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Tefera AA, Ibrahim NA, Umer AA. Adherence to iron and folate supplementation and associated factors among women attending antenatal care in public health facilities at Covid-19 pandemic in Ethiopia. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000825. [PMID: 36962981 PMCID: PMC10021611 DOI: 10.1371/journal.pgph.0000825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/06/2022] [Indexed: 06/18/2023]
Abstract
Adhesion is the degree to which a patient complies with treatment recommendations made by a health care professional. The majority of pregnant women worldwide don't get the recommended amounts of iron and folic acid (30 to 60 mg of iron and 400 g of folic acid/day for 6 months) pregnant women are more likely to develop iron- and folic acid deficiency anemia. For iron and folate supplementation programs to be effective in Ethiopia, adherence is a significant issue. So, this study aimed to evaluate the level and barriers preventing women receiving antenatal care from taking iron and folate supplements. A phenomenological qualitative study design was added to a facility-based cross-sectional study. The sample was established using a double population proportion formula. For the quantitative and qualitative study, 308 pregnant women and the focal points for the health facilities were chosen at random, using systematic random sampling and purposive sampling techniques. For the quantitative study, a face-to-face interviewer-guided, pre-tested structured questionnaire was used; for the qualitative study, a semi-structured questionnaire was used. Data was entered twice, cross-checked by comparing the two separate entries in Epi Data version 7.2.2.6, and exported to SPSS version 25 for analysis. COR and AOR with 95% CI are used to evaluate the relationship between variables and control for confounding factors. Statistical significance was declared at a p-value < 0.05. All, 308 (100%) participants were involved. 56.5% of pregnant women attending an ANC clinic (95% CI: 51%-62.2%) adhered to Iron and folate supplementation. Mothers with primary education], Urban residents mothers, Mother who had four or more ANC visits, mothers who had registered for their first ANC at early gestational age, mothers who had good awareness about birth defects were independent predictors of adherence to Iron and folate supplementation. In our study, adherence to iron and folate supplementation was low relative to previous research findings. Promoting early and frequent ANC visits and improving pregnant women's awareness of anemia and birth defects through education is necessary to increase the adherence status.
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Affiliation(s)
| | - Neil Abdurashid Ibrahim
- Department of Midwifery, College of Medicine and Health Science, Dire-Dawa University, Dire-Dawa, Ethiopia
| | - Abdurezaq Adem Umer
- Public Health Department, College of Medicine and Health Science, Dire-Dawa University, Dire-Dawa, Ethiopia
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Tesfay N, Hailu G, Woldeyohannes F. Effect of optimal antenatal care on maternal and perinatal health in Ethiopia. Front Pediatr 2023; 11:1120979. [PMID: 36824654 PMCID: PMC9941639 DOI: 10.3389/fped.2023.1120979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/09/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION Receiving at least four antenatal care (ANC) visits have paramount importance on the health of mothers and perinates. In Ethiopia, several studies were conducted on ANC service utilization; however, limited studies quantified the effect of care on maternal and perinate health. In response to this gap, this study is conducted to quantify the effect of optimal ANC care (≥4 visits) on maternal and perinatal health among women who received optimal care in comparison to women who did not receive optimal care. METHODS The study utilized the Ethiopian perinatal death surveillance and response (PDSR) system dataset. A total of 3,814 reviewed perinatal deaths were included in the study. Considering the nature of the data, preferential within propensity score matching (PWPSM) was performed to determine the effect of optimal ANC care on maternal and perinatal health. The effect of optimal care was reported using average treatment effects of the treated [ATT]. RESULT The result revealed that optimal ANC care had a positive effect on reducing perinatal death, due to respiratory and cardiovascular disorders, [ATT = -0.015, 95%CI (-0.029 to -0.001)] and extending intrauterine life by one week [ATT = 1.277, 95%CI: (0.563-1.991)]. While it's effect on maternal health includes, avoiding the risk of having uterine rupture [ATT = -0.012, 95%CI: (-0.018 to -0.005)], improving the utilization of operative vaginal delivery (OVD) [ATT = 0.032, 95%CI: (0.001-0.062)] and avoiding delay to decide to seek care [ATT = -0.187, 95%CI: (-0.354 to -0.021)]. CONCLUSION Obtaining optimal ANC care has a positive effect on both maternal and perinatal health. Therefore, policies and interventions geared towards improving the coverage and quality of ANC services should be the top priority to maximize the benefit of the care.
