Compliance and its Determinants Regarding Iron and Folic Acid Supplementation among Pregnant Women Attending Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal

Abstract

Background: Like other developing countries, prevalence of anemia among pregnant women in Nepal is considerably high at 48%, as per the Nepal Demographic Health Survey (NDHS) 2011. The most important cause of anemia during pregnancy is an insufficient intake of iron and folic acid in the diet. In 2001, the coverage of IFA in Nepal was only 23% and compliance was negligible. The main constraints were identified to be lack of awareness of the importance of preventing and treating anemia and access to IFA tablets at community level. Methods: The study was a descriptive survey among pregnant women in Kathmandu, Nepal. Systematic random sampling was done to pick out a total of 406 samples. Depending upon their literacy, each sample was either interviewed or handed the questionnaire for self-administration. Results: The mean age of the respondents was 24.57 (SD = 4.622 95%CI 24.12, 25.02) and a majority of them were between the age of 18 to 25 (64.9%). Out of all the respondents, 80.3% had attended school, out of which, a majority (84.7%) had studied up to and beyond School Leaving Certificate level. Even though the literacy rate was high, 56% of the pregnant women had insufficient knowledge regarding anemia, iron deficiency and iron and folic acid supplementation. 297 (73.2%) of the respondents were found to have high compliance to the iron and folic acid supplementation, while 52 (12.8%) and 57 (14%) were found to have moderate and low compliance respectively. On running Chi square analysis, “Ethnicity”, “Attended school”, “Level of knowledge”, “Perceived severity”, “Perceived susceptibility”, “Perceived barriers”, “Perceived benefits” and “Social support” were found to have significant association (p<0.05) with the level of compliance. On carrying out multiple linear regression analysis, it was found that the level of compliance was most affected by “Perceived severity”, “Perceived barriers” and “Social support” of the respondents.

Conclusions: This study infers that there is a lack of knowledge on anemia and iron supplementation, and even though the majority showed high compliance; there were still significant numbers of moderate and low compliers. There is a need to further improve compliance to iron and folic acid supplementation among pregnant women by highlighting the severity of the disease, minimizing the barriers, and enhancing family and healthcare providers’ support. Keywords: anaemia; compliance; determinants; pregnant women; iron and folic acid supplementation.