Factors associated with adherence to Iron/Folate supplementation among pregnant women attending antenatal clinic at Thika District Hospital in Kiambu County, Kenya
Iron deficiency anemia is the most widespread nutritional problem among women and has severe consequences for both their productive and reproductive roles. Iron supplementation is a major strategy to reduce iron deficiency anemia in pregnancy. However, issues of adherence remain unresolved. According to the National Policy in Kenya, pregnant women should be supplemented with 60mg/day for 180 days for Iron and 400 µg of folic acid daily. In Kenya, however, adherence to the intake of the supplements has been very low with only 2.5% of pregnant women taking iron supplements > 90 days of the recommended 180 days. In Central Province only 0.7% took the supplements for ≥ 90 days. The concept of how best to assist women to adhere to a daily regimen of supplement consumption is not fully understood.The objective of this study was to assess the level of adherence and determine the factors associated with adherence to iron-folate supplements among pregnant women attending antenatal clinic at Thika district hospital, Kiambu County, Kenya. A total of 200 pregnant women were recruited to a cross-sectional survey. Using a pre-tested semi- structured questionnaire, data were collected on the women’s socio-demographic and economic characteristics, adherence rate, factors hindering and those associated with adherence to iron/folate supplements, dietary diversity, frequency of consumption of iron and folate rich foods, frequency of antenatal care attendance and nutritional status (mid-upper arm circumference). Key informant interviews were conducted among four health care workers from the district hospital, and a focus group discussion among mothers with infants (< 6 months) at the community level, to collect in-depth data on the iron/folate supplementation program. Data were analyzed using statistical package for social sciences. Descriptive statistics (frequency, percentages and mean) including graphs and tables were used to analyze demographic, socio-economic, frequency of food consumption and mid-upper arm circumference data. Impact of variables on non-adherence was estimated using logistical regression analyses. One sample t- test was used to compare differences in weight gain and mid-upper arm circumference, while relationships between categorical data were analyzed using the Chi-square. Adherence rate (defined as use of supplements for ≥4 days in a week) was 24.5%. Positive significant associations were found between adherence and place of residence (X2=6.77, p=0.009), pregnancy trimester (X2= 7.86, p=0.01), history of low hemoglobin level in current pregnancy (X2=16.45, p=0.00), Hb level at first ANC visit (X2=14.3, p=0.00), knowledge on anemia (X2=9.89, p=0.00) and number of antenatal clinic visits (X2=17.56, p=0.00). No associations were found between adherence and age (p= 0.64), education level (p= 0.41), marital status (p= 0.08), household size (p=0.11), proportion of income spent on food (p=0.91) and number of previous pregnancies (p=0.63). Logistical regression analysis showed awareness on anemia and place of residence as predictors to adherence based on the Wald criterion. Studies have generally shown a lack of awareness on anemia among pregnant women and that when consumers are informed, the compliance rate for taking iron tablets increases. In conclusion adherence rate to iron/folate supplements is low among pregnant women attending antenatal clinic at Thika district hospital. Factors positively significantly associated with adherence include: place of residence, gestational age, history of low hemoglobin level in current pregnancy, knowledge on anemia and number of ante natal care visits by pregnant woman. Recommendations are: sensitization of pregnant women by health professionals on the need to continuously take supplements throughout pregnancy, provision of health education to pregnant women on anemia and importance of visiting antenatal clinic at least four times during the pregnancy period, and establishment of mobile clinics to increase access to antenatal care.