Coverage, compliance and factors associated with utilization of iron supplementation during pregnancy in eight rural districts of Ethiopia: a cross-sectional study.

Samson Gebremedhin,Tsehai Assefa,Girma Mamo,Tibebu Moges,Aregash Samuel

doi:10.1186/1471-2458-14-607

Abstract

BackgroundDespite the efforts to reduce iron deficiency during pregnancy, information on the coverage and factors associated with utilization of iron supplements is lacking. The study is intended to assess the coverage, compliance and factors associated with the use of prenatal iron supplements in eight rural districts of Ethiopia.MethodsThe study comprised two independent surveys conducted among pregnant women (n = 414) and women who gave birth in the preceding year of the survey (n = 1573). In both cases, respondents were selected using multistage sampling technique and data were collected via structured questionnaire. Predictors of iron supplement utilization (ranked categories of number of prenatal supplements taken) were identified using ordinal logistic regression. The outputs of the analysis are given using adjusted Odds Ratio (OR) with 95% Confidence Interval (CI).ResultsAmong women who gave birth in the preceding year, 35.4% (95% CI: 31.3-39.5) were given/prescribed prenatal iron supplement during the index pregnancy and only 3.5% were supplemented for the recommended 91 or more days. Compared to women who had 4 or more ANC visits, those with 0, 1, 2 and 3 visits had 0.04, 0.33, 0.50 and 0.60 times less odds of iron supplement utilization, respectively. Women lacking comprehensive knowledge of anemia (OR = 0. 75 (95% CI: 0.57-0.97)) and those who weren’t informed about the importance of iron supplementation during the pregnancy (OR = 0. 05 (95% CI: 0.04-0.07)) had significantly lower utilization. On the other hand, in pregnant women the prevalence of anemia was 33.2%. Among pregnant women who were given/prescribed supplements, the average level of compliance was 74.9% and about 25.1% had less than 70% adherence. The leading reported reasons for non-adherence were side-effects (63.3%) and forgetfulness (16.7%).ConclusionPromoting early and frequent ANC, enhancing the quality of ANC counseling and promoting the knowledge of women on anemia are essential strategies for improving the utilization of iron supplements.

Highlights

Despite the efforts to reduce iron deficiency during pregnancy, information on the coverage and factors associated with utilization of iron supplements is lacking
Survey among women who gave birth in the last 12 months Socio-demographic information Data were successfully gathered from 1563 women who gave birth in the preceding 12 months with a response rate of 97.1%
Awareness about maternal anemia Near to three-fourth (72.0%) of the respondents had ever heard of anemia

Summary

Introduction

Despite the efforts to reduce iron deficiency during pregnancy, information on the coverage and factors associated with utilization of iron supplements is lacking. Pregnant women and preschool-age children take its disproportionate burden. Almost half of all preschool children (47.4%) and pregnant women (41.8%) and close to onethird of non-pregnant women (30.2%) are anemic [1,2]. Though anemia has multifaceted causes, half of its burden is attributed to Iron Deficiency (ID) [2]. Several studies documented the consequences of maternal anemia including increased risk of maternal death, low birth weight and preterm birth [3]. Besides ID is an underlying cause for 22% of maternal deaths worldwide [5]. A meta-analysis indicated that the risk of maternal death can be reduced by 20% for each 1 g/dl increase in population mean hemoglobin level [5].

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