Factors Influencing Folic Acid and Iron Supplement Use Among Pregnant Women at Hoima Regional Referral Hospital in Uganda

Nuwahereza Godie

Faculty of Clinical Medicine and Dentistry Kampala International University Western Campus Uganda


The study sought to assess adherence levels to Folic Acid and Iron supplementation among expectant women attending antenatal care at Hoima Regional Referral Hospital. Findings revealed a 58.8% adherence rate among pregnant mothers. Among adherents, the majority were younger than 30, Christians, rural residents, cohabiting, had primary education, and were homemakers. Notably, only a minority were experiencing their first pregnancy. Regarding awareness and advice, a significant percentage knew about the preventive benefits of Iron-folic acid supplements against anemia, had received advice on supplementation benefits and the necessity of not missing doses. However, awareness about the specific benefits, dosage, and sources of folic acid and iron was limited. While most attended early ANC visits, only a fraction knew about folic acid benefits and sources, the correct dosage, or foods containing folic acid. Additionally, just over half met the recommended ANC visit frequency. Factors influencing adherence were largely tied to demographics such as age, religion, residence, partnership status, education, and employment, alongside knowledge gaps about supplementation benefits and dosages. Conversely, behaviors like alcohol intake, late or infrequent ANC attendance, and negative experiences during ANC acted as barriers to adherence.

Keywords: Pregnancy, Anaemia, Antenatal Care, Folic acid, Iron supplementation.


Pregnancy is a period of a significant increase in iron requirement over and above the non-pregnant state [1, 2]. Although iron requirements are reduced in the first trimester because of the absence of menstruation, they rise steadily thereafter from approximately 0.8 mg per day in the first month to approximately 10 mg per day during the last 6 weeks of pregnancy [3]. The increased iron requirement is due to the expansion of maternal red blood cell mass for increased oxygen transport, including the transfer of iron, to both the growing fetus and the placental structures, and as a needed reserve for blood loss and lochia at parturition [4]. Due to increased iron requirements, pregnancy is also a period of increased risk for anaemia, thus, a high proportion of women become anaemic during pregnancy [5, 6]. Anaemia is diagnosed as a haemoglobin concentration of less than 11 g/dl for mild anaemia, between 7–9.9 g/dl for moderate anaemia, and less than 7g/dl considered as severe anaemia [7-9]. The World Health Organization recommends, as a part of antenatal care (ANC) programs, a standard daily oral dose of 30–60 mg iron and 400 μg folic acid supplements to begin as early as possible and continue throughout pregnancy [10, 11]. Getachew et al. [12] stated that daily Folic Acid and Iron Supplementation reduces anemia and various adverse obstetric outcomes such as preterm delivery, low birth weight, hemorrhage, perinatal and maternal morbidity, and mortality, lowered resistance to infection, poor cognitive development and reduced maternal work capacity. Globally, anaemia due to folic acid and iron is still a public health problem affecting nearly two billion people [13, 14]. According to the World Health Organization(WHO) report, 38.2% of global and 46.3% of African region pregnant women are affected by anaemia [15]. Despite vulnerability across the population, anaemia is prevalent in pregnant women (> 40%) and young children because of the increased demand for iron-folic acid (IFA) [12]. The World Health Organization (WHO) has recommended that all pregnant women take a standard dose of 30-60 mg of elemental iron along with 400 μg of folic acid daily for the first 6 months [10, 11]. Additionally, in areas where the prevalence of anaemia is over 40%, the WHO recommends postpartum supplementation for 3 months [4]. Evidence from developing countries suggests that the outcome of antenatal IFA supplementation programs is influenced by the behaviour of the pregnant women and the healthcare providers. The pregnant women reported they forgot or were unwilling to take the supplements, while healthcare providers gave inadequate counseling and distribution of iron tablets [16]. In low- and middle-income countries (LMIC), a high proportion of pregnant women suffer from anaemia mainly due to poor adherence to the daily iron-folic acid regimen [4, 17]. Uganda is among countries where there are very high levels of anaemia due to iron and folic acid deficiency among women of reproductive age (15-49 years) and pregnant women irrespective of the available innervations to arrest it [18]. According to the 2006 Uganda Demographic and Health Survey (UDHS), 49.0% of Ugandan women aged 15-49 years were anaemic (Hb <12.0 g/dL), while 64.4% of those pregnant had sub-optimal haemoglobin (Hb) levels (Hb <11.0 g/dL) [19]. Concerning the research done at Mulago National Referral Hospital by Kiwanuka et al. [20], about 12% (11.6%) of the mothers attending the antenatal clinic adhered to iron supplements over 30-day period, mothers, who had had four or more antenatal visits before the survey, had more than 2 week supply of iron supplements in the previous visit, prior health education, were more likely to adhere to iron supplements. Inadequate drug supplies and fear of side effects were the main reasons why participants missed the iron supplements. In Hoima District, little research has been done about the adherence of mothers to folic acid and iron supplementation among pregnant women, and yet maternal anaemia is at an increase, no publications have so far been made, thus a need for this research. Hoima District is one of the districts of Uganda with high levels of maternal death some of whom are due to anaemia from iron and folic acid deficiency irrespective of their availability, an indication of either poor adherence and/or other related factors, this research will therefore intend to undertake a comprehensive study into folic acid and iron supplementation at the maternal child health clinic at the Hoima regional referral hospital.


The adherence to folic acid and iron supplementations stood at 58.8% among pregnant mothers at Hoima Hospital. This is critical with socio-demographics, especially being <30 years of age, Christian by religion, from rural residence, living with their Partners, at the most accomplished primary level of education, and Housewives as well as knowledge of the importance, dosage of folic acid, correct dosage, food sources and advise and emphasis to adhere. However, alcohol intake late and limited attendance for ANC as well as a bad experience after having attended ANC prevented many from adhering to folic acid and iron supplementation.


The stakeholders should ensure that there is a thorough sensitization and more education concerning the benefits of adherence and the associated disadvantages of poor or failure to adhere to drugs especially folic acid and iron supplementations during pregnancy. The healthcare givers too should be increased in numbers at the antenatal care clinic and if possible at community levels; and emphasized to thoroughly work on these pregnant mothers; encouraging them on how to carry on with their pregnancy including avoidance of alcohol intake. The sensitization should also emphasize and aim at imparting more knowledge of the importance, and dosage of folic acid, correct dosage, and food sources and advise couples to offer support and if possible accompany them on some ANC visits to get to know or be counseled on how to deal with their partners during pregnancy and as well remind them to adhere to folic acid and iron supplements where necessary.


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 CITE AS: Nuwahereza Godie (2023). Factors Influencing Folic Acid and Iron Supplement Use Among Pregnant Women at Hoima Regional Referral Hospital in Uganda. INOSR APPLIED SCIENCES 11(1):64-73.