Determinants of compliance to iron folate supplementation among pregnant women attending antenatal care in public health facilities of South West Ethiopia: A case-control study

Background: The prevalence of anemia among pregnant women remains high globally, particularly in low-income settings. Iron and folic acid supplementation (IFAS) during pregnancy is the most widely employed strategy to alleviate adverse pregnancy outcomes. This study aimed to explore the determinants of compliance with iron supplementation in the study area. Aim: To identify determinants of IFAS compliance among pregnant women attending antenatal care (ANC) in Mettu town, South West Ethiopia, in 2021. Methods: A facility-based, unmatched case-control study was conducted from May to July 2021 with a total sample size of 344 (115 cases and 229 controls). Cases and controls were selected using systematic random sampling. Data was collected using a structured, pretested interviewer-administered questionnaire, entered into Epi-data software version 3.1, and exported to SPSS version 23 for analysis. Variables with p < 0.25 during bivariate analyses were entered into a multivariable logistic regression model. Then, variables with a p < 0.05 at 95% confidence interval (CI) were declared to be statistically significant determinants of IFAS. The odds ratio was used to indicate the strength of the association. Result: Having Previous history of anaemia (adjusted odds ratio [AOR] = 5.8, 95% CI [2.5-13.6], p < 0.01), having good knowledge about IFAS (AOR = 3.3, 95% CI [1.7-6.7], p < 0.001), being a government employee (AOR = 5.2 [2.4-11.5], p < 0.01], and receiving counseling service during ANC (2.495% CI [1.3-4.7] p < 0.01) were among determinants of adherence to IFAS. Conclusions: Maternal knowledge about IFAS, counseling about IFAS, occupation, and history of anaemia were found to be significantly associated factors with compliance with iron folate supplementation during pregnancy. This implies that adherence to IFAS can be improved through improving maternal knowledge about importance of IFAS, quality counseling services and strengthening an overall ANC follow-up services.