{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T12:28:47Z","timestamp":1788956927422,"version":"build-2803163510"},"reference-count":88,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Womens Health (Lond Engl)"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Despite the government\u2019s effort to reduce the prevalence of anaemia among reproductive-age women globally, it continues as a significant public health issue, especially in low- and middle-income countries. Iron\u2013folic acid (IFA) supplementation is a widely used intervention to prevent anaemia, but compliance remains a major challenge. There is a lack of literature examining IFA supplementation compliance during pregnancy and its impact on preventing and controlling anaemia during post-pregnancy in the East Africa region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>This study aims to investigate compliance with IFA supplementation during pregnancy and its impact on post-pregnancy anaemia among reproductive-age women in East Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>This study was designed as a cross-sectional survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This study used data from 43,200 reproductive-age women from 2015 to 2022 demographic and health survey datasets. We used multilevel mixed-effect logistic regression analysis to identify associated factors with IFA supplementation compliance during pregnancy. Furthermore, a propensity score matching (PSM) analysis was used to determine the effect of IFA supplementation compliance on anaemia after pregnancy among women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The level of compliance with IFA supplementation during pregnancy was 31.33% (95% confidence interval (CI): 30.89, 31.77), whereas the prevalence of anaemia among reproductive-age women was 32.08% (95% CI: 31.64, 32.52). Maternal education, the timing of antenatal care (ANC) visits, wanted index pregnancy (last pregnancy), wealth status, healthcare access, mass media exposure and ANC services from skilled healthcare providers were significantly associated with compliance with IFA supplementation among pregnant women. The PSM analysis indicated a significant positive association between IFA supplementation compliance during pregnancy and prevention of post-pregnancy anaemia among reproductive-age women, with an average treatment effect on the treated (ATT) of 25.55% (ATT\u2009=\u2009\u22120.2555, 95% CI: \u22120.3440, \u22120.1669, p\u2009&lt;\u20090.0001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Despite universal IFA supplementation, anaemia remains prevalent in East African countries due to low level of compliance with IFA supplementation. Targeting individual and socio-economic factors during IFA supplementation promotion helps to prevent anaemia after pregnancy. Further research is recommended to gain deeper insights.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17455057251317547","type":"journal-article","created":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T08:59:04Z","timestamp":1739177944000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Iron and folic acid supplementation compliance during pregnancy and its effect on post-pregnancy anaemia among reproductive-age women in East Africa"],"prefix":"10.1177","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1970-5102","authenticated-orcid":false,"given":"Melaku Tadege","family":"Engidaw","sequence":"first","affiliation":[{"name":"Public Health, School of Medicine and Dentistry, Gold Coast Campus, Griffith University, Gold Coast, QLD, Australia"},{"name":"Department of Public Health (Human Nutrition), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Lee","sequence":"additional","affiliation":[{"name":"Public Health, School of Medicine and Dentistry, Gold Coast Campus, Griffith University, Gold Coast, QLD, Australia"},{"name":"Department of Medical Research, China Medical University Hospital, Taichung City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faruk","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Public Health, School of Medicine and Dentistry, Gold Coast Campus, Griffith University, Gold Coast, QLD, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,2,10]]},"reference":[{"key":"bibr1-17455057251317547","unstructured":"WHO. WHO global anaemia estimates, 2021 edition, 2021. https:\/\/www.who.int\/data\/gho\/data\/themes\/topics\/anaemia_in_women_and_children."},{"key":"bibr2-17455057251317547","volume-title":"Worldwide prevalence of anaemia 1993\u20132005; WHO Global Database of anaemia","author":"De Benoist B","year":"2008"},{"key":"bibr3-17455057251317547","first-page":"116","volume":"3","author":"Osungbade KO","year":"2012","journal-title":"Anemia"},{"key":"bibr4-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(13)70001-9"},{"key":"bibr5-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00577-8"},{"key":"bibr6-17455057251317547","volume-title":"Unleashing gains in economic productivity with investments in nutrition","author":"Kakietek J","year":"2017"},{"key":"bibr7-17455057251317547","doi-asserted-by":"publisher","DOI":"10.3109\/19390211.2013.859210"},{"key":"bibr8-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/133.5.1468S"},{"key":"bibr9-17455057251317547","unstructured":"Braunstein GD. MSD Manual Professional Edition. Etiology of Anemia \u2013 Hematology and Oncology, May 2024. https:\/\/www.msdmanuals.com\/professional\/hematology-and-oncology\/approach-to-the-patient-with-anemia\/etiology-of-anemia."