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Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

Compliance with Iron and folic acid supplementation (IFAS) and associated factors among pregnant women: results from a cross-sectional study in Kiambu County, Kenya

Authors: Mary Wanjira Kamau, Waithira Mirie, Samuel Kimani

Published in: BMC Public Health | Issue 1/2018

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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.
Literature
1.
go back to reference MoPHS. The Kenya National Technical Guidelines for micronutrient deficiency control. Nairobi: Division of nutrition ed.; 2008. MoPHS. The Kenya National Technical Guidelines for micronutrient deficiency control. Nairobi: Division of nutrition ed.; 2008.
2.
go back to reference Elder LK: Issues in programming for maternal anaemia. Mother Care; 2000. Elder LK: Issues in programming for maternal anaemia. Mother Care; 2000.
3.
go back to reference MoH. Accelerating reduction of iron deficiency anaemia among pregnant women in Kenya: plan of action 2012-2017. Nairobi: Division of nutrition ed.; 2012. MoH. Accelerating reduction of iron deficiency anaemia among pregnant women in Kenya: plan of action 2012-2017. Nairobi: Division of nutrition ed.; 2012.
4.
go back to reference WHO. Essential nutrition actions: improving maternal, newborn, infant and young child health and nutrition. Geneva: World Health Organization; 2013. WHO. Essential nutrition actions: improving maternal, newborn, infant and young child health and nutrition. Geneva: World Health Organization; 2013.
5.
go back to reference USAID. Spring nutrition technical brief: A simple method for making a rapid, initial assessment of the consumption and distribution of iron-folic acid supplements among pregnant women in developing countries. 2014. USAID. Spring nutrition technical brief: A simple method for making a rapid, initial assessment of the consumption and distribution of iron-folic acid supplements among pregnant women in developing countries. 2014.
6.
go back to reference Mulambah CS, Siamba DN, Ogutu PA, Siteti DI, Wekesa AW. Anaemia in pregnancy: Prevalence and possible risk factors in Kakamega County, Kenya. Sci J Public Health. 2014;2:216–22. Mulambah CS, Siamba DN, Ogutu PA, Siteti DI, Wekesa AW. Anaemia in pregnancy: Prevalence and possible risk factors in Kakamega County, Kenya. Sci J Public Health. 2014;2:216–22.
7.
go back to reference WHO. Micronutrients. Geneva: World Health Organization; 2014. WHO. Micronutrients. Geneva: World Health Organization; 2014.
8.
go back to reference MoH. Maternal, Infant and Young Child Nutrition: National operational guidelines for health workers. Nairobi: Division of Nutrition ed.; 2013. MoH. Maternal, Infant and Young Child Nutrition: National operational guidelines for health workers. Nairobi: Division of Nutrition ed.; 2013.
9.
go back to reference MoH. National Iron and Folic Acid Supplementation; Communication strategy, 2013-2017. Nairobi: Division of nutrition ed.; 2013. MoH. National Iron and Folic Acid Supplementation; Communication strategy, 2013-2017. Nairobi: Division of nutrition ed.; 2013.
10.
go back to reference Aamer I, Zulfiqar AB. Routine iron/folate supplementation during pregnancy: Effect on maternal anaemia and birth outcomes. Paediatr Perinat Epidemiol. 2012;26:168–77. Aamer I, Zulfiqar AB. Routine iron/folate supplementation during pregnancy: Effect on maternal anaemia and birth outcomes. Paediatr Perinat Epidemiol. 2012;26:168–77.
11.
go back to reference Bilimale A, Anjum J, Sangolli HN, Mallapur M. Improving adherence to oral iron supplementation during pregnancy. Australas Med J. 2010;3 Bilimale A, Anjum J, Sangolli HN, Mallapur M. Improving adherence to oral iron supplementation during pregnancy. Australas Med J. 2010;3
12.
go back to reference Waweru J, Mugenda OM, Kuria E. Anaemia in the context of pregnancy and HIV/AIDS: A case of Pumwani maternity hopital in Nairobi Kenya. Afr J Food Agric Nutr Dev. 2009;9:748–63. Waweru J, Mugenda OM, Kuria E. Anaemia in the context of pregnancy and HIV/AIDS: A case of Pumwani maternity hopital in Nairobi Kenya. Afr J Food Agric Nutr Dev. 2009;9:748–63.
