MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES

MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES.

DEPARTMENT OF COMMUNITY NURSING
BACHELOR OF SCIENCE IN NURSING.

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RESEARCH PROPOSAL
NAME: MHUHI PASCHAL IZACK
REG NO; 2015-04-08708
SUPERVISOR; RASHID HERI
COORDINATOR; DR.ANNE OUTWATER
FACTORS ASSOCIATED WITH ADHERENCE TO FERROUS SULPHATE/FOLIC ACID SUPPLEMENTATION AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINIC AT MNAZI MMOJA RCH IN ILALA DISTRICT.

CHAPTER ONE: INTRODUCTION
Background
Anemia is global public health problem affecting two billion people worldwide. Almost all preschool, pregnant women, and close to one third of non-pregnant women are anemic worldwide. Africa has the largest number of women with anemia next to south and southest Asia.

Folate is the general term for a water soluble B vitamin naturally found in food such as leafy vegetables, legumes, egg yolks, liver and some citrus fruits. Folic acid is commonly added to fortified foods and found in supplements. The bioavailability of naturally occurring folate is less than that of folic acid.
This vitamin is essential for normal cell growth and replication. Folate and vitamin B12 deficiency acknowledged as the most common cause of macrocytic anemia; inadequate maternal folate status has been linked to abruption of placenta, pre- eclampisia,spontaneous abortion, still birth, and serious congenital anomalies of the brain and spine such as neural tube defects(NTDs).ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.1100/tsw.2010.188″,”ISBN”:”1537-744X (Electronic)\r1537-744X (Linking)”,”ISSN”:”1537744X”,”PMID”:”20890579″,”abstract”:”<p>Vitamin A deficiency (VAD) is a huge public health burden among preschool-aged children in sub-Saharan Africa, and is associated with a high level of susceptibility to infectious diseases and pediatric blindness. We examined the Nigerian national vitamin A capsule (VAC) supplementation program, a short-term cost-effective intervention for prevention of VAD-associated morbidity for equity in terms of socioeconomic and geographic coverage. Using the most current, nationally representative data from the 2008 Nigerian Demographic and Health Survey, we applied multilevel regression analysis on 19,555 children nested within 888 communities across the six regions of Nigeria. The results indicate that there was variability in uptake of VAC supplement among the children, which could be attributed to several characteristics at individual, household, and community levels. Individual-level characteristics, such as maternal occupation, were shown to be associated with receipt of VAC supplement. The results also reveal that household wealth status is the only household-level characteristic that is significantly associated with receipt of VAC, while neighborhood socioeconomic disadvantage and geographic location were the community-level characteristics that determined receipt of VAC. The findings from this study have shown that both individual and contextual socioeconomic status, together with geographic location, is important for uptake of VAC. These findings underscore the need to accord the VAC supplementation program the much needed priority with focus on characteristics of neighborhoods (communities), in addition to individual-level characteristics.</p>”,”author”:{“dropping-particle”:””,”family”:”Aremu”,”given”:”Olatunde”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Lawoko”,”given”:”Stephen”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Dalal”,”given”:”Koustuv”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”container-title”:”TheScientificWorldJournal”,”id”:”ITEM-1″,”issued”:{“date-parts”:”2010″},”page”:”1901-1914″,”title”:”Childhood vitamin A capsule supplementation coverage in Nigeria: A multilevel analysis of geographic and socioeconomic inequities”,”type”:”article-journal”,”volume”:”10″},”uris”:”http://www.mendeley.com/documents/?uuid=07b815a1-b504-4d6b-ab84-71df68af8af5″},”mendeley”:{“formattedCitation”:”(Aremu, Lawoko, & Dalal, 2010)”,”plainTextFormattedCitation”:”(Aremu, Lawoko, & Dalal, 2010)”,”previouslyFormattedCitation”:”(Aremu, Lawoko, & Dalal, 2010)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Aremu, Lawoko, & Dalal, 2010)
Both Folic acid and iron deficiency during pregnancy at risk factors for anemia, preterm delivery, low birth weight and this contributes to the poor neonatal health and increased maternal mortality. Studies indicate that mothers who receive antenatal care service will have infants with a reduced risk of neonatal deaths.

Supplementation with folic acid have been shown to reduce risk of for congenital heart defects, cleft lip, limb defects, and urinary tract anomalies. Folic acid deficiency during pregnancy may increase risk for preterm delivery, low birth weight, and intra uterine fetal growth retardation and may increase the homocysteine level in the blood which may which may lead to spontaneous abortion and pregnancy complication such as placenta abruption and pre- eclampsiaADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.1016/j.jtumed.2013.08.002″,”ISSN”:”1658-3612″,”author”:{“dropping-particle”:””,”family”:”Ahmad”,”given”:”Bashaier”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Anam”,”given”:”Nehal”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Khalid”,”given”:”Norah”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Mohsen”,”given”:”Reem”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Zaal”,”given”:”Lena”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Jadidy”,”given”:”Esraa”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Alalati”,”given”:”Somaya”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”container-title”:”Journal of Taibah University Medical Sciences”,”id”:”ITEM-1″,”issue”:”3″,”issued”:{“date-parts”:”2013″},”page”:”199-204″,”publisher”:”Taibah University”,”title”:”Perceptions of women of reproductive age about vitamin and folic acid supplements during pregnancy , Taibah University , Almadinah Almunawwarah , Kingdom of Saudi Arabia”,”type”:”article-journal”,”volume”:”8″},”uris”:”http://www.mendeley.com/documents/?uuid=30e8d976-143a-4f12-8135-735e7fef4798″},”mendeley”:{“formattedCitation”:”(Ahmad et al., 2013)”,”plainTextFormattedCitation”:”(Ahmad et al., 2013)”,”previouslyFormattedCitation”:”(Ahmad et al., 2013)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Ahmad et al., 2013).

