IFAS) is less than half in pregnant women, and the significant obstacles to non-adherence are fear of side effects and forgetfulness. This trial was designed to mitigate the side effects and tackle forgetfulness with telephonic intervention. The objectives were to investigate the effectiveness of the telephonic intervention on oral IFAS adherence and hemoglobin and the reasons for non-adherence to oral IFAS, to find out the proportion of anemia in the study population, and to assess the effectiveness of the intervention on maternal and neonatal outcomes.

Methods

Hospital-based open-label multi-centric parallel-group randomized controlled trial, used block randomization and allocated treatment in a 1:1 ratio recruited 286 anemic pregnant women between 14 and 24 weeks of gestation with hemoglobin level < 11 g/dl having smartphones at a secondary hospital and a tertiary hospital in Eastern India. The experimental group received telephonic intervention for one month via structured text reminders, WhatsApp audio messages, and phone calls. The standard course of treatment was given to the control group.

Results

286 women (n1 =143, n2 =143) were randomized, 36 had attrition leaving 250 for analysis (n1 =123, n2 =127), the experimental group experienced a 44.9 % and the control group 13.8 % increase in adherence (P < 0.001). The leading reasons for non-adherence were forgetfulness (24 %), nausea and vomiting (23.2 %), and constipation (18.8 %). Hemoglobin level increased by 0.8 g/dl (P < 0.001) in the experimental group and 0.2 g/dl (P < 0.807) in the control group.

Conclusion

In addition to improving adherence to oral IFAS, telephonic intervention mitigates side effects and enhances hemoglobin in anemic pregnant women. The increase in adherence was threefold in the experimental group compared to a marginal rise in the control group. This study recommends the implementation of a telephonic intervention to promote adherence to oral IFAS among anemic pregnant women.

Antenatal Care Services in Sudan Before and During the 2023 War: A Review Article

Antenatal care (ANC) is provided by skilled healthcare professionals to pregnant women to ensure the best health conditions for both mother and baby during pregnancy. It includes risk identification, prevention, management of pregnancy-related diseases, health education, and health promotion. Antenatal care has a great effect on vital health indicators such as maternal and neonatal mortality by identifying and treating pregnancy-related complications. Political instability and armed conflict have seriously affected the health system, which has catastrophic implications for pregnant women's health. This review aimed to summarize the literature on ANC in Sudan before and during political instability and war by highlighting its effect on maternal mortality, coverage, care providers, quality of care, accessibility, and utilization. Other aspects of this review are the ANC components and service provision during the war. In addition, the author tried to identify the gaps and point out the future research needs in Sudan. A total of 58 articles about ANC in Sudan have been reviewed through PubMed, Google Scholar, ResearchGate databases, and other search tools. The keywords used were "antenatal care", "coverage", "service providers", "service quality", "accessibility and utilization", "components", and "ANC during the war". All the keywords were followed by "Sudan" to confine the search. According to the reviewed data, ANC services in Sudan, even during normal political situations, were not sufficient and of poor quality in most of the reviewed regions. The political instability and armed conflicts worsened the situation, and it became catastrophic. To improve the accessibility and quality of ANC services, we will need the collaboration of all stakeholders to address the health needs of vulnerable groups, people in remote rural areas, and nomadic communities towards providing the required health services in general and ANC in particular. On the other hand, an important aspect of this development is the availability of skilled healthcare providers and the adoption, revision, and updating of working procedure guidelines to match the needs of the local communities. The main shareholders are the local communities; they must be empowered and involved by raising their awareness. Then, effective, punctual, and applicable contingency plans should be ready for any unfortunate crises.

Level and factors associated with compliance to iron-folic acid supplementation among pregnant women in rural Soro district, Hadiya Zone, Ethiopia: cross-sectional study

BACKGROUND

Despite the advantages of iron and folic acid supplementation, the compliance status among pregnant women for the supplements is very low in Ethiopia. However, the factors found to be associated with the compliance of iron and folic acid supplementation varies depending on geographical locations and socio-cultural characteristics within the country. Therefore, this study assessed the compliance to iron and folic acid supplements and its associated factors among pregnant women in the rural Soro district, Hadiya Zone, Southern Ethiopia.

METHODS

Cross-sectional study design was applied to conduct the study. The total sample size was 274. This study was conducted from June 10 up to 20, 2018. Women who live in rural Soro district at least for 6months and gave live birth 12 months prior to the survey were included in the study. The study subjects were selected by applying the simple random sampling method. Independent variables with p-value less than or equal to 0.25 during bivariate analysis were candidate for multivariable analysis. Finally, during multivariable analysis the independent variables with P-value less than 0.05 were declared as factors significantly associated with compliance to iron-folic acid supplementation during pregnancy.

RESULTS

Of the whole study participants only 51(18.8%) women had taken iron folic acid supplements for at least 90 days during their last pregnancy. Women who had frequent visits to health facilities for ante natal care were more likely to be compliant with iron-folic acid supplements than their counterparts [AOR(95%CI) = 4.50(1.18, 17.14)].

CONCLUSION

In this study, the higher proportion of pregnant women did not take adequate dose of iron and folic acid tablets during their last pregnancy. Women who had a frequent visit to health facilities for antenatal care were more likely to be compliant for iron folic acid supplements than their counterparts. Every effort should be made in the community and health facilities by concerned bodies working in the maternal health area to mobilize pregnant women to take the antenatal care for at least four times to achieve the minimum dose of iron and folic acid supplements.

Adherence to Iron-Folic Acid Among Pregnant Women Attending Antenatal Care in Southern Ethiopia, 2022

Background

Among the micronutrient deficiencies, iron and folic acid are the most common and frequently occur in pregnant women. So, the objective of this study was to assess the adherence to iron and folic acid among pregnant women booking antenatal services in the study area.

Materials and Methods

A facility-based cross-sectional study design was used from January to April 2022. A structured questionnaire was used to collect data using systematic sampling techniques to approach 339 pregnant women. Data were entered and analyzed using SPSS software version 20. A descriptive analysis was performed. Adjusted odds ratios and corresponding 95% confidence intervals (CIs) were used, and statistical significance was reported at p-values <0.05 with 95% confidence.

Results

In this study, 339 (99%) pregnant women participated. The mean age of the respondents was 28.04 years old, with a standard deviation of 5.3 years. The rate of adherence to iron and folic acid supplementation (IFAS) in pregnant women was 62.8%. Mothers under 19 years old (adjusted odds ratio [AOR] = 0.025; 95% CI [0.003-0.218]), daily (AOR = 0.127; 95% CI [0.028-0.568]), and those with a history of miscarriage (AOR = 0.276; 95% CI [0.086-0.891]) were less likely to be using IFAS. However, greater knowledge of IFAS was positively correlated with use of the supplements (AOR = 5.56; 95% CI [1.23-8.34]).

Conclusions

In this study, the adherence rate with IFAS of pregnant women in the study area was 62.8%. This indicates that one in four women is not in compliance with IFAS. Appropriate counseling and health education should be provided to pregnant women to improve compliance.

What Makes Bangladeshi Pregnant Women More Compliant to Iron-Folic Acid Supplementation: A Nationally Representative Cross-Sectional Survey Result

BACKGROUND

Iron-Folic Acid Supplementation (IFAS) is an effective strategy to prevent iron deficiency anemia during pregnancy. We aimed to explore the key factors associated with compliance to IFA tablets in Bangladesh.

METHODS

This study analyzed the 2017-2018 Bangladesh Demographic and Health Survey data of 3828 pregnant women aged 15-49 years. We categorized compliance into two categories; at least 90 days and full 180 days of consumption. We performed multivariable logistic regression to identify the association between key factors and IFAS compliance.

RESULTS

The prevalence of consumption of IFA tablets for at least 90 days was 60.64%, and only 21.72% of women consumed the IFA for the full 180 days. About three-quarters of the women (73.36%) having at least four antenatal care visits (ANC) consumed IFA for at least 90 days, whereas only three in ten women (30.37%) consumed IFA for a minimum of 180 days. For compliance with IFA for at least 90 days, respondent's age of 20-34 years (aOR 1.26, 95% CI 1.03-1.54), respondent's educational qualification of secondary (aOR 1.77, 95% CI 1.16-2.70) or higher (aOR 2.73, 95% CI 1.65-4.53), husband's educational qualification of secondary (aOR 1.33, 95% CI 1.00-1.77) or higher (aOR 1.75, 95% CI 1.22-2.52), and having received at least four antenatal care (ANC) visits from medically skilled providers (aOR 2.53, 95% CI 2.14-3.00) were significantly associated with higher odds of compliance. For compliance with IFA for at least 180 days, respondent's educational qualification of higher (aOR 2.45, 95% CI 1.34-4.48), and having received at least four ANC visits from medically skilled providers (aOR 2.43, 95% CI 1.97-3.00) were significantly associated with higher odds of compliance. Intimate partner violence was negatively associated with compliance with IFA for at least 180 days (aOR 0.62, 95% CI 0.48-0.81).

CONCLUSIONS

The full compliance to IFAS is still sub-optimal in Bangladesh. Further precise context-specific intervention strategies must be developed and implemented with fidelity.

