Factors Influencing Utilization of Iron and Folic Acid Supplementation Services among Women Attending Antenatal Clinic at Nyeri Provincial Hospital Kenya

Abstract

Iron deficiency is the most common nutritional cause of anaemia and has been associated with poor pregnancy outcome. On the other hand, lack of adequate folate intake prior to conception and during the early weeks of pregnancy increases the risk of the development of neural tube defects. In Kenya all pregnant women are targeted for free folic acid and iron supplementation. However, information about whether folic acid and iron supplements are actually used by the women is not available, and there is concern that women would not take them because of perceived side effects, particularly of iron supplements. This study aimed at determining factors associated with utilization of iron and folic acid supplementation services and the prevalence of anaemia among pregnant women attending antenatal clinic at Nyeri Provincial General Hospital. A cross sectional study was conducted among pregnant women selected through systematic random sampling. A semi-structured questionnaire was administered to collect information on receipt and use of supplements where high compliance to supplementation was defined as using each of the supplements for more than four days in a week. After administration of the questionnaire, haemoglobin level was determined directly from capillary blood via finger pricks and measured using a portable HemoCue B-Hb photometer. Of the 381 women interviewed, 51.2% and 69.3% reported being given iron and folic acid supplements respectively. Less than half 44.6 % and 58% reported receiving information on iron and folic acid respectively. Of the women who received supplements, 67.7% reported being initiated on iron supplements after 16 weeks gestation while 80.7% reported being initiated on folic acid supplements after 12 weeks. The most frequently xviii cited reason by the women for not taking the supplements was not receiving supplies of iron (89.4%) and folic acid (81.3%) supplements during ANC visits. Among those who reported receiving iron and folic acid supplements, 80.5% and 82.2% reported high compliance respectively.The prevalence of anaemia was 7.8%. The mean haemoglobin level was 12.6±1.2 g/dl. In multivariate analysis the only factor that was significantly associated with compliance to iron supplements (p=0.05) was to protect oneself from anaemia (OR=12.20). While factors significantly associated with compliance to folic acid supplementation (P=0.05) were: in order to improve general health (OR=20.82), because the health worker advised to take folic acid supplements (OR=56.02) and to protect oneself from anaemia (OR=14.10). Improvement in supplies of the supplements, sensitization and training of health workers to give information while delivering supplementation services and sensitization of community members