One of the major intervention to prevent anemia, folic acid and ferrous sulphate deficiency is ferrous sulphate/ folic acid supplementation. World health organization (WHO) recommends that all pregnant women should receive standard dose of 30-60mg and 400 ug of ferrous sulphate and folic acid during gestation as part of their ANC follow up.

Many countries aim for women to receive 90 or more tablets during pregnancy. However, in area where the prevalence of anemia is high greater than 40%, the supplementation should continue for three months in the postpartum period. Other intervention such as iron food, water fortification, and anti-parasitic treatment are also suggested though their effectiveness is not clear.ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.1371/journal.pone.0169415″,”ISBN”:”1111111111″,”ISSN”:”19326203″,”PMID”:”28129344″,”abstract”:”BACKGROUND Iron deficiency during pregnancy is a risk factor for anemia, preterm delivery, and low birth weight. Iron/Folic Acid supplementation with optimal adherence can effectively prevent anemia in pregnancy. However, studies that address this area of adherence are very limited. Therefore, the current study was conducted to assess the adherence and to identify factors associated with a number of Iron/Folic Acid uptake during pregnancy time among mothers attending antenatal and postnatal care follow up in Akaki kality sub city. METHODS Institutional based cross-sectional study was conducted on a sample of 557 pregnant women attending antenatal and postnatal care service. Systematic random sampling was used to select study subjects. The mothers were interviewed and the collected data was cleaned and entered into Epi Info 3.5.1 and analyzed by R version 3.2.0. Hierarchical Negative Binomial Poisson Regression Model was fitted to identify the factors associated with a number of Iron/Folic Acid uptake. Adjusted Incidence rate ratio (IRR) with 95% confidence interval (CI) was computed to assess the strength and significance of the association. RESULT More than 90% of the mothers were supplemented with at least one Iron/Folic Acid supplement from pill per week during their pregnancy time. Sixty percent of the mothers adhered (took four or more tablets per week) (95%CI, 56%-64.1%). Higher IRR of Iron/Folic Acid supplementation was observed among women: who received health education; which were privately employed; who achieved secondary education; and who believed that Iron/Folic Acid supplements increase blood, whereas mothers who reported a side effect, who were from families with relatively better monthly income, and who took the supplement when sick were more likely to adhere. CONCLUSION Adherence to Iron/Folic Acid supplement during their pregnancy time among mothers attending antenatal and postnatal care was found to be high. Activities that would address the above mentioned factors were highly recommended to ensure the sustainability of mothers’ adherence to the supplement.”,”author”:{“dropping-particle”:””,”family”:”Gebreamlak”,”given”:”Bisratemariam”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Dadi”,”given”:”Abel Fekadu”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Atnafu”,”given”:”Azeb”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”container-title”:”PLoS ONE”,”id”:”ITEM-1″,”issue”:”1″,”issued”:{“date-parts”:”2017″},”page”:”12″,”title”:”High adherence to iron/folic acid supplementation during pregnancy time among antenatal and postnatal care attendant mothers in Governmental Health Centers in Akaki Kality Sub City, Addis Ababa, Ethiopia: Hierarchical negative binomial poisson regression”,”type”:”article-journal”,”volume”:”12″},”uris”:”http://www.mendeley.com/documents/?uuid=9acc0960-b4bd-4982-b610-4e201ae0f40c”},”mendeley”:{“formattedCitation”:”(Gebreamlak, Dadi, ; Atnafu, 2017)”,”plainTextFormattedCitation”:”(Gebreamlak, Dadi, ; Atnafu, 2017)”,”previouslyFormattedCitation”:”(Gebreamlak, Dadi, ; Atnafu, 2017)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Gebreamlak, Dadi, & Atnafu, 2017)
The national guideline for control and prevention of micronutrient deficiencies stated daily iron supplementation for at least 6 months during pregnancy and 3 months postpartum have a significance importance. The national nutrition strategy (NNS) also stated a goal to enrich the number of women receiving iron/folic acid supplementation more than 90 days during pregnancy and postpartum by 50% .On the top of that ,the national nutrition program (NNP) stated as pregnant women should get should routine ferrous sulphate and folic acid supplementation.ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.1371/journal.pone.0169415″,”ISBN”:”1111111111″,”ISSN”:”19326203″,”PMID”:”28129344″,”abstract”:”BACKGROUND Iron deficiency during pregnancy is a risk factor for anemia, preterm delivery, and low birth weight. Iron/Folic Acid supplementation with optimal adherence can effectively prevent anemia in pregnancy. However, studies that address this area of adherence are very limited. Therefore, the current study was conducted to assess the adherence and to identify factors associated with a number of Iron/Folic Acid uptake during pregnancy time among mothers attending antenatal and postnatal care follow up in Akaki kality sub city. METHODS Institutional based cross-sectional study was conducted on a sample of 557 pregnant women attending antenatal and postnatal care service. Systematic random sampling was used to select study subjects. The mothers were interviewed and the collected data was cleaned and entered into Epi Info 3.5.1 and analyzed by R version 3.2.0. Hierarchical Negative Binomial Poisson Regression Model was fitted to identify the factors associated with a number of Iron/Folic Acid uptake. Adjusted Incidence rate ratio (IRR) with 95% confidence interval (CI) was computed to assess the strength and significance of the association. RESULT More than 90% of the mothers were supplemented with at least one Iron/Folic Acid supplement from pill per week during their pregnancy time. Sixty percent of the mothers adhered (took four or more tablets per week) (95%CI, 56%-64.1%). Higher IRR of Iron/Folic Acid supplementation was observed among women: who received health education; which were privately employed; who achieved secondary education; and who believed that Iron/Folic Acid supplements increase blood, whereas mothers who reported a side effect, who were from families with relatively better monthly income, and who took the supplement when sick were more likely to adhere. CONCLUSION Adherence to Iron/Folic Acid supplement during their pregnancy time among mothers attending antenatal and postnatal care was found to be high. Activities that would address the above mentioned factors were highly recommended to ensure the sustainability of mothers’ adherence to the supplement.”,”author”:{“dropping-particle”:””,”family”:”Gebreamlak”,”given”:”Bisratemariam”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Dadi”,”given”:”Abel Fekadu”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Atnafu”,”given”:”Azeb”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”container-title”:”PLoS ONE”,”id”:”ITEM-1″,”issue”:”1″,”issued”:{“date-parts”:”2017″},”page”:”12″,”title”:”High adherence to iron/folic acid supplementation during pregnancy time among antenatal and postnatal care attendant mothers in Governmental Health Centers in Akaki Kality Sub City, Addis Ababa, Ethiopia: Hierarchical negative binomial poisson regression”,”type”:”article-journal”,”volume”:”12″},”uris”:”http://www.mendeley.com/documents/?uuid=9acc0960-b4bd-4982-b610-4e201ae0f40c”},”mendeley”:{“formattedCitation”:”(Gebreamlak et al., 2017)”,”plainTextFormattedCitation”:”(Gebreamlak et al., 2017)”,”previouslyFormattedCitation”:”(Gebreamlak et al., 2017)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Gebreamlak et al., 2017)
Even though ANC is used as a major platform for ferrous sulphate and folic acid supplementation, its coverage nationally only 43% .More than half of pregnant women who were included in a study conducted nationally were not were not have at least one antenatal care visit.

