Magnitude and determinants of adherence to iron and folic acid supplementation among pregnant women in Katavi region 2022

Abstract

ABSTRACT Background: The most frequent causes of anaemia in pregnant women in sub-Saharan Africa are iron and folic acid deficiencies. Iron and folic acid deficiency anaemia harm both mother and child health. Tanzania adopted the World Health Organization's (2012) recommendation of daily Iron and folic acid supplementation(IFAS) as a key intervention to reduce the risk of maternal anaemia, and congenital malformations. However, its adherence is still low (20.3%) thus not conferring the expected benefits. However, adherence may have been changing over time but there are no reported sources/studies over the last five years, particularly for Katavi. The study aimed to determine the magnitude and assess the factors associated with IFAS adherence among pregnant women in the Katavi region for 2022. Methodology: A cross-sectional hospital-based study was conducted on pregnant women in the Katavi region in 2022. A mixed methods approach was used to comprehensively understand the research question due to the obtained numerical data and the provided insights into context, motivations, and perceptions. Katavi region was selected purposively based on its low performance for the TDHS-2015/2016, which provided ongoing government interventions in the region. Data were collected from 396 pregnant women consecutively using an interviewer-administered questionnaire. Quantitative data was entered in MS Excel, cleaned, and exported to STATA 15.1 for analysis. Bivariate and multivariate negative binomial regressions were employed to identify the influencing factors. Four focus group discussions and key informant interviews were conducted for the qualitative component. Qualitative data was transcribed into English, and coded, and themes identified were analyzed manually in Microsoft Word and triangulated with quantitative findings. Results: A total of 396 pregnant women were interviewed. The Median age of the respondents was 27 (IQR=21-34) years. Adherence to IFAS was found to be 30.1%; 95% CI = 2.75- 11.79. Self-employed [aPR=1.6, 95% CI=1.02-2.42], Prime gravida [aPR=1.7, 95% CI = 1.20-2.50], number of ANC visits above four [aPR=20.7, 95% CI = 7.73-55.20], good knowledge of IFAS [aPR=1.5, 95% CI = 1.13-1.95], good anaemia knowledge [aPR=1.7, 95% CI = 1.17-2.59] were factors associated with adherence to IFAS. The qualitative study found that side effects, forgetfulness, and inadequate stocks of IFAS at health facilities are reasons for non-adherence. Conclusion: Iron and folic acid adherence is still low in the Katavi region. This study has identified self-employed, gravidity, the number of ANC visits attended, and knowledge of IFAS and anaemia as factors associated with adherence. This emphasizes the need for targeted interventions that consider occupational, educational, and healthcare access elements to improve iron and folic acid adherence among pregnant women.