Date Published: May 13, 2019
Publisher: F1000 Research Limited
Author(s): Mary Kamau, Samuel Kimani, Waithira Mirie.
Background: The increased demand for iron and folic acid during pregnancy is not met through diet due to insufficiency or reduced bioavailability of nutrients among women from low income countries. Thus, iron and folic acid supplementation (IFAS) is a promising interventional strategy for control of anaemia during pregnancy. Kenya adopted the global IFAS intervention with a target of 80% coverage by 2017, however, the compliance remains low. Increasing awareness, counselling, communication and community education on IFAS have improved compliance among pregnant women. Thus, we aimed to determine: IFAS knowledge, availability, practices, and content of IFAS counselling among pregnant women attending health facilities in Kiambu County, Kenya.
Nutritional status during conception and pregnancy is a predictor of maternal and infant outcomes
1. Pregnancy increases metabolic activity including demand for macro and micro nutrients, particularly iron and folic acid. The levels of body stores for most critical nutrients, particularly iron and folate, are usually suboptimal by the time of conception among most women in developing countries, thus their requirement is greater resulting in a need for supplementation. This implies that a slight decrease in haemoglobin levels in pregnant women can cause anaemia which can result in severe and often fatal consequences especially if not addressed early
2. The consequences include increased risk of mortality, morbidity, postpartum haemorrhage, and poor birth outcomes, including foetal growth retardation, preterm births and low birthweight
This was a cross-sectional study conducted between June and October 2016 involving 364 pregnant women, from Kiambu County, Kenya. Using two stage cluster sampling, one Sub-County (Lari) and five of its major public health facilities (Lari, Githirioini, Kagwe, Kagaa, and Kinale) were selected for the study. The Sub-County was selected on the basis of having existing functional community units (with active community health volunteers in health care activities implying completeness in health care provision at level one of health care service delivery). The study population consisted of all pregnant women who attended antenatal care in the selected health facilities who were: aged 15–49 years, below 33 weeks in their pregnancy gestation, not suffering from any chronic illness and who provided informed consent to participate in the study.
The objectives of this study were to assess maternal knowledge on iron and folic acid supplementation, availability of IFAS counselling documents in health facilities, practices and content of IFAS counselling information provided to pregnant women in health facilities and determine the association between content of counselling information and level of maternal knowledge on IFAS. The study was based at the antenatal clinic where IFAS services are provided. Health care providers, specifically nurses, working in those antenatal clinics are expected to provide IFAS counselling information together with the supplements as part of Focused Antenatal Care (FANC) to all pregnant women attending antenatal care in all public health facilities in Kenya. The Ministry of Health, through the Division of Nutrition, where micronutrient deficiency control and supplementation programmes fall, is supposed to facilitate quality counselling on IFAS by providing the appropriate job aids including IEC materials and counselling guides on IFAS.
Findings from this study indicate that less than half of the pregnant women had high IFAS knowledge, IFAS documents were scarce in health facilities, there was limited and varied IFAS counselling information in different health facilities and content of counselling was associated with levels of knowledge on IFAS among pregnant women. Counselling information on the duration of IFAS supplementation, IFAS side effects and their management were significantly associated with high levels of knowledge on IFAS among pregnant women. This underscores the need to strengthen focused and targeted counselling for women attending antenatal clinic to improve compliance and pregnancy outcomes. The researchers recommend provision of IFAS documents and IEC materials to peripheral health facilities, standardization of counselling content provided on IFAS and formal involvement of community health workers in the IFAS programme for closer follow-up and counselling of the pregnant women at community level. Further, intervention studies are recommended that allow for causal inferences.
Verbal and written informed consent was provided by all the study participants before recruitment into the study.
The data underlying this study is available from Open Science Framework Dataset 1: Knowledge and counselling, Dataset 2: Observation checklist-counselling. DOI
https://doi.org/10.17605/osf.io/x8tj333. This dataset is available under a CCO 1.0 Universal license