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Alie MS, Gichew S, Alemayehu D. Hotspot analysis of anaemia among pregnant women in Ethiopia: hotspot analysis of national demographic and health survey data. BMJ Open 2024; 14:e086539. [PMID: 39097301 PMCID: PMC11298733 DOI: 10.1136/bmjopen-2024-086539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/23/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND Anaemia is a significant global health problem, especially, in developing nations like Ethiopia. Despite increasing rates over the past two decades, there is limited research on the specific prevalence of anaemia among pregnant women in the country. OBJECTIVE To identify hotspot areas of anaemia-associated factors among pregnant women in Ethiopia. STUDY DESIGN Cross-sectional. SETTING Ethiopian demographic study from 2005 to 2016. PARTICIPANTS This study analysed 3350 pregnant women. PRIMARY AND SECONDARY OUTCOME MEASURES Hotspot area of anaemia among pregnant women, trend of anaemia and associated factors. RESULTS The prevalence of anaemia among pregnant women has shown significant fluctuations over the years. Between 2005 and 2011, there was a notable decrease from 30.9% to 21.5% while the prevalence increased from 21.5% in 2011 to 29.58% in 2016. The identified determinants of anaemia among pregnant women were female-headed household, belonging to the highest wealth quintile, being in the second or third trimester of pregnancy, being a working woman and residing in the Somalia region. Hotspot areas, where the prevalence of anaemia was particularly high, were identified in Somalia, Dire Dawa, Afar and Harari regions. CONCLUSION Anaemia during pregnancy is a major public health concern in Ethiopia, with a concerning increase between 2011 and 2016. Hotspot areas like Somali, Dire Dawa, Afar and Harari are particularly affected. Shockingly, nearly one in three pregnant women in Ethiopia suffer from anaemia. To address this issue effectively, targeted interventions prioritising economically disadvantaged households and pregnant women in their second and third trimesters are crucial. Monitoring spatial patterns and contributing factors is vital to develop tailored interventions and improve maternal health outcomes in these high-risk areas. By strategically targeting hotspot areas nationwide, significant progress can be made in reducing anaemia among pregnant women.
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Affiliation(s)
- Melsew Setegn Alie
- Department of Public Health, School of Public Health, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Simegnew Gichew
- Department of Public Health, School of Public Health, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Dereje Alemayehu
- Department of Public Health, School of Public Health, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
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Tsegai MB, Berhe AH, Tesfaezgi SB, Weldemariam DG, Petros KT, Weldetinsae HB, Tesfamariam EH. Knowledge, Attitude, and Practice Regarding Supplemental Iron and Folic Acid Amongst Women Delivering in Edaga-Hamus Community Hospital: A Cross-Sectional Study in Asmara, Eritrea. Int J Womens Health 2023; 15:1593-1609. [PMID: 37881442 PMCID: PMC10595971 DOI: 10.2147/ijwh.s419813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/30/2023] [Indexed: 10/27/2023] Open
Abstract
Purpose In Eritrea, every pregnant woman is provided with a supplemental iron and folic acid (IFA) tablet starting from the first antenatal visit throughout the end of pregnancy. In Zoba Maekel, two-third of first antenatal visits have been at either the second or third trimesters. This practice could limit pregnant women's timely access to the nutritional supplement and its benefits. Therefore, this study aims to identify the knowledge, attitude, and practice of women delivering in Edaga-Hamus Community Hospital towards the supplemental IFA tablet. Materials and Methods A health facility-based cross-sectional study was carried out on 360 women delivering in Edaga-Hamus Community Hospital. Data were collected using a structured questionnaire through systematic sampling. Associated factors were identified using bivariate and multivariable logistic regression. Associations with a p-value <0.05 were considered significant. Results Mothers with higher level of IFA knowledge and attitude held 52.8% and 65.4%, respectively. Health care workers were predominantly (92.3%) the main source for IFA information. Possible IFA side-effects were known by 64.8% of the mothers, even though only 28.2% knew reduction of side effects if taken with food. Almost all (96.1% and 97.0% respectively) believed IFA is beneficial and can prevent anemia. Only 27.9% had appropriately practiced taking the IFA supplement. Mothers who visited for antenatal care more than 8 times (AOR: 4.02, 95% CI: 1.45, 11.09) and 5 to 8 times (AOR: 2.87, 95% CI: 1.52, 5.41) had increased odds of appropriate IFA practice compared to those who visited for 1 to 4 times. Women who had planned pregnancies (AOR: 2.03, 95% CI: 1.01, 4.10) were more likely to have appropriate practice than their counterparts who had unplanned pregnancies. Conclusion The study indicated that further strategies need to be implemented to increase the current level of knowledge, attitude, and practice of IFA.
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Affiliation(s)
| | | | | | | | | | | | - Eyasu H Tesfamariam
- Department of Statistics, Biostatistics and Epidemiology, College of Science, Eritrean Institute of Technology, Mai-Nefhi, Eritrea
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Demie TG, Gessese GT, Woldeamanuel BT, Biratu TD, Handebo S. Adherence to iron supplement intake during pregnancy and associated factors in Ethiopia: Further analysis of a national population-based study. Food Sci Nutr 2023; 11:5460-5471. [PMID: 37701196 PMCID: PMC10494606 DOI: 10.1002/fsn3.3503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 04/25/2023] [Accepted: 06/02/2023] [Indexed: 09/14/2023] Open
Abstract
Iron deficiency during pregnancy is a risk factor for anemia, preterm delivery, and low birth weight. Poor adherence to iron supplement intake remains a problem in many countries including Ethiopia. This analysis aimed at determining the proportion of adherence to iron supplement intake and its associated factors among pregnant women in Ethiopia. We used the data from the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS), which is a cross-sectional and nationally representative survey. A weighted sample of 3927 pregnant women was included in the study. Bivariate and multivariable binary logistic regression analyses were performed to identify factors associated with adherence to iron supplement intake. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) and p-value <.05 were used to declare statistical significance. Our analysis revealed that out of 2356 (60.0%) pregnant women who took iron supplements during their most recent pregnancy, only 417 (17.7%; 95% CI: 0.162-0.193) adhered to the WHO-recommended iron intake for 90 days or more. The subnational regions, level of education, literacy, the timing of first antenatal care booking, and past place of delivery were significantly associated with iron supplement intake. Interventions to enhance the uptake of iron supplementation better focus on improving women's education and literacy, early initiation and frequency of ANC visits, and institutional delivery. Raising community awareness through educating pregnant women is also recommended to improve adherence to iron supplement intake.
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Affiliation(s)
- Takele Gezahegn Demie
- School of Public HealthSaint Paul's Hospital Millennium Medical CollegeAddis AbabaEthiopia
| | | | | | - Tolesa Diriba Biratu
- School of Public HealthSaint Paul's Hospital Millennium Medical CollegeAddis AbabaEthiopia
| | - Simegnew Handebo
- School of Public HealthSaint Paul's Hospital Millennium Medical CollegeAddis AbabaEthiopia
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Yalew M, Getachew S, Mohammed K, Hankarso H, Bayile A, Asmamaw SD, Assefa MG, Bazie GW, Mebratu W, Kefale B, Damtie Y, Arefaynie M, Birhane T, Dewau R, Cherie N, Addisu E, Mitiku K, Tadese F, Wendie TF, Habtie A, Mekonnen TC, Tadesse SE, Bedane GT, Wasihun Y, Tsega TD, Taddele M, Tefera Z, Adane B, Wagaye B, Ayele FY, Zerga AA, Molla A, Desalegn B, Birkie M, Bewket B, Alemu BK, Zewdie S, Tsegaye MK, Bitew A, Mehari K, Derseh L. Individual and contextual-level factors associated with iron-folic acid supplement intake during pregnancy in Ethiopia: a multi-level analysis. BMC Pregnancy Childbirth 2023; 23:260. [PMID: 37072714 PMCID: PMC10111777 DOI: 10.1186/s12884-023-05593-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/10/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Anemia is still one of the major public health problems in many developing countries including Ethiopia. Thus, this study aimed to assess individual and contextual-level factors associated with iron-folic acid supplement intake during pregnancy in Ethiopia. METHODS A secondary analysis was done on the 2019 mini-Ethiopian Demographic and Health Survey (EDHS) dataset. A total of 3,927 pregnant women who gave birth five years before the survey were included in the analysis. Multi-level mixed-effect logistic regression analysis was done by STATA/SE version 14.0 to identify individual and contextual-level factors. Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was used to show the strength and direction of the association. The level of statistical significance was declared at a P value less than 0.05. RESULTS Those primary educated [AOR = 1.83, 95% CI: (1.24, 2.74)], secondary educated [AOR = 2.75, 95% CI: (1.57, 4.824)], women who had greater than 5 living children [AOR = 2.02, 95% CI: (1.25, 3.27)], women who had ANC visit [AOR = 21.26, 95% CI: (13.56, 33.32)] and women who lived in a cluster with high proportion of women had ANC visit [AOR = 1.72, 95% CI: (1.17, 2.54)] and women who lived in Somali [AOR = 0.44 0.73, 95% CI: (0.22, 0.87)] were significantly associated with iron-folic acid intake during pregnancy. CONCLUSIONS Both individual and contextual-level factors were significantly associated with iron-folic acid intake during pregnancy. From individual-level factors: education status of women, the total numbers of living children, and ANC follow-up are significant and from contextual-level factors: region and living in a high proportion of women who had ANC follow-up were found to have a statistically significant association. Promoting women's education and maternal health services like ANC and intervention targeting the Somali region would be the recalled area of the government.
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Affiliation(s)
- Melaku Yalew
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Injibara University, Injibara, Ethiopia.