The use of supplement in urban area 27.2% was better than the rural areas 15.2%.Ferrous sulphate and folic acid supplementation is affected by supply related factors and poor adherence for the for the ferrous sulphate/folic acid supplement. Among women who were pregnant in the last five years, less than one percent received and took the ideal minimum number of tablets and had one time ANC visit. Studies on the level of adherence and factors associated were limited in number and showed discrepancy within the area and among different population. Hence this study was conducted to estimate the number of ferrous sulphate and folic acid uptake, the level of adherence and its associated factors among mothers during their antenatal care follow up period.ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.1371/journal.pone.0169415″,”ISBN”:”1111111111″,”ISSN”:”19326203″,”PMID”:”28129344″,”abstract”:”BACKGROUND Iron deficiency during pregnancy is a risk factor for anemia, preterm delivery, and low birth weight. Iron/Folic Acid supplementation with optimal adherence can effectively prevent anemia in pregnancy. However, studies that address this area of adherence are very limited. Therefore, the current study was conducted to assess the adherence and to identify factors associated with a number of Iron/Folic Acid uptake during pregnancy time among mothers attending antenatal and postnatal care follow up in Akaki kality sub city. METHODS Institutional based cross-sectional study was conducted on a sample of 557 pregnant women attending antenatal and postnatal care service. Systematic random sampling was used to select study subjects. The mothers were interviewed and the collected data was cleaned and entered into Epi Info 3.5.1 and analyzed by R version 3.2.0. Hierarchical Negative Binomial Poisson Regression Model was fitted to identify the factors associated with a number of Iron/Folic Acid uptake. Adjusted Incidence rate ratio (IRR) with 95% confidence interval (CI) was computed to assess the strength and significance of the association. RESULT More than 90% of the mothers were supplemented with at least one Iron/Folic Acid supplement from pill per week during their pregnancy time. Sixty percent of the mothers adhered (took four or more tablets per week) (95%CI, 56%-64.1%). Higher IRR of Iron/Folic Acid supplementation was observed among women: who received health education; which were privately employed; who achieved secondary education; and who believed that Iron/Folic Acid supplements increase blood, whereas mothers who reported a side effect, who were from families with relatively better monthly income, and who took the supplement when sick were more likely to adhere. CONCLUSION Adherence to Iron/Folic Acid supplement during their pregnancy time among mothers attending antenatal and postnatal care was found to be high. Activities that would address the above mentioned factors were highly recommended to ensure the sustainability of mothers’ adherence to the supplement.”,”author”:{“dropping-particle”:””,”family”:”Gebreamlak”,”given”:”Bisratemariam”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Dadi”,”given”:”Abel Fekadu”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Atnafu”,”given”:”Azeb”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”container-title”:”PLoS ONE”,”id”:”ITEM-1″,”issue”:”1″,”issued”:{“date-parts”:”2017″},”page”:”12″,”title”:”High adherence to iron/folic acid supplementation during pregnancy time among antenatal and postnatal care attendant mothers in Governmental Health Centers in Akaki Kality Sub City, Addis Ababa, Ethiopia: Hierarchical negative binomial poisson regression”,”type”:”article-journal”,”volume”:”12″},”uris”:”http://www.mendeley.com/documents/?uuid=9acc0960-b4bd-4982-b610-4e201ae0f40c”},”mendeley”:{“formattedCitation”:”(Gebreamlak et al., 2017)”,”plainTextFormattedCitation”:”(Gebreamlak et al., 2017)”,”previouslyFormattedCitation”:”(Gebreamlak et al., 2017)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Gebreamlak et al., 2017)
Problem statement.

Poor consumption of ferrous sulphate/folic acid supplements among pregnant women is associated with neural tube defects and maternal anemia in child and pregnant mothers respectively.

Folate deficiency is one of the common vitamin deficiency in women. Women who take low level of folate during pregnancy are at risk for poor pregnancy outcomes including neural tube defects (NTDs) and anemia. The prevalence of anemia and severe anemia in pregnant women were 60% and 3.8% in pregnant women respectively. Pregnant women become anemic because their blood also used by unborn child.

