Determinants associated with adherence to ironfolic acid supplementation among pregnant women in kasulu communities, north-western, Tanzania

Abstract

Pregnant women are at high risk of iron and folic acid deficiency anemia. Tanzania adopted the WHO recommendation of 2012 that, all pregnant women should consume a dose of 30- 60 mg IFAS 400 μg daily for first six (6) months. Iron and Folic Acid Supplementation is the main cost-effective strategy to control anemia during pregnancy however, adherence to IFAS in Tanzania is low (21%) and more in Kigoma region (7%). Associated determinants with adherence to IFAS have not been well established and studies to assess IFAS in Kasulu district are limited. Participants were selected at the health facility through systematic random sampling. A structured questionnaire was used to collect quantitative information and binary logistic regression models were used to determine the factors associated with the adherence to IFAS with statistical significance of p-value<0.05 using SPSS software (version 22). Similarly, pregnant and women with children aged 0-6 months were purposively selected from health facilities and allocated in four focus group discussions for qualitative information. In addition, an in-depth interview (IDIs) was conducted among six health care providers who were purposefully selected from two health facilities. Thematic analysis was done for qualitative data and triangulated with quantitative findings. Adherence to IFAS was found to be 20.3%. In a binary logistic regression model, factors associated with adherence to IFAS include distance to health facilities (AOR=0.338, 95% CI:131-886), counseled on the benefits of IFAS (AOR=3.864, 95% CI: 1.422-10.500), knowledge on anemia (AOR=3.840, 95% CI: 1.335-10.685), number of IFAS given at each visit (AOR=15.718, 95% CI: 5.33546.311), Time at

first ANC visit (AOR=3.724, 95% CI: 1.417-9.791), number of meals per day (AOR=3.349, 95% CI: 1.184-9.212) and number of the children (AOR=3.462, 95% CI: 1.035-12.070). From the qualitative findings, low knowledge of anemia and benefits of IFAS among women and health care providers, late first ANC, economic factors, less reminded to the uptake of IFAS, negligence and forgetfulness were the main reasons for low adherence. Overall, adherence to IFAS was low. Therefore, strengthening systems to create community awareness, health promotion, education program among health care providers and pregnant women, strengthen supply chain and reminder mechanisms is potential to improve the adherence to IFAS.