Publication:

Adherence and barriers of prophylactic iron and folic acid supplementation in children: a community-based mixed method study

Background Anemia is a public health challenge in India among children, adolescents and reproductive age women. Still, 58% of under-five children in India and 43% in Puducherry are anaemic. To determine the proportion of mothers of one-to-nine-year children, aware about iron and folic acid (IFA) supplementation, the proportion of children adherent to the dosage of IFA and the barriers for the adherence to IFA.

Methods A community-based explanatory sequential mixed methods study consisting survey using a semi-structured questionnaire and followed by focus group discussions (FGD) using an interview guide. The data was collected using EpiCollect5 analysed using SPSS. The results were expressed as proportions with 95% confidence interval (CI) and the qualitative results were expressed as a conceptual framework.

Results Awareness about IFA supplementation given to children from the public health system was 57% (95% CI: 51.8-62.0) among mothers of one-to-nine-year children. Adherence to IFA supplementation was 34% (28.9.0-38.6). The main reason of the non-adherence reported by the mothers was non-availability of the supplements, nausea and vomiting among children and forgetfulness of the mother. In the FGD, supply side reasons were non-palatability and wrong dose administration, and demand side reasons were lack of awareness and coverage.

Conclusions Only one out of ten children among under five years were taking IFA syrup and only half of the children ages five-to-nine-years consumed IFA tablets given in their schools. Irregular distribution of IFA tablets, medication side-effects, and non-palatability of the medication were the main reasons quoted by the mother for non-adherence.