Factors associated with prenatal folic acid and iron supplementation among 21,889 pregnant women in Northern Tanzania: A cross-sectional hospital-based study

BMC Public Health

Anne Kjersti Daltveit¹  Rolv Terje Lie¹  Rachael Manongi⁴  Olola Oneko³  Truls Østbye²  Cathrine Hoyo²  Olukemi Ogundipe⁵ 

[1] Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway;Duke Global Health Institute, Duke University, Durham, NC, USA;Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Tumaini University, Moshi, Tanzania;Department of Community Health, Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania;Duke University School of Medicine, Durham, NC, USA

关键词: Tanzania;    Pregnant women;    Supplement;    Iron;    Folic acid;   

Others  :  1163494
DOI  :  10.1186/1471-2458-12-481

 received in 2012-01-18, accepted in 2012-06-13,  发布年份 2012

【 摘 要 】

Background

Folate and iron deficiency during pregnancy are risk factors for anaemia, preterm delivery, and low birth weight, and may contribute to poor neonatal health and increased maternal mortality. The World Health Organization recommends supplementation of folic acid (FA) and iron for all pregnant women at risk of malnutrition to prevent anaemia. We assessed the use of prenatal folic acid and iron supplementation among women in a geographical area with a high prevalence of anaemia, in relation to socio-demographic, morbidity and health services utilization factors.

Methods

We analysed a cohort of 21,889 women who delivered at Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania, between 1999 and 2008. Logistic regression models were used to describe patterns of reported intake of prenatal FA and iron supplements.

Results

Prenatal intake of FA and iron supplements was reported by 17.2% and 22.3% of pregnant women, respectively. Sixteen percent of women reported intake of both FA and iron. Factors positively associated with FA supplementation were advanced maternal age (OR = 1.17, 1.02-1.34), unknown HIV status (OR = 1.54, 1.42-1.67), a diagnosis of anaemia during pregnancy (OR = 12.03, 9.66-14.98) and indicators of lower socioeconomic status. Women were less likely to take these supplements if they reported having had a malaria episode before (OR = 0.57, 0.53-0.62) or during pregnancy (OR = 0.45, 0.41-0.51), reported having contracted other infectious diseases (OR = 0.45, 0.42-0.49), were multiparous (OR = 0.73, 0.66-0.80), had preeclampsia/eclampsia (OR = 0.48, 0.38-0.61), or other diseases (OR = 0.55, 0.44-0.69) during pregnancy. Similar patterns of association emerged when iron supplementation alone and supplementation with both iron and FA were evaluated.

Conclusions

FA and iron supplementation are low among pregnant women in Northern Tanzania, in particular among women with co-morbidities before or during pregnancy. Attempts should be made to increase supplementation both in general and among women with pregnancy complications.

