Volume 8, Issue 6, November 2020, Page: 179-185
The Impact of Iron and Folate Adherence on the Prevalence of Anaemia in Pregnant Nigerian Women
Akinola Oyekemi Ifeoluwapo, Department of Haematology and Blood Transfusion, Edo University, Iyamho, Nigeria
Uwaibi Noel, Department of Community Medicine, Edo University, Iyamho, Nigeria
Nwagu Marcellinus Uchechukwu, Department of Haematology and Blood Transfusion, Edo University, Iyamho, Nigeria
Ohenhen Victor, Department of Obstetrics and Gynaecology, Central Hospital, Benin City, Nigeria
Egbo Ojevwe Harrison, Department of Anatomical and Histopathology, Edo University, Iyamho, Nigeria
Erhabor Osarenokemen Julie, Department of Obstetrics and Gynaecology, Stella Obasanjo Women and Children Hospital, Benin City, Nigeria
Omozuwa Eghosasere Sunday, Department of Obstetrics and Gynaecology, Edo University, Iyamho, Nigeria
Omokhua Gabriella, Department of Medical Microbiology, Edo University, Iyamho, Nigeria
Adeyemi Oluwafemi, Department of Haematology and Blood Transfusion, Edo University, Iyamho, Nigeria
Received: Oct. 27, 2020;       Accepted: Nov. 5, 2020;       Published: Nov. 11, 2020
DOI: 10.11648/j.jgo.20200806.15      View  37      Downloads  26
Abstract
Introduction: The impact of adherence to taking prescribed medications for chronic illnesses has been widely studied with a view to understanding its role on disease burden. This has been extrapolated to the physiologic pregnancy state, where women are expected to take haematinics due to their susceptibility to anaemia. The prevalence of anaemia in pregnancy is reportedly high with more burden on developing countries. This has led to the recommendation of iron and folate supplements for women during pregnancy. Methods: We set out to determine the level of adherence (and deterrents) to taking iron and folate supplements as well as the prevalence of anaemia in pregnant women (18-45 years old) attending antenatal care at the Stella Obasanjo Women and Children Hospital (SOWCH) and the Central Hospital in Benin City, Nigeria between July-December, 2019. An association between occurrence of anaemia and adherence level was also assessed. Results: 400 pregnant women participated in this study. The mean age (±SD) of the study population was 30±4 years, mean gestational age (±SD) was 31±5 weeks. Majority of the women (82.0%) were in their third trimester, 17.5% and 0.5% in second and first trimesters respectively. Total adherence scores obtained ranged from 0-8, with 63.5% being non-adherent to taking their iron and folate supplements. Factors that influenced adherence positively were higher income (p=0.00) and being employed (p=0.01). Top three identified reason for non-adherence were forgetfulness to take prescribed supplement (62.5%), feeling too bored to take supplements daily (44.3%) and unavailability of supplements (38.0%). The mean Hb (±SD) was 10.9±1.1g/dl. The prevalence of anaemia in pregnancy was 46.8%, with mild (43.8%) and moderate (3.3%) forms only. Of the non-adherent group, 69.7% were anaemic versus 30.3% of the adherent group. There was an association between the occurence of anaemia and non-adherence to taking supplements (p=0.01). Conclusion: There is a high level of non-adherence to taking iron and folate, prevalence of anaemia, and an association between them. Benefits of adherence to these supplements should be reinforced to women of child bearing age.
Keywords
Adherence, Anaemia, Pregnancy, Iron, Folate, Impact
To cite this article
Akinola Oyekemi Ifeoluwapo, Uwaibi Noel, Nwagu Marcellinus Uchechukwu, Ohenhen Victor, Egbo Ojevwe Harrison, Erhabor Osarenokemen Julie, Omozuwa Eghosasere Sunday, Omokhua Gabriella, Adeyemi Oluwafemi, The Impact of Iron and Folate Adherence on the Prevalence of Anaemia in Pregnant Nigerian Women, Journal of Gynecology and Obstetrics. Vol. 8, No. 6, 2020, pp. 179-185. doi: 10.11648/j.jgo.20200806.15
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
World Health Organization. Adherence to long-term therapies: evidence for action. Geneva, Switzerland, 2003.
[2]
DiMatteo M. R. (2004). Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research. Medical Care, 42: 200–209.