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Affiliation(s)
- Neamin Tesfay
- Center of Public Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Girmay Hailu
- Center of Public Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Fitsum Woldeyohannes
- Health Financing Department, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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Ali EH, Alkindi S, Mohamed AO, Awadalla KE, Abdlgadir O, Adam G, Magdi M, Ibrahim AK, Ghebremeskel K. Adverse Pregnancy Outcomes in Sickle Cell Trait: a Prospective Cohort Study Evaluating Clinical and Haematological Parameters in Postpartum Mothers and Newborns. Mediterr J Hematol Infect Dis 2023; 15:e2023002. [PMID: 36660349 PMCID: PMC9833303 DOI: 10.4084/mjhid.2023.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 12/10/2022] [Indexed: 01/03/2023] Open
Abstract
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.
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Affiliation(s)
- E H Ali
- Lipidomics and Nutrition Research Centre, School of Human Sciences, London Metropolitan University, UK
| | - S Alkindi
- Department of Haematology, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - A O Mohamed
- Department of Biochemistry, Faculty of Medicine, University of Khartoum, Sudan
| | | | - O Abdlgadir
- Sudan Sickle Cell Anaemia Centre, El Obeid - SUDAN
| | - G Adam
- Faculty of Education, Al Azhri University, Sudan
| | - M Magdi
- Directorate of Planning, Ministry of Health Oman, Muscat, Sultanate of Oman
| | - A K Ibrahim
- Sudan Sickle Cell Anaemia Centre, El Obeid - SUDAN
| | - K Ghebremeskel
- Lipidomics and Nutrition Research Centre, School of Human Sciences, London Metropolitan University, UK
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NOPTRIANI SONIA, SIMBOLON DEMSA. Probability of non-compliance to the consumption of Iron Tablets in pregnant women in Indonesia. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E456-E463. [PMID: 36415291 PMCID: PMC9648554 DOI: 10.15167/2421-4248/jpmh2022.63.3.2340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 08/24/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION The low non-compliance to the consumption of Iron Tablets in pregnant women is an obstacle in the implementation of government programs to prevent and overcome the anemia problems in pregnant women. This study was conducted to determine the probability of non-compliance of pregnant women in the consumption of iron tablets in Indonesia. METHODS A cross-sectional study using the 2017 IDHS data. The sample was 12,466 women of childbearing age 15-49 years in Indonesia who consumed Iron Tablets during their last pregnancy. Univariate analysis used proportion measure, the bivariate analysis using chi-square test and multivariate used binary logistic regression test. Statistical analysis using SPSS-26 software. RESULTS The level of non-compliance to the consumption of Iron Tablets during pregnancy in Indonesia is only 48.47%. The risk factors for quantity (p = 0.000, OR 2.085), and quality (p = 0.000, OR 1.655) Antenatal Care (ANC) was not good, examiners were pregnancy not health workers (p = 0.000, OR 1.816), residence in rural areas (p = 0.000, OR 1.262), and very poor socioeconomic status (p value = 0.000, OR 2.041) were significantly related to non-compliance with Iron Tablets consumption. The probability of non-compliance to the consumption of Iron Tablets in pregnant women with risk factors is 88%. CONCLUSION Quantity of ANC and socioeconomic have a high influence on compliance to consumption of iron tablets, so it is important to bring nutrition workers at ANC activities to educate pregnant women about the benefits, side effects, and ways of consumption of iron tablets, reactivate supervisors for consumption of iron tablets, increase access health services in rural areas and families with low socioeconomic status, as well as providing free health care programs for the poor.
