Cited by 154Medication Adherence and ComplianceGlobal Maternal and Child HealthPublic Health and Nutrition

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Determinants of compliance with iron supplementation among pregnant women in Senegal

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Seck, Binetou C, Jackson, Robert T·2008·Public Health Nutrition

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Abstract

Background: Community iron supplementation programmes for pregnant women have lacked effectiveness, partly because of low compliance. Objective: To determine factors that influence compliance among pregnant women in Senegal. Design: Two hundred and twenty-one pregnant women, recruited from six health centres in Dakar during their first prenatal visit, were randomly assigned to receive either a prescription to purchase iron/folic acid tablets (control, n = 112) to be taken daily, according to official policy, or to receive free tablets (treatment, n = 109). Compliance was assessed 20 weeks after enrolment through interviews and pill count. Women with low or high compliance (<70% or ≥70%) were asked to explain what influenced their adherence to supplementation. Results: Overall compliance was 69%; it was significantly higher in the treatment than in the control group (86% vs. 48%; P < 0.0001). Women with high compliance (58%) were motivated by: (1) the perception of improved health upon taking the tablets (treatment = 24%, control = 10%); (2) the insistence by midwives that they take the tablets; and (3) the mention that the tablets would improve health. Women with low compliance (42%) reported: (1) the experience of side-effects that they associated with the tablets (treatment = 13%, control = 14%); (2) misunderstanding that they needed to continue taking the tablets throughout pregnancy (treatment = 0%, control = 18%); and (3) forgetfulness. Conclusion: Compliance with iron/folic acid supplementation in Senegal can be increased by providing women with clear instructions about tablet intake and educating them on the health benefits of the tablets.

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ResultInfluential
Individual and Structural Environmental Influences on Utilization of Iron and Folic Acid Supplementation among Pregnant Women in Harare, Zimbabwe
Tinago, C. B., Ingram, L., Blake, C., & Frongillo, E. (2016) · Maternal and Child Nutrition · doi:10.1111/mcn.12350 · Cited by 32
“…lack of knowledge, side effects and difficult access and underutilization of ANC services, while utilization was enhanced by improved health for mother and baby, less fatigue, and improved appetite (Galloway &McGuire 1994; Galloway et al. 2002; Seck & Jackson 2008; Nisar et al. 2014).”
Background
Patterns of compliance with prenatal iron supplementation among Peruvian women
Zavaleta, N., Caulfield, L. E., Figueroa, A., & Chen, P. (2012) · Maternal and Child Nutrition · doi:10.1111/j.1740-8709.2012.00407.x · Cited by 27
“These included maternal age, education, income, marital status, caste, smoking and drinking (Ekstrom et al. 1996; Aguayo et al. 2005; Seck & Jackson 2007; Lutsey et al. 2008; Kulkarni et al. 2009).”
BackgroundResultInfluential
With adaptation, the WHO guidelines on calcium supplementation for prevention of pre‐eclampsia are adopted by pregnant women
Omotayo, M. O., Martin, S., Stoltzfus, R. J., Ortolano, S. E., Mwanga, E., & Dickin, K. L. (2017) · Maternal and Child Nutrition · doi:10.1111/mcn.12521 · Cited by 33
“…of micronutrient recommendations have focused on iron supplementation among end‐users in low‐income settings (Aguayo et al., 2005; Dairo & Lawoyin, 2006; Galloway et al., 2002; Galloway & McGuire, 1994; Seck & Jackson, 2008; Tessema, Jefferds, Cogswell, & Carlton, 2009; Young & Ali, 2005).”
