Determinants of adherence to iron-folic acid supplementation during pregnancy among mothers seeking Maternal and Child Healthcare 0-6 months post-delivery at Kakamega County Referral Hospital

Abstract

Maternal anaemia is a significant contributor to pregnancy-related mortalities worldwide, and its aetiology has been linked to iron deficiency. To meet the increased nutritional demand in pregnancy, supplementation of iron and folic acid is vital. The supplements are provided freely to pregnant women during antenatal visits at public health facilities but their uptake in Kenya remain unacceptably low. We sought to identify the prevalence of self-reported Iron and Folic Acid supplementation (IFAs) adherence during pregnancy and its determinants among mothers seeking Maternal and Child Healthcare (MCH) 0-6 months post-delivery at Kakamega county hospital. To achieve this, an institution based cross-sectional study incorporating a mixed-method study design was conducted between May to August 2020. Both qualitative and quantitative data were collected. Quantitative data were collected through face-to-face interviews with eligible mothers of 0-6 months post-delivery using semi-structured questionnaires. Qualitative data were obtained through Key Informant Interviews (KIIs) with Community Health Volunteers (CHVs) and healthcare providers. During data collection, a systematic random sampling technique was used, and a total of 241 mothers of 0-6 months post-delivery were interviewed. The qualitative data collected were transcribed in Microsoft word 2016 and organized into themes using NVIVO 12. The quantitative data were analyzed using R statistical software version 3.5.2. The findings of the descriptive analysis, Chi-square tests and logistic regression were presented through tables and figures. Inferences were made at a 95% Confidence Interval (CI). The results showed a moderate adherence to IFAs (60.6%) during pregnancy among mothers seeking MCH at Kakamega county hospital. Some of the reasons for non-adherence stated by the respondents included: IFAs related side effects (41.3%), forgetfulness (37.3%) and bad smell of the supplements (10.3%). Higher IFAs adherence was noted among the primigravida participants (OR=2.704; 95% CI: 1.262, 5.793; p=0.010) compared to multigravida participants and those with a higher knowledge level of anaemia (OR=3.215; 95% CI: 1.346, 7.68; p=0.009) compared to their counterparts of low anaemia knowledge. Health system-related factors found to influence IFAs compliance positively were: having had pregnancy counselling before conception (OR=2.086, 95% CI: 1.071, 4.255; p<0.01) and having received education on IFAs during ANC visits (OR=2.372, 95% CI: 1.109, 5.218; p=0.028). Also, KIIs with CHVs linked IFAs adherence to socio-cultural factors such as strong religious beliefs, misconceptions and old age pregnancies. The study concluded that there is a moderate adherence to IFAs during pregnancy among mothers seeking MCH at Kakamega county hospital. The greatest impediments of IFAs compliance during pregnancy are IFAs related side effects, forgetfulness, and the bad smell of the IFAs tablets. We recommend that the MCH department of Kakamega county hospital intensify counselling on IFAs among all the mothers seeking ANC, especially on home-based remedies of IFAs related side effects. Supposedly, little incentives such as issuing a card or certificate to mothers who complete more than 4 ANC visits could boost ANC adherence.