Determinants of Knowledge and Adherence to Iron and Folic Acid Supplementation Among Pregnant Women: An Analytical Cross-Sectional Study

ABSTRACT Background: Iron and folic acid supplementation (IFAS) is one of the key strategies to counter the anaemia of pregnancy but non-adherence to supplementation is a major challenge in India. Understanding the determinants of knowledge, attitudes and adherence among pregnant women is important to strengthening maternal health interventions. Methods: A cross-sectional analytical study was carried out among pregnant women attending antenatal clinics in the government health centers in Nellore District of Andhra Pradesh recruiting 150 pregnant women. A structured and validated questionnaire was completed to gather socio-demographic characteristics, knowledge about anemia and about IFAs, adherence patterns (amount of pills and 7-day recall) and psychosocial determinants. Statistical analyses comprised descriptive statistics and chi-square and multivariate logistic regression to determine independent predictive factors of adherence. Results: Only 40% of women showed good adherence of IFAS. Although 76.7% of the respondents knew about IFAS, only 48% of them knew the indicating sign, 40% knew the correct dosage and 36.7% knew the recommended duration. Common barriers were forgetfulness (56.7%), side effects (46.7%) and lack of counseling (40%). Adherence was reported to be significantly higher in women who were highly educated (secondary or more years of education) compared to those with less education (p < 0.01), those receiving structured pharmacist-led counseling (p < 0.01) and those with good supportive family members (p < 0.05). Logistic regression showed that maternal education (AOR = 2.6; 95% CI: 1.3-4.8) and structured counseling (AOR = 3.1; 95% CI: 1.5-6.2) were a significant independent predictor of good adherence. Conclusion: Adherence to IFAS is below the target level and is significantly governed by maternal education, family allotment, the standard of education and counselling concerning health. Pharmacist-led interventions with the inclusion of family could help with compliance and contribute to achieving improved maternal health outcomes.