Local conceptions of the role of folate in neural tube defects in Zambia

OBJECTIVE

In sub-Saharan Africa, neural tube defects (NTDs) are the second most common birth defect, occurring eight times more frequently than in the US. The objective of this study was to assess baseline Zambian caregiver understanding of folate and NTDs and the effectiveness of an NTD prevention educational program.

METHODS

This prospective survey-based study included Zambian caregivers of children born with NTDs who completed pre- and post-educational program surveys between January 2020 and January 2021. The verbal survey was administered in English or local Zambian dialects. The 1-hour educational program administered by local Zambian research nurses sought to facilitate understanding of the direct relationship between prenatal folate supplementation and NTDs.

RESULTS

Sixty-one eligible caregivers with a median age of 20 (IQR 24-29) years completed the survey. Participants were predominantly from regions outside of Lusaka Province (68%, 41/60) rather than the capital city, Lusaka (32%, 19/60). Most had received prenatal care (91%, 57/61), and 80% (47/59) reported folate use in pregnancy. Of the mothers who took folate during pregnancy, 24% (11/45) reported use within the first 4 weeks after conception, while 76% (34/45) started thereafter. Myelomeningocele was the most common NTD (74%, 32/43), followed by meningocele (14%, 6/43). Prior to the educational program, 52% (29/56) of caregivers reported that NTDs were caused by a vitamin deficiency, which improved to 98% (55/56) after the program (p < 0.001). Furthermore, only 54% (33/61) of caregivers believed that folate should be taken before conception on the baseline survey evaluation, which improved to 95% (58/61, p < 0.001) after the program. All survey participants (58/58) found the educational session helpful.

CONCLUSIONS

This study found that a high proportion of Zambian caregivers had received prenatal care and even had taken folate during pregnancy, but none had taken it prior to pregnancy. An educational program effectively improved understanding about the role and timing of perinatal folate administration in NTD prevention. This result also emphasizes the need for folate fortification and folate education for not only mothers but also primary care providers.

Prevalence and Associated Risk Factors for Anemia in Pregnant Women in White Nile State, Sudan: A Cross-Sectional Study

Introduction

Anemia during pregnancy can lead to several adverse maternal and perinatal outcomes. Despite preventive measures, anemia during pregnancy remains a threatening health problem, especially in sub-Saharan African countries.

Objective

We aimed to determine the prevalence of, and factors associated with, anemia among pregnant women at Rabak Maternity Hospital, Sudan.

Methods

We conducted a cross-sectional study involving pregnant women who presented to Rabak Maternity Hospital from September to December 2021. Questionnaires were completed via face-to-face interviews to gather both obstetric and sociodemographic information (i.e., age, parity, history of miscarriage, education, level of antenatal care), and hemoglobin levels were estimated. A logistic regression analysis was performed.

Results

The median (interquartile range) of the age and parity of the 208 women enrolled in the study was 25 (21.0-30.0) years and 2 (1-4), respectively. Forty-five (21.6%) women did not use iron-folic acid during the index pregnancy. Eighty-eight (42.3%) women had anemia, and four (1.9%) had severe anemia. In the univariate analysis, age, parity, history of miscarriage, interpregnancy interval, education, and antenatal care level were shown not to be associated with anemia. A higher number of women with anemia did not use iron-folic acid during the index pregnancy than those without anemia (29/80 [33.0%] vs. 16/120 [13.3%], respectively, p = .001). Not taking iron-folic acid was found to be associated with anemia in the multivariate analysis (adjusted odds ratio = 3.19, 95% confidence interval = 1.60-6.63).

Conclusion

Anemia was found to be a major health problem among the pregnant women in this study. There is no clear evidence across the women with anemia that their anemia stems from lack of using iron-folic acid (in fact, some women used iron-folic acid and they were anemic). There is a possibility that using iron-folic acid may prevent anemia in this part of Sudan.

Adverse Pregnancy Outcomes in Sickle Cell Trait: a Prospective Cohort Study Evaluating Clinical and Haematological Parameters in Postpartum Mothers and Newborns

Background

Sickle cell trait (SCT) is a congenital condition caused by the inheritance of a single allele of the abnormal haemoglobin beta gene, HbS. Carriers of SCT are generally asymptomatic, and they do not manifest the clinical and haematological abnormalities of sickle cell anaemia (SCA). However, there is evidence that they display some symptoms in stressful situations. Pregnancy is a stressful physiological event, and it is not clear if SCT adversely affects pregnancy outcomes, particularly in those from developing countries where people regularly suffer from nutritional insufficiency.

Objective

This study aims to investigate pregnancy outcomes in Sudanese women with SCT. Subjects and methods: Pregnant women with (HbAS, n=34) and without (HbAA, n=60) SCT were recruited during their first trimester at El Obeid Hospital, Kordofan, Western Sudan. Following appropriate ethical approval and informed consent from the participants, detailed anthropometric, clinical, haematological, obstetric, and birth outcome data were registered. In addition, blood samples were collected at enrolment and at delivery.

Results

At enrolment in the first trimester, the SCT group did not manifest SCA symptoms, and there was no difference in the haematological parameters between the SCT and control groups. However, at delivery, the women with SCT, compared with the control group, had lower levels of hemoglobin (Hb, p=0.000), packed cell volume (PCV, p=0.000), mean corpuscular haemoglobin (MCH, p=0.002) and neutrophil counts (p=0.045) and higher mean corpuscular volume (MCV, p=0.000) and platelet counts (p=0.000). Similarly, at delivery, the babies of SCT women had lower birth weight (p=0.000), lower Hb (p=0.045), PCV (p=0.000), MCH (p=0.000), and higher neutrophil (p=0.004) and platelet counts (p=0.000) than the babies of the healthy control group. Additionally, there were more miscarriages, stillbirths, and admissions to the Special Care Baby Unit (SCBU) in the SCT group.

Conclusions

The study revealed that SCT is associated with adverse pregnancy outcomes, including maternal and neonatal anaemia, low birth weight, and increased risk of stillbirth, miscarriage, and admission to SCBU. Therefore, pregnant women with SCT should be given appropriate pre-conceptual advice and multidisciplinary antenatal and postnatal care.

A Systematic review of factors affecting compliance toward oral iron-folic acid supplementation among pregnant women in India

Background: Iron-folic acid deficiency is the most common complication during pregnancy. Iron deficiency is responsible for various health complications among pregnant women. Compliance with IFA supplementation is variable across India several factors are associated with compliance with IFA supplementation. Objective: The objective of this systematic review is to assess the factors affecting compliance toward oral iron-folic acid supplementation among pregnant women in India. Methods: The primary search was carried out using PubMed, Google scholar, the WHO website, and Research Gate which provide access to full?text research articles from January 2012 to 25th January 2022 published data were searched. Result: A total of 74 studies were identified, and 20 were included in this review. Out of the 20 studies, sixteen were cross-sectional, two mixed methods, and two randomized control trials. knowledge of IFA, education, socioeconomic status, the timing of registration and number of antenatal visits, type of family, and age of the pregnant women were the factors that affect the compliance of IFA supplementation. Conclusion: Knowledge of iron-folic acid supplementation, Timing of registration and number of Antenatal Care visits, educational level of the pregnant women, and age of the pregnant women were factors associated with the compliance of IFA supplementation among pregnant women in India.

Prevalence of anaemia and its associated factors among lactating mothers in eastern Sudan: a cross-sectional study

BACKGROUND

Lactating mothers are susceptible to anaemia. Little published data are available on lactational anaemia in Africa, including Sudan. This study was conducted to assess the prevalence of and associated factors for anaemia among lactating mothers in eastern Sudan.

METHODS

A cross-sectional study was conducted and sociodemographic and clinical characteristics were gathered through a questionnaire.

RESULTS

A total of 650 lactating mothers were included in the analysis. Their median age and parity were 28.0 y (interquartile range [IQR] 23.7‒32.0) and 3.0 (IQR 2.0‒4.0), respectively. Haemoglobin (Hb) levels ranged from 7.0 to 15.0 g/dL (median 11.2 [IQR 10.4‒12.0]). Of the 650 lactating mothers, 442 (68.0%) had anaemia (Hb <12.0 g/dL). In multivariate analysis, lactating mothers with education less than the secondary level (adjusted odds ratio [AOR] 1.58 [95% confidence interval {CI} 1.05 to 2.37]) and lactating mothers who underwent caesarean delivery (AOR 1.74 [95% CI 1.17 to 2.58]) had a higher probability of being anaemic. Employment was associated to a lower frequency of anaemia (AOR 0.39 [95% CI 0.20 to 0.79]).

CONCLUSIONS

This study showed a high prevalence of anaemia among lactating mothers. Public health intervention activities designed towards education would be helpful to reduce anaemia.

Higher Dietary Intake of Animal Protein Foods in Pregnancy Is Associated with Lower Risk of Adverse Birth Outcomes

BACKGROUND

The prevalence of adverse birth outcomes is highest in resource-limited settings such as sub-Saharan Africa. Maternal consumption of diets with adequate nutrients during pregnancy may protect against these adverse outcomes.

OBJECTIVES

The objective was to determine the association between maternal dietary consumption of animal source foods (ASFs) and the risk of adverse birth outcomes among HIV-negative pregnant women in Tanzania.