},{"key":"bibr10-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.14092"},{"key":"bibr11-17455057251317547","unstructured":"Alexander L. Tackling iron deficiency in developing countries. The Borgen Project, https:\/\/borgenproject.org\/tackling-iron-deficiency-in-developing-countries\/ (2020)."},{"key":"bibr12-17455057251317547","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.20.280180"},{"issue":"5","key":"bibr13-17455057251317547","first-page":"627","volume":"130","author":"Kalaivani K.","year":"2009","journal-title":"Indian J Med Res"},{"key":"bibr14-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/71.5.1285s"},{"key":"bibr15-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2009.06.002"},{"key":"bibr16-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-12-481"},{"key":"bibr17-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0208137"},{"key":"bibr18-17455057251317547","unstructured":"WHO. Antenatal iron supplementation, https:\/\/www.who.int\/data\/nutrition\/nlis\/info\/antenatal-iron-supplementation (accessed 8 August 2023)."},{"key":"bibr19-17455057251317547","volume-title":"Guideline: daily iron and folic acid supplementation in pregnant women","author":"World Health Organization","year":"2012"},{"key":"bibr20-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1177\/0962280210394483"},{"key":"bibr21-17455057251317547","volume-title":"Guideline: daily iron supplementation in adult women and adolescent girls","author":"World Health Organization","year":"2016"},{"key":"bibr22-17455057251317547","unstructured":"United Nations Department of Economic and Social Affairs. Sustainable Development Goal 2: End hunger, achieve food security and improved nutrition and promote sustainable agriculture, https:\/\/sdgs.un.org\/goals\/goal2#targets_and_indicators (accessed 8 August 2023)."},{"key":"bibr23-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-020-05755-9"},{"key":"bibr24-17455057251317547","volume-title":"Developing and validating an iron and folic acid supplementation indicator for tracking progress towards global nutrition monitoring framework targets: final report June 2018","author":"World Health Organization","year":"2018"},{"key":"bibr25-17455057251317547","volume-title":"Global Nutrition Monitoring Framework: operational guidance for tracking progress in meeting targets for 2025","author":"World Health Organization","year":"2017"},{"key":"bibr26-17455057251317547","unstructured":"Nutrition International. Iron-Folic Acid Supplementation in Pregnancy: Program Logic Model and Key Considerations for Program Success, 2019. https:\/\/www.nutritionintl.org\/wp-content\/uploads\/2019\/11\/NI-IFA-Program-logic-model-and-considerations.pdf (accessed 8 August 2023)."},{"key":"bibr27-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1111\/jebm.12344"},{"issue":"7","key":"bibr28-17455057251317547","volume":"2015","author":"Pe\u00f1a-Rosas JP","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"bibr29-17455057251317547","doi-asserted-by":"publisher","DOI":"10.3390\/nu12030606"},{"key":"bibr30-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980015001652"},{"key":"bibr31-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/2902498"},{"key":"bibr32-17455057251317547","volume-title":"Mini Ethiopia Demographic and Health Survey 2019","author":"CSA Ethiopia and ICF International","year":"2019"},{"key":"bibr33-17455057251317547","doi-asserted-by":"publisher","DOI":"10.4314\/ejhs.v27i2.6"},{"key":"bibr34-17455057251317547","volume-title":"Accelerating reduction of iron deficiency anaemia among pregnant women in Kenya: plan of action 2012\u20132017","author":"Ministry of Health","year":"2012"},{"key":"bibr35-17455057251317547","volume-title":"UNICEF Programming Guidance; Prevention of malnutrition in women before and during pregnancy and while breastfeeding","author":"UNICF","year":"2021"},{"key":"bibr36-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12508"},{"key":"bibr37-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-019-0679-8"},{"key":"bibr38-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1177\/1357633X14533895"},{"key":"bibr39-17455057251317547","doi-asserted-by":"publisher","DOI":"10.4103\/2249-4863.192374"},{"issue":"4","key":"bibr40-17455057251317547","first-page":"197","volume":"12","author":"Siabani S","year":"2018","journal-title":"J Fam Reprod Health"},{"key":"bibr41-17455057251317547","doi-asserted-by":"publisher","DOI":"10.4103\/1119-3077.141427"},{"key":"bibr42-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12532"},{"key":"bibr43-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-011-1279-z"},{"key":"bibr44-17455057251317547","volume-title":"Guideline: iron supplementation in postpartum women","author":"WHO","year":"2016"},{"key":"bibr45-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-010-1144-5"},{"key":"bibr46-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-022-12710-2"},{"key":"bibr47-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-85622-7"},{"key":"bibr48-17455057251317547","volume-title":"WHO recommendations on antenatal care for a positive pregnancy experience","author":"World Health Organization","year":"2016"},{"key":"bibr49-17455057251317547","doi-asserted-by":"publisher","DOI":"10.4103\/sja.SJA_543_18"},{"key":"bibr50-17455057251317547","volume-title":"Guide to DHS statistics","author":"Croft TN","year":"2018"},{"key":"bibr51-17455057251317547","unstructured":"World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and mineral nutrition information system. Document reference WHO. NMH\/NHD\/MNM\/11.1, http:\/\/www.who.int\/entity\/vmnis\/indicators\/haemoglobin (2011)."