Adherence to Iron-Folic Acid Supplementation and Associated Factors Among Pregnant Women Attending Antenatal Clinic In Shashemene town Health Facility, Southeast Ethiopia,2024; Facility based cross-sectional Study

Adherence to Iron-Folic Acid Supplementation and Associated Factors Among Pregnant Women Attending Antenatal Clinic In Shashemene town Health Facility, Southeast Ethiopia,2024; Facility based cross-sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Adherence to Iron-Folic Acid Supplementation and Associated Factors Among Pregnant Women Attending Antenatal Clinic In Shashemene town Health Facility, Southeast Ethiopia,2024; Facility based cross-sectional Study Assefa washo, Ashenafi Tsegaye This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4462717/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background; Pregnant women are at a high risk of anemia, with iron-folate deficiency being the most common cause of anemia among pregnant women. Despite the well-known importance of iron and folic acid supplementation (IFAS) during pregnancy, adherence to these supplements is relatively low and associated factors were not well identified in the study area. The aim of this study was to assess Iron - Folic Acid Supplementation adherence and Associated Factors among Pregnant Women Attending Antenatal Clinic in Shashemene town public health facilities, Southeast Ethiopia; 2024. Method Facility-based cross-sectional study design was employed selecting 415 pregnant women attending antenatal care services in four public health institutions of Shashemene town. Health facility were selected by simple random sampling using lottery method. Based on quarterly report of population size, proportion to sample size allocation made at each selected health facilities. Finally, pregnant women who visited for Antenatal care service at selected health facilities during data collection period were consecutively included in the study. Data were collected by interview. Then it was entered into EPI Data version 3.1 and exported to SPSS version 27 for analysis. Bivariate and multivariate binary logistic regression techniques were used to identify independent predictors. A p-value < 0.05 was taken as indication of statistical significance Results The overall adherence status of pregnant women attending antenatal clinic was found to be 66.5%. Participating on pregnant mother conference (AOR = 5.39, 95%CI: 3.29–8.83), having less than four children (AOR = 1.88, 95% CI (1.12, 3.13) and good knowledge of IFAS (AOR = 2.61, 95% CI (1.51, 4.53), were statistically and positively associated with pregnant mothers adherence to iron and folic acid supplementation. Conclusions The study revealed a notably high adherence to iron-folic acid (IFA) supplementation among the women included, surpassing rates observed in both national and international studies. Factors contributing to this included receiving information and education on IFA supplementation during pregnant mother conferences conducted by health professionals, possessing knowledge about IFAS, and having fewer than or equal to four children. Intervention strategies targeting these factors are strongly recommended to sustain and potentially increase mothers' adherence to IFA supplementation. Adherence status Iron and folic acid pregnant women shashemene town Figures Figure 1 Contributions To The Literature Despite the well-known importance of iron and folic acid supplementation (IFAS) during pregnancy, adherence to these supplements is relatively low and associated factors were not well identified in the study area. Pregnant mother conferences conducted by health professionals, possessing knowledge about IFAS, and having fewer than or equal to four children contributing factors for adherence to IFAS. Intervention strategies targeting these factors are strongly recommended to sustain and potentially increase mothers' adherence to IFA supplementation. Introduction In a woman’s life, pregnancy is a critical stage that affects the future generation. During pregnancy, due to the physiological and hormonal change, the requirement of iron–folic acid is enhanced. The increased demand for nutrients cannot be met by diet alone as the bioavailability of nutrients in pregnant women decline( 1 , 2 ). If the demands of these nutrients cannot be met, ultimately the mothers will be anemic( 3 ). The adherence to iron folic acid (IFA) supplementation is the extent to which pregnant women take iron-folic acid medication. It is the condition of sticking to the dose and time for taking the iron-folic acid supplement as prescribed by health care providers or per recommendations. To say pregnant mothers are adhere to iron-folic acid supplementation they should have to took 90 tablets or more of the supplement during their pregnancy time ( 1 , 2 , 4 ) Anemia affects more than two billion people, 30–50% of whom are from developing countries including Ethiopia( 5 ). Nearly 50% of all anemia can be attributed to iron deficiency. Folic acid is also a vital micronutrient required for the metabolism, fetal growth, and the development of the neural tube ( 6 – 8 ). Globally, the estimated prevalence of anemia among non- pregnant and pregnant women was 29% and 38%, respectively, whereas, in Africa, the estimated proportions were 37.8% and 46.3%, respectively( 9 ). Prevalence and determinants of anemia among pregnant women in ten East Africa from recent Demographic and Health Surveys shows pooled prevalence 41.82% with a large difference between specific countries which ranged from 23.36% in Rwanda to 57.10% in Tanzania( 9 ). The Ethiopian Demographic Health Survey 2016 (EDHS) showed the overall prevalence of anemia among pregnant women to be 41%, of which 20% were moderately anemic, 18%, mildly anemic and 3%, severely anemic( 10 ). The systematic review and meta-analysis study conducted in Ethiopia shows pooled prevalence of anemia among pregnant women was 26.4%( 11 ). Globally, anemia reduction is the second nutritional goal for 2025 and is a key component of achieving women’s and children’s health. The goal is to reduce anemia in women of reproductive age by 50% ( 2 ). Iron-folic acid supplementation (IFAS) is one of the most important interventions to reduce anemia among pregnant women( 2 ). Regardless of WHO recommendations, adherence to iron-folic acid supplementation is still low in many countries, especially in low-resource setting countries. Many developing countries, have been implementing IFA supplementation programs through ANC program but only a few countries have reported significant improvement in IFA supplementation and anemia control and prevention ( 2 , 7 , 12 , 13 ). In Ethiopia, despite the IFA supplementation provision for pregnant women being an integral part of Antenatal care (ANC) and is free of charge as the national program to prevent IFA deficiency during pregnancy an intervention, adherence to IFA is still said to be low, inconsistency and its level is varies in across different setting and area. According to the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS) the percentage of women taking Iron supplements for 90 days or more increased from 5% in 2016 to 11% in 2019 but remains at a substandard level and there is also great variation between urban and rural residents( 10 , 14 ). Studies conducted on Iron-folic in different parts of countries revealed that the adherence of Iron-folic among pregnant Mother ranged from 22.9% study conducted Mille and Assayita of Afar regional State to 76.9% study conducted on Dangila of Amhara regional state ( 1 , 3 , 6 , 15 – 23 ). The factor associated with iron-folic acid adherence identified by previous studies were history of past abortion( 15 ) knowledge about anemia ( 1 , 3 , 15 – 17 , 20 ) knowledge about IFA( 1 , 17 , 20 ) received health education ( 15 , 16 ) counseled on IFA( 3 ) have four and more ANC visit( 3 , 17 ) maternal education ( 20 , 22 ) husband education ( 20 ) achieved secondary school ( 6 , 23 ) age of mother ( 16 , 20 ) history of anemia during previous pregnancy ( 16 ) complication of previous pregnancy ( 19 ) distance from health facility( 21 ) being government employee( 21 ) and early start of antenatal care ( 21 – 23 ). Even though every government health institution provides IFA supplementation and the service is free of charge to supplement the mother, the prevalence of anemia is slowly decreased in Ethiopia. In addition, to the investigators best knowledge no information is available in the study area. Due to these facts, this study aimed to assess adherence to iron and folic acid supplementation and associated factors among pregnant women attending public health facility of Shashemene town, West Arsi, Ethiopia, from November 1 to January 30, 2023. Methods Study area and period and Study design Shashemene is a town of West Arsi Zone located in Oromia region, South West Ethiopia. It sites at : 7°12′N Longitude: 38°36′E with an elevation between, 2,470 and 2,550 meters above sea level. It is located 250 km away from capital city of Addis Ababa. It is situated at the place where the high road intersection leads to 5 major roads turning to Hawassa, Wondo, Bale, Addis Ababa and Arba Minch. Based on the 2007 national census conducted by the central statistical agency of Ethiopia, Shashemene city has a total population projection is 394,412 and whom; 201,150 females. Estimated reproductive age groups in the town were 87,283. There are two public hospitals, six public health centers. Facility based cross sectional study was conducted from November 1, 2023- January 30, 2023. Populations; All pregnant women supplemented iron -folic acid in Shashemene town public health facilities source Population. Pregnant women who were previously supplemented with iron - folic acid tablets at least one month prior to data collection and come to selected health facilities during the study period were study Population. Eligibility criteria ; pregnant women who had at least one ANC visit in health institution and supplement with IFA tablets at selected health facilities were included in the study whereas Pregnant women who are unable to hear and/or speak, and those who have mental disorder were excluded. Sample size determination For the first objective sample size will be determined using single population proportion The sample size is calculated using a single population proportion with the following assumptions: the prevalence of IFA supplements adherence from a previous study in Dilla town (p = 43.3%)( 1 ) = The level of confidence was 95%, and Margin of error (d) = 0.05. n = \(\frac{\left(\text{Z}\raisebox{1ex}{$\alpha $}\!\left/ \!\raisebox{-1ex}{$2$}\right.