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Shiferaw Getachew
- Head office manager of Mida Weremo woreda, North Shewa, Amhara Regional State, Ethiopia
| | - Keriya Mohammed
- Independet researcher, Dessie, Amhara Regional State, Ethiopia
| | - Hailu Hankarso
- Yirgalem Medical College, Hawassa University, Hawassa, Ethiopia
| | - Adane Bayile
- Head manager of Maternal and Child Health, Boru Meda Hospital, Amhara Regional State, Bahir Dar, Ethiopia
| | | | | | - Getaw Walle Bazie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Wondwosen Mebratu
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bereket Kefale
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yitayish Damtie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- Department of Reproductive and Family Health, School of Public Health, College of Health Sciences, Injibara University, Injibara, Ethiopia
| | - Mastewal Arefaynie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tesfaye Birhane
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Reta Dewau
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Nigus Cherie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Elsabeth Addisu
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Kefale Mitiku
- Department of Physiology, College of Health Sciences, Injibara University, Injibara, Ethiopia
| | - Fentaw Tadese
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | | | - Adane Habtie
- Department of Health Promotion, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Tefera Chane Mekonnen
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Sisay Eshete Tadesse
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | | | - Yitbarek Wasihun
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tilahun Degu Tsega
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Injibara University, Injibara, Ethiopia
| | - Mekuanint Taddele
- Department of Health Promotion and Behavior, School of Public Health, College of Health Sciences, Injibara University, Injibara, Ethiopia
| | - Zenebe Tefera
- Department of Midwifery, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bezawit Adane
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Injibara University, Injibara, Ethiopia
| | - Birhanu Wagaye
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Fanos Yeshanew Ayele
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Aregash Abebayehu Zerga
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Abebaw Molla
- Department of Public Health Nutrition, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Biruk Desalegn
- Department of Epidemiology and Biostatistics, Kotebe Health Science College, Kotebe University, Addis Abab, Ethiopia
| | - Mengesha Birkie
- Department of Psychiatry Nursing, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Bekalu Bewket
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Belete Kassa Alemu
- Department of Pharmacy, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Segenet Zewdie
- Department of Pharmacy, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Meseret Kefale Tsegaye
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abebayehu Bitew
- Department of Gynecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kassu Mehari
- Department of Statistics, College of Natural Sciences, Wollo University, Dessie, Ethiopia
| | - Lemma Derseh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Mao Y, Hu H, Chen D, Fang Y, Liu J, Li M, Zhou W. Investigating continuation of folic acid supplementation during peri-conceptional period: a community-based cross-sectional study. Reprod Health 2023; 20:34. [PMID: 36803517 PMCID: PMC9942345 DOI: 10.1186/s12978-023-01564-5] [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] [Received: 03/02/2021] [Accepted: 01/05/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Maternal folate may not reach an optimal level to prevent neural tube defects if supplementation commenced post-conception or took place pre-conception only. Our study aimed to investigate the continuation of folic acid (FA) supplementation from pre-conception to post-conception during peri-conceptional period and to examine its differences in FA supplementation between the subgroups taking the initiation timing into consideration. METHODS This study was conducted in two community health service centers in Jing-an District of Shanghai. Women accompanying their children to pediatric health clinics of the centers were recruited and asked to recall information concerning their socioeconomic and previous obstetric characteristics, utilization of healthcare and FA supplementation before and/or during pregnancy. The continuation of FA supplementation during peri-conceptional period were categorized into three subgroups: Supplementing with FA pre- and post-conception; supplementing with FA preconception only or post-conception only; no FA supplements pre-conception and post-conception. The relationship between FA continuation and couples' characteristics were examined as setting the first subgroup as the base reference. RESULTS Three hundred and ninety-six women were recruited. Over 40% of the women started FA supplementation after conception and 30.3% of them supplemented with FA from pre-conception to the first trimester of their pregnancy. Compared to this one-third of participants, women who didn't supplemented with any FA during peri-conceptional period were more likely to have no utilization of pre-conception healthcare ([Formula: see text]= 2.47, 95% [Formula: see text]: 1.33-4.61) or antenatal care ([Formula: see text]= 4.05, 95% [Formula: see text]: 1.76-9.34), or who had a lower family socioeconomic status ([Formula: see text]= 4.36, 95% [Formula: see text]: 1.79-10.64). Women who supplemented with FA pre-conception only or post-conception only were more likely to have no utilization of pre-conception healthcare ([Formula: see text]= 2.94, 95% [Formula: see text]: 1.79-4.82), or to have no previous pregnancy complication ([Formula: see text]=1.80, 95% [Formula: see text]: 0.99-3.28). CONCLUSION Over two-fifth of the women started FA supplementation and only one-third of them had an optimal supplementation from pre-conception to the first trimester. Maternal utilization of healthcare before or during pregnancy together with maternal and paternal socioeconomic status may play a role in the continuation to FA supplementation pre- and post-conception.
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Affiliation(s)
- Yanyan Mao
- NHC Key Laboratory of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai, 200237 China
| | - Hong Hu
- Community Health Service Center of Jing-An-Si, Jing-an District, Shanghai, 200040 China
| | - Dongyan Chen
- Community Health Service Center of Pengpu Estate, Jing-an District, Shanghai, 200435 China
| | - Yuhang Fang
- NHC Key Laboratory of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai, 200237 China
| | - Jun Liu
- grid.488200.6NHC Key Laboratory of Birth Defects and Reproductive Health (Chongqing Population and Family Planning Science and Technology Research Institute), Chongqing, 400020 China
| | - Min Li
- NHC Key Laboratory of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai, 200237 China
| | - Weijin Zhou
- NHC Key Laboratory of Birth Defects and Reproductive Health (Chongqing Population and Family Planning Science and Technology Research Institute), Chongqing, 400020, China.
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Edeo Berarti A, Gebrie M, Beyene B. Adherence To Iron Folic Acid Supplementation and Associated Factors Among Antenatal CARE Attending Women in Sire District Primary Health Care Units, South-East Ethiopia: A Facility Based Cross-Sectional Study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2023. [DOI: 10.1016/j.ijans.2023.100526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Menezes R, Lelijveld N, Wrottesley SV, Brennan E, Mates E, James PT. Integrating Women and Girls' Nutrition Services into Health Systems in Low- and Middle-Income Countries: A Systematic Review. Nutrients 2022; 14:4488. [PMID: 36364750 PMCID: PMC9657561 DOI: 10.3390/nu14214488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 08/16/2023] Open
Abstract
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.
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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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Asres AW, Hunegnaw WA, Ferede AG, Azene TW. Compliance level and factors associated with iron-folic acid supplementation among pregnant women in Dangila, Northern Ethiopia: A cross-sectional study. SAGE Open Med 2022; 10:20503121221118989. [PMID: 36003078 PMCID: PMC9393355 DOI: 10.1177/20503121221118989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/22/2022] [Indexed: 01/25/2023] Open
Abstract
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.
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Affiliation(s)
- Abiyot Wolie Asres
- Department of Epidemiology and Biostatistics, School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Tamirat KS, Kebede FB, Gonete TZ, Tessema GA, Tessema ZT. Geographical variations and determinants of iron and folic acid supplementation during pregnancy in Ethiopia: analysis of 2019 mini demographic and health survey. BMC Pregnancy Childbirth 2022; 22:127. [PMID: 35168542 PMCID: PMC8848817 DOI: 10.1186/s12884-022-04461-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 02/04/2022] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Koku Sisay Tamirat
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | | | - Tajebew Zayede Gonete
- Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getayneh Antehunegn Tessema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Khani Jeihooni A, Rakhshani T, Harsini PA, Layeghiasl M. Effect of educational program based on theory of planned behavior on promoting nutritional behaviors preventing Anemia in a sample of Iranian pregnant women. BMC Public Health 2021; 21:2198. [PMID: 34852814 PMCID: PMC8638108 DOI: 10.1186/s12889-021-12270-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Iron deficiency anemia (IDA) is one of the most common problems during pregnancy. The aim of this research was to determine the effect of educational program based on Theory of Planned Behavior (TPB) on promoting nutritional behaviors preventing anemia in a pregnant woman in Shiraz city, Iran. METHODS This quasi-experimental study was done on 150 pregnant women (75 experimental and 75 control groups) who were selected using randomly sampling method in in Shiraz city, Iran, in 2020-2021. The educational intervention for the experimental group included six educational sessions for 50 or 55 min-based TPB model. A questionnaire consisted of items about demographic information, TPB constructs (attitude, perceived behavioral control, subjective norms and behavioral intention) was used to measure the nutritional behaviours preventing iron deficiency anemia in pregnancy women before and 3 months after the intervention. RESULTS The results showed that before the educational intervention, there was no significant difference between the two groups in terms of knowledge, attitude, perceived behavioral control, subjective norms, behavioral intention and nutritional performance; however, three months after the educational intervention, the experimental group showed a significant increase in each of the mentioned variables. For example the mean and standard deviation score of behavioral intention after intervention in the experimental group was significantly increased (25.57 ± 1.66, P = 0.001),and the mean and standard deviation score of performance after intervention in the experimental group was significantly increased (31.03 ± 2.19, P = 0.001), (P < 0.05). CONCLUSIONS After the educational intervention, the experimental group showed a significant increase in of the knowledge, attitude, perceived behavioral control, subjective norms, behavioral intention and nutritional performance. Therefore the results of the study showed positive effect of nutrition educational intervention program base on TPB model on improvement of iron deficiency anemia preventive behaviours in the pregnancy women.
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Affiliation(s)
- Ali Khani Jeihooni
- Nutrition Research Center, Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tayebeh Rakhshani
- Nutrition Research Center, Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pooyan Afzali Harsini
- Department of Public Health, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehdi Layeghiasl
- Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Solomon Y, Sema A, Menberu T. Adherence and associated factors to iron and folic acid supplementation among pregnant women attending antenatal care in public hospitals of Dire Dawa, Eastern Ethiopia. Eur J Midwifery 2021; 5:35. [PMID: 34514359 PMCID: PMC8386124 DOI: 10.18332/ejm/138595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/17/2021] [Accepted: 06/06/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Worldwide, 41.8% of pregnant women have anemia. Nationally, only 0.4% of pregnant women take the recommended 180-day iron supplement for more than 90 days. This study aimed to determine adherence to iron and folic acid supplements and factors affecting it among pregnant women attending antenatal care in public hospitals of Dire Dawa City, eastern Ethiopia. METHODS An institutional-based cross-sectional study design was conducted from 1 January 2019 to 30 June 2019. In all, 416 pregnant women were selected using a systematic random sampling method. Data were collected using an interviewer-administered questionnaire and analyzed using SPSS version 22.00. Bivariate and multivariable logistic regression with a 95% confidence interval was done, and variables at a p<0.05 were considered statistically significant to the outcome variable. RESULTS The study revealed that 71.8% of pregnant women have adhered to iron/folic acid supplements. Pregnant women who had ≥4 antenatal care visits (AOR=3.15; 95% CI: 1.16–9.05), got advice about iron/folic acid supplementation (AOR=3.12; 95% CI: 1.15–5.29), good knowledge about iron/folic acid supplementation (AOR=3.56; 95% CI: 1.42–8.54), good knowledge about anemia (AOR=5.22; 95% CI: 2.06–8.33), and currently anemic (AOR=2.58; 95% CI: 2.38–9.61) were significantly associated with adherence of iron/folic acid supplementation. CONCLUSIONS The adherence of iron/folic acid supplementation of pregnant women was good. Getting advice about iron/folic acid supplementation, ≥4 antenatal care visits, having good knowledge about iron/folic acid supplementation and anemia, and currently anemic, were factors associated with adherence to iron/folic acid supplementation.
