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

Abstract Introduction While Iron and Folic Acid Supplementation (IFAs) policy is offered free of charge in Kenya and has been implemented in Kenya and other low and middle-income-countries for decades, effectiveness of this intervention in improving maternal nutrition status has been inadequate. This study aims to acquire insight into the degree to which IFAs policy guidelines during pregnancy have been implemented as intended and the challenges to implementation fidelity. Methods Data was collected in rural Uasin Gishu County in the western part of Kenya through document analysis, questionnaires among programme recipients (n=188) and semi-structured interviews with programme implementers (n=6). Themes emerging from data are critically discussed using a conceptual framework based on programme theory and the programme implementation fidelity framework. Results Coverage of IFAs is widespread. However, policy content, frequency and participant responsiveness is not fully implemented. Only 10% accessed intervention within the first trimester as recommended by policy guidelines, only 18% and 15% of the respondents received 90 or more iron and folic acid pills respectively during their entire pregnancy period only 28% reported receiving nutritional counselling, 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 were established to be the main challenges to effective implementation fidelity. Anticipated health consequences and emphasis by the health officer to take the pills were established to be motivations for adherence to supplements. Conclusions Rather than targeting pregnant women who turn up for care at the health facilities, IFAs interventions should introduce community-based outreach programmes and make use of community-based health workers. This will not only relief the crowded health facilities for effective implementation integrity, but will also reach out to pregnant women within the first trimester when IFAs impact on health is greater and reach out to those women do not turn up at all for interventions at a health facility. Due to shortage and low compliance to IFAs pills, nutritional counselling is vital to promote consumption of locally available micro-nutrient rich food sources.

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Compliance with Iron and Folic Acid Supplementation (IFAS) and associated factors among pregnant women in Sub-Saharan Africa: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0249789 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249789

Author(s):

Meseret Belete Fite ◽

Kedir Teji Roba ◽

Lemessa Oljira ◽

Abera Kenay Tura ◽

Tesfaye Assebe Yadeta

Keyword(s):

Systematic Review ◽

Folic Acid ◽

Pregnant Women ◽

Meta Analysis ◽

Folic Acid Supplementation ◽

Sub Saharan Africa ◽

Global Public Health ◽

Acid Supplementation ◽

Iron And Folic Acid ◽

Sub Saharan

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

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

International Journal of Reproductive Medicine ◽

10.1155/2018/2365362 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 6

Author(s):

Negussie Boti ◽

Tezera Bekele ◽

Wanzahun Godana ◽

Eskeziyaw Getahun ◽

Feleke Gebremeskel ◽

...

Keyword(s):

Folic Acid ◽

Pregnant Women ◽

Associated Factors ◽

Folic Acid Supplementation ◽

Deficiency Anemia ◽

Southern Ethiopia ◽

Acid Supplementation ◽

Iron And Folic Acid ◽

Iron Folic Acid Supplementation ◽

Iron Folic Acid

Background. Iron deficiency anemia among pregnant women is one of the most common public health problems in developing country particularly in Ethiopia. Iron/folic acid supplementation with optimal adherence is the main cost-effective strategy for prevention and control of iron deficiency anemia in pregnant women. However, level of adherence to iron/folic acid supplementation and its associated factors were not well identified in study area. Therefore, the aim of this study was to determine the level of adherence to iron/folic acid supplementation and associated factors among pregnant women in Burji Districts, southern Ethiopia. Methods. A community-based cross-sectional study was conducted among 317 pregnant women in Burji Districts from March to April 2017 using interviewer administered questionnaires. Data were entered into Epi Info 3.5.1 and exported to SPSS version 20.0 for analysis. Binary and multivariable logistic regression was used to identify factors associated with iron/folic acid supplementation. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value <0.05 were used to declare statistical significance. Results. Among women participating in the study, 163(51.4%) were adherent to iron/folate acid supplementation. Factors significantly associated with adherence to iron and folic acid supplementation were maternal educational status (AOR: 2.47, 95% CI: 1.13-4.97), early registration for ANC (AOR: 2.49, 95% CI: 1.45 – 4.27), history of anemia during current pregnancy (AOR: 2.02, 95% CI: 1.09-3.72), and knowledge about iron and folic acid supplementation (AOR: 1.96, 95% CI: 1.02-3.76). Forgetfulness and fear of side effects were among the leading reasons of pregnant women for nonadherence to iron and folic acid supplementation. Conclusions. This study revealed that adherence to iron /folic acid supplementation was found to be 51.4%. Maternal educational status, early registration for ANC, history of anemia during current pregnancy, and knowledge about iron and folic acid supplementation were significant factors associated with adherence to iron/folic acid supplementation among pastoralist’s pregnant women. Therefore, anemia prevention strategy should include strengthening giving awareness, counseling, strengthening community health education, and participation in health programs which are necessary to improve the uptake of iron/folic acid supplements.

