Assessment of Adherence to Iron and Folic Acid Supplementation and Prevalence of Anemia in Pregnant Women

Anemia during pregnancy is a worldwide problem, Iron deficiency and folate deficiency are considered as the first two causes of nutritional anemia. Many antenatal care program distributed iron and folic acid supplementation to pregnant women's the effectiveness of theses intervention in reducing maternal anemia's still has been in adequate. Some suggest that poor compliance is the probable reason for the ineffectiveness of such program. Aim of the Work: The aim of this study is to improve the adherence of pregnant women to Iron and Folic acid supple-mentation. Study Objectives: To measure the adherence (compliance) of pregnant women to iron and folic acid supplementation and prevalence of anemia in pregnant women and to study the different factors affecting the adherence to Iron and Folic acid supplementation. Material and Methods: This descriptive cross sectional study was conducted on 270 pregnant women in the second or third trimester attending El-Salam Primary Health Care center in Ismailia governorate were included in the study. study done on January, February, March 2008. Women were excluded from the study if have any of the following disorders including (Hemolytic anemia, hemoglobinopathies, mental disorders, chronic diseases, or chronic inflammatory disorders). All women were assessed for adherence to iron and folic acid supplement through self reported and pill count adherence. Hemoglobin concentration from follow-up charts was recorded. Results: According to self reported adherence; 58.9% showed no adherence and 41.1% shows adherence while concerning pill count adherence 63.3% showed no adherence and 36.7% showed adherence. Statistically significant differ-ence was found between results of self reported adherence and pill count adherence. 62.2% of the study group were anemic. Hemoglobin level ranged between 6.9-13.0g/dl, and mean ± SD were 10.5±0.7g/dl. 126/168 (75%) mild anemia, 39/168 (23,2%) moderate anemia, 3/168 (1.8%) severe anemia. Most prevalent cause of non-adherence was frustration from many tablets (75/270 pregnant women; 54.3%). When Correspondence to: Dr. Zakia M.. studying the best fitting multiple linear regression model for pill count adherence among pregnant women of study sample, it was found that age, income, pregnancy spacing, ANC visits, knowledge of folic acid and family encouragement were statistically significant independent positive predictors of pill count adherence. Conversely, crowding index, gravidity, and side effects occurrence were statistically significant indepen-dent negative predictors of pill count adherence. The model explains 24% of the variation of pill count adherence, as indicated by the value of r-square. Conclusion: Pill count is more accurate method for esti-mation of adherence to iron and folic acid supplement than self reported adherence. Age, income, pregnancy spacing, ANC visits, knowledge of folic acid and family encouragement were statistically significant independent positive predictors. Conversely, crowding index, gravidity, and side effects occur-rence were statistically significant independent negative predictors.

妊娠期贫血是全球范围内的一个普遍问题，铁缺乏和叶酸缺乏被视为营养性贫血的前两大原因。众多产前保健项目为孕妇分发铁和叶酸补充剂，但这些干预措施在降低母体贫血方面的有效性仍显不足。部分研究者认为，不遵守治疗规范可能是此类项目无效的主要原因。研究目标：本研究的目的是提高孕妇对铁和叶酸补充剂的依从性。研究目标：测量孕妇对铁和叶酸补充剂的依从性（遵守度）以及妊娠期贫血的患病率，并研究影响对铁和叶酸补充剂依从性的不同因素。材料与方法：本研究是一项描述性横断面研究，对艾兹拉姆省伊スマ利亚市沙拉姆初级卫生保健中心的270名处于孕中期或孕晚期的孕妇进行了研究。研究时间为2008年1月至3月。如有以下疾病之一（溶血性贫血、血红蛋白病、精神疾病、慢性疾病或慢性炎症性疾病），则排除妇女参与研究。所有妇女均通过自我报告和药丸计数依从性评估对铁和叶酸补充剂的依从性。记录随访图表中的血红蛋白浓度。结果：根据自我报告的依从性，58.9%的受试者表示无依从性，而41.1%表示有依从性；在药丸计数依从性方面，63.3%的受试者表示无依从性，而36.7%表示有依从性。自我报告依从性和药丸计数依从性结果之间存在统计学上的显著差异。研究组中有62.2%的受试者患有贫血。血红蛋白水平介于6.9-13.0g/dl之间，平均值为±0.7g/dl。其中126/168（75%）患有轻度贫血，39/168（23.2%）患有中度贫血，3/168（1.8%）患有重度贫血。非依从性最常见的原因是对多种药片感到沮丧（75/270名孕妇；54.3%）。在研究样本中，针对最佳拟合多元线性回归模型进行药丸计数依从性研究时，发现年龄、收入、孕次间隔、产前检查次数、叶酸知识及家庭支持是统计学上显著的独立正相关预测因素。相反，拥挤指数、孕次和副作用的发生是统计学上显著的独立负相关预测因素。该模型解释了药丸计数依从性变化的24%，这是由r平方值所指示的。结论：与自我报告的依从性相比，药丸计数是评估铁和叶酸补充剂依从性的更准确方法。年龄、收入、孕次间隔、产前检查次数、叶酸知识及家庭支持是统计学上显著的独立正相关预测因素。相反，拥挤指数、孕次和副作用的发生是统计学上显著的独立负相关预测因素。