Compliance to Iron-Folic Acid Supplementation and Its Association with the Number of ANC Visits in Ethiopia: Systematic Review and Meta-Analysis

Abstract

Background. The World Health Organization recommended that 80% of communities in all countries should receive the standard dose of iron folic acid. But, in Ethiopia, this target was not yet achieved. The compliance of iron folic acid was also variable across each district. Therefore, the aim of this study was to assess women compliance with iron-folic acid supplementation and its association with a number of antenatal care visits in Ethiopia using systematic review and meta-analysis, 2018. Methods. In the current meta-analysis, the target variables were searched from different electronic database system like PubMed, Google Scholar, Science Direct, and Cochrane Library. To predict the pooled prevalence of compliance with iron-folic acid supplementation in Ethiopia, all original studies were considered. All necessary data were extracted by using a standardized data extraction format. The data were analyzed by using STATA 14 statistical software. Heterogeneity between the studies was assessed by Cochrane Q and I2 tests. A random effect model was computed to estimate the pooled compliance with iron-folic acid supplementation. Results. Twelve full-text studies were included in the meta-analysis. The findings of this meta-analysis revealed that the pooled prevalence of compliance with iron-folic acid supplementation in Ethiopia was 43.63% (CI: 28.00, 59.25%). The women from the city administration had a high rate of compliance as compared with other regions of Ethiopia. The odds of having four or more antenatal care visit were the independent pooled predictor of compliance with iron-folic acid supplementation. Conclusion. Current compliance with iron-folic supplementation was lower than the World health organization recommendation. Mothers from the city administration who utilized the antenatal care four and above times, had high level compliance with iron-folic acid supplementation. Therefore, we recommended that women should visit the antenatal clinic four times to compliance with the iron folic acid supplementation.

Interventions to increase adherence to micronutrient supplementation during pregnancy: a systematic review

“…Previously published systematic reviews used different cutoffs to define adherence to micronutrient supplements in pregnancy, which varied from 70% 48 to 95% 7 of the recommended daily supplementation dose or was defined as the intake of micronutrient tablets for 90 days or more. 49 Given this variability in the definition of adherence and the criticism of using a specific threshold (which could not be proved to be linked to clinical outcomes 50 ), in the present work, we decided to report adherence to the micronutrient supplementation regimen as measured and defined by the study authors. Consequently, we found that the included studies used a wide range of methods to measure adherence (from prevalidated questionnaires to self-reported recall or pill counting) and to define adherence (from a minimum number of tablets taken over a certain period of time to the use of behavior scales).…”

“…Defining and quantifying adherence, as well as providing an estimate of the effect size of an intervention on adherence for a pooled body of evidence, is challenging. Previously published systematic reviews used different cutoffs to define adherence to micronutrient supplements in pregnancy, which varied from 70% 48 to 95% 7 of the recommended daily supplementation dose or was defined as the intake of micronutrient tablets for 90 days or more 49 . Given this variability in the definition of adherence and the criticism of using a specific threshold (which could not be proved to be linked to clinical outcomes 50 ), in the present work, we decided to report adherence to the micronutrient supplementation regimen as measured and defined by the study authors.…”

Magnitude and determinants of adherence to iron supplementation among Ethiopian pregnant women: A cross sectional study from a national survey

“…The magnitude of compliance to iron supplementation in our study was low compared to other studies. A systematic review and Meta analysis study by Yineger Workineh et al showed that the overall prevalence of compliance with iron-folic acid supplementation was 43.63% [7]. Another systematic review and Meta analysis research by Desta et al also showed that 46.15% of Ethiopian women had adhered to iron and folic acid supplementation [14].…”

“…Additionally, a study conducted in eight rural Woredas of Ethiopia revealed that, those women who had less than four ANC visits were less likely adhere to iron supplementation [15]. A Meta analysis studies also indicated that having of four or more ANC visits increased compliance of mothers to iron supplementation [7,14]. The possible reason could be that those mothers who had repeated ANC might be exposed to repeated counseling on anemia and the benefits of iron supplementation.…”

“…According to the 2016 EDHS, 58% of women did not take any iron supplementation during their last pregnancy while only 5% of the women took iron tablets for ≥ 90 days [3]. A Meta analysis of 12 studies also showed that the pooled prevalence of compliance with iron-folic acid (IFA) supplementation in Ethiopia was 43.63% [7].…”