Iron and folic acid supplementation and malaria risk Relation between severe malaria morbidity in children and level of Plasmodium. Objective: To assess whether iron and folic acid supplementation reduce the risk . The relationship between the duration of use of the supplements and the risk. At least half of this anaemia burden is assumed to be due to iron deficiency. Pregnant women require additional iron and folic acid to meet their.
For example, if the mother interrupts the tablet after doctors counseling, she may also advised by other mothers or those who already gave birth in the near months about the side effects and its importance. This is a very nice thing. But, these tablets have side effects which may lead the woman to stop taking it. So, if possible, the government takes an assignment to change or to provide another kind of tablets like prenatal, which are a proven lesser side effect tablets compared to this supplement, either free of charge or in relatively cheap cost.
In addition, despite the challenges, side effects they have, women sacrifice for all better and good out come and healthy baby. Discussion The aim of this study was to determine the rates of adherence and identify factors associated with IFA supplementation among ANC attending pregnant women in Mizan-Aman health facilities, Ethiopia, This study found that the self-report adherence rate of the pregnant women in Mizan-Aman health facilities was The result is higher compared with most of other studies done in Ethiopia.
It is greater than the studies done in Mecha district, western Amhara, The probable reason may be the difference in geographic locations and time gap between studies, differences in awareness of pregnant women about IFA supplementation and educational status and inaccessibility of health institutions.
It is still greater than studies done abroad. The study done in Pakistan, India, Cairo, Kenya [ 16264142 ] also showed us lower adherence level to IFA supplement compared to this study respectively. However the adherence rate among women in this study was lower compared to studies done in Khartoum, Sudan which was In addition, low attention to adherence issue due to lack of information regarding the severity and magnitude of the problem and poor follow up of the program in this study area may be the other reason for this difference.
Adherence may be enhanced by a number of factors. In this study, three most mentioned factors shown to have a significant association with the Adherence was health care providers strong counseling about IFA supplementation counseling on benefit of taking IFA supplements, How frequently and for how long shall the IFA supplement be taken, the side effects of IFA…increasing blood volume of the pregnant mother if taken with regular bases and fear of illnesses if IFA supplement misses on a daily base.
This was supported by findings from the qualitative study as a 26 year midwife described. During their first visit, we were able to tell them why the IFA will be given, for how long and the harms if they do not take the medicine.
This might be due to the gestational stage of study subjects. In this study, women who had higher knowledge of anaemia were two times more likely to be adhered compared to those who had low knowledge of anaemia AOR: The probable reason could be knowledge helps women to have a good perception of benefits of taking IFA supplements. Similar results were reported in Mecha district, Western Amhara, in which women with good knowledge of anaemia were more likely to be more compliant AOR: This result is complemented by qualitative study, which was mentioned by 30 year pregnant mother.
I was found an anemic during the first three four months. It means that I lacked some amount of blood since I shared it with the fetus. Its symptom was dizziness, headache and generalized weakness.
It was prevented by taking fluids and iron folic acid tablets so, knowing this little information about anaemia leads me to take all tablets without interruption. The possible reason behind this is the fact that family encouragement to take IFA supplement is best described by reminding her when she is forgetting to take the supplement that is very useful to increase blood volume during pregnancy period since this two factors are best of the prominent reasons mentioned as the reasons of non-adherence and adherence, respectively.
Because of this and my eagerness to finish it, it is only two tablets to complete the full dose. This result were inconsistent with studies conducted in Northern zone of Tigray and Lucknow, India in which adherence was better observed among pregnant women who were early registered for antenatal care service as compared to late registered women in which pregnant women who were early registered for antenatal care service were about 1. A number of factors may influence adherence.
Two most cited factors that negatively influenced adherence to IFA supplement was forgetfulness and experiencing side effects. Or it may be due to lack of knowledge on the advantage of the tablet.
And at the end of delivery she throws it. Definitely this was from lack of knowledge especially not understanding the advantages and disadvantages of the tablets. This result was greater than studies done in Nigeria, Senegal and Goba woreda which accounts But, it was lesser than studies done in eight rural districts in Ethiopia and Mecha distric, Western Amhara which accounts This result is greater than studies done in Senegal, Nigeria, eight rural districts of Ethiopia and Goba woreda which accounts 17, 15, In this study, adherence rate was lesser observed among pregnant women who had medical illnesses during their pregnancy time as compared to those pregnant women who had no medical illness in which pregnant women who had medical illness during the pregnancy period were about The probable reason for this is may be there had been a pill burden impact on those pregnant women who had any medical illnesses during pregnancy period compared to healthy pregnant women.
This is may be due to the effect of side effects on Adherence may be explained in terms of physical, mental and social discomforts as it is explained by nausea and vomitinggastritis, diarrhea, constipation and heart burn.
Strength and Limitation of the Study Strengths of the study Among the notable strengths of this study were that adequate sample size and better to avoid recall biased and more over this study has tried to complement the quantitative data by a qualitative method.