METHODS

Using dietary intake data from 7564 HIV-negative pregnant women, we used Poisson regression with the empirical variance (generalized estimating equation) to estimate the RR of adverse birth outcomes-preterm birth, very preterm birth, small for gestational age (SGA), low birth weight (LBW), stillbirth, and neonatal death-for higher and lower frequency of ASF intake.

RESULTS

Median daily dietary intake of animal protein was 17 g (IQR: 1-48 g). Higher frequency of ASF protein intake was associated with lower risk of neonatal death (quartile 4 compared with quartile 1; RR: 0.59; 95% CI: 0.38, 0.90; P-trend = 0.01). Higher fish intake was associated with lower risk of very preterm birth (high tertile compared with low; RR: 0.76; 95% CI: 0.58, 0.99; P-trend = 0.02). Any meat intake was protective of preterm birth (RR: 0.73; 95% CI: 0.65, 0.82; P < 0.001), very preterm birth (P < 0.001), LBW (P < 0.001), and neonatal death (P = 0.01) but was associated with increased risk of SGA (RR:1.19; 95% CI: 1.01, 1.36; P = 0.04). Any egg intake was protective of very preterm birth (RR: 0.50; 95% CI: 0.31, 0.83; P = 0.01) as compared with no egg intake. Finally, any dairy intake was associated with lower risk of preterm birth (RR: 0.82; 95% CI: 0.68, 0.98; P = 0.03) and very preterm birth (RR: 0.53; 95% CI: 0.34, 0.84; P = 0.01).

CONCLUSIONS

Higher frequency of dietary intake of ASF is associated with lower risk of adverse birth outcomes in urban Tanzania. Promoting prenatal dietary intake of ASF may improve birth outcomes in this region and similar resource-limited settings.

Integrating Women and Girls' Nutrition Services into Health Systems in Low- and Middle-Income Countries: A Systematic Review

Women's nutrition has been highlighted as a global priority to ensure the health and well-being of both them and future generations. This systematic review summarises the available literature on the integration of nutrition services for girls and women of reproductive age (GWRA) into existing public health systems across low- and middle-income countries, as well as any barriers to integration. We searched PubMed and Cochrane Database of Systematic Reviews for articles published since 2011 according to eligibility criteria. A total of 69 articles were included. Evidence suggested that several services for GWRA are well integrated into public health systems, including antenatal care services, nutrition education and counselling, and micronutrient supplementation programmes. However, there was limited evidence on the integration of family planning, adolescent health, and reproductive health services. Barriers to integration fell into five main themes: lack of training and capacity building, poor multisectoral linkages and coordination, weak advocacy, lack of M&E systems, and inequity. We identified a lack of evidence and services for non-pregnant GWRA and for women postpartum. Addressing barriers to integration and gaps in nutrition services for GWRA would increase service coverage and contribute to improving health outcomes for GWRA and future generations.

Compliance level and factors associated with iron-folic acid supplementation among pregnant women in Dangila, Northern Ethiopia: A cross-sectional study

Objectives

Iron-folic acid non-compliance is a major problem in the study area. Therefore, this study aimed to assess the level of iron-folic acid supplementation compliance and associated factors among pregnant women.

Methods

A community-based cross-sectional study design was conducted among pregnant women from 1 to 30 November 2018 in Dangila, Northern Ethiopia. A multi-stage sampling technique was used to select the participants. The data were collected using a structured questionnaire. For data entry and analysis, Epi Info 7 and Statistical Package for Social Science (SPSS) 23.0 were used, respectively. Bivariable and multivariable logistic regression analyses were done. Descriptive statistics like mean and standard deviation, and odds ratios with their respective confidence intervals were calculated. Statistically significant was declared at a p value of less than 0.05. The results were presented using text, tables, and figures.

Results

A total of 589 pregnant women were involved, yielding a response rate of 91.2%. The average age of the participants in the study was 30.90 ± 5.93 years. The average weekly iron-folic acid pill intake was 5.3. The iron-folic acid compliance rate was 76.9% (95% confidence interval: 73.5-80.6). Women who had four or fewer alive children (adjusted odds ratio = 2.68, 95% confidence interval: 1.37-5.23), took less than 30 min to get to the health facility (adjusted odds ratio = 1.90, 95% confidence interval: 1.16-3.10), being a government employee (adjusted odds ratio = 0.16, 95% confidence interval: 0.03-0.81), attended antenatal care conferences (odds ratio = 2,95% confidence interval: 1.16-3.42), and started iron-folic acid tablets in the first trimester (odds ratio = 2.3, 95% confidence interval: 1.39-3.87) were associated with iron-folic acid compliance.

Conclusion

The level of iron-folic acid supplementation compliance was low. Attending antenatal care training and starting to take iron-folic acid pills early in the first trimester were both factors associated with iron-folic acid supplementation compliance. Health care and health extension workers should emphasize and monitor the iron pill-taking habits of pregnant women in home-to-home visits.

Magnitude and factors associated with iron supplementation among pregnant women in Southern and Eastern Regions of Ethiopia: Further Analysis of mini demographic and health survey 2019

Background

Anemia is a global public health problem that affects pregnant women. The most common cause of anemia is iron deficiency which is extremely common in developing countries. World health organization reported that 36.5% of pregnant women are anemic globally. In Ethiopia, 27.08% of women of the reproductive age group are anemic. Therefore, this study aimed to identify the magnitude and factors associated with iron supplementation during pregnancy in the southern and eastern regions of Ethiopia.

Methods

The data used in this analysis were extracted from Mini Demographic and Health Survey 2019. The survey was conducted in 9 regional states and two city administrations. The data used in the analysis were extracted from individual women datasets, and 1780 study participants were included in this study. The logistic regression analysis including bivariate and multivariable logistic regression at a 95% confidence interval and a p-value less than 0.05 was used.

Result

The finding of the study shows that iron supplementation during pregnancy in Southern and Eastern parts of Ethiopia was 50.06%. Among those who received iron, only about 20% took it for 90 days and more during their pregnancy. Iron supplementation among the pregnant women was affected by secondary education [AOR = 2.20, 95%CI (1.325, 3.638)], residing in urban [AOR = 1.75, 95%CI (1.192, 2.574)], having media at home [AOR = 1.41, 95%CI (1.022, 1.946)], having antenatal care follow up [AOR = 9.27, 95%CI (4.727, 18.169)], having 4 and more ANC follow up [AOR = 2.01, 95%CI (1.468,2.760], having antenatal care follow up at government health institutions [AOR = 3.40, 95%CI (1.934, 5.982)], and giving birth at governmental health institutions [AOR = 1.70, 95%CI (1.236, 2.336)].

Conclusion

Only one in two pregnant women was supplemented with iron during their recent pregnancy. The supplementation was affected by women's education, place of residence, presence of media at home, antenatal care follow-up, the number of antenatal care follow up, antenatal care follows up at governmental health institutions, and giving birth at the governmental health institution. The availability and accessibility of maternal care services and their functionality in providing maternal care services improve the supplementation.

Hemoglobin and Red Blood Cells Count in Pregnant Sudanese Women

The study discussed the physiological changes of pregnancy in Sudanese pregnant women the study aimed to assess the effect of pregnancy in Red blood cell, Packed Cell Volume (PCV) and hemoglobin among Sudanese pregnant women, and to correlate the PCV as an indicator of hemodilution in different trimesters among Sudanese women using or not using iron and folic acid supplement. The researcher used across sectional study which applied on 300 pregnant women presented to Port-Sudan obstetrical Hospital for antenatal care from 2019 to 2020. The samples were collected with Chemically clean and sterile disposable needles, syringes and swab were used for all blood samples, 4.5 mL of blood was collected from each participant into a tube containing the anticoagulant Ethylene Diamine Tetraacetic Acid (EDTA), gently mixed the tube five to six times A full blood count was performed using Hematological analyzer (Sysmex XP 300). The study found out that 90 women in each trimester of pregnancy (first, second and third) the mean value of Hemoglobin (Hb) in pregnant women was 11.3±1.4 g/dl, 11.4 ±1.4 g/dl and 10.3±1.2 g/dl in 1st, 2nd and 3rd trimester respectively. The study also found out that the mean value of PCV was 33.35%. Moreover, Hb was lower during 3rd trimester compared with 1st (hemodilution). The cut off level for anemia in Sudanese non pregnant females could be even lower than 11g/dl as the normal level was found to be lower than the international one. Due to hemodilution anemia in pregnancy is considered if Hb less than 9g/dl. The study recommends that diagnosis of anemia should be revised during pregnancy as this study has shown Hb level less than 9g/dl (66%) can be the cut off level.

Geographical variations and determinants of iron and folic acid supplementation during pregnancy in Ethiopia: analysis of 2019 mini demographic and health survey

Background

One of the packages of critical antenatal care treatments for pregnant women includes iron and folic acid (Fe/FA) supplementation. Using recently available and nationwide representative survey data, this study aimed to determine the spatial patterns and drivers of Fe/FA supplementation during pregnancy.

