Prevalence and Factors Associated with Non-Adherence to Iron and Folic Acid Supplementation among Women for Antenatal Care at Mwembeladu Hospital, Zanzibar

Background: Daily iron and folic acid supplementation (IFAS) during pregnancy reduces the risk of all types of maternal anaemia and iron deficiency anaemia at term; despite the WHO recommendations, pregnant women are still vulnerable because the use of Iron and Folic Acid Supplementation is still low in many countries including Tanzania. Therefore, the study aims to comprehensively understand the prevalence and factors associated with non-adherence to Iron and Folic Acid Supplementation among pregnant women attending Antenatal Care at Mwembeladu Hospital. Achieving this objective will contribute to developing effective strategies to improve IFAS adherence.

Methodology: The study was cross-sectional and ANC-based, using questionnaires. Questionnaires were distributed to the 260 pregnant women attending ANC at Mwembeladu Hospital. Data were analyzed using SPSS computer software version 22.

Results: Our study showed that 52.7% had more than 4 ANC visits. Based on self-reported adherence, about (61.9%) of pregnant women were taking IFAS supplementation, and (38.1%) were not taking IFAS completely. Among those taking IFAS, (60.2%) out of 161 pregnant women were taking four tablets per week as recommended by WHO, and (39.8%) out of 161 were not following the WHO recommendations. Therefore, out of 260, zero adherence was 38.1%, poor adherence was 24.6%, and good adherence was 37.3%. Hence, 62.7% were non-adherent to IFAS supplementation as recommended by WHO. Also, the result showed that the major factors militating against pregnant women taking IFAS are lack of knowledge of IFAS (22.1%), side effects of IFAS (19%), forgetfulness (18.4%), and lack of understanding of anaemia (12.3%).

Conclusion: Overall, the adherence to IFAS among pregnant women was low and did not meet the WHO recommendations for preventing and treating anaemia during pregnancy. Socio-demographic factors, including occupation and education level, maternal characteristics, parity, and gestation age, are not significantly associated with adherence to IFAS. Factors associated with poor adherence to IFAS include side effects, failure to access IFAS, forgetfulness, and knowledge about anaemia and IFAS. Healthcare facilities and providers should strengthen the system to create community awareness of IFAS, its benefits, and side effects, as this will help increase adherence to IFAS among pregnant women.