scholarly journals Implementation fidelity of Iron and Folic Acid supplementation (IFAs) and associated challenges among pregnant women in Uasin Gishu County Kenya

2020 ◽  
Author(s):  
Roselyter Monchari Riang'a ◽  
Anne Kisaka Nangulu ◽  
Jacqueline E.W. Broerse
Keyword(s):  
Folic Acid ◽  
Side Effects ◽  
Implementation Fidelity ◽  
Folic Acid Supplementation ◽  
Food Sources ◽  
Careful Examination ◽  
Acid Supplementation ◽  
Nutritional Counselling ◽  
Participant Responsiveness ◽  
Iron And Folic Acid

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 programme 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 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 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 take the pills 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.

scholarly journals Implementation fidelity of nutritional counselling, Iron and Folic Acid supplementation guidelines and associated challenges in rural Uasin Gishu County Kenya

2020 ◽  
Author(s):  
Roselyter Monchari Riang'a ◽  
Anne Kisaka Nangulu ◽  
Jacqueline E.W. Broerse
Keyword(s):  
Folic Acid ◽  
Side Effects ◽  
Implementation Fidelity ◽  
Folic Acid Supplementation ◽  
Food Sources ◽  
Careful Examination ◽  
Acid Supplementation ◽  
Nutritional Counselling ◽  
Participant Responsiveness ◽  
Iron And Folic Acid

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.

scholarly journals Implementation fidelity of nutritional counselling, Iron and Folic Acid supplementation guidelines and associated challenges in rural Uasin Gishu County Kenya

2020 ◽  
Author(s):  
Roselyter Monchari Riang'a ◽  
Anne Kisaka Nangulu ◽  
Jacqueline E.W. Broerse
Keyword(s):  
Folic Acid ◽  
Side Effects ◽  
Implementation Fidelity ◽  
Folic Acid Supplementation ◽  
Food Sources ◽  
Careful Examination ◽  
Acid Supplementation ◽  
Nutritional Counselling ◽  
Participant Responsiveness ◽  
Iron And Folic Acid

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.

scholarly journals Implementation fidelity of nutritional counselling, iron and folic acid supplementation guidelines and associated challenges in rural Uasin Gishu County Kenya

BMC Nutrition ◽  
2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Roselyter Monchari Riang’a ◽  
Anne Kisaka Nangulu ◽  
Jacqueline E. W. Broerse
Keyword(s):  
Folic Acid ◽  
Side Effects ◽  
Implementation Fidelity ◽  
Folic Acid Supplementation ◽  
Food Sources ◽  
Careful Examination ◽  
Acid Supplementation ◽  
Nutritional Counselling ◽  
Participant Responsiveness ◽  
Iron And Folic Acid

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.

scholarly journals Implementation fidelity of Iron and Folic Acid supplementation (IFAs) and associated challenges among pregnant women in rural Uasin Gishu County Kenya

2020 ◽  
Author(s):  
Roselyter Monchari Riang'a ◽  
Anne Kisaka Nangulu ◽  
Jacqueline E.W. Broerse
Keyword(s):  
Folic Acid ◽  
Side Effects ◽  
Implementation Fidelity ◽  
Folic Acid Supplementation ◽  
Food Sources ◽  
Careful Examination ◽  
Acid Supplementation ◽  
Nutritional Counselling ◽  
Participant Responsiveness ◽  
Iron And Folic Acid

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 to 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.

scholarly journals Implementation fidelity of Iron and Folic Acid supplementation (IFAs) and associated challenges among pregnant women in Uasin Gishu County Kenya

2020 ◽  
Author(s):  
Roselyter Monchari Riang'a ◽  
Anne Kisaka Nangulu ◽  
Jacqueline E.W. Broerse
Keyword(s):  
Folic Acid ◽  
Pregnant Women ◽  
Implementation Fidelity ◽  
First Trimester ◽  
Folic Acid Supplementation ◽  
Community Based ◽  
Acid Supplementation ◽  
Nutritional Counselling ◽  
Effective Implementation ◽  
Iron And Folic Acid

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.

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

2019 ◽  
Vol 16 (1) ◽  
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.

scholarly journals Counselling on iron and folic acid supplementation (IFAS) is associated with improved knowledge among pregnant women in a rural county of Kenya: a cross-sectional study

2018 ◽  
Vol 1 ◽  
pp. 21
Author(s):  
Mary Kamau ◽  
Samuel Kimani ◽  
Waithira Mirie
Keyword(s):  
Folic Acid ◽  
Side Effects ◽  
Pregnant Women ◽  
Folic Acid Supplementation ◽  
Cross Sectional Study ◽  
Health Facilities ◽  
Sectional Study ◽  
Cross Sectional ◽  
Acid Supplementation ◽  
Iron And Folic Acid

Background: The demand for iron and folic acid, is greatly increased during pregnancy. The high demand 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: availability, practices, and content of IFAS counselling on knowledge of antenatal mothers attending health facilities in Kiambu County, Kenya. Methods: A cross-sectional study involving 364 pregnant women aged 15-49 years attending antenatal clinic. A two stage cluster sampling, including one sub-county and five public primary 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: Content of counselling substantially contributed to high level of knowledge on IFAS among pregnant women. Counselling information on the duration of IFAS supplementation, IFAS side effects, and their management are the predictors of IFAS knowledge among pregnant women. This underscores the need to strengthen focused and targeted IFAS counselling for pregnant women to improve compliance and pregnancy outcomes.

Impact of iron and folic acid supplementation on oxidative stress during pregnancy

2015 ◽  
Vol 35 (8) ◽  
pp. 803-806 ◽  
Author(s):  
E. Lymperaki ◽  
A. Tsikopoulos ◽  
K. Makedou ◽  
E. Paliogianni ◽  
L. Kiriazi ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Folic Acid ◽  
Folic Acid Supplementation ◽  
Acid Supplementation ◽  
Iron And Folic Acid

scholarly journals Adherence to iron and folic acid supplementation and associated factors among antenatal care attendants in Northwest Ethiopia

2020 ◽  
Vol 9 (1) ◽  
pp. 20
Author(s):  
Berhanu Abebaw Mekonnen ◽  
Yadeta Dessie ◽  
Negga Baraki ◽  
Abdu Oumer ◽  
Mehari Gebru
Keyword(s):  
Folic Acid ◽  
Antenatal Care ◽  
Folic Acid Supplementation ◽  
Northwest Ethiopia ◽  
Adherence Rate ◽  
P Value ◽  
Cross Sectional ◽  
Acid Supplementation ◽  
Iron And Folic Acid ◽  
Pregnant Mothers

<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>

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