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Affiliation(s)
- Yonatan Solomon
- Department of Nursing, College of Medicine and Health Sciences, Dire-Dawa University, Dire Dawa, Ethiopia
| | - Alekaw Sema
- Department of Midwifery, College of Medicine and Health Sciences, Dire-Dawa University, Dire Dawa, Ethiopia
| | - Tamiru Menberu
- Department of Medical Laboratory, College of Medicine and Health Sciences, Dire-Dawa University, Dire Dawa, Ethiopia
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Agegnehu CD, Tesema GA, Teshale AB, Alem AZ, Yeshaw Y, Kebede SA, Liyew AM. Spatial distribution and determinants of iron supplementation among pregnant women in Ethiopia: a spatial and multilevel analysis. Arch Public Health 2021; 79:143. [PMID: 34376252 PMCID: PMC8353869 DOI: 10.1186/s13690-021-00669-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal anemia continues as a global public health concern particularly in developing countries including Ethiopia. It is associated with an increased risk of maternal death, obstetric complications, preterm birth, and low birth weight. Even though maternal anemia is the commonest problem in Ethiopia, there is limited evidence on the spatial distribution and determinants of iron supplementation. Therefore, this study aimed to investigate the spatial distribution and determinants of iron supplementation among pregnant women in Ethiopia. METHOD A secondary data analysis was conducted based on the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 7589 women was included for analysis. For the spatial analysis; ArcGIS version 10.6, and SaT Scan version 9.6 statistical software were employed to explore the spatial distribution, and to identify significant hotspot areas of iron supplementation in Ethiopia. For the determinant factors, multilevel logistic regression analysis was fitted to identify significant individual and community level determinants of iron supplementation. Deviance, Median Odds Ratio (MOR), and Intra-class Correlation Coefficient (ICC) were used for model comparison and for assessing model fitness. Variables with a p-value of less than 0.2 in the bivariable analysis were considered in the multivariable multilevel analysis. In the multivariable multilevel analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was used to declare significant determinants of iron supplementation. RESULTS The spatial distribution of iron supplementation was significantly varied across the country with Global Moran's index value of 0.3 (p < 0.001). The SaTScan analysis identified a total of 271 significant clusters, of these 89 clusters were primary clusters located in the Southwest Somali and Central Oromia regions (LLR = 66.69, P < 0.001, RR = 1.35). ANC visit (AOR = 3.66, 95%CI: 3.21, 417), community education [AOR = 1.31, 95%CI, 1.07, 1.59), media exposure (AOR = 1.33, 95%CI: 1.15, 1.53), distance to health facility (AOR = 1.32, 95%CI: 1.16, 1.50), region and household wealth index were statistically significant determinant factors of iron supplementation. CONCLUSION Iron supplementation among pregnant women were significantly varied across the country. Therefore, the finding of this study could help to design effective public health interventions targeting areas with low iron supplementation and maternal health services should be delivered in all areas of our country. Besides, public health programs should enhance iron supplementation through promoting ANC visits, media exposure, and giving special emphasis to marginalized and remote areas.
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Affiliation(s)
- Chilot Desta Agegnehu
- School of Nursing, College of Medicine and Health Sciences and Comprehensive specialized hospital, University of Gondar, Gondar, Ethiopia.
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yigizie Yeshaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sewnet Adem Kebede
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemneh Mekuriaw Liyew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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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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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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Iron and Folic Acid Supplementation Compliance and Associated Factors among Pregnant Women Attending Antenatal Clinic in Shalla District, Southwest Ethiopia: A Cross-Sectional Study. J Nutr Metab 2021; 2021:6655027. [PMID: 33854798 PMCID: PMC8019646 DOI: 10.1155/2021/6655027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background Iron-folate supplementation for a pregnant mother is a cost-effective intervention to reduce iron deficiency anemia during pregnancy. The aim of this study was to assess the iron-folic acid supplements and associated factors among pregnant women attending antenatal clinics in the public health center of Shalla district, Southwest Ethiopia. Methods Institutional-based cross-sectional study design was conducted among 402 randomly selected pregnant mothers between February and April 2019. Data were collected using an interviewer-administered structured questionnaire from pregnant mothers attending antenatal care and using iron-folate supplements. Descriptive and multivariate logistic regression analyses were employed. Results Pill count compliance rate was found to be (154) 38.3%. Pregnant mothers who had anemia in their previous pregnancy [(AOR = 11.35, 95% CI: 4.76–27.03)], counseling on iron-folate supplements [(AOR = 11.39, 95% CI: 5.09–27.03)], awareness of the benefit of the iron-folate supplements [(AOR = 2.22, 95% CI: 1.18–3.92)], and being a member of the Health Development Army [(AOR = 2.11, 95% CI: (1.2, 3.9)] were significantly associated with compliance with iron-folate supplement. Conclusion Compared to the World Health Organization cut-off point, the pill count compliance rate of iron-folate supplementation among pregnant women in the study area was very low. Previous history of anemia and lack of knowledge about its benefit were some of the factors associated with it. Therefore, the healthcare providers should give continuous awareness creation and counseling services focusing on the benefit of iron-folate supplementation for pregnant mothers and their neonates.
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Wang S, Wei J, Wang D, Hua L, Pan D, Fu L, Yang J, Sun G. The association between folic acid supplementation, maternal folate during pregnancy and intelligence development in infants: a prospective cohort study. FOOD SCIENCE AND HUMAN WELLNESS 2021. [DOI: 10.1016/j.fshw.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mekonnen A, Alemnew W, Abebe Z, Demissie GD. 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. Patient Prefer Adherence 2021; 15:843-851. [PMID: 33911855 PMCID: PMC8071691 DOI: 10.2147/ppa.s299294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/25/2021] [Indexed: 01/04/2023] Open
Abstract
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.
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Affiliation(s)
| | - Wallelign Alemnew
- Department of Health Education and Behavioral Health Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Correspondence: Wallelign Alemnew Email
| | - Zegeye Abebe
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getu Debalkie Demissie
- Department of Health Education and Behavioral Health Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Tegodan E, Tura G, Kebede A. Adherence to Iron and Folic Acid Supplements and Associated Factors Among Pregnant Mothers Attending ANC at Gulele Sub-City Government Health Centers in Addis Ababa, Ethiopia. Patient Prefer Adherence 2021; 15:1397-1405. [PMID: 34188456 PMCID: PMC8236246 DOI: 10.2147/ppa.s301630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/02/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Even though antenatal care (ANC) visits seems to be the key strategy to increase adherence to iron and folic acid supplements during pregnancy, the problem still remains unresolved. Therefore, this study planned to assess adherence to iron and folic acid supplements and associated factors among pregnant mothers attending ANC at Gulele sub-city Government Health Centers in Addis Ababa, Ethiopia, 2019. METHODS An institution-based cross-sectional study design was conducted on 403 pregnant women attending ANC at governmental health centers in Gulele sub city of Addis Ababa from May to June, 2019. The study participants were selected by systematic random sampling techniques, and an interviewer administered questionnaire was used to collect data. Descriptive statistics and logistic regression models were used to analyze the data. The results were considered statistically significant at p-value <0.05. RESULTS The proportion of mother's adherent to iron and folic acid supplements was 62.3% with a 95% CI of 57.5-67.0. Women who had no formal education (AOR=2.37; 95% CI=1.25-4.51), poor knowledge about anemia (AOR=1.97; 95% CI=1.24-3.13), developing any other health problem during current pregnancy (AOR=2.59; 95% CI=1.55-4.32), attending health information about iron/folic acid supplement (AOR=2.06; 95% CI=1.08-3.921 and forgetful (AOR=2.23; 95% CI=1.40-3.56) mothers were more likely to be non-adherent to the supplement compared with their counterparts. CONCLUSION AND RECOMMENDATION The status of maternal adherence was medium compared with other studies, and maternal educational status, knowledge about anemia, exposure to information, experiencing of health problems, and forgetfulness were associated with adherence behavior. This indicates that improving dissemination of information about the supplements and designing a reminder mechanism was needed to improve the adherence status of mothers to the supplement.
