Barriers to Adherence to Iron Supplements in Pregnancy in Rural South India

Abstract

Background Despite ongoing iron supplementation programmes the prevalence of iron deficiency anemia in India is high. Alleged poor adherence to prescribed iron and folic acid supplements is an often-cited reason for poor outcome of the iron supplementation programme.Objective To assess the levels of adherence to iron supplements in pregnancy and to identify the barriers of adherence to iron supplements in pregnancy at an antenatal clinic in Rural Karnataka. Methodology This is a cross sectional study involving 150 pregnant women on iron supplements for at least one month at the antenatal clinic of a rural hospital near Bangalore between March and May 2011. Adherence to iron supplements and its barriers were assessed using a pretested interviewer administered questionnaire. Adherence was defined as the percentage of prescribed doses consumed in the month prior to the interview. Good adherence was considered as an adherence rate of ge 80. In addition qualitative methods like focus group discussions and Key informant interviews were used to supplement quantitative data obtained. Results The mean age of the participants was 21.93 plusmn 2.44yrs 97 were educated and 5 employed. Fifty seven percent were in their first pregnancy. Of the women 86 were anemic with mean hemoglobin level of 9.55 plusmn 1.47gmdl. Forty two percent had adherence levels le80. The most common reasons for non-adherence were medication side effects and forgetfulness. Encouragement from family determined adherence to iron supplements plt0.05.Conclusions The nearly 40 non-adherence to iron supplements implies that iron supplementation in some Indian settings is far from being successful. Side-effects of iron tablets followed by forgetfulness were the most common barriers of adherence identified in the study. Encouragement played an important role in adherence.