Maternal Related Factors Associated with Compliance to Iron and Folic Supplementation among Pregnant Mothers in Machakos County

Iron is one of the essential nutrients that is responsible for synthesis of hemoglobin and whose demand increases during pregnancy. Iron and folate supplements are administered during pregnancy in order to cater for the increased demand during pregnancy to help supply the elements to both the fetus and the pregnant mother. According to the KDHS, 2014, in Kenya, the biggest challenge has been compliance to the supplements by the pregnant women, with only 14% of all pregnant women complying with the recommended schedule. This study therefore aims to examine the barriers that influence compliance to prenatal iron/folate supplementation among pregnant women in Machakos County. A facility based cross-sectional study was carried out in three sub-county hospitals within Machakos County. The facilities were randomly selected from seven sub-county hospitals. The study sampled a total of 204 pregnant women aged 18-49 years through systematic random sampling. Compliance to iron/folate was measured through Morisky medication compliance scale questionnaire. Data was collected through a structured questionnaire. Then organized and coded in to a computer software SPSS, version 24, for analysis. Logistic regression was done to assess possible associations and the strength of association was measured using odds ratio, with 95% confidence interval. Data was presented in forms of bar charts and tables. Three focus group discussions with health unit managers and administrators were done. The data from the focused group discussions was organized and emerging themes reported. Consent was sought before actual data collection Results: Majority of the respondents were between 21 years and 40 years, with a few above the age of 40 years. Expectedly 84% were married and 76% had secondary level of education. More than half of the mothers were casual workers and 69% of them received family support during pregnancy. Among the socio-demographic factors of the respondents, family support and level of education of the mother were significantly associated with adherence to iron and folate supplements. Compliance to the supplements was improved when the supplements were given in combined form. Provision of health education in pregnancy especially counseling on nutritional value of supplementing iron stores in the body and how to manage side effects of iron and folate supplements were significantly associated with compliance to iron and folate supplements. Past experience of the mothers' especially previous history of anemia, current haemoglobin level and bad obstetric history of the mother were found to increase compliance to the supplements. The study recommends the government of Kenya, through the County governments to develop policies on procurement and distribution of combined iron and folate supplement. This will promote availability of the drugs and improve compliance to the supplements.