title: Coverage, compliance and factors associated with utilization of iron supplementation during pregnancy in eight rural districts of Ethiopia: a cross-sectional study.
abstract: BACKGROUND
  Despite the efforts to reduce iron deficiency during pregnancy, information on the coverage and factors associated with utilization of iron supplements is lacking. The study is intended to assess the coverage, compliance and factors associated with the use of prenatal iron supplements in eight rural districts of Ethiopia.
  
  
  METHODS
  The study comprised two independent surveys conducted among pregnant women (n = 414) and women who gave birth in the preceding year of the survey (n = 1573). In both cases, respondents were selected using multistage sampling technique and data were collected via structured questionnaire. Predictors of iron supplement utilization (ranked categories of number of prenatal supplements taken) were identified using ordinal logistic regression. The outputs of the analysis are given using adjusted Odds Ratio (OR) with 95% Confidence Interval (CI).
  
  
  RESULTS
  Among women who gave birth in the preceding year, 35.4% (95% CI: 31.3-39.5) were given/prescribed prenatal iron supplement during the index pregnancy and only 3.5% were supplemented for the recommended 91 or more days. Compared to women who had 4 or more ANC visits, those with 0, 1, 2 and 3 visits had 0.04, 0.33, 0.50 and 0.60 times less odds of iron supplement utilization, respectively. Women lacking comprehensive knowledge of anemia (OR = 0. 75 (95% CI: 0.57-0.97)) and those who weren't informed about the importance of iron supplementation during the pregnancy (OR = 0. 05 (95% CI: 0.04-0.07)) had significantly lower utilization. On the other hand, in pregnant women the prevalence of anemia was 33.2%. Among pregnant women who were given/prescribed supplements, the average level of compliance was 74.9% and about 25.1% had less than 70% adherence. The leading reported reasons for non-adherence were side-effects (63.3%) and forgetfulness (16.7%).
  
  
  CONCLUSIONS
  Promoting early and frequent ANC, enhancing the quality of ANC counseling and promoting the knowledge of women on anemia are essential strategies for improving the utilization of iron supplements.
authors.affiliation: School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia. samsongmgs@yahoo.com.
authors.forename: Samson
authors.initials: S
authors.lastname: Gebremedhin
authors.forename: Aregash
authors.initials: A
authors.lastname: Samuel
authors.forename: Girma
authors.initials: G
authors.lastname: Mamo
authors.forename: Tibebu
authors.initials: T
authors.lastname: Moges
authors.forename: Tsehai
authors.initials: T
authors.lastname: Assefa
mesh_terms: D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D019587:Dietary Supplements / Q000706:statistics & numerical data*; D005002:Ethiopia; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007501:Iron / Q000008:administration & dosage / Q000627:therapeutic use*; D016015:Logistic Models; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000517:prevention & control*; D037841:Pregnant People; D011295:Prenatal Care / Q000379:methods / Q000706:statistics & numerical data; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D007501:Iron