Factors Influencing Adherence to Iron and Folic Acid Supplementation among Pregnant Women attending Antenatal Care in Rubanda District, South Western-Uganda

Purpose: Globally, about 40% of pregnant women have anemia. Pregnant women are at high risk of iron and folic acid deficiency anemia due to increased nutrient requirement during pregnancy. Iron/folic acid supplementation with optimal adherence is the main cost-effective strategy for prevention of iron deficiency anemia in pregnant women. However, there remains poor adherence to iron and folic acid supplementation in pregnancy in many countries especially low-income countries. The aim of this study was to evaluate the level of adherence and the factors influencing adherence to iron and folic acid supplementation among pregnant women attending antenatal care in Rubanda District, south Western-Uganda. 
Methodology: A multi-Health facility based observational and descriptive cross-sectional study was done. One hundred seventy two (172) pregnant mothers attending antenatal clinic in six selected health facilities in Rubanda District were enrolled in this study from December 2021 to March 2022. The interviewer administered questionnaire was used to study the participant characteristics and logistic regression was used to identify the factors influencing adherence to iron and folic acid supplements. 
Findings: Majority of women were aged between 20-29 years (57.56%), married (94.77%) and unemployed (80.23%). More than half of the respondents (62.21%, 95% CI 54.89%-69.53%) had taken at least 80% of the prescribed iron and folic acid tablets. This reflected good adherence level. Factors independently influencing adherence included maternal age below 20 years (aOR 3.83, 95% CI 1.12-13.08, p-value 0.032), age between 20-29 years (aOR=4.86, 95%CI: 2.03-11.63, p value <0.001), adherence partner (aOR=2.82, 95%CI: 1.34-5.91, pvalue <0.001) and being counselled on importance of iron and folic acid tablets (aOR=4.42, 95%CI: 2.08-9.42, p-value <0.001). 
Recommendations: Intensive counselling during antenatal care about the importance of iron and folic acid supplements should be done on a daily basis with particular attention to women aged 30 years and above.