Method

The data for this study was obtained from Ethiopia’s 2019 Mini Demographic and Health Survey (EMDHS). We used the Kid’s Record (KR) dataset, and a total weighted sample of 3926 reproductive-age women who gave birth within the previous 5 years was used as the study’s final sample size. To analyze the spatial distributions (geographic variation of Fe/FA supplementation) different statistical software like Excel, ArcGIS, and Stata 14 were used. A two-level multilevel binary logistic regression model was fitted to identify both individual and community-level factors associated with Fe/FA supplementation during pregnancy.

Result

This study found that there were significant geographical variations of iron and folic acid supplementation across Ethiopia, eastern and southern parts of the country were predicted to have low Fe/FA supplementation coverage. Advanced maternal age (AOR = 0.75: 95%CI: 0.59 0.96), resides in developing region (AOR = 0.57, 95%CI: 0.43 0.74), not attended formal education (AOR = 0.60, 95%CI: 0.39 0.92), middle (AOR = 1.51, 95%CI: 18 1.93) and rich wealth status (AOR = 1.48, 95%CI: 1.15 1.91), and four and above ANC visits (AOR = 4.35 95%CI: 3.64 5.21) were determinants of iron and folic acid supplementation among pregnant women.

Conclusion

Our research found that there were geographical variations across the country, with low coverage seen in Ethiopia’s eastern and southern regions. Iron and folic acid supplementation coverage were inadequate among pregnant women with low education, advanced maternal age, and those from underdeveloped countries. Conversely, increasing iron and folic acid uptake was associated with higher socioeconomic class and four or more ANC visits. The findings of this study highlight the importance of increasing maternal health care, such as iron and folic acid supplements, for underserved populations.

Adherence to Iron and Folic Acid Supplementation (IFAS) intake among pregnant women: A systematic review meta-analysis

OBJECTIVE

Adherence to iron and folic acid supplementation represents a significant factor contributing to the prevention and treatment of anaemia in pregnancy. However, limited studies have systematically investigated iron and folic acid supplementation adherence among pregnant mothers using a global perspective. We aimed to systematically identify iron and folic acid supplementation adherence and associated factors among pregnant women.

DESIGN

For this systematic review and meta-analysis, we did a systematic search of Academic Search Complete, CINAHL, MEDLINE, PubMed, and Web of Science from inception to October 20, 2020. We included all cohort, case-control, and cross-sectional studies and used the Joanna Briggs Institute tool to assess study quality. A meta-analysis was performed to synthesise the pooled odds ratio for iron and folic acid supplementation adherence using a random-effects model. Heterogeneity was measured using the I² statistic, and Egger's test was used to assess publication bias.

MEASUREMENTS AND FINDINGS

Eighteen studies were included in systematic review and meta-analysis, including a total of 5,537 pregnant women. The pooled odds ratio for iron and folic acid supplementation adherence in primipara vs multipara, anaemia vs non-anaemia, knowledgeable vs limited knowledge of anaemia, and knowledgeable vs limited knowledge of iron and folic acid supplementation were 3.91 (95% confidence interval: 1.75-8.75), 1.09 (95% confidence interval: 0.67-1.77), 0.32 (95% confidence interval: 0.15-0.69), and 2.48 (95% confidence interval: 1.13-5.47), respectively.

KEY CONCLUSIONS

This review yielded evidence that having one pregnancy, having anaemia, and having satisfactory knowledge of both anaemia and iron and folic acid supplementation were positively associated with iron and folic acid supplementation adherence.

Individual and community-level determinants of Iron-Folic Acid Intake for the recommended period among pregnant women in Ethiopia: A multilevel analysis

Background

Iron-folic acid (IFA) intake for the recommended period during pregnancy reduces the risk of anemia and congenital anomalies. However, IFA intake for the recommended period is still very low in low-income countries including Ethiopia. Thus, the aim of this study was to assess both individual-and community-level determinants of IFA intake for the recommended period among pregnant women in Ethiopia.

Methods

Data were retrieved from the Demographic and Health Survey program's official database website (http://dhsprogram.com). A two-stage stratified cluster sampling technique was employed to conduct the 2016 Ethiopian Demographic and Health Survey. A sample of 3088 pregnant women who had received at least one dose of IFA in Ethiopia were included in this study. A multivariable multilevel logistic regression analysis model was fitted to identify the determinants of IFA intake below the recommended period [< 90 days] during pregnancy. Akaike's Information Criterion (AIC) was used during the model selection procedure.

Results

This study revealed that 87.6% [95% CI; 86.3%, 88.6%] of the women took IFA below the recommended period during the index pregnancy. After adjusting for the covariates: living in rural areas [AOR = 1.74: 95% CI 1.37, 2.50], and women's illiterate proportion [AOR = 1.43: 95% CI 1.06, 1.70] were community level factors. Whereas, primary education level [AOR = 0.63: 95% CI 0.40, 0.78], poorer wealth index [AOR = 1.53: 95% CI 1.08, 3.09], 4 + antenatal care visits [AOR = 0.43: 95% CI 0.31, 0.69], and receive nutritional counseling during pregnancy [AOR = 0.63: 95% CI 0.37, 0.84] were the individual-level factors of IFA intake below the recommended period during pregnancy.

Conclusions

In this study, nearly nine out of ten pregnant women did not take IFA for the recommended period. Thus, promoting recommended ANC visits, enhancing the quality of nutritional counseling, strengthening the expansion of media, and educate rural women towards the importance of optimal intake of IFA during pregnancy. Besides, the policymakers should design essential strategies based on identified barriers to improve the IFA intake for the recommended period.

Predictors of iron consumption for at least 90 days during pregnancy: Findings from National Demographic Health Survey, Pakistan (2017-2018)

BACKGROUND

Iron supplementation is considered an imperative strategy for anemia prevention and control during pregnancy in Pakistan. Although there is some evidence on the predictors of iron deficiency anemia among Pakistani women, there is a very limited understanding of factors associated with iron consumption among Pakistani pregnant women. Thus, this study aimed to investigate the predictors of iron consumption for at least ≥90 days during pregnancy in Pakistan.

METHODS

We analyzed dataset from the nationally representative Pakistan Demographic Health Survey 2017-2018. The primary outcome of the current study was the consumption of iron supplementation for ≥90 days during the pregnancy of the last birth. Women who had last childbirth 5 years before the survey and who responded to the question of iron intake were included in the final analysis (n = 6370). We analyzed the data that accounted for complex sampling design by including clusters, strata, and sampling weights.

RESULTS

Around 30% of the women reported consumed iron tablets for ≥90 days during their last pregnancy. In the multivariable logistic regression analysis, we found that factors such as women's age (≥ 25 years) (adjusted prevalence ratio (aPR) = 1.52; 95% CI: 1.42-1.62)], wealth index (rich/richest) (aPR = 1.25; [95% CI: 1.18-1.33]), primary education (aPR = 1.33; [95% CI: 1.24-1.43), secondary education (aPR = 1.34; [95% CI: 1.26-1.43), higher education (aPR = 2.13; [95% CI: 1.97-2.30), women's say in choosing husband (aPR = 1.68; [95% CI: 1.57-1.80]), ≥ five antenatal care visits (aPR =2.65; [95% CI (2.43-2.89]), history of the last Caesarian-section (aPR = 1.29; [95% CI: 1.23-1.36]) were significantly associated with iron consumption for ≥90 days.

CONCLUSION

These findings demonstrate complex predictors of iron consumption during pregnancy in Pakistan. There is a need to increase the number of ANC visits and the government should take necessary steps to improve access to iron supplements by targeting disadvantaged and vulnerable women who are younger, less educated, poor, and living in rural areas.

Adherence to prenatal iron–folic acid supplementation and associated factors among pregnant women attending antenatal care services in Dilla town, South Ethiopia

Background:

During pregnancy, due to the physiological and hormonal change, the requirement of iron–folic acid is enhanced. Therefore, the occurrence of iron/folic acid deficiency is relatively high and it is responsible for 95% of anemia during pregnancy.

Objectives:

The aim of this study was to assess adherence to prenatal iron–folic acid supplementation (IFAS) and associated factors among pregnant women attending antenatal care services at public health facilities of Dilla town.

Methods:

Facility-based cross-sectional study design was employed selecting 403 pregnant women attending antenatal care services in three public health institutions of Dilla town. The women were included in the study by simple random sampling. Data were collected by interview and document review. Then it was entered into EPI Data version 3.1 and exported to SPSS version 20 for analysis. Bivariate and multivariate binary logistic regression techniques were used to identify independent predictors. A p-value <0.05 was taken as indication of statistical significance.

Results:

From the total of planned 403 pregnant women, 396 participated in the study, with a response rate of 98.2%. Of these, 172 (43.4%) pregnant women were adhered to IFAS. The study also revealed that history of previous anemia (adjusted odds ratio (AOR) = 1.87; 95% confidence interval (CI): (1.01–3.47); p = 0.04), frequency of antenatal care center (ANC) visits (AOR = 2.51; 95% CI: (1.17–5.37); p = 0.01), knowledge of IFA supplement (AOR = 2.28; 95% CI: (1.36–3.82); p = 0.002), and knowledge of anemia (AOR = 2.30; 95% CI: (1.40–3.77); p = 0.001) were independent predictors of adherence to IFAS.

Conclusion:

The finding of this study showed that less than half of the pregnant women were adhered to IFAS. History of previous anemia, frequency of ANC visits, knowledge of IFA supplement, and knowledge of anemia were the factors associated with adherence to IFA supplement.