Adherence-Specific Social Support Enhances Adherence to Calcium Supplementation Regimens among Pregnant Women
Martin, S., Omotayo, M. O., Pelto, G. H., Chapleau, G. M., Stoltzfus, R. J., & Dickin, K. L. (2017) · Journal of Nutrition · doi:10.3945/jn.116.242503 · Cited by 28
Reproductive morbidity among Iranian women; issues often inappropriately addressed in health seeking behaviors
Tehrani, F. R., Simbar, M., & Abedini, M. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-863 · Cited by 26
“Active screening of these women and referring of complicated cases could significantly reduce secondary complications such as anemia, a major indirect cause of maternal mortality [38] In the present study, the majority of women with reproductive morbidities had not sought appropriate care except for infertility; this…”
Background
Maternal knowledge on iron and folic acid supplementation and associated factors among pregnant women in a rural County in Kenya
Kamau, M., Mirie, W., & Kimani, S. (2019) · International Journal of Africa Nursing Sciences · doi:10.1016/j.ijans.2019.01.005 · Cited by 27
Compliance with the consumption of iron and folate supplements by pregnant women in Mafikeng local municipality, North West province, South Africa
Mbhenyane, X., & Cherane, M. (2017) · African Health Sciences · doi:10.4314/ahs.v17i3.8 · Cited by 25
Time to start and adherence to iron-folate supplement for pregnant women in antenatal care follow up; Northern Ethiopia
Gebremichael, T. G., Haftu, H., & Gereziher, T. A. (2019) · Patient Preference and Adherence · doi:10.2147/ppa.s184168 · Cited by 26
Antenatal care and mothers’ education improved iron-folic acid adherence at Denbiya district health centers, Northwest Ethiopia: using pills count method
Tarekegn, M., Wubshet, M., Atenafu, A., Derso, T., & Woretaw, A. (2019) · Archives of Public Health · doi:10.1186/s13690-019-0356-y · Cited by 24
Acceptability and Utilization of Three Nutritional Supplements during Pregnancy: Findings from a Longitudinal, Mixed-Methods Study in Niger
Clermont, A., Kodish, S. R., Seck, A. M., Salifou, A., Rosen, J. G., Grais, R. F., & Isanaka, S. (2018) · Nutrients · doi:10.3390/nu10081073 · Cited by 26
“A large number of individual and program-related factors have been identified as influencing adherence, including organoleptic properties of the supplements [13,16,20,22], provision of the supplement at no cost [14,21], reminders to take the supplement [15,16,21], and perceptions of supplement benefits [14,15,17,20].”
Background
The Experience of Anaemia and Ingesting Oral Iron Supplementation in Pregnancy: A Qualitative Study
O’Toole, F., Hokey, E., McAuliffe, F. M., & Walsh, J. (2024) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2024.03.005 · Cited by 14
Impact of Hypertensive Disorders of Pregnancy on Stillbirth and Other Perinatal Outcomes: A Multi-Center Retrospective Study
Basta, M., Hanif, K., Zafar, S., Khabazeh, A., Amin, F., Khan, S. S., Ghaffar, U., Muthanna, F. M. S., & Wali, S. (2022) · Cureus · doi:10.7759/cureus.22788 · Cited by 24
Treatment response to standard of care for severe anemia in pregnant women and effect of multivitamins and enhanced anthelminthics
Christian, P. S., Shahid, F., Rizvi, A., Klemm, R. D. W., & Bhutta, Z. A. (2009) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.2008.26826 · Cited by 20
Barriers and facilitators of micronutrient supplementation among non-pregnant women of reproductive age in Johannesburg, South Africa
Silubonde, T. M., Draper, C. E., Baumgartner, J., Ware, L. J., Smuts, C. M., & Norris, S. A. (2022) · PLOS Global Public Health · doi:10.1371/journal.pgph.0001310 · Cited by 24
Adherence to Iron with Folic Acid Supplementation Among Pregnant Women Attending Antenatal Care in Public Health Centers in Simada District, Northwest Ethiopia: Using Health Belief Model Perspective
Mekonnen, A., Alemnew, W., Abebe, Z., & Demissie, G. D. (2021) · Patient Preference and Adherence · doi:10.2147/ppa.s299294 · Cited by 26
“This result is supported by other studies in Ethiopia(17,31,32) and West Africa, Senegal.(33) The possible justifications for these may be getting advice may increase the level of knowledge, attitude and practice toward IFAS adherence.”
Result
Adherence to recommendations on lipid‐based nutrient supplement and iron and folic acid tablet consumption among pregnant and lactating women participating in a community health programme in northwest Bangladesh
Harding, K. L., Matias, S. L., Mridha, M. K., Moniruzzaman, M., Vosti, S. A., Hussain, S., Dewey, K. G., & Stewart, C. P. (2016) · Maternal and Child Nutrition · doi:10.1111/mcn.12252 · Cited by 21
“…Seck & Jackson 2008; Shankar et al. 2009; Kulkarni et al. 2010; Mridha et al. 2012), perceived benefits of the supplement (Ghanekar et al. 2002; Seck & Jackson 2008; Tessema et al. 2009; Oriji et al. 2011; Zavaleta et al. 2012) and remembering to take supplements (Ghanekar et al. 2002; Seck &…”
BackgroundResultInfluential
Factors associated with socio‐demographic characteristics and antenatal care and iron supplement use in Ethiopia, Kenya, and Senegal
Verney, A., Reed, B. A., Lumumba, J. B., & Kung’u, J. K. (2018) · Maternal and Child Nutrition · doi:10.1111/mcn.12565 · Cited by 16
“…school longer or reach higher levels of education are better informed about health services available to them and are in a better position to make decisions about their own health (Houweling, Ronsmans, Campbell, & Kunst, 2007; Seck & Jackson, 2008; Simkhada, Teijlingen, Porter, & Simkhada, 2008).”