\right)2 \text{p}\left(1-\text{p}\right)}{{d}^{2}}\) where n = required sample size Z α/2 = significance level at 0.05 p = prevalence of Iron and folic acid compliance = 0.433 d = the margin of error = 0.05 n = \(\frac{\left(1.96\right)2\text{*} 0.433\left(1-0.433\right)}{{0.05}^{2}}\) = 3.842*0.433*0.567/0.0025 = 377 By considering a 10% non-respondent rate the total final sample size will be 415. For the second specific objective sample size is calculated considering two population proportions using Epi-info version 7. Factors which significantly related with dependent variable were used based on the following assumptions 95% level of confidence, 80% power and finally the two sample size were compared and formula that provide maximum sample size was used. Different literatures showed different levels of contribution of the factors that affect adherence to IFA supplementation (Table 1 ). Table 1 ; calculated sample size for factors associated with compliance to iron folic acid supplementation among pregnant women, 2024 Factors 95%:CI power % outcome un-exposed AOR Sample size Final sample size with 10% addition Reference History Abortion 95 80 70.5 3.92 144 149 ( 15 ) Knowledge of IFA 95 80 70.3 2.63 236 260 ( 17 ) Knowledge of Anaemia 95 80 34.7 2.3 206 226 ( 1 ) Educational status (primary ) 95 80 34.8 3.72 88 97 ( 15 ) Sampling procedure There are eight public health facilities (two hospitals and six health centers) providing Antenatal care services at Shashemene town. Four health facilities, three health centers and one Hospital (Melka Oda General Hospital, Abosto Health Center, Awasho Health Center, Bulchana Health Center) were selected by simple random sampling using lottery method. Based on quarterly report of population size, proportion to sample size allocation were made at each selected health facilities. Finally, pregnant women who visited for Antenatal care service at selected health facilities during data collection period were consecutively included in the study (Fig. 1 ). Study Variables Dependent variable Iron - folic acid adherence Independent Variables Socio-demographic factors; Age, Educational status, residence, educational status of partners, Monthly income. Pregnancy related factor; Parity, Gravidity, Gestational age, Abortion history, number ANC visit. Knowledge related factors; Knowledge about Anemia, Knowledge about IFA supplementation, Benefits of IFA tablet. Drug and behavior related factors; side effect, forgetfulness Health care system and service related factors; time taken to health facility presence of ANC conference, presence of health education. Supplement related factors. Number IFA tablet given per visit, time of IFAS initiation. Variable definitions Adherence to IFA IFA adherence requires that the woman take four tablets at least per week (≥ 4 times per week) for the previous 1 month. Pregnant women who took at least 57% of the expected dose of the IFA tablets in the previous one week before data collection, which is equivalent to consuming at least 1 tablet daily for 4 days in the week consecutively or consuming 17 tablets in a month daily without missing the prescribed doses, was considered as adhered with IFA supplement. Non-adherence to IFA Pregnant mother is said to be non-adhered to IFA supplement if they took for less than < 4 days per week tablets during 1 last month Good Knowledge about IFAS Pregnant women who answer the mean value and above from comprehensive questions that was used to assess the knowledge of study participants about the benefits and risks to be compliant and not adherent to IFAS were considered to have good knowledge about. Good Knowledge about Anemia; Respondents were asked questions related to the cause, signs and symptoms, method of prevention, consequence of anemia and risk groups for anemia. Accordingly, pregnant women who scored greater than the mean value of correct responses were considered as knowledgeable about anemia otherwise, they were considered as not knowledgeable. Data collection tool and data collection procedure Structured questionaries’ is developed in English and translated to Afan oromo for data collection. Data were collected by face to face exit interview using structured questionnaire consisting of items that assess socio-demographic characteristics, time to start and adherence to iron-folate supplement, knowledge of anemia and iron-folate supplement, pregnancy-related experiences. Questions adapted from different literatures, chart and registration. Data was collected over a three-month period by three health workers (two qualified midwives and one qualified nurse) and one supervisor. Data quality assurance The questionnaire initially prepared in English and then were translated to Afan Oromo and back into English. The questionnaire were pre-tested before implementation on twenty one ( 21 ) pregnant women attending ANC and using IFA supplement at Arsi Nagelle Health Center and revisions were made to the tool based on the results. One day of training was given to data collectors and supervisor on the objective of the study, data collection process, and relevance of the study to both data collectors and supervisors before actual data collection. In addition to supervisor, the investigators were actively involved in the supervision of data collection and the completed questionnaire were cross-checked daily for completeness. Data collectors were supervised at each site and regular communication carried out between the data collectors, supervisors, and the investigators. The data were checked on-site for completeness. Data processing and Analysis The collected data were coded and entered into Epi data version 3.1 and exported to SPSS version 27 statistical software package for analysis. Descriptive analyses were performed to summarize the variables presented using tables and figures. Hosmer and Lemeshow fitness of goodness test was conducted and model fitness declared if p-value was > 0.05. Multi co linearity test were done through VIF, tolerance and condition index and no multi co linearity was detected. Variables exhibiting a p-value < 0.25 in the bivariate analysis were selected for multivariable analysis to ascertain associated factors. Adjusted Odds Ratios (AORs) with corresponding 95% Confidence Intervals (CIs) were calculated for each independent variable, with statistical significance declared at P < 0.05. Results and Discussion Results Socio‑demographic characteristics From a total of 415 pregnant women, 403 were participated in the study, with a response rate of 97.1%. The mean age of study participants was 27.89 (± 5.28 SD) years. All most all, 391 (97%) of the study participants were married. Two hundred fifty seven (63.8%) were at secondary school and above and 250 (62%) were housewives. The majority, 347 (86.1%) of the respondents were from urban residents and 239 (59.3%) had 1–4 family size (Table 2 ) Table 2 The socio-demographic characteristics of respondents in Shashemene town public health facilities, southwest Ethiopia; 2023 (n = 403). Variables Category Frequency Percent Mother age 15–19 years 23 5.7 20–24 years 78 19.4 >=25 years 302 74.9 Place of residence Urban 347 86.1 Rural 56 13.9 Distance from house less than 30 minute 170 42.2 greater than 30 minute 233 57.8 Educational Status Mother No formal education 77 19.1 Primary1-8 69 17.1 secondary and above 257 63.8 Occupation of Mother Housewife 250 62.0 Daily labor 62 15.4 others (Governmental employee, merchant,) 92 22.6 Marital status Married 391 97.0 Others (Single, Divorced and widow) 12 3.0 Partner occupation Farmer 67 16.6 Daily labor 80 19.9 Governmental employee 146 36.2 Others (Merchant 110 27.3 Obstetrics and health related characteristics The mean gestational age of the pregnant women during the current visit was 28 (SD ± 6.68) weeks and 249 (61.8%) of them were in third trimester. Regarding gravidity and parity, majority (90.1%) of women were multigravida and 40(9.9%) were primiparous. This study showed that nearly one third 30% of women had history of abortion. Concerning the utilization of antenatal care, more than half, 372 (92.4%) of respondents had at least two antenatal contact a, 202 (50.1%) had three ANC contact and 2.5% had eight contact (Table 3 ). Table 3 Obstetrics and health related characteristics to supplementation among respondents in Shashemene Southern Ethiopia 2023 (N = 403). Variables Category Frequency Percent Do pregnant mother has anemia during current pregnancy Yes 104 25.8 No 299 74.2 History of Abortion Yes 121 30.0 No 282 70.0 Trimester of pregnancy 1st Trimester Pregnancy 10 2.5 2nd Trimester Pregnancy 144 35.7 3rd Trimester Pregnancy 249 61.8 ANC categorized Less than 4 Visit 196 48.6 Four and Above Visit 207 51.4 Gravidity Primi Para 40 9.9 Multpara 363 90.1 Knowledge status of respondents on Anemia and Benefit of IFAS Majority, 379 (94%) of the respondents have ever heard about anemia. About 314(77.9%) of the respondents had good knowledge about anemia whereas 22.1% had poor knowledge of anemia. Regarding knowledge on the benefit of IFAS 299 (74.2%) of the respondents had good knowledge whereas 25.8% had poor knowledge about iron and folic acid supplementation Health facility related characteristics Of the total respondents, 170 (42.2%) said that, it took them 30 min or less to reach the nearest health facility from their place of residence. Adherence status to IFA supplementation The overall adherence status (took IFA tablets for ≥ 4 days/week for the previous 1 month preceding the survey) of pregnant women attending antenatal clinics was 66.5%. Factors associated with adherence to IFA supplementation Variables that showed an association with IFA supplement at p-values less than 0.25 during bivariate were entered into multivariate logistic Regression. Nine ( 9 ) variables ( Place of residence, gravidity history, knowledge about Anemia, does pregnant mother have current anemia, knowledge about IFAS, Pregnant mother conference participation, time takes from home to the health facility, family size and do you get advice about IFAS) were candidate variables for multivariate logistic regression analysis. Finally, after adjusting for confounders using multivariate logistic regression model, three ( 3 ) variables (knowledge about IFAS, Pregnant mother conference participation and family size) were found to be statistically significant predictors for adherence to IFA supplement. Adherence to IFA supplement has increased in the women who have good Knowledge about IFAS. Pregnant women who had good Knowledge about IFAS were 2.6 times (AOR = 2.61, 95% CI (1.51, 4.53), more likely to be adhered to IFA supplement than those pregnant women who had poor Knowledge about IFAS. Moreover, pregnant mother conference participation has also been an important predictor of adherence to IFA supplement. Pregnant women who participated Pregnant mother conference were 5.4 times (AOR = 5.39, 95% CI (3.29, 8.83), more likely to be adhered to IFAS compared to those pregnant women not participated pregnant mother conference. Pregnant women who had family size four and less 1.9 times (AOR = 1.88, 95% CI (1.12, 3.13) more likely to be adhered to IFAS than those pregnant women who had family size more than four (Table 4 ) Table 4 ; Factors associated with adherence to IFA supplementation among pregnant women in Shashemene town, South east, Ethiopia 2024 (N = 403) Variables Category Compliance status COR 95% (CI) AOR 95% (CI) yes no Place of residence Urban 225(64.8%) 122(35.2%) 0.56 (0.29–1.08) 0.49 (0.24–1.02) Rural 43(76.8%) 13(23.2%) Ref Gravidity history No 30(75%) 10(25%) 1.58 (0.75–3.33) 2.16 (0.95–4.93) Yes 238(65.6%) 125(34.4%) ref Knowledge about Anemia Poor 39(49.4%) 40(50.6%) 0.40 (0.25–0.67) 0.64 (0.36–1.15) Good 229(70.7%) 95(29.3%) ref Pregnant mother have current anemia Yes 9(37.5%) 15(62.5%) 0.28(0.12–0.65) 0.83(0.30–2.33) No 259(68.3%) 120(31.7%) Ref Knowledge about IFAS Good 214(71.6%) 85(28.4%) 2.33(1.47–3.69) 2.61(1.51–4.53)* Poor 54(51.9%) 50(48.1%) Ref Conference participation Yes 174(79.8%) 44(20.2%) 3.83(2.47–5.94) 5.39(3.29–8.83)* No 94(50.8%) 91(49.2%) Ref Time it takes from your home to the health facility 4 97(59.1%) 67(40.9%) Ref History of abortion No 197(69.9%) 85(30.1%) 1.63(1.05–2.54) 1.25(0.76–2.06) Yes 71(58.7%) 50(41.3%) Ref Advised about IFAS No 38(56.7%) 29(43.3%) 0.60 (0.35–1.03) 