Adherence to Iron with Folic Acid Supplementation Among Pregnant Women Attending Antenatal Care in Public Health Centers in Simada District, Northwest Ethiopia: Using Health Belief Model Perspective

INTRODUCTION

Even though the World Health Organization recommends daily oral iron with folic acid (IFA) supplementation as part of the antenatal care to prevent anemia, still the utilization remains low in Sub-Saharan Africa, particularly in Ethiopia. Therefore, the aim of this study was to assess the magnitude of adherence of iron with folic acid supplementation and associated factors among pregnant women who were attending antenatal care (ANC).

METHODS

A facility-based cross-sectional study was conducted from February 24 to March 23, 2020. Four hundred and twenty-two participants were selected using systematic random sampling technique. Data were collected using a structured questionnaire through face-to-face interview. Data were entered and analyzed using EpiData and SPSS version 20.0, respectively. Bivariate and multivariable logistic regression analyses were done to identify associated factors of adherence, and P<0.05 was used as cutoff to determine statistical significance at multivariable logistics regressions.

RESULTS

In this study, 414 (98%) pregnant women participated. The mean age of the respondents was 28.69 ±SD 5.49 years. The magnitude of adherence of IFA supplementation among pregnant women was 67.6% (95%CI: 63.3-72.5). Pregnant women who had a past history of preterm delivery (AOR=3.70; 95%CI: 1.46-9.37), counseling on IFA supplementation (AOR=2.28; 95%CI: 1.15-4.53), high perceived benefit (AOR=2.72; 95%CI: 1.25-5.90) and high self-efficacy (AOR=2.91; 95%CI: 1.40-6.04) were found to be significant associated factors of adherence to IFA supplementation.

CONCLUSION

In this study, adherence to IFA supplementation among pregnant women is relatively high. Past history of preterm delivery, counseling on IFA supplementation, perceived benefit and self-efficiency had association with adherence to IFA supplementation. Proper counseling and health education should be given to pregnant women to increase their adherence.

Predictors of prenatal iron folic acid supplement utilization in Wolaita, South Ethiopia: a community based cross-sectional study (quantitative and qualitative approach)

BACKGROUND

Effectiveness of prenatal iron supplementation program depends on utilization of the supplement by pregnant women. Nevertheless, in Ethiopia, regardless of increasing efforts, lower proportion of pregnant women use the supplementation for recommended 3 months and above but, the reason is not clear. This study aimed to identify the level and factors associated with utilization of prenatal iron supplementation.

METHODS

A community based cross-sectional quantitative study complemented with qualitative component was carried out in January, 2016. A total of 411 pregnant women who gave birth 6 months preceding data collection were selected using multi-stage cluster sampling technique. Qualitative data were collected by conducting four focus group discussions (FGDs) of local pregnant mothers and interviewing district maternal and child health (MCH) focal, 3MCH heads of health centers and four health extension workers. Factors associated with appropriate utilization of supplementation were assessed using multivariate logistic regression. The outputs of analyses were presented using Adjusted Odds Ratio (AOR) with 95% confidence intervals (CI).

RESULT

From the study participants, 11.5% (95% CI = 9.9-13.1%) took the supplement for the recommended duration of 3 months or above. Pregnant women who could not read and write had 77% reduced odds of using iron supplementation than their counterparts (AOR = 0.23(95% CI: 0.07-0.75)). As compared to women who had four or more antenatal care (ANC), women with 2 and 3 ANC visits had 78% (AOR = 0.22(0.07-0.63)) and 66% (AOR = 0.34(0.14-0.81)) reduced odds of using the supplementation, respectively. As compared to women who were aware of benefits of taking the supplement for maternal and child health, the counterparts had 90% (AOR = 0.10 (0.10-0.63)) reduced odds of using the supplement. Women who were not knowledgeable of anemia had 85% (AOR = 0.15(0.04-0.62) reduced odds of using the supplement than those who were knowledgeable. The qualitative study indicated that there was no problem in the supply and logistic system of iron supplement and leading reasons for not taking the supplement were late initiation of Antenatal Care, lack of awareness and occurrence of side effects; unpleasant taste, nausea, vomiting.

CONCLUSION

In the study area utilization of prenatal iron supplementation is very low. Improving maternal education, ensuring early and frequent ANC, educating pregnant women about the benefits of service and ensuring comprehensive knowledge of anemia expected to improve the utilization of prenatal iron supplementation.

Infant hydrocephalus in sub-Saharan Africa: Impact of perioperative care in the Zanzibar archipelago

INTRODUCTION

Child hydrocephalus in low- and middle-income countries represents one of the most sensitive ethical and health problems facing international health development. The most optimistic estimates indicate that 200,000 newborns annually will develop hydrocephalus or be born with a neural tube defect in East, Central and South Africa (ECSA). It is estimated that less than 10% of these children will be operated by ventriculoperitoneal shunts, and in general in poor quality conditions or with a very high complication rate.

OBJECTIVE

To describe the general characteristics, epidemiology and demographic data of childhood hydrocephalus of patients treated at the NED Institute in the Zanzibar archipelago, and assess the clinical details and medium-term results of the impact of the set-up nursing care.

MATERIAL AND METHODS

This is a descriptive and analytical observational study of a retrospective nature, in patients diagnosed and treated with childhood hydrocephalus, in the period from September 2016 to September 2018. With the implementation of a series of perioperative nursing protocols in these patients, the results obtained were described and analyzed.

RESULTS

A total of 96 patients were treated for childhood hydrocephalus. 51% (n=49) of these patients were male, with a mean age of 9.25 months. All the mothers of the patients were monitored during pregnancy, but only 8% were treated with folic acid during pregnancy. 81% of children were born through vaginal delivery or uncomplicated spontaneous delivery. Regarding the etiology, 27.1% of treated hydrocephalus was associated with an infectious cause and 35.4% with an unknown cause. 67 ventriculoperitoneal shunt surgery and 15 endoscopic ventriculostomies were performed. The complication rate was 23.17%.

CONCLUSIONS

The results of this research indicate that childhood hydrocephalus in Zanzibar has etiology, evolution and complications that are similar to or less than those described to date in East Africa. Implementing a series of perioperative protocols and standardized nursing care positively influences the results obtained. Currently, the Mnazi Mmoja Surgical NED Institute is one of the few centers in East Africa with an exhaustive record of healthcare activity and is the first health center that offers further training to nurses.

Adherence to iron-folic acid supplementation among pregnant women in Ethiopia: a systematic review and meta-analysis

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.

Adherence of iron and folic acid supplementation and determinants among pregnant women in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Iron and folic acid deficiency anaemia are one of the global public health challenges that pose 1.45% of all disability-adjusted life-years. It is recognized as a cause for an unacceptably high proportion of maternal and perinatal morbidity and mortality. Adherence to iron and folic acid supplementation during the antenatal period is paramount to reduce anaemia and its associated morbidities. Although several studies have been conducted across the country, their reports were inconsistent and inconclusive for intervention. Therefore, this systematic review and meta-analysis were aimed to estimate the pooled national level adherence to iron and folic acid supplementation and its determinants among pregnant women in Ethiopia.

METHODS

This systematic review and meta-analysis were pursued the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guideline. An extensive search of databases including, PubMed, Google Scholar, and African Journals Online were conducted to access articles. The Newcastle- Ottawa quality assessment tool was used to assess the quality of each study and meta-analysis was conducted using a random-effects model. I² test and Egger's test were used to assess the heterogeneity and publication bias respectively. The meta-analysis of estimating national level adherence were done using STATA version 11 with 95% CI.

RESULTS

Twenty studies with a total of 16,818 pregnant women were included in this meta-analysis. The pooled national level iron and folic acid supplementation's adherence were 46.15% (95%CI:34.75,57.55). The highest adherence was observed in Addis Abeba, 60% (95%CI: 55.93, 64.07) followed by Tigray, 58.9% (95% CI: 33.86, 84.03). Women who received supplemental information [OR = 2.34, 95%CI: 1.05, 5.24], who had good knowledge [OR = 2.2, 95%CI: 1.05, 5.24], began the ANC visit before 16 weeks [OR = 2.41, 95%CI: 1.76, 3.29], and had ≥4 ANC visits [OR = 2.59, 95% CI: 1.09, 6.15] were more likely adhere to the supplementation. Fear of side effects (46.4, 95% CI: 30.9 61.8) and forgetfulness (30.7, 95% CI: 17.6, 43.8) were the major barriers of adherence of the supplementations.

CONCLUSIONS

More than four of nine pregnant women have adhered to the iron and folic acid supplementation. This meta-analysis revealed that receiving supplemental counselling, knowledge of the supplement; early registration and frequent ANC visit were significantly associated with the adherence of the iron and folic acid supplementation. Therefore, provision of strengthened supplemental counselling service, antenatal care services, and improving the knowledge of the supplementation is a crucial strategy to increase the adherence among pregnant women in Ethiopia. Besides, addressing the barriers of the adherence of the supplement mainly counseling or managing of side effects and reducing of forgetfulness to take the tablet through getting family support or male involvement during visit is mandatory.

