scholarly journals Self-management of iron and folic acid supplementation during pre-pregnancy, pregnancy and postnatal periods: a systematic review

2021 ◽  
Vol 6 (5) ◽  
pp. e005531
Author(s):  
Shannon E King ◽  
Ping Teresa Yeh ◽  
Dong Keun Rhee ◽  
Özge Tuncalp ◽  
Lisa M Rogers ◽  
...  

IntroductionWhile the use of folic acid pre-pregnancy and iron and folic acid (IFA) during pregnancy and postnatal have been demonstrated to be effective and are recommended interventions by WHO, ensuring individuals adhere to the supplementation regimen can be a challenge. Self-care interventions that support an individual’s ability to promote their own health with or without the support of health workers could help promote the uptake and adherence to supplementation. This systematic review assessed the evidence around self-management of IFA or folic acid supplementation accessed over-the-counter during pre-pregnancy, pregnancy and postnatal periods.MethodsPeer-reviewed studies were included if they compared self-management of IFA or folic acid supplementation with health worker-initiated supplement use on maternal and/or fetal and newborn health outcomes, end-users’ or health workers’ values and preferences, or cost and/or cost-effectiveness. We searched PubMed, CINAHL, LILACS and EMBASE for articles published through November 2020, hand-searched clinical trial registries, reviewed databases and contacted experts in the field. Abstract screening and full-text review were conducted independently by two reviewers.ResultsOverall, 2344 results were identified, and 28 studies were identified for full-text review. All studies were excluded, as they were not primary research, lacked the outcomes of interest, lacked specificity in supplement type, and/or lacked a comparison group.ConclusionNo evidence was identified that distinguishes self-management of folic acid supplements pre-pregnancy and of IFA supplements during pregnancy and postnatal, highlighting a gap in our current understanding of self-care related to dietary supplementation in pregnancy. The findings of this review identify an area for further research to support the current movement towards self-care interventions as an added choice to help individuals more fully attain their reproductive health and rights.Systematic review registration numberPROSPERO CRD42020205548

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249789
Author(s):  
Meseret Belete Fite ◽  
Kedir Teji Roba ◽  
Lemessa Oljira ◽  
Abera Kenay Tura ◽  
Tesfaye Assebe Yadeta

Background Anemia is one of the world’s leading cause of disability and the most serious global public health issues. This systematic review and meta-analysis was conducted very carefully in order to give up the pooled compliance of Iron and Folic-Acid Supplementation in Sub-Saharan Africa. Methods To conduct this brief systematic review and meta-analysis, a related literature search was done from different sources, PubMed Medline and Google Scholar Journals. Then IFA Supplementation related searching engine was used to make the work more meaningful and intensive. Moreover, we used modified Newcastle-Ottawa quality assessment scale for cross sectional studies to assess the quality of the study in terms of their inclusion. Then, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed to carry out the work in a carful manner. Finally, the pooled effect size was computed using the review manager and Compressive Meta-analysis software. Results Twenty-three studies, which encompassed 24272 pregnant women, were chosen for the analysis. From those an overall prevalence of compliance with Iron and Folic Acid Supplementation (IFAS) in pregnancy in SSA was 39.2%. However, the result from meta-analysis showed that women who were counseled on IFAS in their courses of pregnancy were 1.96 times more likely to adhere to IFAS compared to those who were not counseled [OR:1.96, 95% CI (1.76-,5.93)]. Moreover, it showed that women who had knowledge of IFAS were 2.71 times more likely to have compliance with IFAS as compared to those who had no knowledge of IFAS [OR:2.71, 95% CI (1.33,5.54)]. Also it revealed that those women who had knowledge of anemia were 5.42 times more likely to have compliance with IFAS as compared with those who had no knowledge of anemia [OR5.42, 95% CI (1.52, 19.43)]. Furthermore, women who had received fourth visit for ANC were 1.54 times more likely to have compliance with IFAS as compared to those who had not received for ANC [OR 1.54, 95% CI (0.66, 3.58.43)]. Conclusions Our finding from this systematic review and meta-analysis shows the low case in prevalence of compliance to IFAS among pregnant women in SSA. Predictors for this includes: knowledge about anemia, knowledge about IFAS, counseling on IFAS and receiving fourth antenatal care visit were statistically correlated positively with compliance to IFAS. This demands careful appraisal of effect of prevention work for functioning policy, programs and plan nutrition intrusions for refining maternal dietary intake in gestation. Also dietary education intrusion requires to be planned to satisfy the needs of pregnant women. So we hope that the result of this study might be essential as a bridging stone for policy makers of Africa; exclusively for maternal and child health care. Finally, we recommended further studies to be conducted in the area of the study for more intensive and detailed suggestions.


2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Melaku Desta ◽  
Bekalu Kassie ◽  
Habtamu Chanie ◽  
Henok Mulugeta ◽  
Tadesse Yirga ◽  
...  

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.