1.01(0.52–1.96) Yes 230(68.5%) 106(31.5%) Ref Note: Variables were included in the adjusted model based on a P – value of < 0.25 in the unadjusted model and Hosmer and Lemeshow goodness of fit test predicted the outcome variable. * Significant at P – value < 0.001. Discussion This study was conducted to assess Adherence to IFAS and identify factors associated with it among pregnant women in shashemene town of Oromia region. Among 403 pregnant women who participated in the study, (268, 66.5%) were adhered to IFA supplementation. This study in line with study conducted in Zinder of Niger 68.6% ( 12 ), among pregnant women of Eritrea, in Shire refugee camps 64.7% ( 24 ), Gulele Sub-City 62.3%( 25 ), Tikur Anbessa Specialized, Hospital, Ethiopia 63.6%( 26 ) and 65% in Lay Armachiho( 27 ). But it is lower as compared to the comparative study done in Dangila, Northern Ethiopia revealed 76.9%( 21 ), in Yeka Sub City, Addis Ababa 71.3%( 23 ), Dire dewa 71.8%( 28 ). This difference may be due to variations in socio-cultural, geographical location between the regions of country and it may due to differences in training level of health care professionals and standard of the health care institution in the different level of health care facilities. This explanation is supported by a study stating high adherence is expected in well-organized setups as adequate counseling and sustainable product availability are better in such facilities. However, this finding was higher than other studies conducted in different areas of Ethiopia; such as Ayder Comprehensive Specialized Hospital ,Northern Ethiopia 10.5%( 29 ), Aykel town, Northwest Ethiopia 47.6%( 15 ), North Wollo Zone 43.1% ( 3 ), Mecha district, Western Amhara 20.4%( 16 ), Mille and Assaita Districts, Afar 22.9%( 18 ), Hawassa city, South Ethiopia 38.3%( 19 ), Wondo district 44.3%( 20 ), Dilla town 43.4%( 1 ), Kasulu Communities in North-Western Tanzania 20.3%( 4 ) and Kiambu County, Kenya 32.7% ( 30 ) .This may be related to increased knowledge of pregnant women about anemia and IFA supplementation over time. The educational level of the study participants and their husbands may also have increased adherence in our study. Pregnant women who had good Knowledge about IFAS were 2.6 times (AOR = 2.61, 95% CI (1.51, 4.53), more likely to be adhered to IFA supplement than those pregnant women who had poor Knowledge about IFAS. Knowledge of IFAS was associated with women’s adherence to iron and folic acid supplementation in studies conducted in Wondo district, Dilla town, Burji Districts, Segen Area People’s Zone, public hospitals of Dire Dawa, Aykel town, Hawassa city and Kiambu County, Kenya ( 1 , 15 , 19 , 20 , 22 , 28 , 30 ). This may be because knowledge helps women understand the benefits of taking the supplement and the consequences of not taking the supplement for the mother and fetus during pregnancy, labor and delivery. In this study, women with four or fewer children were shown to be 1.88 times more adhered than women with more than four children. This outcome is consistent with Study conducted in Dangila, Northern, Ethiopia ( 21 ) and Kasulu Communities in North-Western Tanzania( 4 ).This outcome is due to the fact that they require more healthy youngsters who can appropriately follow the recommendations of health professionals. In the current study, pregnant women participated on Pregnant mother conference were 5.39 times more likely to adhere to their iron- folate supplement when compared with those who were not participated. This finding was supported by the study conducted in the Dangila Ethiopia( 21 ) and Aykel North west Ethiopia( 15 ). The counseling and health education provided during pregnant women conference by health care provider, encourage women to take the supplement as prescribed, and educate them on the health benefit of taking iron folate supplement( 28 ). The possible explanation may be that pregnant women who received health education might have the opportunity to understand the purpose, importance, possible side effects and duration and dosage of the supplement. Limitation Adherence to IFA supplementation was determined by self-reporting, which may affect actual compliance due to the potential for over-reporting or under-reporting of tablets consumed. Since the study was based on the consumption of iron and folic acid tablets from the previous month, they might be subject to potential recall bias. As both dependent and independent variables were determined at one point in time, it is impossible to indicate which comes first. Therefore, further studies are recommended with all necessary variations with robust study designs supported by qualitative methods. Conclusion and Recommendation Adherence to Iron-folic acid supplement among women who were included in the study was found to be high as compared to other national and international studies. Getting information and education by pregnant mother conference about Iron/Folic Acid supplement from health professionals, Knowledge about IFAS and Women who had less than or equal to four live children were the factors that increased the number of Iron/Folic Acid uptake by the mothers. Intervention modalities that could touch the above factors were highly recommended to sustain adherence level of the mothers to Iron/Folic Acid supplementation. Abbreviations AOR Adjusted Odd Ratio ANC Antenatal Care BMI Body mass index BMC Bio Med Central COR Crude Odds Ratio ECI Early childhood initiatives EMDHS Ethiopian Mini Demographic and Health Surveys FMOH Federal Ministry of Health Hgb Hemoglobin HC Health Center IDA Iron deficiency anemia IFA Iron folic acid LBW Low birth weight MND Micro Nutrient Deficiency NTD Neural Tube BD Birth Defect PW Pregnant Women REC Research and Ethical committee SRS Simple Random Sampling SSA Sub-Saharan Africa SPSS Statically package for social science VIF Variance inflation factors WHO World Health Organization. Declarations Ethical approval and consent to participate Ethical approval was obtained from Paradise Valley College Research and Community service by observing appropriateness and scientific integrity of the study. Permission was obtained from Shashemene Town Health Office and Melka Oda General Hospital. Verbal informed consent was obtained from each participant. Confidentiality and privacy were maintained by using code during data collection. They were also provided with the information regarding the purpose, objective, potential risks and benefits of the study. Consent for publication: Not applicable Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests: Authors declare that they have no any competing interest Funding: no fund was obtained for this study Authors' contributions: Both authors have been involved in conception, Design, analysis, interpretation, report writing and manuscript writing. Acknowledgments: The authors would like to thanks Paradise Valley College for its cooperation and financial support for data collection. We are grateful to all data collectors, supervisors and participants for their valuable contribution. References Mamo TT, Ashenafi E, Gube AA, Bekele T. Adherence to prenatal iron–folic acid supplementation and associated factors among pregnant women attending antenatal care services in Dilla town, South Ethiopia. Med Access@ Point Care. 2021;5:23992026211008805. Organization WH. Global Nutrition Monitoring Framework: operational guidance for tracking progress in meeting targets for 2025. Geneva: License: CC BY-NC-SA 3.0 IGO. 2017. Demis A, Geda B, Alemayehu T, Abebe H. Iron and folic acid supplementation adherence among pregnant women attending antenatal care in North Wollo Zone northern Ethiopia: institution based cross-sectional study. BMC Res Notes. 2019;12:1–7. Lyoba WB, Mwakatoga JD, Festo C, Mrema J, Elisaria E. Adherence to iron-folic acid supplementation and associated factors among pregnant women in Kasulu communities in north-western Tanzania. International Journal of Reproductive Medicine. 2020;2020. Fite MB, Assefa N, Mengiste B. Prevalence and determinants of Anemia among pregnant women in sub-Saharan Africa: a systematic review and Meta-analysis. Archives Public Health. 2021;79:1–11. Gebreamlak B, Dadi AF, Atnafu A. High adherence to iron/folic acid supplementation during pregnancy time among antenatal and postnatal care attendant mothers in Governmental Health Centers in Akaki Kality Sub City, Addis Ababa, Ethiopia: Hierarchical negative binomial poisson regression. PLoS ONE. 2017;12(1):e0169415. Paudyal N, Parajuli KR, Garcia Larsen V, Adhikari RK, Devkota MD, Rijal S, et al. A review of the maternal iron and folic acid supplementation programme in Nepal: Achievements and challenges. Matern Child Nutr. 2022;18:e13173. Asmamaw DB, Debebe Negash W, Bitew DA, Belachew TB. Poor adherence to iron-folic acid supplementation and associated factors among pregnant women who had at least four antenatal care in Ethiopia. A community-based cross-sectional study. Front Nutr. 2022;9:1023046. Liyew AM, Tesema GA, Alamneh TS, Worku MG, Teshale AB, Alem AZ, et al. Prevalence and determinants of anemia among pregnant women in East Africa; A multi-level analysis of recent Demographic and Health Surveys. PLoS ONE. 2021;16(4):e0250560. Maryland EMDHSR. USA: EPHI and ICF. Ethiopian Public Health Institute (EPHI) [Ethiopia] and ICF. 2019. Ethiopia Mini Demographic and Health Survey: Key Indicators 2019. Geta TG, Gebremedhin S, Omigbodun AO. Prevalence and predictors of anemia among pregnant women in Ethiopia: Systematic review and meta-analysis. PLoS ONE. 2022;17(7):e0267005. Begum K, Ouédraogo CT, Wessells KR, Young RR, Faye MT, Wuehler SE, et al. Prevalence of and factors associated with antenatal care seeking and adherence to recommended iron-folic acid supplementation among pregnant women in Zinder. Niger Maternal child Nutr. 2018;14:e12466. Suryanarayana R, Chandrappa M, Santhuram AN, Prathima S, Sheela S. Prospective study on prevalence of anemia of pregnant women and its outcome: A community based study. J family Med Prim care. 2017;6(4):739–43. EDHS M, USA: EPHI and ICF. Ethiopian Public Health Institute (EPHI) [Ethiopia] and ICF. 2016. Ethiopia Mini Demographic and Health Survey: Key Indicators. 2016. Assefa H, Abebe SM, Sisay M. Magnitude and factors associated with adherence to Iron and folic acid supplementation among pregnant women in Aykel town, Northwest Ethiopia. BMC Pregnancy Childbirth. 2019;19:1–8. Taye B, Abeje G, Mekonen A. Factors associated with compliance of prenatal iron folate supplementation among women in Mecha district, Western Amhara: a cross-sectional study. Pan Afr Med J. 2015;20(1). Molla T, Guadu T, Muhammad EA, Hunegnaw MT. Factors associated with adherence to iron folate supplementation among pregnant women in West Dembia district, northwest Ethiopia: a cross sectional study. BMC Res Notes. 2019;12:1–6. Gebre A, Debie A, Berhane A, Redddy PS. Determinants of compliance to iron-folic acid supplementation among pregnant women in pastoral communities of Afar region: the cases of mille and assaita districts, Afar, Etiopia-2015. Medico Res chronicles. 2017;4(04):352–62. Kassa ZY, Awraris T, Daba AK, Tenaw Z. Compliance with iron folic acid and associated factors among pregnant women through pill count in Hawassa city, South Ethiopia: a community based cross-sectional study. Reproductive health. 