Effect of community based health education on knowledge and attitude towards iron and folic acid supplementation among pregnant women in Kiambu County, Kenya: A quasi experimental study

INTRODUCTION

Iron and Folic Acid Supplementation (IFAS) services are currently provided free of charge to pregnant women in Kenya during antenatal care (ANC) but compliance remains low. Poor awareness is an important factor contributing to low utilization of IFAS. Inadequate counselling is one of the key factors associated with poor awareness on IFAS. Community based health education is a promising diversification strategy for IFAS health education to curb this problem.

OBJECTIVES

To determine effect of community based IFAS health education, utilizing CHVs, on IFAS knowledge, levels of counselling on various IFAS topics and attitude towards IFAS among pregnant women in Kiambu County.

METHODOLOGY

A Pretest-Posttest Quasi-Experimental study design, consisting of intervention and control group, was applied among 340 pregnant women 18-49 years, in five health facilities, selected using two stage sampling in Lari Sub-County, Kiambu County, Kenya. Community health volunteers provided IFAS health education with weekly supplements and follow-ups to pregnant women in intervention group, while control group received the same from health care providers. Baseline and endline data were collected during ANC and compared. Quantitative data was analyzed using STATA version 14. Analysis of effect of intervention was done using Difference-In-Difference approach.

RESULTS

There was an effect difference in maternal IFAS knowledge of 13%, with intervention group levels increasing most by 35 percentage points. The odds of being knowledgeable were 3 times more at endline than baseline. There was significant (p<0.001) change in proportion with positive attitude towards IFAS: the odds of having positive attitude at endline was 9 times that of baseline (OR = 9.2:95%CI 3.1, 27.2).

CONCLUSION

Implementation of community based health education improved maternal knowledge, positive attitude and proportion of pregnant women counselled on IFAS, better improvement being recorded in intervention group. Hence, there is need to integrate community based approach with antenatal IFAS distribution to improve supplementation.

Maternal folic acid supplementation and infant birthweight in low- and middle-income countries: A systematic review

The relationship between maternal folic acid supplementation in pregnancy and infant birthweight has not been well described in low‐ and middle‐income countries. We conducted a systematic review and meta‐analysis of the current evidence of the association between folic acid supplementation in pregnancy on three primary outcomes: the incidence of low birthweight, small for gestational age, and mean birthweight. Seventeen studies were identified, which satisfied the inclusion criteria, covering a total of 275,421 women from 13 cohort studies and four randomized controlled trials. For the primary outcome of mean birthweight (n = 9), the pooled mean difference between folic acid and control groups was 0.37 kg (95% confidence interval [CI]: 0.24 to 0.50), and this effect was larger in the randomized controlled trials (0.56, 95% CI: 0.15 to 0.97, n = 3). The pooled odds ratio was 0.59 for low birthweight (95% CI: 0.47 to 0.74, n = 10) among folic acid supplementation versus control. The pooled odds ratio for the association with small for gestational age was 0.63 (95% CI: 0.39 to 1.01, n = 5). Maternal folic acid supplementation in low‐ and middle‐income countries was associated with an increased mean birthweight of infants and decreases in the incidence of low birthweight and small for gestational age.

Comparative analysis of trends and determinants of anaemia between adult and teenage pregnant women in two rural districts of Ghana

Background

The prevalence of iron deficiency anaemia remains high in pregnant women and the situation may be worse for pregnant adolescents. This study aimed to comparatively analyse the trends and determinants of anaemia between adult and teenage pregnant women in rural Ghana.

Methods

A retrospective study design was employed. Data including primarily pregnancy history, haemoglobin levels and anaemia status were collected from the manual medical records of 1002 women stored in the repositories of two rural district hospitals in the Ashanti Region of Ghana over the years 2011–2015. Data was analysed using chi-square analysis, t-test, two-way ANOVA and binary logistic regression. Bivariate and multivariate analyses were also done to establish associations and predictors of anaemia.

Results

An overall drop in mean haemoglobin from 11.1 g/dl in 2011 to 10.6 g/dl in 2015 was observed for adults, while an overall increase from 9.4 g/dl to 10.2 g/dl occurred in teenagers. Further, anaemia prevalence declined at the 36th week of pregnancy, and from 2011 to 2015, for both teenagers and adults. Among factors tested for association with haemoglobin levels using bivariate and multivariate analyses, gestational age alone was significant (P = 0.028). Between-subject effects determined using 2-way ANOVA indicated year of pregnancy alone, as well as in combination with age group (F = 3.1, P = 0.019) significantly affected haemoglobin levels. From binary regression analysis, BMI (OR 0.967, 95% CI:0.936–0.999, P = 0.042), gestational age (OR 1.058, 95% CI:1.013–1.106, P = 0.011) and pregnancy year (OR-2012(0.402); 2013(0.53); 2014(0.569); 2015(0.817), 95% CI: 2012(0.256–0.631); 2013(0.338–0.829); 2014(0.366–0.886); 2015(0.501–1.333), P = 0.001) were found to be significant predictors of anaemia at first antenatal visit. Also, the trimester of reporting for antenatal care, specifically the second trimester (OR-0.261, 95% CI: 0.072–0.951, P = 0.042) and the pregnancy year (OR-2012(0.235); 2013(0.206); 2014(0.530); 2015(0.222), 95% CI: 2012(0.101–0.545); 2013(0.081–0.522); 2014(0.197–1.428); 2015(0.049–1.018), P = 0.003) were more significant at the 36th pregnancy week.

Conclusions

Although the trends observed were decreasing in both adults and teenagers in the years reported, anaemia levels remained high for each year in either group. Anaemia, therefore remains a major health problem, especially in the areas studied, and antenatal interventions need a second look to know what might make them more effective.

Better-Educated, Older, or Unmarried Pregnant Women Comply Less with Iron-Folic Acid Supplementation in Southern Ethiopia

Daily iron supplementation, with or without folic acid, is a proven public health intervention. Although maintaining compliance is crucial for the success of the intervention, inconsistent findings are available on compliance and its predictors in Ethiopia. The aim of this study was to estimate the iron-folic acid (IFA) supplementation compliance rate and its predictors among pregnant women in Wolaita Zone, Southern Ethiopia. A cross-sectional study was conducted in eight randomly selected health centers in Wolaita, Southern Ethiopia. A total of 647 pregnant women were included using multistage sampling procedure. Data were entered into Epi Info (a free statistical analysis software) and exported to SPSS. Bivariate relationship was explored through correlation coefficients. A multiple linear regression model was constructed to estimate the variability coefficient of the compliance rate due to selected factors. Of 647 pregnant women, only 18 (2.8%) pregnant women had received the supplement for 90 days or more. Overall, the compliance rate was 73.2% (95% CI, 70.72 to 75.79). Experiencing heartburn and vomiting significantly reduced the compliance rate. Unintended pregnancy and better education were negatively associated with compliance. By contrast, acceptability of IFA supplement, number of antenatal care (ANC) visits, and being ever married were positive predictors. On average, a pregnant woman did not take more than one-fourth of the daily IFA supplementation. During ANC visits, addressing the issues of side effects, unintended pregnancy, and acceptability of the supplement may improve compliance rate. Overall in Ethiopia, educated, older, and unmarried Ethiopian women need additional attention for successful compliance.

Large for gestational age and macrosomia in pregnancies without gestational diabetes mellitus

Objective: This study aims to estimate the prevalence and risk factors of macrosomia and LGA (large for gestational age) in non-GDM (gestational diabetes mellitus) pregnant women in Fuyang, Anhui Province of China.Methods: A large population-based cohort study was conducted among non-GDM pregnant women aged 18-45 years. Maternal sociodemographic data prior to pregnancy were collected using interviewer-administered standardized questionnaire. Maternal obstetrical delivery records and newborn hospital records were extracted from antenatal care booklets and hospital discharge abstracts. Logistic regression analysis was used to identify the predictors of macrosomia and LGA.Results: The incidence of macrosomia and LGA was 9.2 and 15.9%, respectively. Mothers ≥35 years of age (aOR 2.75, 95% CI 1.98, 3.80), male neonates (aOR 1.68, 95% CI 1.51, 1.89), overweight and obese (aOR 1.61, 95% CI 1.34, 1.92 and aOR 3.05, 95% CI 2.05, 4.56, respectively) were associated with increased risk of macrosomia. Compared with the less educated mothers, the educated mothers were more likely to have increased risk of macrosomia. IFA (iron and folic acid) supplements intake during pregnancy was more likely to deliver macrosomia or LGA (aOR1.32, 95% CI 1.08, 1.49 and aOR1.42, 95% CI 1.24, 1.61, respectively) as compared with no IFA supplements intake. SCr (serum creatinine concentration) >80 µmol/L was related to decreased risk of macrosomia (aOR 0.73, 95% CI 0.61, 0.86) and LGA (aOR 0.67, 95% CI 0.59, 0.77) as compared with normal range (44-80 µmol/L).Conclusions: There was a high prevalence of macrosomia and LGA in non-GDM pregnant women in China. Healthcare educations and reasonable body weight are necessary for pregnant women to prevent macrosomia and LGA. Pregnant women should be checked regularly and have the first prenatal visit as soon as possible.