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Affiliation(s)
- Eleni Tegodan
- Addis Ababa, Gulele Sub City, Hidase Health Center, Addis Ababa, Ethiopia
| | - Gurmesa Tura
- Jimma University, Institute of Health, Department of Population and Family Health, Jimma, Ethiopia
| | - Ayantu Kebede
- Jimma University, Institute of Health, Department of Epidemiology, Jimma, Ethiopia
- Correspondence: Ayantu Kebede Tel +251910170632 Email
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Riang'a RM, Nangulu AK, Broerse JEW. Implementation fidelity of nutritional counselling, iron and folic acid supplementation guidelines and associated challenges in rural Uasin Gishu County Kenya. BMC Nutr 2020; 6:78. [PMID: 33334353 PMCID: PMC7747396 DOI: 10.1186/s40795-020-00403-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 12/01/2020] [Indexed: 11/15/2022] Open
Abstract
Background Implementation fidelity which is defined as the degree to which programmes are implemented as intended is one of the factors that affect programme outcome, thus requiring careful examination. This study aims to acquire insight into the degree to which nutritional counselling and Iron and Folic Acid supplementation (IFAs) policy guidelines during pregnancy have been implemented as intended and the challenges to implementation fidelity. Methods Data were collected in rural Uasin Gishu County in the western part of Kenya through document analysis, questionnaires among intervention recipients (n = 188) and semi-structured interviews with programme implementers (n = 6). Data collection and analysis were guided by an implementation fidelity framework. We specifically evaluated adherence to intervention design (content, frequency, duration and coverage), exposure or dosage, quality of delivery and participant responsiveness. Results Coverage of nutritional counselling and IFAs policy is widespread. However, partial provision was reported in all the intervention components. Only 10% accessed intervention within the first trimester as recommended by policy guidelines, only 28% reported receiving nutritional counselling, only 18 and 15% of the respondents received 90 or more iron and folic acid pills respectively during their entire pregnancy period, and 66% completed taking the IFAs pills that were issued to them. Late initial bookings to antenatal care, drug stock shortage, staff shortage and long queues, confusing dosage instructions, side effects of the pills and issuing of many pills at one go, were established to be the main challenges to effective implementation fidelity. Anticipated health consequences and emphasis by the health officer to comply with instructions were established to be motivations for adherence to nutritional counselling and IFAs guidelines. Conclusions Implementation fidelity of nutritional counselling and IFAs policy in Kenya is generally weak. There is need for approaches to enhance early access to interventions, enhance stock availability, provide mitigation measures for the side effects, as well as intensify nutritional counselling to promote the consumption of micronutrient-rich food sources available in the local environment to substitute for the shortage of nutritional supplements and low compliance to IFAs.
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Affiliation(s)
- Roselyter Monchari Riang'a
- Current address: Department of Sociology, Psychology and Anthropology, School of Arts and Social Sciences, Moi University, Eldoret, Kenya.
| | - Anne Kisaka Nangulu
- Current address: Principle, Bomet University College, Bomet, Kenya.,Current address: Department of History and political Science, School of Arts and Social Sciences, Moi University, Eldoret, Kenya
| | - Jacqueline E W Broerse
- Current address: Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Gebrie A, Alebel A. A systematic review and meta-analysis of the prevalence and predictors of anemia among children in Ethiopia. Afr Health Sci 2020; 20:2007-2021. [PMID: 34394267 PMCID: PMC8351872 DOI: 10.4314/ahs.v20i4.59] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Anemia is a wide-spread public health problem characterized by a decrease in hemoglobin concentration and/ or red blood cell volume below an established cut-off value. In developing countries including Ethiopia, about half of children are estimated to be anemic. Therefore, the purpose of this study was to determine the pooled prevalence of anemia and its predictor factors among children in Ethiopia. Method The studies were identified through explicit and exhaustive search of reputable databases (PubMed, Google scholar, Science Direct, EMBASE, Cochrane library, and the hand search of reference lists of previous prevalence studies to retrieve more related articles. Thirty-nine studies were selected based on a comprehensive list of inclusion and exclusion criteria. Data were extracted using a standardized and pre-tested data extraction checklist, and the analysis was done using STATA 14 statistical software. To assess heterogeneity, the Cochrane Q test statistic and I2 tests were used. In our analysis, considerable heterogeneity was observed. Therefore, a random effect meta-analysis model was used to estimate the pooled prevalence of anemia. Moreover, the predictor factors of anemia were examined. Results The forest plot of 39 included studies revealed that the overall pooled prevalence of anemia among children in Ethiopia was 34.4% (95% CI: 29.1, 39.7%). Sub-group analysis showed that the highest anemia prevalence was observed in Somali Region with a prevalence of 49.4 % (95% CI: 20.9, 77.8). Also, anemia in children was found to be highest in the age group of less than five years (45.2, 95% CI: 39.6,50.8). Low literacy of families: 1.3 (95% CI: 1.1, 1.7), low family socioeconomic status: 1.9 (95% CI: 1.1,3.01.3), having housewife mothers or with no job: 1.5 (95% CI: 1.4, 1.9) and rural residence: 3.3 (95% CI: 1.7,6.1) were found to be predictors of anemia among children. Conclusion In this study, one in three children were anemic in Ethiopia. It is a moderate public health problem in children in this study. Low literacy, low socioeconomic status as well as rural residence of the families and helminthic infection of the children were found to be predictors of anemia in the children. Community and school-based interventions should be strengthened to improve the problem.
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Affiliation(s)
- Alemu Gebrie
- Department of Biomedical Science, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Animut Alebel
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Debi S, Basu G, Mondal R, Chakrabarti S, Roy SK, Ghosh S. Compliance to iron-folic-acid supplementation and associated factors among pregnant women: A cross-sectional survey in a district of West Bengal, India. J Family Med Prim Care 2020; 9:3613-3618. [PMID: 33102338 PMCID: PMC7567271 DOI: 10.4103/jfmpc.jfmpc_392_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/25/2020] [Accepted: 05/13/2020] [Indexed: 12/01/2022] Open
Abstract
Background: Iron-deficiency anemia is considered to be a major health problem in India. This can complicate a normal pregnancy resulting in poor maternal and fetal outcomes. Iron-folic-acid (IFA) supplementation to antenatal and postnatal mothers given through the National Health Mission (NHM) serves as a major tool to combat this problem. Aim: This study aimed to assess compliance to IFA supplement and associated factors among antenatal mothers in a district of West Bengal, India. Methods: A cross-sectional observational study was conducted among 208 pregnant mothers attending different subcenters, using multistage sampling technique. Data were collected on their demographic, obstetric profile, compliance to IFA tablets, and knowledge on various health care-related factors through direct interviews. Data were analyzed using SPSS 22.0 (licensed) considering the confidence interval to be 95%. Results: Compliance rate was 81.74%. The most common cause of noncompliance was forgetfulness (73.7%). On multivariate regression analysis, age, history of deworming, and education became the significant predictors for noncompliance to IFA. Conclusions: Compliance to IFA supplementation was better than the national average, although deworming and education can lead to a better outcome. Health workers played a pivotal role for the success of this national program.
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Affiliation(s)
- Saha Debi
- Pharmacovigilance, Mahesh Bhattacharya Homeopathic Medical College and Hospital, West Bengal, India
| | - Gandhari Basu
- Department of Community Medicine, College of Medicine and JNM Hospital, WBUHS, West Bengal, India
| | - Reshmi Mondal
- Department of Community Medicine, College of Medicine and JNM Hospital, WBUHS, West Bengal, India
| | - Sreetama Chakrabarti
- Department of Community Medicine, College of Medicine and JNM Hospital, WBUHS, West Bengal, India
| | - Suman K Roy
- Department of Community Medicine, College of Medicine and JNM Hospital, WBUHS, West Bengal, India
| | - Shubhamoy Ghosh
- Department of Pathology and Microbiology, Mahesh Bhattacharya Homeopathic Medical College and Hospital, West Bengal, India
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Adherence to Iron-Folic Acid Supplementation and Associated Factors among Pregnant Women in Kasulu Communities in North-Western Tanzania. Int J Reprod Med 2020; 2020:3127245. [PMID: 32566646 PMCID: PMC7293754 DOI: 10.1155/2020/3127245] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/18/2020] [Accepted: 04/15/2020] [Indexed: 12/30/2022] Open
Abstract
Introduction Pregnant women are at a high risk of anaemia, with iron-folate deficiency being the most common cause of anaemia among pregnant women. Despite the well-known importance of iron and folic acid supplementation (IFAS) during pregnancy, adherence to these supplements is relatively low and associated factors were not well identified in the study area. This study is aimed at investigating adherence to IFAS and associated factors among pregnant women in Kasulu district, north-western Tanzania. Methods A health facility cross-sectional survey with a mixed-method approach was conducted in Kasulu district from March to April 2019. A structured questionnaire was given to 320 women with children aged 0-6 months to assess factors associated with adherence to IFAS among pregnant women. Data were entered into SPSS version 22.0 for analysis. Binary logistic regression was further employed to determine the factors associated with adherence to IFAS. Focus group discussions were done with 19 pregnant women and 15 mothers of children aged 0-6 months to obtain more clarifications on the factors associated with adherence to IFAS. Furthermore, in-depth interviews were done with six health care providers to explore their perceptions of IFAS. Results Out of the 320 respondents of the survey, 20.3% (n = 65) adhered to IFAS. Factors associated with adherence to IFAS among pregnant women included time to start ANC (AOR = 3.72, 95% CI: 1.42, 9.79), knowledge of anaemia (AOR = 3.84, 95% CI: 1.335, 10.66), counseling on the importance of the iron-folic acid (AOR = 3.86, 95% CI: 1.42, 10.50), IFAS given during clinical visit (AOR = 15.72, 95% CI: 5.34, 46.31), number of meals consumed (AOR = 3.44, 95% CI: 1.28, 9.21), number of children (AOR = 3.462, 95% CI: 1.035, 11.58), and distance to health facility (AOR = 0.34, 95% CI: 0.131, 0.886). Qualitative findings revealed that delayed first ANC visit, lack of remainder for pregnant women to take IFAS, low awareness about the negative effects of anaemia, low of knowledge of IFAS and management of side effects, negative beliefs about the use of IFAS, and follow-up mechanism were major reasons for poor adherence. Conclusion Adherence to iron-folic acid supplementation during pregnancy was low. Strengthening systems for creating reminding mechanism, raising community awareness through educational programs to pregnant women and health providers could improve adherence to IFAS.
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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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Mohammed BS, Helegbe GK. Routine haematinics and multivitamins: Adherence and its association with haemoglobin level among pregnant women in an urban lower-middle-income country, Ghana. Basic Clin Pharmacol Toxicol 2020; 127:21-29. [PMID: 31977143 DOI: 10.1111/bcpt.13390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/09/2020] [Accepted: 01/21/2020] [Indexed: 11/28/2022]
Abstract
In low- and middle-income countries, medications are routinely prescribed for maternal and foetal well-being. The objective of this study was to assess the adherence with routine haematinics and multivitamins among pregnant women in a lower-middle-income country, Ghana. A questionnaire was used to collect data from 350 pregnant women utilizing the antenatal clinic of the Tamale Teaching Hospital. Adherence was about 63% for folic acid, 63% for ferrous sulphate and 58% for multivitamins. For folic acid, younger age, secondary and tertiary education had about 31%, 46% and 41%, respectively, less likelihood of non-adherence. Second trimester of pregnancy was associated with two times more likelihood of adherence with folic acid. For ferrous sulphate, younger age had about 30% less likelihood of non-adherence, and second trimester linked to twice more likelihood of adherence. Secondary education had about 40% less likelihood of non-adherence with multivitamins. More of those who adhered with folic acid (89%), ferrous sulphate (89%) and multivitamins (91%) had their haemoglobin level increased. Adherence with routine haematinics was adequate; age, education and trimester of pregnancy predicted folic acid and ferrous sulphate adherence. Education predicted adherence with multivitamins. Adherence was associated with change in level of haemoglobin during antenatal visits.
