Exploring adherence to iron and folic acid supplementation in pregnant women at rural health facilities in Waghimra zone, Northern Ethiopia.

BACKGROUND: Iron deficiency anemia is a prevalent condition during pregnancy, particularly in resource-limited areas, and is associated with negative fetal and maternal outcomes. A key strategy to prevent anemia during pregnancy involves ensuring adequate iron and folic acid supplementation (IFAS), diversifying the diet, deworming and infections control, such as malaria. This study aimed to assess the extent to which pregnant women at rural health facilities adhere to IFAS and to identify the factors contributing to this adherence. METHODS: A multi-center cross-sectional study was conducted from February to June 2024 at rural health facilities in Ethiopia. Systematic random sampling was used to recruit study participants, and data were collected through semi-structured questionnaires, client interviews, and document reviews. The data were entered into Epi-Data 4 and then exported to STATA-16 for analysis. To explore the association between outcome and independent variables, both bi-variable and multivariable logistic regression models were applied. After performing multivariable regression, variables with a p-value < 0.05 were considered statistically significant. RESULTS: Four hundred and six pregnant women were study participants. The mean age of the pregnant women was 27.9 years (SD ± 7.1). Adherence to IFAS was 45.1% [95% CI: 40.3-49.9%]. Counseling on the importance of IFAS (AOR = 2.29; 95% CI: 1.21-4.34), number of antenatal care (ANC) contacts (AOR = 3.50; 95% CI: 1.54-7.92), good knowledge of IFAS (AOR = 4.22; 95% CI: 2.43-7.31), and anemia (AOR = 3.07; 95% CI: 1.36-6.89) were associated factors. CONCLUSIONS: The adherence of pregnant women to IFAS was very low compared to the world health organization recommendation (45% vs. > 80%). Counseling regarding the importance of IFAS, the number of ANC contacts, good knowledge of IFAS, and anemia status were independent predictors. Creating awareness about IFAS, providing counseling during ANC contacts, and strengthening the monitoring and evaluation system are all critically important.