Adherence to Iron-Folate Supplementation and Associated Factors among Pastoralist's Pregnant Women in Burji Districts, Segen Area People's Zone, Southern Ethiopia: Community-Based Cross-Sectional Study

Background

Iron deficiency anemia among pregnant women is one of the most common public health problems in developing country particularly in Ethiopia. Iron/folic acid supplementation with optimal adherence is the main cost-effective strategy for prevention and control of iron deficiency anemia in pregnant women. However, level of adherence to iron/folic acid supplementation and its associated factors were not well identified in study area. Therefore, the aim of this study was to determine the level of adherence to iron/folic acid supplementation and associated factors among pregnant women in Burji Districts, southern Ethiopia.

Methods

A community-based cross-sectional study was conducted among 317 pregnant women in Burji Districts from March to April 2017 using interviewer administered questionnaires. Data were entered into Epi Info 3.5.1 and exported to SPSS version 20.0 for analysis. Binary and multivariable logistic regression was used to identify factors associated with iron/folic acid supplementation. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value <0.05 were used to declare statistical significance.

Results

Among women participating in the study, 163(51.4%) were adherent to iron/folate acid supplementation. Factors significantly associated with adherence to iron and folic acid supplementation were maternal educational status (AOR: 2.47, 95% CI: 1.13-4.97), early registration for ANC (AOR: 2.49, 95% CI: 1.45 – 4.27), history of anemia during current pregnancy (AOR: 2.02, 95% CI: 1.09-3.72), and knowledge about iron and folic acid supplementation (AOR: 1.96, 95% CI: 1.02-3.76). Forgetfulness and fear of side effects were among the leading reasons of pregnant women for nonadherence to iron and folic acid supplementation.

Conclusions

This study revealed that adherence to iron /folic acid supplementation was found to be 51.4%. Maternal educational status, early registration for ANC, history of anemia during current pregnancy, and knowledge about iron and folic acid supplementation were significant factors associated with adherence to iron/folic acid supplementation among pastoralist's pregnant women. Therefore, anemia prevention strategy should include strengthening giving awareness, counseling, strengthening community health education, and participation in health programs which are necessary to improve the uptake of iron/folic acid supplements.

Consumption habits of pregnant women in the Jazan region, Saudi Arabia: a descriptive study

OBJECTIVE

Maternal nutritional habits are critical for the health of both mother and offspring. Postpartum outcomes for mother and infant are strongly influenced by the mother's nutritional status. Information about consumption habits among pregnant women in Saudi Arabia is scarce. Thus, this study aims to describe the consumption habits of pregnant women in the Jazan region, Saudi Arabia.

RESULTS

Meat, fish, and fruits were consumed by 97%, 86%, and 90% of the sample. Sugary desserts, fast food, and canned food were consumed by 90%, 81%, and 71% of the sample. Caffeine, juices, and milk were consumed by 75%, 92%, and 81% of the sample. Previous percentages show general higher consumption habits of food and beverages. Over-the-counter medication was used by only 17%. Folic acid, iron, and calcium use by 77%, 64%, and 58% of the sample, respectively. These percentage shows conservative use of Over-the-counter medication and sub-optimal use of important dietary supplements. Moreover, there was a positive association between caffeine intake and trimesters. Furthermore, there was negative association between education level and fish intake. Finally, canned foods consumption was higher among low income pregnant women.

Intake of supplementary food during pregnancy and lactation and its association with child nutrition in Timor Leste

Abstract

There is little evidence on maternal consumption of supplementary food on nutritional status of children. The objectives of this study were to measure the prevalence and determinants of supplementary food intake during pregnancy and lactation, and their association with nutritional status of under-five children in Timor Leste.

Methods

Cross-sectional data from Timor Leste Demographic and Health Survey on 5,993 mother (15-49 years) child dyads (<5 years) were included in the analysis. Self-reported intake of supplementary food intake was the explanatory variable. Child's nutritional status was assessed by stunting, wasting, and underweight and categorized according to WHO recommendations.

Results

The prevalence of taking supplementary food during pregnancy and lactation was, respectively, 29.1% (95% CI [27.2-31.0]) 31.0% (95% CI [29.1-33.0]), and that of taking iron supplement during pregnancy was close to three-fifths (63.1%, 95% CI [60.9-65.3]). The odds of taking supplementary food during pregnancy and lactation were lower among those in the younger age groups and higher among urban residents. Compared with mothers who had supplementary food during pregnancy and lactation, those did not have had respectively 1.36 (OR = 1.360, 95% CI [1.191-2.072]) and 1.15 times (OR = 1.152, 95% CI [1.019-1.754]) higher odds of having stunted, and 1.30 (OR = 1.307, 95% CI [1.108-1.853]) and 1.43 (OR = 1.426, 95% CI [1.140-1.863]) times higher odds of having underweight children. Those who had none of the supplements had respectively 1.67 (OR = 1.674, 95% CI [1.118-2.087]) and 1.63 (OR = 1.631, 95% CI [1.130-2.144]) times higher odds of having stunted and underweight children.

Conclusion

A great majority of the mothers in Timor Leste are not taking supplementary food during pregnancy and lactation. We found a positive relationship between supplementary food intake during pregnancy and lactation with stunting and wasting among under-five children.

Prevalence, types and determinants of anemia among pregnant women in Sudan: a systematic review and meta-analysis

Background

Anemia during pregnancy is a public health problem especially in developing countries and it is associated with maternal and perinatal adverse outcomes. There is no meta-analysis on anemia during pregnancy in Sudan. The current systemic review and meta-analysis was conducted to assess the prevalence, types and determinant of anemia during pregnancy in Sudan.

Methods

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. The databases (PubMed, Cochrane Library, Google Scholar, CINAHL, and African Journals Online) were searched using; anemia, pregnancy related anemia and Sudan. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) and Modified Newcastle – Ottawa quality assessment scale were used for critical appraisal of studies. The pooled Meta logistic regression was computed using OpenMeta Analyst software.

Results

Sixteen cross-sectional studies included a total of 15, 688 pregnant women were analyzed. The pooled prevalence of anemia among pregnant women in Sudan was 53.0% (95%, CI = 45.9–60.1). The meta-analysis showed no statistical significant between the age (mean difference = 0.143, 95 CI = − 0.033 − 0.319, P = 0.112), parity (mean difference = 0.021, 95% CI = − 0.035 − 0.077, P = 0.465) between the anemic and no anemic women. Malaria was investigated in six studies. Pregnant women who had malaria infection during pregnancy were 1.94 times more likely to develop anemia than women who had no malaria infection (OR = 1.94, 95% CI =1.33–2.82). Six (37.5%) studies investigated type of anemia. The pooled prevalence of iron deficiency anemia (IDA) among pregnant women in Sudan was 13.6% (95% CI = 8.9–18.2).

Conclusion

There is a high prevalence of anemia among pregnant in the different region of Sudan. While age and parity have no association with anemia, malaria infection was associated with anemia. Interventions to promote the strengthening of antenatal care, and access and adherence to nutrition, and malaria preventive measures are needed to reduce the high level of anemia among pregnant women in Sudan.

Electronic supplementary material

The online version of this article (10.1186/s12878-018-0124-1) contains supplementary material, which is available to authorized users.

Experience in the Early Surgical Management of Myelomeningocele in Zanzibar

BACKGROUND

Neural tube defects are a large health burden for East African countries. Health strategies in the prevention of this disease include nutritional prophylaxis, prenatal diagnosis, and availability of early neonatal neurosurgery. The main objective of this study is to describe our experience in the early surgical management of neural tube defects in the Zanzibar archipelago.

METHODS

From December 2016 to December 2017, we prospectively collected data on all patients admitted with the diagnosis of myelomeningocele. We collected variables regarding demographics, maternal health, preoperative imaging, surgical procedures, and complications at follow-up.

RESULTS

We collected data on 19 patients. Mean age was 9.8 ± 18.7 days. Of these patients, 52.6% were male and 47.3% were female; 47.3% patients were from Unguja, 42.0% from Pemba, and 5.2% from mainland Tanzania; 68.4% of all mothers were found to have undergone prenatal ultrasonography and 89.5% of all patients received surgery. Surgical wound infection was present in 29.4% of all surgical patients and 52.9% developed secondary hydrocephalus.

CONCLUSIONS

Neural tube defects are a prevailing condition in East Africa. We believe that more health initiatives should address its prevention, mainly through maternal nutrition. On the basis of our findings, we consider early neonatal neurosurgery as the most important factor in reducing immediate morbidity and mortality.

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

BACKGROUND

Macro and micronutrients including iron and folic acid deficiencies are prevalent in Kenya, particularly during pregnancy resulting in anaemia. Despite efforts to control anaemia in pregnancy by adopting Iron and Folic Acid Supplementation (IFAS), this public health problem has persisted contributing to significant morbidity and mortality. The problem notwithstanding, there is poor IFAS compliance, whose reasons remain poorly understood, calling for their investigations. We sought to determine compliance status with IFAS and associated factors among pregnant women.

METHODS

This was a cross-sectional study involving 364 pregnant women aged 15-49 years. Using two stage cluster sampling, one Sub-County and five public health facilities in Kiambu County were selected. All pregnant women attending antenatal clinics who met inclusion criteria and consented to participate in the study were recruited. Compliance with IFAS was defined as taking supplements at least 5 out of 7 days per week. A structured interviewer-administered questionnaire consisting of sociodemographic data, IFAS maternal knowledge and compliance practices was pretested and administered. Descriptive and inferential statistics were computed using STATA.