2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Meseret Belete Fite ◽  
Nega Assefa ◽  
Bizatu Mengiste

Abstract Background Anemia is one of the world’s leading cause of disability and the most serious global public health issues. This systematic review and meta-analysis was carried out very prudently in order to give up the pooled prevalence and determinants of anemia in Sub-Saharan Africa. Methodology To carry out this ephemeral systematic review and meta-analysis, a correlated literature review was done from various sources, PubMed Medline and Google Scholar Journals. Anemia related searching engine was used to make the study more evocative and intensive. We used modified Newcastle-Ottawa quality assessment scale for cross sectional studies to evaluate the quality of the study in relations of their inclusion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was tracked to conduct this study. The pooled effect size was computed using the review manager and Compressive Meta-analysis software. Results Twenty-fife studies, which encompassed 15,061 pregnant women, were chosen for the analysis. From those an overall prevalence of anemia in pregnancy in SSA was 35.6%. However, the result from meta-analysis showed that women who were infected with intestinal parasite were 3.59 times more likely to develop anemia compared to those who were not infected [OR:3.59, 95% CI (2.44,5.28)].The result showed that women who had no iron and folic-acid supplementation were 1.82 times more likely to develop anemia compared to those women who had iron and folic-acid supplementation {OR:1.82, 95% CI (1.22,2.70]. Women who had women were in third trimester pregnancy were 2.37 times more likely to develop anemia compared to those who were in first and second trimester [OR:2.37, 95% CI (1.78, 3.24)]. Women who had low dietary diversity score were 3.59 times more likely to develop anemia compared to those who had high dietary diversity score [OR: 3.59, 95% CI (2.44, 5.28]. Conclusions Our finding from this systematic review and meta-analysis displays the high case in prevalence of anemia among pregnant women in Sub-Saharan Africa. Predictors for this includes: intestinal parasite, iron and folic-acid supplementation, third trimester pregnancy and dietary diversified intake score were statistically correlated positively with anemia in pregnancy. These need cautious evaluation of impact of prevention effort for operational policy, programs and design nutrition intrusions for refining maternal food consumption during pregnancy. Also, dietary education intrusion requires to be prearranged to satisfy the desires of pregnant women. The finding of this work will be used as an evidences for policy makers of Africa; entirely for maternal and child health care. Lastly, we suggested further investigations to be carried out in the area of the study for more rigorous and comprehensive recommendations.


2015 ◽  
Vol 35 (8) ◽  
pp. 803-806 ◽  
Author(s):  
E. Lymperaki ◽  
A. Tsikopoulos ◽  
K. Makedou ◽  
E. Paliogianni ◽  
L. Kiriazi ◽  
...  

2020 ◽  
Vol 9 (1) ◽  
pp. 20
Author(s):  
Berhanu Abebaw Mekonnen ◽  
Yadeta Dessie ◽  
Negga Baraki ◽  
Abdu Oumer ◽  
Mehari Gebru

<p>Iron and folic acid supplementation is the key approach for anemia prevention and control during pregnancy. In Ethiopia only &lt;1% of pregnant mothers ingest the ideal number of tablets. Although, adherence is the most important challenge, literature is dearth and the predictors are undoubtedly recognized. Institution based quantitative cross sectional study design triangulated with qualitative methods was employed among 395 systematically selected pregnant mothers attending antenatal care in Debre Markos town, Ethiopia. Data were collected using interviewer administered structured questionnaire. Data were entered into Epi data and exported to SPSS software. Bivariate and multivariable Logistic regression with the 95% confidence interval was computed. P-value &lt; 0.05 was declared as statistically significant. Eight in-depth interviews were conducted. The data were entered and analyzed using open code software. Adherence rate was 55.5% (95%CI, 50.5%-60.4%). Pregnant mothers who had; history of anemia during current pregnancy [AOR:7.9, 95%CI (4.44-14.01)], primary education (AOR:4.0, 95%CI (1.88-8.54)], secondary education and above (AOR:3.6, 95%CI (1.20-6.94)], good knowledge of iron and folic acid supplementation [AOR:2.1, 95%CI (1.24-3.56)], and early registration for antenatal care (AOR:1.8, 95%CI (1.06-3.11)] were predictors of iron and folic acid supplementation adherence. The rate of adherence was low. Getting medical advice and fear of illness if missed were the primary reasons that enforce mothers to take the tablets. Hence, improving mothers’ knowledge regarding overall aspects of the tablet through better advice, community teaching and the mass media at large, would improve adherence.</p>


2020 ◽  
Author(s):  
Roselyter Monchari Riang'a ◽  
Anne Kisaka Nangulu ◽  
Jacqueline E.W. Broerse

Abstract BackgroundImplementation 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.MethodsData 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.ResultsCoverage 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.ConclusionsImplementation 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.


2020 ◽  
Vol 23 (15) ◽  
pp. 2819-2823
Author(s):  
Christopher R Sudfeld ◽  
Rajesh Kumar Rai ◽  
Anamitra Barik ◽  
Joseph J Valadez ◽  
Wafaie W Fawzi

AbstractObjective:To assess the coverage of the adolescent weekly iron and folic acid supplementation (WIFS) programme in rural West Bengal, India.Design:We conducted a population-based cross-sectional survey of intended WIFS programme beneficiaries (in-school adolescent girls and boys and out-of-school adolescent girls).Setting:Birbhum Health and Demographic Surveillance System.Participants:A total of 4448 adolescents 10–19 years of age participated in the study.Results:The percentage of adolescents who reported taking four WIFS tablets during the last month as intended by the national programme was 9·4 % among in-school girls, 7·1 % for in-school boys and 2·3 % for out-of-school girls. The low effective coverage was due to the combination of large deficits in WIFS provision and poor adherence. A large proportion of adolescents reported they were not provided any WIFS tablets in the last month: 61·7 % of in-school girls, 73·3 % of in-school boys and 97·1 % of out-of-school girls. In terms of adherence, only 41·6 % of in-school girls, 38·1 % of in-school boys and 47·4 % of out-of-school girls reported that they consumed all WIFS tablets they received. Counselling from teachers, administrators and school staff was the primary reason adolescents reported taking WIFS tablets, whereas the major reasons for non-adherence were lack of perceived benefit, peer suggestion not to take WIFS and a reported history of side effects.Conclusions:The effective coverage of the WIFS programme for in-school adolescents and out-of-school adolescent girls is low in rural Birbhum. Integrated supply- and demand-side strategies appear to be necessary to increase the effective coverage and potential benefits of the WIFS programme.


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