Sorro district is one of the ten woradas and two urban adminstrations in Hadiya zone. It is located in 262km from Addis Ababa and 32 km from zonal capital, Hossana. The total population of Sorro district is 268281 and female accounts 134673(50.2%) as reported by the district’s finance and economic development office in 2017G.C. The total number of households at the district estimated to be 29126 .
Community based cross sectional study was employed to assess the status of and factors associated with compliance of iron folic acid supplements among pregnant women at the study area.
Inclusion and Exclusion criteria
All women who lived in rural Soro district at least for 6months and gave live birth 12 months prior to the survey. Mothers who were severely sick and unable to respond excluded from the study. Additionally mothers who can’t talk and hear due to disability were not included in the study.
Source and study population
The source population was all mothers who live in rural Soro district and gave birth one year prior to the date of interview. The study population of this study was all mothers who gave birth within one year prior to the date of survey and selected for the study.
Sample Size determination
To estimate the sample size for compliance of IFA supplementation among women single proportion formula was used by using the following assumptions: Anticipated Proportion of mothers compliant of IFA supplementation is 20.4 % , 5% type I error, margin of error 5 % and 10% contingency for the non response. By considering non-response rate of 10%, the final sample size was 274 women who gave birth 12 months before the date of the survey.
Sampling Techniques and Procedures
Soro district was chosen purposively out of ten rural districts in Hadiya Zone. Then twelve rural kebeles (smallest administrative units) were selected randomly by using lottery method out of 46 rural kebeles found in Sorro district. The list of households having women with children less than one year was registered by using health development armies from each selected kebeles. Then the sample size was allocated proportionally for each kebele. After preparing the sampling frame simple random sampling method was applied to collect data from the index mother.
A mother was categorized as adherent for IFA supplements during pregnancy if she has reported as at least 90 doses of iron folic acid supplements were taken during her last pregnancy .
Data collection procedures
Quantitative data were collected by using pretested structured questionnaire adopted from EDHS and different literatures which were designed to assess maternal health care practices in developing countries. Questionnaire was prepared by English language and translated to local language, Hadiyissa and back translated to English by fluent speakers of the two languages. Intensive training was given for supervisors and data collectors on the purpose of study, how to handle questionnaires, how to conduct data collection and on ethical consideration. Then data were collected by using twelve trained female data collectors who were fluent in local language Hadiyissa with prior experience of participation in data collection. Four BSc health professionals were participated on supervision of the data collection process. Five percent of the questionnaires were pre tested before actual data collection period. Strict supervision was done by supervisors and the overall quality of the data collection was monitored by investigators of the study. Data were collected from June 10 up to 20, 2018. Data collectors submit daily collected data for supervisors and the collected data had been checked for completeness, consistency and any error was being corrected immediately.
Dependent variable: adherence of IFA tablets during pregnancy
Socio demographic and economic characteristics, maternal health service related characteristics, obstetric characteristics and knowledge of IFA supplementation and anemia. Knowledge on anemia was assessed by asking questions about causes, symptoms, prevention and treatment of anemia. Similarly knowledge according to IFA was assessed by asking questions about uses of IFA tablets, duration of adequate intake, time of starting supplements and side effects. Correct answer scored one point and incorrect answer scored zero. Those who had correctly answered more than 80% of anemia and iron folic assessing questions were decided as having high knowledge on anemia and IFA. Additionally those mothers who had correctly responded 60-80% and less than 60% of knowledge assessing questions were also categorized as medium and low knowledge of anemia and IFA respectively .
Data processing, analysis and presentation
After field work data was checked for completeness and consistence before data entry and cleaning. Then Data was entered on Epi info version 3.5.4 and exported to SPSS for windows version 16 (SPSS Inc. version 16, Chicago, Illinois) to do analysis. Descriptive summary was presented by using frequencies, proportions, means and tables. Household socioeconomic data was collected based on household assets and analyzed by using principal component analysis. Both bivariate and multivariable logistic regression analysis was used to assess the association of independent variables with outcome variable and to control the possible confounding factors. Compliance of IFA supplements was coded as “1” while noncompliance of IFA supplements was coded as “0” for running logistic regression analysis. Odds ratio with 95% confidence interval was used to assess strength of association. Any significantly associated variable with p-value less than or equal to 0.25 during bivariate analysis was candidate for multivariable analysis. Finally during multivariable analysis an independent variable with P-value less than 0.05 was considered as statistically significant and an independent predictor of compliance of iron supplements during pregnancy.