Publications

Abstract

Background: Despite ongoing iron supplementation programmes, the prevalence of iron deficiency anemia in India is high. Alleged poor adherence to prescribed iron and folic acid supplements is an often-cited reason for poor outcome of the iron supplementation programme.

Objective: To assess the levels of adherence to iron supplements in pregnancy and to identify the barriers of adherence to iron supplements in pregnancy, at an antenatal clinic in Rural Karnataka. 

Methodology: This is a cross sectional study involving 150 pregnant women, on iron supplements for at least one month, at the antenatal clinic of a rural hospital near Bangalore, between March and May 2011. Adherence to iron supplements and its barriers were assessed using a pretested interviewer administered questionnaire. Adherence was defined as the percentage of prescribed doses consumed in the month prior to the interview. Good adherence was considered as an adherence rate of ≥ 80%. In addition, qualitative methods like focus group discussions and Key informant interviews were used to supplement quantitative data obtained.

Results: The mean age of the participants was 21.93 ± 2.44yrs, 97% were educated and 5% employed. Fifty seven percent were in their first pregnancy. Of the women, 86% were anemic, with mean hemoglobin level of 9.55 ± 1.47gm/dl. Forty two percent had adherence levels ≤80%. The most common reasons for non-adherence were medication side effects and forgetfulness. Encouragement from family determined adherence to iron supplements (p<0.05). 

Conclusions: The nearly 40% non-adherence to iron supplements implies that iron supplementation in some Indian settings is far from being successful. Side-effects of iron tablets followed by forgetfulness were the most common barriers of adherence identified in the study. Encouragement played an important role in adherence.