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Affiliation(s)
| | - DEMSA SIMBOLON
- Correspondence: Demsa Simbolon, Department of Nutrition, Health Polytechnic of the Ministry of Health Bengkulu. E-mail:
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Beressa G, Lencha B, Bosha T, Egata G. Utilization and compliance with iron supplementation and predictors among pregnant women in Southeast Ethiopia. Sci Rep 2022; 12:16253. [PMID: 36171347 PMCID: PMC9519626 DOI: 10.1038/s41598-022-20614-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 09/15/2022] [Indexed: 11/30/2022] Open
Abstract
Anemia is predicted to affect 38% (32 million) of pregnant women worldwide. However, evidence for utilization and compliance with iron supplementation and predictors during pregnancy in low-income countries, including Ethiopia, is sparse and inconclusive. Therefore, we aimed to assess utilization and compliance with iron supplementation and predictors among pregnant women in Robe Town, Southeast Ethiopia. A community-based cross-sectional study was employed among randomly selected 445 pregnant women attending antenatal care at health facilities from May to July 2015. A systematic random sampling was used to select respondents. Data were collected using a pre-tested, interviewer-administered, structured questionnaire. Bivariable and multivariable logistic regression analyses were conducted to identify predictors of compliance with iron supplementation. An odds ratio, along with a 95% confidence interval (CI), was used to estimate the strength of the association. In this study, 54% [95% CI (49.4, 58.4%)], 45.2% [95% CI (40.9, 49.4%)], 4.3% [95% CI (2.5, 6.3%)], and 2.2% [95% CI (1.1, 3.6%)] of women received iron supplements during their first, second, third, and fourth antenatal care visits, respectively. The level of compliance with iron supplementation was 92.4% [95% CI (89.9, 94.6%)]. Having a formal education (AOR = 4.45, 95% CI 1.41, 13.99), being in the high wealth quintile (AOR = 0.18, 95% CI 0.05, 0.68), medium wealth quintile [(AOR = 0.33, 95% CI (0.11, 0.98)], receiving iron supplements for free (AOR = 3.77, 95% CI 1.33, 10.69), not experiencing discomfort related to iron supplements intake (AOR = 2.94, 95% CI 1.17, 7.39), having comprehensive knowledge about anemia (AOR = 2.62, 95% CI 1.02, 6.70), being knowledgeable about iron supplements (AOR = 3.30, 95% CI 1.12, 9.76), having information about importance of iron supplementation during pregnancy (AOR = 2.86; 95% CI 1.04, 7.87), and ever being visited by urban health extension workers (AOR = 0.31; 95% CI 0.12, 0.83) was significantly associated with compliance with iron supplementation during pregnancy. The utilization of iron supplementation during pregnancy was low, with relatively high compliance with the supplements. Thus, comprehensive nutrition education and free provision of iron supplementation are crucial tools to increase utilization and compliance with iron supplementation during pregnancy. Further research with a strong study design using golden standard methods is warranted.
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Affiliation(s)
- Girma Beressa
- School of Health Sciences, Madda Walabu University, P.O. Box 302, Goba, Ethiopia.