[3]
WHO guidelines. Daily iron and folate acid supplementation in pregnant women. World Health Organization. Geneva, 2012.
[4]
de Benoist B., McLean E., Egli I. and Cogswell M. (2008). Worldwide Prevalence of Anaemia 1993–2005: Who Global Database on Anaemia. WHO, Geneva, Switzerland.
[5]
Kumar P., Pore P. and Patil U. (2012). Maternal anemia and its impact on perinatal outcome in a tertiary care hospital of Pune, in Maharashtra. Indian Journal of Basic and Applied Medical Research, 1: 111-119.
[6]
World Health Organization. Standards for Maternal and Neonatal Care: Iron and Folate Supplementation: World Health Organization, 2006.
[7]
Mengist, H. M., Zewdie, O., and Belew A. (2017). Intestinal helminthic infection and anaemia among pregnant women attending ante-natal care (ANC) in East Wollega, Oromia, Ethiopia. BMC Research Notes, 10: 440. https://doi.org/10.1186/s13104- 017-2770-y.
[8]
B. Taye, G. Abeje, and A. Mekonen, (2015). “Factors associated with compliance of prenatal iron folate supplementation among women in Mecha district, Western Amhara: a cross-sectional study.” Pan African Medical Journal, 20: 43.
[9]
Ugwu E. O., Olibe A. O., Obi S. N. and Ugwu A. O., (2014). “Determinants of compliance to iron supplementation among pregnant women in Enugu, Southeastern Nigeria,” Nigerian Journal of Clinical Practice, 17: 608–612.
[10]
Morisky, D., Green, L., and Levine, D. (1986). Morisky Medication Adherence Scales: MMAS-4 and MMAS-8 MMAS-8 1), 8. Retrieved from https://www.thenationalcouncil.org/wpcontent/uploads/2017/03/5_Morisky_Medication_Adherence-Scale.pdf.
[11]
Nigerian National Minimum wage amended Act (2011). Available at www.ilo.org>docs.
[12]
Kominiarek M. A., and Rajan P. (2016) Nutrition Recommendations in Pregnancy and Lactation. Medical Clinics of North America, 100: 1199-1215.
[13]
Idowu O. A., Mafiana C. F., and Dapo S. (2005). Anaemia in pregnancy: A survey of pregnant women in Abeokuta, Nigeria. African Health Scencesi, 5: 295–299.
[14]
Ibrahim Z. K., Abd El-Hamid S., Mikhail H., and Khattab M. S. (2011). Assessment of Adherence to Iron and Folic Acid Supplementation and Prevalence of Anaemia in Pregnant Women. Medical Journal of Cairo University, 79: 115-121.
[15]
Seck B. C., and Jackson R. T. (2008). Determinants of compliance with iron supplementation among pregnant women in Senegal. Public Health Nutrition, 11: 596–605.
[16]
Kiwanuka T. S., Ononge S., Kiondo P., and Namusoke F. (2017). Adherence to iron supplements among women receiving antenatal care at Mulago National Referral Hospital, Uganda-cross-sectional study. BMC Research Notes, 10: 510.
[17]
Sawicki E., Stewart K., Wong S., Leung L., Paul E., and George J. (2011). Medication use for chronic health conditions by pregnant women attending an Australian maternity hospital. Australian and New Zealand Journal of Obstetrics and Gynaecology, 51: 333-338.
[18]
Osborn C. Y., Kripalani S., Goggins K. M., and Wallston K. A. (2017). Financial Strain is Associated with Medication Nonadherence and Worse Self-rated Health among Cardiovascular Patients. Journal of Health Care for the Poor and Underserved, 28: 499–513.
[19]
Fernandez-Lazaro C. I., Adams D. P., Fernandez-Lazaro D, Garcia-González J. M., Caballero-Garcia A., and Miron-Canelo J. A. (2018). Medication adherence and barriers among low-income, uninsured patients with multiple chronic conditions. Research in Social and Administrative Pharmacy, https://doi.org/10.1016/j.sapharm.2018.09.006.
[20]
Ba D. M., Ssentongo P., Kjerulff K. H., Na M., Liu G., Gao X., and Du P. (2019). Adherence to Iron Supplementation in 22 Sub-Saharan African Countries and Associated Factors among Pregnant Women: A Large Population-Based Study. Current Developments in Nutrition, 3: 120.