The required hemoglobin level of pregnant women are 11g/dl.However, during pregnant majority of the women are below 11g/dl thus during antenatal care (ANC) they are given ferrous sulphate/folic acid supplements to help them to increase the amount of blood which is real needed to their bodies and help them deliver safely. ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.3390/nu9121327″,”ISBN”:”1607255103″,”ISSN”:”20726643″,”PMID”:”29210994″,”abstract”:”Iron is particularly important in pregnancy and infancy to meet the high demands for hematopoiesis, growth and development. Much attention has been given to conditions of iron deficiency (ID) and iron deficient anemia (IDA) because of the high global prevalence estimated in these vulnerable life stages. Emerging and preliminary evidence demonstrates, however, a U-shaped risk at both low and high iron status for birth and infant adverse health outcomes including growth, preterm birth, gestational diabetes, gastrointestinal health, and neurodegenerative diseases during aging. Such evidence raises questions about the effects of high iron intakes through supplementation or food fortification during pregnancy and infancy in iron-replete individuals. This review examines the emerging as well as the current understanding of iron needs and homeostasis during pregnancy and infancy, uncertainties in ascertaining iron status in these populations, and issues surrounding U-shaped risk curves in iron-replete pregnant women and infants. Implications for research and policy are discussed relative to screening and supplementation in these vulnerable populations, especially in developed countries in which the majority of these populations are likely iron-replete.”,”author”:{“dropping-particle”:””,”family”:”Brannon”,”given”:”Patsy M.”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Taylor”,”given”:”Christine L.”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”container-title”:”Nutrients”,”id”:”ITEM-1″,”issue”:”12″,”issued”:{“date-parts”:”2017″},”page”:”1-17″,”title”:”Iron supplementation during pregnancy and infancy: Uncertainties and implications for research and policy”,”type”:”article-journal”,”volume”:”9″},”uris”:”http://www.mendeley.com/documents/?uuid=92dd43a6-db90-41aa-ab5b-acf0a27cf611″},”mendeley”:{“formattedCitation”:”(Brannon ; Taylor, 2017)”,”plainTextFormattedCitation”:”(Brannon ; Taylor, 2017)”,”previouslyFormattedCitation”:”(Brannon ; Taylor, 2017)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Brannon & Taylor, 2017)
Many articles and research have been done to assess the effective, perception of ferrous sulphate/folic acid supplements among pregnant women in general area (Dar es salaam) but few has been done to assess pregnant women adherence to ferrous sulphate/folic acid supplements to pregnant women especially small area like Amana at Ilala district.

The best way which can enable pregnant women to adhere to ferrous sulphate/folic acid daily neither explained nor full understood.

This result into significance to study the factors influencing adherence to ferrous sulphate/folic acid to facilitates plans towards improvement of ferrous/folic acid supplementation programs and eliminate poor maternal birth outcomes associated with adherence to ferrous sulphate/folic acid.

This study is going to determine the factors associated with adherence to ferrous sulphate/folic acid among pregnant women at Mnazi Mmoja RCH in Ilala district.

CONCEPTUAL FRAMEWORK
It has been constructed with reference from different literatures. Several factors can have both positive and negative influence to pregnant women adherence to ferrous sulphate/Folic acid supplements as shown in a simplified conceptual framework below.
2867025358776Maternal and child Health Training programs
00Maternal and child Health Training programs
1419225358776Marital status
00Marital status
-276225358775Family and social support
00Family and social support

81597510414000
529590019685Negative/ positive adherence to ferrous sulphate/folic acid
00Negative/ positive adherence to ferrous sulphate/folic acid
3790950229236Proper health care
00Proper health care
337185016256000183832516256000
2752725309880Trained health personel00Trained health personel
-276225152400Economic status
00Economic status
1181100152400Regular antenatal visit (attendance)
00Regular antenatal visit (attendance)

86677519431000
311467510477600
86677515684500189547515684400
-361950280035Accessibility to health facilities
00Accessibility to health facilities

1181100137160Education status/ level
00Education status/ level
2647950141605Traditional believes and health risk behaviors
00Traditional believes and health risk behaviors

Family and social support, economic status, marital status, and accessibility to health care facilities these factors contribute to adherence and on other hand contribute to non-adherence of pregnant women to ferrous sulphate/folic acid.
In other hand maternal child health training, traditional believes in combination with attendance to antenatal clinic affects directly adherence of pregnant women to ferrous sulphate/ folic acid supplements.

PURPOSE OF THE STUDY.

The study looks on the factors associated with adherence of pregnant women to ferrous sulphate/folic acid supplements.

Significance of the study.

The finding from the study will enable to assist pregnant women to adhere to ferrous sulphate/folic acid and facilitate initiatives towards strengthening ferrous sulphate/folic acid supplementation program during ANC visits and reduce negative birth outcome among pregnant women associated with ferrous sulphate/folic acid deficiencies.

Hypothesis.

Women with education are more likely to adhere to ferrous sulphate/folic acid than those without education.

Variables.

Dependent variables.

Adherence to ferrous sulphate/folic acid
Independent variables.

Women with or without education.

Research questions:
1. What are factors for adherence of pregnant women to ferrous Sulphate /folic acid at Mnazi Mmoja RCH?
2. What are factors for non-adherence of pregnant women to ferrous
Sulphate/folic acid at Mnazi Mmoja RCH?
RESEARCH OBJECTIVES:
General objective.

The general objective of the study is to determine the factors associated with adherence to ferrous sulphate/folic acid among pregnant women at Mnazi Mmoja RCH.

Specific objectives.

1. To determine factors for adherence of pregnant women to ferrous
Sulphate/folic acid.

2. To determine factors for non-adherence of pregnant women to ferrous
Sulphate/folic acid.

LITERATURE REVIEW.