| | - Bikila Lencha
- School of Health Sciences, Madda Walabu University, P.O. Box 302, Goba, Ethiopia
| | - Tafese Bosha
- School of Nutrition, Food Science and Technology, Hawassa University, P.O. Box 05, Hawassa, Ethiopia
| | - Gudina Egata
- School of Public Health, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia
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Determining Prevalence of Anemia and Its Associated Factors in Cameroon: A Multilevel Analysis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9912549. [PMID: 34778462 PMCID: PMC8580646 DOI: 10.1155/2021/9912549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 09/15/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022]
Abstract
Background Anemia constitutes a major public health concern, which is associated with maternal and perinatal mortality. In low- and middle-income countries, the burden of anemia is profoundly high. Cameroon, as one of the low- and middle-income countries, has a disproportionate anemia burden. Factors associated with anemia prevalence are largely unknown in Cameroon. Hence, we determined the prevalence of anemia and its individual/household and community-level factors among adult women in Cameroon. Methods We derived data from the 2018 Cameroon Demographic and Health Survey for analysis in this study. Using the Stata version 14 software, univariate multilevel logistic regression analysis was used to select variables that had significant association with anemia at p < 0.05. Statistically significant variables were included in a multivariable multilevel logistic regression modelling to examine their associations with anemia. Results were reported using adjusted odds ratios (AOR) with their respective 95% confidence interval (CI). Results A total of 6,809 women aged 15-49 years were involved in this study with a mean age 30 ± 11.87 years. Approximately two-fifths of women were anemic. Of them, 0.8% were severely anemic, while 17.4% and 21.5% were moderately and mildly anemic, respectively. Current employment status (yes AOR = 0.77, 95% CI; 0.61-0.96) and parity (1-2 children AOR = 0.61, 95% CI; 0.44-0.86) were the main individual level factors associated with anemia, whereas region (Douala region AOR = 2.65, 95% CI; 1.61-4.36, North-West region AOR = 0.53, 95% CI; 0.28-0.99) was the community-level factor associated with anaemia. Conclusion Empowerment of women through employment opportunities as well as focusing special attention in region where high prevalence of anemia could be crucial to decrease the burden of anemia and related maternal and perinatal mortality in the country.
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Felipe-Dimog EB, Yu CH, Ho CH, Liang FW. Factors Influencing the Compliance of Pregnant Women with Iron and Folic Acid Supplementation in the Philippines: 2017 Philippine Demographic and Health Survey Analysis. Nutrients 2021; 13:nu13093060. [PMID: 34578937 PMCID: PMC8468511 DOI: 10.3390/nu13093060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
Anemia in pregnancy, which is a public health concern for most developing countries, is predominantly caused by iron deficiency. At least, 180 days of iron and folic acid (IFA) supplementation is recommended for pregnant women to mitigate anemia and its adverse effects. This study aimed to examine compliance with the recommendation of IFA supplementation and its underlying factors using the 2017 Philippine National Demographic and Health Survey data. The variables assessed included age, highest level of education, occupation, wealth index, ethnicity, religion, residence, number of pregnancies, time of first antenatal care (ANC) visit and number of ANC visits. Compliance with the recommendation of at least 180 days of IFA supplementation was the outcome variable. The study assessed 7983 women aged 15-49 years with a history of pregnancy. Of these participants, 25.8% complied with the IFA supplementation recommendation. Multiple logistic regression analysis showed that pregnant women of Islamic faith and non-Indigenous Muslim ethnicity were less likely to comply with the IFA supplementation recommendation. Being aged between 25 and 34 years, having better education and higher wealth status, rural residency, initiating ANC visits during the first trimester of pregnancy and having at least four ANC visits positively influenced compliance with IFA supplementation. The effect of residence on IFA adherence differed across the wealth classes. Strategies targeted at specific groups, such as religious minorities, poor urban residents, the less educated and young women, should be strengthened to encourage early and regular antenatal care visits for improving compliance.
