Oral iron adherence and associated factors among pregnant women with anemia in central Peru
DOI:
https://doi.org/10.64716/hfxm9108Keywords:
Medication Adherence, Pregnancy, Anemia, Iron, Prenatal Care, Cross-Sectional StudiesAbstract
Background: Adherence to oral iron is an important component of anemia management during pregnancy, but it varies with individual circumstances and access to care. Objective: To assess adherence and associated patient, socioeconomic, treatment, and health-service factors among pregnant women with anemia in Pichanaki, Peru. Methods: An analytical cross-sectional study included 163 women in their second or third trimester. Data were collected between August and October 2024 using a questionnaire covering ten candidate factors and the four-item Morisky–Green questionnaire. Adherence required all four responses to be consistent with medication-taking recommendations. Associations were evaluated using Pearson’s chi-square test. Results: Overall, 85 women were adherent (52.1%; 95% confidence interval, 44.5–59.7%) and 78 were nonadherent (47.9%). Age of 31 years or older, second-trimester pregnancy, monthly income of at least 1,025 Peruvian soles, higher education, favorable perceived treatment effectiveness, reported treatment tolerance, home visits, and timely access to care were associated with adherence (all p < 0.001). Iron preparation (p = 0.408) and reported adverse effects (p = 0.801) were not significantly associated with adherence. Conclusions: Approximately half of the participants met the adherence criterion. The observed associations identify patient groups and aspects of treatment experience and service access that warrant attention in antenatal follow-up. They represent unadjusted cross-sectional associations and do not establish causal effects.
Downloads
References
Stevens GA, Paciorek CJ, Flores-Urrutia MC, Borghi E, Namaste S, Wirth JP, et al. National, regional, and global estimates of anaemia by severity in women and children for 2000-19: a pooled analysis of population-representative data. Lancet Glob Health. 2022;10(5):e627-e639. doi:10.1016/S2214-109X(22)00084-5
Shi H, Chen L, Wang Y, Sun M, Guo Y, Ma S, et al. Severity of anemia during pregnancy and adverse maternal and fetal outcomes. JAMA Netw Open. 2022;5(2):e2147046. doi:10.1001/jamanetworkopen.2021.47046
Lewkowitz AK, Tuuli MG. Identifying and treating iron deficiency anemia in pregnancy. Hematology Am Soc Hematol Educ Program. 2023;2023(1):223-228. doi:10.1182/hematology.2023000474
Finkelstein JL, Cuthbert A, Weeks J, Venkatramanan S, Larvie DY, De-Regil LM, et al. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev. 2024;(8):CD004736. doi:10.1002/14651858.CD004736.pub6
Gomes F, King SE, Dallmann D, Golan J, da Silva ACF, Hurley KM, et al. Interventions to increase adherence to micronutrient supplementation during pregnancy: a systematic review. Ann N Y Acad Sci. 2021;1493(1):41-58. doi:10.1111/nyas.14545
Saragih ID, Dimog EF, Saragih IS, Lin CJ. Adherence to iron and folic acid supplementation (IFAS) intake among pregnant women: a systematic review meta-analysis. Midwifery. 2022;104:103185. doi:10.1016/j.midw.2021.103185
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;5:35. doi:10.18332/ejm/138595
Tefera AA, Ibrahim NA, Umer AA. Adherence to iron and folate supplementation and associated factors among women attending antenatal care in public health facilities at COVID-19 pandemic in Ethiopia. PLOS Glob Public Health. 2023;3(1):e0000825. doi:10.1371/journal.pgph.0000825
Muthuraj LP, Kandasamy S, Subbiah P, Sibqathulla MJ, Velappan LK, Gopal M, et al. Sociocultural and drug-related factors associated with adherence to iron-folic acid supplementation among pregnant women: a mixed-methods study. J Educ Health Promot. 2023;12:121. doi:10.4103/jehp.jehp_1008_22
Santos-Antonio G, Gonzales-Achuy E, Solís-Sánchez G, Hinojosa-Mamani P, Aparco JP. Adherencia al consumo de hierro en gestantes de cuatro ciudades del Perú y sus potenciales factores asociados, 2021. An Fac Med. 2025;86(2):154-162. doi:10.15381/anales.v86i2.30986
