Knowledge, attitudes and practices regarding iron-folic acid (IFA) supplementation in pregnancy: A case study of ANC clients attending KCCA health centres, Kampala
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Introduction: About 41.8% of pregnant women worldwide are anemic; half of this anaemia burden is due to iron deficiency. Developing countries are the most affected and in Uganda, 31% of the pregnant women have iron deficiency anemia. Maternal Folate deficiency is one of the maternal risk factors for neural tube defects (NTDs) and preconceptional folate deficiency contributes to about 300,000 new cases of NTDs each year globally resulting in about 41, 000 deaths (Blencowe et al., 2010). The Ministry of Health recommends a daily intake of sixty (60) mg of Iron and 400 µg of Folic acid supplementation for all women during pregnancy and a daily 400 µg of folate a month prior conception. However, only 4 % and 9% of pregnant women in Uganda and Kampala respectively are taking the Iron/Folic Acid supplements (IFAS) for the recommended 90+ days. Preconceptional supplementation of folic acid has been shown to decrease the occurrence of NTDs, apart from preventing anaemia. Daily oral IFAS is recommended as part of the antenatal care to reduce the risk of low birth weight, maternal anaemia and iron deficiency Knowledge and beliefs are known to influence up-take of health interventions by women, therefore the women‘s knowledge and attitude towards Iron/Folic Acid supplementation (IFAS) may be useful for increasing iron supplement use. In Uganda, little is known about the pregnant women‘s knowledge, attitude and practices regarding iron and folic acid supplementation. Objective: This study intended to establish the knowledge, attitudes, and practices regarding IFAS among pregnant women attending antenatal care in Kampala. Methods: A health facility based cross-sectional study was conducted in the six (6) KCCA health centers. Respondents (pregnant women) seeking antenatal care (ANC) services were selected by systematic random sampling. Data on socio-demographic characteristics, knowledge, attitudes and practices regarding IFAS was collected using an interviewer administered and structured questionnaire. Qualitative data was collected by conducting key informant interviews with health workers. Quantitative data was entered into EpiDATA and analyzed using STATA 12. Qualitative data was analyzed manually by content analysis based on condensation and abstraction of main themes. Results Out of 423 participants,343 (81.1%) had ever heard about IFAS, 80.6% had been taking IFA supplements, Only 19.4% knew that folic acid supplementation should begin at preconception and preconception-use of folic acid was very low (16.5%). Those with adequate knowledge were 68.9%, 68.3 % had a positive attitude and 79.2% had good practices. Women with adequate knowledge were more likely to have positive attitudes and good practices regarding IFAS with adjusted odds ratios of 4.18; 95%CI 4.18(2.566.83) and 3.86; 95%CI 3.86(2.37-6.30) respectively. Graduates were 5.6times more likely to be knowledgeable than those with no formal education (AOR 5.6; 95%CI 1.4 – 22.3). Respondents who made 3 ANC visits were 2.41 times more likely to be knowledgeable than those who had attended only once (AOR 2.41; 95% CI 1.23 – 4.72). Married women were 1.8 times more likely to have adequate knowledge regarding IFAS compared to the single (AOR 1.8; 95% CI 1.1 – 3.0). Conclusion and recommendation Relatively a good number of pregnant women attending ANC in KCCA health centers had adequate knowledge, a positive attitude and good practices regarding IFAS. However, only a few were aware of the importance of preconceptional use of FA and their actual preconceptional use of FA was very low which calls for health workers focus on informing all women of reproductive age about the importance of FA (prevention of NTDs) and encouraging its preconceptional use. Stock-out was the major reason why mothers stopped taking IFAS, implying that more efforts are needed to ensure access to IFAS for pregnant women. Completing at least the secondary level of education was a strong predictor of both IFAS knowledge and practice. Being married, attending more than two ANC visits were strong predictors for adequate knowledge, positive attitude and good practices regarding IFAS. Adequate IFAS knowledge among pregnant women has a positive impact on the attitude and general practice regarding IFAS which provides strong support for the fact that encouraging mothers to attend antenatal care and increasing IFAS awareness promotes its use. The implication of this study is that understanding the pregnant women‘s knowledge, local beliefs, attitudes and practice regarding IFAS is needed to design more effective methods of health education for pregnant women and to provide maternal services or programs with IFAS as component.