Assessment of Factors Associated with Adherence to Iron-Folic Acid Supplementation Among Urban and Rural Pregnant Women in North Western Zone of Tigray, Ethiopia: Comparative Study

Introduction: Iron deficiency is the leading nutrient deficiency in the world affecting the lives of more than 2 billion people, accounting to over 30% of the world’s population. Pregnant women are particularly at high risk of iron deficiency. Objective: To determine and compare the adherence rate and identify factors associated with iron folic acid supplementation among urban and rural pregnant women attending antenatal clinics in North Western Zone of Tigray, Ethiopia. Methods: An institution based comparative cross sectional study was employed among 358 urban and 356 rural pregnant women attending antenatal clinics in North Western Zone of Tigray from March to April 2014. Logistic regression analysis was used to identify factors associated with adherence to iron-folic acid supplementation among urban and rural pregnant women. All tests were two-sided and p value < 0.05 was considered statistically significant. Results: The rate of adherence to iron folic acid supplementation among the pregnant women in the urban and rural communities was 37.2% (95%CI, 32.26%42.25%) and 28.9% (95%CI, 24.4%-33.81%) respectively indicating that there was no significant difference among the two groups with regard to adherence to iron-folic acid supplementation. The independent predictors for maternal adherence to iron folic acid supplementation were early registration (AOR= 1.778, 95% CI= 1.076– 2.936), having four or more visits (AOR=3.784, 95%CI=2.073-6.909), previous anemia (AOR=1.913, 95%CI=1.135-3.223), and current anemia (AOR= 0.408, 95%CI=0.224-0.744) for urban pregnant women. Similarly, elderly age (AOR=0.527, 95%CI=0.315-0.881), early registration (AOR=1.918, 95%CI=1.116-3.296), previous anemia (AOR= 2.472, 95%CI=1.352-4.517) and current anemia (AOR=0.400, 95%CI=0.214-0.749) were the independent predictors for maternal adherence to iron folic acid supplementation for the rural pregnant women. Conclusion: Adherence rate to iron-folic acid supplementation in both urban and rural communities were very low. Comprehensive nutrition education should focus on the importance of adherence to iron folic acid tablets both for urban and rural pregnant women.