Adherence to iron with folic acid supplementation and its associated factors among pregnant women attending antenatal care follow up at Debre Tabor General Hospital, Ethiopia, 2017

Introduction
Nutritional anemia is a major public health problem throughout the world, particularly in developing countries. Iron with folic acid supplementation (IFAS) is recommended to mitigate anemia and its resulting complications during pregnancy. There has been limited study on IFAS adherence of pregnant women in the study area. The aim of this study was to assess adherence to IFAS and its associated factors among pregnant women attending antenatal care service in Debre Tabor General Hospital, Ethiopia.
Methods
An institution-based cross-sectional study was conducted from January 9 to April 8, 2017, at Debre Tabor General Hospital. A total of 262 study participants were included and selected by systematic random sampling. The entire interviewed questionnaire was checked and entered into EpiData version 3.1 and then exported to SPSS version 20 for windows for analysis. IFAS adherence status was defined as, if pregnant mothers took 65% or more of the IFAS which is equivalent to taking IFAS at least 4 days a week during the 1-month period preceding the study. Regressions were fitted to identify independent predictors of IFAS adherence. A P-value of less than 0.05 was used to declare statistical significance.
Results
A total of 241 pregnant women were included (92% response rate), of which 107 (44%) were adherent to IFAS. Only 39% received IFAS counseling, and 52% had some knowledge of IFAS. Gravidity (AOR = 2.92 95% CI (1.61, 5.30)), gestational age at first ANC visit (AOR = 3.67, 95% CI (1.94, 6.97)), pregnant women who got advice about IFAS (AOR = 2.04, 95%CI (1.12, 3.75)), current anemia (AOR = 2.22, 95%CI (1.45, 4.29)), and had knowledge about IFAS (AOR = 3.27, 95% CI (1.80, 5.95)) were statistically associated with adherence to IFAS among pregnant women.
Conclusion
Overall, IFAS adherence among pregnant women was low. The associated factors with adherence of IFAS were counseling and knowledge, early ANC attendance, pregnancy history, and current anemia diagnosis. IFAS counseling by health workers was low but, when given, was associated with improved IFAS adherence. Health workers and health extension workers should consistently counsel on IFAS benefits during ANC visit, to improve IFAS adherence during the current and subsequent pregnancies.

## 引言
营养性贫血是全球范围内的重大公共卫生问题，在发展中国家尤为突出。铁剂联合叶酸补充疗法（Iron with folic acid supplementation, IFAS）被推荐用于缓解妊娠期贫血及其继发并发症。目前针对本研究区域孕产妇IFAS依从性的相关研究较为匮乏。本研究旨在评估埃塞俄比亚德布雷塔博尔综合医院产前检查（Antenatal Care, ANC）门诊孕产妇的IFAS依从性及其相关影响因素。

## 方法
本研究于2017年1月9日至4月8日在德布雷塔博尔综合医院开展，为基于机构的横断面研究。采用系统随机抽样法纳入共计262名研究对象。所有访谈问卷均经过核查后录入EpiData 3.1版，随后导出至Windows版SPSS 20.0进行统计分析。IFAS依从性定义为：研究前1个月内，孕产妇服用的IFAS剂量达到规定剂量的65%及以上，相当于每周至少服用4次IFAS。采用回归分析筛选IFAS依从性的独立影响因素，以P值<0.05作为统计学显著性判定标准。

## 结果
本研究最终纳入241名孕产妇，应答率为92%，其中107名（44%）孕产妇IFAS依从性良好。仅39%的孕产妇接受过IFAS相关健康宣教，52%的孕产妇具备IFAS相关知识。孕次（调整后比值比（Adjusted Odds Ratio, AOR）=2.92，95%置信区间（95% Confidence Interval, 95% CI）：1.61~5.30）、首次产前检查时的孕周（AOR=3.67，95%CI：1.94~6.97）、接受过IFAS相关指导的孕产妇（AOR=2.04，95%CI：1.12~3.75）、合并当前贫血的孕产妇（AOR=2.22，95%CI：1.45~4.29）以及具备IFAS相关知识的孕产妇（AOR=3.27，95%CI：1.80~5.95），均与孕产妇的IFAS依从性呈显著统计学关联。

## 结论
总体而言，孕产妇的IFAS依从性水平较低。与IFAS依从性相关的影响因素包括健康宣教与知识储备、首次产前检查时机、孕次以及当前贫血诊断情况。尽管医护人员开展IFAS相关健康宣教的比例较低，但接受过宣教的孕产妇IFAS依从性显著更高。建议医护人员及基层卫生工作者在产前检查过程中持续开展IFAS获益相关的健康宣教，以提升当前及后续妊娠期间孕产妇的IFAS依从性。