A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of
Master of Science in Public Health Research at Nelson Mandela African Institution of
Science and Technology
Pregnant women are at high risk of iron and folic acid deficiency anemia. Tanzania adopted
the WHO recommendation of 2012 that, all pregnant women should consume a dose of 30-
60 mg IFAS 400 μg daily for first six (6) months. Iron and Folic Acid Supplementation is the
main cost-effective strategy to control anemia during pregnancy however, adherence to IFAS
in Tanzania is low (21%) and more in Kigoma region (7%). Associated determinants with
adherence to IFAS have not been well established and studies to assess IFAS in Kasulu
district are limited. Participants were selected at the health facility through systematic
random sampling. A structured questionnaire was used to collect quantitative information
and binary logistic regression models were used to determine the factors associated with the
adherence to IFAS with statistical significance of p-value<0.05 using SPSS software (version
22). Similarly, pregnant and women with children aged 0-6 months were purposively
selected from health facilities and allocated in four focus group discussions for qualitative
information. In addition, an in-depth interview (IDIs) was conducted among six health care
providers who were purposefully selected from two health facilities. Thematic analysis was
done for qualitative data and triangulated with quantitative findings. Adherence to IFAS was
found to be 20.3%. In a binary logistic regression model, factors associated with adherence to
IFAS include distance to health facilities (AOR=0.338, 95% CI:131-886), counseled on the
benefits of IFAS (AOR=3.864, 95% CI: 1.422-10.500), knowledge on anemia (AOR=3.840,
95% CI: 1.335-10.685), number of IFAS given at each visit (AOR=15.718, 95% CI: 5.33546.311),
Time
at
first ANC visit (AOR=3.724, 95% CI: 1.417-9.791), number of meals per
day (AOR=3.349, 95% CI: 1.184-9.212) and number of the children (AOR=3.462, 95% CI:
1.035-12.070). From the qualitative findings, low knowledge of anemia and benefits of IFAS
among women and health care providers, late first ANC, economic factors, less reminded to
the uptake of IFAS, negligence and forgetfulness were the main reasons for low adherence.
Overall, adherence to IFAS was low. Therefore, strengthening systems to create community
awareness, health promotion, education program among health care providers and pregnant
women, strengthen supply chain and reminder mechanisms is potential to improve the
adherence to IFAS.