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Adherence to Iron and Folic Acid Supplementation and Its Associated Factors among Pregnant Women Attending Antenatal Care at Bwindi Community Hospital, Western Uganda

International Journal of Reproductive Medicine ◽

10.1155/2021/6632463 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Christine Nimwesiga ◽

Mereth Murezi ◽

Ivan Mugisha Taremwa

Keyword(s):

Logistic Regression ◽

Folic Acid ◽

Pregnant Women ◽

Associated Factors ◽

Community Hospital ◽

Folic Acid Supplementation ◽

Regression Analyses ◽

Acid Supplementation ◽

Iron And Folic Acid ◽

Western Uganda

Aims/Objectives. This study assessed the adherence to iron and folic acid supplementation and the associated factors among pregnant women attending antenatal care at Bwindi Community Hospital, in Western Uganda. Methods. This was a cross-sectional study that used an interviewer-administered questionnaire and reviewed medical records. Binary and multivariable logistic regression analyses were used to identify factors associated with iron and folic acid supplementation. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p value < 0.05 were used to assess for statistical significance. Results. We enrolled 438 pregnant women aged 16 to 41years. Participants’ mean age (±standard deviation (SD)) was 25.9 (±3.17) years. The self-reported adherence to iron and folic acid supplementation (consumed ≥4 tablets a week or 20 tablets in a month daily without missing the prescribed dosage) was 22.37% ( N = 98 ). Among the adherent pregnant women, the reported reasons (and their respective proportionality) for adherence were getting advice and counseling from the healthcare worker about the good effects of iron and folic acid supplementation ( N = 34 , 34.69%) and knowledge about the health benefits of iron and folic acid supplementation such as preventing anemia ( N = 16 , 16.33%), among others. On the other hand, the reported reasons (and their respective proportionality) for iron and folic acid nonadherence were forgetfulness ( N = 158 , 46.47%), taking too many pills ( N = 7 , 2.06%), not knowing the usefulness of iron and folic acid supplementation ( N = 29 , 8.53%), fear of the side effects of the medication ( N = 119 , 35.00%), and not getting the supplement from the hospital ( N = 27 , 7.94%). Bivariable and multivariable logistic regression analyses indicated that pregnant women who were primigravida ( adjusted odds ratio AOR = 4.5 ), who have parity of 2 or 3 ( AOR = 3.4 ), who perceived importance of iron and folic acid supplementation to prevent anemia ( AOR = 2.9 ), and who considered it important to take iron and folic acid supplementation ( AOR = 2.9 ) showed a statistically significant association with adherence to iron and folic acid supplementation. Moreover, pregnant women who perceived the risk of not taking iron and folic acid supplementation ( AOR = 5.2 ), those who received sufficient health education regarding the goals of iron and folic acid supplementation as well as the dangers of not taking the supplements ( AOR = 4.4 ) and adequate counseling, and those who obtained an explanation of the effects of iron and folic acid ( AOR = 4.8 ) showed a significant association with adherence to iron and folic acid supplementation. Conclusion. This study found a low adherence of iron and folic acid supplementation and was associated with obstetric and client- and health system-related characteristics. To this end, there is a need for individualized strategies targeting such factors and intensifying health education, guidance, and counseling to optimize adherence to iron and folic acid supplementation.