Background
Predictors of optimum antenatal iron-folate supplementation in a low resource rural set-up in Eastern Kenya
Juma, M., Oiye, S. O., & Konyole, S. O. (2015) · Journal of Public Health and Epidemiology · doi:10.5897/jphe2015.0770 · Cited by 18
“One of the pathways in which spouse influence can positively affect iron supplementation is through the spouses acting as active reminders (Seck and Jackson, 2008; Nisar et al., 2014), and it is thus evident that the spouses of the study mothers are not playing this role in a significant manner.”
Background
Perinatal outcomes of women with hypertensive disorders of pregnancy in Jimma Medical Center, southwest Ethiopia: Retrospective cohort study
Jaleta, D. D., Gebremedhin, T., & Gerbaba, M. J. (2021) · PLoS ONE · doi:10.1371/journal.pone.0256520 · Cited by 22
Compliance to Iron-Folic Acid Supplementation and Its Association with the Number of ANC Visits in Ethiopia: Systematic Review and Meta-Analysis
Workineh, Y., Kasa, A. S., Ayalew, E., & Temesgen, W. A. (2019) · Advances in Preventive Medicine · doi:10.1155/2019/3602585 · Cited by 18
PROTOCOL: Nutrition interventions and programs for reducing mortality and morbidity in pregnant and lactating women and women of reproductive age: a systematic review
Middleton, P., Crowther, C. A., Bubner, T., Flenady, V., Bhutta, Z. A., Trach, T. S., & Lassi, Z. S. (2012) · Campbell Systematic Reviews · doi:10.1002/cl2.84 · Cited by 4
Maternal Knowledge Associated with the Prevalence of Iron and Folic Acid Supplementation Among Pregnant Women in Muntinlupa, Philippines: A Cross-Sectional Study
Yamashita, T., Roces, R. E. D., Llave, C., Tuliao, M. T. R., Kamau, M. W., Yamada, C., Tanaka, Y., Shimazawa, K., Iwamoto, S., & Matsuo, H. (2021) · Patient Preference and Adherence · doi:10.2147/ppa.s291939 · Cited by 17
Home consumption of two fortified balanced energy protein supplements by pregnant women in Burkina Faso
de Kok, B., Moore, K., Jones, L., Vanslambrouck, K., Toe, L. C., Ouédraogo, M., Ganaba, R., de Pee, S., Bedford, J., Lachat, C., et al. (2021) · Maternal and Child Nutrition · doi:10.1111/mcn.13134 · Cited by 17
“Overall, the need for clear instructions and educational message is often mentioned as a key element to ensure appropriate utilization (Aguayo et al., 2005; Kodish, Aburto, Hambayi, Kennedy, & Gittelsohn, 2015; Seck & Jackson, 2008).”
Background
Utilization and compliance with iron supplementation and predictors among pregnant women in Southeast Ethiopia
Beressa, G., Lencha, B., Bosha, T., & Egata, G. (2022) · Scientific Reports · doi:10.1038/s41598-022-20614-9 · Cited by 21
“94 Gestational age ≤ 12 3 (75) 1 (25) 1 1 13–24 92 (92) 8 (8) 3.”
Sorption behavior and release kinetics of iron (II) ions by oleoyl chitosan polymeric nanoparticles
Jaber, N., & Aiedeh, K. (2019) · Journal of Drug Delivery Science and Technology · doi:10.1016/j.jddst.2019.101354 · Cited by 16
An approach to Hemequity: Identifying the barriers and facilitators of iron deficiency reduction strategies in low‐ to middle‐income countries
Ge, S., Ali, S. H., Haldane, V. E., Bekdache, C., Tang, G. H., & Sholzberg, M. (2025) · British Journal of Haematology · doi:10.1111/bjh.19984 · Cited by 18
“43,51,53,56 62”
Factors associated with non-adherence to prescribed iron supplement use: a study with pregnant women in the city of Rio de Janeiro
Niquini, R. P., Bittencourt, S. D. D. A., Lacerda, E. M. D. A., Saunders, C., & Leal, M. D. C. (2016) · Revista Brasileira de Saúde Materno Infantil · doi:10.1590/1806-93042016000200007 · Cited by 14
Non-invasive hemoglobin screening device: a promising digital method for reducing anemia prevalence through routine screening and timely intervention
Mahapatra, P. P. D., Roy, C., Agarwal, K., Sharma, S. D., Chowdhury, S. R., Sharma, S., Rajagopal, H., & Meher, D. (2024) · Hematology · doi:10.1080/16078454.2024.2365078 · Cited by 9
“Also, another study found that the tablet’s unappealing taste, smell, or color, nausea, difficulty in swallowing and form of injection/liquid were some of the major deciding factors for women to discontinue taking iron supplements [33–37].”
