Daily oral iron and folic acid supplementation is recommended for antenatal care. It helps in reduce low birth weight, preterm birth, maternal anaemia at term and maternal iron deficiency at term. All women of reproductive age should get 400 micrograms of folic acid each day in addition to consuming food with folate from a varied diet to help prevent neural tube defect (NTD). NTDs are major birth defects of the baby brain and spine [1].

About 41.8% of pregnant women worldwide are anaemic; half of this anaemia burden is due to iron deficiency. Developing countries are the most affected. Maternal folate deficiency is one of the maternal risk factors for neural tube defects and pre-conception folate deficiency contributes to about 300000 new cases of NTDs each year globally resulting in about 41000 deaths [2].

It is estimated that more than 40% of pregnant women worldwide are anaemic. As last half of this anaemia burden is assumed tube due to iron deficiency. Pregnant women require additional iron and folic acid to meet their own nutritional needs as well as those of the developing fetus. Deficiency in iron and folic acid during pregnancy can potentially negatively impact the health of the mother, her pregnancy as well as fetal development [3].

Conducted a study on antenatal iron and folic acid supplementation used by antenatal mothers in Khartoum Sudan [4]. They found that rates of iron-folic supplementation and the associated factors during pregnancy and the effects of taking iron-folic acid supplementation on rates of maternal anaemia and low birth weight infant total of 856 women 788(92.1%) used iron-folic acid supplementation during pregnancy and 65.4% used folic acid and the result shows that their baby is healthy [4].

A study was carried out by [5] to find out the importance of IFA in pregnancy. This study included 190 pregnant women seeking ante-natal care in tertiary health Centres in the Mangalore city in South India. After Institutional Ethics Committee (IEC) approval, data was collected by personal interview. Missing ≥2 doses consecutively was considered non-compliance. The data was analyzed using SPSS (Statistical Package for Social Sciences) version 11.5.

Results: The mean age of the study population was 25.8 years (SD: 4.1). Majority of the subjects consumed mixed diet and 72.1% belonged to lower socioeconomic status. Overall, compliance with IFA tablets was 64.7%. Compliance increased with the increase in age, birth order, and single daily dose. Forgetfulness and both perceived as well as experienced side effects of IFA therapy were the important factors for non-compliance.

Conclusion: There was a moderate level of Compliance towards IFA tablets with key social and demographic factors playing important roles [5].

A study was done by [6] to find out Compliance with Iron and Folic Acid Supplementation (IFAS) and associated factors among pregnant women in Sub-Saharan Africa. Twenty-three studies, which encompassed 24272 pregnant women, were chosen for the analysis. From those an overall prevalence of compliance with Iron and Folic Acid Supplementation (IFAS) in pregnancy in SSA was 39.2%. However, the result from the meta-analysis showed that women who were counselled on IFAS in their courses of pregnancy were 1.96 times more likely to adhere to IFAS compared to those who were not counselled. Moreover, it showed that women who had knowledge of IFAS were 2.71 times more likely to have compliance with IFAS as compared to those who had no knowledge of IFAS. Also, it revealed that those women who had knowledge of anaemia were 5.42 times more likely to have compliance with IFAS as compared with those who had no knowledge of anaemia. Furthermore, women who had received a fourth visit for ANC were 1.54 times more likely to have compliance with IFAS as compared to those who had not received for ANC. Our finding from this systematic review and meta-analysis shows the low case prevalence of compliance to IFAS among pregnant women in SSA [6].

A cross-sectional study was done by [7] to find if iron and folic acid supplementation in pregnancy improves child survival in Indonesia. They determined whether live-born children <5 y of age born to mothers who used antenatal iron-folic acid supplements had a reduced risk of death. Pooled 1994, 1997, 2002–2003, and 2007 Indonesia Demographic and Health Survey data were used to examine the relation between the use of iron-folic acid supplements and child death in 3 cumulative (0–30 d, 0–11 mo, and 0–4 y) and 4 mutually exclusive (first day of life and 1–30 d, 1–11 mo, and 1–4 y of age) time periods. Risk of death was estimated by using Cox regression to control for 19 potential confounders. Survival information for 52,917 singleton live-born infants and 1525 deaths of children <5 y of age was examined. After adjustment for potential confounders, risk of death of children <5 y of age was reduced significantly by 34% if the mother consumed any iron-folic acid supplements. In developing countries increased use of antenatal iron-folic acid supplements will reduce deaths of children <5 y of age, especially in the first year of life [7].