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Affiliation(s)
- Eva Belingon Felipe-Dimog
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Sanmin District, Kaohsiung 807, Taiwan;
- Department of Nursing, Mountain Province State Polytechnic College, Bontoc 2616, Mountain Province, Philippines
| | - Chia-Hung Yu
- Department of Anesthesiology, Chi Mei Medical Center, No 901, Zhonghua Road, Yongkang District, Tainan City 710, Taiwan;
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, No 901, Zhonghua Road, Yongkang District, Tainan City 710, Taiwan;
| | - Fu-Wen Liang
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Sanmin District, Kaohsiung 807, Taiwan;
- Department of Medical Research, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Road, Sanmin District, Kaohsiung 807, Taiwan
- Correspondence: ; Tel.: +886-7-312-1101 (ext. 2786)
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Bahati F, Kairu-Wanyoike S, Nzioki JM. Adherence to iron and folic acid supplementation during pregnancy among postnatal mothers seeking maternal and child healthcare at Kakamega level 5 hospital in Kenya: a cross-sectional study. Wellcome Open Res 2021; 6:80. [PMID: 34405117 PMCID: PMC8366300 DOI: 10.12688/wellcomeopenres.16699.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Maternal anaemia is a public health problem worldwide, and its aetiology is linked to iron deficiency. The high nutrient demand during pregnancy exacerbates the condition. To meet the increased nutritional demand, supplementation of iron and folic acid (IFA) is key. The supplements are provided freely to pregnant women during antenatal visits at public health facilities, however, their uptake and adherence in Kenya remain unacceptably low. Methods: A hospital-based cross-sectional study involving 241 postnatal mothers seeking maternal and child healthcare (MCH) care at Kakamega level 5 hospital was conducted. Both quantitative and qualitative data were collected. Quantitative data were collected from 241 eligible postnatal mothers, while qualitative data were obtained through key informant interviews with community health volunteers and healthcare providers. Results: There was a moderate adherence to IFA supplementation (60.6%) during pregnancy among postnatal mothers seeking MCH care at Kakamega level 5 hospital. Some of the reasons for non-adherence stated by the respondents included; IFA related side effects (41.3%), forgetfulness (37.3%) and bad smell of the IFA supplements (10.3%). Higher IFA adherence was noted among the primigravida participants (OR=2.704; 95% CI: 1.262, 5.793; p=0.010) compared to multigravida participants, and those with a higher knowledge level of anaemia (OR=3.215; 95% CI: 1.346, 7.68; p=0.009) compared to their counterparts with low anaemia knowledge. Other factors that showed correlation with IFA adherence were: IFA education, pregnancy counselling before conception and the number of antenatal care visits attained. Conclusion: There is a moderate adherence to IFA supplementation during pregnancy among mothers seeking MCH at Kakamega level 5 hospital. The greatest impediments of IFA compliance during pregnancy are IFA side effects, forgetfulness and the bad smell of the IFA tablets. Therefore, providing IFA education to pregnant mothers incorporated with probable ways of managing the IFA side effects would contribute to IFA supplementation adherence.
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Affiliation(s)
- Felix Bahati
- Health Services Research Unit, KEMRI Wellcome Trust, Nairobi, Nairobi, 43640-00100, Kenya
- Environmental Health and Disease Control, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Nairobi, 62 000 – 00200, Kenya
| | - Salome Kairu-Wanyoike
- Directorate of Veterinary Services, Ministry of Agriculture, Livestock, Fisheries and Cooperatives, Nairobi, Nairobi, Kangemi 00605, Kenya
| | - Japheth Mativo Nzioki
- Environmental Health and Disease Control, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Nairobi, 62 000 – 00200, Kenya
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Compliance with Iron and Folic Acid Supplementation (IFAS) and associated factors among pregnant women in Sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2021; 16:e0249789. [PMID: 33852614 PMCID: PMC8046188 DOI: 10.1371/journal.pone.0249789] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background Anemia is one of the world’s leading cause of disability and the most serious global public health issues. This systematic review and meta-analysis was conducted very carefully in order to give up the pooled compliance of Iron and Folic-Acid Supplementation in Sub-Saharan Africa. Methods To conduct this brief systematic review and meta-analysis, a related literature search was done from different sources, PubMed Medline and Google Scholar Journals. Then IFA Supplementation related searching engine was used to make the work more meaningful