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4(10):e296. doi:10.1371/journal.pmed.0040296
Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67-74. doi:10.1097/00005650-198601000-00007
World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-2194. doi:10.1001/jama.2013.281053
Saeed MS, Adam GK, Hussein SM, AlHabardi N, Adam I. Prevalence and factors associated with adherence to iron-folic acid supplementation among pregnant women in Eastern Sudan: a cross-sectional study. Patient Prefer Adherence. 2024;18:1665-1674. doi:10.2147/PPA.S476738
Seidu H, Gaa PK, Mogre V. Adherence to iron and folic acid supplementation among pregnant women from Northern Ghana. Nutr Metab Insights. 2024;17:11786388231218664. doi:10.1177/11786388231218664
Yismaw AE, Tulu HB, Kassie FY, Araya BM. Iron-folic acid adherence and associated factors among pregnant women attending antenatal care at Metema District, Northwest Ethiopia. Front Public Health. 2022;10:978084. doi:10.3389/fpubh.2022.978084
Hardido TG, Mikamo AA, Legesse CT. Adherence to iron-folic acid among pregnant women attending antenatal care in Southern Ethiopia, 2022. Womens Health Rep (New Rochelle). 2023;4(1):431-437. doi:10.1089/whr.2023.0020
Zegeye B, Adjei NK, Olorunsaiye CZ, Ahinkorah BO, Ameyaw EK, Seidu AA, et al. Pregnant women's decision-making capacity and adherence to iron supplementation in sub-Saharan Africa: a multi-country analysis of 25 countries. BMC Pregnancy Childbirth. 2021;21(1):822. doi:10.1186/s12884-021-04258-7
Salifu Y, Agyeman YN, Lasong J. Adherence to and predictors of iron-folate acid supplementation among pregnant women in a pastoral population in Ghana: a community-based cross-sectional study. Reprod Health. 2024;21(1):165. doi:10.1186/s12978-024-01877-z
Kebaabetswe P, Diseko M, Zash R, Mayondi G, Mabuta J, Mmalane M, et al. A qualitative assessment of barriers to iron and folic acid supplementation among pregnant women in Botswana. BMC Public Health. 2024;24(1):3369. doi:10.1186/s12889-024-20685-5
Shumi L, Gedefa AG, Bidira K. Determinants of compliance to iron folate supplementation among pregnant women attending antenatal care in public health facilities of South West Ethiopia: a case-control study. Health Sci Rep. 2024;7(4):e1998. doi:10.1002/hsr2.1998
Mulugeta SS. Geographical disparities and determinants of adherence to iron folate supplementation among pregnant women in Ethiopia: spatial and multilevel analysis of the Ethiopian Mini Demographic and Health Survey of 2019. BMJ Open. 2022;12(9):e061900. doi:10.1136/bmjopen-2022-061900
Ejara D, Ferede A, Shifa JE, Bekele F, Ahmed Hassen T. Compliance level and associated factors of iron folic acid supplementation among pregnant women in North Shoa Zone, Ethiopia. Sci Rep. 2024;14(1):13407. doi:10.1038/s41598-024-63111-x
Sharma S, Smitha MV, Balakrishnan D. Telephonic intervention to combat non-adherence to oral iron-folic acid supplementation in pregnancy: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol X. 2023;20:100235. doi:10.1016/j.eurox.2023.100235
Reshid M, Anato A. Community-based nutrition education and counselling provided during pregnancy: effects on knowledge and attitude towards iron-folic acid supplementation. J Nutr Sci. 2024;13:e58. doi:10.1017/jns.2024.59
Downloads
Published
Data Availability Statement
The data supporting this study are not publicly shared because they concern participants’ health and treatment experiences. Requests for deidentified data may be addressed to the corresponding author and will be considered subject to participant confidentiality and applicable institutional authorization.
Issue
Section
License
Copyright (c) 2026 Rudyard Wilhelm Aquepucho-Bellota, Raul Achahui-Ventura, Rossemarie Jetzabel Loaiza-Molina, Shelly Wendy Ipenza-Mejía (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright and grant TUMI Health Sciences Research the right of first publication. Articles are published under the Creative Commons Attribution 4.0 International License (CC BY 4.0).
