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Counselling and knowledge on iron and folic acid supplementation (IFAS) among pregnant women in Kiambu County, Kenya: a cross-sectional study.

ABSTRACT: 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. Methods: A cross-sectional study involving 364 pregnant women aged 15-49 years. A two stage cluster sampling, including one sub-county and five public health facilities were used. A pre-tested, structured questionnaire consisting of socio-demographic data, maternal knowledge and counselling on IFAS was used. An observation checklist was used to observe practices and content of antenatal counselling session in each facility. Data was analysed using STATA in which descriptive and inferential statistics were computed. Results: Of 364 respondents, less than half (40.9%) scored high on knowledge on IFAS. Women who were counselled on duration of IFAS intake, side effects, and their mitigation were more likely (p <0.005) to have high IFAS knowledge. Although all the health facilities had varied IFAS posters displayed, none had key IFAS counselling documents. Conclusion: Less than half of the pregnant women had high IFAS knowledge, IFAS documents were scarce in health facilities, IFAS counselling information in different health facilities was limited and varied, and content of counselling was associated with levels of knowledge on IFAS. This underscores the need to strengthen focused and targeted IFAS counselling for pregnant women and standardization of counselling messages to improve compliance and pregnancy outcomes.

SUBMITTER: Kamau M

PROVIDER: S-EPMC7118767 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:INTRODUCTION:Iron and Folic Acid Supplementation (IFAS) is an essential and affordable intervention strategy for prevention of anaemia during pregnancy. The supplements are currently provided for free to pregnant women in Kenya during antenatal care (ANC), but compliance remains low over the years. There is need for diversification of IFAS programme implementation by exploring other distribution channels to complement existing antenatal distribution and ensure consistent access to IFAS supplements. OBJECTIVES:To determine the effect of a community-based approach of IFAS distribution on compliance and assess side-effects experienced and their mitigation by pregnant women in Kiambu County. METHODOLOGY:A pretest-posttest quasi-experimental study design was used, consisting of an intervention and a control group, among 340 pregnant women 15-49 years, in five health facilities in Lari Sub-County in Kiambu County, between June 2016 and March 2017. Community health volunteers provided IFAS supplements, counselling and weekly follow-up to pregnant women in the intervention group while the control group followed standard practice from health facilities. Baseline and endline data were collected during antenatal care and compared. Quantitative data was analyzed using STATA version 14. Analysis of effect of intervention was done using Difference-In-Difference regression approach. RESULTS:Levels of compliance increased by 8% in intervention group and 6% in control group. There was increased awareness of IFAS side-effects across groups. The intervention group reported experiencing less side-effects and were better able to manage them compared to the control group. CONCLUSION:Implementation a community-based approach improved maternal compliance with IFAS, awareness of IFAS side effects and their management, with better improvement being recorded in the intervention group. Hence, there is need to integrate community-based approach with antenatal distribution of IFAS to improve supplementation.

Project description:BackgroundThe knowledge possessed by healthcare workers (HCWs), along with their attitudes and practices play a vital role in effectively managing a pandemic. This is crucial considering that HCWs are exposed to great risk at the forefront of such crises. We aimed to describe the knowledge, attitude, and practices (KAP) of HCWs during the COVID-19 pandemic in Kiambu county, Kenya.MethodsA cross-sectional study using a structured questionnaire was conducted from 11th March 2021 to 12th August 2021. Bloom's cutoff points were used to determine KAP scores (>80%: good, 60-79%: medium and <60% poor). Multivariable ordinal logistic regression analyses were conducted, calculating adjusted odds ratios (AOR) at a 95% confidence interval. Spearman's rank correlations were used to examine the relationship between KAP scores.Results438 HCWs participated in the study, majority of whom were female (64.5%), had obtained a diploma (59.6%) and were informed through government websites (78.6%). 43.0% had good knowledge, 17.5% good attitudes, and 68.4% good practice. 23.0% had medium knowledge, 35.6% medium attitude, 15.7% medium practice, while 34.0% had poor knowledge, 46.9% poor attitude and 15.9% poor practice. Only 68.9% of the caregivers correctly recognized the county's COVID-19 isolation centre and only 7.9% chose the two correct documents for the entry of data for a suspected COVID-19 case. Furthermore, the general attitude towards their own personal safety and their training regarding PPEs (17.8% and 23.8% strongly agreed with the contrary) were less compelling. There was a significant positive association between obtaining information from international government sites [AOR: 1.382 (1.058-1.807); p = 0.0178)] and good knowledge. Referring to local government sites for information regarding COVID-19 produced better attitudes [AOR: 1.710 (1.194-2.465); p = 0.0036] and produced almost twice the odds of having better practice [AOR: 1.800 (1.181-2.681); p = 0.0048]. There was a significant correlation between knowledge and practice (r = -0.330, p = 2.766×10-11), and knowledge and attitude (r = -0.154, p = 6.538×10-3).ConclusionThis study emphasizes the substantial impact that governing bodies have on shaping favorable KAP. As a result, it's crucial for local government platforms to prioritize the dissemination of up-to-date information that aligns with international standards. This information should be tailored to the specific region, focusing on addressing deficiencies in healthcare practices and patient management. The identification of a significant number of HCWs lacking confidence in managing COVID-19 patients and feeling unprotected underscores a clear need for improvement in their understanding and implementation of preventive measures. This gap can be bridged by adequately equipping HCWs with locally manufactured PPEs. This aspect is crucial for pandemic preparedness, and we further advocate for the creation of a locally produced repository of medical equipment. These actions are pivotal in improving future crisis management capabilities.

