The Influence of Antenatal Oral Iron and Folic Acid Side Effects on Supplementation Duration in Low-Resource Rural Kenya: A Cross-Sectional Study

Abstract

Background. Undesirable effects of a daily regimen of iron and folic acid ingested jointly (iron-folate) are potential disincentives to optimal antenatal supplementation. We intended to profile antenatal iron-folate side effects and elucidate their influence on supplementation duration in low-resource rural Kenya. Methods. This was a cross-sectional descriptive study of randomly selected postnatal mothers of under-five-year-old children. Using a modified WHO Safe Motherhood Assessment standard questionnaire, they recalled the total number of days of antenatal iron-folate intake and the attendant supplement-attributed undesirable experiences. The analyses considered only participants who ingested the supplements in their immediate last pregnancies (n=277). Results. About half of the study participants reported at least a side effect and a mean of 2.4 (SD 1.5) effects per person in the entire pregnancy period. Most common reported effects were chest pains (31.8%), constipation (28.5%), severe stomach pains (11.6%), and diarrhoea (11.6%). Mothers who reported at least a side effect ingested the supplements for ten days less compared to those who did not experience any effect (p=0.03); and a greater proportion of the former were primigravida (p=0.02) and used combined form of iron and folic acid (p=0.003). In a multivariate analysis, significant correlations with supplementation compliance (ingestion for 90+ days) were found only for nausea and severe stomach pain experiences (r=−0.1, p=0.04; r=0.2, p=0.01, resp.). Conclusions. The commonness of undesirable experiences attributed to daily ingestion of 60 mg iron and 0.4 mg folic acid and their deterrence to longer supplementation durations suggest the need for considering a weekly intermittent regimen for some antenatal women in such set-ups. Our study demonstrated that potentially, more counselling on nausea as a side effect might be critical in advancing iron-folate supplementation compliance.

Individual and community-level determinants of Iron-Folic Acid Intake for the recommended period among pregnant women in Ethiopia: A multilevel analysis

“…90 days or more. The identified factors include; maternal socioeconomic status and sociodemographic factors [17,19,20], lack of recommended ANC visits [17,21], intolerance of gastrointestinal side effects while taking the tablets [22], inadequate supply of IFA tablets/syrups and poor counseling towards IFA utilization [19,23], inadequate utilization of prenatal health-care services [21], and poor family/relative support [19,24].…”

Risk factors for Gestational diabetes mellitus among pregnant women attending antenatal clinic in Kisumu City, western Kenya

“…To prevent poor pregnancy-related outcomes due to iron and folic de ciencies, the WHO recommends that pregnant women should be given daily iron and folic supplementation (IFAS). Based on this, several countries including Kenya have included IFAS in their ANC service package [19]. However, studies have shown association between IFAS and the likelihood of developing GDM among pregnant women [20,21],…”

Compliance to Iron Folic Acid Supplementation and its associated factors among post-partum mothers of Bharatpur Metropolitan

“…Side effects of Iron Folic Acid (IFA) supplementation refer to any adverse and unwanted reactions experienced by individuals who have consumed IFA tablets, including symptoms such as vomiting, nausea, dizziness, heartburn, and diarrhea [9].…”