So the implementation of mixed method could be the strong side of the study. In addition to this, pre-test of questionnaire done in health centers other than the study unit, training of data collectors and sampling techniques employed were also the strength of the study.
Limitations of the study Among the limitations of the study is that information on adherence rate was from self-report of taking tablets. Therefore, we could not reject the possibility of reporting pregnant women who did not actually ingest the tablets.
Conclusion Generally, adherence rate of IFA supplementation riches Even though it is higher than other studies in different places of the country, still there is a need to progress a lot. This study also highlighted a number of important findings.
Having satisfactory knowledge on Anaemia, having encouragement from family member, and strong counseling about benefits of IFA supplement were statistically significant independent positive predictors for maternal adherence to IFA supplementation.
In other way, early registration for Anti Natal Care, experiencing medical illnesses during pregnancy period and experiencing side effects for IFA supplements were statistically significant independent negative predictors for maternal adherence to IFA supplementation.
There were also important factors which play a great role for adherence of IFA supplement. Recommendation With respect to the findings and objectives of the study, some recommendations have been made at different levels.
Government level The government plays a greater role on capacity building and provisions of IFA supplement. Moreover, the provision of supplements should be proven lesser side effects in different forms.
Especially syrups should be available in all health sectors to improve the uptake of IFA supplements. Community level For communities, at different level, awareness creation about IFA supplementation and media coverage should able to support the utilization of IFA supplement. Discussions with women who gave birth previously and families at home should be encouraged.
Special attentions should be given for any techniques that help the women to remind on daily bases on full courses of the utilization period. Facility level Providers should counsel pregnant women on IFA supplement benefit, risks if they miss the tablet and for how long they utilize it.
Professionals have a huge gap on IFA supplement especially on periods of start and for how long they provide it. This should be improved by referring the manuals and guidelines on micronutrient supplementation.
Moreover, they should communicate with senior staffs and personnel who had a better experience on this area. It has been found that those who need the supplements most, comply the least [ 26 ].
Many factors have been reported to affect IFAS compliance, notably health sector and client related issues, affecting and causing a lack of demand from both health sector and clients [ 27 ]. Specifically these factors include: Other barriers include inadequate distribution of IFAS, beliefs against consuming medications during pregnancy, and fears that taking too much iron may cause too much blood or a big baby, making delivery difficult.
It is noteworthy to mention that concern for maternal and fetal health positively influence taking IFAS [ 30 ] similar to improved maternal physical well-being and enhanced appetite with the alleviation of symptoms of anaemia, particularly fatigue [ 33 ]. There is need to scale up interventions to address this poor compliance. Further, combination of low dose iron and folic acid into one tablet was done to reduce pill burden thus increase compliance.
Therefore, there is urgent need to address the factors affecting compliance and develop innovative strategies to mitigate them to increase IFAS coverage and eventually, substantially reduce the burden of pregnancy-related anaemia for improved maternal and child outcome. There is however, scarce information on the reasons for persistently low compliance with IFAS in Kenya. We sought therefore to determine the compliance status of pregnant women with IFAS and factors influencing their compliance.
One Sub-County and five of its public health facilities were sampled.
Study population and sampling Two-stage cluster sampling was used to identify one sub-county and five public health facilities. The two stages included selection of a sub-county and the health facilities. The sampling frame constituted of all the sub-counties in Kiambu County. Sample size determination The sample size was determined to establish prevalence of IFAS compliance, assuming the prevalence was The minimum sample size was therefore The study achieved a sample size of which is Data collection methods A structured, interviewer-administered questionnaire consisting of 33 closed-ended questions categorized into; socio-demographic data 12maternal knowledge 9 and current practices towards IFAS 12was developed, pretested and used in this study.
The questions which were tested and re-tested included: Since all the questions repeated had a kappa value of above 0.
To ensure validity, the tool was shared and discussed with experts from the Ministry of Health, division of nutrition, and the study supervisors. The obtained feedback was used to refine the tool. The questionnaires were administered by trained research assistants to all pregnant women who met the inclusion criteria and consented to the study. Pregnant women had no prior information before the interview regarding being assessed on compliance with IFAS because pre-testing had been carried out in a different sub-County.
Conversely the respondents who took less than five IFAS tablets were considered as non-compliant. The compliance level was disaggregated to show the aforesaid categories of compliance. The independent variables included socio demographic characteristics age, education and occupation of the pregnant motherhealth care related factors IFAS advice, parity, gravidity and gestation and knowledge on IFAS.
A generalized linear model with a Poisson distribution and a log link was used to account for clustering.
This model was preferred over logistic regression as it generates more precise and accurate prevalence ratios and confidence levels. Approval to conduct the study was also obtained from Kiambu County, Lari Sub-county authorities and all the health facilities involved.
Participation in the study was purely voluntary. The study participants provided verbal and written informed consent before commencement of the interview. Results Socio-demographic characteristics of study participants A total of pregnant women participated in the study. The mean age of the study participants was