A study was done by Monica Steffi Thomas, [8] to find how effective iron supplementation is during pregnancy and childhood in reducing anaemia among 6-59 months old children in India. In total, 145,904 last-born 6–59-month-old children were included in the analysis. Among the children, 39.9% were non-anaemic (≥11 g/dL), 27.8% mildly anaemic (10–10.9 g/dL), 30.7% moderately anaemic (7–9.9 g/dL), and 1.6% severely anaemic (<7 g/dL). The National Iron plus Initiative strategy of child's iron supplementation should be evaluated to identify the reasons of its ineffectiveness in anemia reduction [8].

A survey was done by [9] to find The Role of Maternal Diet and Iron-folic Acid Supplements in Influencing Birth Weight. Infants whose mothers consumed milk and curd daily, fruits daily or weekly had higher odds of not having a low birth weight baby. The daily consumption of pulses and beans increased the odds while weekly consumption of fish decreased the odds of not having a LBW infant. Intake of iron–folic acid supplements during pregnancy increased birth weight by 6.46 g per month. Improved intake of micronutrient-rich foods can increase birth weight [9].

A cross sectional study was done by [10] to Compliance level and factors associated with iron-folic acid supplementation among pregnant women in Dangila, Northern Ethiopia. A community-based cross-sectional study design was conducted among pregnant women from 1 to 30 November 2018 in Dangila, Northern Ethiopia. A total of 589 pregnant women were involved, yielding a response rate of 91.2%. The average age of the participants in the study was 30.90 ± 5.93 years. The average weekly iron-folic acid pill intake was 5.3. The iron-folic acid compliance rate was 76.9%. Women who had four or fewer alive children took less than 30 min to get to the health facility, being a government employee, attended antenatal care conferences, and started iron-folic acid tablets in the first trimester were associated with iron-folic acid compliance. The level of iron–folic acid supplementation compliance was low. Attending antenatal care training and starting to take iron-folic acid pills early in the first trimester were both factors associated with iron–folic acid supplementation compliance [10].

Research Approach and Design

A quantitative research approach was adopted for the study, utilizing a descriptive survey design to assess the knowledge and practice level of antenatal mothers regarding iron and folic acid supplementation.

Setting and Population

The study was conducted in a selected hospital of Bhubaneswar, Odisha. The target population included antenatal mothers in their 2nd and 3rd trimesters who attend the antenatal outpatient department (OPD) during the data collection period.

Sample Size and sampling Technique

A total of 70 antenatal mothers were selected for the study using a purposive sampling technique. This method was chosen based on inclusion criteria relevant to the study objectives.

Sampling Criteria

Antenatal mothers in their second and third trimesters and willing to participate in the study was under inclusion criteria. Exclusion criteria of the study was non- pregnant women and adolescent girls and those unwilling to participate.

Development and Description of Tools

Three self-structured tools were developed:

Socio-demographic Questionnaire: Included 11 items to collect information on age, education, religion, family type, food habits, occupation, income, body weight, pregnancy order, hemoglobin level, and gestational week.

Knowledge Assessment Questionnaire: Contained 13 multiple-choice questions, each carrying one mark. Scoring was categorized as:

• Poor Knowledge: 5–7
• Average Knowledge: 8–10
• Good Knowledge: 11–13

Practice Assessment Scale: A 3-point Likert scale (Never = 3, Sometimes = 2, All the time = 1) consisting of 7 items. Scoring was categorized as:

• Good Practice: 14–16
• Excellent Practice: 17–19

Validity and Reliability

The tools were validated by five experts in Community Health Nursing and Obstetrics and Gynecological Nursing. The reliability of the structured questionnaires was established using Cronbach’s alpha formula to ensure internal consistency.

Pilot Study

A pilot study was conducted in a separate hospital setting in Bhubaneswar over three days. Ten percent of the sample size (n=7) was used to test the feasibility and clarity of the tool, and no major changes were required.