2019;16:1–8. Mengistu T, Lencha B, Mekonnen A, Degno S, Yohannis D, Beressa G. Compliance to iron folic acid supplementation and its associated factors among pregnant women attending Antenatal clinic in Wondo district: a cross-sectional study. Sci Rep. 2023;13(1):17468. Asres AW, Hunegnaw WA, Ferede AG, Azene TW. Compliance level and factors associated with iron–folic acid supplementation among pregnant women in Dangila, Northern Ethiopia: A cross-sectional study. SAGE Open Med. 2022;10:20503121221118989. Boti N, Bekele T, Godana W, Getahun E, Gebremeskel F, Tsegaye B et al. Adherence to Iron-Folate supplementation and associated factors among Pastoralist’s pregnant women in Burji districts, Segen area People’s zone, southern Ethiopia: community-based cross-sectional study. International journal of reproductive medicine. 2018;2018. Urgessa BT, Abdo ZA. Adherence to iron/folic acid supplementation and associated factors among pregnant women attending governmental health center in Yeka Sub City, Addis Ababa, Ethiopia. BLDE Univ J Health Sci. 2020;5(2):145–53. Getachew M, Abay M, Zelalem H, Gebremedhin T, Grum T, Bayray A. Magnitude and factors associated with adherence to Iron-folic acid supplementation among pregnant women in Eritrean refugee camps, northern Ethiopia. BMC Pregnancy Childbirth. 2018;18:1–8. Tegodan E, Tura G, Kebede A. Adherence to iron and folic acid supplements and associated factors among pregnant mothers attending anc at gulele sub-city government health centers in addis ababa, ethiopia. Patient preference and adherence. 2021:1397 – 405. Nasir BB, Fentie AM, Adisu MK. Adherence to iron and folic acid supplementation and prevalence of anemia among pregnant women attending antenatal care clinic at Tikur Anbessa Specialized Hospital, Ethiopia. PLoS ONE. 2020;15(5):e0232625. Agegnehu G, Atenafu A, Dagne H, Dagnew B. Adherence to iron and folic acid supplement and its associated factors among antenatal care attendant mothers in Lay Armachiho health centers, Northwest, Ethiopia, 2017. International journal of reproductive medicine. 2019;2019. Solomon Y, Sema A, Menberu T. Adherence and associated factors to iron and folic acid supplementation among pregnant women attending antenatal care in public hospitals of Dire Dawa, Eastern Ethiopia. Eur J Midwifery. 2021; 5. Gebremichael TG, Haftu H, Gereziher TA. Time to start and adherence to iron-folate supplement for pregnant women in antenatal care follow up; Northern Ethiopia. Patient Prefer Adherence. 2019:1057–63. Kamau MW, Mirie W, Kimani S. Compliance with Iron and folic acid supplementation (IFAS) and associated factors among pregnant women: results from a cross-sectional study in Kiambu County, Kenya. BMC Public Health. 2018;18:1–10. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4462717","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":312313162,"identity":"97987dd9-d908-4ae2-9f9d-f18654b9e0a3","order_by":0,"name":"Assefa washo","email":"","orcid":"","institution":"Hawassa college health science","correspondingAuthor":false,"prefix":"","firstName":"Assefa","middleName":"","lastName":"washo","suffix":""},{"id":312313163,"identity":"abadf99b-d0b7-4e36-95d5-dbf86fe66633","order_by":1,"name":"Ashenafi Tsegaye","email":"data:image/png;base64,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","orcid":"","institution":"Nagelle Arsi Health office","correspondingAuthor":true,"prefix":"","firstName":"Ashenafi","middleName":"","lastName":"Tsegaye","suffix":""}],"badges":[],"createdAt":"2024-05-22 18:53:52","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4462717/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4462717/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58151772,"identity":"0dcda531-f403-4309-aed6-8d89221dd5d3","added_by":"auto","created_at":"2024-06-11 20:13:01","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":450451,"visible":true,"origin":"","legend":"\u003cp\u003eSampling procedure for the study on adherence to Iron - Folic Acid Supplementation and Its Associated Factors among pregnant mothers attending ANC in Shashemene public health facility, Ethiopia, 2024.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4462717/v1/617a4caa37cf507f70d85cac.jpeg"},{"id":58152454,"identity":"bf5359ca-ff7f-4145-a06f-2dcb18b1e2f2","added_by":"auto","created_at":"2024-06-11 20:21:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1315411,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4462717/v1/a3e05a57-55b9-458c-90ba-c627dacef2c3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Adherence to Iron-Folic Acid Supplementation and Associated Factors Among Pregnant Women Attending Antenatal Clinic In Shashemene town Health Facility, Southeast Ethiopia,2024; Facility based cross-sectional Study","fulltext":[{"header":"Contributions To The Literature","content":"\u003cp\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003eDespite the well-known importance of iron and folic acid supplementation (IFAS) during pregnancy, adherence to these supplements is relatively low and associated factors were not well identified in the study area.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePregnant mother conferences conducted by health professionals, possessing knowledge about IFAS, and having fewer than or equal to four children contributing factors for adherence to IFAS.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eIntervention strategies targeting these factors are strongly recommended to sustain and potentially increase mothers' adherence to IFA supplementation.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eIn a woman\u0026rsquo;s life, pregnancy is a critical stage that affects the future generation. During pregnancy, due to the physiological and hormonal change, the requirement of iron\u0026ndash;folic acid is enhanced. The increased demand for nutrients cannot be met by diet alone as the bioavailability of nutrients in pregnant women decline(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). If the demands of these nutrients cannot be met, ultimately the mothers will be anemic(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe adherence to iron folic acid (IFA) supplementation is the extent to which pregnant women take iron-folic acid medication. It is the condition of sticking to the dose and time for taking the iron-folic acid supplement as prescribed by health care providers or per recommendations. To say pregnant mothers are adhere to iron-folic acid supplementation they should have to took 90 tablets or more of the supplement during their pregnancy time (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAnemia affects more than two billion people, 30\u0026ndash;50% of whom are from developing countries including Ethiopia(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Nearly 50% of all anemia can be attributed to iron deficiency. Folic acid is also a vital micronutrient required for the metabolism, fetal growth, and the development of the neural tube (\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Globally, the estimated prevalence of anemia among non- pregnant and pregnant women was 29% and 38%, respectively, whereas, in Africa, the estimated proportions were 37.8% and 46.3%, respectively(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePrevalence and determinants of anemia among pregnant women in ten East Africa from recent Demographic and Health Surveys shows pooled prevalence 41.82% with a large difference between specific countries which ranged from 23.36% in Rwanda to 57.10% in Tanzania(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Ethiopian Demographic Health Survey 2016 (EDHS) showed the overall prevalence of anemia among pregnant women to be 41%, of which 20% were moderately anemic, 18%, mildly anemic and 3%, severely anemic(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The systematic review and meta-analysis study conducted in Ethiopia shows pooled prevalence of anemia among pregnant women was 26.4%(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGlobally, anemia reduction is the second nutritional goal for 2025 and is a key component of achieving women\u0026rsquo;s and children\u0026rsquo;s health. The goal is to reduce anemia in women of reproductive age by 50% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Iron-folic acid supplementation (IFAS) is one of the most important interventions to reduce anemia among pregnant women(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRegardless of WHO recommendations, adherence to iron-folic acid supplementation is still low in many countries, especially in low-resource setting countries. Many developing countries, have been implementing IFA supplementation programs through ANC program but only a few countries have reported significant improvement in IFA supplementation and anemia control and prevention (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Ethiopia, despite the IFA supplementation provision for pregnant women being an integral part of Antenatal care (ANC) and is free of charge as the national program to prevent IFA deficiency during pregnancy an intervention, adherence to IFA is still said to be low, inconsistency and its level is varies in across different setting and area. According to the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS) the percentage of women taking Iron supplements for 90 days or more increased from 5% in 2016 to 11% in 2019 but remains at a substandard level and there is also great variation between urban and rural residents(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStudies conducted on Iron-folic in different parts of countries revealed that the adherence of Iron-folic among pregnant Mother ranged from 22.9% study conducted Mille and Assayita of Afar regional State to 76.9% study conducted on Dangila of Amhara regional state (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16 CR17 CR18 CR19 CR20 CR21 CR22\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe factor associated with iron-folic acid adherence identified by previous studies were history of past abortion(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) knowledge about anemia (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) knowledge about IFA(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) received health education (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) counseled on IFA(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) have four and more ANC visit(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) maternal education (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) husband education (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) achieved secondary school (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) age of mother (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) history of anemia during previous pregnancy (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) complication of previous pregnancy (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) distance from health facility(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) being government employee(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) and early start of antenatal care (\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEven though every government health institution provides IFA supplementation and the service is free of charge to supplement the mother, the prevalence of anemia is slowly decreased in Ethiopia. In addition, to the investigators best knowledge no information is available in the study area. Due to these facts, this study aimed to assess adherence to iron and folic acid supplementation and associated factors among pregnant women attending public health facility of Shashemene town, West Arsi, Ethiopia, from November 1 to January 30, 2023.