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Affiliation(s)
| | - Gideon Kofi Helegbe
- Department of Biochemistry, University for Development Studies, Tamale, Ghana
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Kamau MW, Kimani ST, Mirie W, Mugoya IK. Effect of a community-based approach of iron and folic acid supplementation on compliance by pregnant women in Kiambu County, Kenya: A quasi-experimental study. PLoS One 2020; 15:e0227351. [PMID: 31923240 PMCID: PMC6953847 DOI: 10.1371/journal.pone.0227351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 12/17/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Iron and Folic Acid Supplementation (IFAS) is an essential and affordable intervention strategy for prevention of anaemia during pregnancy. The supplements are currently provided for free to pregnant women in Kenya during antenatal care (ANC), but compliance remains low over the years. There is need for diversification of IFAS programme implementation by exploring other distribution channels to complement existing antenatal distribution and ensure consistent access to IFAS supplements. OBJECTIVES To determine the effect of a community-based approach of IFAS distribution on compliance and assess side-effects experienced and their mitigation by pregnant women in Kiambu County. METHODOLOGY A pretest-posttest quasi-experimental study design was used, consisting of an intervention and a control group, among 340 pregnant women 15-49 years, in five health facilities in Lari Sub-County in Kiambu County, between June 2016 and March 2017. Community health volunteers provided IFAS supplements, counselling and weekly follow-up to pregnant women in the intervention group while the control group followed standard practice from health facilities. Baseline and endline data were collected during antenatal care and compared. Quantitative data was analyzed using STATA version 14. Analysis of effect of intervention was done using Difference-In-Difference regression approach. RESULTS Levels of compliance increased by 8% in intervention group and 6% in control group. There was increased awareness of IFAS side-effects across groups. The intervention group reported experiencing less side-effects and were better able to manage them compared to the control group. CONCLUSION Implementation a community-based approach improved maternal compliance with IFAS, awareness of IFAS side effects and their management, with better improvement being recorded in the intervention group. Hence, there is need to integrate community-based approach with antenatal distribution of IFAS to improve supplementation.
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Affiliation(s)
| | | | - Waithira Mirie
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
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Gebremichael TG, Welesamuel TG. Adherence to iron-folic acid supplement and associated factors among antenatal care attending pregnant mothers in governmental health institutions of Adwa town, Tigray, Ethiopia: Cross-sectional study. PLoS One 2020; 15:e0227090. [PMID: 31910215 PMCID: PMC6946125 DOI: 10.1371/journal.pone.0227090] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 12/12/2019] [Indexed: 11/30/2022] Open
Abstract
Background Iron-folic acid supplementation during pregnancy is among the very effective interventions to prevent iron deficiency anemia, low birth weight, and prematurity. There is a need of having recent studies on adherence to the supplement that consider the very recent interventions targeted to scale up the use of iron–folic acid (IFA) supplement. Therefore we sought to assess adherence to IFA supplement and its associated factors among antenatal care attending pregnant mothers in governmental health institutions of Adwa town. Methods Institution-based cross-sectional study was conducted among 629 antenatal care attending pregnant mothers. Systematic random sampling method was used to select the study subjects. Data were collected through face-to-face interview and chart-review. Bivariable and multivariable binary logistic regression was computed. Variables with P-value <0.05 were considered statistically significant at 95% confidence interval (CI). Result Only 40.9% (95%CI: 37.0%- 44.7%) of participants were adherent (took four or more tablets per week). Women in the age group of 25–29 years [AOR: 2.22(1.21–4.07)] had increased odds of adherence as compared to those in the age group ≥ 35 years. Women who received nutrition counseling [AOR: 4.12(2.12–8.03)] and partner support [AOR: 2.23 (1.42–3.49)] had increased odds of adherence as compared to those who didn’t receive nutrition counseling and partner support respectively. Similarly, women who had satisfactory knowledge on IFA supplement (AOR: 2.16(1.37–3.40)) had increased odds of adherence as compared to those who didn’t have satisfactory knowledge on IFA supplement. Conclusion Adherence to the supplement was low. Efforts shall be done to improve awareness of pregnant mothers about IFA supplement through targeted nutrition counseling that includes the engagement of a partner.
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Affiliation(s)
| | - Tsehaynesh Gidey Welesamuel
- Department of Public Health, Axum University Specialized and Compressive Hospital,Axum University,Axum,Ethiopia
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Compliance to Iron-Folic Acid Supplementation and Its Association with the Number of ANC Visits in Ethiopia: Systematic Review and Meta-Analysis. Adv Prev Med 2019; 2019:3602585. [PMID: 32089891 PMCID: PMC7024091 DOI: 10.1155/2019/3602585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/15/2019] [Accepted: 09/26/2019] [Indexed: 11/29/2022] Open
Abstract
Background The World Health Organization recommended that 80% of communities in all countries should receive the standard dose of iron folic acid. But, in Ethiopia, this target was not yet achieved. The compliance of iron folic acid was also variable across each district. Therefore, the aim of this study was to assess women compliance with iron-folic acid supplementation and its association with a number of antenatal care visits in Ethiopia using systematic review and meta-analysis, 2018. Methods In the current meta-analysis, the target variables were searched from different electronic database system like PubMed, Google Scholar, Science Direct, and Cochrane Library. To predict the pooled prevalence of compliance with iron-folic acid supplementation in Ethiopia, all original studies were considered. All necessary data were extracted by using a standardized data extraction format. The data were analyzed by using STATA 14 statistical software. Heterogeneity between the studies was assessed by Cochrane Q and I2 tests. A random effect model was computed to estimate the pooled compliance with iron-folic acid supplementation. Results Twelve full-text studies were included in the meta-analysis. The findings of this meta-analysis revealed that the pooled prevalence of compliance with iron-folic acid supplementation in Ethiopia was 43.63% (CI: 28.00, 59.25%). The women from the city administration had a high rate of compliance as compared with other regions of Ethiopia. The odds of having four or more antenatal care visit were the independent pooled predictor of compliance with iron-folic acid supplementation. Conclusion Current compliance with iron-folic supplementation was lower than the World health organization recommendation. Mothers from the city administration who utilized the antenatal care four and above times, had high level compliance with iron-folic acid supplementation. Therefore, we recommended that women should visit the antenatal clinic four times to compliance with the iron folic acid supplementation.
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Desta M, Kassie B, Chanie H, Mulugeta H, Yirga T, Temesgen H, Leshargie CT, Merkeb Y. Adherence of iron and folic acid supplementation and determinants among pregnant women in Ethiopia: a systematic review and meta-analysis. Reprod Health 2019; 16:182. [PMID: 31864397 PMCID: PMC6925441 DOI: 10.1186/s12978-019-0848-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 12/11/2019] [Indexed: 01/21/2023] Open
Abstract
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.
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Affiliation(s)
- Melaku Desta
- Department of Midwifery, College of Health Science, Debre Markos University, PO. Box: 269, Debre Markos, Ethiopia.
| | - Bekalu Kassie
- Department of Midwifery, College of Health Science, Debre Markos University, PO. Box: 269, Debre Markos, Ethiopia
| | - Habtamu Chanie
- Department of Midwifery, College of Health Science, Debre Markos University, PO. Box: 269, Debre Markos, Ethiopia
| | - Henok Mulugeta
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Tadesse Yirga
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Habtamu Temesgen
- Department of Nutrition and Food Science, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Cheru Tesema Leshargie
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Yoseph Merkeb
- Department of Biomedical Science, College of Health Science, Debre Markos University, Debre Markos, 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: 54] [Impact Index Per Article: 10.8] [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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Kamau M, Mirie W, Kimani S, Mugoya I. 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. PLoS One 2019; 14:e0224361. [PMID: 31765422 PMCID: PMC6876988 DOI: 10.1371/journal.pone.0224361] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 10/11/2019] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Mary Kamau
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
| | - Waithira Mirie
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
| | - Samuel Kimani
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
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Alemu BK, Wolle NN. Prescription drug use and potential teratogenicity risk among pregnant women attending maternal and child health clinic of Kemisse General Hospital, Northeast, Ethiopia. BMC Res Notes 2019; 12:592. [PMID: 31533806 PMCID: PMC6751805 DOI: 10.1186/s13104-019-4641-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 09/11/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To investigate medications prescribed for pregnant women and their potential teratogenicity risk in Kemisse General Hospital. RESULT A total of 263 medical records of pregnant women were reviewed, of which 234 pregnant women were prescribed with a total of 430 prescription drugs. The average numbers of drugs per pregnant women was found to be 1.84. Most pregnant women 166 (63.2%) were in the third trimester and more than half of them (51.3%) were multigravida. The maximum number of drugs were prescribed in the second trimester 162 (37.67%) followed by third trimester 143 (33.26%). Supplemental drugs were the most widely used medications 297 (69.07%) and followed by 82 (19.1%) drugs from category B; 54 (12.6%) drugs from category C; and the rest 7 (1.6%) drugs from category D. There was no any drug from category X. Moreover, approximately one third of the pregnant women encountered with drugs from category B, C and D. However, there were no FDA category C and D drugs prescribed in first trimester.
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Affiliation(s)
- Belete Kassa Alemu
- Department of Pharmacy, Pharmacology and Toxicology Unit, College of Medicine and Health Sciences, Wollo University, P.o.box 1145, Dessie, Ethiopia.
