Adherence to Iron and Folic acid supplementation and its associated factors among pregnant women attending antenatal care in government hospitals of Addis Ababa, Ethiopia ,2025

Abstract

Abstract Introduction: Iron and folic acid supplementation during pregnancy is crucial for maternal and fetal health, preventing anemia and neural tube defects. However, adherence to IFAS recommendations remains a challenge, particularly in low-resource settings. Objective: To assess adherence of Iron and Folic acid supplementation and its associated factors among pregnant women attending antenatal care in government hospitals of Addis Ababa, Ethiopia ,2025. Methods: An institutional-based cross-sectional study was conducted at St Paul Hospital, Zewditu Memorial Hospital , Gahandi Memorial Hospital, and Yekatit 12 Hospital,Addis Ababa, Ethiopia from the 1st of June to 30th of July , 2025 with a sample of 391 study participants using a systematic sampling method. Data was cleaned, edited, coded and entered into Epi-data version 3.0.1 and exported to SPSS version 25 for analysis. Variables having a P-value less than 0.25 in bivariable analysis were entered into multivariable analysis and variables having a P-value less than 0.05 and a 95%CI in multivariable logistic regression were declared as statistically significant. Results were presented using tables and graphs. Ethical approval was secured and informed consent was obtained from participants. Results: A total of 391 pregnant women participated in the study, yielding a response rate of 100%. The mean age of the participants was 29.3 years (±3.8 standard deviation). The overall adherence to iron–folic acid supplementation among pregnant women was 74.1%. In the multivariable analysis, the timing of the first antenatal care (ANC) visit (AOR = 2.73; 95% CI: 1.62–4.62), having four or more ANC visits (AOR = 2.92; 95% CI: 1.58–5.42), receiving counseling on iron–folic acid supplementation (AOR = 4.41; 95% CI: 1.94–10.04), presence of anemia during the current pregnancy (AOR = 5.03; 95% CI: 2.20–11.52), and good knowledge of iron–folic acid supplementation (AOR = 4.66; 95% CI: 2.60–8.34) were significantly associated with adherence to iron–folic acid supplementation during pregnancy. Conclusion and recommendations: The study found a relatively high level of adherence to iron–folic acid supplementation among pregnant women; however, a substantial proportion remained non-adherent. Strengthening early and regular antenatal care attendance, enhancing counseling services, and improving maternal knowledge through structured health education should be prioritized. Key words: Adherence, Iron, Folic Acid, Pregnant Women, Antenatal care