Magnitude and determinants of adherence to iron-folic acid supplementation among Somaliland pregnant women in Ahmed-dhagah district: A facility based cross-sectional study

Background: Iron deficiency is a major cause of anemia globally, especially in low-income countries, and pregnant women are at higher risk. Despite guidelines recommending IFA supplementation, adherence remains low. Therefore, the aim of this study is to assess the adherence to iron -folic acid (IFA) supplementation among pregnant women receiving antenatal care services in the Ahmed-Dhagah district, Hargeisa, Somaliland. Methods: A cross-sectional study was conducted at an institutional level from May to July 2022. A systematic sampling method was used to select 320 pregnant women. Data collection was performed using the Kobo Collect Android app, and the data were analyzed using SPSS. Descriptive statistics, bivariate analysis, and multivariable logistic regression analysis were employed to identify independent variables associated with adherence to IFA supplementation. Statistical significance was determined using a p -value <0.05. Results: Only 74 (24%) women adhered to >= 65% of the recommended IFA supplement doses, equivalent to more than four days a week. In the multivariate logistic regression model, the husband ' s educational status (AOR = 8.468, 95% CI: 3.436, 20.87), number of antenatal care visits (AOR = 3.385, 95% CI: 1.55, 7.39), and maternal knowledge about anemia (AOR = 3.534, 95% CI: 1.739, 7.194) were identified as factors significantly associated with good adherence to IFA supplementation. Conclusion: The pregnant women ' s adherence to IFA supplementation was very low compared to WHO guidelines. Factors like the husband ' s education, antenatal care visits, and maternal knowledge of anemia affected adherence. Common reasons for non-compliance included forgetfulness, drug side effects, and fear of side effects.