School of Public Health (Public-Health)

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Browsing School of Public Health (Public-Health) by Author "Abiika, Angella."
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    Iron and folic acid supplementation adherence and its associated factors among pregnant women attending antenatal care at selected health facilities in Kawempe Division- Kampala, Uganda
    (Makerere University, 2025) Abiika, Angella.
    Iron and folic acid supplementation (IFAS) is essential for preventing maternal anemia and improving birth outcomes, yet adherence among pregnant women remains low, posing risks to maternal and neonatal health. This study focused on assessing adherence to IFAS and its influencing factors among pregnant women attending ANC at selectedhealth center facilities in Kawempe Division, Kampala, Uganda. This was a mixed methods approach that employed both qualitative and quantitative methods. These methods employed a cross-sectional study conducted at selectedhealth facilities in Kawempe Division. These included Kawempe community Hospital, Komamboga Health Center I11, St. Stephen Mpererwe hospital and Kyadondo Health Center. A total of 427 pregnant women attending ANC were included in the study. Adherence to IFAS was measured as the consumption of at least 90% of prescribed supplements over the previous week. Bivariate and multivariable analyses were used to identify factors associated with adherence using a Modified Poisson regression model with robust standard errors in STATA 14. Qualitative data was collected through six focus group discussions (FGDs) with purposively selected pregnant women. Additionally, eight key informant interviews were conducted with health workers who were selected due to their expertise in delivering IFAS services. Qualitative data interview transcripts were analyzed using Open Code software version 14.02 while thematic analysis approach was employed to identify health workers’ insights on the factors influencing adherence to iron and folic acid supplementation. Findings were triangulated for a comprehensive understanding of adherence and its determinants. The overall adherence rate to IFAS was 72.83%, with 27.17% of participants reporting non-adherence. Factors significantly associated with adherence included cohabiting marital status, 0.79 (95% CI: 0.666-0.947, p = 0.01) and receiving medical or nutritional education 1.3 (95% CI: 1.225-1.383, p < 0.001) during ANC visits. Women with university degrees were more likely to adhere (40.4%). FGDs with first-time and experienced mothers revealed mixed understandings of anemia; while experienced mothers recognized it as a blood deficiency, first-time mothers often misattributed its cause of not taking adequate water. Across all groups, IFAS was generally valued for preventing miscarriages and aiding fetal development, yet side effects like nausea, vomiting and dizziness, forgetfulness, and inconsistent supplement availability hindered adherence. Cultural misconceptions, such as fears of large babies from IFAS, further complicated acceptance. Support from family members improved adherence, with many women encouraged by relatives to take supplements. KIIs with health workers emphasized the importance of IFAS for fetal development, especially in early pregnancy. However, frequent stock-outs, side effects, and patient forgetfulness were seen as persistent barriers. Health workers noted an increase in IFAS adherence due to routine education, although mild anemia remains prevalent, potentially indicating lapses in supplement intake. The adherence rate to IFAS among pregnant women in Kawempe Division were relatively high compare to the low adherence prevalence rate of 23% (UDHS report ,2016) , though gaps remain. Education, family support, and health worker engagement during ANC visits were key facilitators of adherence. However, stock outs, side effects and misinformation were significant barriers. There is still a need for targeted interventions to enhance patient-centered health education and address supply chain challenges and clearer guidelines to support effective IFAS utilization and address maternal anemia. Strengthen health education and address supply issues to improve IFAS adherence, especially targeting women from lower socio-economic backgrounds and those with limited health literacy.