Adherence and factors associated with number of ferrous sulphate/folic acid uptake by mothers; among 557 mothers interviewed more than 90% were supplemented with at least one ferrous sulphate/folic acid supplement from pill in a week during pregnancy time. Adherence, which was considered as taking of ferrous sulphate/folic acid supplements for four or more times a week during pregnancy time was found to be 60.1%.

Most of those who did not adhere stated side effects as main reason. Heart burn was the frequent side effect reported by 96.6% of non-adhered mothers while the rest also reported vomiting approximately 1.6% and 1.3% reported constipation and 0.5% reported diarrhea.ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.1371/journal.pone.0169415″,”ISBN”:”1111111111″,”ISSN”:”19326203″,”PMID”:”28129344″,”abstract”:”BACKGROUND Iron deficiency during pregnancy is a risk factor for anemia, preterm delivery, and low birth weight. Iron/Folic Acid supplementation with optimal adherence can effectively prevent anemia in pregnancy. However, studies that address this area of adherence are very limited. Therefore, the current study was conducted to assess the adherence and to identify factors associated with a number of Iron/Folic Acid uptake during pregnancy time among mothers attending antenatal and postnatal care follow up in Akaki kality sub city. METHODS Institutional based cross-sectional study was conducted on a sample of 557 pregnant women attending antenatal and postnatal care service. Systematic random sampling was used to select study subjects. The mothers were interviewed and the collected data was cleaned and entered into Epi Info 3.5.1 and analyzed by R version 3.2.0. Hierarchical Negative Binomial Poisson Regression Model was fitted to identify the factors associated with a number of Iron/Folic Acid uptake. Adjusted Incidence rate ratio (IRR) with 95% confidence interval (CI) was computed to assess the strength and significance of the association. RESULT More than 90% of the mothers were supplemented with at least one Iron/Folic Acid supplement from pill per week during their pregnancy time. Sixty percent of the mothers adhered (took four or more tablets per week) (95%CI, 56%-64.1%). Higher IRR of Iron/Folic Acid supplementation was observed among women: who received health education; which were privately employed; who achieved secondary education; and who believed that Iron/Folic Acid supplements increase blood, whereas mothers who reported a side effect, who were from families with relatively better monthly income, and who took the supplement when sick were more likely to adhere. CONCLUSION Adherence to Iron/Folic Acid supplement during their pregnancy time among mothers attending antenatal and postnatal care was found to be high. Activities that would address the above mentioned factors were highly recommended to ensure the sustainability of mothers’ adherence to the supplement.”,”author”:{“dropping-particle”:””,”family”:”Gebreamlak”,”given”:”Bisratemariam”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Dadi”,”given”:”Abel Fekadu”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Atnafu”,”given”:”Azeb”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”container-title”:”PLoS ONE”,”id”:”ITEM-1″,”issue”:”1″,”issued”:{“date-parts”:”2017″},”page”:”12″,”title”:”High adherence to iron/folic acid supplementation during pregnancy time among antenatal and postnatal care attendant mothers in Governmental Health Centers in Akaki Kality Sub City, Addis Ababa, Ethiopia: Hierarchical negative binomial poisson regression”,”type”:”article-journal”,”volume”:”12″},”uris”:”http://www.mendeley.com/documents/?uuid=9acc0960-b4bd-4982-b610-4e201ae0f40c”},”mendeley”:{“formattedCitation”:”(Gebreamlak et al., 2017)”,”plainTextFormattedCitation”:”(Gebreamlak et al., 2017)”,”previouslyFormattedCitation”:”(Gebreamlak et al., 2017)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Gebreamlak et al., 2017) Hierarchical negative binomial poison regression were fitted systematically to identify factors associated with a number of ferrous sulphate/folic acid uptake by mothers. In the final model, the incidence of taking more number of ferrous sulphate/folic acid supplement by mother was higher among mother’s who had achieved secondary education, who were private employee, who had received health education and who thought ferrous sulphate/folic acid supplements increase blood.ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.1371/journal.pone.0169415″,”ISBN”:”1111111111″,”ISSN”:”19326203″,”PMID”:”28129344″,”abstract”:”BACKGROUND Iron deficiency during pregnancy is a risk factor for anemia, preterm delivery, and low birth weight. Iron/Folic Acid supplementation with optimal adherence can effectively prevent anemia in pregnancy. However, studies that address this area of adherence are very limited. Therefore, the current study was conducted to assess the adherence and to identify factors associated with a number of Iron/Folic Acid uptake during pregnancy time among mothers attending antenatal and postnatal care follow up in Akaki kality sub city. METHODS Institutional based cross-sectional study was conducted on a sample of 557 pregnant women attending antenatal and postnatal care service. Systematic random sampling was used to select study subjects. The mothers were interviewed and the collected data was cleaned and entered into Epi Info 3.5.1 and analyzed by R version 3.2.0. Hierarchical Negative Binomial Poisson Regression Model was fitted to identify the factors associated with a number of Iron/Folic Acid uptake. Adjusted Incidence rate ratio (IRR) with 95% confidence interval (CI) was computed to assess the strength and significance of the association. RESULT More than 90% of the mothers were supplemented with at least one Iron/Folic Acid supplement from pill per week during their pregnancy time. Sixty percent of the mothers adhered (took four or more tablets per week) (95%CI, 56%-64.1%). Higher IRR of Iron/Folic Acid supplementation was observed among women: who received health education; which were privately employed; who achieved secondary education; and who believed that Iron/Folic Acid supplements increase blood, whereas mothers who reported a side effect, who were from families with relatively better monthly income, and who took the supplement when sick were more likely to adhere. CONCLUSION Adherence to Iron/Folic Acid supplement during their pregnancy time among mothers attending antenatal and postnatal care was found to be high. Activities that would address the above mentioned factors were highly recommended to ensure the sustainability of mothers’ adherence to the supplement.”,”author”:{“dropping-particle”:””,”family”:”Gebreamlak”,”given”:”Bisratemariam”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Dadi”,”given”:”Abel Fekadu”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Atnafu”,”given”:”Azeb”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”container-title”:”PLoS ONE”,”id”:”ITEM-1″,”issue”:”1″,”issued”:{“date-parts”:”2017″},”page”:”12″,”title”:”High adherence to iron/folic acid supplementation during pregnancy time among antenatal and postnatal care attendant mothers in Governmental Health Centers in Akaki Kality Sub City, Addis Ababa, Ethiopia: Hierarchical negative binomial poisson regression”,”type”:”article-journal”,”volume”:”12″},”uris”:”http://www.mendeley.com/documents/?uuid=9acc0960-b4bd-4982-b610-4e201ae0f40c”},”mendeley”:{“formattedCitation”:”(Gebreamlak et al., 2017)”,”plainTextFormattedCitation”:”(Gebreamlak et al., 2017)”,”previouslyFormattedCitation”:”(Gebreamlak et al., 2017)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Gebreamlak et al., 2017)