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy area and period and Study design\u003c/h2\u003e \u003cp\u003eShashemene is a town of West Arsi Zone located in Oromia region, South West Ethiopia. It sites at : 7\u0026deg;12\u0026prime;N Longitude: 38\u0026deg;36\u0026prime;E with an elevation between, 2,470 and 2,550 meters above sea level. It is located 250 km away from capital city of Addis Ababa. It is situated at the place where the high road intersection leads to 5 major roads turning to Hawassa, Wondo, Bale, Addis Ababa and Arba Minch. Based on the 2007 national census conducted by the central statistical agency of Ethiopia, Shashemene city has a total population projection is 394,412 and whom; 201,150 females. Estimated reproductive age groups in the town were 87,283. There are two public hospitals, six public health centers. Facility based cross sectional study was conducted from November 1, 2023- January 30, 2023.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePopulations;\u003c/b\u003e All pregnant women supplemented iron -folic acid in Shashemene town public health facilities source Population. Pregnant women who were previously supplemented with iron - folic acid tablets at least one month prior to data collection and come to selected health facilities during the study period were study Population.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEligibility criteria\u003c/b\u003e; pregnant women who had at least one ANC visit in health institution and supplement with IFA tablets at selected health facilities were included in the study whereas Pregnant women who are unable to hear and/or speak, and those who have mental disorder were excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSample size determination\u003c/h2\u003e \u003cp\u003eFor the first objective sample size will be determined using single population proportion The sample size is calculated using a single population proportion with the following assumptions: the prevalence of IFA supplements adherence from a previous study in Dilla town (p\u0026thinsp;=\u0026thinsp;43.3%)(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;The level of confidence was 95%, and Margin of error (d)\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003en = \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{\\left(\\text{Z}\\raisebox{1ex}{$\\alpha $}\\!\\left/ \\!\\raisebox{-1ex}{$2$}\\right.\\right)2 \\text{p}\\left(1-\\text{p}\\right)}{{d}^{2}}\\)\u003c/span\u003e\u003c/span\u003e where\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;required sample size\u003c/p\u003e \u003cp\u003eZ\u003csub\u003eα/2\u003c/sub\u003e= significance level at 0.05\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;prevalence of Iron and folic acid compliance\u0026thinsp;=\u0026thinsp;0.433\u003c/p\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;the margin of error\u0026thinsp;=\u0026thinsp;0.05\u003c/p\u003e \u003cp\u003en = \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{\\left(1.96\\right)2\\text{*} 0.433\\left(1-0.433\\right)}{{0.05}^{2}}\\)\u003c/span\u003e\u003c/span\u003e = 3.842*0.433*0.567/0.0025 = 377\u003c/p\u003e \u003cp\u003eBy considering a 10% non-respondent rate the total final sample size will be 415.\u003c/p\u003e \u003cp\u003eFor the second specific objective sample size is calculated considering two population proportions using Epi-info version 7. Factors which significantly related with dependent variable were used based on the following assumptions 95% level of confidence, 80% power and finally the two sample size were compared and formula that provide maximum sample size was used. Different literatures showed different levels of contribution of the factors that affect adherence to IFA supplementation (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e; calculated sample size for factors associated with compliance to iron folic acid supplementation among pregnant women, 2024\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95%:CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003epower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e% outcome un-exposed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSample size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFinal sample size with 10% addition\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory Abortion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge of IFA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge of Anaemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational status (primary )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSampling procedure\u003c/h2\u003e \u003cp\u003eThere are eight public health facilities (two hospitals and six health centers) providing Antenatal care services at Shashemene town. Four health facilities, three health centers and one Hospital (Melka Oda General Hospital, Abosto Health Center, Awasho Health Center, Bulchana Health Center) were selected by simple random sampling using lottery method. Based on quarterly report of population size, proportion to sample size allocation were made at each selected health facilities. Finally, pregnant women who visited for Antenatal care service at selected health facilities during data collection period were consecutively included in the study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStudy Variables\u003c/h2\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eDependent variable\u003c/h2\u003e \u003cp\u003eIron - folic acid adherence\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eIndependent Variables\u003c/h2\u003e \u003cp\u003e \u003cb\u003eSocio-demographic factors;\u003c/b\u003e Age, Educational status, residence, educational status of partners, Monthly income.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePregnancy related factor;\u003c/b\u003e Parity, Gravidity, Gestational age, Abortion history, number ANC visit.\u003c/p\u003e \u003cp\u003e \u003cb\u003eKnowledge related factors;\u003c/b\u003e Knowledge about Anemia, Knowledge about IFA supplementation, Benefits of IFA tablet.\u003c/p\u003e \u003cp\u003e \u003cb\u003eDrug and behavior related factors; side\u003c/b\u003e effect, forgetfulness\u003c/p\u003e \u003cp\u003e \u003cb\u003eHealth care system and service related factors;\u003c/b\u003e time taken to health facility presence of ANC conference, presence of health education.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSupplement related factors.\u003c/b\u003e Number IFA tablet given per visit, time of IFAS initiation. \u003cb\u003eVariable definitions\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAdherence to IFA\u003c/strong\u003e \u003cp\u003eIFA adherence requires that the woman take four tablets at least per week (\u0026ge;\u0026thinsp;4 times per week) for the previous 1 month. Pregnant women who took at least 57% of the expected dose of the IFA tablets in the previous one week before data collection, which is equivalent to consuming at least 1 tablet daily for 4 days in the week consecutively or consuming 17 tablets in a month daily without missing the prescribed doses, was considered as adhered with IFA supplement.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eNon-adherence to IFA\u003c/strong\u003e \u003cp\u003ePregnant mother is said to be non-adhered to IFA supplement if they took for less than \u0026lt;\u0026thinsp;4 days per week tablets during 1 last month\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eGood Knowledge about IFAS\u003c/strong\u003e \u003cp\u003ePregnant women who answer the mean value and above from comprehensive questions that was used to assess the knowledge of study participants about the benefits and risks to be compliant and not adherent to IFAS were considered to have good knowledge about.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eGood Knowledge about Anemia;\u003c/b\u003e Respondents were asked questions related to the cause, signs and symptoms, method of prevention, consequence of anemia and risk groups for anemia. Accordingly, pregnant women who scored greater than the mean value of correct responses were considered as knowledgeable about anemia otherwise, they were considered as not knowledgeable.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData collection tool and data collection procedure\u003c/h2\u003e \u003cp\u003eStructured questionaries\u0026rsquo; is developed in English and translated to Afan oromo for data collection. Data were collected by face to face exit interview using structured questionnaire consisting of items that assess socio-demographic characteristics, time to start and adherence to iron-folate supplement, knowledge of anemia and iron-folate supplement, pregnancy-related experiences. Questions adapted from different literatures, chart and registration. Data was collected over a three-month period by three health workers (two qualified midwives and one qualified nurse) and one supervisor.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eData quality assurance\u003c/h2\u003e \u003cp\u003eThe questionnaire initially prepared in English and then were translated to Afan Oromo and back into English. The questionnaire were pre-tested before implementation on twenty one (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) pregnant women attending ANC and using IFA supplement at Arsi Nagelle Health Center and revisions were made to the tool based on the results. One day of training was given to data collectors and supervisor on the objective of the study, data collection process, and relevance of the study to both data collectors and supervisors before actual data collection. In addition to supervisor, the investigators were actively involved in the supervision of data collection and the completed questionnaire were cross-checked daily for completeness. Data collectors were supervised at each site and regular communication carried out between the data collectors, supervisors, and the investigators. The data were checked on-site for completeness.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData processing and Analysis\u003c/h2\u003e \u003cp\u003eThe collected data were coded and entered into Epi data version 3.1 and exported to SPSS version 27 statistical software package for analysis. Descriptive analyses were performed to summarize the variables presented using tables and figures. Hosmer and Lemeshow fitness of goodness test was conducted and model fitness declared if p-value was \u0026gt;\u0026thinsp;0.05. Multi co linearity test were done through VIF, tolerance and condition index and no multi co linearity was detected. Variables exhibiting a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.25 in the bivariate analysis were selected for multivariable analysis to ascertain associated factors. Adjusted Odds Ratios (AORs) with corresponding 95% Confidence Intervals (CIs) were calculated for each independent variable, with statistical significance declared at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results and Discussion","content":"\u003ch3\u003eResults\u003c/h3\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSocio‑demographic characteristics\u003c/h2\u003e \u003cp\u003eFrom a total of 415 pregnant women, 403 were participated in the study, with a response rate of 97.1%. The mean age of study participants was 27.89 (\u0026plusmn;\u0026thinsp;5.28 SD) years. All most all, 391 (97%) of the study participants were married. Two hundred fifty seven (63.8%) were at secondary school and above and 250 (62%) were housewives. The majority, 347 (86.1%) of the respondents were from urban residents and 239 (59.3%) had 1\u0026ndash;4 family size (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe socio-demographic characteristics of respondents in Shashemene town public health facilities, southwest Ethiopia; 2023 (n\u0026thinsp;=\u0026thinsp;403).