Compliance with iron-folate supplementation among pregnant women in Southern Ethiopia: a multi-center cross-sectional study

BackgroundIron-folate supplementation is a vital and economical approach to preventing iron deficiency anemia in pregnant women. The World Health Organization targets 70% compliance, while Ethiopia's 2030 National Nutrition Program-II aims for 50% of pregnant women receiving iron-folate for 90 days by 2023. Despite various initiatives, compliance in Ethiopia continues to be low. This study examined compliance with iron-folate supplementation and its influencing factors among pregnant women in Southern Ethiopia.MethodsA multi-center cross-sectional study was conducted among 604 systematically selected pregnant women from April 1 to 30, 2022, using structured interviewer-administered questionnaires. Data were collected via the open data kit application and analyzed in the SPSS version 25 software. Bivariable and multivariable analyses were used to identify factors associated with compliance. An odds ratio with a 95% confidence interval was used to assess the direction and strength of the association.ResultsIron-folate supplementation compliance was 47.7% [95% CI 43.71%, 51.68%]. Being an urban dweller [AOR: 2.8, 95% CI 1.70, 4.86], attending primary education [AOR: 2.0, 95% CI 1.13, 3.75], having secondary education or more [AOR: 5.3, 95% CI 2.83, 10.22], being multiparous [AOR: 1.9, 95% CI 1.05, 3.52], receiving home visits [AOR: 2.0, 95% CI 1.08, 3.83], receiving counseling on iron-folate [AOR: 2.5, 95% CI 1.30, 4.78], possessing good knowledge of iron-folate [AOR: 3.1, 95% CI 2.04, 4.72], and having a good understanding of anemia [AOR: 3.2, 95% CI 2.12, 4.88] were significantly associated with compliance.ConclusionIron-folate supplementation compliance among pregnant women in Southern Ethiopia is progressing towards the 2030 national nutrition program target, although it remains below World Health Organization recommendations. Therefore, it is crucial to strengthen home visits and counseling to enhance knowledge of Iron-folate and anemia, as well as ensure consistent intake of iron-folate.