},{"key":"bibr52-17455057251317547","unstructured":"The Nemours Foundation. Folic acid and pregnancy (for parents) \u2013 nemours KidsHealth, https:\/\/kidshealth.org\/en\/parents\/preg-folic-acid.html (accessed 18 July 2023)."},{"key":"bibr53-17455057251317547","volume-title":"Multilevel and longitudinal modeling using Stata","author":"Hesketh SR","year":"2021"},{"key":"bibr54-17455057251317547","volume-title":"Multilevel statistical models","volume":"922","author":"Goldstein H","year":"2011"},{"key":"bibr55-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1111\/resp.12312"},{"key":"bibr56-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1093\/cdn\/nzz120"},{"key":"bibr57-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1177\/03795721231179570"},{"key":"bibr58-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-023-05593-7"},{"key":"bibr59-17455057251317547","doi-asserted-by":"crossref","unstructured":"Merse F, Fanta A, Kelbiso L. IFA utilization and factors associated with IFA utilization among pregnant women attending ANC at government health facilities and family guidance clinic in Hawassa city, South Ethiopia, https:\/\/www.stephypublishers.com\/sojmccr\/pdf\/SOJMCCR.MS.ID.000512.pdf (2022).","DOI":"10.21203\/rs.3.rs-1516338\/v1"},{"key":"bibr60-17455057251317547","unstructured":"Smitha Mv, Indumathi P, Parichha S, et al. Compliance with IFA supplementation and its barriers in postpartum women in Odisha, India. Rochester, NY, https:\/\/papers.ssrn.com\/abstract=4626996 (2023)."},{"key":"bibr61-17455057251317547","doi-asserted-by":"publisher","DOI":"10.47203\/IJCH.2022.v34i04.002"},{"issue":"2","key":"bibr62-17455057251317547","first-page":"272","volume":"7","author":"Haile MT","year":"2017","journal-title":"J Nutr Health Food Eng"},{"key":"bibr63-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-14-607"},{"key":"bibr64-17455057251317547","doi-asserted-by":"publisher","DOI":"10.4314\/mmj.v28i1.1"},{"key":"bibr65-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1007\/s13524-014-0359-9"},{"key":"bibr66-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1111\/j.1728-4465.2008.00148.x"},{"key":"bibr67-17455057251317547","doi-asserted-by":"publisher","DOI":"10.2307\/2991608"},{"issue":"3","key":"bibr68-17455057251317547","first-page":"214","volume":"10","author":"Widowati LP","year":"2022","journal-title":"JNKI J Ners Dan Kebidanan Indones Indones J Nurs Midwifery"},{"key":"bibr69-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0286052"},{"key":"bibr70-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1007\/s00038-019-01238-9"},{"issue":"4","key":"bibr71-17455057251317547","first-page":"272","volume":"10","author":"Gwatkin DR","year":"2007","journal-title":"Niger J Clin Pract"},{"key":"bibr72-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1186\/1475-9276-2-8"},{"key":"bibr73-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-14-305"},{"key":"bibr74-17455057251317547","doi-asserted-by":"publisher","DOI":"10.5539\/jsd.v9n1p187"},{"key":"bibr75-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czaa192"},{"key":"bibr76-17455057251317547","unstructured":"Medic East Africa. Universal Health Coverage in East Africa. 2019, p. 11, https:\/\/www.mediceastafrica.com\/content\/dam\/Informa\/mediceastafrica\/2019\/downloads\/universal-health-coverage-east-africa.pdf (accessed 31 July 2024) ."},{"key":"bibr77-17455057251317547","doi-asserted-by":"publisher","DOI":"10.2147\/RMHP.S263132"},{"key":"bibr78-17455057251317547","doi-asserted-by":"publisher","DOI":"10.2190\/IQ.35.1.d"},{"key":"bibr79-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2004.02.033"},{"key":"bibr80-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2019-002020"},{"key":"bibr81-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-13-256"},{"key":"bibr82-17455057251317547","doi-asserted-by":"publisher","DOI":"10.12691\/ajphr-2-4-5"},{"key":"bibr83-17455057251317547","doi-asserted-by":"publisher","DOI":"10.47391\/JPMA.Ind-S2-37"},{"issue":"6","key":"bibr84-17455057251317547","first-page":"354","volume":"6","author":"Putri AP","year":"2023","journal-title":"Int J Nurs Health Serv"},{"key":"bibr85-17455057251317547","doi-asserted-by":"publisher","DOI":"10.18203\/2394-6040.ijcmph20181234"},{"key":"bibr86-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1016\/j.cegh.2017.04.004"},{"key":"bibr87-17455057251317547","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.06.035659"},{"key":"bibr88-17455057251317547","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13477"}],"container-title":["Women's Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17455057251317547","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/17455057251317547","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17455057251317547","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T08:28:30Z","timestamp":1777710510000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/17455057251317547"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":88,"alternative-id":["10.1177\/17455057251317547"],"URL":"https:\/\/doi.org\/10.1177\/17455057251317547","relation":{},"ISSN":["1745-5057","1745-5065"],"issn-type":[{"value":"1745-5057","type":"print"},{"value":"1745-5065","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]},"article-number":"17455057251317547"}}