Adherence and barriers of prophylactic iron and folic acid supplementation in children: a community-based mixed method study

Abstract

Background: Anemia is a public health challenge in India among children, adolescents and reproductive age women. Still, 58% of under-five children in India and 43% in Puducherry are anaemic. To determine the proportion of mothers of one-to-nine-year children, aware about iron and folic acid (IFA) supplementation, the proportion of children adherent to the dosage of IFA and the barriers for the adherence to IFA. Methods: A community-based explanatory sequential mixed methods study consisting survey using a semi-structured questionnaire and followed by focus group discussions (FGD) using an interview guide. The data was collected using EpiCollect5 analysed using SPSS. The results were expressed as proportions with 95% confidence interval (CI) and the qualitative results were expressed as a conceptual framework. Results: Awareness about IFA supplementation given to children from the public health system was 57% (95% CI: 51.8-62.0) among mothers of one-to-nine-year children. Adherence to IFA supplementation was 34% (28.9.0-38.6). The main reason of the non-adherence reported by the mothers was non-availability of the supplements, nausea and vomiting among children and forgetfulness of the mother. In the FGD, supply side reasons were non-palatability and wrong dose administration, and demand side reasons were lack of awareness and coverage. Conclusions: Only one out of ten children among under five years were taking IFA syrup and only half of the children ages five-to-nine-years consumed IFA tablets given in their schools. Irregular distribution of IFA tablets, medication side-effects, and non-palatability of the medication were the main reasons quoted by the mother for non-adherence.