Compliance with and acceptability of two fortified balanced energy protein supplements among pregnant women in rural Nepal
Lama, T., Moore, K., Isanaka, S., Jones, L., Bedford, J., de Pee, S., Katz, J., Khatry, S., Leclerq, S., & Tielsch, J. (2021) · Maternal and Child Nutrition · doi:10.1111/mcn.13306 · Cited by 13
Predictors of iron consumption for at least 90 days during pregnancy: Findings from National Demographic Health Survey, Pakistan (2017–2018)
Ali, S. A., Ali, S. A., Razzaq, S., Khowaja, N., Gutkind, S., Raheman, F. U., & Suhail, N. (2021) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-021-03825-2 · Cited by 15
“Likewise, 44% of preterm births, 25% of babies with low birth weight, and 21% of perinatal mortality are due to anemia during pregnancy in LMICs [10].”
ResultInfluential
Dietary diversity cutoff values predicting anemia varied between mid and term of pregnancy: a prospective cohort study
Zerfu, T. A., Baye, K., & Faber, M. (2019) · Journal of Health Population and Nutrition · doi:10.1186/s41043-019-0196-y · Cited by 19
Routine Iron Supplementation and Anaemia by Third Trimester in a Nigerian Hospital
Adanikin, A. I., Awoleke, J., Olofinbiyi, B., Adanikin, P., & Ogundare, O. R. (2015) · Ethiopian Journal of Health Sciences · doi:10.4314/ejhs.v25i4.3 · Cited by 15
“Our compliance rate, however, is comparable with studies from India and Senegal where compliance was 65% and 69% respectively (23,24).”
Result
Compliance and patterns of iron-folic acid intake among adolescent girls and antenatal women in rural Tamil Nadu
Selvaraj, K., Arumugasamy, P., & Sarkar, S. (2017) · CHRISMED Journal of Health and Research · doi:10.4103/cjhr.cjhr_88_16 · Cited by 12
“[15,16] Compared to Indian settings studies reported from Africa had shown poor compliance among pregnant women.[22,23] A study conducted among adolescent tribal girls of Madhya Pradesh had shown 89% compliance, but this was an interventional study conducted under trial design.”
Result
Iron deficiency anemia status in Iranian pregnant women and children: an umbrella systematic review and meta-analysis
Dehghani, A., Molani‐Gol, R., Rafraf, M., Mohammadi-Nasrabadi, F., & Zarnaq, R. K. (2024) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-024-06575-z · Cited by 17
“Adherence to supplements is very different and influenced by demographic, social and health factors [83–88] and this reason can cause differences in different regions of Iran.”
Background
Predictors of prenatal iron folic acid supplement utilization in Wolaita, South Ethiopia: a community based cross-sectional study (quantitative and qualitative approach)
Wana, E. W. (2020) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-020-02883-2 · Cited by 14
Using formative research to promote antenatal care attendance and iron folic acid supplementation in Zinder, Niger
Hess, S., Ouédraogo, C., Bamba, I., Wessells, K., Keith, N., Faye, T., Ndiaye, B., Doudou, M., & Nielsen, J. (2018) · Maternal and Child Nutrition · doi:10.1111/mcn.12525 · Cited by 12
Better-Educated, Older, or Unmarried Pregnant Women Comply Less with Iron–Folic Acid Supplementation in Southern Ethiopia
Seifu, C. N., Whiting, S. J., & Hailemariam, T. G. (2019) · Journal of Dietary Supplements · doi:10.1080/19390211.2019.1629145 · Cited by 12
“As reported by different studies (Seck and Jackson 2008; Gebremedhin et al. 2014), our findings also show that side effects impede compliance of IFA supplementation; similar results were observed in India (Bilimale et al. 2010) and the Philippines (Aikawa et al. 2006; Lutsey et al. 2008).”