13.
go back to reference MoH. National Policy Guidelines on Combined Iron and Folic Acid (IFA) Supplementation for Pregnant Mothers in Kenya. Nairobi: Division of nutrition ed.; 2013. MoH. National Policy Guidelines on Combined Iron and Folic Acid (IFA) Supplementation for Pregnant Mothers in Kenya. Nairobi: Division of nutrition ed.; 2013.
14.
go back to reference Singh MB, Fotedar R, Lakshminarayana J. Micronutrient deficiency status among women of desert areas of western Rajasthan, India. Public Health Nutr. 2008;12:624–9.CrossRefPubMed Singh MB, Fotedar R, Lakshminarayana J. Micronutrient deficiency status among women of desert areas of western Rajasthan, India. Public Health Nutr. 2008;12:624–9.CrossRefPubMed
16.
go back to reference WHO. Guideline: daily iron and folic acid supplementation in pregnant women. Geneva: World Health Organization; 2012. WHO. Guideline: daily iron and folic acid supplementation in pregnant women. Geneva: World Health Organization; 2012.
17.
go back to reference KNBS. Macro ICF: Kenya Demographic and Health Survey (KDHS) 2014. Nairobi: KNBS; 2015. KNBS. Macro ICF: Kenya Demographic and Health Survey (KDHS) 2014. Nairobi: KNBS; 2015.
18.
go back to reference KNBS. Macro ICF: Kenya Demographic and Health Survey (KDHS) 2008–09. Nairobi: Kenya National Bureau of Statistics; 2010. KNBS. Macro ICF: Kenya Demographic and Health Survey (KDHS) 2008–09. Nairobi: Kenya National Bureau of Statistics; 2010.
19.
go back to reference MoPHS. Kenya nutrition bulletin. vol. 2. Nairobi: Division of nutrition ed.; 2012. MoPHS. Kenya nutrition bulletin. vol. 2. Nairobi: Division of nutrition ed.; 2012.
20.
go back to reference MoPHS. National Nutrition Action Plan 2012-2017. Nairobi: Division of nutrition ed.; 2012. MoPHS. National Nutrition Action Plan 2012-2017. Nairobi: Division of nutrition ed.; 2012.
21.
go back to reference Dinga LA. Factors associated with adherence to iron/folate supplementation among pregnant women attending antenatal clinic at Thika District Hospital in Kiambu County. Kenya: University of Nairobi, Food Science, Nutrition and Technology, Faculty of Agriculture; 2013. Dinga LA. Factors associated with adherence to iron/folate supplementation among pregnant women attending antenatal clinic at Thika District Hospital in Kiambu County. Kenya: University of Nairobi, Food Science, Nutrition and Technology, Faculty of Agriculture; 2013.
22.
go back to reference Juma M, Oiye SO, Konyole SO. Predictors of optimum antenatal iron-folate supplementation in a low resource rural set-up in eastern Kenya. J Public Health Epidemiol. 2015;7:337–45.CrossRef Juma M, Oiye SO, Konyole SO. Predictors of optimum antenatal iron-folate supplementation in a low resource rural set-up in eastern Kenya. J Public Health Epidemiol. 2015;7:337–45.CrossRef
24.
go back to reference Yip R. Iron deficiency: contemporary scientific issues and international programmatic approaches. J Nutr. 1994;124:1479S–90S.CrossRefPubMed Yip R. Iron deficiency: contemporary scientific issues and international programmatic approaches. J Nutr. 1994;124:1479S–90S.CrossRefPubMed
25.
go back to reference Pena-Rosas JP, Viteri FE. Effects of routine oral iron supplementation with or without folic acid for women during pregnancy. Cochrane Database Syst Rev. 2006;19(3):CD004736. Pena-Rosas JP, Viteri FE. Effects of routine oral iron supplementation with or without folic acid for women during pregnancy. Cochrane Database Syst Rev. 2006;19(3):CD004736.
26.
go back to reference Dairo MD, Lawoyin TO. Demographic factors determining compliance to iron supplementation in pregnancy in Oyo state, Nigeria. Niger J Med. 2006;15(3):241-4. Dairo MD, Lawoyin TO. Demographic factors determining compliance to iron supplementation in pregnancy in Oyo state, Nigeria. Niger J Med. 2006;15(3):241-4.
27.
go back to reference MCSP: MCSP nutrition Brief. Community-Based Distribution of Iron-Folic Acid Supplementation: Evidence and Program Implications. MCSP; 2017. MCSP: MCSP nutrition Brief. Community-Based Distribution of Iron-Folic Acid Supplementation: Evidence and Program Implications. MCSP; 2017.