Project description:ABSTRACT Background: Data on cervical cancer knowledge, perceptions, screening practices and other relevant health behaviours among women in rural Kenya is limited. Yet understanding this information is a key first step in developing evidence-based interventions aimed at addressing the low uptake of screening services and heavy cervical cancer disease burden within Kenya. Consequently, our study sought to assess cervical cancer knowledge, attitude, and practice amongst women of reproductive age within Kiambu County, known for a high cervical cancer disease burden. Methods: This was an analytical cross-sectional study undertaken in April 2022. Data was collected using interviewer-administered questionnaires from 472 females randomly selected from within the community. Data analysis included descriptive statistics (mean values, standard deviations, and frequencies) and logistic regression, using STATA version 13. Results: More than 80% of respondents were aware of cervical cancer though only 54% answered at least half of the knowledge questions correctly. Knowledge of HPV was particularly low, likely because 55% of the study sample stated they had never heard of HPV. Though 89% of study participants deemed cervical cancer preventable, more than 60% had an unfavourable attitude towards cervical cancer screening, deeming the process expensive, painful, and embarrassing. In line with the latter observation, only 20% of our sample had ever been screened for cervical cancer and less than half of this group had undergone regular screening. Notably, knowing a place where cervical cancer screening services are provided had the largest increase in odds of being screened (3.94; 95% CI: 1.08–14.37). Fear of tests and outcomes was also noted to be a prime concern amongst our study participants. Conclusion: A clear message from this study is the need to ensure community members are aware of where to access screening services and strategies are implemented to address prevalent fears and negative perceptions. Abbreviations: CHV: Community Health Volunteers; HPV: Human papillomavirus; HIV/AIDS: Human immunodeficiency virus/Acquired immune deficiency syndrome; LEEP: Loop Electrosurgical Excision Procedure; LMICs: Low- and Middle-Income Countries; NCI: National Cancer Institute; NACOSTI: National Commission for Science, Technology, and Innovation; VIA: Visual inspection with acetic acid; VILLI: Visual inspection with Lugol’s iodine; WHO: World Health Organisation

Project description:ObjectivesIron-folic acid non-compliance is a major problem in the study area. Therefore, this study aimed to assess the level of iron-folic acid supplementation compliance and associated factors among pregnant women.MethodsA community-based cross-sectional study design was conducted among pregnant women from 1 to 30 November 2018 in Dangila, Northern Ethiopia. A multi-stage sampling technique was used to select the participants. The data were collected using a structured questionnaire. For data entry and analysis, Epi Info 7 and Statistical Package for Social Science (SPSS) 23.0 were used, respectively. Bivariable and multivariable logistic regression analyses were done. Descriptive statistics like mean and standard deviation, and odds ratios with their respective confidence intervals were calculated. Statistically significant was declared at a p value of less than 0.05. The results were presented using text, tables, and figures.ResultsA total of 589 pregnant women were involved, yielding a response rate of 91.2%. The average age of the participants in the study was 30.90 ± 5.93 years. The average weekly iron-folic acid pill intake was 5.3. The iron-folic acid compliance rate was 76.9% (95% confidence interval: 73.5-80.6). Women who had four or fewer alive children (adjusted odds ratio = 2.68, 95% confidence interval: 1.37-5.23), took less than 30 min to get to the health facility (adjusted odds ratio = 1.90, 95% confidence interval: 1.16-3.10), being a government employee (adjusted odds ratio = 0.16, 95% confidence interval: 0.03-0.81), attended antenatal care conferences (odds ratio = 2,95% confidence interval: 1.16-3.42), and started iron-folic acid tablets in the first trimester (odds ratio = 2.3, 95% confidence interval: 1.39-3.87) were associated with iron-folic acid compliance.ConclusionThe level of iron-folic acid supplementation compliance was low. Attending antenatal care training and starting to take iron-folic acid pills early in the first trimester were both factors associated with iron-folic acid supplementation compliance. Health care and health extension workers should emphasize and monitor the iron pill-taking habits of pregnant women in home-to-home visits.