RESULTS

Of the 364 respondents interviewed, 32.7% were IFAS compliant and 40.9% scored high on its knowledge. Of those with high IFAS knowledge, 48.3% were compliant compared to those with low knowledge (21.4%, n = 46, PR = 2.25;95%CI = 1.59-3.17, p < 0.001). Women who were multigravid (30.4%) were less likely to comply compared to primigravid (37.2%, n = 45, PR = 0.68;95%CI = 0.47-0.99, p = 0.004). Multivariate analysis revealed that respondents counselled on management of IFAS side effects (100%, n = 4) were more compliant (76.2%, n = 112, aPR = 1.31;95%CI = 1.19-1.44, p < 0.001).

CONCLUSION

Few pregnant women were compliant with IFAS regimen, associated with: knowledgeability on IFAS, primi-gravidity, and IFAS counselling especially on management of its side effects. These underscore the need for approaches to scale up health awareness on the benefits of IFAS, mitigation measures for the side effects, as well as targeted counselling.

Magnitude and factors associated with adherence to Iron-folic acid supplementation among pregnant women in Eritrean refugee camps, northern Ethiopia

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.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-1716-2) contains supplementary material, which is available to authorized users.

High level of hemoglobin, white blood cells and obesity among Sudanese women in early pregnancy: a cross-sectional study

Aim:

To investigate the association between obesity and anemia/hemoglobin levels.

Material & methods:

A cross-sectional study was conducted at Khartoum, Sudan. Obstetric data were collected from 388 pregnant women at mean (standard deviation) of 10.5 (3.1) weeks of gestation using questionnaires. Weight and height were determined, and BMI was calculated.

Results:

There were 15 (4.4%), 95 (28.1%), 127 (37.6) and 101 (29.9%) women who were underweight, normal weight, (18.5–24.9 kg/m²), overweight (25–29.9 kg/m²) and obese (≥30 kg/m²), respectively. Hemoglobin levels and white blood cell counts were significantly higher in obese than nonobese groups. Compared with normal BMI, overweight and obesity were associated with higher hemoglobin level.

Conclusion:

Obese women had higher white blood cell count and hemoglobin level.

Obesity during pregnancy has many maternal and perinatal adverse effects. The current study was conducted to investigate the association between obesity, hemoglobin level and white blood cell count among pregnant Sudanese women in their early pregnancy. Around a third of the 388 women were obese. Hemoglobin level and white blood cells count were significantly higher in obese than nonobese women. Further studies are needed to fully understand the implications of this relationship.

High Adherence to Iron/Folic Acid Supplementation during Pregnancy Time among Antenatal and Postnatal Care Attendant Mothers in Governmental Health Centers in Akaki Kality Sub City, Addis Ababa, Ethiopia: Hierarchical Negative Binomial Poisson Regression

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.

Differences in spatial distributions of iron supplementation use among pregnant women and associated factors in Ethiopia: evidence from the 2011 national population based survey

BACKGROUND

Iron supplementation during pregnancy prevents against low birth weight, incidence of prematurity and postpartum hemorrhage. However, the coverage of iron supplementation is still low in Ethiopia. This study aimed to investigate the spatial variations and associated factors of iron supplementation during pregnancy using the 2011 national demographic and health survey data.

METHODS

This study used secondary data from the 2011 Ethiopian demographic and health survey. The survey was cross sectional and used a multistage cluster sampling procedure. A logistic regression statistical model using adjusted odds ratio (AOR) and 95% confidence interval (CI) was used to identify the associated factors. Getis-Ord G-statistic was used to identify high and low hotspot areas of iron tablet supplementation during pregnancy.

RESULTS

The coverage of iron tablet supplementation was 17.1% [95%CI: (16.3-17.9)] with the highest coverage of 38.9% [95%CI: (32.4--46.1)] in Addis Ababa followed by Tigray regional state with 33.8% [95%CI: (29.9-38.00)]. The lowest coverage was found in Oromiya regional state at 11.9% [95%CI: (10.7-13.0)]. Multivariable analysis showed that mothers who were aware of the Community Conversation Program had 20% [AOR = 1.2; 95% CI: (1.04-1.4)] higher odds of taking iron tablets. The odds of taking iron tablets was 2.9 times [AOR = 2.9; 95% CI: (2.3-3.7)] higher among those who took deworming tablets. Those mothers who attended the minimum four antenatal visits recommended by WHO were 3.9 times [AOR = 3.9; 95% CI: (3.3-4.6)] more likely and those mothers in the age group 31-49 years were 2.9 times [AOR = 2.9; 95% CI: (1.1-7.4)] more likely to use iron tablets as compared to those mothers who did not attend antenatal care and mothers in the age group less than 20 years. Mothers having a family size of 10 and above had 32% [AOR = 0.68; 95% CI: (0.49-0.97)] lower odds of taking iron tablets during pregnancy. The spatial analysis found that only northern, central and eastern parts of Ethiopia were identified as hotspots of iron supplementation.

CONCLUSION

Iron supplementation use was not equally distributed in Ethiopia, with relatively higher prevalence in Tigray, Addis Ababa and Harari regional states. Attention should be given to younger age mothers, mothers with large family size and mothers who reside in areas with low coverage of iron tablet distribution. Promotion of antenatal care services based on the WHO standard can be used as an intervention for improving iron supplementation during pregnancy.

Dietary iron and calcium intakes during pregnancy are associated with lower risk of prematurity, stillbirth and neonatal mortality among women in Tanzania

Objective

Prematurity, stillbirth and other adverse birth outcomes remain major concerns in resource-limited settings. Poor dietary intake of micronutrients during pregnancy has been associated with increased risk of adverse outcomes. We determined the relationships between dietary Fe and Ca intakes during pregnancy and risks of adverse birth outcomes among HIV-negative women.

Design

Women’s diet was assessed through repeated 24 h diet recalls in pregnancy. Mean intakes of total Fe, Fe from animal sources and Ca during pregnancy were examined in relation to adverse birth outcomes and neonatal mortality. Women were prescribed daily Fe supplements as per standard perinatal care.

Setting

Dar es Salaam, Tanzania.

Subjects

A cohort of 7634 pregnant women.

Results

Median (interquartile range) daily dietary intake of total Fe, animal Fe and Ca was 11·9 (9·3–14·7), 0·5 (0–1·1) and 383·9 (187·4–741·2) mg, respectively. Total Fe intake was significantly associated with reduced risk of stillbirth (trend over quartiles, P=0·010). Animal Fe intake was significantly associated with reduced risk of preterm birth and extreme preterm birth. Animal Fe intake was inversely related to neonatal mortality risk; compared with women in the lowest intake quartile, those in the top quartile were 0·51 times as likely to have neonatal death (95 % CI 0·33, 0·77). Higher Ca intake was associated with reduced risk of preterm birth (relative risk; 95 % CI: 0·76; 0·65, 0·88) and extreme preterm birth (0·63; 0·47, 0·86). Women in the highest Ca intake quartile had reduced risk of neonatal mortality (0·59; 0·37, 0·92).

Conclusions

Daily dietary Fe and Ca intakes among pregnant women are very low. Improvement of women’s diet quality during gestation is likely to improve the risks of adverse birth outcomes.

Prevalence and Sociodemographic and Lifestyle Determinants of Anemia during Pregnancy: A Cross-Sectional Study of Pregnant Women in China

OBJECTIVE

This study aimed to assess the differences regarding anemia among pregnant women with diverse characteristics and lifestyle factors.

METHODS

A cross-sectional study of pregnant women was conducted between June and August 2015 in 16 hospitals in five provinces of Mainland China. Self-reported doctor-diagnosed anemia was used in the study.

RESULTS

We included 2345 pregnant women. Of the participants, 1755 (74.8%) were pregnant women of first pregnancy (PWFP) and 590 (25.2%) were second pregnancy (PWSP). The mean age of the participants was 28.1 years (SD 4.1). Overall, the prevalence of anemia was 12.7% (13.4% and 10.7% among PWFP and PWSP, respectively). The prevalence for not eating breakfast was 11.0%. Compared with PWFP, PWSP was inversely associated with the risk of anemia (odds ratio (OR) 0.66, 95% CI 0.48-0.91). Compared with those being registered in a low ranking hospital, pregnant women who were admitted to a high (OR 0.40, 95% CI 0.28-0.57) or a medium ranking hospital (OR 0.58, 95% CI 0.37-0.92) were inversely associated with the risk of anemia. Compared with women of low income (<¥4,500), those with high income were less likely to have anemia (OR 0.68, 95% CI 0.50-0.94). Compared with women with non-manual jobs, women with manual jobs (OR 1.70, 95% CI 1.17-2.45) and unemployed women (OR 1.42, 95% CI 1.04-1.93) were associated with a greater likelihood of suffering from anemia.

CONCLUSIONS

Pregnant women not eating breakfast are of concern. Anemia is highly prevalent among pregnant women in China. Lower socio-economic status, manual jobs, PWFP, and those who attend a lower quality hospital have a greater likelihood of suffering from anemia. Tailored interventions are needed to address these issues.