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Assefa H, Abebe SM, Sisay M. Magnitude and factors associated with adherence to Iron and folic acid supplementation among pregnant women in Aykel town, Northwest Ethiopia. BMC Pregnancy Childbirth 2019; 19:296. [PMID: 31412795 PMCID: PMC6693280 DOI: 10.1186/s12884-019-2422-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 07/24/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Physiological changes during pregnancy, foetal growth and development increase the requirement for Iron and Folic Acid. The increased demand of these nutrients is not meet through diet alone due to decreased bioavailability of nutrients during pregnancy. In 2004, Ethiopia adopted the global Iron and Folic Acid supplementation strategy targeting to reduce the prevalence of Iron deficiency anemia in women of reproductive age and children under five, by one third. However, the prevalence of anemia remains high and only 5% of pregnant women took Iron and Folic Acid tablets for 90 days or more during their most recent pregnancy in Ethiopia. Therefore, we conducted this study to assess the magnitude and associated factors of adherence to Iron and Folic Acid supplementation during pregnancy. METHODS A facility based cross sectional study was conducted from February to May, 2018 among pregnant women in Northwest Ethiopia. Systematic random sampling technique was used to select 418 study subjects. Bivariable and multivariable logistic regression analyses were computed to identify predictor variables. RESULTS Rate of adherence to Iron and Folic Acid supplementation among pregnant women was 47.6%. Pregnant women who had a past history of abortion, knowledge of anemia and received health education were more likely to be adherent with Iron and Folic Acid supplementation. Furthermore, knowledge about benefits of the supplement and not facing any problem in the health facilities during Iron and Folic Acid tablet collection were factors associated with Iron and Folic Acid supplementation adherence. CONCLUSIONS Rate of adherence to Iron and Folic Acid supplementation was low in Aykel town. Therefore, strengthening and promoting health education, creating awareness and avoiding discouraging conditions in health facilities during tablet collection are very crucial to improve and increase the low rate of Iron and Folic Acid supplementation adherence in the study area.
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Affiliation(s)
- Habtamu Assefa
- Gorgora Health Center, University of Gondar, Gondar, Ethiopia
| | - Solomon Mekonnen Abebe
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mekonnen Sisay
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Liu D, Cheng Y, Dang S, Wang D, Zhao Y, Li C, Li S, Lei F, Qu P, Mi B, Zhang R, Li J, Zeng L, Yan H. Maternal adherence to micronutrient supplementation before and during pregnancy in Northwest China: a large-scale population-based cross-sectional survey. BMJ Open 2019; 9:e028843. [PMID: 31399455 PMCID: PMC6701669 DOI: 10.1136/bmjopen-2018-028843] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To report the situation of maternal micronutrient supplementation before and during pregnancy in Northwest China and to examine the rates of and factors related to the adherence to micronutrient supplementation among pregnant women in this region, where dietary micronutrient intake is commonly insufficient. DESIGN A large-scale population-based cross-sectional survey. SETTING Twenty counties and ten districts of Shaanxi Province. PARTICIPANTS A sample of 30 027 women were selected using a stratified multistage random sampling method. A total of 28 678 women were chosen for the final analysis after excluding those who did not provide clear information about nutritional supplementation before and during pregnancy. MAIN OUTCOME MEASURES Maternal adherence to micronutrient supplementation (high and low) were the outcomes. They were determined by the start time and duration of use according to Chinese guidelines (for folic acid (FA) supplements) and WHO recommendations (for iron, calcium and multiple-micronutrient (MMN) supplements). RESULTS In total, 83.9% of women took at least one kind of micronutrient supplement before or during pregnancy. FA (67.6%) and calcium (57.5%) were the primarily used micronutrient supplements; few participants used MMN (14.0%) or iron (5.4%). Adherence to supplementation of all micronutrients was low (7.4% for FA, 0.6% for iron, 11.7% for calcium and 2.7% for MMN). Higher educational levels, higher income levels, urban residence and better antenatal care (including pregnancy consultation and a higher frequency of antenatal visits) were associated with high adherence to micronutrient supplementation. CONCLUSION Maternal micronutrient supplementation before and during pregnancy in Northwest China was way below standards recommended by the Chinese guidelines or WHO. Targeted health education and future nutritional guidelines are suggested to improve this situation, especially in pregnant women with disadvantaged sociodemographic conditions.
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Affiliation(s)
- Danmeng Liu
- Department of Epidemiology and Health Statistics, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Yue Cheng
- Department of Nutrition, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Shaonong Dang
- Department of Epidemiology and Health Statistics, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Duolao Wang
- Liverpool School of Tropical Medicine, Liverpool University, Pembroke Place, UK
| | - Yaling Zhao
- Department of Epidemiology and Health Statistics, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Chao Li
- Department of Epidemiology and Health Statistics, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Shanshan Li
- Department of Epidemiology and Health Statistics, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Fangliang Lei
- Department of Epidemiology and Health Statistics, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Pengfei Qu
- Translational Medicine Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Baibing Mi
- Department of Epidemiology and Health Statistics, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Ruo Zhang
- Department of Epidemiology and Health Statistics, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Jiamei Li
- Department of Emergency Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lingxia Zeng
- Department of Epidemiology and Health Statistics, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Hong Yan
- Department of Epidemiology and Health Statistics, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Nutrition and Food Safety Engineering Research Center of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, China
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Tarekegn M, Wubshet M, Atenafu A, Derso T, Woretaw A. Antenatal care and mothers' education improved iron-folic acid adherence at Denbiya district health centers, Northwest Ethiopia: using pills count method. Arch Public Health 2019; 77:30. [PMID: 31285822 PMCID: PMC6591834 DOI: 10.1186/s13690-019-0356-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 05/21/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Anemia is the leading public health problem among pregnant women worldwide. Iron-Folic Acid (IFA) supplementation is the strategy to control pregnancy induced anemia, but its adherence status was not well studied. OBJECTIVE The aim of this study was to assess the prevalence of IFA adherence and associated factors among pregnant women attending antenatal care at Denbiya district health centers. METHODS Cross -sectional study design was conducted in Denbiya district health centers from April 2 to May 27, 2016. A total of 395 study participants were enrolled in the study. Systematic random sampling was used to select study participants. Data were collected using the interviewer-administered technique. Adherence to IFA supplementation was assessed by the pills count method. A logistic regression model was used. RESULTS The study revealed that the prevalence of good adherence towards IFA supplementation among Antenatal care (ANC) service users' at Denbiya district health centers were found to be 28.01% [95% CI, 24.01, 35.9]. Attending secondary school and above [Adjusted Odds Ratio (AOR) = 3.44, 95% CI: 1.09, 10.92], having two ANC visits [AOR = 2.53, 95% CI: 1.34, 4.76] and three and above ANC visits [AOR = 4.14, 95% CI: 2.14, 8.01] were significantly associated with good adherence of IFA supplementation. To the contrary, husband education status; secondary school and above reduced the odds of good adherence by 77% compared to illiterates to IFA supplementation [AOR = 0.23, 95% CI: 0.07, 0.72]. CONCLUSION The prevalence of good adherence among pregnant women towards IFA supplementation was low. Mothers' education and having two or more ANC visits were positively associated with good adherence towards IFA supplementation.
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Affiliation(s)
- Missa Tarekegn
- Kolladiba Health center, Maternal and child health department, Gondar, Ethiopia
| | - Mamo Wubshet
- Paulos Medical College Addis Ababa University, Addis Ababa, Ethiopia
| | - Azeb Atenafu
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Terefe Derso
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abere Woretaw
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Adherence to Iron and Folic Acid Supplement and Its Associated Factors among Antenatal Care Attendant Mothers in Lay Armachiho Health Centers, Northwest, Ethiopia, 2017. Int J Reprod Med 2019; 2019:5863737. [PMID: 31275954 PMCID: PMC6582864 DOI: 10.1155/2019/5863737] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/04/2019] [Accepted: 05/20/2019] [Indexed: 12/02/2022] Open
Abstract
Background Iron deficiency is the leading nutrient deficiency globally affecting the lives of more than two billion people worldwide. Pregnant women are at higher risk of iron and folic acid deficiency due to lack of iron and folic acid or due to poor adherence. Adherence to iron and folic acid supplement is taking 65% or more of the recommended supplement, equivalent to taking the supplement at least 4 days a week during 3 months period using recording, reporting, and checking cards. Objective The current study aimed at assessing adherence to iron and folic acid supplement during pregnancy and its associated factors among pregnant women attending antenatal care. Methods Institution based cross-sectional study was conducted from February to March 2017. Systematic random sampling technique was used to select the study subjects. Data were collected using structured and pretested interviewer-administered questionnaire. Bivariable and multivariable logistic regression analysis were used to identify factors associated with adherence to iron and folic acid supplement among pregnant women. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to display the level of significance. Variables with a p-value less than 0.05 had been considered statistically significant. Result Adherence to iron and folic acid in the current study was 28.7% with 95% CI (24.3, 33.6%). Educational status of mothers (AOR= 9.27 (95%CI: 2.47, 34.71)), educational status of husband (AOR= 0.31(95% CI: 0.11,0.88)), family size of four (AOR=3.70(95%CI: 1.08,12.76)), family size of five and above (AOR= 4.88(95% CI: 1.20, 19.85)), mothers who had 2500-3500 Ethiopian birr household average monthly income (AOR= 0.46(95% CI: 0.24,0.89)), mothers who had registered at 17-24 weeks of gestation (AOR=0.40(95% CI: 0.22-0.74)) and registered at 25-28 weeks (AOR=0.20(95% CI 0.10, 0.41)), and mothers who had collected their iron and folic acid starting at first visit at first month of pregnancy (AOR= 2.42(95% CI:1.05, 5.58)) had significant association with iron and folic acid adherence. Conclusion and Recommendation Adherence of iron and folic acid was only 28.7% in the current study. Maternal and husband education status, family size, registration time, economic status, and first visit in the first month with duration of iron and folic acid taken were factors significantly associated with adherence to iron and folic acid supplement. Therefore, anaemia prevention strategy via improved iron and folic acid supplement adherence should comprise strategies of educating pregnant mothers, improving economic status, and early antenatal care (ANC) registration that can improve adherence to iron and folic acid supplement.