On other side, the incidence of taking more number of ferrous sulphate/folic acid supplement by mother was lower among mothers who reported any side effects, among mothers’ whose monthly income was in category of 135-180 USD and 181-225 USD and among mother’s who took the supplement the supplement when they were sick.ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.1371/journal.pone.0169415″,”ISBN”:”1111111111″,”ISSN”:”19326203″,”PMID”:”28129344″,”abstract”:”BACKGROUND Iron deficiency during pregnancy is a risk factor for anemia, preterm delivery, and low birth weight. Iron/Folic Acid supplementation with optimal adherence can effectively prevent anemia in pregnancy. However, studies that address this area of adherence are very limited. Therefore, the current study was conducted to assess the adherence and to identify factors associated with a number of Iron/Folic Acid uptake during pregnancy time among mothers attending antenatal and postnatal care follow up in Akaki kality sub city. METHODS Institutional based cross-sectional study was conducted on a sample of 557 pregnant women attending antenatal and postnatal care service. Systematic random sampling was used to select study subjects. The mothers were interviewed and the collected data was cleaned and entered into Epi Info 3.5.1 and analyzed by R version 3.2.0. Hierarchical Negative Binomial Poisson Regression Model was fitted to identify the factors associated with a number of Iron/Folic Acid uptake. Adjusted Incidence rate ratio (IRR) with 95% confidence interval (CI) was computed to assess the strength and significance of the association. RESULT More than 90% of the mothers were supplemented with at least one Iron/Folic Acid supplement from pill per week during their pregnancy time. Sixty percent of the mothers adhered (took four or more tablets per week) (95%CI, 56%-64.1%). Higher IRR of Iron/Folic Acid supplementation was observed among women: who received health education; which were privately employed; who achieved secondary education; and who believed that Iron/Folic Acid supplements increase blood, whereas mothers who reported a side effect, who were from families with relatively better monthly income, and who took the supplement when sick were more likely to adhere. CONCLUSION Adherence to Iron/Folic Acid supplement during their pregnancy time among mothers attending antenatal and postnatal care was found to be high. Activities that would address the above mentioned factors were highly recommended to ensure the sustainability of mothers’ adherence to the supplement.”,”author”:{“dropping-particle”:””,”family”:”Gebreamlak”,”given”:”Bisratemariam”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Dadi”,”given”:”Abel Fekadu”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Atnafu”,”given”:”Azeb”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”container-title”:”PLoS ONE”,”id”:”ITEM-1″,”issue”:”1″,”issued”:{“date-parts”:”2017″},”page”:”12″,”title”:”High adherence to iron/folic acid supplementation during pregnancy time among antenatal and postnatal care attendant mothers in Governmental Health Centers in Akaki Kality Sub City, Addis Ababa, Ethiopia: Hierarchical negative binomial poisson regression”,”type”:”article-journal”,”volume”:”12″},”uris”:”http://www.mendeley.com/documents/?uuid=9acc0960-b4bd-4982-b610-4e201ae0f40c”},”mendeley”:{“formattedCitation”:”(Gebreamlak et al., 2017)”,”plainTextFormattedCitation”:”(Gebreamlak et al., 2017)”,”previouslyFormattedCitation”:”(Gebreamlak et al., 2017)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Gebreamlak et al., 2017)
Anemia is a wide spread condition of pregnancy in many countries across all regions of the world. Current world health organization guidelines for nutrition and ANC recommend universal iron and folic acid supplementation for pregnant women where anemia is wide spread. However many countries are not giving priority to implementing this recommendation, and anemia remains the most common health condition of pregnancy. National health authorities have paid insufficient attention to ferrous sulphate/folic acid supplementation, in part because of the lack of easily accessible information regarding the importance of anemia in pregnancy, evidence that the intervention programs can be successful in addressing the problem, and how large scale problem have achieved results.ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.1177/15648265100312S202″,”ISBN”:”0379-5721 (Print)\r0379-5721 (Linking)”,”ISSN”:”03795721″,”PMID”:”20715594″,”author”:{“dropping-particle”:””,”family”:”Sanghvi”,”given”:”Tina G”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Harvey”,”given”:”Philip W J”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Wainwright”,”given”:”Emily”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”id”:”ITEM-1″,”issue”:”8″,”issued”:{“date-parts”:”2014″},”page”:”100-107″,”title”:”Maternal iron – folic acid supplementation programs : Evidence of impact and implementation”,”type”:”article-journal”,”volume”:”31″},”uris”:”http://www.mendeley.com/documents/?uuid=9cfb15a0-5f5e-4969-8652-c1ebc8d694e3″},”mendeley”:{“formattedCitation”:”(Sanghvi, Harvey, & Wainwright, 2014)”,”plainTextFormattedCitation”:”(Sanghvi, Harvey, & Wainwright, 2014)”,”previouslyFormattedCitation”:”(Sanghvi, Harvey, & Wainwright, 2014)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Sanghvi, Harvey, ; Wainwright, 2014)
Nutrition knowledge and education about ferrous sulphate/folic acid; pregnant women said they were not given education on ferrous sulphate/folic acid supplements. About 55% indicated to have knowledge about ferrous sulphate/folic acid supplements despites claims of not having been taught; only 12.5% of pregnant women demonstrated understanding of the consequences of not taking folic supplements.
Compliance can be increased by providing women with clear instructions and educating them on the benefits of tablets. Provision of supportive and sensitive antenatal care services appears to promote acceptance of services and attendance thus impacting on compliance.ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.4314/ahs.v17i3.8″,”ISSN”:”16806905″,”PMID”:”29085393″,”abstract”:”BACKGROUND Anaemia due to iron deficiency is recognized as one of the major nutritional deficiencies in women and children in developing countries. Daily iron supplementation for pregnant women is recommended in many countries. The aim of the study was to investigate the factors that contribute to compliance to the consumption of iron and folate supplements by pregnant woman in Mafikeng local municipality, North West Province, South Africa. RESEARCH METHODS A mixed method of descriptive, exploratory and cross-sectional design was used. Ten clinics were used as a sample frame where 57 pregnant women and 10 health workers were purposefully and conveniently selected. Quantitative techniques were used to collect data on attendance, consumption and nutrition knowledge using the self-reported questionnaire by pregnant women, and structured interview for health workers. Qualitative design was used to conduct in – depth focus-group discussions to gather information on compliance to the consumption of supplements by pregnant women. FINDINGS The findings of the study revealed good antenatal clinic attendance, availability of supplements and 93% compliance to the consumption of iron and folate supplements. RECOMMENDATIONS High compliance to the consumption of iron and folate supplements by pregnant women was reported, and this should be reinforced.”,”author”:{“dropping-particle”:””,”family”:”Mbhenyane”,”given”:”Xikombiso”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Cherane”,”given”:”Matodzi”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”container-title”:”African Health Sciences”,”id”:”ITEM-1″,”issue”:”3″,”issued”:{“date-parts”:”2017″},”page”:”657-670″,”title”:”Compliance with the consumption of iron and folate supplements by pregnant women in Mafikeng local municipality, North West Province, South Africa”,”type”:”article-journal”,”volume”:”17″},”uris”:”http://www.mendeley.com/documents/?uuid=23ba77fc-6b19-4277-a4db-e310a6e66bb1″},”mendeley”:{“formattedCitation”:”(Mbhenyane & Cherane, 2017)”,”plainTextFormattedCitation”:”(Mbhenyane & Cherane, 2017)”,”previouslyFormattedCitation”:”(Mbhenyane & Cherane, 2017)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Mbhenyane ; Cherane, 2017)
According to the 2008 report of WHO, 1.62 billion (24.8%) people are affected globally from anemia. But it is main public issue in developing countries where around 52% of pregnant women are anemic, whereas this proportion is 23% in developed countries.

