Iron And Folic Acid Supplementation Among Pregnant Women: A Community-Based Approach In Kiambu County, Kenya

Abstract

Background: Iron and folic acid are micronutrients whose deficiency is common during pregnancy resulting in anaemia. Iron and Folic Acid Supplementation (IFAS), an essential intervention strategy for prevention of anaemia during pregnancy, is currently provided for free to pregnant women in Kenya during antenatal care (ANC). Despite these efforts, compliance with IFAS remains low over the years and iron-deficiency anaemia remains a public health problem in Kenya affecting 55% pregnant women. Objective: To implement a community-based approach for iron and folic acid supplementation and education among pregnant women in Kiambu County, Kenya. Methods: A Pretest-Posttest Quasi-Experimental study design was used, consisting of intervention and control group, using mixed methods to collect quantitative and qualitative data, among 364 pregnant women 15-49 years, Health Care Providers (HCPs) and Community Health Volunteers (CHVs) in five health facilities in Lari Sub-County, Kiambu County. The CHVs provided IFAS supplements, education and weekly follow-up to pregnant women in intervention group while control group followed standard practice from health facilities. Baseline and endline data were collected during ANC and compared. Quantitative data was analyzed using STATA version 14. Analysis of effect of intervention was done using Difference-In-Difference regression approach. Thematic analysis was used for qualitative data. Results: The level of utilization existing IFAS policy documents by HCPs was 55%, most being unavailability at health facilities. The intervention resulted in effect difference in maternal IFAS knowledge of 19.1% with intervention group levels increasing most by 34% (from 57.4% to 91.7%). There was significant (p<0.001) change in the proportion with positive attitude towards 2 IFAS: the odds of having positive attitude at endline was 9 times that of baseline (OR=9.2:95%CI 3.1, 27.2). Levels of compliance increased by 8% (from 63.8% to 71.4%) in intervention group and 6% (from 68.5% to 74.3%) in control group. However, these differences did not yield statistical significance between the two study groups. There was slight improvement in mean haemoglobin levels in intervention group (from 13.08 to 13.39 g/dl) compared to slight decrease in control group (from 13.89 to 13.15 g/dl). Qualitative findings elicited three themes namely: perceived benefits, challenges experienced and recommendations regarding Community-based Approach (CBA) of IFAS. The approach was perceived to be beneficial by the participants, with reported perceived increased access and utilization of both IFAS and ANC services. The main challenge experienced was CHVs lack of salary and IFAS stock-outs aggravated by the increased IFAS utilization. The participants recommended complementing antenatal IFAS distribution with CBA of IFAS. Conclusion: Implementation of CBA of IFAS increased supplement awareness and utilization as well as consumption of iron/folate rich sources of food, leading to reduced anaemia levels and better pregnancy outcomes. The potential of CHVs in IFAS programme is not fully utilized but very promising. Recommendation: Based on the study findings, there is need to adopt CBA of IFAS to complement antenatal distribution for diversification of IFAS policy implementation in Kenya. Thus, CHVs need formal integration into existing vertical health facility approach in provision of community based IFAS services to augment IFAS delivery to pregnant women to improve the low compliance levels.