28.
go back to reference Maina-Gathigi L, Omolo J, Wanzala P, Lindan C, Makokha A. Utilization of folic acid and iron supplementation services by pregnant women attending an antenatal clinic at a regional referral hospital in Kenya. Matern Child Health J. 2013;17:1236–42.CrossRefPubMed Maina-Gathigi L, Omolo J, Wanzala P, Lindan C, Makokha A. Utilization of folic acid and iron supplementation services by pregnant women attending an antenatal clinic at a regional referral hospital in Kenya. Matern Child Health J. 2013;17:1236–42.CrossRefPubMed
29.
go back to reference Gebremedhin S, Aregash S, Girma M, Tibebu M, Tsehai A. Coverage, compliance and factors associated with utilization of iron supplementation during pregnancy in eight rural districts of Ethiopia: a cross-sectional study. BMC Public Health. 2014;14:607. Gebremedhin S, Aregash S, Girma M, Tibebu M, Tsehai A. Coverage, compliance and factors associated with utilization of iron supplementation during pregnancy in eight rural districts of Ethiopia: a cross-sectional study. BMC Public Health. 2014;14:607.
30.
go back to reference Pal PP, Sharma S, Sarkar TK, Mitra P. Iron and folic acid consumption by the ante-natal mothers in a rural area of India in 2010. Int J Prev Med. 2013;4:1213–6.PubMedPubMedCentral Pal PP, Sharma S, Sarkar TK, Mitra P. Iron and folic acid consumption by the ante-natal mothers in a rural area of India in 2010. Int J Prev Med. 2013;4:1213–6.PubMedPubMedCentral
31.
go back to reference Nisar Y, Michael JD, Ali MM. Factors associated with non-use of antenatal iron and folic acid supplements among Pakistani women: a cross sectional household survey. BMC Pregnancy Childbirth. 2014;14(1):305. Nisar Y, Michael JD, Ali MM. Factors associated with non-use of antenatal iron and folic acid supplements among Pakistani women: a cross sectional household survey. BMC Pregnancy Childbirth. 2014;14(1):305. 
32.
33.
go back to reference Galloway R, Dusch E, Elder L, Achadi E, Grajeda R, Hurtado E. Women’s perceptions of iron deficiency and anemia prevention and control in eight developing countries. Soc Sci Med. 2002;55(4):529-44. Galloway R, Dusch E, Elder L, Achadi E, Grajeda R, Hurtado E. Women’s perceptions of iron deficiency and anemia prevention and control in eight developing countries. Soc Sci Med. 2002;55(4):529-44.
34.
go back to reference Charoenlarp P, Dhanamitta S, Kaewvichit R, Silprasert A, Suwanaradd C, Na-Nakorn S, Prawatmuang P, Vatanavicharn S, Nutcharas U, Pootrakul P. A WHO collaborative study on iron supplementation in Burma and in Thailand. Am J Clin Nutr. 1988;47(2):280-97. Charoenlarp P, Dhanamitta S, Kaewvichit R, Silprasert A, Suwanaradd C, Na-Nakorn S, Prawatmuang P, Vatanavicharn S, Nutcharas U, Pootrakul P. A WHO collaborative study on iron supplementation in Burma and in Thailand. Am J Clin Nutr. 1988;47(2):280-97.
35.
go back to reference Arega Sadore A, Abebe Gebretsadik L, Aman Hussen M. Compliance with Iron-folate supplement and associated factors among antenatal care attendant mothers in Misha District, South Ethiopia: community based cross-sectional study. J Environ Public Health. 2015;2015:781973.CrossRefPubMedPubMedCentral Arega Sadore A, Abebe Gebretsadik L, Aman Hussen M. Compliance with Iron-folate supplement and associated factors among antenatal care attendant mothers in Misha District, South Ethiopia: community based cross-sectional study. J Environ Public Health. 2015;2015:781973.CrossRefPubMedPubMedCentral
36.
go back to reference Taye B, Abeje G, Mekonen A. Factors associated with compliance of prenatal iron folate supplementation among women in Mecha district, western Amhara: a cross-sectional study. Pan Afr Med J. 2015;20:43.CrossRefPubMedPubMedCentral Taye B, Abeje G, Mekonen A. Factors associated with compliance of prenatal iron folate supplementation among women in Mecha district, western Amhara: a cross-sectional study. Pan Afr Med J. 2015;20:43.CrossRefPubMedPubMedCentral
37.