Data Collection Procedure

Formal administrative permission was obtained from the concerned hospital authority. Written informed consent was secured from participants. Data collection was carried out through structured interviews using the validated tools.

Ethical Considerations

Ethical clearance was obtained from the Institutional Ethical Committee. Informed consent was taken from each participant. Anonymity and confidentiality of the participants were strictly maintained.

Data Analysis

Collected data were analyzed using SPSS version 20.0. Descriptive statistics (frequency, percentage) were used to describe socio-demographic variables, knowledge, and practice levels. Inferential statistics (Chi-square test) were used to assess the association between knowledge/practice and selected demographic variables. A p-value of <0.05 was considered statistically significant.

The above table-1 revealed that frequency (F) and percentage (%) distribution of participants according to 58.6% of the samples age was 22-25 years. 68.6%of the samples were educated at primary level. 77.0 % samples were Hinduism. 48.6% samples were nuclear family. 60.0% of pregnant women were non-vegetarian. 63.0%of the samples were housewife. 45.7% of pregnant women families were 20001-25000 per capita monthly family income. 60.0% pregnant women were 55-63 kg of body weight. 64.0% samples were 1st pregnancy. 61.4% samples were Hb levels in between 11.3-12.2. 50.0% of samples were gestation week of 18-21.

Table 1: Frequency (f), Percentage (%) distribution of samples according to the level of knowledge.

The above table shows that 7.1% antenatal mothers had good knowledge (score 11-13) and 60.0% had average knowledge (score 8-10) and 32.9% antenatal mothers had poor knowledge (score 5-7).

Table 2: Frequency (f), Percentage (%) distribution of samples according to the level of practice.

The table above indicates that, above table 2 shows that, 25.7% antenatal mothers had good practice (score 14-16) and 74.3% had excellent practice (score 17-19).

Table 3: Association between knowledge and demographic variables were assessed by using Chi-Square test. The results summary of Chi-Square test is tabulated below.

P ≤ 0.05^* = Significant

Above table shows that the P value of age of occupational status is smaller than 0.05, which was found to have statistically significant association with level of knowledge. And rest have no significant association with the level of knowledge.

Table 4: Association between practice and demographic variables were assessed by using Chi-Square test. The results summary of Chi-Square test is tabulated below.

P ≤ 0.05* = Significant

Above table shows that, the P value of body weight is less than 0.05, which was found to have statistically significant association with level of practice. And rests have no significant association with the level of practice.

The present study was assessing the level of knowledge and practice towards iron and folic supplementation among antenatal mothers in selected hospitals of BBSR. The study involved non- experimental descriptive survey research design among 70 samples according to inclusion and exclusion criteria. The structure questionnaire for socio demographic data, structured knowledge questionnaire for knowledge and structured practice questionnaire for practice were used for the data collection.  The majority of the mother had average knowledge 60% and 70% having good practice. The occupational status was found to have statistically significant association with level of knowledge. Similarly, body weight was found to have statistically significant association with level of practice.

A study was carried by [11] to find out maternal importance of iron and folic acid supplementation in pregnancy in Bangladesh. They analysed the number of IFA tablets received and consumed during pregnancy and examined the factors influencing IFA consumption. The study shows that there is a linear relationship between the occupational status and the number of IFA supplements consumed. Women’s body weight, free IFA, and advice on IFA were also associated with higher IFA consumption [11].

Nursing Implication

Integrate IFA awareness in community nursing curriculum. Nurses should educate pregnant women about the timing, dosage, and benefits of IFA.

Most antenatal mothers demonstrated average knowledge and good to excellent practice regarding iron and folic acid supplementation. Socio-demographic factors like occupation and body weight significantly impacted these levels. This indicates the need for enhanced education and reinforcement during antenatal visits.

Funding

No Funding

Conflicts of interest

There are no conflicts of interest for the writers.

Acknowledgement

The authors sincerely appreciate all the participants who willingly dedicated their time and thoughtfully provided sincere and well- considered responses.

Ethics Approval

Approval of research problem & objectives by the research committee. Approval for conducting study from Institutional Ethics Committee of Institute of Medical Sciences. Participants were not to be harmed physically, psychologically emotionally. Information of participants was confidential. Participant’s right, of autonomy was maintained.

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