Journal of
Public Health and Epidemiology

  • Abbreviation: J. Public Health Epidemiol.
  • Language: English
  • ISSN: 2141-2316
  • DOI: 10.5897/JPHE
  • Start Year: 2009
  • Published Articles: 653

Full Length Research Paper

Predictors of optimum antenatal iron-folate supplementation in a low resource rural set-up in Eastern Kenya

Juma M
  • Juma M
  • Department of Nursing, Kenya Medical Training Centre, P.O Box 30195, Nairobi, Kenya.
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Oiye Shadrack O.
  • Oiye Shadrack O.
  • Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi, P.O Box 19676 – 00200 Nairobi, Kenya.
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Konyole Silvernus O
  • Konyole Silvernus O
  • Masinde Muliro University of Science and Technology, P. O Box 190-50100, Kakamega, Kenya.
  • Google Scholar

  •  Received: 05 August 2015
  •  Accepted: 29 September 2015
  •  Published: 30 November 2015


There is depressed prevalence of the optimum iron-folate supplementation in Kenya and in other sub-Saharan Africa countries. The study was motivated by the paucity of area-specific data on predictors of optimum iron-folate supplementation. The aim of the study was to assess the maternal, knowledge and institutional factors that predict 90+ days (optimum) iron-folate supplementation among pregnant women in a rural set-up in Eastern Kenya. A descriptive cross-sectional study to collect quantitative data from 352 mothers of under-five years old children attending 7 health facilities in Kalama Division of Machakos constituency within Machakos County in lower Eastern Kenya. Using a standard questionnaire, mothers recalled the number of days they had ingested iron-folate supplements in their latest pregnancies. The overall prevalence of optimum supplementation (90+ days) during latest pregnancies was 18.3% and on average the study mothers were supplemented for ~38 days during the antenatal period. Mothers who visited antenatal care (ANC) for ≥4days (odd ratio [OR]: 2.756, 95% confidence interval [CI]: 1.396-5.445) were more likely to take iron-folate supplements for 90+ days and be supplemented for more days (45.8) than <4 days visitors (26.2 days), p=0.017. Earlier ANC visit was associated with the mean days of supplementation (p=0.006), but not with optimum supplementation (OR: 0.412, 95% CI: 0.236-0.719). Knowledge on supplementation for a minimum of 90 days predicted optimum supplementation (OR: 5.872, 95% CI: 2.945 -11.709). Knowledge on when to start supplementation and importance of supplementation only predicted higher days of supplementation (p<0.05), but not the optimum supplementation. Pregnant women who used tablet form were more likely to be supplemented optimally (OR: 1.007, 95% CI: 1.004-1.116).  Those who were supplemented with a combined form of supplement were more likely to have more days of supplementation (p=0.004), but not optimum (OR: 1.125, 95% CI: 0.419-3.021) compared to those who used single iron and folate supplement. To increase the proportion of pregnant mothers taking iron-folate supplements for 90+ days in low resource rural set-ups, there should be intensified counselling/education on ANC attendance ≥ 4 times and on minimum number of days for optimum iron-folate supplementation. Use of tablets as opposed to syrup increases the likelihood for antenatal ingestion of iron-folate supplements for 90+ days in rural low-resource set-up.


Key words: Predictors, optimum supplementation, iron-folate supplements, pregnant women