Effectiveness of Public Health Education On The Uptake of Iron and Folic Acid Supplements among Pregnant Women: A Stepped Wedge Cluster Randomised Trial
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Date
2022
Authors
Njiru, Haron
Njogu, Eunice
Gitahi, Mary W
Kabiru, Ephantus
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ Journals
Abstract
Introduction Iron deficiency is the most prevalent
micronutrient deficiency in pregnancy globally responsible
for nearly 120 000 maternal deaths per year and a fifth
of maternal mortality. Over 46% of pregnant women in
Africa and 62% of pregnant women in Kenya are anaemic.
Anaemia has severe economic and health consequences.
Daily iron and folic acid supplementation (IFAS) is an
efficacious strategy recommended in pregnancy to reduce
the risk of anaemia and improve maternal and neonatal
survival. However, most pregnant women do not consume
IFAS as recommended. Limited knowledge on IFAS, its
benefits and its connection with anaemia, and mitigation
of its side effects lead to poor consumption. The main
objective of this trial is to determine the effectiveness of
public health education on uptake of antenatal IFAS.
Methods and analysis A stepped wedge cluster
randomised trial with antenatal clinics as units of
randomisation. Twelve clusters will be randomised
to receive the intervention and levels of IFAS uptake
compared with preintervention period. The 9-month
trial
will enrol 1205 pregnant women. The primary outcome
will be the proportion of pregnant women effectively
taking up IFAS measured through self-reports,
residual
pill count and inspection of pill reminder cards. Routine
clinical data on haemoglobin counts and fetal growth
monitoring will also be used. Descriptive and bivariate
analysis will be conducted in Stata using Pearson’s χ2
test for association, and multivariate logistic regression to
identify determinants of uptake. The potential public health
benefits will be estimated using the number needed to
treat and the preventable fraction.
Ethics and dissemination Ethical approval was
granted by Kenyatta University Ethics Review Committee
(PKU/2443/11575). The research permit is obtained from
Kenya National Commission for Science, Technology
and Innovation (NACOSTI/P/22/16168). Findings will be
disseminated through peer-reviewed
publications and
public health conferences
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Citation
Njiru, H., Njogu, E., Gitahi, M. W., & Kabiru, E. (2022). Effectiveness of public health education on the uptake of iron and folic acid supplements among pregnant women: a stepped wedge cluster randomised trial. BMJ Open, 12(9), e063615.