【 授权许可】

   
2012 Ogundipe et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Berry RJ, Li Z, Erickson JD, Li S, et al.: Prevention of neural-tube defects with folic acid in China. China-U.S. collaborative project for neural tube defect prevention. N Engl J Med 1999, 341:1485-1490.
• [2]Czeizel AE, Dudás I: Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. N Engl J Med 1992, 327:1832-1835.
• [3]Institute of Medicine: Dietary reference intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic acid, Biotin, and Choline. Washington, DC: National Academy Press; 1998. (prepublication edition)
• [4]World Health Organization Department of Making Pregnancy Safer: Standards for Maternal and Neonatal Care. 2007. [1 screen]. Available from: http://whqlibdoc.who.int/hq/2007/a91272.pdf webcite
• [5]Stoltzfus RJ: Iron interventions for women and children in low-income countries. J Nutr 2011, 141:756-762.
• [6]Bhutta ZA, Darmstadt GL, Hasan BS, et al.: Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: a review of the evidence. Pediatrics 2005, 115(2 Suppl):519-617.
• [7]Carmichael SL, Shaw GM, Yang W, et al.: National birth defects prevention study. Correlates of intake of folic acid-containing supplements among pregnant women. Am J Obstet Gynecol 2006, 194:203-210.
• [8]Allen LH: Anaemia and iron deficiency: effects on pregnancy outcome. Am J Clin Nutr 2000, 71(5 Suppl):1280-1284.
• [9]Cogswell ME, Parvanta I, Ickes L, et al.: Iron supplementation during pregnancy, anaemia, and birth weight: a randomized controlled trial. Am J Clin Nutr 2003, 78:773-781.
• [10]Merchant AT, Msamanga G, Villamor E, et al.: Multivitamin supplementation of HIV-positive women during pregnancy reduces hypertension. J Nutr 2005, 135:1776-1781.
• [11]Villamor E, Msamanga G, Saathoff E, et al.: Effects of maternal vitamin supplements on malaria in children born to HIV-infected women. Am J Trop Med Hyg 2007, 76:1066-1071.
• [12]National Bureau of Statistics (NBS) [Tanzania] and ORC Macro: Tanzania Demographic and Health Survey 2004–05. Dar Es Salaam, Tanzania: National Bureau of Statistics and ORC Macro; 2005.
• [13]Massawe SN, Urassa EN, Nyström L, Lindmark G: Effectiveness of primary level antenatal care in decreasing anemia at term in Tanzania. Acta Obstet Gynecol Scand 1999, 78:573-579.
• [14]Hinderaker SG, Olsen BE, Lie RT, Bergsjø PB, Gasheka P, Bondevik GT, Ulvik R, Kvåle G: Anemia in pregnancy in rural Tanzania: associations with micronutrients status and infections. Eur J Clin Nutr 2002, 56:192-199.
• [15]Charles DH, Ness AR, Campbell D, et al.: Folic acid supplements in pregnancy and birth outcome: re-analysis of a large randomised controlled trial and update of Cochrane review. Paediatr Perinat Epidemiol 2005, 19:112-124.
• [16]Nilsen RM, Vollset SE, Gjessing HK, et al.: Patterns and predictors of folic acid supplement use among pregnant women: the Norwegian Mother and Child Cohort Study. Am J Clin Nutr 2006, 84:1134-1141.
• [17]Timmermans S, Jaddoe VW, Mackenbach JP, Hofman A, Steegers-Theunissen RP, Steegers EA: Determinants of folic acid use in early pregnancy in a multi-ethnic urban population in The Netherlands: The Generation R study. Prev Med 2008, 47:427-432.
• [18]Cogswell ME, Kettel-Khan L, Ramakrishnan U: Iron supplement use among women in the United States: science, policy and practice. J Nutr 2003, 33:1974-1977.
• [19]Knudsen VK, Hansen HS, Ovesen L, et al.: Iron supplement use among Danish pregnant women. Public Health Nutr 2007, 10:1104-1110.
• [20]Lutsey PL, Dawe D, Villate E, et al.: Iron supplementation compliance among pregnant women in Bicol, Philippines. Public Health Nutr 2008, 11:76-82.
• [21]Seck BC, Jackson RT: Determinants of compliance with iron supplementation among pregnant women in Senegal. Public Health Nutr 2008, 11:596-605.
• [22]Habib NA, Daltveit AK, Bergsjo P, et al.: Maternal HIV Status and pregnancy outcomes in North Eastern Tanzania: A registry based study. BJOG 2008, 115:616-624.
• [23]Bartlett JA, Shao JF: Successes, challenges, and limitations of current antiretroviral therapy in low-income and middle-income countries. Lancet Infect Dis 2009, 9:637-649.
• [24]World Health Organization: Global health risks: mortality and burden of disease attributable to selected major risks. Geneva: World Health Organization; 2009. Retrieved from http://www.who.int/healthinfo/global_burden_disease/global_health_risks/en/index.html webcite
• [25]Bergsjo P, Seha AM, Ole-King'ori N: Hemoglobin concentration in pregnant women. Experience from Moshi, Tanzania. Acta Obstet Gynecol Scand 1996, 75:241-244.
• [26]Fawzi WW, Msamanga GI, Spiegelman D, et al.: Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania. Lancet 1998, 351:1477-1482.
• [27]van Eijk AM, Ouma PO, Williamson J, et al.: Plasma folate level and high-dose folate supplementation predict sulfadoxine-pyrimethamine treatment failure in pregnant women in Western Kenya who have uncomplicated malaria. J Infect Dis 2008, 198:1550-1553.