Iron folic acid supplementation adherence level and its associated factors among pregnant women in Ethiopia: a multilevel complex data analysis of 2019 Ethiopian mini demographic and health survey data.

Background: Iron and folic acid deficiency is a worldwide public health concern, particularly in low and middle-income countries. In Ethiopia, adherence to iron and folic acid supplements is still very low. Despite the fact that a number of studies on IFA supplementation have been conducted in Ethiopia, they do not indicate a nationwide problem and do not use advanced models to demonstrate clustering effects. The purpose of this study was to assess the level of non-adherence to iron folic acid supplementation and predictors among pregnant women in Ethiopia. Objective: To assess iron folic acid supplementation adherence level and its associated factors among pregnant women in Ethiopia using data from the 2019 Mini-Ethiopian demographic health survey. Methods: The Mini Ethiopian Demographic and Health Survey 2019 data were obtained from the official database website of the Demographic and Health Survey program (http://dhsprogram.com). The analysis included a sample of 2,356 weighted study participants. A multivariable multilevel mixed-effects logistic regression model was used Variables with p-values less than 5%) was reported as statistically significant variables in the multivariable analysis. Results: The proportion of mothers who did not adhere to iron and folic acid supplements was 81.03% (95 %CI, 79.39, and 82.56). Birth interval less than 2 years [AOR: 2.03; 95% CI: 1.12, 3.66], women ever born less than six children [AOR: 1.99; 95% CI: 1.09, 3.64], starting ANC visit during first trimester [AOR: 2.74; 95 %CI: 1.03, 7.30], region [AOR = 0.24; 95% CI: 0.10], and having a high no ANC visit in the community [AOR = 1.77; 95% CI: 1.08, 2.88] were statistically significant factors. There was Intra-Custer Correlation (ICC = 17.72%), indicating that 17.72% variability in non-adherence levels was due to clusters. Conclusion and recommendation: In Ethiopia, nearly four out of every five pregnant women did not receive iron folic acid supplementation for the recommended periods. Birth intervals, number of children, timing of ANC visits, region, and community level no ANC service were significant factors for non-adherence IFAS. As a result, the community, govern metal and non-governmental sectors enacting on health should focus on reducing non-adherence through tailored interventions on factors that influence it.

Cigarette smoking prevalence and associated factors among college students, Amhara, Ethiopia.

INTRODUCTION: tobacco is the only legal drug that kills many of its users when used exactly as intended by the manufacturers. It is estimated that of the 1.1 billion smokers worldwide, nearly 80% of them live in low and middle-income countries. This trend increases in college and university students with most smokers starting to smoke during adolescent. The aim of this study is to assess cigarette smoking prevalence and associated factors among a select group of college of teachers´ education students. METHODS: a cross-sectional study was conducted. Multistage sampling was used to select 605 study participants from across the eight departments of the Injibara College of Teachers´ Education. Each subject was selected by simple random sampling technique after proportional allocation to each class. EpiData version 4.2 was used for data entry and Stata version 14 was used for data cleaning and analysis. Variables with p-value < 0.2 in bi-variable analysis were selected for multi-variable analysis. Adjusted odds ratio (AOR) with 95% confidence interval (CI) was reported to show the strength of association. RESULTS: the current prevalence of cigarette smoking is 6.8% amongst the Injibara College of Teachers´ Education students. Males [AOR: 2.84 (95% CI: 1.13, 7.14)], divorced marital status [AOR: 7.27 (95% CI: 1.23, 42.85)], food source in hostel [AOR: 11.62 (95% CI 3.23, 41.71)] and exposure to family/other smokers [AOR: 6.17 (95% CI: 2.17, 16.06)] were statistically significant factors for cigarette smoking. CONCLUSION: the prevalence of cigarette smoking was relatively low. Male, marital status, source of food, and exposure to family/other smokers were identified associated factors. Policy makers and health regulatory body are strongly encouraged to consider this evidence and the associated factors for smoking in their efforts to develop and implement tobacco control laws.

Adherence status to iron with folic acid supplementation and associated factors among pregnant women receiving antenatal care at public health facilities in Northwest Ethiopia.