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMother age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;19 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;24 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;=25 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e74.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePlace of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e347\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e86.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDistance from house\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eless than 30 minute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003egreater than 30 minute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducational Status Mother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary1-8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esecondary and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eOccupation of Mother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily labor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eothers (Governmental employee, merchant,)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e391\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e97.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers (Single, Divorced and widow)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ePartner occupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily labor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernmental employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers (Merchant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eObstetrics and health related characteristics\u003c/h2\u003e \u003cp\u003eThe mean gestational age of the pregnant women during the current visit was 28 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;6.68) weeks and 249 (61.8%) of them were in third trimester. Regarding gravidity and parity, majority (90.1%) of women were multigravida and 40(9.9%) were primiparous. This study showed that nearly one third 30% of women had history of abortion. Concerning the utilization of antenatal care, more than half, 372 (92.4%) of respondents had at least two antenatal contact a, 202 (50.1%) had three ANC contact and 2.5% had eight contact (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eObstetrics and health related characteristics to supplementation among respondents in Shashemene Southern Ethiopia 2023 (N\u0026thinsp;=\u0026thinsp;403).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDo pregnant mother has anemia during current pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e74.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of Abortion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTrimester of pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1st Trimester Pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2nd Trimester Pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3rd Trimester Pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eANC categorized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than 4 Visit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFour and Above Visit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGravidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimi Para\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMultpara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eKnowledge status of respondents on Anemia and Benefit of IFAS\u003c/h2\u003e \u003cp\u003eMajority, 379 (94%) of the respondents have ever heard about anemia. About 314(77.9%) of the respondents had good knowledge about anemia whereas 22.1% had poor knowledge of anemia. Regarding knowledge on the benefit of IFAS 299 (74.2%) of the respondents had good knowledge whereas 25.8% had poor knowledge about iron and folic acid supplementation\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eHealth facility related characteristics\u003c/h2\u003e \u003cp\u003eOf the total respondents, 170 (42.2%) said that, it took them 30 min or less to reach the nearest health facility from their place of residence.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eAdherence status to IFA supplementation\u003c/h2\u003e \u003cp\u003eThe overall adherence status (took IFA tablets for \u0026ge;\u0026thinsp;4 days/week for the previous 1 month preceding the survey) of pregnant women attending antenatal clinics was 66.5%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with adherence to IFA supplementation\u003c/h2\u003e \u003cp\u003eVariables that showed an association with IFA supplement at p-values less than 0.25 during bivariate were entered into multivariate logistic Regression. Nine (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) variables ( Place of residence, gravidity history, knowledge about Anemia, does pregnant mother have current anemia, knowledge about IFAS, Pregnant mother conference participation, time takes from home to the health facility, family size and do you get advice about IFAS) were candidate variables for multivariate logistic regression analysis.\u003c/p\u003e \u003cp\u003eFinally, after adjusting for confounders using multivariate logistic regression model, three (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) variables (knowledge about IFAS, Pregnant mother conference participation and family size) were found to be statistically significant predictors for adherence to IFA supplement.\u003c/p\u003e \u003cp\u003eAdherence to IFA supplement has increased in the women who have good Knowledge about IFAS. Pregnant women who had good Knowledge about IFAS were 2.6 times (AOR\u0026thinsp;=\u0026thinsp;2.61, 95% CI (1.51, 4.53), more likely to be adhered to IFA supplement than those pregnant women who had poor Knowledge about IFAS. Moreover, pregnant mother conference participation has also been an important predictor of adherence to IFA supplement. Pregnant women who participated Pregnant mother conference were 5.4 times (AOR\u0026thinsp;=\u0026thinsp;5.39, 95% CI (3.29, 8.83), more likely to be adhered to IFAS compared to those pregnant women not participated pregnant mother conference. Pregnant women who had family size four and less 1.9 times (AOR\u0026thinsp;=\u0026thinsp;1.88, 95% CI (1.12, 3.13) more likely to be adhered to IFAS than those pregnant women who had family size more than four (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e; Factors associated with adherence to IFA supplementation among pregnant women in Shashemene town, South east, Ethiopia 2024 (N\u0026thinsp;=\u0026thinsp;403)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eCompliance status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCOR 95% (CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAOR 95% (CI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePlace of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e225(64.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e122(35.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.56 (0.29\u0026ndash;1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.49 (0.24\u0026ndash;1.02)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43(76.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(23.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGravidity history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.58 (0.75\u0026ndash;3.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.16 (0.95\u0026ndash;4.93)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e238(65.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e125(34.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eKnowledge about Anemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39(49.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40(50.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.40 (0.25\u0026ndash;0.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.64 (0.36\u0026ndash;1.15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e229(70.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95(29.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePregnant mother have\u0026nbsp;current anemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15(62.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.28(0.12\u0026ndash;0.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.83(0.30\u0026ndash;2.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e259(68.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e120(31.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eKnowledge about IFAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e214(71.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85(28.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.33(1.47\u0026ndash;3.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.61(1.51\u0026ndash;4.53)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54(51.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50(48.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eConference participation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e174(79.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44(20.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.83(2.47\u0026ndash;5.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.39(3.29\u0026ndash;8.83)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94(50.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91(49.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTime it takes from your home to the health facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;30 minute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121(71.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49(28.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.45(0.94\u0026ndash;2.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.47(0.92\u0026ndash;2.35)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;30 minute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e147(63.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86(36.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e171(71.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68(28.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.74(1.14\u0026ndash;2.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.88(1.12\u0026ndash;3.13)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97(59.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67(40.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of abortion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e197(69.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85(30.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.63(1.05\u0026ndash;2.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.25(0.76\u0026ndash;2.06)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71(58.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50(41.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAdvised about IFAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38(56.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29(43.