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Saronga NJ, Burrows T, Collins CE, Ashman AM, Rollo ME. mHealth interventions targeting pregnancy intakes in low and lower-middle income countries: Systematic review. MATERNAL AND CHILD NUTRITION 2019; 15:e12777. [PMID: 30609297 DOI: 10.1111/mcn.12777] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 11/28/2018] [Accepted: 12/12/2018] [Indexed: 11/28/2022]
Abstract
Dietary intake during pregnancy plays a vital role in determining the health of both mother and baby. Maternal undernutrition affects a large proportion of women in low and lower middle income countries (LLMIC) likely influencing high maternal, infant, and child mortality in these countries. Mobile health (mHealth) interventions have been proposed as effective solutions to improve maternal and neonatal health. This paper reviews the literature to evaluate the effectiveness of mHealth interventions on improving dietary/nutrients intake of pregnant women in LLMIC. Eight electronic databases were searched from inception up to April 2018, including the MEDLINE, EMBASE, CINAHL, Cochrane, Web of Science, Scopus, Global Index Medicus, and Maternity and Infant Care. Using Covidence, two reviewers assessed articles for inclusion, assessed study quality and extracted data. Only studies published in English language were included. Data were summarised narratively. In total, 6,778 were identified of which four were included, with three randomised controlled trials and one prepost experimental study. Studies were conducted in India (n = 2), Indonesia (n = 1), and Kenya (n = 1). All articles evaluated the use of nutrient supplements; iron supplements (n = 1), vitamin supplements (composition not mentioned; n = 1), or calcium supplements (n = 1). This review suggests that mHealth interventions can be used to improve intake of micronutrient supplementation and nutritional status of pregnant women in LLMIC. Further studies are needed to address the limited evidence base related to mHealth nutrition interventions targeting dietary intakes of pregnant women in LLMIC.
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Affiliation(s)
- Naomi J Saronga
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, New Castle, Australia.,School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, New Castle, Australia.,Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Tracy Burrows
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, New Castle, Australia.,School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, New Castle, Australia
| | - Clare E Collins
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, New Castle, Australia.,School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, New Castle, Australia
| | - Amy M Ashman
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, New Castle, Australia.,School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, New Castle, Australia
| | - Megan E Rollo
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, New Castle, Australia.,School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, New Castle, Australia
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Gebremariam AD, Tiruneh SA, Abate BA, Engidaw MT, Asnakew DT. Adherence to iron with folic acid supplementation and its associated factors among pregnant women attending antenatal care follow up at Debre Tabor General Hospital, Ethiopia, 2017. PLoS One 2019; 14:e0210086. [PMID: 30615646 PMCID: PMC6322725 DOI: 10.1371/journal.pone.0210086] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 12/17/2018] [Indexed: 12/04/2022] Open
Abstract
Introduction Nutritional anemia is a major public health problem throughout the world, particularly in developing countries. Iron with folic acid supplementation (IFAS) is recommended to mitigate anemia and its resulting complications during pregnancy. There has been limited study on IFAS adherence of pregnant women in the study area. The aim of this study was to assess adherence to IFAS and its associated factors among pregnant women attending antenatal care service in Debre Tabor General Hospital, Ethiopia. Methods An institution-based cross-sectional study was conducted from January 9 to April 8, 2017, at Debre Tabor General Hospital. A total of 262 study participants were included and selected by systematic random sampling. The entire interviewed questionnaire was checked and entered into EpiData version 3.1 and then exported to SPSS version 20 for windows for analysis. IFAS adherence status was defined as, if pregnant mothers took 65% or more of the IFAS which is equivalent to taking IFAS at least 4 days a week during the 1-month period preceding the study. Regressions were fitted to identify independent predictors of IFAS adherence. A P-value of less than 0.05 was used to declare statistical significance. Results A total of 241 pregnant women were included (92% response rate), of which 107 (44%) were adherent to IFAS. Only 39% received IFAS counseling, and 52% had some knowledge of IFAS. Gravidity (AOR = 2.92 95% CI (1.61, 5.30)), gestational age at first ANC visit (AOR = 3.67, 95% CI (1.94, 6.97)), pregnant women who got advice about IFAS (AOR = 2.04, 95%CI (1.12, 3.75)), current anemia (AOR = 2.22, 95%CI (1.45, 4.29)), and had knowledge about IFAS (AOR = 3.27, 95% CI (1.80, 5.95)) were statistically associated with adherence to IFAS among pregnant women. Conclusion Overall, IFAS adherence among pregnant women was low. The associated factors with adherence of IFAS were counseling and knowledge, early ANC attendance, pregnancy history, and current anemia diagnosis. IFAS counseling by health workers was low but, when given, was associated with improved IFAS adherence. Health workers and health extension workers should consistently counsel on IFAS benefits during ANC visit, to improve IFAS adherence during the current and subsequent pregnancies.
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Affiliation(s)
| | - Sofonyas Abebaw Tiruneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Bedilu Abebe Abate
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melaku Tadege Engidaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Desalegn Tesfa Asnakew
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Molla T, Guadu T, Muhammad EA, Hunegnaw MT. Factors associated with adherence to iron folate supplementation among pregnant women in West Dembia district, northwest Ethiopia: a cross sectional study. BMC Res Notes 2019; 12:6. [PMID: 30612583 PMCID: PMC6322306 DOI: 10.1186/s13104-019-4045-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/02/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE In Ethiopia, iron folate tablets are prescribed for all pregnant mothers during their antenatal visits and given for free; however, only limited data are available on their adherence. Therefore, the aim of this study was to assess adherence to iron folate supplementation and its associated factors among pregnant women in West Dembia district, northwest Ethiopia. An institution based cross-sectional study was conducted on 348 pregnant women that had at least one antenatal care visit. Bivariate and multivariate logistic regressions were employed to identify the predictors at p-value < 0.2 and 0.05 respectively. RESULTS Adherence to iron folate supplementation in this study was 52.9% [95% CI (47.7, 58.0%)]. Women who had good knowledge about anemia (AOR: 2.63, 95% CI 1.51, 4.59), knowledge about iron folate supplementation (AOR: 2.82, 95% CI 1.52-5.23), four and more ANC visits (AOR: 6.97, 95% CI 3.25, 14.96), and anemia history during current pregnancy (AOR: 13.87, 95% CI 3.75, 51.35) were significantly associated with adherence to iron folate supplementation. Therefore, preventing prenatal anemia, improving knowledge of women about anaemia and iron folate supplementation, and increasing ANC services are essential to increase adherence.
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Affiliation(s)
- Tsegaye Molla
- Amhara Region Central Gondar Health Department Northwest Ethiopia, University of Gondar, P.o.box.196, Gondar, Ethiopia
| | - Tadesse Guadu
- Department of Environmental and Occupational Health, College of Medicine and Health Sciences, University of Gondar, P.o.box.196, Gondar, Ethiopia
| | - Esmael Ali Muhammad
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.o.box.196, Gondar, Ethiopia
| | - Melkamu Tamir Hunegnaw
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.o.box.196, Gondar, Ethiopia
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Gebremichael TG, Haftu H, Gereziher TA. Time to start and adherence to iron-folate supplement for pregnant women in antenatal care follow up; Northern Ethiopia. Patient Prefer Adherence 2019; 13:1057-1063. [PMID: 31308638 PMCID: PMC6613598 DOI: 10.2147/ppa.s184168] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 05/29/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Iron folate supplementation is a cost-effective way of reducing iron deficiency anemia, low birth weight, and neural tube defects in resource-limited countries like Ethiopia. Late to start and poor adherence to iron-folate supplement has restricted its effectiveness. The aim of this study was to determine the time to start and adherence level of iron-folate supplementation to pregnant women attending at the Ayder Comprehensive Specialized Hospital. METHODS Two hundred pregnant women were recruited in cross-sectional study design between February and April 2018. RESULTS From the total participant pregnant women the urban dweller constituted the major proportion of 182 (91%). Seventy-eight (39%) of the participants had two antenatal care visits, whereas only, 21 (10.5%) of them had an antenatal care visit three and above. One hundred fifty-five (77.5%) participants women had knowledge about the cause of anemia in pregnancy. In this study, 143 (71.5%) of the pregnant women started their iron folate supplement in the second and third trimester. The adherence of iron folate intake was 10.5%. Healthcare education and counseling about iron-folate supplementation (AOR =4.55, 95% CI =[1.534, 13.512]), number of pregnancies (AOR =6.941, 95% CI =[1.511, 31.09]), and number of antenatal visit (AOR =0.242, 95% CI =[0.069, 0.852]) were significantly associated with adherence to iron-folate supplementation. CONCLUSION Time to start iron folate supplement in the first trimester was low and the adherence level was also very poor, which can be attributed by the number of antenatal care visits, frequency of pregnancy and healthcare education and counseling about iron folate supplement.
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Affiliation(s)
- Teklu Gebrehiwot Gebremichael
- Clinical Pharmacy Department, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- Correspondence: Teklu Gebrehiwot GebremichaelSchool of Pharmacy, College of Health Sciences, Mekelle University, Mekelle 1871, EthiopiaTel +251 93 373 0004Fax +251 3 441 6681 Email
| | - Hansa Haftu
- Pediatrics and Child Health Department, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Teklebrhan Aregawi Gereziher
- Clinical Pharmacy Department, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Bedewi N, Sisay M, Edessa D. Drug utilization pattern among pregnant women attending maternal and child health clinic of tertiary hospital in eastern Ethiopia: Consideration of toxicological perspectives. BMC Res Notes 2018; 11:858. [PMID: 30514377 PMCID: PMC6280540 DOI: 10.1186/s13104-018-3966-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/29/2018] [Indexed: 02/03/2023] Open
Abstract
Objective This study is aimed to investigate drug utilization pattern among pregnant women attending maternal and child health clinic of tertiary hospital in eastern Ethiopia from March 1 to April 20, 2018. Result A total of 369 pregnant women medical records were reviewed. The mean age of pregnant women was 24.34 (± 4.48) years and the majority of them were within the age of 18-25 years. About three-fourths (n = 277, 75.1%) of them were urban residents. Besides, 314 (85.1%) women had taken at least one drug with a total of 377 drugs prescribed. From which, supplemental drugs accounted majority of the drug therapy (84.88%) whereas non-supplemental drugs (15.12%) were used by 41 pregnant women during the review period. According to Food and Drug Administration FDA pregnancy risk classification, 320 (84.88%) drugs were prescribed from category A; 33 (8.75%) drugs were from category B; 19 (5.04%) drugs were from category C and 5 (1.33%) drugs were from category D. There was no drug prescribed from category X. As this result indicated, there is a decrease in the prevalence of drug use from Category A to X as the possibility of potential risk to fetus might outweigh the potential benefit to the mother. Some drugs were utilized from category D for treatment of chronic illnesses. Electronic supplementary material The online version of this article (10.1186/s13104-018-3966-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Neim Bedewi
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O.Box, 235, Harar, Ethiopia
| | - Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O.Box, 235, Harar, Ethiopia.
