DETERMINANTS OF IRON SUPPLEMENT NON-ADHERENCE AMONG YOUNG PREGNANT WOMEN IN SOUTHERN WEST-BANK: AWARENESS OF ANEMIA AND IRON –FOLIC ACID SUPPLEMENTS

Muamar M. A. Shaheen* and Hatem Hejaz

ABSTRACT

Background: About 41.8% of pregnant women are anemic worldwide, with the highest proportion affected in developing countries. In Palestine, iron and folic acid supplements are available for free in most governmental antenatal care clinics, however anemia due to iron deficiency is still one of the most prevalent forms of anemia among pregnant women. Objectives: To determine the percentage age of Palestinian pregnant women who take iron-supplements during pregnancy. To determine major factors associated with non-adherence to iron-folic acid supplements among pregnant women and awareness of anemia as related to adherence. Methods: This is a questionnaire-based cross-sectional study conducted on 286 pregnant women receiving antenatal care at private and governmental antenatal care clinics between January and April 2018 in Hebron city. A standardized slightly modified interview-administered questionnaire was used in this study. Data was analyzed using Microsoft SPSS version 20S. Results: Women were divided into 2 categories according to their iron-intake commitment period; ≤3 months or > 3 months. There was a significant difference between the 2- categories in relation to number of antenatal care clinic visits, mean ±SD was 2.06±0.864 and 2.58±0.745, for category-1 and -2, respectively, α= 0.033. There was also a significance difference between the two categories in relation to physician advice. Rate of commitment to iron-supplement (> 3months) was 48.9 %. Rate of adherence to iron-supplements (≥ 6 unit doses per week), regardless of commitment period, was 49.3%.The main reason of non-adherence to iron supplement among subjects of study was forgetfulness, (42.6%). Other factors for non-adherence were; fear from side effects (21.8 %), specific reasons (such as; taste, having balanced diet is enough), (9.9 %), it might be harmful to the mother or the baby (8.1 %), and might deliver a big size baby (1.8 %). Specific feared side effects by these women were constipation, changing stool color, abdominal pain, other side effects, and diarrhea at rates; 34.2%, 12.7%, 8.5 %, 6.4 %, and 2.8 %, respectively. Diarrhea was the only significant side effect when comparing women in the 2 commitment categories at α=0.031. On a 1-3 scale, women’s mean knowledge about iron supplements ranged from 1.5-3 (middle to high). Regardless, 40% of participants think that folic acid is same as iron, and about 60 % think iron should be taken from date of conception. Majority of these women have poor knowledge about causes of anemia, its complications on mother or fetus, and iron-rich diets. Hemoglobin levels differ significantly according to women`s awareness of iron- supplements, α=0.000. Conclusion: Determinants of adherence to iron supplement can be with maternal education, number of visits to antenatal clinics, and knowledge about the importance and duration of iron-supplement. Women mix GIT symptoms with iron-intake complications. A cutoff line between these symptoms is still blurred and need more investigation.

Keywords: Iron-deficiency anemia, iron-folic acid supplement, adherence, awareness, antenatal clinic, determinant, pregnancy.