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.60 (0.35\u0026ndash;1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.01(0.52\u0026ndash;1.96)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e230(68.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106(31.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eNote: Variables were included in the adjusted model based on a P \u0026ndash; value of \u0026lt;\u0026thinsp;0.25 in the unadjusted model and Hosmer and Lemeshow goodness of fit test predicted the outcome variable. * Significant at P \u0026ndash; value\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDiscussion\u003c/h3\u003e\n\u003cp\u003eThis study was conducted to assess Adherence to IFAS and identify factors associated with it among pregnant women in shashemene town of Oromia region. Among 403 pregnant women who participated in the study, (268, 66.5%) were adhered to IFA supplementation.\u003c/p\u003e \u003cp\u003eThis study in line with study conducted in Zinder of Niger 68.6% (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), among pregnant women of Eritrea, in Shire refugee camps 64.7% (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), Gulele Sub-City 62.3%(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), Tikur Anbessa Specialized, Hospital, Ethiopia 63.6%(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) and 65% in Lay Armachiho(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). But it is lower as compared to the comparative study done in Dangila, Northern Ethiopia revealed 76.9%(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), in Yeka Sub City, Addis Ababa 71.3%(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), Dire dewa 71.8%(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). This difference may be due to variations in socio-cultural, geographical location between the regions of country and it may due to differences in training level of health care professionals and standard of the health care institution in the different level of health care facilities. This explanation is supported by a study stating high adherence is expected in well-organized setups as adequate counseling and sustainable product availability are better in such facilities.\u003c/p\u003e \u003cp\u003eHowever, this finding was higher than other studies conducted in different areas of Ethiopia; such as Ayder Comprehensive Specialized Hospital ,Northern Ethiopia 10.5%(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), Aykel town, Northwest Ethiopia 47.6%(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), North Wollo Zone 43.1% (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), Mecha district, Western Amhara 20.4%(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), Mille and Assaita Districts, Afar 22.9%(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), Hawassa city, South Ethiopia 38.3%(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), Wondo district 44.3%(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), Dilla town 43.4%(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), Kasulu Communities in North-Western Tanzania 20.3%(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) and Kiambu County, Kenya 32.7% (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) .This may be related to increased knowledge of pregnant women about anemia and IFA supplementation over time. The educational level of the study participants and their husbands may also have increased adherence in our study.\u003c/p\u003e \u003cp\u003ePregnant women who had good Knowledge about IFAS were 2.6 times (AOR\u0026thinsp;=\u0026thinsp;2.61, 95% CI (1.51, 4.53), more likely to be adhered to IFA supplement than those pregnant women who had poor Knowledge about IFAS. Knowledge of IFAS was associated with women\u0026rsquo;s adherence to iron and folic acid supplementation in studies conducted in Wondo district, Dilla town, Burji Districts, Segen Area People\u0026rsquo;s Zone, public hospitals of Dire Dawa, Aykel town, Hawassa city and Kiambu County, Kenya (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). This may be because knowledge helps women understand the benefits of taking the supplement and the consequences of not taking the supplement for the mother and fetus during pregnancy, labor and delivery.\u003c/p\u003e \u003cp\u003eIn this study, women with four or fewer children were shown to be 1.88 times more adhered than women with more than four children. This outcome is consistent with Study conducted in Dangila, Northern, Ethiopia (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) and Kasulu Communities in North-Western Tanzania(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).This outcome is due to the fact that they require more healthy youngsters who can appropriately follow the recommendations of health professionals.\u003c/p\u003e \u003cp\u003eIn the current study, pregnant women participated on Pregnant mother conference were 5.39 times more likely to adhere to their iron- folate supplement when compared with those who were not participated. This finding was supported by the study conducted in the Dangila Ethiopia(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) and Aykel North west Ethiopia(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The counseling and health education provided during pregnant women conference by health care provider, encourage women to take the supplement as prescribed, and educate them on the health benefit of taking iron folate supplement(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The possible explanation may be that pregnant women who received health education might have the opportunity to understand the purpose, importance, possible side effects and duration and dosage of the supplement.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLimitation\u003c/strong\u003e \u003cp\u003eAdherence to IFA supplementation was determined by self-reporting, which may affect actual compliance due to the potential for over-reporting or under-reporting of tablets consumed. Since the study was based on the consumption of iron and folic acid tablets from the previous month, they might be subject to potential recall bias. As both dependent and independent variables were determined at one point in time, it is impossible to indicate which comes first. Therefore, further studies are recommended with all necessary variations with robust study designs supported by qualitative methods.\u003c/p\u003e \u003c/p\u003e "},{"header":"Conclusion and Recommendation","content":"\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003cp\u003eAdherence to Iron-folic acid supplement among women who were included in the study was found to be high as compared to other national and international studies. Getting information and education by pregnant mother conference about Iron/Folic Acid supplement from health professionals, Knowledge about IFAS and Women who had less than or equal to four live children were the factors that increased the number of Iron/Folic Acid uptake by the mothers.\u003c/p\u003e \u003cp\u003eIntervention modalities that could touch the above factors were highly recommended to sustain adherence level of the mothers to Iron/Folic Acid supplementation.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdjusted Odd Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eANC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAntenatal Care\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBio Med Central\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCrude Odds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eECI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEarly childhood initiatives\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEMDHS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEthiopian Mini Demographic and Health Surveys\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFMOH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFederal Ministry of Health Hgb Hemoglobin\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealth Center\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIDA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIron deficiency anemia\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIFA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIron folic acid\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLBW\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow birth weight\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMND\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMicro Nutrient Deficiency\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNTD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNeural Tube\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBirth Defect\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePW\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePregnant Women\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eREC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eResearch and Ethical committee\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSRS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSimple Random Sampling\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSSA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSub-Saharan Africa\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatically package for social science\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVIF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVariance inflation factors\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from Paradise Valley College Research and Community service by observing appropriateness and scientific integrity of the study. Permission was obtained from Shashemene Town Health Office and Melka Oda General Hospital. Verbal informed consent was obtained from each participant. Confidentiality and privacy were maintained by using code during data collection. They were also provided with the information regarding the purpose, objective, potential risks and benefits of the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u0026nbsp; The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e Authors declare that they have no any competing interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eno fund was obtained for this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e Both authors have been involved in conception, Design, analysis, interpretation, report writing and manuscript writing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e The authors would like to thanks Paradise Valley College for its cooperation and financial support for data collection. We are grateful to all data collectors, supervisors and participants for their valuable contribution.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMamo TT, Ashenafi E, Gube AA, Bekele T. Adherence to prenatal iron\u0026ndash;folic acid supplementation and associated factors among pregnant women attending antenatal care services in Dilla town, South Ethiopia. Med Access@ Point Care. 2021;5:23992026211008805.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrganization WH. Global Nutrition Monitoring Framework: operational guidance for tracking progress in meeting targets for 2025. Geneva: License: CC BY-NC-SA 3.0 IGO. 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDemis A, Geda B, Alemayehu T, Abebe H. Iron and folic acid supplementation adherence among pregnant women attending antenatal care in North Wollo Zone northern Ethiopia: institution based cross-sectional study. BMC Res Notes. 