Better-Educated, Older, or Unmarried Pregnant Women Comply Less with Iron–Folic Acid Supplementation in Southern Ethiopia

Abstract

Daily iron supplementation, with or without folic acid, is a proven public health intervention. Although maintaining compliance is crucial for the success of the intervention, inconsistent findings are available on compliance and its predictors in Ethiopia. The aim of this study was to estimate the iron–folic acid (IFA) supplementation compliance rate and its predictors among pregnant women in Wolaita Zone, Southern Ethiopia. A cross-sectional study was conducted in eight randomly selected health centers in Wolaita, Southern Ethiopia. A total of 647 pregnant women were included using multistage sampling procedure. Data were entered into Epi Info (a free statistical analysis software) and exported to SPSS. Bivariate relationship was explored through correlation coefficients. A multiple linear regression model was constructed to estimate the variability coefficient of the compliance rate due to selected factors. Of 647 pregnant women, only 18 (2.8%) pregnant women had received the supplement for 90 days or more. Overall, the compliance rate was 73.2% (95% CI, 70.72 to 75.79). Experiencing heartburn and vomiting significantly reduced the compliance rate. Unintended pregnancy and better education were negatively associated with compliance. By contrast, acceptability of IFA supplement, number of antenatal care (ANC) visits, and being ever married were positive predictors. On average, a pregnant woman did not take more than one-fourth of the daily IFA supplementation. During ANC visits, addressing the issues of side effects, unintended pregnancy, and acceptability of the supplement may improve compliance rate. Overall in Ethiopia, educated, older, and unmarried Ethiopian women need additional attention for successful compliance.

Keywords:

• compliance
• Ethiopia
• iron–folate supplementation
• pregnant women
• side effects

Acknowledgments

The authors acknowledge the study participants in the study area.

Declaration of interest

The authors declare no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding

The funding for data collection was obtained from Wolaita Sodo University. However, the funder does not have a role in design, analysis, interpretation of data, and writing the manuscript.

Additional information

About the authors

Canaan Negash Seifu, MSc, School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia. Research interests: maternal and child health and nutrition, child malnutrition

Susan J. Whiting, PhD, Professor, College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada. Research interests: vitamins, minerals, maternal and child nutrition

Tewodros Getachew Hailemariam, School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia. Research interests: social and demographic determinants of health, HIV, women’s health, and child health