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Nutrition counselling and knowledge on iron and folic acid supplementation among pregnant women in Nyeri County, Kenya

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20211209 ◽

2021 ◽

Vol 8 (4) ◽

pp. 1620

Author(s):

Henry Mburu Ng'the ◽

Douglas Nderitu ◽

Stephanie Wanja

Keyword(s):

Folic Acid ◽

Pregnant Women ◽

Quantitative Data ◽

Folic Acid Supplementation ◽

Acid Supplementation ◽

Focused Antenatal Care ◽

Folic Acid Supplements ◽

Iron And Folic Acid ◽

Low Levels ◽

The Government

Background: In the world, a deficiency of iron is the most common nutrition disorder affecting more than 30% of the global populace more so children and women. Countries in the developing world are working in programs on implementing the iron and folic acid supplementation (IFAS) although the effectiveness of curbing anemia is usually affected by non-compliance to iron and folic acid supplements by women who are pregnant. The government of Kenya has come up with strategies to deal with anemia which include supplementation of iron and folic acid, implementation of focused antenatal care even though they have encountered a few hurdles resulting to sub optimal coverage and low levels of compliance.Methods: This was a mixed method study whereby both qualitative and quantitative data was analysed. A sample size of 385 pregnant women were interviewed. Data was collected using questionnaires. Descriptive statistics were used to analyze the quantitative data which was presented in form of frequency and percentage tables, bar graphs and pie charts. Results: Results show that 96% of the expectant women indicated that they were advised to take fruits while 86% indicated that they were advised to take green vegetables. This shows that pregnant women in the study had good knowledge of their dietary needs.Conclusions: The study concludes that expectant women had high nutrition knowledge on foods that raise the haemoglobin levels during gravidity.

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The effect of early antenatal booking on adherence to Iron/folic acid supplementation among antenatal care attendees in Libo kemkem district, Ethiopia

10.21203/rs.2.13116/v1 ◽

2019 ◽

Author(s):

Tewachew Muche liyeh ◽

Yitayal Ayalew Goshu ◽

Amare Simegn Ayele ◽

Yibeltal Abebe

Keyword(s):

Folic Acid ◽

Antenatal Care ◽

Pregnant Women ◽

Folic Acid Supplementation ◽

Medical Advice ◽

Adherence Rate ◽

Acid Supplementation ◽

Iron And Folic Acid ◽

Iron Folic Acid Supplementation ◽

Iron Folic Acid

Abstract Background Iron and folic acid supplementation is the feasible and cost effective strategy to control and prevent anemia in pregnancy. Pregnant women are vulnerable for iron deficiency anemia due to increased nutrient requirement during pregnancy. In Ethiopia, the national data suggests that from all pregnant women supplemented with these tablets, only 5.1% consumed more than 90 tablets during their pregnancy time. The factors for this low adherence are not clearly known. Objective: To assess factors associated with adherence to iron-folic acid supplementation among pregnant women attending antenatal care service in Libo Kemkem district, Ethiopia 2017. Method: Hospital based cross sectional study was conducted using quantitative methods on 406 pregnant women attending antenatal care at Libo Kemkem district public health institutions. Systematic random sampling method was used. An interview with pre tested semi structured questionnaire was carried out. The collected data was entered in Epi data 4.1 and analyzed with SPSS version 20. Bivariate and multivariable logistic regression model were used. Odds ratio with 95% interval was computed and P- value <0.05% considered as level of significance. Result: About 406 respondents were included in the study. The adherence rate of iron-folic acid supplementation was 49.3% (95% CI= 44.3%-54.2%). Factors significantly associated with adherence to iron-folic acid utilization were urban residence (AOR =4.8, 95% CI=1.82-12.79), women aged 21-30 (AOR = 4.3, 95% CI=1.60-11.42) ,women aged 31-40 (AOR =4.2, 95% CI=1.33-13.41),early ANC booking (AOR =4.1, 95% CI=1.80-9.30) and getting medical advice (AOR = 2.5, 95% CI = 1.04 – 6.16). Fear of side effects, forgetfulness and too many pills were the major reasons for missing the doses of tablets. Conclusion: adherence rate of iron and folic acid supplementation was low. Residence, maternal age, early ANC booking and getting medical advice were significantly associated with adherence to iron and folic acid. Key Words: Iron-folic acid, pregnant women and adherence