INTRODUCTION: Iron and folic acid deficiency is among the most frequent nutrient inadequacies in the world, affecting expected two billion people, and causing nearly a million deaths. The adherence rate to iron with folic acid supplements remains very low in Ethiopia. Therefore, this study aimed to assess adherence status to iron with folic acid supplementation and associated factors among pregnant women receiving antenatal care at public health facilities in Northwest Ethiopia. METHODS: A facility-based cross-sectional study was conducted among pregnant women at public health facilities in the Debay Tilat Gen district from 27 February 2018 to 27 March 2018. Systematic random sampling was used to select pregnant women. Data were entered into Epidata version 3.1 and analysis was performed using SPSS version 20. Binary logistic regression was used to predict the association of the dependent variable with independent variables. Variables that showed association at a p-value of less than 0.25 in the bivariable analysis were a candidate for multivariable analysis. Finally, variables at a p-value less than 0.05 with corresponding 95% confidence interval declared statistically significant factors of iron with folic acid supplementations. RESULTS: A total of 400 participants were included in the study. The mean (± standard deviation) age of study participants was 26.64 (±4.37 standard deviation) years. This study revealed that about 52.8% of pregnant women attending antenatal care clinics were adherent to iron with folic acid supplementation. Counseling on iron with folic acid supplementations (adjusted odd ratio = 2.53, 95% confidence interval = 1.37-4.66; p-value < 0.003), having current anemia (adjusted odd ratio = 4.21, 95% confidence interval = 1.77-9.94; p-value < 0.001), and good knowledge of iron with folic acid supplementations (adjusted odd ratio = 2.1, 95% confidence interval = 1.29-3.44; p-value < 0.003) showed statistically significant associations with adherence to iron with folic acid supplementation. CONCLUSION: This study revealed that more than half of pregnant women were adherent to iron with folic acid supplementation. Knowledge of iron with folic acid supplementations, current anemia, and being counseled were factors associated with pregnant women's adherence to iron with folic acid supplementation. Therefore, counseling and awareness creation should be strengthened by health institutions.

Adherence of iron and folic acid supplementation and determinants among pregnant women in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Iron and folic acid deficiency anaemia are one of the global public health challenges that pose 1.45% of all disability-adjusted life-years. It is recognized as a cause for an unacceptably high proportion of maternal and perinatal morbidity and mortality. Adherence to iron and folic acid supplementation during the antenatal period is paramount to reduce anaemia and its associated morbidities. Although several studies have been conducted across the country, their reports were inconsistent and inconclusive for intervention. Therefore, this systematic review and meta-analysis were aimed to estimate the pooled national level adherence to iron and folic acid supplementation and its determinants among pregnant women in Ethiopia. METHODS: This systematic review and meta-analysis were pursued the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guideline. An extensive search of databases including, PubMed, Google Scholar, and African Journals Online were conducted to access articles. The Newcastle- Ottawa quality assessment tool was used to assess the quality of each study and meta-analysis was conducted using a random-effects model. I2 test and Egger's test were used to assess the heterogeneity and publication bias respectively. The meta-analysis of estimating national level adherence were done using STATA version 11 with 95% CI. RESULTS: Twenty studies with a total of 16,818 pregnant women were included in this meta-analysis. The pooled national level iron and folic acid supplementation's adherence were 46.15% (95%CI:34.75,57.55). The highest adherence was observed in Addis Abeba, 60% (95%CI: 55.93, 64.07) followed by Tigray, 58.9% (95% CI: 33.86, 84.03). Women who received supplemental information [OR = 2.34, 95%CI: 1.05, 5.24], who had good knowledge [OR = 2.2, 95%CI: 1.05, 5.24], began the ANC visit before 16 weeks [OR = 2.41, 95%CI: 1.76, 3.29], and had ≥4 ANC visits [OR = 2.59, 95% CI: 1.09, 6.15] were more likely adhere to the supplementation. Fear of side effects (46.4, 95% CI: 30.9 61.8) and forgetfulness (30.7, 95% CI: 17.6, 43.8) were the major barriers of adherence of the supplementations. CONCLUSIONS: More than four of nine pregnant women have adhered to the iron and folic acid supplementation. This meta-analysis revealed that receiving supplemental counselling, knowledge of the supplement; early registration and frequent ANC visit were significantly associated with the adherence of the iron and folic acid supplementation. Therefore, provision of strengthened supplemental counselling service, antenatal care services, and improving the knowledge of the supplementation is a crucial strategy to increase the adherence among pregnant women in Ethiopia. Besides, addressing the barriers of the adherence of the supplement mainly counseling or managing of side effects and reducing of forgetfulness to take the tablet through getting family support or male involvement during visit is mandatory.