2019;12:1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLyoba WB, Mwakatoga JD, Festo C, Mrema J, Elisaria E. Adherence to iron-folic acid supplementation and associated factors among pregnant women in Kasulu communities in north-western Tanzania. International Journal of Reproductive Medicine. 2020;2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFite MB, Assefa N, Mengiste B. Prevalence and determinants of Anemia among pregnant women in sub-Saharan Africa: a systematic review and Meta-analysis. Archives Public Health. 2021;79:1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGebreamlak B, Dadi AF, Atnafu A. High adherence to iron/folic acid supplementation during pregnancy time among antenatal and postnatal care attendant mothers in Governmental Health Centers in Akaki Kality Sub City, Addis Ababa, Ethiopia: Hierarchical negative binomial poisson regression. PLoS ONE. 2017;12(1):e0169415.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaudyal N, Parajuli KR, Garcia Larsen V, Adhikari RK, Devkota MD, Rijal S, et al. A review of the maternal iron and folic acid supplementation programme in Nepal: Achievements and challenges. Matern Child Nutr. 2022;18:e13173.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsmamaw DB, Debebe Negash W, Bitew DA, Belachew TB. Poor adherence to iron-folic acid supplementation and associated factors among pregnant women who had at least four antenatal care in Ethiopia. A community-based cross-sectional study. Front Nutr. 2022;9:1023046.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiyew AM, Tesema GA, Alamneh TS, Worku MG, Teshale AB, Alem AZ, et al. Prevalence and determinants of anemia among pregnant women in East Africa; A multi-level analysis of recent Demographic and Health Surveys. PLoS ONE. 2021;16(4):e0250560.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaryland EMDHSR. USA: EPHI and ICF. Ethiopian Public Health Institute (EPHI) [Ethiopia] and ICF. 2019. Ethiopia Mini Demographic and Health Survey: Key Indicators 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeta TG, Gebremedhin S, Omigbodun AO. Prevalence and predictors of anemia among pregnant women in Ethiopia: Systematic review and meta-analysis. PLoS ONE. 2022;17(7):e0267005.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBegum K, Ou\u0026eacute;draogo CT, Wessells KR, Young RR, Faye MT, Wuehler SE, et al. Prevalence of and factors associated with antenatal care seeking and adherence to recommended iron-folic acid supplementation among pregnant women in Zinder. Niger Maternal child Nutr. 2018;14:e12466.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSuryanarayana R, Chandrappa M, Santhuram AN, Prathima S, Sheela S. Prospective study on prevalence of anemia of pregnant women and its outcome: A community based study. J family Med Prim care. 2017;6(4):739\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEDHS M, USA: EPHI and ICF. Ethiopian Public Health Institute (EPHI) [Ethiopia] and ICF. 2016. Ethiopia Mini Demographic and Health Survey: Key Indicators. 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAssefa H, Abebe SM, Sisay M. Magnitude and factors associated with adherence to Iron and folic acid supplementation among pregnant women in Aykel town, Northwest Ethiopia. BMC Pregnancy Childbirth. 2019;19:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaye B, Abeje G, Mekonen A. Factors associated with compliance of prenatal iron folate supplementation among women in Mecha district, Western Amhara: a cross-sectional study. Pan Afr Med J. 2015;20(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMolla T, Guadu T, Muhammad EA, Hunegnaw MT. Factors associated with adherence to iron folate supplementation among pregnant women in West Dembia district, northwest Ethiopia: a cross sectional study. BMC Res Notes. 2019;12:1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGebre A, Debie A, Berhane A, Redddy PS. Determinants of compliance to iron-folic acid supplementation among pregnant women in pastoral communities of Afar region: the cases of mille and assaita districts, Afar, Etiopia-2015. Medico Res chronicles. 2017;4(04):352\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKassa ZY, Awraris T, Daba AK, Tenaw Z. Compliance with iron folic acid and associated factors among pregnant women through pill count in Hawassa city, South Ethiopia: a community based cross-sectional study. Reproductive health. 2019;16:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMengistu T, Lencha B, Mekonnen A, Degno S, Yohannis D, Beressa G. Compliance to iron folic acid supplementation and its associated factors among pregnant women attending Antenatal clinic in Wondo district: a cross-sectional study. Sci Rep. 2023;13(1):17468.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsres AW, Hunegnaw WA, Ferede AG, Azene TW. Compliance level and factors associated with iron\u0026ndash;folic acid supplementation among pregnant women in Dangila, Northern Ethiopia: A cross-sectional study. SAGE Open Med. 2022;10:20503121221118989.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoti N, Bekele T, Godana W, Getahun E, Gebremeskel F, Tsegaye B et al. Adherence to Iron-Folate supplementation and associated factors among Pastoralist\u0026rsquo;s pregnant women in Burji districts, Segen area People\u0026rsquo;s zone, southern Ethiopia: community-based cross-sectional study. International journal of reproductive medicine. 2018;2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUrgessa BT, Abdo ZA. Adherence to iron/folic acid supplementation and associated factors among pregnant women attending governmental health center in Yeka Sub City, Addis Ababa, Ethiopia. BLDE Univ J Health Sci. 2020;5(2):145\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGetachew M, Abay M, Zelalem H, Gebremedhin T, Grum T, Bayray A. Magnitude and factors associated with adherence to Iron-folic acid supplementation among pregnant women in Eritrean refugee camps, northern Ethiopia. BMC Pregnancy Childbirth. 2018;18:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTegodan E, Tura G, Kebede A. Adherence to iron and folic acid supplements and associated factors among pregnant mothers attending anc at gulele sub-city government health centers in addis ababa, ethiopia. Patient preference and adherence. 2021:1397\u0026thinsp;\u0026ndash;\u0026thinsp;405.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNasir BB, Fentie AM, Adisu MK. Adherence to iron and folic acid supplementation and prevalence of anemia among pregnant women attending antenatal care clinic at Tikur Anbessa Specialized Hospital, Ethiopia. PLoS ONE. 2020;15(5):e0232625.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgegnehu G, Atenafu A, Dagne H, Dagnew B. Adherence to iron and folic acid supplement and its associated factors among antenatal care attendant mothers in Lay Armachiho health centers, Northwest, Ethiopia, 2017. International journal of reproductive medicine. 2019;2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSolomon Y, Sema A, Menberu T. Adherence and associated factors to iron and folic acid supplementation among pregnant women attending antenatal care in public hospitals of Dire Dawa, Eastern Ethiopia. Eur J Midwifery. 2021; 5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGebremichael TG, Haftu H, Gereziher TA. Time to start and adherence to iron-folate supplement for pregnant women in antenatal care follow up; Northern Ethiopia. Patient Prefer Adherence. 2019:1057\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKamau MW, Mirie W, Kimani S. Compliance with Iron and folic acid supplementation (IFAS) and associated factors among pregnant women: results from a cross-sectional study in Kiambu County, Kenya. BMC Public Health. 2018;18:1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Adherence status, Iron and folic acid, pregnant women, shashemene town","lastPublishedDoi":"10.21203/rs.3.rs-4462717/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4462717/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground;\u003c/h2\u003e \u003cp\u003ePregnant women are at a high risk of anemia, with iron-folate deficiency being the most common cause of anemia among pregnant women. Despite the well-known importance of iron and folic acid supplementation (IFAS) during pregnancy, adherence to these supplements is relatively low and associated factors were not well identified in the study area. The aim of this study was to assess Iron - Folic Acid Supplementation adherence and Associated Factors among Pregnant Women Attending Antenatal Clinic in Shashemene town public health facilities, Southeast Ethiopia; 2024.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eFacility-based cross-sectional study design was employed selecting 415 pregnant women attending antenatal care services in four public health institutions of Shashemene town. Health facility were selected by simple random sampling using lottery method. Based on quarterly report of population size, proportion to sample size allocation made at each selected health facilities. Finally, pregnant women who visited for Antenatal care service at selected health facilities during data collection period were consecutively included in the study. Data were collected by interview. Then it was entered into EPI Data version 3.1 and exported to SPSS version 27 for analysis. Bivariate and multivariate binary logistic regression techniques were used to identify independent predictors. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was taken as indication of statistical significance\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe overall adherence status of pregnant women attending antenatal clinic was found to be 66.5%. Participating on pregnant mother conference (AOR\u0026thinsp;=\u0026thinsp;5.39, 95%CI: 3.29\u0026ndash;8.83), having less than four children (AOR\u0026thinsp;=\u0026thinsp;1.88, 95% CI (1.12, 3.13) and good knowledge of IFAS (AOR\u0026thinsp;=\u0026thinsp;2.61, 95% CI (1.51, 4.53), were statistically and positively associated with pregnant mothers adherence to iron and folic acid supplementation.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe study revealed a notably high adherence to iron-folic acid (IFA) supplementation among the women included, surpassing rates observed in both national and international studies. Factors contributing to this included receiving information and education on IFA supplementation during pregnant mother conferences conducted by health professionals, possessing knowledge about IFAS, and having fewer than or equal to four children. Intervention strategies targeting these factors are strongly recommended to sustain and potentially increase mothers' adherence to IFA supplementation.\u003c/p\u003e","manuscriptTitle":"Adherence to Iron-Folic Acid Supplementation and Associated Factors Among Pregnant Women Attending Antenatal Clinic In Shashemene town Health Facility, Southeast Ethiopia,2024; Facility based cross-sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-11 20:12:57","doi":"10.21203/rs.3.rs-4462717/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"446bef75-2c1b-412a-86e1-7cf5fbdc7189","owner":[],"postedDate":"June 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-11T20:12:57+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-11 20:12:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4462717","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4462717","identity":"rs-4462717","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}