| | - Dumessa Edessa
- Department of Pharmacy Practice, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box, 235, Harar, Ethiopia
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Teixeira JA, Castro TG, Wall CR, Marchioni DM, Berry S, Morton SMB, Grant CC. Determinants of folic acid supplement use outside national recommendations for pregnant women: results from the Growing Up in New Zealand cohort study. Public Health Nutr 2018; 21:2183-2192. [PMID: 29708087 PMCID: PMC11106014 DOI: 10.1017/s1368980018000836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/14/2018] [Accepted: 03/06/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the sociodemographic and lifestyle factors associated with insufficient and excessive use of folic acid supplements (FAS) among pregnant women. DESIGN A pregnancy cohort to which multinomial logistic regression models were applied to identify factors associated with duration and dose of FAS use. SETTING The Growing Up in New Zealand child study, which enrolled pregnant women whose children were born in 2009-2010. SUBJECTS Pregnant women (n 6822) enrolled into a nationally generalizable cohort. RESULTS Ninety-two per cent of pregnant women were not taking FAS according to the national recommendation (4 weeks before until 12 weeks after conception), with 69 % taking insufficient FAS and 57 % extending FAS use past 13 weeks' gestation. The factors associated with extended use differed from those associated with insufficient use. Consistent with published literature, the relative risks of insufficient use were increased for younger women, those with less education, of non-European ethnicities, unemployed, who smoked cigarettes, whose pregnancy was unplanned or who had older children, or were living in more deprived households. In contrast, the relative risks of extended use were increased for women of higher socio-economic status or for whom this was their first pregnancy and decreased for women of Pacific v. European ethnicity. CONCLUSIONS In New Zealand, current use of FAS during pregnancy potentially exposes pregnant women and their unborn children to too little or too much folic acid. Further policy development is necessary to reduce current socio-economic inequities in the use of FAS.
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Affiliation(s)
- Juliana A Teixeira
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- The Centre for Longitudinal Research – He Ara ki Mua, School of Population Health (Building 730, Level 3), Tamaki Campus, University of Auckland, 261 Morrin Road, St Johns, Auckland 1072, New Zealand
| | - Teresa G Castro
- The Centre for Longitudinal Research – He Ara ki Mua, School of Population Health (Building 730, Level 3), Tamaki Campus, University of Auckland, 261 Morrin Road, St Johns, Auckland 1072, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Clare R Wall
- The Centre for Longitudinal Research – He Ara ki Mua, School of Population Health (Building 730, Level 3), Tamaki Campus, University of Auckland, 261 Morrin Road, St Johns, Auckland 1072, New Zealand
- Discipline of Nutrition and Dietetics, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Dirce Maria Marchioni
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Sarah Berry
- The Centre for Longitudinal Research – He Ara ki Mua, School of Population Health (Building 730, Level 3), Tamaki Campus, University of Auckland, 261 Morrin Road, St Johns, Auckland 1072, New Zealand
| | - Susan MB Morton
- The Centre for Longitudinal Research – He Ara ki Mua, School of Population Health (Building 730, Level 3), Tamaki Campus, University of Auckland, 261 Morrin Road, St Johns, Auckland 1072, New Zealand
| | - Cameron C Grant
- The Centre for Longitudinal Research – He Ara ki Mua, School of Population Health (Building 730, Level 3), Tamaki Campus, University of Auckland, 261 Morrin Road, St Johns, Auckland 1072, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
- Starship Children’s Hospital, Auckland District Health Board, Auckland, New Zealand
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Birhanu TM, Birarra MK, Mekonnen FA. Compliance to iron and folic acid supplementation in pregnancy, Northwest Ethiopia. BMC Res Notes 2018; 11:345. [PMID: 29848380 PMCID: PMC5977755 DOI: 10.1186/s13104-018-3433-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/11/2018] [Indexed: 11/20/2022] Open
Abstract
Objective Strict compliance to iron and folic acid supplementation is vital for prevention of anemia in pregnancy. However, data are scarce in Ethiopia. So, we conducted this study to assess the level of compliance to iron and folic acid supplementation during pregnancy and its associated factors. Results Of 418 women, over half, 231 (55.3%), adhered to the recommended iron and folic acid supplementation. Women who started antenatal care (ANC) follow up early [AOR; 95% CI 2.43 (1.12–5.26)], had more frequent number of ANC visit [AOR; 95% CI 2.73 (1.32–5.61)], took small number of tablets per visit [AOR; 95% CI 3.0 (1.21–7.43)], had history of anemia [AOR; 95% CI 1.9 (1.17–3.12)], and were from urban areas [AOR; 95% CI 2.2 (1.29–3.77)], were more likely to conform to recommended iron and folic acid supplementation. Therefore, there need to be prescription of the lowest possible number of tablets per visit. Furthermore, education targeting on increasing maternal health service utilization need to be in place. There need to also be further research aimed at determining the number of tablets to be prescribed per visit specific to individuals’ background characteristics.
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Affiliation(s)
- Tesfaye Molla Birhanu
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mequanent Kassa Birarra
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantahun Ayenew Mekonnen
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Kamau MW, Mirie W, Kimani S. Compliance with Iron and folic acid supplementation (IFAS) and associated factors among pregnant women: results from a cross-sectional study in Kiambu County, Kenya. BMC Public Health 2018; 18:580. [PMID: 29720135 PMCID: PMC5930505 DOI: 10.1186/s12889-018-5437-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 04/11/2018] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Mary Wanjira Kamau
- School of Nursing Sciences, College of Health Sciences, University of Nairobi, Nairobi, Kenya.
| | - Waithira Mirie
- School of Nursing Sciences, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Samuel Kimani
- School of Nursing Sciences, College of Health Sciences, University of Nairobi, Nairobi, Kenya
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Thomford NE, Dzobo K, Yao NA, Chimusa E, Evans J, Okai E, Kruszka P, Muenke M, Awandare G, Wonkam A, Dandara C. Genomics and Epigenomics of Congenital Heart Defects: Expert Review and Lessons Learned in Africa. OMICS : A JOURNAL OF INTEGRATIVE BIOLOGY 2018; 22:301-321. [PMID: 29762087 PMCID: PMC6016577 DOI: 10.1089/omi.2018.0033] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Congenital heart defects (CHD) are structural malformations found at birth with a prevalence of 1%. The clinical trajectory of CHD is highly variable and thus in need of robust diagnostics and therapeutics. Major surgical interventions are often required for most CHDs. In Africa, despite advances in life sciences infrastructure and improving education of medical scholars, the limited clinical data suggest that CHD detection and correction are still not at par with the rest of the world. But the toll and genetics of CHDs in Africa has seldom been systematically investigated. We present an expert review on CHD with lessons learned on Africa. We found variable CHD phenotype prevalence in Africa across countries and populations. There are important gaps and paucity in genomic studies of CHD in African populations. Among the available genomic studies, the key findings in Africa were variants in GATA4 (P193H), MTHFR 677TT, and MTHFR 1298CC that were associated with atrial septal defect, ventricular septal defect (VSD), Tetralogy of Fallot (TOF), and patent ductus arteriosus phenotypes and 22q.11 deletion, which is associated with TOF. There were no data on epigenomic association of CHD in Africa, however, other studies have shown an altered expression of miR-421 and miR-1233-3p to be associated with TOF and hypermethylation of CpG islands in the promoter of SCO2 gene also been associated with TOF and VSD in children with non-syndromic CHD. These findings signal the urgent need to develop and implement genetic and genomic research on CHD to identify the hereditary and genome-environment interactions contributing to CHD. These projected studies would also offer comparisons on CHD pathophysiology between African and other populations worldwide. Genomic research on CHD in Africa should be developed in parallel with next generation technology policy research and responsible innovation frameworks that examine the social and political factors that shape the emergence and societal embedding of new technologies.
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Affiliation(s)
- Nicholas Ekow Thomford
- 1 Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, Institute for Infectious Disease and Molecular Medicine, University of Cape Town , Cape Town, South Africa
- 2 School of Medical Sciences, University of Cape Coast , Cape Coast, Ghana
| | - Kevin Dzobo
- 3 ICGEB, Cape Town Component, University of Cape Town , Cape Town, South Africa
- 4 Division of Medical Biochemistry, IIDMM, Department of IBM, Faculty of Health Sciences, University of Cape Town , Cape Town, South Africa
| | - Nana Akyaa Yao
- 5 National Cardiothoracic Centre, Korle Bu Teaching Hospital , Accra, Ghana
- 6 University of Ghana Medical School, University of Ghana , Accra, Ghana
| | - Emile Chimusa
- 1 Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, Institute for Infectious Disease and Molecular Medicine, University of Cape Town , Cape Town, South Africa
| | - Jonathan Evans
- 1 Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, Institute for Infectious Disease and Molecular Medicine, University of Cape Town , Cape Town, South Africa
| | - Emmanuel Okai
- 2 School of Medical Sciences, University of Cape Coast , Cape Coast, Ghana
- 7 Cape Coast Teaching Hospital , Cape Coast, Ghana
| | - Paul Kruszka
- 8 National Human Genome Research Institute, Medical Genetics Branch, National Institutes of Health , Bethesda, Maryland, USA
| | - Maximilian Muenke
- 8 National Human Genome Research Institute, Medical Genetics Branch, National Institutes of Health , Bethesda, Maryland, USA
| | - Gordon Awandare
- 9 Department of Biochemistry, WACCBIP, University of Ghana , Legon, Accra, Ghana
| | - Ambroise Wonkam
- 1 Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, Institute for Infectious Disease and Molecular Medicine, University of Cape Town , Cape Town, South Africa
| | - Collet Dandara
- 1 Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, Institute for Infectious Disease and Molecular Medicine, University of Cape Town , Cape Town, South Africa
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