Project description:BackgroundIron and Folic Acid Supplementation (IFAS) is recommended by World Health Organization as part of antenatal care to prevent anaemia in pregnancy. In 2010, Kenya adopted this recommendation and the current policy is to provide one combined IFAS tablet for daily use throughout pregnancy, free of charge, in all public health facilities. However, adherence remains low over the years though anaemia in pregnancy remains high. Integration of IFAS into community-based interventions has been recommended because of its excellent outcome. Using Community Health Volunteers (CHVs) to distribute IFAS has not been implemented in Kenya before.MethodsFollowing an intervention study implementing a community-based approach for IFAS in five public health facilities in Lari Sub-County, 19 interviews were conducted among CHVs, nurses and pregnant women participating to describe their experiences. Thematic analysis of data was done using NVivo and findings described, with use of quotes.FindingsThe nurses, CHVs and pregnant women were all positive and supportive of community-based approach for IFAS. They reported increased access and utilization of both IFAS and antenatal services leading to perceived reduction in anaemia and better pregnancy outcomes. Counselling provided by CHVs improved IFAS knowledge among pregnant women and consequent adherence. The increased IFAS utilization led to main challenge experienced being IFAS stock-outs. All participants recommended complementing antenatal IFAS distribution approach with community-based approach for IFAS.ConclusionUsing CHVs to implement a community-based approach for IFAS was successful and increased supplement awareness and utilization. However, the role of CHVs in IFAS programme implementation is not clearly defined in current policy and their potential in IFAS education and distribution is not fully utilized. All participants endorsed integration of community-based approach for IFAS into the antenatal approach to enhance IFAS coverage and adherence among pregnant women for better pregnancy outcomes.

Project description:BACKGROUND:Despite the supplementation of iron-folic acid is the recommended strategy during the antenatal period; iron deficiency anemia is the commonest hematologic complication during pregnancy. Therefore, this systematic review and meta-analysis aimed to assess the level of adherence to iron-folic acid supplementation and its associated factors among pregnant women in Ethiopia. METHODS:Systematic review and meta-analysis guideline was followed for this study. Different online databases were used for the review: PubMed, HINARI, EMBASE, Google Scholar and African Journals Online. Different searching terms were applied based on the adapted PICO principles to achieve and access all the essential articles. The data were entered and analyzed using Microsoft Excel and Stata 11 software respectively. RESULTS:Fifteen studies were included in this systematic review and meta-analysis with a total of 5808 pregnant women. The overall pooled prevalence of adherence to iron-folic acid supplementation among pregnant women in Ethiopia was 41.38% (95% CI: 33.09, 49.67). Having secondary and above educational status of the women (AOR:2.68,95%CI:1.25, 5.74), having an early registration of antenatal care follow-up (?16?weeks) (AOR:2.54,95%CI:1.99, 3.24), having anemia complication during current pregnancy (AOR:3.01,95%CI:1.88, 4.81), having good knowledge of iron-folic acid supplementation (AOR: 2.96, 95%CI:1.76, 4.99), having four times or more antenatal care follow up (AOR:3.66, 95%CI:2.81, 4.77), getting health education about benefit of iron and folic acid (AOR:2.62,95%CI:1.46,4.72), and having good knowledge about anemia (AOR:2.99,95%CI:2.32, 3.85) were associated risk factors for adherence to iron-folic acid supplementation. CONCLUSION:The overall pooled prevalence adherence of IFAS among pregnant women was lower than the WHO recommendations. Educational status, early registration of ANC, anemia in the current pregnancy, good knowledge of IFAS, number of ANC visits, good knowledge of anemia and receiving health education about the benefit of IFAS were factors associated with the adherence of IFAS among pregnant women in Ethiopia. This finding is important to design strategic policies and to prevent anemia and congenital anomaly resulted from inadequate intake of iron and folic acid.

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Counselling and knowledge on iron and folic acid supplementation (IFAS) among pregnant women in Kiambu County, Kenya: a cross-sectional study.

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