Determinants of adherence to iron and folate supplementation during pregnancy. A case study in West Nile Region, Arua City
Lowudu, Wilson Nelson
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Iron and folate supplementation can effectively control and prevent anemia in pregnancy. However, limited adherence is thought to be a major reason for the low effectiveness of iron supplementation programs .This research describes the level of adherence to and knowledge on anemia and its prevention, including use of iron and folate supplementation during pregnancy. MoH and WHO recommends all pregnant women should receive and consume a standard dose of 30-60mg iron + 400 µg folic acid daily supplement starting as early as possible and should be taken throughout pregnancy to control and prevent micro-nutrient deficiencies. However, adherence rate is only 23% of women took iron and folate tablets for the least 90 days during their last pregnancy. Therefore, the aim of this research was to delineate the level of adherence and factors influencing the use of iron and folate supplementation among pregnant women in West Nile Region, Arua City/District. A quantitative survey, was performed in this study using interviewer administered questionnaires, in the period of August 2021. A total of 121 pregnant women were interviewed in-depth for the quantitative data and data were entered to SPSS software for analysis. Frequencies, percentages, means and standard deviation, Chi – square, Univariate and binary logistic regression was used for statistical analysis to measure level of adherence to iron and folate supplementation, factor associated with iron and folate acid supplementation and knowledge on use of iron /folate acid supplementation. Odds ratio (OR) with 95% confidence interval (CI) and P – Value of < 0.05 were used to declare statistical significance. A PROCEDE – PROCEED Model – Predisposing factors, Enabling factors, Reinforcing factors and Environmental factors was used explain the variables. Results revealed that, the level of adherence was 59.5% and the positive predictors of adherence were the number of tablets received, access to prenatal care with OR = 15.376 (4.276 – 55.297) 95% CI, P – value of 0.000 and OR = 3.294 (1.170 – 9.277) 95% CI, P – value of 0.019 and reminding technique OR = 3.111 (1.078 – 8.977) 95% CI, P – value of 0.030. About 62.8% of pregnant women were knowledgeable about anemia and its prevention and 83.5% were knowledgeable about importance of taking iron and folate tablets. In conclusion, adherence to Iron and Folic Acid Supplementation has improved but still low. For optimal achievement for appropriate level of adherence access to and follow-up of antenatal care, including use of reminding technique were considered as essential elements to improve iron and folate supplementation. Therefore, Community-based interventions through a multifaceted strategy, to improve adherence in West Nile region, Arua City will be required.