[21]
Ministry of Health, Federal Republic of Nigeria. National Health Insurance Scheme 2006.
[22]
Titilayo A., Palamuleni M. E., and Omisakin O. (2016). Sociodemographic factors influencing adherence to antenatal iron supplementation recommendations among pregnant women in Malawi: analysis of data from the 2010 Malawi Demographic and Health Survey. Malawi Medical Journal, 28: 1–5.
[23]
Agegnehu G., Atenafu A., Dagne H., and Dagnew B. (2019). Adherence to iron and folic acid supplement and its associated factors among antenatal care attendant mothers in Lay Armachiho health centers, Northwest, Ethiopia. International Journal of Reproductive Medicine, 2019: 5863737.
[24]
Nisar Y. B., Dibley M. J., and Mir A. M. (2014). Factors associated with non-use of antenatal iron and folic acid supplements among Pakistani women: a cross sectional household survey. BMC Pregnancy and Childbirth, 14: 305.
[25]
Fouelifack F. Y., Sama J. D., and Sone C. E. (2019). Assessment of adherence to iron supplementation among pregnant women in the Yaounde gynaeco-obstetric and paediatric hospital. Pan African Medical Journal; 34: 211. doi: 10.11604/pamj.2019.34.211.16446.
[26]
Matsui D. (2012). Adherence with drug therapying Pregnancy. Hindawi Obstetrics and Gynaecology International. Article ID 796590; 1-5. Doi: 10.1155/2012/796590.
[27]
Binetou C. S., and Robert T. J. (2008). Determinants of compliance with iron supplementation among pregnant women in Senegal. Public Health Nutrition, 11: 596-605.
[28]
Ikeanyi E. M., Ibrahim A. I. (2015). Does antenatal care attendance prevent anemia in pregnancy at term? Nigerian Journal of Clinical Practice, 18: 323–327.
[29]
Omote V., Ukwamedua H. A., Bini N., Kashibu E., Ubandoma J. R., and Ranyang A. (2020). Prevalence, Severity, and Correlates of Anaemia in Pregnancy among Antenatal Attendees in Warri, South-Southern Nigeria: A Cross-Sectional and Hospital-Based Study. Hindawi Anaemia. Article ID 1915231, 1-7. https://doi.org/10.1155/2020/1915231.
[30]
Bukar M., Audu B. M., Yahaya U. R., and Melah G. S. (2008). Anaemia in pregnancy at booking in Gombe, North-Eastern Nigeria. Journal of Obstetrics and Gynaecology, 28: 775–778.
[31]
Marahatta R. (2007). Study of anaemia in pregnancy and its outcome in Nepal Medical College Teaching Hospital, Kathmandu, Nepal Nepal Medical College Journal, 9: 270–274.
[32]
Msuya S. E., Hussein T. H., Uriyo J., Sam N. E., and Stray-Pedersen B. (2011). Anaemia among pregnant women in Northern Tanzania: Prevalence, risk factors and effect on perinatal outcomes. Tanzanian Journal of Health Research, 13: 33–39.
[33]
Sholeye O. J., Animashaun V. J., and Shorunmu T. O. (2017). Anaemia in pregnancy and its associated factors among primary care clients in Sagamu, Southwest, Nigeria: A facility-based study. Journal of Family Medicine and Primary Care, 6: 323–329.
[34]
Bothwell T. H. (2000). Iron requirements in pregnancy and strategies to meet them. American Journal of Clinical Nutrition, 72: 257S-264S.
[35]
Pena-Rosas J. P., De-Regil L. M., Dowswell T., and Viteri F. E. Daily oral iron supplementation during pregnancy. The Cochrane Database Systematic Review. 2012; 12: Cd004736.
[36]
Habib F., Alabdin E. H., Alenazy M., Nooh R. (2009). Compliance to iron supplementation during pregnancy. Journal of Obstetrics and Gynaecology, 29: 487–492.
[37]
Lindsay K. L., Gibney E. R., and McAuliffe F. M. (2012). Maternal nutrition among women from Sub-Saharan Africa, with a focus on Nigeria, and potential implications for pregnancy outcomes among immigrant populations in developed countries. Journal of Human Nutrition and Diet, 25: 534-546.
Browse journals by subject