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Adherence and Associated Factors to Iron and Folic Acid Supplementation Among Pregnant Women Attending Antenatal Care in Public Hospitals of Dire Dawa, Eastern Ethiopia

European Journal of Midwifery ◽

10.18332/ejm/138595 ◽

2021 ◽

Vol 5 (August) ◽

pp. 1-7

Author(s):

Yonatan Solomon ◽

Alekaw Sema ◽

Tamiru Menberu

Keyword(s):

Folic Acid ◽

Antenatal Care ◽

Pregnant Women ◽

Associated Factors ◽

Folic Acid Supplementation ◽

Public Hospitals ◽

Eastern Ethiopia ◽

Acid Supplementation ◽

Dire Dawa ◽

Iron And Folic Acid

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Counselling and knowledge on iron and folic acid supplementation (IFAS) among pregnant women in Kiambu County, Kenya: a cross-sectional study

AAS Open Research ◽

10.12688/aasopenres.12891.2 ◽

2019 ◽

Vol 1 ◽

pp. 21

Author(s):

Mary Kamau ◽

Samuel Kimani ◽

Waithira Mirie

Keyword(s):

Folic Acid ◽

Pregnant Women ◽

Community Education ◽

Folic Acid Supplementation ◽

Cross Sectional Study ◽

Health Facilities ◽

Sectional Study ◽

Cross Sectional ◽

Acid Supplementation ◽

Iron And Folic Acid

Background: The increased demand for iron and folic acid during pregnancy is not met through diet due to insufficiency or reduced bioavailability of nutrients among women from low income countries. Thus, iron and folic acid supplementation (IFAS) is a promising interventional strategy for control of anaemia during pregnancy. Kenya adopted the global IFAS intervention with a target of 80% coverage by 2017, however, the compliance remains low. Increasing awareness, counselling, communication and community education on IFAS have improved compliance among pregnant women. Thus, we aimed to determine: IFAS knowledge, availability, practices, and content of IFAS counselling among pregnant women attending health facilities in Kiambu County, Kenya. Methods: A cross-sectional study involving 364 pregnant women aged 15-49 years. A two stage cluster sampling, including one sub-county and five public health facilities were used. A pre-tested structured questionnaire consisting of socio-demographic data, maternal knowledge and counselling on IFAS was used. An observation checklist was used to observe practices and content of antenatal counselling session in each facility. Data was analysed using STATA in which descriptive and inferential statistics were computed. Results: Of 364 respondents, less than half (40.9%) scored high on knowledge on IFAS. Women who were counselled on duration of IFAS intake, side effects, and their mitigation were more likely (p <0.005) to have high IFAS knowledge. Although all the health facilities had varied IFAS posters displayed, none had key IFAS counselling documents. Conclusion: Less than half of the pregnant women had high IFAS knowledge, IFAS documents were scarce in health facilities, IFAS counselling information in different health facilities was limited and varied and content of counselling was associated with levels of knowledge on IFAS. This underscores the need to strengthen focused and targeted IFAS counselling for pregnant women and standardization of counselling messages to improve compliance and pregnancy outcomes.

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

Reproductive Health ◽

10.1186/s12978-019-0848-9 ◽

2019 ◽

Vol 16 (1) ◽

Cited By ~ 3

Author(s):

Melaku Desta ◽

Bekalu Kassie ◽

Habtamu Chanie ◽

Henok Mulugeta ◽

Tadesse Yirga ◽

...

Keyword(s):

Systematic Review ◽

Folic Acid ◽

Side Effects ◽

Pregnant Women ◽

Meta Analysis ◽

National Level ◽

Folic Acid Supplementation ◽

Acid Supplementation ◽

Life Years ◽

Iron And Folic Acid

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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