and intensive. Moreover, we used modified Newcastle-Ottawa quality assessment scale for cross sectional studies to assess the quality of the study in terms of their inclusion. Then, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed to carry out the work in a carful manner. Finally, the pooled effect size was computed using the review manager and Compressive Meta-analysis software. Results Twenty-three studies, which encompassed 24272 pregnant women, were chosen for the analysis. From those an overall prevalence of compliance with Iron and Folic Acid Supplementation (IFAS) in pregnancy in SSA was 39.2%. However, the result from meta-analysis showed that women who were counseled on IFAS in their courses of pregnancy were 1.96 times more likely to adhere to IFAS compared to those who were not counseled [OR:1.96, 95% CI (1.76-,5.93)]. Moreover, it showed that women who had knowledge of IFAS were 2.71 times more likely to have compliance with IFAS as compared to those who had no knowledge of IFAS [OR:2.71, 95% CI (1.33,5.54)]. Also it revealed that those women who had knowledge of anemia were 5.42 times more likely to have compliance with IFAS as compared with those who had no knowledge of anemia [OR5.42, 95% CI (1.52, 19.43)]. Furthermore, women who had received fourth visit for ANC were 1.54 times more likely to have compliance with IFAS as compared to those who had not received for ANC [OR 1.54, 95% CI (0.66, 3.58.43)]. Conclusions Our finding from this systematic review and meta-analysis shows the low case in prevalence of compliance to IFAS among pregnant women in SSA. Predictors for this includes: knowledge about anemia, knowledge about IFAS, counseling on IFAS and receiving fourth antenatal care visit were statistically correlated positively with compliance to IFAS. This demands careful appraisal of effect of prevention work for functioning policy, programs and plan nutrition intrusions for refining maternal dietary intake in gestation. Also dietary education intrusion requires to be planned to satisfy the needs of pregnant women. So we hope that the result of this study might be essential as a bridging stone for policy makers of Africa; exclusively for maternal and child health care. Finally, we recommended further studies to be conducted in the area of the study for more intensive and detailed suggestions.
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Bahati F, Kairu-Wanyoike S, Nzioki JM. Adherence to iron and folic acid supplementation during pregnancy among postnatal mothers seeking maternal and child healthcare at Kakamega level 5 hospital in Kenya: a cross-sectional study. Wellcome Open Res 2021; 6:80. [PMID: 34405117 PMCID: PMC8366300 DOI: 10.12688/wellcomeopenres.16699.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 04/04/2024] Open
Abstract
Background: Maternal anaemia is a public health problem worldwide, and its aetiology is linked to iron deficiency. The high nutrient demand during pregnancy exacerbates the condition. To meet the increased nutritional demand, supplementation of iron and folic acid (IFA) is key. The supplements are provided freely to pregnant women during antenatal visits at public health facilities, however, their uptake and adherence in Kenya remain unacceptably low. Methods: A hospital-based cross-sectional study involving 241 postnatal mothers seeking maternal and child healthcare (MCH) care at Kakamega level 5 hospital was conducted. Both quantitative and qualitative data were collected. Quantitative data were collected from 241 eligible postnatal mothers, while qualitative data were obtained through key informant interviews with community health volunteers and healthcare providers. Results: There was a moderate adherence to IFA supplementation (60.6%) during pregnancy among postnatal mothers seeking MCH care at Kakamega level 5 hospital. Some of the reasons for non-adherence stated by the respondents included; IFA related side effects (41.3%), forgetfulness (37.3%) and bad smell of the IFA supplements (10.3%). Higher IFA adherence was noted among the primigravida participants (OR=2.704; 95% CI: 1.262, 5.793; p=0.010) compared to multigravida participants, and those with a higher knowledge level of anaemia (OR=3.215; 95% CI: 1.346, 7.68; p=0.009) compared to their counterparts with low anaemia knowledge. Other factors that showed correlation with IFA adherence were: IFA education, pregnancy counselling before conception and the number of antenatal care visits attained. Conclusion: There is a moderate adherence to IFA supplementation during pregnancy among mothers seeking MCH at Kakamega level 5 hospital. The greatest impediments of IFA compliance during pregnancy are IFA side effects, forgetfulness and the bad smell of the IFA tablets. Therefore, providing IFA education to pregnant mothers incorporated with probable ways of managing the IFA side effects would contribute to IFA supplementation adherence.