One third of women of childrearing age are already anemic even prior to conception, the risk is further enhanced by increased body iron requirement during gestation. Dietary habit in developing countries cannot supply 30-40mg of iron that required for absorption of 4-6mg, needed during the latter stages of pregnancy.

Oral folic acid supplements is notorious for its side effects, namely constipation,diarrhoea,hearburn,nausea,epigastric pain, seen in up to 20% of patients and limits compliance to the different ferrous sulphate/folic acid supplements. The estimated adherence rate hovers around 40-60%.ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.13040/IJPSR.0975-8232.9(3).1242-46″,”author”:{“dropping-particle”:””,”family”:”Block”,”given”:”A”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”id”:”ITEM-1″,”issue”:”3″,”issued”:{“date-parts”:”2018″},”page”:”1242-1246″,”title”:”COMPARISON OF EFFICACY OF FERROUS CALCIUM CITRATE”,”type”:”article-journal”,”volume”:”9″},”uris”:”http://www.mendeley.com/documents/?uuid=fa6e599f-0b95-421c-b655-d29399b44c38″},”mendeley”:{“formattedCitation”:”(Block, 2018)”,”plainTextFormattedCitation”:”(Block, 2018)”,”previouslyFormattedCitation”:”(Block, 2018)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Block, 2018)
Factors associated with compliance of iron and folic acid (IFA) there are significant association between the compliance of iron and ferrous sulphate/folic acid and some socio demographic variables such as religion, ethnicity, educational status of women, education status of husband, type of family, place of residence, and family monthly income. Also compliance to folic acid associated with frequency of antenatal checkup, counseled for iron and folic acid during pregnancy and previous history of anemia. Compliance of folic acid not associated with age of woman, working status of women and time to reach health institution.ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“abstract”:”Background: Anemia is the commonest medical disorder in pregnancy and has been associated with poor pregnancy outcome. The purpose of this study was to determine the compliance rate and factors associated with iron and folic acid consumption among pregnant women. Methods: A descriptive cross-sectional study was carried out in a tertiary hospital with sample size of 246 pregnant women. Results: The study showed 55.7% compliance rate of iron and folic acid among pregnant women. Significant association was observed between the compliance of the iron and folic acid and religion of women (p<0.001), ethnicity (p=0.001), educational status of women (p<0.001), occupation of husband (p=0.002), type of family (p=0.001), place of residence (p=0.02), family monthly income (p=0.007), frequency of antenatal check up (p<0.001), counseled for IFA during this pregnancy (p=0.024) and previous history of anaemia (p=0.029). Conclusion: It is concluded that increase in frequency in antenatal care and proper counseling for consumption of IFA during pregnancy have positive influence in increasing compliance rate of iron and folic acid.”,”author”:{“dropping-particle”:””,”family”:”Neupane”,”given”:”Nirmala”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Sharma”,”given”:”Sarita”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Kaphle”,”given”:”Hari Prasad”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”container-title”:”International Journal of Research and Current Development”,”id”:”ITEM-1″,”issue”:”1″,”issued”:{“date-parts”:”2015″},”page”:”43-47″,”title”:”Factors affecting compliance of iron and folic acid among pregnant women attaining Western Regional Hospital, Pokhara, Nepal”,”type”:”article-journal”,”volume”:”1″},”uris”:”http://www.mendeley.com/documents/?uuid=5136ca1a-3e04-406f-a6ef-6797e6277f9f”},”mendeley”:{“formattedCitation”:”(Neupane, Sharma, & Kaphle, 2015)”,”plainTextFormattedCitation”:”(Neupane, Sharma, & Kaphle, 2015)”,”previouslyFormattedCitation”:”(Neupane, Sharma, & Kaphle, 2015)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Neupane, Sharma, ; Kaphle, 2015)
Proper maternal supplementation is important for coping with extra demand for normal development of a growing fetus. The most important supplements are vitamin and folic acid. Adequate folic acid intake during the preconception period help to protect a child against a number of congenital malformations including neural tube defects. Consumption of at least 400ug of folic acid at least 1 months before conception and in the early days of pregnancy could prevent 50-70% of neural tube defects and intake of nutrients must be increased during pregnancy to cope with the demands of the growing fetus and mother.