go back to reference Gebreamlak B, Dadi AF, Atnafu A. High adherence to Iron/folic acid supplementation during pregnancy time among antenatal and postnatal care attendant mothers in governmental health centers in Akaki Kality Sub City, Addis Ababa, Ethiopia: hierarchical negative binomial Poisson regression. PLoS One. 2017;12:e0169415.CrossRefPubMedPubMedCentral Gebreamlak B, Dadi AF, Atnafu A. High adherence to Iron/folic acid supplementation during pregnancy time among antenatal and postnatal care attendant mothers in governmental health centers in Akaki Kality Sub City, Addis Ababa, Ethiopia: hierarchical negative binomial Poisson regression. PLoS One. 2017;12:e0169415.CrossRefPubMedPubMedCentral
38.
go back to reference Wendt A, Young M, Stephenson R, Webb Girard A, Ramakrishnan U, Martorell R. Antenatal care and counseling measures increase iron and folic acid receipt among pregnant women in Bihar, India. FASEB J. 2014;28(1):256.3. Wendt A, Young M, Stephenson R, Webb Girard A, Ramakrishnan U, Martorell R. Antenatal care and counseling measures increase iron and folic acid receipt among pregnant women in Bihar, India. FASEB J. 2014;28(1):256.3.
39.
go back to reference Chakma T, Vinay Rao P, Meshram PK. Factors associated with high compliance/feasibility during iron and folic acid supplementation in a tribal area of Madhya Pradesh, India. Public Health Nutr. 2013;16:377–80.CrossRefPubMed Chakma T, Vinay Rao P, Meshram PK. Factors associated with high compliance/feasibility during iron and folic acid supplementation in a tribal area of Madhya Pradesh, India. Public Health Nutr. 2013;16:377–80.CrossRefPubMed
40.
go back to reference Aguayo VM, Kone D, Bamba SI, Diallo B, Sidibe Y, Traore D, Signe P, Baker SK. Acceptability of multiple micronutrient supplements by pregnant and lactating women in Mali. Public Health Nutr. 2005;8:33–7.CrossRefPubMed Aguayo VM, Kone D, Bamba SI, Diallo B, Sidibe Y, Traore D, Signe P, Baker SK. Acceptability of multiple micronutrient supplements by pregnant and lactating women in Mali. Public Health Nutr. 2005;8:33–7.CrossRefPubMed
41.
go back to reference Zavaleta N, Caulfield LE, Figueroa A, Chen P. Patterns of compliance with prenatal iron supplementation among Peruvian women. Matern Child Nutr. 2014;10:198–205.CrossRefPubMed Zavaleta N, Caulfield LE, Figueroa A, Chen P. Patterns of compliance with prenatal iron supplementation among Peruvian women. Matern Child Nutr. 2014;10:198–205.CrossRefPubMed
42.
go back to reference Abdullahi H, Gasim GI, Saeed A, Imam AM, Adam I. Antenatal iron and folic acid supplementation use by pregnant women in Khartoum, Sudan. BMC Research Notes. 2014;7:498.CrossRefPubMedPubMedCentral Abdullahi H, Gasim GI, Saeed A, Imam AM, Adam I. Antenatal iron and folic acid supplementation use by pregnant women in Khartoum, Sudan. BMC Research Notes. 2014;7:498.CrossRefPubMedPubMedCentral
43.
go back to reference Rai S. Compliance and its determinants regarding Iron and folic acid supplementation among pregnant women attending Paropakar maternity and Women’s hospital, Kathmandu. Nepal: Nepal: Nepal Health Research Council; 2013. Rai S. Compliance and its determinants regarding Iron and folic acid supplementation among pregnant women attending Paropakar maternity and Women’s hospital, Kathmandu. Nepal: Nepal: Nepal Health Research Council; 2013.
44.
go back to reference Al-Hossani H, Abouzeid H, Salah MM, Farag HM, Fawzy E. Knowledge and practices of pregnant women about folic acid in pregnancy in Abu Dhabi, United Arab Emirates. East Mediterr Health J. 2010;16:402–7.CrossRefPubMed Al-Hossani H, Abouzeid H, Salah MM, Farag HM, Fawzy E. Knowledge and practices of pregnant women about folic acid in pregnancy in Abu Dhabi, United Arab Emirates. East Mediterr Health J. 2010;16:402–7.CrossRefPubMed
Metadata
Title
Compliance with Iron and folic acid supplementation (IFAS) and associated factors among pregnant women: results from a cross-sectional study in Kiambu County, Kenya
Authors
Mary Wanjira Kamau
Waithira Mirie
Samuel Kimani
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-5437-2

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