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Affiliation(s)
- Felix Bahati
- Health Services Research Unit, KEMRI Wellcome Trust, Nairobi, Nairobi, 43640-00100, Kenya
- Environmental Health and Disease Control, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Nairobi, 62 000 – 00200, Kenya
| | - Salome Kairu-Wanyoike
- Directorate of Veterinary Services, Ministry of Agriculture, Livestock, Fisheries and Cooperatives, Nairobi, Nairobi, Kangemi 00605, Kenya
| | - Japheth Mativo Nzioki
- Environmental Health and Disease Control, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Nairobi, 62 000 – 00200, Kenya
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Sendeku FW, Azeze GG, Fenta SL. Adherence to iron-folic acid supplementation among pregnant women in Ethiopia: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2020; 20:138. [PMID: 32131751 PMCID: PMC7057669 DOI: 10.1186/s12884-020-2835-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/24/2020] [Indexed: 01/19/2023] Open
Abstract
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.
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Affiliation(s)
- Fikadu Waltengus Sendeku
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Getnet Gedefaw Azeze
- Department of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Selamawit Lake Fenta
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Ba DM, Ssentongo P, Kjerulff KH, Na M, Liu G, Gao X, Du P. Adherence to Iron Supplementation in 22 Sub-Saharan African Countries and Associated Factors among Pregnant Women: A Large Population-Based Study. Curr Dev Nutr 2019; 3:nzz120. [PMID: 31777771 PMCID: PMC6867960 DOI: 10.1093/cdn/nzz120] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/10/2019] [Accepted: 10/18/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Iron deficiency anemia during pregnancy is a significant public health problem in sub-Saharan Africa (SSA) and is associated with serious adverse health outcomes. Although it is recommended that all women receive iron supplementation during pregnancy, little research has been conducted to measure overall compliance with this recommendation or variation across SSA countries. OBJECTIVES To assess prevalence and sociodemographic-economic factors associated with adherence to iron supplementation among pregnant women in SSA. METHODS This was a weighted population-based cross-sectional study of 148,528 pregnant women aged 15-49 y in 22 SSA countries that participated in the Demographic and Health Surveys (DHS) in 2013-2018 and measured iron supplementation during pregnancy. Adherence to iron supplementation was defined as using iron supplementation for ≥90 d during pregnancy of the most recent birth. RESULTS The overall prevalence of adherence to ≥90 d of iron supplementation during pregnancy was 28.7%, ranging from 1.4% in Burundi to 73.0% in Senegal. Factors associated with adherence included receiving ≥4 antenatal care visits [adjusted Prevalence Ratio (aPR): 25.73; 95% CI: 22.36, 29.60] compared with no antenatal visits; secondary or higher education (aPR: 1.17; 95% CI: 1.14, 1.19) compared with no education; wealthy (aPR: 1.13; 95% CI: 1.10, 1.16) compared with poor; and older women aged 35-49 y (aPR: 1.07; 95% CI: 1.05, 1.10) compared with younger women aged 15-24 y. CONCLUSIONS Adherence to iron supplementation during pregnancy in SSA is low and varies substantially across countries and in relation to factors such as number of antenatal visits, education, and level of family wealth. These results underscore the need for increased efforts to improve the uptake of iron supplementation for pregnant women in SSA.
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Affiliation(s)
- Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
- Center for Neural Engineering, Department of Engineering, Science and Mechanics, The Pennsylvania State University, University Park, PA, USA
| | - Kristen H Kjerulff
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Muzi Na
- Department of Nutritional Sciences, Penn State University, State College, PA, USA
| | - Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Xiang Gao
- Department of Nutritional Sciences, Penn State University, State College, PA, USA
| | - Ping Du
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
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