Women require planned health education programs to improve their attitudes, with special attention during antenatal care. Many countries require fortification of foodstuffs with folic acid and encourage women to take the recommended amount of vitamin (0.4mg/day) before and during pregnancy.ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.1016/j.jtumed.2013.08.002″,”ISSN”:”1658-3612″,”author”:{“dropping-particle”:””,”family”:”Ahmad”,”given”:”Bashaier”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Anam”,”given”:”Nehal”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Khalid”,”given”:”Norah”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Mohsen”,”given”:”Reem”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Zaal”,”given”:”Lena”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Jadidy”,”given”:”Esraa”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Alalati”,”given”:”Somaya”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”container-title”:”Journal of Taibah University Medical Sciences”,”id”:”ITEM-1″,”issue”:”3″,”issued”:{“date-parts”:”2013″},”page”:”199-204″,”publisher”:”Taibah University”,”title”:”Perceptions of women of reproductive age about vitamin and folic acid supplements during pregnancy , Taibah University , Almadinah Almunawwarah , Kingdom of Saudi Arabia”,”type”:”article-journal”,”volume”:”8″},”uris”:”http://www.mendeley.com/documents/?uuid=30e8d976-143a-4f12-8135-735e7fef4798″},”mendeley”:{“formattedCitation”:”(Ahmad et al., 2013)”,”plainTextFormattedCitation”:”(Ahmad et al., 2013)”,”previouslyFormattedCitation”:”(Ahmad et al., 2013)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Ahmad et al., 2013)
REFERENCES:
ADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY Ahmad, B., Anam, N., Khalid, N., Mohsen, R., Zaal, L., Jadidy, E., ; Alalati, S. (2013). Perceptions of women of reproductive age about vitamin and folic acid supplements during pregnancy , Taibah University , Almadinah Almunawwarah , Kingdom of Saudi Arabia. Journal of Taibah University Medical Sciences, 8(3), 199–204. https://doi.org/10.1016/j.jtumed.2013.08.002
Aremu, O., Lawoko, S., ; Dalal, K. (2010). Childhood vitamin A capsule supplementation coverage in Nigeria: A multilevel analysis of geographic and socioeconomic inequities. TheScientificWorldJournal, 10, 1901–1914. https://doi.org/10.1100/tsw.2010.188
Block, A. (2018). COMPARISON OF EFFICACY OF FERROUS CALCIUM CITRATE, 9(3), 1242–1246. https://doi.org/10.13040/IJPSR.0975-8232.9(3).1242-46
Brannon, P. M., ; Taylor, C. L. (2017). Iron supplementation during pregnancy and infancy: Uncertainties and implications for research and policy. Nutrients, 9(12), 1–17. https://doi.org/10.3390/nu9121327
Gebreamlak, B., Dadi, A. F., ; Atnafu, A. (2017). High adherence to iron/folic acid supplementation during pregnancy time among antenatal and postnatal care attendant mothers in Governmental Health Centers in Akaki Kality Sub City, Addis Ababa, Ethiopia: Hierarchical negative binomial poisson regression. PLoS ONE, 12(1), 12. https://doi.org/10.1371/journal.pone.0169415
Mbhenyane, X., ; Cherane, M. (2017). Compliance with the consumption of iron and folate supplements by pregnant women in Mafikeng local municipality, North West Province, South Africa. African Health Sciences, 17(3), 657–670. https://doi.org/10.4314/ahs.v17i3.8
Neupane, N., Sharma, S., ; Kaphle, H. P. (2015). Factors affecting compliance of iron and folic acid among pregnant women attaining Western Regional Hospital, Pokhara, Nepal. International Journal of Research and Current Development, 1(1), 43–47. Retrieved from http://www.journalijrcd.com
Sanghvi, T. G., Harvey, P. W. J., ; Wainwright, E. (2014). Maternal iron – folic acid supplementation programs?: Evidence of impact and implementation, 31(8), 100–107. https://doi.org/10.1177/15648265100312S202