Study design
An institutional based unmatched case control study was conducted to identify the determinant factors of adherence to iron-folate supplementation among post-natal mothers in Addis Ababa referral hospitals, Ethiopia, 2020. Addis Ababa is the capital city of Ethiopia.
Study area
This study was conducted in three referral hospitals of Addis Ababa, namely Zewditu Memorial Hospital (ZMH), Palouse hospital and Gandhi Memorial Hospital (GMH). Addis Ababa is the capital city of Ethiopia. The latitude of Addis Ababa is 9.005401, and the longitude is 38.763611.7 Based on the 2017 population projection, the total Population of the city is 3,273,001, among which 1,772,001 are women and 1,551,000 are men. According to Ethiopian Demographic and Health Survey (EDHS) 2011, the coverage of antenatal care (ANC) services, birth assistance by skilled provider, and postnatal care in the city were 93.6%, 83.9%, and 47.7%, respectively.8
Source and study population
The source population for this study was all women who were attending PNC follow up at Addis Ababa Gandhi, St. Paul, and Zewditu referral hospitals, Addis Ababa Ethiopia, during data collection time. All randomly selected women who were attending PNC follow up at Gandhi, St. Paul, and Zewditu referral hospitals, Addis Ababa Ethiopia, during the study period and those who fulfill the inclusion criteria were the study population.
Inclusion criteria and exclusion criteria
The inclusion criteria for this study were all postnatal mothers at Addis Ababa health referral hospitals during the study period were included and Mothers who were critically ill during the study and whose gestational age is below 37 weeks (preterm delivery) were excluded from the study.
Sample size determination and sampling procedure
The sample size was calculated using Epi Info, Stat Calc, and considering 95% confidence level (CI) 80% power, control to case ratio of 2, minimum odd ratio of 2 (OR), and 10% non-response gave a minimum sample of 82 cases of adherence and 164 controls.
This study was conducted in three referral hospitals of Addis Ababa, namely Zewditu Memorial Hospital (ZMH), Palouse hospital and Gandhi Memorial Hospital (GMH).the number of participants per hospital was allocated based on the average number of mothers who attend PNC follow up per year. Previous PNC follow up per year for Zewditu Memorial Hospital, Palouse Hospital, Gandhi Memorial Hospital were 2471,2580,974, respectively. Based on this data and the sample size of the study, the participants of each hospital were selected using a systematic random sampling method with intervals of two.
Operational definition
Antenatal service: Pregnancy check-up by health personnel, provision of iron/folic acid supplements, tetanus vaccination and health education and counseling.
ANC follow up: A woman who had regular antenatal care four times during pregnancy period.
Cases: For this study, cases are women who took 90+ tablets during pregnancy period
Controls: Controls are women who took less than 90 tablets during their pregnancy period.
Adherence: Mothers are said to be adhered to IFA supplement if they took 90 or more of the supplement, during pregnancy period.
Non-adherence: Pregnant mother is said to be non-adherence to IFA supplement if they took less than 90 tablets during pregnancy period.
Trimester: The number of week during pregnancy (1st, 1-12 weeks, 2nd, 13-26 weeks, 3rd, 27-40 weeks).Gravidity: The number of pregnancy whatever the outcome.
Parity: The number of live births among pregnancy
Preconception folic acid supplementation: Standard recommendation of folic acid (400μg/day) for all women from the moment they begin trying to conceive until 12 weeks of gestation should take folic acid supplements.
Close family member: Are individuals who are related by blood and it includes grandparents, parents, siblings and children.
DDS: Number of food groups consumed in the previous day will be added and Lowest dietary diversity is (≤ 3 food groups), Medium dietary diversity (4 and 5 food groups) and High dietary diversity (≥ 6 food groups).
Knowledge: From those knowledge questions asked those who answer less than two answers have poor knowledge and those who answer more than two answers have good knowledge.
Data collection and Analysis
The data collection instruments were questionnaire contents included socio-demographic, obstetric history, Health facility and knowledge related variables, dietary and nutritional factors, and pre-conception related variables. Women who took more than nighty tablets were considered to have adhered to the supplementation.
The quaternary was pretested on 12 women of similar population at Tikur Anbesa hospital. Data were collected and supervised by six BSc nurses. Both data collectors and supervisors were trained on how to collect the data and how to use the data collection instruments. The supervisors checked the completeness of the data every day.
The collected data were entered, coded and cleaned using Epi DATA version 7.2, and the data management and analysis were performed using SPSS version 20.0 software. Socio-demographic, obstetric, heath faculty and knowledge related variables, dietary and nutritional factors, and pre-conception related factors of women were presented in text and tables. Bivariate analysis was done and variables with less than 0.25 P-values were included in the multiple logistic regression analysis. In the multivariable analysis, predictors with P-value less than 0.05 were considered statically significant.