Result
Prenatal anemia control and anemia in children aged 6–23 months in sub‐Saharan Africa
Wilunda, C., Tanaka, S., Esamai, F., & Kawakami, K. (2016) · Maternal and Child Nutrition · doi:10.1111/mcn.12375 · Cited by 17
“There is also need to improve compliance with iron supplementation as this may be a problem (Gebremedhin et al., 2014; Seck and Jackson, 2008), and to promote initiation of iron supplementation as early as possible during pregnancy to maximize the chance of taking the supplements for at least 6 months.”
Background
Survey of women's perceptions of information provided in the prevention or treatment of iron deficiency anaemia in an Australian tertiary obstetric hospital.
Vosnacos, E., & Pinchon, D. (2015) · Women and Birth · doi:10.1016/j.wombi.2014.11.004 · Cited by 9
ADHERENCE IN PREGNANCY: A SYSTEMATIC REVIEW OF THE LITERATURE
Oladejo, M., & Bewley, S. (2012) · Fetal and Maternal Medicine Review · doi:10.1017/s0965539512000113 · Cited by 10
Family-centered Health Education Intervention for Improving Iron−folic Acid Adherence and Anemia Reduction among Antenatal Mothers in Rural Jodhpur: A Quasi-experimental Study
Singh, G. P., Ranjitha, R., Baskaran, P., Goel, A. D., Gupta, M. K., Dileepan, S., Choudhary, Y., Rehana, V. R., & Raghav, P. R. (2024) · Indian Journal of Public Health · doi:10.4103/ijph.ijph_844_23 · Cited by 7
Prevalence and factors associated with compliance to iron and folic acid supplementation in pregnancy in Tamale Metropolis, Ghana
Wemakor, A., Garti, H., Akai, M. M., Napari, A. A., & Dankyi-Frimpomaa, J. (2020) · Nutrire · doi:10.1186/s41110-020-00120-6 · Cited by 9
“I Have Remained Strong Because of That Food”: Acceptability and Use of Lipid-Based Nutrient Supplements Among Pregnant HIV-Infected Ugandan Women Receiving Combination Antiretroviral Therapy
Young, S. L., Natamba, B., Luwedde, F., Nyafwono, D., Okia, B., Osterbauer, B., Natureeba, P., Johnson, L. M., Michel, C., Zheng, A., et al. (2014) · AIDS and Behavior · doi:10.1007/s10461-014-0947-0 · Cited by 8
Adherence to iron folic acid supplementation and associated factors among antenatal CARE attending women in Sire district primary health care units, South-East Ethiopia: A facility based cross-sectional study
Berarti, A. E., Bore, M. G., & Beyene, B. (2023) · International Journal of Africa Nursing Sciences · doi:10.1016/j.ijans.2023.100526 · Cited by 8

Authors: Seck, B. C., & Jackson, R. T.
Affiliations: University of Maryland, College Park (US)
Corresponding author: Seck, Binetou C
Venue: Public Health Nutrition
Publisher: Cambridge University Press (CUP)
Published: 2008-06
Volume: 11
Issue: 6
Pages: 596-605
ISSN: 1368-9800 (ISSN-L)
1475-2727
DOI: 10.1017/s1368980007000924
OpenAlex: W2035452438
Cited by: 154
References: 0
Citations by year: 2026: 4 · 2025: 1 · 2024: 12 · 2023: 2 · 2022: 13 · 2021: 9 · 2020: 5 · 2019: 20 · 2018: 8 · 2017: 14 · 2016: 11 · 2015: 13 · 2014: 14 · 2013: 5 · 2012: 12
FWCI: 2.12
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.cambridge.org/core/terms (unspecified)
Locations: Public Health Nutrition (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Public Health and Nutrition
Keywords: iron supplementation, folic acid, medication adherence, pregnant women, prenatal care, free medication, pill count, adverse effects, health education, midwife counseling, Senegal
MeSH terms: Adult, Female, Folic Acid, Folic Acid Deficiency, Humans, Patient Acceptance of Health Care, Patient Compliance, Patient Education as Topic, Pregnancy, Prenatal Care, Surveys and Questionnaires, Senegal, Anemia, Iron-Deficiency, Iron, Dietary, Dietary Supplements, Maternal Nutritional Physiological Phenomena

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Determinants of compliance with iron supplementation among pregnant women in Senegal

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